parenting

What Does that Growth Chart Mean?

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Today’s post is brought to you by Prakar Poudel, International Medical Graduate, Future Pediatrician!

Growth is what makes children unique.

Everyone from Grandma to your neighbor watches the growth and development process from the moment your child is born until they become a fully mature adult. Natural laws dictate that the growth of each child is a unique, continuous and orderly process, although the different parts of a child can grow at different rates!

It is essential for your pediatrician to monitor the growth of your child until they are through adolescence, because changes in growth could be a sign of medical illness.

The most common measures to track are weight and height. However, the eruption of teeth and measurement of head circumference, chest circumference, mid-upper arm circumference and body mass index are other measures for tracking growth.

In general, a child:

  • doubles birth weight by age 6 months
  • triples birth weight by 12 months
  • quadruples birth weight by 2 years

Similarly, a child’s height:

  • will be around 50 cm (~20 in) at birth
  • will gain an additional 25cm (~10 in) by 1 year
  • 12.5 cm (~5 in) by 2 years, and
  • 10 cm (~4 in) by 3 years of age

One important note is that if growth in height is less than 4 cm (~1.6 in) per year after the age of 4 years, this suggests the child has a poor growth rate and needs a pediatrician’s visit.

The head circumference of a baby also increases at the rate of 2 cm (~.8 in) per month until 3 months of age and 2 cm per 3 months until 12 months of age.

If the measurement of the mid part of the biceps (upper arm) is below 12.5 cm in a newborn, the child also needs immediate medical attention. Average biceps size is in the graph below:

Lastly, teeth can also be considered a vital measure to track the child’s growth. As the child grows, primary (temporary) teeth erupt and fall in synchrony with the eruption of permanent teeth. All the temporary teeth fall and get replaced by permanent teeth by the age of 12 years.

Each child’s growth rate and velocity will be different and unique, so the Center for Disease Control (CDC) has created growth charts for weight, height and head circumference for each sex and age to monitor the overall growth of your child. The charts shown below are an example of growth charts of weight for age in boys and girls. All other kinds of growth charts can be found in your nearby children’s doctor.

A single appropriate growth chart is used for each child. The important part of plotting in these charts is that your child should be following a consistent percentile for it to be considered adequate growth. If your child’s weight crosses at least 2 percentiles – say falls from 75th percentile to the 25th – your child may need to see a pediatrician.

Any worries? Pediatricians love this stuff – call yours!

How to Fight with Your Child: Quarantine Edition

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The most basic principle of conflict resolution, that both parties in the conflict have to be treated as equals, flies out the window when that conflict is with a child or between children.

Equality is a tricky area in parenting. Yes, this child is in every way your equal in humanity and way ahead of you in potential. He or she is undeniably not your equal in size, power, or – for a while – intelligence and experience. If we allow a child equal power in a conflict what we get is a spoiled, obnoxious child who will put his or her own future in jeopardy by making bad decisions.

Equality is likewise tricky between two children, because we cannot count on children not to take advantage of their greater size, intelligence, or experience. A referee is needed.

When we are in conflict with our children, or they are in conflict with each other, we must treat them with respect as the complete human beings they are, while we decisively withhold the power they are grasping for.

The standard steps to conflict resolution apply, but they must be adjusted for the relative sizes of the combatants:

 

First, listen.

It is all too easy to dismiss a child. You are the parent, you know what they are going to say, and you know what your decision is going to be, so why waste the time, right?

How did that attitude make you feel the last time you were on the receiving end of it?

Take a moment to listen to their side, even if it is ridiculous, because just knowing they are being listened to is a win for a child. This is much easier to do when your 4 year old is explaining to you why she thinks she should have ice cream for lunch, than it is when your 13 year old is explaining why it is not a problem that you caught him smoking. Give them the time to speak, no matter how tempting it is to cut them off.

Actually focus on them and pay attention to what they are saying. Don’t let your mind wander into thinking about what you will say next, or the errands you have to run.  The prize you get for listening is a better understanding of your progeny; as a bonus, they then have to listen to you, to be fair. Another win!

Sometimes it helps to set a timer prominently between you and give each person a minute to speak without interruption.

After one contender has their moment to speak, their opponent should repeat back what they heard. Sometimes what we mean to say is not what comes out of our mouths, and sometimes what we hear is not what was actually said.

 

Communicate, and insist that they communicate.

Don’t fling insults and accusations. Don’t bring up past history. Don’t yell, because yelling looses it’s power quickly. Don’t threaten with ultimatums – they backfire. Never denigrate your child and never label them: labels stick, and children sometimes try to live up to them.  Sit down at their level, look them in the eye, speak at normal volume, and stick to the subject.

 

Don’t make assumptions.

Or jump to conclusions. Slow down and give yourself the time to fully understand, or mistakes will be made.

 

Summarize.

After everyone has had a chance to make their points, sum them up. Name the problem, list the arguments on each side.

 

Start with areas of agreement.

In every discussion there are points of agreement. Start with those points, and work from there. We agree that ice cream is delicious, and it does have calcium in it for your bones, but…

In the end, you are the parent and must make the decision that you feel is best. Listening to your children along the way does no harm, strengthens relationships, will make them feel valued, and will nourish their self esteem. Understanding their thought processes and point of view may also help prevent later conflicts. Avoid the pitfalls – jumping to conclusions, towering over your child, name calling – and you will not have damage to repair later.

The experience of being treated fairly and with respect will carry forward and encourage your children to demand respect as they become adults. And learning how to argue without destroying a relationship? Priceless.

Summertime Rashes

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little cute girl near the pool with a circle for swimmingWhen the days warm up, pediatric offices see a lot of summer skin problems. Kids aren’t often ill during the summer, but they do get sunburns, bites, jellyfish stings, and rashes.

Sunburn

No one thinks about sunscreen on that first glorious sunshiny day, so sunburns are usually our first evidence that summer is here. Remember to use sunscreen, of course, and don’t forget to reapply it every hour.

If your child does burn, give ibuprofen immediately – it helps with the inflammation and can actually reduce the depth of injury. Use aloe generously: it lessens the pain, moisturizes the skin, and helps heal the damage. If the burn is bad, call your doctor. Prescription steroids and burn creams will help.

Bug Bites

Bug bites are also very popular in the summer, from mosquitos, fire ants, yellow flies, and fleas. Insects inject toxins into children’s skin when they bite; how much a particular child reacts depends on how sensitive he or she is.

Cover up little arms and legs when you can, especially if you are going to be outdoors around twilight. There are excellent clothing treatments available that will keep bugs away and last through several washings, protecting your child indirectly.

If your child is older than 2 months, use insect repellant with DEET on exposed skin, even though it’s nasty. It works and it’s a whole lot better than getting insect borne encephalitis. 10% DEET lasts about 2 hours; 30% lasts about 5 hours. Don’t use anything stronger than 30% on a child. Don’t reapply in the same day, and do wash it off when you go back inside.

Creams with pramoxine or calamine will help with itchiness. Cortisone creams help itch and also swelling and redness, but can only be used a couple of times a day. If there are lots of bites, an antihistamine by mouth will also help with swelling and itch.

Never use antihistamine creams (benadryl is the most common), because children can react to the topical antihistamine and actually get worse instead of better.

Bee stings

Bee and wasp stings are treated much the same way, after making sure to remove the stinger and apply a cool compress (and yes, Grandma’s idea about the wet mud does help).

Poison ivy, oak, and sumac

If your child is a forest dweller, he or she will at some point get poison ivy, oak or sumac. These plants produce a poison called urushiol in their sap and leaves, causing redness, itch and blistering.

The severity of this reaction also varies depending on your munchkin’s sensitivity. My brother’s eyes would swell shut if someone burnt it a block away; I could pull it up and throw it away with no reaction.

Wash both the child and his or her clothes as soon as possible. No lounging on the furniture! The toxin can stay on surfaces for months. Once the toxin is either absorbed into the skin or washed off, the rash is no longer contagious. Blister fluid does not contain urushiol.

The rash will develop first where the most toxin was deposited, in streaks and patches. It can spread for a week or so to the areas where less toxin landed, then take another two weeks to clear.

If the rash is mild, you can treat it at home with cool compresses, baking soda or oatmeal baths, the same creams you used for those pesky bug bites, and that antihistamine by mouth. See? Grandma was right again.

If the rash is not mild, or your child has it on their face, around their eyes, or on their genitals (and how did that plant get there?) call your doc. We can put them on steroids, which help enormously.

Jellyfish stings

If you harbor a small mermaid or man in your home, she or he may get stung by a jellyfish. There are some extremely dangerous jellyfish, so if your child has any trouble breathing, is weak or nauseated, has pain away from the sting, or has sweating, cramping, or diarrhea, call your doctor immediately.

If it is a simple sting, first remove the barbs by scraping it with a towel or a credit card. Don’t rub. Put suntan oil or salt water and hot sand on the sting; heat will deactivate the poison.

Do NOT wash the sting with fresh water – it will make the nematocysts (poison sacks) explode and release more poison into the skin. Your child will scream and not love you anymore. Put only fluids with lots of particles in them on the sting: sting-away, vinegar or steak sauce, for example. Ibuprofen will also help the pain and inflammation.

Allergic rashes

Last, we see allergic reactions to everything from sunscreen to henna tattoos to jewelry to pool chemicals from fun in the sun. Kids with sensitive skin or eczema will rash out in the summer from the heat, humidity and sweat.

By now you can probably sense a common theme (or you could just ask Grandma): give your itchy red bumpy child a cool bath with mild soap. Moisturize and apply topical steroids or give antihistamines by mouth.

If any of this doesn’t work, call me! It gets lonely in a pediatric office during the summer when all the kids are healthy.

DomesticatedMomster
The Blogger's Pit Stop

Summertime Injuries: Preventing the Scary Stuff

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safety signSafety is not simple. There is no clear division between “this activity will be safe,” and “this activity will injure my child.” We could wrap our children up, keep them indoors, and not allow them to play with anything remotely dangerous—but then we would have a child who is lonely, overweight and really bored…who would get into trouble and injure themselves… Or not get in trouble and develop diabetes, heart disease and knee problems from obesity.

Kids need to be active, and summertime brings many interesting opportunities for exercise, adventure and injury.

Wouldn’t it be great if some doctor type person would tell you what activities were the most likely to bring ER bills into your life?

Oh, wait… That’s me! So:

The most common causes of accidental death are gunshots, motorized vehicle and bike accidents, drowning, poisoning, and fire. Drowning, MVAs, bike accidents, and trampoline accidents are all more common in the summer, when kids are out of school.

Water Safety

Drowning is every pediatrician’s worst nightmare. It is currently the fifth leading cause of accidental death. An average of 700 children drown each year: about 2 each day. Most are under 4; 80% are male. For every death, there are 5 more children who drowned but survived, commonly with irreversible damage to their brains.

Infants and toddlers drown in bath tubs, buckets, toilets – it only requires is about an inch of water, just enough to cover their nose and mouth. Older children drown in pools, rivers, lakes, and oceans.

Never leave any child alone for even a moment near open water, whether it is an ocean, a bathtub, or a water bucket. All it takes is one moment of inattention for a child to slip away. If there is open water, you need to be within touching distance and focused on your child. The story I have heard over and over is, “We were right there, just talking, but nobody noticed anything until we realized he was gone.” Keep your kids in sight, and don’t let yourself get distracted. Be especially careful at the end of the day, as the water empties and people are gathering up their belongings and leaving. Children will want to swim just a minute more, or will attempt to go back for that last toy floating in the water.

Pools should be fenced in and closed off with a self-latching gate at the end of the day, and all the toys should be put away. Life vests are fabulous for a parent’s mental health and relaxation (swimmies and floaties are not life jackets). Life preservers and a shepherd’s crook should be placed obviously nearby wherever kids are swimming.

Sign your kids up for swimming lessons, even if you are afraid. A middle schooler or teen will never admit to their friends that they don’t know how to swim. They will fake it, sometimes unsuccessfully. Don’t, however, trust a young child to remember his or her swimming lessons when they need them. If they are startled or scared, they will forget everything they learned and just sink to the bottom.

Know what to look for. In real life, drowning does not look like it does in the movies. It is possible to miss someone drowning right in front of you if you do not know what you are seeing. They do not shout for help and wave their arms. They tire, and panic. A drowning child might never make a sound, but quietly slip under the water. An older child might keep themselves above the water for a while, but their head might be low in the water, with their mouth at water level, or perhaps with their head tilted back. Their eyes might be blank or closed. They will sometimes hang vertically in the water without paddling their legs, or appear to paddle with no purposeful movement. A drowning person is very easy to miss if you are not vigilant; and easy to help if you are.

Somebody should know CPR—why not you? Your local fire department or hospital will have classes.

Swimming is a necessary skill, fun, and excellent exercise; it is also a time for close observation and care.

Motorized Vehicles

The other motorized vehicles—ATVs, dirt bikes, snowmobiles, and Sea-Doos—are also commonly out in the summer. They are the perfect storm: they go fast, have no outside framework, roll over easily, and the only things that keep them from crashing are your children’s foresight, common sense, and trained reflexes. The United States averaged 23,800 dirt bike crashes requiring emergency room visits every year between 2001 and 2004; these numbers go up as dirt bikes become more popular. Don’t. Really, just don’t. You do like the kid, right?

Bikes

Bikes come out of the garage when the weather warms up and the roads are not covered in ice. And yes, the dorky bike helmet is an excellent idea.

Thousands of children are injured or killed every year due to bike accidents, frequently right near their homes. In 2010 alone, there were 800 deaths, 26,000 traumatic brain injuries and 515,000 emergency room visits after bike accidents.

Asphalt is not soft, even right next to your house. When a car hits a child, the child flies through the air. The heaviest part of the child—the head—lands first.

Make them wear the dorky helmet, on top of the head please, covering the top of the forehead, and tied snugly under the chin, not dangling on the back of the head. Hang it on the bike handlebars when not in use so that it is the first thing on and the last thing off. Keep a big lock handy so that if you catch them on the bike without the helmet, you can lock it up and they can walk for a week. Sorry kid, that was the rule and you knew it. There is no need for any argument.

Please don’t buy a bike two sizes too big. Your child will fall off. Children should be able to place the balls of their feet on the ground while their rump is on the seat, and their whole foot should be flat when they are standing over the crossbar. An extra bike or two over the years is cheaper than a broken child.

Trampolines

Trampolines are a huge source of income for surgeons and orthopedists. If you would like to make them poor, don’t buy a trampoline. If you have one, please be careful. Most trampoline accidents occur when there is more than one person on the trampoline, especially when they are not the same size. The smaller one goes flying or is fallen upon. Safety nets and pads are better than no safety nets and pads.

On second thought, forget I said all that. Let’s go back to no trampolines. Kids break bones, damage their kidneys, and hurt their heads and spines.

Children will at some point injure themselves because they need to be free to run, swim, and climb monkey bars and trees. Try not to obsess over scraped knees, a goose egg on the forehead, or a few stitches. Everybody gets those, and your children will find a way. Concentrate on the risks that will kill them or seriously injure them: motor vehicle accidents, drowning, fires, poisonings, and gunshots. Don’t go out of your way to buy things that will hurt them, such as trampolines and ATVs. Make it so they have to get creative if they want to injure themselves. Creativity is good, right?

Domesticated Momster
The Blogger's Pit Stop

Top Ten Tips for Summer Vacation Success

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skateboarder-01School’s out! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have my top ten tips:

10. Pack a simple medicine kit: don’t waste a day of vacation at the doctor’s office, refilling the prescription you forgot at home. Take:

  • any prescription meds your child sometimes needs, even if they haven’t used them in a while (asthma and allergy meds come to mind)
  • frequently used over-the-counter stuff: acetaminophen or ibuprofen, an antihistamine, insect repellant with DEET (the other stuff really doesn’t work, and insect borne encephalitis is unpleasant), sunscreen, and hand sanitizer
  • basic first aid supplies (band aids, gauze pads, tape, antibiotic ointment, cortisone cream, alcohol, tweezers, scissors, thermometer)

9.  Write out a budget before you go. I know, I am a fun sucker, but it has to be done. Know how much money you have and where you plan to spend it. Give the kids an allowance for souvenirs. They will be more careful with money they consider their own, and they will not be constantly asking for things. “Can I have that?” can be answered with “Sure, it’s your money. But are you positive that is where you want to spend it? There might be something better later…” Also, knowing how much you yourself have to spend will save you stress and regret later.

8.  Keep to healthy foods most of the time. (Here I go, sucking out the fun again!) Kids will have more energy, feel better and have a better attitude if they are nourished. And it’s cheaper. Have a basket of fruit available, some whole grain crackers, cheese, peanut butter, popcorn – food with nutrients. Don’t waste valuable vacation time sitting in the drive thru line and arguing over food.

7.  Keep to established routines when you can. Bring along a book for that bedtime story, keep bed time the same, set aside time for their bath. Kids don’t always deal well with change, and vacations are all about change. A few familiar routines will help them feel less stressed. And a full night’s sleep is an absolute necessity if you don’t want an emotional wreck for a kid.

6.  Keep an eye on the little ones. You are in a different environment with new dangers. Distractions abound. Kids on vacation get lost, or get into Grandma’s meds or the local pool. Check out my summer safety tips.

5.  Find interesting things to keep their brains busy. Bored kids whine, and then they find their own version of interesting things. Have a stock of books, games and videos for the car. Bring a journal for them to write in, and art supplies. Explore the area you travel to – Google it before you go. See the sights, hit the museums, find the local artists and craftsmen. Check out ideas to abolish summer boredom.

4.  Keep your own mind open to new and different ways of doing things, so that your kids will do the same. Kids internalize their parent’s judgments, and they will close down their minds and wipe possibilities out of their lives if that is the example you set.

3.  Keep them physically active as well. A tired kid is less stressed, sleeps better, and is not sitting around thinking of ways to get into trouble.

2.  Keep stress to a minimum. Use a GPS if you’re driving: arguments with the navigator have ruined many a vacation. Keep your expectations in line with the actual possibilities, to avoid disapointment. Don’t overschedule – leave time for that relaxing hike and to have a conversation over dinner. Stay within your budget – your hindbrain will know you are overspending and your stress will mount. Stressed out people snap at each other and cannot enjoy time or family.

1.  Align your vacation with your priorities, then toss out the rest. What are the goals of this vacation? Relaxation, family time, memories, enrichment, joy? Plan the vacation and activities that will get you there, and don’t let exhaustion, stress, and fear get in your way. Don’t stop at Uncle Joe’s house if you know he will stress you out; don’t vacation with those friends who overspend or forget to pay their half of the bill. Don’t worry if the kids are getting dirty or if your Aunt Judy wouldn’t approve. Just say no, open up, and relax.

And have a fantastic vacation!

Top 10 Tips for Successful Summer Vacations

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little cute girl near the pool with a circle for swimming

School’s out! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have a top ten from the Doc:

10. Pack a simple medicine kit: don’t waste a day of vacation at my office, refilling the prescription you forgot at home. Take:

  • any prescription meds your child sometimes needs, even if they haven’t used them in a while (asthma and allergy meds come to mind)
  • frequently used over-the-counter stuff: acetaminophen or ibuprofen, an antihistamine, insect repellant with DEET (the other stuff really doesn’t work, and insect borne encephalitis is unpleasant), sunscreen, and hand sanitizer
  • basic first aid supplies (band aids, gauze pads, tape, antibiotic ointment, cortisone cream, alcohol, tweezers, scissors, thermometer)

9.  Write out a budget before you go. I know, I am a fun sucker, but it has to be done. Know how much money you have and where you plan to spend it. Give the kids an allowance for souvenirs. They will be more careful with money they consider their own, and they will not be constantly asking for things. “Can I have that?” can be answered with “Sure, it’s your money. But are you positive that is where you want to spend it? There might be something better later…” Also, knowing how much you yourself have to spend will save you stress and regret later.

8.  Keep to healthy foods most of the time. (Here I go, sucking out the fun again!) Kids will have more energy, feel better and have a better attitude if they are nourished. And it’s cheaper. Have a basket of fruit available, some whole grain crackers, cheese, peanut butter, popcorn – food with nutrients. Don’t waste valuable vacation time sitting in the drive thru line and arguing over food.

7.  Keep to established routines when you can. Bring along a book for that bedtime story, keep bed time the same, set aside time for their bath. Kids don’t always deal well with change, and vacations are all about change. A few familiar routines will help them feel less stressed. And a full night’s sleep is an absolute necessity if you don’t want an emotional wreck for a kid.

6.  Keep an eye on the little ones. You are in a different environment with new dangers. Distractions abound. Kids on vacation get lost, or get into Grandma’s meds or the local pool. Check out my summer safety tips.

5.  Find interesting things to keep their brains busy. Bored kids whine, and then they find their own version of interesting things. Have a stock of books, games and videos for the car. Bring a journal for them to write in, and art supplies. Explore the area you travel to – Google it before you go. See the sights, hit the museums, find the local artists and craftsmen. Check out ideas to abolish summer boredom.

4.  Keep your own mind open to new and different ways of doing things, so that your kids will do the same. Kids internalize their parent’s judgments, and they will close down their minds and wipe possibilities out of their lives if that is the example you set.

3.  Keep them physically active as well. A tired kid is less stressed, sleeps better, and is not sitting around thinking of ways to get into trouble.

2.  Keep stress to a minimum. Use a GPS if you’re driving: arguments with the navigator have ruined many a vacation. Keep your expectations in line with the actual possibilities, to avoid disapointment. Don’t overschedule – leave time for that relaxing hike and to have a conversation over dinner. Stay within your budget – your hindbrain will know you are overspending and your stress will mount. Stressed out people snap at each other and cannot enjoy time or family.

1.  Align your vacation with your priorities, then toss out the rest. What are the goals of this vacation? Relaxation, family time, memories, enrichment, joy? Plan the vacation and activities that will get you there, and don’t let exhaustion, stress, and fear get in your way. Don’t stop at Uncle Joe’s house if you know he will stress you out; don’t vacation with those friends who overspend or forget to pay their half of the bill. Don’t worry if the kids are getting dirty or if your Aunt Judy wouldn’t approve. Just say no, open up, and relax.

And have a fantastic vacation!

Why is Being Short a Bad Thing?

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Sad child on black background. Portrait depression girlThe time has come to question our assumptions.

We know that humans come in all sizes, shapes, colors, talents, and smarts. Things would get pretty boring–and confusing–if everyone looked alike and had the same talents and abilities; we need variety to keep the world turning. Who would grow the food and fix the plumbing if we were all rock stars?

Why then do we then pick one or two sorts of humans and define them as good? Why is tall better than short? Why is blond better than brunette? Why is aggressive good in a male and not so good in a female? Who makes these arbitrary decisions?

We need to take a breath and examine our assumptions, because they effect every aspect of our lives. We especially need to consider how they affect our children’s lives.

Thoughtless, arbitrary assumptions can place expectations on our children that will crush their fragile frames.

It is easy to assume that athleticism is good, and slide from there over to I want you to be athletic, and will be disappointed in you if you are not. It is common to assume that girls should be nice, and then wear a dismayed look when a daughter’s competitive streak comes to the fore.

It is equally easy for a daughter to internalize that look of disappointment or dismay, and lacerate her own self-esteem.

So let’s question our assumptions.

I am where I am partly because I was fueled by soul deep anger and competitiveness. I am told these traits are “negative” in a woman, but they motivated me and gave me the power to overcome endless obstacles. Why then are such things defined as negative – should it not depend on how they are used? These traits are part of my whole–should I not embrace them if I am to love myself? Or do I have to embrace only the parts of me of which others would approve, and try to bury the rest? Why? Because society says so? Religion? Because I am a woman and we are assumed to be a certain way? Because they are not happy, perky feelings?

Who defines what is a negative trait, and what is positive? Is it social mores, extended family, religious books, the entertainment industry? These entities don’t even know you or your children, so why should you trust them to decide what you or they should be?

We want our children to like themselves in their entirety, not just selective bits and pieces. We do not want them to feel that they need to hide parts of themselves because they believe those parts to be bad, or shameful. Down that path lies broken relationships and depression.

If your child is short, tall, brunette, round, skinny, bookish, hates books… take this moment to make sure that you are not harboring assumptions about which bits and pieces are “good” and which are “bad.” Kids are experts at reading their parents, and stamping themselves with those unvoiced judgements. Value honesty, responsibility, inspiration–traits that will help them succeed in any field–and all the parts and pieces of your actual children, because every part of them deserves your acceptance and love.

Domesticated Momster

All the Right Foods

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Little chief-cook tasting the carrot isolated on white

One of my favorite teachers once said “Never fight a battle with a child that you cannot win.” Excellent, timeless advice.

Luckily, children are young and inexperienced. We adults are old and treacherous–we can outsmart them.

This is particularly good advice when it comes to nourishing a child. The grown ups need to win food battles, because the losing side is populated with joint pain, back pain, heart disease, stroke and death. We have to set up this battle so that we cannot lose, because otherwise our child will suffer.

There are two keys to making this work.

The first is that children do not cry for what they don’t know exists. A three year old who doesn’t know about chicken nuggets and French fries does not beg for them. If it’s not too late, start on day one and keep only healthy food in the house, in the proportions you want them to consume. Eat at home. Then let them have it. Everything in the house is good for them, so you never have any arguments over what your urchins can or cannot eat. If they munch on healthy snacks throughout the day, like whole grain crackers with cheese or pieces of fruit or veggies, it really doesn’t matter if they eat formal meals.  There is no need to argue over what they need to eat before they leave the table.

If it is too late and they already have some bad habits, explain to them that you’re turning over a new leaf, eating healthier, and throwing out all the junk. Then do it, and put in earplugs. It gets better in about two weeks if you are consistent and don’t give in.

The second key is that “never” is a lot easier for a child to deal with than “sometimes.” “Never” is a shake of the head, a smile, and a change of subject. “Sometimes” is endless daily arguments over what they want today because sometimes they get it, sometimes you buy it, sometimes it’s O.K. It’s easier for the child as well: children are less stressed and develop healthier habits when they can eat when they’re hungry, eat whatever is available, and stop eating when they’re not hungry.

So what edibles do you bring into the house? Start with whole foods: things that look like they grew out of the ground or lived on it. Shop mostly around the outside of the grocery store where they keep the produce, meats, and dairy. Avoid the aisles unless there is something specific on them that you need. Don’t buy anything with ingredients that you can’t pronounce without a chemistry degree, and don’t buy sodas.

Make a meal plan for the week, taking into account what is in season, what you like to eat, and what your week is going to be like. Make meals ahead that you can reheat or reinvent later in the week when you have a crazy busy night. Throw together an extra pan of lasagna, bake a larger chicken than you need so you can make quick quesadillas, or save some leftovers for a shepherd’s pie. Plan ahead so you won’t be tempted by the drive through.

About 2/3 of everything children eat should be fruits, veggies and whole or enriched grains. This leaves only about 1/3 for proteins (meat, eggs, cheese, beans, and nuts) and starches (potatoes, bread, corn). That translates to a maximum of about 6 ounces per day of protein containing foods for a medium sized child, and 6 ounces of starch. Visually this is a portion about the size of a deck of cards, much less than the average child eats. This leaves lots of room in their stomachs for fruits, vegetables, and whole grains.

Children don’t overeat on a diet that is mostly fruits and veggies, which means you don’t have to chase them around trying to limit how much they eat so that they won’t get chubby. Feel free to let them have seconds, thirds and fourths on the broccoli and carrots, but sorry kid, that’s all the meat and potatoes we made.

Arrange the battlefield ahead of time in such a way that you have no chance of losing–you don’t even actually need to fight–so that your child will grow up healthy, nourished and strong, with good lifelong habits. Do this consistently and everyone’s lives will be less stressful. Your children will know that food is nourishment of the body, not an emotional crutch for the soul.

Below is a chart that should give you an idea of what the goals are for your child’s diet, based on their sex, age, and activity level:

diet table2

Happy Haunting! How to Stay Safe on Halloween…

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Little girl and boy carving pumpkin at Halloween. Dressed up children trick or treating. Kids trick or treat. Child in witch costume playing in autumn park. Toddler kid with jack-o-lantern.

Time again for the annual “How to keep your kid alive and still have a happy Halloween” article. I know you’ve read this sort of thing before, but skim through – you might see something you forgot!

First, costumes. From tiny ones that want to be lions to preteens dripping blood, costumes are the best part of Halloween. For a few hours we suspend boring reality and play at being something else. How better to encourage creativity and imagination?

Please try for bright, easy to see colors. Check to make sure the fabric is flame retardant and add reflective tape. Make sure the costume fits well so your little guy won’t trip. Stick your little girl’s feet into comfortable shoes. Pin a paper with their name, address and phone number inside their pockets in case you get separated.

Paint their faces so they don’t need to wear masks that can obstruct their vision.

Be careful about those accessories! Long scythes and pitchforks can be trip hazards. Accessories should be soft, short, fake and flexible. Guns that look real have caused problems when people were unsure they were toys. Arm them with a flashlight with fresh batteries instead.

On the subject of home décor: I once put a big fat candle on a table decorated with straw. It took my next-door neighbor–a fireman–raising his brow for me to see that this was not a terribly bright idea. So. Be careful where you put flame. Fire inside a floor level pumpkin with costumes sweeping by–not so good. Try battery powered candles or glow sticks instead. The fireman will appreciate it.

Only the grown ups get to use sharp objects, so pumpkin carving is for big people only. Nothing ruins a holiday like a trip to the ER. Kids can design with markers or paint.

Next, inspect your yard and home for trip hazards such as bikes and hoses. Check for frayed wires, and poorly lit areas.

There are, I admit, children who may disagree with me about costumes being the best part of Halloween. There is that other thing they like a lot: running around neighborhoods screaming maniacally and getting free candy. I would frown upon such activity but I have fond memories of doing the same.

So, on the subject of trick-or-treating: the number one way children are hurt on Halloween is by running in front of cars in the excitement of the moment. Teach them basic safety and know where your kids are and who they are with.

Kids under 12 walk with a grown-up (No, that is not up for debate; blame it on me.) Over 12, it depends on the maturity of the child and the safety of the neighborhood. If they are not with a grown-up, they need to travel in a group, on a preplanned path. If you can find a neighborhood where they close off the streets, enjoy! If not, hike through a familiar neighborhood (it can’t hurt to check the registered sex offender site and avoid those houses).

Everyone needs to stay in well-lit areas, avoiding short cuts, alleys and darkness. Use sidewalks and walk facing traffic. Be careful when crossing the street: even if the approaching car does see your child, the one behind him or her might not. Make sure they know to never approach parked cars and never enter a house. Have your big kid carry a cell phone and check in every hour. Agree on a curfew.

When they get home, go through their haul. Throw out anything that looks like it was tampered with, anything home made (if you don’t know the maker), choking hazards, and whatever else you can get away with. Freeze some for holiday cookies later.

Last, take care to keep your pets safe during the holiday. Keep chocolate and anything sweetened with xylitol away from your dog. Watch for choking hazards and yummy electric wires, and lock your four legged ones away from the front door so they won’t escape when the hoodlums knock.

Happy Haunting!

Your Kid’s Brain on No Sleep

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Tired Teenager With TabletEvery animal sleeps. Birds sleep attached to their branches, bats sleep upside down, whales sleep half their brains at a time–all of us need to catch some Z’s. Science doesn’t have a complete understanding of why we sleep, but we do have some ideas and we know people run into problems if they do not get enough.

Humans sleep in cycles from light sleep into heavy and then into dreams. Adults cycle about four times per night; infants cycle about every hour (that’s why they can wake up every hour). Each stage has a function: if you don’t get enough time in each stage you will not feel rested, even if you spent enough hours horizontal.

During the first stage, or “N1”, you are in drowsy sleep. You are not completely out, but neither are you completely aware of your environment. If someone sat beside you to read a book you would not notice; if that person said your name you would.

During N2 you loose all conscious awareness; N3 brings you into deep sleep.

Rapid eye movement (REM) sleep is the fourth stage. During REM sleep you dream, and your voluntary muscles become atonic, or mostly paralyzed, so you don’t whack yourself in the head.

Then you cycle through the phases again. Most deep sleep is early in the night; most REM sleep is later toward morning. (That’s why kids mostly wet the bed early in the night.)

If you get enough sleep you feel energetic during the day, your brain works and your emotions are under control.

The opposite happens if you, or your children, are sleep deprived. If your children do not get enough sleep they are tired, they cannot concentrate and they can be irritable.

Lack of sleep affects their working memory: the memory they employ constantly to reason and function. Without an effective working memory they will find it harder to make decisions. It will be difficult to focus and learn.

Sleep is necessary to organize, consolidate and solidify what your children have learned during the day, so it can be there the next day when they need it. There is even some evidence that REM sleep is necessary for your child’s brain to develop properly in the first place.

Many of these symptoms duplicate those of ADD, depression, and Oppositional Disorder. Sleep deprivation also affects the function of your immune system, your ability to heal, your growth hormone levels and your ability to lose weight–important stuff.

So how do you know if your children are getting enough sleep? Look at them during the day. If they are sleeping adequately they will wake up easily, perhaps without an alarm. They will be awake during the day, not sleepy, not dosing off when they are still. They will be less irritable. They will be able to concentrate, focus and learn.

If they are not getting enough sleep, getting more is a priority. Make sure there is enough time allotted in their busy schedules, and try to make bedtime the time of day that they are actually sleepy. Every person has a circadian rhythm that includes a time in the evening when they get drowsy. That time should be bedtime. It should be approximately the same every day, to avoid permanent jet lag.

During the day make sure they eat healthy whole foods. No caffeine please, no tobacco exposure (yes I mean you!) and watch that sugar intake. Also, they need at least twenty minutes of aerobic exercise every day to wash those stress chemicals out of their bodies.

Quiet things down about two hours before bedtime: no TV, no vigorous exercise. Turn on some quiet music, play a board game, or read a book. Lower the light level. Give your youngster a warm bath and read a bedtime story. Don’t even think of having a TV in the bedroom! Make their bedroom comfortable, quiet and a little cool.

Enough sleep is essential if you want a child who is not moody and has a functioning brain and energized body. If you are thinking your munchkin has a behavioral problem like ADD, Oppositional Defiant Disorder or depression, consider first whether he or she is getting enough sleep. If not, change what you need to to ensure that they do. Get that TV out of the bedroom, give them a healthy diet and enough exercise, and don’t expose him to cigarettes. Quiet things down two hours before bed. And get some sleep.

Domesticated Momster