pediatricassociatesofgreatersalem

The Dangers of Cannabis Use and Teenagers

Mon, 19 Jun 2023 20:48:55 GMT

A Columbia University study finds that recreational use of cannabis is dangerous for teenagers’ emotional and physical development.

A Columbia University study found that teens who use cannabis recreationally are two to four times more likely to develop psychiatric disorders, such as depression and suicidality, than teens who don’t use cannabis at all.

The research also finds that casual cannabis use puts teens at risk for problem behaviors, including poor grades, truancy, and trouble with the law, which can have long-term negative consequences and may keep youth from developing their full potential in adulthood. Perceptions exist among youth, parents, and educators that casual cannabis use is benign, but studies show that is not the case. Cannabis use has strong associations to adverse mental health and life outcomes for teens who don’t necessarily have a substance abuse problem, difficulty thinking, problem-solving, and reduced memory, as well as a risk of long-term addiction.

Immature Brain Regions put Teens at Elevated Risk
Numerous studies note that exposing developing brains to cannabis can alter the development of the cerebral cortex, the brain’s center of reasoning and executive function. This poses a risk to young people whose brains have not matured and cause more susceptibility to developing other forms of addiction later in life.

Teens who feel depressed or suicidal may use cannabis as way to relieve their suffering, however using cannabis likely worsens depressive and suicidal symptoms.

Teenage marijuana use is at its highest level in 30 years, and today's teens are more likely to use marijuana than tobacco. Many states allow recreational use of marijuana in adults ages 21 and over. Today's marijuana plants are grown differently than in the past and can contain two to three times more tetrahydrocannabinol (THC), the ingredient that makes people high. The ingredient of the marijuana plant thought to have most medical benefits, cannabidiol (CBD), has not increased and remains at about 1%.

It is often difficult for parents to watch for cannabis use in their child because of the many ways it can be used:

Smoking the dried plant (buds and flowers) in a rolled cigarette (joint), pipe, or bong
Smoking liquid or wax marijuana in an electronic cigarette, also known as vaping
Eating "edibles" which are baked goods and candies containing marijuana products
Drinking beverages containing marijuana products
Using oils and tinctures that can be applied to the skin

Long-term use of marijuana can lead to:

Cannabis Use Disorder
The same breathing problems as smoking cigarettes (coughing, wheezing, trouble with physical activity, and lung cancer)
Decreased motivation or interest which can lead to decline in academic or occupational performance
Lower intelligence
Mental health problems, such as schizophrenia, depression, anxiety, anger, irritability, moodiness, and risk of suicide
Tips on discussing marijuana with your child: Ask what they have heard about using marijuana. Listen carefully, pay attention, and try not to interrupt. Avoid making negative or angry comments.
Offer your child facts about the risks and consequences of smoking marijuana.
Ask your child to give examples of the effects of marijuana. This will help you make sure that your child understands what you talked about.
If you choose to talk to your child about your own experiences with drugs, be honest about why you used and the pressures that contributed to your use. Be careful not to minimize the dangers of marijuana or other drugs and be open about any negative experiences you may have had. Given how much stronger marijuana is today, its effect on your child would likely be much different than what you experienced .
Explain that research tells us that the brain continues to mature into the 20s. While it is developing, there is greater risk of harm from marijuana use.

Parents and Prevention
Parents can help their children learn about the harmful effects of marijuana use. Talking to your children about marijuana at an early age can help them make better choices and may prevent them from developing a problem with marijuana use later. Begin talking with your child in an honest and open way when they are in late elementary and early middle school. Youth are less likely to try marijuana if they can ask parents for help and know exactly how their parents feel about drug use.

If your child is already using marijuana, try asking questions in an open and curious way as your teen will talk more freely if not feeling judged.

If you have concerns about your child's drug use, please talk with your child's Care Team.

Resources:
https://www.columbiapsychiatry.org/news/recreational-cannabis-use-among-u-s-adolescents-poses-risk-adverse-mental-health-and-life-outcomes#:~:text=A%20Columbia%20University%20study%20has,t%20use%20cannabis%20at%20all.
https://www.samhsa.gov/sites/default/files/TTHY-Marijuana-Broch-2020.pdf
https://childmind.org/article/talk-teenager-substance-use-abuse/

Source:
AACAP
Columbia University

Childhood Obesity

Thu, 02 Mar 2023 20:58:56 GMT

Childhood obesity is a growing health problem in young children.

Obesity is a complex and often persistent condition involving an excessive amount of body weight that affects the health of over 14.4 million children and adolescents, making it one of the most common pediatric chronic diseases in the United States.

Usually, unhealthy weight gain results from inherited, physiological and environmental factors, combined with diet, physical activity and exercise choices.

Researchers say the rate of childhood obesity in the United States continues to increase. The prevalence in the U.S. is about 20% (about one in five kids), according to the CDC.
In September 2021, a report from the CDC found the rate of body mass index nearly doubled during the pandemic in almost half a million U.S. kids between 2 and 19 years old.
Parents, doctors, and educators can all play a role in helping children eat a healthier diet and exercise more often.

What causes unhealthy weight gain in childhood ? Childhood obesity is a complicated disease that has many contributing factors. It’s not just laziness or a lack of willpower.

Diet . Regularly eating high-calorie foods, such as fast foods, baked goods, vending machine snacks, candy and desserts can cause unhealthy weight gain, more evidence points to sugary drinks, including fruit juices and sports drinks, as culprits in some people.
Lack of exercise . Too much time spent in sedentary activities, such as watching television or playing video games, also contributes to the problem. TV shows also often feature ads for unhealthy foods.
Family factors . If your child comes from a family of people with weight problems, he or she may be more likely to put on weight. This is especially true in an environment where high-calorie foods are always available and physical activity isn't encouraged.
Psychological factors . Personal, parental and family stress can cause children to overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom. Their parents might have similar tendencies.
Socioeconomic factors . Lower income neighborhoods may have limited resources/access to supermarkets with healthy options and might not have access to a safe place to exercise.
Certain medications . Some prescription drugs can increase the risk of gaining an unhealthy amount of weight. They include prednisone, lithium, amitriptyline, paroxetine (Paxil), gabapentin (Neurontin, Gralise, Horizant) and propranolol (Inderal, Hemangeol).

Complications from childhood obesity:

Asthma
Sleep apnea
Type 2 diabetes.
High blood pressure (hypertension)
High cholesterol
Heart disease
Stroke
Musculoskeletal disorders such as osteoarthritis
Certain cancers, including colon cancer and breast cancer
Fatty liver
In addition, children who have obesity are at a higher risk of experiencing:
Bullying
Social isolation
Low self-esteem
Depression

What can be done?
Increasing access to healthy foods as well as adequate physical activity. Prevention is more effective than playing catch-up later. Previous treatment guidance for providers had focused on a "watchful waiting" strategy or delaying treatment to see if a child or teen can "outgrow" unhealthy weight gain on their own.

Research suggests that traditional approaches to treatment may not be as effective as previously thought and new strategies are necessary to tackle this growing problem. The AAP recently published its first comprehensive guidance recommending early and more proactive treatment which includes medications and surgery for some young patients. Health problems that come with obesity pile up over time. Living with obesity and the associated health problems become harder to treat, therefore, a more aggressive approach may be recommended in some cases.

Source: AAP, CDC

RSV: When It's More Than Just a Cold

Fri, 28 Oct 2022 21:00:05 GMT

RSV is a cold that can become serious for babies. When to call your doctor?

What is RSV? Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults.

RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States.

Symptoms
People infected with RSV usually show symptoms within 4 to 6 days after getting infected. Symptoms of RSV infection usually include:

Runny nose
Decrease in appetite
Coughing
Sneezing
Fever
Wheezing

These symptoms usually appear in stages and not all at once. In very young infants with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties.

Most children will have had an RSV infection by their 2nd birthday.

Infants with a higher risk for severe RSV infection include:

12 weeks old or younger (at the start of RSV season)
Premature or low birth weight infants
Chronic lung disease of prematurity
Babies with certain types of heart defects
Those with weak immune systems due to illness or treatments
Additional risk factors for severe RSV infections include: a mother who smoked during pregnancy, exposure to secondhand smoke, a history of allergies and eczema, not breastfeeding, being around children in a child care setting or living in crowded conditions.

When should you call the doctor?
RSV symptoms are typically at their worst on days 3 through 5 of illness . Fortunately, almost all children recover from an RSV infection on their own.

Call your pediatrician right away if your child has:

Symptoms of bronchiolitis
Cough
Production of mucus, which can be clear, white, yellowish-gray or green in color — rarely, it may be streaked with blood
Fatigue
Shortness of breath
Slight fever and chills
Chest discomfort
Symptoms of dehydration (fewer than 1 wet diaper every 8 hours)
Pauses or difficulty breathing
Gray or blue color to tongue, lips or skin
Significantly decreased activity and alertness

Some children with RSV may be at increased risk of developing a bacterial infection, such as an ear infection. Call your doctor if your child has:

Symptoms that worsen or do not start to improve after 7 days
A fever (with a rectal temperature of 100.4°F or higher) and they are younger than 3 months of age (12 weeks).
A fever that rises above 104°F repeatedly for a child of any age.
Poor sleep or fussiness, chest pain, ear tugging or ear drainage

Is RSV contagious? Yes. RSV spreads just like a common-cold virus―from one person to another.

Direct person-to-person contact with saliva, mucus, or nasal discharge.
Unclean hands (RSV can survive 30 minutes or more on unwashed hands).
Unclean objects or surfaces (RSV can survive up to 6 hours on surfaces, toys, keyboards, door knobs, etc.).

Keep in mind, children and adults can get RSV multiple times–even during a single season. Often, however, repeat infections are less severe than the first one.

What can you do to help your child feel better?
There is no cure for RSV, to help your child feel more comfortable, treat the symptoms as you would a bad cold:

Nasal saline with gentle suctioning to allow easier breathing and feeding.
Cool-mist humidifier to help break up mucus and allow easier breathing.
Hydration, fluids and frequent feedings.
Acetaminophen or ibuprofen (if older than 6 months) to help with low-grade fevers. (Avoid aspirin and talk to your doctor about cough and cold medications).

How can you protect your children from RSV?

Wash your hands! Use soap and water and scrub for at least 20 seconds.
Vaccinate. Keep your children up to date on their immunizations and get the whole family annual flu shots. ( Remember, you can get a COVID-19 vaccine and flu shot at the same time).
Vaccinate your children ages 6 mo.+ against COVID-19 .
Children 5yrs + who had their primary series more than 2 months ago should receive an updated COVID-19 booster ASAP.
Adults who are around infants – get Tdap vaccine to protect against whooping cough
Limit your baby's exposure to crowds, other children, and anyone who is sick.
Keep children home from daycare or school who have fever, especially with a cough, difficulty breathing or shortness of breath, congestion, runny nose, or sore throat, until they are fever-free for 24 hours without medications that reduce fever.
Clean high touch surfaces in your home frequently with household disinfectants.
Feed your baby breastmilk. It has unique antibodies to prevent and fight infections.

More information

Reference: CDC, AAP

Dr. Morgan a Panelist Discussing ePrescribing

Tue, 17 Dec 2019 02:12:11 GMT

SureScripts Critical Performance Improvement Summit in Minneapolis, MN.

Dr. Morgan was recently a panelist at the SureScripts Critical Performance Improvement Summit in Minneapolis, MN. The session focused on provider and pharmacist perspectives on challenges facing the current state of ePrescribing.

Photo Left to right: Lucrezia Finnegan, MBA, RPh (from CVS), Mark Weiner, MD, FACMI (Weill-Cornell Medicine), Dr. Stephen Morgan, MD, MS, FAAP (Pediatric Associates of Salem & Beverly), Jennifer Boehne, PharmD, MBI, MPH (CVS), Scott Rochowiak (Moderator of the Panel).

PAGS Lecture Series: Pediatric Growth Patterns

Mon, 02 Dec 2019 02:05:57 GMT

The Medical Team at PAGS believes that practicing pediatrics encompasses the whole child. We regularly evaluate and discuss the physical, social, emotional, and developmental well-being of children from newborn to young adults. The foundation of the whole child is his/her growth and development.

On 11/21/19, Dr. Dorit Koren MGHfC Pediatric Endocrinologist, met with our clinical staff in our office to discuss normal growth that may be concerning to parents and children as well as abnormal growth patterns.

Phases of Growth

There are 4 phases of growth:

Fetal growth which is primarily a reflection of maternal health and nutrition
Accelerated growth in the 1st 2 years: on average almost 10 inches in 1st year and almost 4 inches in 2ndyear depending on genetics.
Steady growth in pre-pubertal years with rate of growth declining gradually before plateauing
Acceleration of growth during puberty: Approximately 2-4 inches per year for girls and approximately 3-5 inches per year for boys.

There is no more growth after growth plates close.

Measuring Growth

We use WHO curves from 0-2 yrs. (length while lying down) and CDC curves from 2-20 yrs. (standing height). On average there is a 0.3inch difference between recumbent height and standing height so growth percentiles may shift slightly during the transition at the 2½-year physical or 3-year physicals.

Growth patterns vary around the world, with Norwegian groups for instance, having higher average growth percentiles than children in the U.S. and Korean children having lower average growth percentiles. Approximately 2% of the US population may have short stature . Short stature may not be abnormal.

Growth failure is defined as rate of growth below what is expected for age, sex, genetics. and stage of puberty.

downward crossing of 2 or more major percentiles
height dropping below 3rd percentile

Behind the Scenes

Growth hormone is released by the pituitary gland in the brain. Other hormones in our body such as thyroid hormones and the gonadal hormones (estradiol, progesterone and testosterone) stimulate production of growth hormone.

Atypical Growth Patterns

Benign short stature - NOT abnormal
Familial short stature: Most, perhaps all, people in family and extended family have short stature
Constitutional delay of growth and puberty: Puberty is later than average and peak height velocity occurs later. For example, the boys who are shorter than their peers in middle school and grow in college is totally normal.
Pathological causes of atypical growth:
Under nutrition, malabsorption (celiac disease)
Neglect
Hypothyroidism, growth hormone deficiency
Chronic anemia
Systemic illnesses such as Crohn’s disease, cancer
Some chronic medications such as long-term oral steroids

Initial evaluation for abnormal growth pattern will include review of family and pregnancy history, medications. We may do screening blood work and bone age X-rays that typically look at an X-ray of the bones of the hand that stages the radiographic age compared to the actual chronologic age. More studies and imaging may be necessary depending on preliminary tests obtained, if warranted, by a specialist such as Dr. Koren who is a pediatric endocrinologist who sees patients at MGH in Boston and also in Salem and Danvers.

Your child’s growth charts provides us with a window into typical and atypical growth patterns and can be reassuring although your child may not match his peers in terms of height at a given moment in time.

We are grateful to Dr. Koren for taking the time to spend with us as we continue with life-long learning in Pediatrics.

Air Travel Tips from the American Academy of Pediatrics

Tue, 26 Nov 2019 01:55:20 GMT

Traveling with children can be a delight and a challenge. Here are some helpful strategies and tips to make things easier.

The American Academy of Pediatrics (AAP) has the following tips for safe and stress-free family air travel.

General Air Travel Tips

Allow your family extra time to get through security - especially when traveling with younger children.
Have children wear shoes and outer layers of clothing that are easy to take off for security screening. Children younger than 12 years are not required to remove their shoes for routine screening.
Strollers can be brought through airport security and gate-checked to make travel with small children easier.
Talk with your children about the security screening process before coming to the airport. Let them know that bags (backpack, dolls, etc.) must be put in the X‑ray machine and will come out the other end and be returned to them.
Discuss the fact that it's against the law to make threats such as; "I have a bomb in my bag." Threats made jokingly (even by a child) can delay the entire family and could result in fines.
Arrange to have a car safety seat at your destination or bring your own. Airlines will typically allow families to bring a child's car safety seat as an extra luggage item with no additional luggage expense. Check the airline's website ahead of time so you know their policy before you arrive at the airport.
When traveling on an airplane, a child is best protected when properly restrained in a car safety seat appropriate for the age, weight and height of the child. The car safety seat should have a label noting that it is FAA-approved. Belt-positioning booster seats cannot be used on airplanes, but they can be stowed in overhead bins or checked as luggage (usually without baggage fees) for use in rental cars, taxis or ride shares. Children who weigh more than 40 lbs can use the aircraft seat belt.
Although the FAA allows children under age 2 to be held on an adult's lap, the AAP recommends that families explore options to ensure that each child has her own seat. If it is not feasible to purchase a ticket for a small child, try to select a flight that is likely to have empty seats where your child could ride buckled in her car safety seat.
Alternatively, there are also some FAA-approved harnesses for older infants and toddlers that fold down in a small, compact bag for convenience.
Pack a bag of toys and snacks to keep your child occupied during the flight.
In order to decrease ear pain during descent, encourage your infant to nurse or suck on a bottle. Older children can try chewing gum or drinking liquids with a straw.
Wash hands frequently and consider bringing hand-washing gel and disinfectant wipes to prevent illnesses during travel.
Consult your pediatrician before flying with a newborn or infant who has chronic heart or lung problems or with upper or lower respiratory symptoms.
Consult your pediatrician if flying within 2 weeks of an episode of an ear infection or ear surgery.

International Travel

If traveling internationally, check with your doctor to see if your child might need additional vaccines or preventive medications, and make sure your child is up-to-date on routine vaccinations. Bring mosquito protection in countries where mosquito-borne diseases such as malaria are present.
In order to reduce jet lag, adjust your child's sleep schedule 2-3 days before departure. After arrival, be active outside or in brightly lit areas during daylight hours to promote adjustment.
Stay within arm's reach of children while swimming, as pools may not have safe, modern drain systems and both pools and beaches may lack lifeguards.
Ensure that your child wears a life jacket when on smaller boats and set an example by wearing your life jacket.
Conditions at hotels and other lodging may not be as safe as those in the U.S. Carefully inspect for exposed wiring, pest poisons, paint chips, or inadequate stairway or balcony railings.
When traveling, be aware that cribs or play yards provided by hotels may not meet current safety standards. If you have any doubt about the safety of the crib or play yard, ask for a replacement or consider other options. (Also applies to travel in the U.S.)

For more helpful information please visit American Academy of Pediatrics .

Strategies for College Stress

Tue, 11 Jun 2019 01:48:22 GMT

Senior year is a time of intense anxiety and loss, surrounding an inevitable next step for many youth — college. As much as we would like summer vacation to be about, well, vacationing, odds are many students and their parents aren't having a totally worry-free summer.

For graduating high school seniors, college is on the horizon, bringing with it many emotions. The excitement and anticipation of the impending transitions to college and living away from family, meeting new friends and living independently can be stressful. What do we know about anxiety during the college years? How can you prepare yourself and your child?

Rachel Bedick, LICSW at PAGS, recommends the following article about the stresses that can affect our children through the college years with helpful strategies to address them.

Click link to read:
https://www.health.harvard.edu/blog/anxiety-in-college-what-we-know-and-how-to-cope-2019052816729

Keeping Kids Safe On-line

Fri, 15 Mar 2019 01:40:25 GMT

How can I keep my kids safe online?! Viral challenges like the “momo challenge” that surfaced recently are only one of the many dangers that face our young, impressionable children.

How can I keep my kids safe online?! The internet is an invaluable resource; full of useful knowledge, but it can be a perilous place for our children. Viral challenges like the “momo challenge” that surfaced recently are only one of the many dangers that face our young, impressionable children. Though many are now saying it was a fake viral media scare, the idea that someone may be able to get access to our children and encourage them to engage in increasingly harmful behavior, even self-harm or commit suicide it is in fact, the stuff that parent’s nightmares are made of. Even if Momo was a hoax, who actually knows what are kids are being exposed to online, right?! Our kids are using Instagram, Finsta or Rinsta, Snapchat, Fortnight and other online gaming, while most of us parents are still “tweeting” or on Facebook. The disconnect between the new and the old leads to parental anxiety and at times, panic and misinformation.

As an adult, you are probably aware how to protect yourself, your privacy, identity and how to avoid predators. But generally, a child or young adolescent is focused on connecting and relating with friends and safety is usually their last priority. With kids getting smartphones, ipads and other devices at younger ages, it’s more important than ever to teach them how to be safe online. Whether it’s social media, gaming, or anything else, they should have a basic idea of how to protect themselves online.

Talk to your kids early and often. Children may have a natural aptitude for online technology, but they can also be naive and trusting on social media. There is a generational difference in the definition of a “friend” and not to mention; “catfishing” is real. It is important to educate them about the risks and how to stay safe online- The same way you would teach them about keeping their bodies safe… and if you are not doing this then that’s another conversation to start having!

Consider parental controls. While talking to our kids is vital, the truth is that a backup won’t hurt. Parental control tools can help, allowing you to filter content and programs or monitor usage remotely. There are family share programs, apps like BARK and security companies like Trend Micro Service.

The world is a crazy place! Momo challenge, Tide Pod Challenge, the Blue Whale game or children’s YouTube videos being spliced with instructions on how to kill yourself - it’s enough to seriously consider moving to the remote wilderness with no internet access or perhaps considering, “is it possible to raise my child in an actual bubble?” But we can’t… despite our best intentions we can’t control everything and most likely our kids will eventually come into contact with the internet whether we like it or not. Children need to learn to navigate the world safely and that includes online. What you can do to help your kids is encourage an open dialogue about social media and the internet. This will make them more likely to see something like Momo and not fall victim to it and to talk with you about things that they encounter that don’t feel right or scare them. Be a safe space for your child to talk to you. Don’t be reactive and let them know they can talk to you about anything.

What Parents Need to Know About Vaping

Thu, 06 Sep 2018 01:36:03 GMT

How do we discourage vaping and educate teens and their parents on the dangers of e-cigarette use in what the FDA is calling an epidemic.

As I was driving home last week, I happened to look over at the car next to me, where a young girl was driving a sedan. I watched as she put this small device in her mouth and began to inhale, and then I realize she was vaping. My immediate thought was how common this has become and how important it is for parents to be aware of this new trend.

School is back in session, as we prepare our children for the upcoming school year; we buy them new clothes, school supplies and textbooks. We sit with them to discuss expectations for the coming year and talk about how to handle bullies, peer pressure, saying “No to drugs” and other social pressures.

Vaping has become the latest trend in our youth. Last year, reports indicated that approximately 1 in 6 high school students reported using a vaping device . Those numbers are staggering to me! It is important to take time to educate adolescents on the dangers of vaping.

What is Vaping?

Vaping or juuling (jewel-ing) {Juul is a brand device that looks more like a flash drive than an e-cigarette} is inhaling and exhaling vapor or aerosol that is produced by an e-cigarette or similar device/mechanism. These vapors come in a variety of flavors that include cotton candy, banana nut, watermelon, and peach just to name a few. The flavoring can be composed of thousands of chemicals that can include nicotine, formaldehyde, and/or tetrahydrocannabinol (THC which is found in marijuana).

Vaping is being marketed as way to stop people from smoking cigarettes. Unfortunately, due to the enticing selling points it is becoming more and more popular. The biggest selling point is that it is a safer alternative to smoking a pack of cigarettes and having less of an effect on the lungs. Varieties of flavors also help make vaping intriguing. Inhaling watermelon or mango vapor, sounds sweet and delish, so how bad can it really be?

What Are the Risks to Vaping/Juuling?

The fact of the matter is that there are a number of risks associated with vaping.

The liquid nicotine that is contained in these vapor fluids can be just as addictive as to that of cigarettes. These vapors get deposited into your lungs causing irritation. Those that are physically active such as high school athletes may notice a decrease in their endurance and speed. Along with the liquid nicotine that you are inhaling, your body is also subjected to: carbon monoxide, carcinogens and thousands of other chemicals while vaping. Inhaling these toxins can lead to the damage of the lining of the mouth creating sores depending on usage/high doses.

Not only does vaping affect your lungs, it affects your brain too. Please note: The brain continues to develop into your 20’s. Studies have been done demonstrating the negative effects that drugs and alcohol have on the developing brain. Nicotine is no different, as it is also a drug. It can affect chemical balance in your brain and lead to addiction, poor decision making, decreased ability to stay focused, anxiety and/or depression to mention a few.

For many years we have come to know marijuana as the gateway drug, meaning it has the potential to lead our children to seek other alternatives of getting high. Now vaping is becoming the new gateway drug while having the potential to increase the likelihood of smoking cigarettes and/or trying other substances.

How to Address This Topic With Your Adolescent?

As pediatric healthcare providers, we encourage our patients to talk to their parents. However, we advise that parents and guardians address issues like this with their adolescent first so they can make informed decisions, reducing the chance of getting misguided information from their peers. Set up a time with your child, where both of you can speak to each other openly, maybe going for a walk, or getting ice cream; you want to create a time where you are able to connect with them. Make your child aware of your concerns and feelings about this new trend, educate them on side effects, and answer their questions and concerns openly and honestly.

If you learn that your child has tried vaping or is currently vaping, take a step back and breathe. It’s not a reflection on you or your parenting. There is a lot of peer pressure placed on our children and the best thing you can do is to educate yourself and talk to your child. Try to determine what lured them into vaping and how you as a family can move on from it in a healthy way.

As a parent of four teenagers, I realize how difficult it is to keep up to date with the latest trends or even how to approach situations like these. An open line of communication with your child is key. Don’t dismiss or cut off their questions, but determine what is driving their curiosity. Is it friends at school, the media, or both? Along with educating yourself, your care team at PAGS is always willing to help and guide you into the right direction.

This blog only highlights some of the concerns with vaping. Parents need to educate themselves. As Dr. Jacques wrote in a previous blog, you want to make sure that the website where you research this information is credible. Specifically, for vaping I would recommend the following:

"Let's Just Google It"

Wed, 06 Jun 2018 01:22:08 GMT

In a time when we rely on “Google” to answer almost any and all questions that come up on a given day, more people are turning to the internet for medical advice.

As a parent I am a member of various blogs and websites so I often come across the use of internet and social media platforms as a first go-to for other parents seeking such advice. For example, I often read blog posts on the safety of various medications, skin products, sleep surfaces, infant feeding advice, advice on vaccines, etc. People are using the internet to research symptoms prior to coming to the doctors' office or will self-diagnose and not see their doctor at all. The amount of knowledge at our fingertips is both amazing and daunting. On the one hand, the internet and social media bring people with similar illnesses together and can offer meaningful support. On the other hand, there are many sources of false information that can not only confuse parents and patients, but can also be harmful.

As a parent and a pediatrician I appreciate how the availability of this information has transformed the doctor-patient relationship. I think it helps foster excellent discussions and new ways to approach illness in children. As a doctor, I also feel it is part of my job to help guide patients to the most accurate websites rather than leaving them to feel overwhelmed. I hope the following pointers can help patients navigate the seemingly endless amount of information and advice available online.

ACCURACY - Does the website use reliable research?
Check several sources for the same information; are the results the same? You can do this by searching for your topic followed by the words "science" or "debunk" to see if the subject has been researched further. If the website lists references you can use those for further information.
Websites with reference material within the site are usually more accurate and reliable.
AUTHORITY - What are the credentials of the authors?
Look to be sure the website is written by doctors, nurses or others with a direct role in the health field.
In general, websites that end in .org, .gov, or .edu are usually most reliable for health information.
Interpret headlines with caution - one study may not mean much on its own and you are better off looking into official guidelines and statements from reputable organizations.
BIAS - Who pays for the website?
If a company pays for the website they may have control over the way information is portrayed.
Websites with less advertisements tend to be less biased or have fewer conflicts of interest.
IS IT CURRENT? - When was the website last updated?
Remember that medical research never stops, make sure information is not older than 3 years old.
PERSONAL ACCOUNTS - Be wary!
In terms of blogs and social media platforms, please remember that just because one product or situation was right for one person/family, it does not make it the best option for you or your family.
Call your doctor to discuss the topics you may be researching online and through social media.
No question is "stupid" and we welcome all questions and concerns about your child's health. If we do not know the answer we will surely try to find out and provide you with the most evidence and experienced based answer that we can.
If you feel you have found your answer online feel free to run it by us for our opinion as well. That is why we are here!

Specifically for pediatrics, the websites I like most for general information are:

Our PAGS website has a wealth of information. There is a section to the right with links to over 100 articles that you can search based on your child's symptoms. This same section has medication dosage guidelines. There is resource section with many more websites for many common pediatric physical and mental health concerns.

Should Young Children Play Tackle Football?

Fri, 15 Dec 2017 01:05:56 GMT

As the calendar changes to December the fall sports season comes to an end. This past fall was particularly busy in our practice, seeing a large number of patients with concussive brain injuries. Although there were soccer, volleyball, field hockey and cheerleading athletes with concussive injuries, the vast majority of patients with concussions were football players ranging in age from an 8 year old Pop Warner athlete to a 20 year old college football player. Brain trauma at any age is serious, but what is becoming an increasing concern with football in particular, are the multiple repetitive sub-concussive head impacts that occur throughout a tackle football game.

Some of the best research into sports related brain trauma is being done locally at Boston University. Their research has shown that the most serious brain injury associated with contact sports participation, chronic traumatic encephalopathy (CTE) is related more to repetitive sub-concussive brain trauma than it is to the number of concussions an athlete has been diagnosed with during their sports career.

One study from Boston University that has received a lot of media attention was published in September 2017 and looked at psychiatric and cognitive outcomes in tackle football players who began play before and after age 12. (Age of First Exposure to American Football and Long Term Neuropsychiatric and Cognitive Outcomes – Robert Stern, et al: Translational Psychiatry, 19 Sept 2017). The study reviewed a group of 214 former tackle football players who had played high school (43), college (103) or professional football (68) and did not participate in any other organized contact sports.

The study showed that adults who began playing tackle football before age 12 were twice as likely to have problems with self control, problem solving and judgment and three times as likely to suffer clinical depression compared to those adults who began playing tackle football after age 12. These adverse effects were independent of education level, age at the time of the study and duration of football participation.

Other research has shown that a youth football player can receive 250-500 sub-concussive hits to the head during a single football season. Using helmets equipped with accelerometers to measure the force of impact during football games, forces of up to 80g have been recorded. In comparison, the maximum force generated on a roller coaster is typically 3-6g and a car driving at 60 mph that slams on the breaks and stops in 4 feet would generate 30g of force. It is thought that this type of high force acceleration and deceleration of the brain into the skull during a football game creates traumatic injury to the brain at the level of individual cells. This trauma occurring multiple times during a tackle football game over the course of a season leads to permanent brain cell injury and loss of function leading to the cognitive and neuropsychiatric changes reported.

The brain is going through a period of tremendous growth from age 8-13. Research done at Wake Forest University in 2016 showed that youth football players between the ages of 8 and 13 had changes in their brain anatomy and function over the course of a single tackle football season. (Sub-concussive Head Impact Exposure and White Matter Tract Changes over a Single Season of Youth Football, C Whitlow et al, Radiology 24 Oct 2016). Using advanced MRI techniques, the study showed a significant relationship between head impact exposure and changes in the brains white matter. The players who experienced more head impacts during the season had more changes in white matter function. Of particular note, none of the players in the study were diagnosed with a concussion. The white matter changes were correlated directly with head impact frequency and force.

This period of rapid brain growth and development between ages 8-13 is a unique time for brain and cognitive development. Brain growth that is slowed by repetitive head impacts is brain growth that will not occur at another time. This is lost opportunity for maximizing the growth and development of a young child’s brain. Children playing tackle football between the ages of 8-13 are all going to be “turning pro” some day in the future in a field other than the NFL. Whatever the field is that these student athletes turn pro in will benefit from a maximally well developed and functioning brain.

Based on my own experience taking care of many student athletes with head injuries over now 28 years of clinical practice and review of the medical research mentioned above and other research studies, I have reached the point where I cannot recommend tackle football as a medically safe athletic activity for athletes before they reach high school. I am a very strong believer that sports participation for children offers unique benefits for the development of mind, body and character. Flag football provides all of these benefits just as well as tackle football while minimizing the vast majority of head impact risks. For those skeptics who will argue that not playing tackle football before high school will put an athlete at a disadvantage when they reach high school, I would remind them that Tom Brady, who most would consider the greatest football player of all time, did not start playing football until he was in high school. By the time a student athlete is entering high school their brains have already gone through the period of rapid growth. They are also older and can participate in a discussion with their parents about the pros and cons of tackle football and reach a decision that works for them.

The decision as to whether a child should play tackle football and at what age to start is a very difficult one for athletes and their families. Parents will often ask me the question: “What would I do if this was my child?” I have three sons, two of which played football in high school. (One is now a high school football coach!) I did not let them play football before high school and would not let them play before high school now if I had to make the decision today. I would still let them play football in high school.

Talking with Your Children About Tragedy in the News

Wed, 13 Jul 2016 01:01:51 GMT

The recent 4th of July week has been particularly tough for us as a nation and for many parents. Unfortunately as a result, we are having many deeper conversations with our children about tragic events happening both in the US and worldwide.

If you have children who are tweens and older, they are likely exposed to these events through some form of social media, while younger children may have seen or heard something at friend’s homes or in public places.

There is a wide range of responses depending on, for example, how much exposure your child has to the news, the age, and the temperament of your child and yours/their personal experiences. Below are some recommendations on how to talk with your children about tragic events in the news:

Pre-school kids: Shield them as much as possible from tragedies. If they are exposed, simple explanations are important. A candid response such as “A bad man hurt a lot of people and the police helped to keep people safe so he could not hurt anyone else” is sufficient at this age.
Elementary school kids: Discuss the facts that are known so they get the information from you. The younger the child is, the more simply the facts should be stated. Some children of this age see things in black and white and there is a wide spectrum of understanding the gray in between. You know your kids best and can judge how thorough your answers can be.
Teens: More detailed discussion may be necessary and as they get older, their frame of reference may depart from yours and they may have differing opinions of why or how an event occurred. This is a great opportunity to engage in a dialogue that can open the doors to why they think/feel that way.

All ages:

Stay calm or at least maintain a calm demeanor.
Avoid replaying the events as is often done on TV and in social media.
Monitor social media use for older tweens and teens.
If you haven’t already, have the kids park their cell phones outside their bedrooms at night to avoid constant notifications that affect sleep.
Be respectful of his questions and be honest (there is a whole range of honest) without being too graphic.
Try to teach or reiterate key things in situations that call for it such as a person is innocent until proven guilty. If there are situations that your kids or yourself may encounter, talk about how they might handle it or how you would. If you have made mistakes in handling similar situations do not be afraid to admit that. It is important for children to know that their parents or guardians make mistakes and can talk about it.
For older kids, leave the door open to continue the conversation especially if conflict develops because of a difference in opinion.
Keep things in perspective. If you truly think so, do your best to explain the unlikelihood this would happen to her or a family member and with regards the most recent tragedy, unlikely to happen to other police officers.
For my 8 year old I would say “It is very unlikely because our police department has a great relationship with the people in our community.”
For an adolescent “Statistics show that it is extremely unlikely and crime is down, although awareness and media coverage of crime is up.”
Maintain routines - continue outdoor play, sporting activities, play dates and all the things your children usually do. Keep regular bedtimes, meal -times and maintain consistency as much as possible.
Encourage outlets if your kids want to help. I like these suggestions from a Dallas psychologist- Dr. Nicholas Wester:
Help younger kids write a letter to the families of victims or make cards.
Help older kids start an activity to generate funds to contribute if that is needed.
Kids can also volunteer for local community groups that may promote ideas that address issues that arise from or caused the tragic event.

Tragedy in the news may affect some children profoundly and they may show signs of anxiety or symptoms may worsen for children who tend to be anxious. Signs of anxiety may include sleep problems, crying easily, nail-biting, and wanting to spend more time with you. Children may even start manifesting anxiety as physical symptoms such as headaches and abdominal pain.

If anxiety becomes more pervasive in school, home and other areas of your child’s life, or if it does not improve over time, please call our office or talk to your child’s psychologist or counselor.

To find out more about talking to your kids about tragedies in the news here are additional resources:

Facing Injection Fears

Mon, 13 Apr 2015 00:38:26 GMT

Your child arrives for the dreaded yearly physical exam - for days you have discussed whether or not he will receive a shot. Or, you come in for a sick visit and your child is too scared to go into the exam room because she is afraid she will have to get a shot. Do either of these scenarios sound familiar?

Most children and adults have some dislike of needles, but for some, the fear is so intense that it interferes with their well-being and health. This fear of needles, which often develops around age 4-5 years old , is real, affecting as many as 63% of all children. Some (up to 5%) have a genetic predisposition to becoming light-headed or even fainting.

Many children will carry this fear into adulthood, potentially leading to avoidance of doctors altogether. As pediatricians and as parents, we understand your child’s feelings. You never want to see your child scared or in pain, and we realize we put both you and your child in an uncomfortable situation.

Based on the Center of Disease Control’s recommendations , however, we administer sometimes up to four shots in a visit to help protect your child from many serious illnesses, and more than 20 shots by the age of six. By their teenage years, most children have had close to 30 vaccine injections. Beyond vaccines, your child may need to have blood work done or an intravenous (IV) line placed in the emergency room or in the hospital. Yikes!

All of these procedures can cause tremendous anxiety for both the parents and the child. To help ease these fears, I would like to offer some coping strategies:

Educate your child about shots. Most fears come from misconceptions - that the shot will take a long time, or that the needle is very big. This often is not the case. Videos can help as a form of habituation, or repeated exposure, to help decrease anxiety around receiving injections. Also, having brave role models can help. A great video for younger children is Jim Henson’s Sid the Science Kid: Getting a Shot, You Can Do It!
Here are some links for shorter videos of children receiving injections:
Kindergarten: brave patient number 1
Older children: Teen receiving allergy shots
Be honest with your child, and ask the medical staff to be honest as well. The shot may hurt a little, so we should not say that it won’t. But we should emphasize that the injection will be very quick, that the doctors and nurses will help make it as comfortable as possible, and that your child needs it to stay healthy.
Distraction techniques can help. Have your child take a big breath in or out during the injection. Blow bubbles, blow on a pinwheel, play music, or read a story or play a short video - all of these things will draw attention away from the actual shot.
For older children and teens, have your child practice being brave. Karen Dahlsgaard, a psychologist at Children’s Hospital of Philadelphia, has introduced the idea of “ Brave Body .” By acting brave, your child can feel brave; she should sit up tall, shoulders back, arms relaxed. Your child can also bring a “coping card,” which is a card with a brave saying that the patient can read before and during the injection.
An example of an actual coping card saying is, “It will hurt for a second, but then it will be over. Millions of people have gotten shots before me and this is no different. I can do it.”
Reward your child for being brave and for facing his fear. A small reward, in the form of a small treat or activity, can help turn the experience into a positive one and hopefully make the next visit a bit easier.

I hope some of these ideas will be helpful next time your child faces an injection. If you have any questions, or desire more information, please feel free to contact me or contact your health care provider here at PAGS.

Also, feel free to share your experiences with your child in the comments section below – we’ve had children try to escape, and others who have hidden under the exam table. It’s always comforting to know that you’re not in this alone!

Toilet Training Tips by Dr. Clovene Campbell

Wed, 04 Mar 2015 21:52:58 GMT

Toilet training can be frustrating for parents and children, but it doesn’t have to be! Below are some common issues to which I think many caregivers can relate, and some helpful tips and strategies for dealing with these issues:

Taking the Terror out of Toilet Training

She says “I don’t wanna!”
Don’t worry if she doesn’t want to yet, and don’t force it. There is no hurry for kids to be trained before pre-school; in fact, many pre-schools accept children who are not yet toilet trained. In the U.S., most children gain complete daytime bladder control by age 3. Although most will be fully toilet trained by 4 years, there are a small percentage of typically-developing children who won’t complete their toilet training until age 5.

A child’s readiness to begin the process is more important than their age. Here are some signs your little one is ready to start:

She tells you her diaper is wet or dirty and it actually is
She takes off her diaper when it’s dirty
She tells you she is going poop or pee in the diaper, and she actually does
She wants to sit on the potty bench when you are on the toilet (indeed!)

He pees in the potty but poops in the diaper
That’s ok. Children will usually toilet train for urine, then within 6 months or so, will toilet train for stool.

She hides under the dining table to go poop
That is fairly common. It is the emerging quest for privacy.

Tips:

Try to have every toileting moment occur in the bathroom to encourage the association.
Suggest privacy in a corner of the bathroom instead of under the dining table, even if she is going in the diaper.
Do away with the changing table. Instead, clean her in the bathroom standing up the way day-care centers and pre-schools do it.
After she gets used to that, negotiate with her to sit on the toilet with the diaper on to pass stool. When she gets used to that, the next step will be to pass stool directly in the toilet.
Provide toys or books (not screens) to encourage staying on the toilet. If you use screens, she may never want to leave!
Positive reinforcement and reward systems like sticker charts may be helpful.

“I’m holding it!”
Constipated children will resist toilet training because it hurts to go. In turn, the child who resists toilet training may become more constipated because they deliberately hold it in. It can be a cycle that is hard to break. When the stools are soft and they have no pain, kids are much more likely to stop holding it and proceed with toilet training for stool.

Tips:

Increase water, fiber, fruits, and vegetables in the diet (not easy if you have a picky eater, I know).
Limit milk to no more than 3 cups per day.
If you allow juice, limit juice intake to 4 ounces of diluted 100% juice per day.
Put a step-stool or a stack of books under the feet to allow for more comfort when passing stool.
Allow your child to blow on a pinwheel (or blow up balloons while supervised) while sitting on the toilet to help pass harder stools.
Talk with us if dietary changes do not help to soften the stool. There are safe medications that can help with this.
Don’t force your child to use the potty; he will most likely resist using it and hold it in more.

She’s dry during the day but still wets the bed at night
Once children become dry during the day, some will be dry at night all at once. For many children, however, being dry at night may take several months to several years. About 20% of children will still wet the bed at 5 years, 10% at 7 years, and 5% by 9-10 years.

Tips:
Make sure the last drink is at dinner, or about 2 hours before bedtime.
Use the bathroom just before going to bed.
Get her up to use the bathroom again when you are going to bed, or about 2 hours after she falls asleep. Bed-wetting alarms may or may not be helpful.
The medication DDaVP (Desmopressin acetate) can be safely used as needed so that your child can enjoy sleepovers.
If your child is getting older and still wetting the bed, we may want to check for infection or other underlying problems.

Accidents
Just as falls are common when a child has just learned to walk, accidents are common when a child has recently toilet trained.

Call us if:

Accidents are frequent or unusual after a long period of being dry during the day.
Your child is urinating frequently.
There is burning or pain with urinating.
There is blood in the urine.

Many of these tips can be applied to, or modified for, children with developmental delays, including those who are non-verbal. Please feel free to talk with us about how you can get help for your child with special needs in developing toilet training skills.

Please feel free to use the comment section below – any and all comments, additional tips, or questions are welcome! Happy toileting!

Tips for Healthy Sleep in Infancy by Dr. Dominica Donnal

Thu, 29 Jan 2015 21:10:29 GMT

One of the biggest challenges facing new parents is the sleep deprivation that comes along with countless nighttime feedings, pre-dawn awakenings, and hours spent rocking your baby to sleep. This is normal and expected in the first months of life; however, by 6 months of age, most healthy babies should be able to fall asleep on their own and stay asleep through the night. Let’s break down the first year and talk about what you can expect from your baby at each age and what you can do to help your baby become a great sleeper.

Zero to Two Months

What should I expect from my baby?
You can expect your baby to sleep 14 – 18 hours total per day. Your baby needs to eat frequently and is not yet neurologically mature enough to fall asleep on his own.

What can I do?
Don’t worry about establishing a sleep schedule or good sleep habits yet - it’s too early! Focus on feeding your baby when he is hungry, and do whatever is necessary to help him fall asleep, including rocking, bouncing, singing, feeding, and providing a pacifier.

Two to Four Months

What should I expect from my baby?
You can expect your baby to sleep 12 to 14 hours with 3 – 4 naps per day. Most healthy, full-term babies should be able to sleep 6 hours without needing to feed by 4 months of age. You may notice that your baby is beginning to develop a more regular sleep pattern and is becoming more aware of his environment.

What can I do?
The most important thing to do at this age is to establish a sleep routine! The goal of your sleep routine is to teach your child to fall asleep, and stay asleep, on his own.

How do I establish a sleep routine?

Pick a few enjoyable activities that you will be able to do every evening with your child.
The key to the routine is consistency - it should include the same activities and occur at the same time every day.
The latter part of the routine should take place in the room where your child will be sleeping.

For example: This is the routine we do with my one-year-old son: At 7:30 p.m. he has a bath. After the bath we dress him in his PJs, read Goodnight Moon , and give him his milk. After his milk we brush his teeth, sing a song, and put him down in his crib by 8 p.m.

Why is it so important for my baby to learn how to fall asleep on his own?
We all go through several sleep cycles each night. At the end of each cycle, there is a brief partial awakening. A baby who knows how to fall asleep on his own will easily move on to the next sleep cycle after this brief awakening. A baby who is accustomed to falling asleep while feeding, for example, does not know how to fall asleep on his own, and he will wake up fully at the end of the cycle, expecting to be fed in order to fall back asleep.

Four to Six Months

What should I expect from my baby?
You can expect your baby to sleep 11 – 14 hours with 2 naps per day. A healthy, full-term baby should be able to sleep 9 hours without needing to eat at 5 months of age, and 12 hours at 6 months. Furthermore, most babies develop the ability to self-soothe (calm themselves) at this age. This means that your baby is now developmentally mature enough to fall asleep on his own.

What can I do?
Continue your sleep routine. Remember to keep nap and bedtimes the same every day and to begin the sleep routine before your baby gets overtired.

Six to Twelve Months

What should I expect from my baby?
You can expect your baby to sleep 11 to 14 hours with two naps per day. By this age, your baby should be sleeping through the night and falling asleep on his own.

What can I do?
If your baby is waking at night or not falling asleep on his own, 6 months is a reasonable age to start sleep training.

How do I sleep train my baby?
Sleep training refers to a variety of behavioral methods that are meant to address sleep problems. There are several different approaches. One that has been proven to be effective and work fairly quickly is the “cry it out” method. With this method, you place your child in his crib at bedtime while he is still awake and allow him to fall asleep on his own. If he cries, there are two options:

Progressive Waiting - You periodically enter the room to check on your child if they are crying, but wait a longer and longer amount of time before doing so. For example: Wait 5 minutes initially, then 10 minutes, then 15 minutes, etc. Your time in the room should be very brief.
Rapid Extinction - You do not enter the room to check on your child even if they are crying, unless of course you are concerned that they are hurt or sick.

The key to sleep training is consistency. It is very difficult to listen to your child cry, but when done correctly, these approaches work quickly; after a few difficult nights, your baby will be falling asleep on his own and sleeping thought the night. Do not feel guilty about letting your child cry – remember that teaching your baby how to sleep on his own is an important part of raising a healthy, well-rested child.

Ask us about developing healthy sleep habits for your baby at his next physical. You can also take a look at Dr. Canapari’s blog for great sleep advice for children of all ages!