Helping Children Handle Stress

How can we help our children handle the stresses of everyday life?

In middle childhood, pressures may come from a number of sources-from within the child herself, as well as from parents, teachers, peers and the larger society in which the child lives. Pressure can take many forms that challenge children and to which they must respond and, often, adapt. Whether these are events of lasting consequence like the divorce of their parents, or merely a minor hassle like losing their homework, these demands or stresses are a part of children’s daily existence.

Children welcome some events and are able to adapt to them with relative ease. They perceive other events as threats to their own or the family’s daily routines or general sense of well-being, and these stresses are more troublesome. Most stress faced by children is in the middle, neither welcomed nor seriously harmful, but rather a part of accomplishing the tasks of childhood and learning about themselves.

Youngsters may also worry about making friends, succeeding in school, combating peer pressure or overcoming a physical impairment. Whatever its form, if stress is too intense or long-lasting, it can sometimes take a toll on children. Clusters of stressful events seem to predispose children to illness. Major events, especially those that forever change a child’s family, like the death of a parent, can have lasting effects on children’s psychological health and well-being. Minor daily stresses can also have consequences. They can contribute to loss of sleep or appetite. Children may become angry or irritable or their school grades may suffer. Their behavior and their willingness to cooperate may change.

How different children cope with stress

Children’s temperaments vary and thus they are quite different in their ability to cope with stress and daily hassles. Some are easygoing by nature and adjust easily to events and new situations. Others are thrown off balance by changes in their lives. All children improve in their ability to handle stress if they previously have succeeded in managing challenges and if they feel they have the ability and the emotional support of family and friends. Children who have a clear sense of personal competence, and who feel loved and supported, generally do well.

Certainly, a child’s age and development will help determine how stressful a given situation may be. Changing teachers at midyear may be a major event for a child in the first grade and merely an annoyance for a sixth-grader. Being short may be a minor issue for a 5- or 6-year-old boy but a source of daily embarrassment for an adolescent. How a child perceives and responds to stress depends in part on development, in part on experience, and in part on a child’s individual temperament.

Ironically, many parents believe that their school-age children are unaware of the stresses around them and are somehow immune to them. After all, their children not only have all their basic needs met, but perhaps they also have a roomful of toys, friends to share them with, plenty of playtime, and a full schedule of extracurricular activities.

Yet children are very sensitive to the changes around them, especially to the feelings and reactions of their parents, even if those feelings are not communicated directly in words. If a parent loses a job, children will have to adjust to their family’s financial crisis; they must deal not only with the obvious family budgetary changes but also with the changes in their parents’ emotional states. Children may have to cope with a bully on the playground, a move to a new neighborhood, a parent’s serious illness or the disappointment of a poor sports performance. They might feel a constant, nagging pressure to dress the “right” way, or to achieve the high grades that can put them on the fast track toward the “right” college.

Stress and today’s middle-years child

Some psychologists believe that today’s middle-years youngsters actually are faced with more stress than the children of previous generations were and have fewer social supports available. The change in family structure from the large, supportive, extended families (including both parents, aunts, uncles and grandparents) of previous generations, to the present high incidence of divorced families, single-parent families and stepfamilies has drastically altered the experience of childhood. Millions of youngsters must adjust to such changes.

Even in intact and stable families, the growing number of households with two working parents often forces children to spend more time in after-school programs or at home alone. For some children this loss of time with their parents is quite stressful. So, too, is the responsibility for caring for themselves and the family home and sometimes for overseeing a younger sibling after school.

Many children and their families are stressed by the multiple activities that fill children’s “free time.” Overscheduled children with inadequate “down time” can become exhausted.

Today’s children are also being raised in an era in which they are exposed to violence and peer pressure about sexual activity and drug use and are warned to be cautious about kidnapping, sexual abuse and other crimes. This sense that they are living in an unsafe world is a constant source of stress for some children. In short, today’s youngsters are regularly confronted with challenges to their coping skills and often are expected to grow up too fast.

Good and bad stress

Not all stress is bad. Moderate amounts of pressure imposed by a teacher or a coach, for example, can motivate a child to keep her grades up in school or to participate more fully in athletic activities. Successfully managing stressful situations or events enhances a child’s ability to cope in the future.

When the stress is continuous or particularly intense, it takes a toll on both the psyche and the body. Sudden stressful events will accelerate your child’s breathing and heartbeat, constrict her blood vessels, increase her blood pressure and muscle tension and perhaps cause stomach upset and headaches. As stress persists, she might be more susceptible to illness and experience fatigue, nightmares, teeth-grinding, insomnia, tantrums, depression and school failure.


Caring for Your School-Age Child: Ages 5 to 12 (Copyright © 2004 American Academy of Pediatrics). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


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Is Your Child Overweight?

Pediatricians evaluate children’s growth and build by means of standardized growth charts and body mass index (BMI). Growth charts show whether a child falls within the normal range of height and weight for her age. Children whose weight or height is above the 85th or below the fifth percentile should be examined by a doctor to determine whether further evaluation is needed. Pediatricians also will watch for fluctuations in children’s weight, which may mean something has changed and put them on the path toward gaining excess weight.

Body mass index is a calculation of your child’s weight relative to height. A BMI above the 85th percentile means overweight, while children above the 95th percentile are considered obese, which increases their risk of chronic diseases such as heart disease and diabetes. The BMI percentile that defines severe obesity is 120% of the 95th percentile. If your child’s BMI is between the 85th and 95th percentiles, her excess weight may be fat or muscle. Growth charts and BMI tell only part of the story because neither method measures body fat. Children and adolescents who are particularly athletic with unusually muscular or lean builds may have a high BMI without having excess fat or being obese. In some obesity clinics, as many as 10% to 15% of children fall into this category. Also keep in mind that there are small differences between African American and white children; at the same BMI measurement, African American children and teenagers tend to have more muscle and bone mass and less body fat. However, almost all children and adolescents with a BMI above the 95th percentile have too much body fat, regardless of their ethnicity or muscularity.

Some parents wonder how it is possible for 17% of 2- to 19-year-olds to be obese when only 5% of the population should have a BMI above the 95th percentile. The BMI charts were based on children and teens studied before 1988, when not as many youth were obese. At that time, only 5% of children and teens were obese.

If your child is overweight because her frame size is increased, reassure her that her extra weight is not fat and encourage her to be physically active to maintain her muscle tone. Also, be actively involved in any discussions with your pediatrician and your child about your child’s weight. To prevent worries about body size, parent and child need to accept the child’s body type. Other members of the family may have a similar build. If you focus inappropriately on weight alone and pester your child to lose weight, she may develop a distorted body image and risk an eating disorder. It’s estimated that 70% to 80% of girls perceive themselves, whether rightly or wrongly, as too fat. Experts warn that a misperception of body image may be partly fueling the current obesity epidemic, with inappropriate dieting followed by rebound weight gain.

Choose to Be Happy – Many adolescents, particularly girls, become deeply unhappy when they realize that they are never going to be shaped like supermodels or earn multimillion-dollar contracts as movie stars.

Help your daughter feel comfortable with who she is. Reassure her that real beauty is more than skin deep. Help her develop her skills and talents and emphasize her positive attributes. Offer her female role models who have made the most of their talents, achieving intellectual and humanitarian goals or raising healthy, balanced children, instead of trading on their looks for superficial success.


Source: Nutrition: What Every Parent Needs to Know (Copyright © American Academy of Pediatrics 2011). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


Types of Exercise for Teens

Aerobic Exercise

A teen’s fitness program should include aerobic exercise such as brisk walking, basketball, bicycling, swimming, in-line skating, soccer, jogging—any continuous activity that increases heart rate and breathing. Regular workouts improve the efficiency of the cardiorespiratory system, so that the heart and lungs don’t have to work as hard to meet the body’s increased demands for freshly oxygenated blood.

Aerobic exercise also affects body weight composition, by burning excess calories that would otherwise get converted to fat. In general, the more aerobic an activity, the more calories are expended. For instance, if a teenager weighing 132 pounds walks at a moderate pace for ten minutes, he burns forty-three calories. Running instead of walking more than doubles the amount of energy spent, to ninety calories.

Low-intensity workouts burn a higher percentage of calories from fat than high-intensity workouts do. However, the more taxing aerobic exercises ultimately burn more fat calories overall. One study compared the burn rates for a thirty-minute walk at three and a half miles per hour and a thirty-minute run at seven miles per hour. The walking group expended an average of 240 calories. Two-fifths came from fat, and three-fifths came from carbohydrates, for a total of ninety-six fat calories. In the running group, the ratio of fat energy burned versus carbohydrate energy burned was significantly less: one to four. Yet overall, the runners consumed 450 calories. Total number of fat calories burned: 108.

Weight Training

Under the guidance of well-trained adults, children aged eight or older can safely incorporate weight training (also called strength training and resistance training) into their workouts to increase muscle strength and muscle endurance. Muscle strength refers to the ability to displace a given load or resistance, while muscle endurance is the ability to sustain less-intense force over an extended period of time. Males will not be able to develop large muscles until after puberty. Females generally are not able to develop large muscle mass. They do not have to worry about getting too muscular.

The Proper Technique: Less Weight, More Reps – Multiple studies show that young people gain strength and endurance faster by lifting moderately heavy weights many times rather than straining to hoist unwieldy loads for just a few repetitions.

Teens should always be supervised by a qualified adult, who can help them and demonstrate the proper technique. For that reason, it’s safer to work out at school or at a health club than on home exercise equipment. Other precautions to take include the following:

  • See your pediatrician for a physical and medical checkup before your youngster starts training.
  • Remember that resistance training is a small part of a well-rounded fitness program. Experts generally recommend that adolescents exercise with weights no more than three times a week.
  • Don’t overdo it (part 1): Excessive physical activity can lead to injuries and cause menstrual abnormalities. Your teenager may be exercising too much if her weight falls below normal or her muscles ache. Complaints of pain warrant a phone call to your pediatrician.
  • Don’t overdo it (part 2): Teens should be reminded not to step up the weight resistance and number of repetitions before they’re physically ready. Getting in shape takes time.
  • Drink plenty of fluids when exercising. Young people are more susceptible to the effects of heat and humidity than adults. Teens’ ability to dissipate heat through sweating is not as efficient as adults. The Centers for Disease Control and Prevention recommends that teens drink at least two six-ounce glasses of water before, during and after working out in steamy conditions.
  • Always warm up and cool down with stretching exercises before and after training. Stretching the muscles increases their flexibility: the ability to move joints and stretch muscles through a full range of motion, and the fourth component of physical fitness. It also helps safeguard against injury.

Source: Caring for Your Teenager (Copyright © 2003 American Academy of Pediatrics). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


Keeping Preschoolers Active

Pediatricians are more aware than ever that a growing number of children are overweight. Your doctor has been keeping track of your child’s height and weight since infancy, and he’ll be able to calculate whether your child weighs more than he should.

Steps You Can Take Now to Reduce Your Child’s Likelihood of Becoming Obese and on Track for a Healthy Life

  • Give some thought to the physical activity in your child’s life. Even though he continues to be a bundle of endless energy, a lot of that energy often goes to waste. Many preschoolers spend several hours a day in front of the TV or computer screen, rather than playing outdoors. In fact, today’s children are only one-fourth as active in their day-to-day lives as their grandparents were.
  • Whether or not your four- or five-year-old is overweight, you need to make sure that physical activity becomes and remains a priority in his life. These preschool years are a time when he should be developing his motor skills, improving his coordination, and playing games and sports with greater skill. You should make sure that he has access to age-appropriate play equipment, such as balls and plastic bats that will make exercise fun and something he looks forward to doing. Of course, these play periods must be supervised; you need to keep him away from dangerous situations like running into the street to chase a ball.
  • Make an effort to turn family time into a physically active time. On a Sunday afternoon, rather than going to the movies, take the entire family on a hike in the hills near your home. Or fly a kite in the park, play tag, or throw a ball back and forth.​

Source: Caring for Your Baby and Young Child: Birth to Age 5, 6th Edition (Copyright © 2015 American Academy of Pediatrics). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


The Active Toddler

Physical activity is important for children of all ages. Of course, it may seem that your own toddler gets all the exercise he needs as he’s constantly on the move from sunup to bedtime. He’s crawling, walking, learning to run and jump, climbing onto and down from furniture without help, and kicking a ball or pulling toys behind him while walking.

By 2 to 3 years of age, your child’s physical activity will move to even more challenging levels. As his coordination keeps improving, he’ll be able to walk up and down stairs. He’ll run easily and start learning to pedal a tricycle. With his short attention span, he may be moving from one activity to the next, almost minute by minute, keeping you on the run just to stay up with him.

We can’t overemphasize how important this active play is. To encourage it in your toddler, you should be discouraging him from watching TV. The AAP believes strongly that children up to 2 years should not be watching any TV, choosing instead to participate in supervised physical activity outdoors and indoors. Encourage them to play with siblings or other children their own age. When planning family activities, make them as active as possible.

You can also promote physical activity by using the stroller judiciously. When you’re out for a walk, don’t automatically sit your toddler in the stroller for the entire trip. Let him get out and walk beside you if that’s what he wants to do.

If your toddler attends child care, find out how active he is there. In too many child care settings, the TV set and not the kids gets a real workout during the day. Safety should also be a big concern while your toddler is in the child care setting whether he’s playing or eating. Request that he always be seated while being fed, rather than running around with food in his mouth on which he could end up choking.


Source: A Parent’s Guide to Childhood Obesity: A Road Map to Health (Copyright © 2006 American Academy of Pediatrics). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


It’s Not Too Early to Book Those Physicals!

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It’s never too early to start thinking about vaccines and physicals for the new school year, or for summer camp!

Please remember to call and book your appointments early to get the most convenient time for your busy schedules. Also please remember, our staff makes it a priority to complete your requests for forms as quickly as possible. We do advise all of our patients that we request a minimum of 3-7 business days to complete those forms.

If your child is planning on playing any summer/fall sports, attending any camps, and for those who are entering college, please plan accordingly so that we can get your form completed and returned to you before your deadlines.

In the event, that we are asked to expedite a form (i.e. 24-hour turn around), please be aware that there will be a $10 fee charged. Please help us to provide you with the best service possible by getting your forms to us in a timely manner.

Call us now! 203 239-4627

Healthy New Year’s Resolutions for Children & Teens

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The start of the new year is a great time to help your children focus on forming good habits. The American Academy of Pediatrics (AAP) provides the following list of ideas for you to talk to your children about trying, depending on their age.

Preschoolers

  • I will try hard to clean up my toys by putting them where they belong.
  • I will let my parents help me brush my teeth twice a day.
  • I will wash my hands after going to the bathroom and before eating.
  • I will learn how to help clear the table when I am done eating.
  • I will be friendly to all animals. I will learn how to ask the owners if I can pet their animal first.
  • I will do my best to be nice to other kids who need a friend or look sad or lonely.
  • I will talk with my parent or a trusted adult when I need help or am scared.

Kids, 5 to 12 years old

  • I will drink reduced-fat milk and water most days. Soda and fruit drinks are only for special times.
  • I will take care of my skin by putting on sunscreen before I go outdoors on bright, sunny days. I will try to remember to stay in the shade whenever possible and wear a hat and sunglasses, especially when I’m playing sports.
  • I will try to find a sport (like basketball or soccer) or an activity (like playing tag, jumping rope, dancing or riding my bike) that I like and do it at least three times a week!
  • I will always wear a helmet when riding a bike, scooter or skateboard.
  • I will wear my seat belt every time I get in a car. I’ll sit in the back seat and use a booster seat until I am tall enough to use a lap/shoulder seat belt.
  • I’ll try to be friendly to kids who may have a hard time making friends by asking them to join activities such as sports or games.
  • I will tell an adult about bullying that I see or hear about to do what I can to help keep school safe for everyone.
  • I will keep my personal info safe and not share my name, home address, school name or telephone number on the Internet. Also, I’ll never send a picture of myself to someone I chat with on the computer without asking my parent if it is okay.
  • I will try to talk with my parent or a trusted adult when I have a problem or feel stressed.
  • I promise that I’ll do my best to follow our household rules for videogames and internet use.

Kids, 13 years old and older

  • I will try to eat two servings of fruit and two servings of vegetables every day. I will drink sodas only at special times.
  • I will do my best to take care of my body through fun physical activity and eating the right types and amounts of foods.
  • When I have some down time for media, I will try to choose educational, high-quality nonn-violent TV shows and video games that I enjoy. I will spend only one to two hours each day – at the most – on these activities. I promise to respect out household rules for videogames and internet use.
  • I will do what I can to help out in my community. I will give some of my time to help others, working with community groups or others that help people in need. These activities will make me feel better about myself and my community.
  • When I feel angry or stressed out, I will take a break and find helpful ways to deal with the stress, such as exercising, reading, writing in a journal or talking about my problem with a parent or friend.
  • When faced with a difficult decision, I will talk about my choices with an adult whom I can trust.
  • When I notice my friends are struggling, being bullied or making risky choices, I will look for a trusted adultso that we can attempt to find a way to help.
  • I will be careful about whom I choose to date. I will treat the other person with respect and not force them to do something they do not want to do. I will not use violence. I will expect to be treated the same way in return.
  • I will resist peer pressure to try tobacco-cigarettes, drugs, or alcohol. I will also avoid the use of e-cigarettes.
  • I agree not to use a cell phone or text message while driving and to always use a seat belt.

From HealthyChildren.org. Published 12/13/16.


Managing School Holidays and Vacations

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Not surprisingly, some single and working parents have grown to dread school vacations, legal holidays (like Martin Luther King Jr. Day and Washington’s Birthday), and “teacher in-service days.” These are days when the child is out of school but parents usually have to be at work. To make matters worse, care givers whom you might rely on at other times of the year often ask for time off during holidays, and community activities like art classes and Scouting often are cancelled too.

The good side of these situations is that you know they are coming and can plan for them. To help in that process, get copies of your child’s school schedule as early as possible so you are aware of vacations several months in advance. Children’s vacation schedules often dictate family vacation plans. With sufficient advance notice, you may be able to block out your own vacation time to coincide with that of your youngster.

Few parents have as much vacation time available as do their children, so arrangements have to be made for child care and supervision within the frame work of the demands of the parents’ jobs. If your spouse has some flexibility in his or her work schedule, divide the home responsibilities so one of you takes time off during different parts of the children’s vacation. Some couples are able to work out a plan where Mom is home in the morning, and Dad replaces her in the afternoon; perhaps one or both can work flexible schedules (6 A.M. to 2 P.M.; 2:30 P.M. to 10:30 P.M.) So that at least one parent is home at all times.

Fortunately, businesses are becoming more sensitive to the family needs of their employees. The federal Medical and Family Leave Act of 1993 is helpful to parents upon the birth or adoption of a child, or when a child is ill, but it does not have any provisions covering school holidays and vacations.

Sometimes neither you nor your spouse will be able to get off work. Or you will need a backup or alternative strategy for unexpected job demands or the sudden loss of a caretaker, both of which require some last-minute juggling of schedules. It is important that school-age children are always supervised, directly if possible and indirectly if not. Indirect supervision means providing a safe environment and a structured schedule of activities, including regular times to check in, even by phone, with a responsible adult. This latter option should be considered only for mature preteenagers and is never the preferred alternative.

When you can’t break away from the office, another option is to call upon extended family members to help. Some parents are able to work out a timetable with several families, where each assumes the caretaking responsibilities for all the children one day a week, or they trade hours of babysitting with each other. Some high school and college students, or after-school child care employees, are willing to work on holidays, perhaps coming to your home to assume the care of the children from several families. (Many high schools and colleges have job-placement offices to find employment for students on vacation; ask for and check references before hiring these young adults for child care.) You may also inquire about special holiday programs and camps that might be planned by local YMCAs, Boys and Girls Clubs, and other com munity organizations. If none exist, gather some parents together and, as a group, urge local organizations or city leaders to provide holiday activities for children.

For some parents of school-age children, the best long-term solution is to work at home all the time, often in a small home-based business of their own. However, while this can be an ideal option, it is not available to everyone, and working at home poses problems of its own.


Source: Caring for Your School-Age Child: Ages 5 to 12 (Copyright © 2004 American Academy of Pediatrics)


Gender Identity Development in Children

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What’s the Difference Between Gender and Sex?
Being a boy or a girl, for most children, is something that feels very natural. At birth, babies are assigned male or female based on physical characteristics. This refers to the “sex” of the child. When children are able to express themselves, they will declare themselves to be a boy or a girl (or sometimes something in between); this is their “gender identity.” Most children’s gender identity aligns with their biological sex. However, for some children, the match between biological sex and gender identity is not so clear. This article discusses how parents can promote healthy gender development in children. See the related article, Gender Non-Conforming & Transgender Children, for additional information.

How Does Gender Identity Develop in Children?
Around two-years-old, children become conscious of the physical differences between boys and girls. Before their third birthday, most children are easily able to label themselves as either a boy or a girl. By age four, most children have a stable sense of their gender identity. During this same time of life, children learn gender role behavior—that is, do­ing “things that boys do” or “things that girls do.”

Before the age of three, children can dif­ferentiate toys typically used by boys or girls and begin to play with children of their own gender in activities identified with that gender. For example, a girl may gravitate toward dolls and playing house. By contrast, a boy may play games that are more active and enjoy toy soldiers, blocks, and toy trucks.

What parents can do:
All children need the opportunity to explore different gender roles and different styles of play. Ensure your young child’s environment reflects diversity in gender roles and encourages opportunities for everyone. Here are some ideas:

  • Children’s books or puzzles showing men and women in non-stereotypical and diverse gender roles (e.g. stay-at-home dads, working moms, male nurses, female police officers, etc.)
  • A wide range of toys for all children, including baby dolls, toy vehicles, action figures, blocks, etc.
  • By age six, most children spend the majority of their playtime with members of their own sex and may gravitate towards sports and other activities that area associated with their gender. It is important to allow children to make choices regarding what sports and other activities they get involved in.

How Do Children Typically Express Their Gender Identity?
In addition to their choices of toys, games, and sports, children typically express their gender identity in the following ways:

  • Clothing or hairstyle
  • Preferred name or nickname
  • Social behavior that reflects varying degrees of aggression, dominance, dependency, and gentleness.
  • Manner and style of behavior and physical gestures and other nonverbal actions identified as masculine or feminine.
  • Social relationships, including the gender of friends, and the people he or she decides to imitate.

While a child’s gender-specific behavior seems to be influenced by their identification with the males and females in their lives, the sense of being a girl or a boy (i.e. gender identity) cannot be changed.

Gender Stereotypes
Over time, society has recognized that stereotypes of masculine and feminine behaviors and characteristics are inaccurate. In the past, girls were only allowed to do feminine things like playing with dolls or cooking. They were expected to be more passive. Boys were expected to be more aggressive and to only show masculine behaviors.

Times have changed:
Our expectations of “what girls do” and “what boys do” have changed. Girls frequently excel at sports and school subjects traditionally thought of as masculine. Boys frequently excel in artistic subjects once traditionally thought of as feminine. All children show some behaviors that were once thought of as typical for the opposite gender — no one shows exclusively male or female traits – and this is normal.

When a child’s interests and abilities are different from what society expects, he or she is often subjected to discrimination and bullying. It is natural for parents to want their child to be accepted socially. However, children need to feel comfortable with and good about themselves. If your son doesn’t excel in sports or even have an interest in them, for example, there will still be many other opportunities and areas in which he can excel. Each child has his own strengths, and at times, they may not conform to society’s or your own expectations, but they will still be a source of his current and future success.

Thus, rather than force your child into the mold of current or traditional gender behavior, help him or her fulfill his or her own unique potential. Don’t become ex­cessively concerned with whether your child’s interests and strengths coincide with the socially defined gender roles of the moment


Source: Section on Lesbian, Gay, Bisexual, Transgender, Health and Wellness (SOLGBTHW) (Copyright © 2015 American Academy of Pediatrics). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.