Improper use of antibiotics: Don’t take the risk!

Improper use of antibiotics is a problem on many levels. It’s easy to get the wrong prescription for an illness if it is improperly diagnosed or if the healthcare provider is trying to keep a patient happy. By taking an antibiotic that isn’t necessary, we increase the problem of Superbugs and even put our own health at risk.

Risks of improper use of antibiotics

Improper use of antibiotics increases risk unnecessarily. Use antibiotics wisely.
Improper use of antibiotics increases risk unnecessarily. Use antibiotics wisely.

Not only is an antibiotic NOT needed for viral illnesses, but taking them when not needed can increase problems.

Risks of antibiotics involve diarrhea, yeast infections, allergic reactions, and more.

Every time we take an antibiotic, we assume the risks associated with the antibiotic. If we have a significant bacterial infection, the risk is warranted. But if we have an infection that the antibiotic will not kill, it is an unnecessary risk.

Dr. Oglesby has a great series on antibiotics, covering general facts on antibiotics (such as how they work), how resistance spreads, and when antibiotics may be needed.

Superbugs

Most of us have heard of superbugs, but there is a misconception about how they work.

Using antibiotics inappropriately can allow bacteria to learn to evade the antibiotic, which makes it ineffective. This means that new antibiotics need to be used to treat infections, which increases the time of illness, the cost of treatment, and the risk of untreatable illnesses. Some bacteria develop resistance to all known treatments, which can lead to death.

“The Last time amoxicillin didn’t work and we had to use something else. Can we use that one again?”

A lot of parents think that if one antibiotic failed with a previous infection, they need a different one. This is not true.

The bacteria develop resistance to an antibiotic. Bacteria can share their genetic material with other bacteria, leading to the quick spread of resistance.

Even someone who has never used an antibiotic can be infected with a resistant bacteria, which makes it harder to treat their infection.

Unfortunately, without a bacterial culture it is impossible to know what the best antibiotic is for any specific infection. We use the type of infection and the bacterial resistance pattern of the area to make the best choice.

It’s not the person that becomes immune to an antibiotic

Very often parents request a different antibiotic because “amoxicillin never works for my family.”

A person does not become immune to a type of antibiotic.

Start with an antibiotic that has a narrow coverage usually

A first line antibiotic is an antibiotic that covers the type of infection that is present, but isn’t so broad that it includes more bacteria than needed. It can also be called narrow-spectrum.

One infection with a superbug might require a strong antibiotic, but the next bacterial infection in the same person might respond well to a first-line treatment, such as amoxicillin.

It’s always wise to start with the first line antibiotic for the type of infection unless a person’s allergic to that antibiotic. It doesn’t matter if it worked the last time or not.

Broad spectrum antibiotics are needed for some serious infections

Remember that broad-spectrum antibiotics that have great killing power can increase the risk of killing the good bacteria that your body needs.

If you have a serious infection, they might be needed. In this case the benefit outweighs the risk.

Each new infection is a new bacteria.

The type of infection will determine the most likely bacteria. A culture from the infection (if possible) will specify exactly what bacteria is the cause and which antibiotics will work.

First line antibiotics are chosen based on type of infection as well as local resistance patterns. Upper respiratory tract bacterial infections tend to use different antibiotics than urinary tract infections or skin infections because different bacteria cause different types of infections.

Allergic reaction

Most people can tolerate antibiotics, but allergic reactions can be serious. It’s not worth the risk if the antibiotic isn’t needed in the first place.

Many people think they’re allergic to an antibiotic when they’re not.

Talk to your doctor about any drug allergies you suspect your child has and why.

Diarrhea

Many kids will get loose stools when they take antibiotics.

Probiotics can help re-establish a healthy amount of good bacteria in the gut and slow the diarrhea most of the time.

Unfortunately there is a type of bacteria commonly called C. diff that can overpopulate after antibiotics and cause severe diarrhea. C. diff causes thousands of deaths every year in adults and children, most often following antibiotic use.

If diarrhea develops during or after antibiotic use, talk to your doctor’s office during regular office hours for advice. If there are signs of dehydration, severe pain, blood in stools, or other concerns you should have your child seen quickly.

Gut flora

Antibiotics kill not only the bacteria causing an infection, but also the “good” bacteria (gut flora) in our bodies.

Our bodies are a habitat for healthy bacteria and yeast. I know this seems unnatural or unhealthy to many people, but we need these bacteria and yeast in a healthy balance.

Gut flora is made of many types of healthy bacteria. These bacteria help us with many functions, such as digestion and weight regulation. Good bacteria make products that lower inflammation in the intestines. They also make neurotransmitters which affect our mood.

Different “good” bacteria can be affected depending on which antibiotic is used.

Yeast infections

As mentioned above, our bodies are an ecosystem of bacteria and yeast. When bacteria are killed off with an antibiotic, it throws off the balance and allows the yeast to overgrow.

Yeast keeps the digestive system healthy and helps our immune system. It can help our body absorb vitamins and minerals from food. Despite what you read online, yeast are very beneficial to us – as long as they remain in healthy balance.

There are a lot of people selling products to treat overgrowth of yeast, which is said to cause all kinds of problems. These types of overgrowth are not recognized as true overgrowth by most physicians, but there are true yeast infections.

Yeast can cause infections of your skin (ringworm), feet (athlete’s foot), mouth (thrush), and penis or vagina (yeast infection). At risk people can develop blood infections with yeast. These can be life threatening. Serious yeast infections tend to occur in diabetics, immunocompromised people and those who were treated with antibiotics.

If you suspect a yeast infection, talk to your physician.

Risk vs benefit

When antibiotics are needed to fight a bacterial infection, it is worth the risk of taking the antibiotic.

The balance flips if you have a common cold – don’t take the risk for something that isn’t needed or beneficial.

Antibiotics do not and will not help treat a cold. Ever.

Don’t try to use an antibiotic to prevent a cold from developing into something else.

Improper use of an antibiotic simply has too many risks and will not help, so there is no benefit.

Prevention is key!

If you’re not sick, you don’t even think about looking for an easy fix for a viral illness.

Use proper handwashing, vaccinate against vaccine preventable diseases, and stay home when sick!

 

Top 10 reasons a child or teen is tired

I see many kids each month who complain of being too tired. Parents often fear the worse, such as low iron or even cancer. There are many things to consider, but there are a few very common reasons that could explain why a child or teen is tired. I’m also including some less common things that make kids feel tired, but are common worries of parents. Always remember that common is common. Serious causes of being tired will not happen with fatigue as the only complaint.

Here are 10 reasons a child or teen is tired:

1. Not enough exercise

top 10 reasons a child is always tiredStrenuous aerobic exercise helps our bodies get healthy, quality sleep. Better quality sleep improves our performance, both physical and mental.

If you lay around, you tend to feel more relaxed, lazy and tired. Getting up and moving can help.

Many kids sit all day at school, then come home to sit more doing homework, watching tv, or playing video games.

Limit time on screens, especially before bedtime. We need to encourage kids to get up and move, ideally outside.

Make it fun!

  • Take a walk to a park, then play
  • Play catch
  • Go on a bike ride
  • Swim
  • Join a sports team
  • Play frisbee
  • Golf
  • Go bowling
  • Dance
  • Try yoga — there are many online videos to get you started

Several of these ideas you can do with your kids. Make it a family goal to be active together! It models the healthy habits you want your kids to live.

2. Celiac disease

Celiac disease is an autoimmune disease in which people can’t eat gluten (a protein found in wheat, barley and rye) because it will damage their small intestine. This can lead to malnutrition and anemia (low red blood cell counts). Symptoms vary, but often include abdominal pain, diarrhea, constipation, fatigue and bloating. In kids it can affect puberty and growth. Celiac disease can run in families.

There are a lot of people who say they feel healthier when they avoid gluten for non-celiac gluten sensitivity. These people have symptoms that are found in celiac disease, such as abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, but do not test positive for celiac disease. It is not clear what the etiology of this is, but removing gluten seems to improve symptoms.

It’s uncommon for kids to have fatigue as the only symptom of celiac disease, but if you are worried about their symptoms, schedule a visit with their physician to discuss it as a possibility.

A quick warning…

Do not remove gluten from their diet without talking to your doctor. Gluten in the diet is needed for testing, which is needed to confirm celiac disease.

Celiac disease is important to diagnose and treat due to chronic issues that can occur from long-term damage to the intestines. If a child doesn’t have a true diagnosis, it is more likely they will not remain compliant with the diet changes that are required.

3. Depression

We often think we would recognize a depressed child or teen. We picture them crying often or appearing sad, but this is not necessarily how they appear. Yes, they can cry and appear sad, but sometimes they don’t.

Depression doesn’t always look like you’d think.

Sometimes parents think their child is angry. Or parents are mad because a teen stops trying at school. The child might get into fights.

Common symptoms of depression:

  1. Sadness, crying and tears
  2. Losing interest in things they usually enjoy
  3. Appearing angry or irritable
  4. Boredom and apathy
  5. Isolation from friends and family
  6. Extreme sensitivity
  7. Headaches, stomach aches, and other ill type symptoms
  8. Low self-esteem or guilt
  9. Poor concentration
  10. Change in eating patterns – either more or less
  11. Low energy
  12. Falling grades
  13. Change in sleeping patterns – either more or less
  14. Self harm (cutting or other behaviors)
  15. Talks of suicidal thoughts or intent

If you think your child is depressed, please get professional help. Sadly, depression is a fairly common underlying reason for kids to be tired.

4. Thyroid problems

Thyroid problems are relatively common and can be present at birth or develop later in life.

Hypothyroidism occurs when the thyroid gland does not make enough thyroid hormone. About 5% of people over 12 years of age has hypothyroidism.

People with hypothyroidism might feel depressed, be tired, have poor focus, and become forgetful. They might gain weight or have slowed growth. They might feel colder than others or have constipation. Sometimes they’ll develop a swelling in their neck called a goiter.

Most of these are very common symptoms that are not specific to thyroid problems. Having some of them does not necessarily mean that there is a problem with the thyroid. If there are several of these symptoms, it’s relatively easy to screen for thyroid problems with a blood test.

Schedule an appointment to talk to your pediatrician if you’re concerned about a thyroid problem.

5. Too much sugar

Although the body needs sugar for energy, eating too much refined sugar can cause weight gain, chronic disease and sugar crashes. Excess weight can make it harder to exercise and sleep, both of which help us not feel tired.

Encourage kids to eat a healthy balance of fruits, vegetables, proteins, and complex carbohydrates.

Limit the juices, candies, and other high-sugar / low nutrition foods. I know this is easier said than done when kids beg and cry for candy. It’s even harder to limit when kids grab their own snacks.

Keep easy to eat healthy snacks available as much as possible. Don’t buy the junk. Kids will get plenty of it outside the home. If it’s not at home, they won’t grab it.

6. Caffeine

Most adults have grabbed a caffeinated beverage to help ward off fatigue, but caffeine can lead to poor sleep and more tiredness. It can become part of an unhealthy cycle.

Kids don’t need caffeine. If they do have it, it should be before noon. Caffeine can stay in your body for about 8 hours and keep you from sleeping.

Children under 10 years of age should not have caffeine due to jitteriness, irritability, and other side effects. It’s recommend that kids who are 10 – 12 should get no more than 85 mg per day. Teens should have 100 mg or less. Up to 400 mg of caffeine a day appears to be safe for most healthy adults.

Mixing caffeine with certain medicines or alcohol can increase its problems.

7. Anemia

Anemia is a low red blood cell count.

Our red blood cells bring oxygen to the cells of our body, and when the levels are low we can feel tired. Other symptoms are irritability and pale skin coloring. Often there are no symptoms with mild anemia.

There are many causes of anemia. Blood work can help to identify anemia and its causes. Treatment depends on the cause.

If you’re worried about anemia, schedule an appointment with your pediatrician. A history and exam will be needed to determine if labs are indicated.

8. Insomnia

It makes sense that if you don’t sleep enough, you’ll be tired. When people have insomnia, they do not sleep enough hours.

There are many causes of insomnia, but all can lead to insufficient sleep. Addressing the underlying cause is important.

  1. Anxiety and depression (see above)
  2. Screens (see below)
  3. Circadian rhythm changes
  4. Allergies or other causes of nasal congestion
  5. Pain
  6. Gastroesophageal reflux
  7. Restless leg syndrome
  8. Some medications and caffeine
  9. Exercise too late in the evening
  10. Nicotine (growing in popularity among kids due to vaping)

If your child is struggling to sleep, schedule an appointment to discuss potential reasons and treatments.

9. Sleep apnea

Sleep apnea happens when a person stops breathing during sleep. It’s usually caused by something blocking the upper airway. You might hear snoring followed by pauses in the breathing pattern, gasps, or choking sounds.

Because the airway is obstructed, oxygenation levels can fall briefly. This triggers the brain to wake up to open the airway. When this happens repeatedly throughout the night, sleep quality is affected. A person wakes feeling tired.

Enlarged tonsils or adenoids and obesity are common causes of sleep apnea. If you think your child has sleep apnea, talk to your child’s pediatrician.

10. Screen time

The light emitted from televisions, computers, tablets, and smart phones trick our brains into staying awake.

When kids are on a screen up until bedtime, their brain is not yet ready to go to sleep. This leads them to stay up too late, which makes them too tired the following day.

Dr. Craig Canapari discusses the problems with screens and sleep in Prevent Sleep Problems in Kids: Keep Technology Out of The Bedroom.

Not enough sleep is the common thread to many of these.

Not enough sleep is the #1 reason I find for kids being tired. They need more sleep.

Studies show that many of us just don’t sleep enough. It’s important for kids to get adequate amounts of sleep. If your child is tired and is not able to sleep sufficiently, talk to your pediatrician about ways to improve sleep and decrease fatigue.

 

Don’t look for quick fixes for your cold! There’s no quick fix

We all have been sick and wish for a magic cure. Sometimes it seems we find the right fix, but it was just coincidental. I see many people who want antibiotics to fix a viral illness because “it always works” but I want to try to show why this isn’t usually the case. Using antibiotics for most colds and coughs isn’t necessary and can lead to problems.

My urgent care experience

This blog is generally about pediatric health, but sometimes the principles are similar in adult medicine, so I’m sharing a personal story.

I was visiting my parents out of town and came down with fever, chills, and a sore throat. Due to the fatigue and shaking chills, I wasn’t sure if I’d be able to drive the 4 hour trip home the following day. I decided to go to a walk in clinic to see if there was a treatment to help get me on my feet again.

Although it’s less common for adults to get Strep throat, I wanted to have my throat swabbed because I had been exposed to just about everything at work.

If it was just a viral illness, fine. I’d tough through it with fluids and a fever reducer for the body-shaking uncomfortable chills.

But a child had gagged and coughed in my face earlier that week when I was doing a throat swab – and he had Strep. If I had Strep (as I hoped), then an antibiotic would treat the cause and I’d be back in shape in no time.

I could technically call out an antibiotic for myself, but I didn’t want to do that. That is poor care and I would never recommend treating anyone with a prescription without a proper evaluation.

I followed my own advice and went to a walk in clinic since I was out of town. If I was at home, I would have gone to my primary care physician because I believe in the medical home.

The provider walked into the exam room looking at the nurse’s notes saying it sounded like I had a sinus infection. (I use the term provider because I don’t recall if he was a physician, NP, or PA.)

What?

He hadn’t even examined me or gotten any history from me other than answers to the cursory questions the nurse asked. Not to mention that my symptoms had just started within the past 24 hours and didn’t include any form of nasal congestion or drainage.

I’m a physician and know that sinusitis must have persistent symptoms for much longer than 24 hours. But I kept that thought to myself for the moment.

He did a quick exam and started writing a script to treat my sudden onset of fever without cough/congestion.

He literally started writing the script as he was telling me, once again, that I had a sinus infection.

Now I couldn’t stay quiet any longer.

antibiotics are not a quick fix for virusesI said I really just wanted a throat swab to see if it was Strep. I didn’t want an antibiotic if it wasn’t Strep throat.

He argued for a bit about the validity of rapid Strep testing.

I argued that I did not meet the criteria for a sinus infection and that the rapid strep tests are indeed fairly reliable (not perfect).

As a pediatrician I won that argument easily. In the end I was swabbed.

The test was negative. I most likely didn’t have Strep throat after all.

He still gave me a prescription for a commonly used antibiotic called a Z-pack, which I threw away.

avoid unnecessary antibiotics
Antibiotics are not a quick fix for viruses and carry risks.

Did I get better?

I felt better the next day, so if I had just taken the z-pack, I would have thought it worked.

Ironically, the Z-pack is not a very good antibiotic against Strep, the one reason I would have taken an antibiotic. Resistance rates are high in my area, so unless a person has other antibiotic allergies (which I do not) I would not choose it for Strep throat.

But my body fought off an unnamed virus all by itself. That’s what our immune system does. Pretty cool, right?

No. Not cool.

Well, yes… it is cool that we can get better with the help of our immune system and no antibiotics. But not cool that a less knowledgeable person would have taken the prescription without question.

Unfortunately, I think many people trust the medical care provider, even when he or she is wrong.  Even smart people don’t know how to diagnose and treat illnesses unless they’re experienced in healthcare, so anyone could be fooled. Especially since we’re vulnerable when we’re sick. Even more so when our kids are sick. We want to do anything to help them.

False security in an unnecessary treatment.

Many parents come into my clinic wanting an antibiotic for their child because the child has the same symptoms as they have and they’ve been diagnosed with a sinus infection, bronchitis, or whatever. They’re on an antibiotic and are getting better, so they presume their child needs the same.

Most of the time they both likely have a viral illness, and the natural progression is to get better without antibiotics, but it’s hard to get buy in to that when a parent’s worried about a child. Even harder when the parent is certain that their antibiotic is fixing their viral illness.

Confirmation bias.

Confirmation bias is the tendency to process information by looking for, or interpreting, information that is consistent with one’s existing beliefs.

A false belief is reinforced when we think we get better due to an antibiotic. It doesn’t prove that the antibiotic worked, but our minds perceive it as such.

We want to believe something works, and when it appears to work, it affirms our false belief.

The wrong treatment plan.

In my example, not only did I not have a sinus infection, but if I did have a false negative Strep test and actually needed an antibiotic for Strep, the Z-pack wasn’t a good choice.

False negative tests mean that there is a disease, but the test failed to show it. False negative tests are the reason I usually do a back up throat culture if I really think it is Strep throat and not a virus.

If the wrong treatment is given, not only do you fail to treat the real cause, but you also take the risks associated with the treatment for no reason.

Doesn’t the doctor (or NP or PA) know the antibiotic won’t work?

Yes, they know (or should know) how antibiotics work and when they’re indicated. But unfortunately, there are other factors at work when quick fixes are chosen.

Top 3 reasons that lead to patients getting unnecessary prescriptions:

1. Time

One problem is that it’s much easier to give a prescription rather than taking time trying to teach why a prescription isn’t needed.

The faster they see a patient, the more patients they can see and the shorter the waiting time is, which makes people happy.

I see many unhappy parents who follow up with me because their child is still sick and the “last doctor” did nothing. I have previously blogged about the Evolution of Illness so will not go into it in depth here.

2. Experience

Sometimes it’s hard for physicians, NPs, and PAs to not try something to make a sick person better. After all, that’s why we do what we do, right? We want to help. We’ve all heard of patients who get progressively ill because an infection wasn’t treated quickly and we don’t want to “miss” something.

While missing a significant illness can happen, it’s not common. Common is common. Most upper respiratory tract infections are viral. It’s knowing how to recognize worrisome symptoms that comes from experience.

Physicians (MD, DO)

Physicians spend years of not only classroom training, but also clinical training to learn to recognize warning signs of illness. Even a brand new physician has at least 2 clinical years during the total 4 years of medical school. Then they spend at least 3 years of residency seeing patients in a supervised capacity before they can work independently. That’s at least 5 years of 60-80 hour work weeks.

The physicians in my office, including myself – now 18 years in practice – still ask for help if we feel it could be beneficial. Sometimes a second set of eyes or putting our heads together helps to put things into a clearer picture.

Trust that if we say it’s a virus, it’s a virus. We know that bodies can still be significantly sick if it’s Just A Virus, but most of the time you can manage symptoms at home. Listen to what we say are warning signs that indicate your child should be reassessed. Bring your child back if symptoms worsen or continue longer than typical. Symptoms can worsen, but taking an antibiotic does not prevent that progression in most cases.

Be sure to question if you do not understand or agree with an assessment or treatment plan, as I did in my example above. It is essential to have this type of communication for the best care.

Nurse Practitioners (NPs) and Physician Assistants (PAs)

I love the NPs in my office. They do a fantastic job and make patient access easier. They see a lot of sick kids and do a great job treating when needed and giving “just” advice when that is what is needed. (That’s usually harder, trust me.)

They are always able ask questions if they don’t know what to do or for a physician to see a patient if a parent wants a second opinion.

I do not want this to become an argument if NPs and PAs are good. They are needed in our healthcare system to help patients get seen in a timely fashion. I welcome and appreciate them as part of the healthcare team.

But I do want to acknowledge that the training and background can vary widely, and I think it’s important to know the experience of your provider. It is not as regulated to become an NP or PA as it is to become a physician.

Many NPs have years of work experience before returning to school to get their advanced degree. But newer online programs do not require much clinical experience. At all.

If they then begin working independently without much supervision, they learn as they go and may or may not learn well. I’m not saying they’re not smart, but I also know how lost I felt those first months as a new physician after many supervised hours, and I know they have a small fraction of those supervised hours. I can’t imagine doing that as a new grad!

This is why I think that all new practitioners should work with others who have more experience, so they can learn from the experience of others. I worry when inexperienced people work alone in clinics, with no one to bounce questions off of.

Learn more about the training of healthcare providers in What kind of doctor is your doctor?

Patient experience and the 6th sense as a parent

Experience as a parent (and patient) matters too.

We can’t see what your child experienced last night if we’re seeing them in the morning and symptoms changed. Many symptoms are worse overnight, which makes it difficult to assess during the day. Of course if symptoms are urgent at night, go to a 24 hour facility that can adequately evaluate the situation.

If you are able to wait until regular business hours, you must describe it so we can understand it.

If you feel uncomfortable with the treatment plan, talk to the provider. List your concerns and let them address them. That’s not the same thing as demanding a prescription or further testing. It means asking for more information about why they feel the current plan is the correct one.

3. Surveys

Many hospitals, clinics and insurance companies are surveying patients to see if “good care” was provided. These surveys are used to place providers on insurance contracts and decide payment and salaries.

People are happier and think care is better if something was done. A lab, x-ray, or prescription (whether needed or not) is “something” people can identify.

People do not feel that information about viral illnesses and what treatments can be done at home is as worthwhile as a tangible treatment, even if it’s the correct treatment. They see the prescription as making the cost and time taken for the office visit “worth it” even if it is bad care. Leaving empty handed (but with proper treatment) doesn’t satisfy.

And the surveys reflect that.

Sadly, the pressure felt by physicians and other medical providers to perform well on surveys has been shown to have many negative side effects. Healthcare costs rise from unnecessary tests and treatments. Side effects of unnecessary treatments occur. Hospitalization rates and death are even higher with high patient satisfaction scores.

Don’t look for a quick fix. Look for the right fix.

Antibiotics certainly have their place. They are very beneficial when used properly. For a fun read about being responsible with antibiotics, visit RESPECT ANTIBIOTICS: USE THEM JUDICIOUSLY TO ENSURE WE CAN STILL WAGE THE WAR AGAINST BACTERIA from Dr. Michelle Ramírez.

If we use antibiotics inappropriately, they cause more problems.



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Dark Under Eye Circles

I see a lot of kids with circles under their eyes. There’s a lot of confusion as to what causes them. Dark circles under the eyes may simply be hereditary – a trait that runs in families, but they also can signify chronic disease.

I’ll cover some causes that are feared but not likely and common causes that can be treated to help decrease the dark appearance of the circles.

Not likely causes

Anemia

allergic shiners, circles under eyesMany parents worry that anemia, or a low red blood cell count, is causing their child’s under eye circles. I’m not sure why this thought is so prevalent, but it’s not the first thing I think about when I see dark circles under the eyes of a child.

Iron deficiency is linked to anemia because iron is a building block of a red blood cell. Iron deficiency is relatively common in kids due to poor diet, so if your kids don’t eat foods rich in iron, you should talk to their doctor.

Anemia can happen in kids, but if under eye circles is the only symptom, it’s not likely. If there are other symptoms then blood work might be indicated.

Symptoms of anemia may include:

  • Pale skin, including the inner eyelids
  • Irritability
  • Feeling tired or having low energy
  • Poor focus and attention
  • Weakness
  • Craving of ice or eating non-food items (pica)
  • Rarely (with more severe anemia)
    • Yellow jaundice (yellow eyes and skin)
    • Rapid heart rate
    • Fast breathing
    • Swelling of hands, feet, or puffy eyelids

Poor sleep

Yes, we often think of circles under the eyes from poor sleep. Poor sleep is not usually the cause of under eye circles in a child, especially when they otherwise appear well rested.

Kids who have chronically poor sleep can appear tired and sluggish, but they also have other symptoms, such as irritability, hyperactivity, poor school performance, and increased injuries.

If you’re worried about your child’s sleep, talk to your pediatrician.

Vitamin deficiency

There are many products containing various vitamins that are sold to help decrease under eye circles, but evidence is lacking that vitamin deficiencies are common causes of under eye circles in children.

Unless there are other significant problems, it is not recommended to check vitamin levels to evaluate under eye circles.

If your child is a picky eater and has a limited intake of nutrients, talk to your pediatrician.

What does cause dark under eye circles?

The skin under the eyes is very thin, so when blood passes through the thin skin it can produce a dark color, much like the blue color of your veins. If the blood circulation slows, the blue color can be more noticeable.

Congestion in your sinuses can lead to congestion in the small veins under your eyes. The blood collects in the skin under your eyes and these swollen veins dilate and darken. This creates the effect of dark circles and puffiness.

Dark circles are of course more noticeable in fair skinned people.

The most common cause of under eye circles is chronic congestion, but chronic congestion can be from various causes.

Allergic shiners

Allergies are probably the most common cause of dark circles under the eyes, so the circles are also called “allergic shiners.” They get this name due to the purplish hue of the skin, resembling a black eye, AKA “shiner.”

If allergies are the cause, you will usually see other symptoms of allergy, such as

  • Runny nose
  • Itchy, watery eyes
  • Sneezing
  • Itchy throat
  • Itchy roof of mouth
  • Sinus pressure or fullness

Treating the allergies can often make the allergic shiners disappear.

Upper respiratory tract infections

Viruses that cause nasal congestion can also lead to dark circles under the eyes. These can be brief if the cold clears quickly, or seem to come and go with recurrent infections, as often happens during the cold and flu season.

Sinus infections can cause chronic congestion, leading to dark under eye circles.

Though there’s no quick fix to most upper respiratory tract infections because they’re caused by viruses, you can use saline nasal rinses to help clear some of the congestion.

Smoke exposure

Smokers and their children often have chronic congestion.

Studies show that second hand smoke leads to more frequent upper respiratory tract infections and ear infections in kids. It’s not surprising that these kids also develop chronic circles under their eyes.

Mouth breathing

Mouth breathing can itself be from many causes.

Commonly nasal congestion from allergies and upper respiratory tract infections leads to mouth breathing.

Large adenoids can also contribute to mouth breathing and under eye circles, as explained by Ear, Nose, and Throat specialist, Dr. Deborah Burton in GET THE TRUTH ABOUT THE CONSEQUENCES OF MOUTH BREATHING.

Dehydration

Dehydration can make dark circles look more prominent due to sluggish blood flow.

The eyes also appear to sink into the sockets when we’re dehydrated, which can accentuate the dark circle appearance.

Treating and preventing under eye circles

The best ways to prevent dark circles include many things that help us stay healthy anyway.

  • Control allergies
  • Teach kids to wash their hands and keep hands away from their face to help prevent infections
  • Drink plenty of water
  • Use sunscreen (sun damages skin over time)
  • Give a healthy balance of foods and talk to your pediatrician if your child isn’t eating a good variety of nutrients
  • Ensure plenty of sleep for age
  • Use nasal saline rinses (see below)
  • If chronically congested or mouth breathing, talk to your child’s doctor to find and address a cause
  • Avoid smoke and secondhand smoke, which lead to chronic congestion
  • Use moisturizers if skin is dry
  • Avoid pollution as much as possible, since it can contribute to chronic congestion

Saline rinses

I often refer to Nasopure’s website because it has great instructions on how to rinse the nose for kids as young as 2 years of age. It also has videos to help kids get comfortable with the idea. I refer to the site simply because I like it, and I receive no compensation for the recommendation.

I do participate in the Amazon Affiliate program, and if you use one of these links to purchase a nasal wash kit, I do make a small profit. As always, I only link to products that I endorse regardless of where you purchase it.


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Pacifiers in babies and children: Encourage or discourage?

There’s a lot of debate about pacifiers and since it’s Children’s Dental Health Month I thought I’d tackle the issue. Many parents are apprehensive to start one with a baby, yet many babies need to suck. Sucking is a natural reflex. Sucking on thumbs, fingers, pacifiers or other objects may make babies feel secure and happy and help them learn about their world. They can even be sucking on a hand or arm when still in the womb. Many babies find their thumb or a finger to suck on and self-soothe if not offered a pacifier.

Baby friendly?

pacifiers, thumb suckingI personally was unhappy to hear of the “baby friendly” initiative at our local hospitals that discourages any pacifier use during hospitalization.  I think it makes parents fear the pacifier even more than they had before and they have benefits as well as cautions.

I’ve seen more mothers get frustrated with breastfeeding when they can’t use a pacifier. I have rarely seen a problem with breastfeeding when babies are allowed to use a pacifier.

Studies do not support the thought that pacifiers affect breastfeeding rates.

This Cochrane Review also failed to show problems.

Things to love about pacifiers:

Babies have a natural desire to suck.

Even in the womb we can see babies sucking. A pacifier allows them to fill this need, which allows parents to have a much needed break.

Pacifiers can help with pain relief.

There’s a natural pain relieving property to sucking. Think about how addicted older kids are to sucking on a thumb or pacifier. It is soothing. Adding sugar to the pacifier for painful procedures helps pain even more.

Don’t give your baby sugar at home. It’s not good for them and can lead to cavities once they have teeth.

Pacifiers help prevent Sudden Infant Death Syndrome (SIDS).

We don’t know why they help, but studies show that pacifier use decreases the risk, along with sleeping alone on a firm, flat surface, on the back, without soft bedding.

Parents can control use.

Pacifiers can be weaned gradually and kids tend to outgrow them earlier than thumb-sucking.

Infants over about 4 months of age can develop other self-soothing abilities, so you can use them just for sleep in older infants and toddlers.

Keep them in the crib to decrease the risk of germ spreading from displaced/replaced pacifiers.

 

I like pacifiers better than thumbs

If a baby wants to suck, he will find his hand if something else isn’t offered. Babies eventually find thumbs or fingers if they want to suck on something.

Thumbs are always with a baby and child, so they can suck on them whenever they want, not just in the crib when a parent gives it.

Thumbs can get red, dry, and cracked with sucking behaviors – especially in dry weather. This can be painful to the child. The drive to suck is so strong they continue to do it despite pain. It can also lead to infections of the thumb.

Most kids will stop a pacifier habit by 3 years of age. If a pacifier is limited to sleep time only, kids are already not in the habit of sucking on something all day long. They only have to learn to fall asleep without sucking.

Thumbsuckers continue their habit more often and much longer. Often it’s not until they’re teased at school that they decide they want to quit. Until they make the decision to quit it’s hard to make it happen.

Thumbs are never clean. At least you can wash the pacifier and keep it in the crib. Kids play with their hands and you can’t keep the thumb out easily after they’ve touched everything.

a few cautions to pacifier use:

 

Don’t use them instead of feedings

Don’t use a pacifier to try to limit the number of breast feedings in a day, especially early on. Newborns need to eat quite a bit. Trying to “hold them off” with a pacifier will only limit your milk supply and could cause them to not gain sufficient weight.

Work with your pediatrician or a lactation consultant to be sure your baby is feeding enough if you’re feeling a need to breastfeed less.

Latch problems

I find that most babies can go back and forth from breast to pacifiers easily.

Most isn’t all.

If your baby seems to have trouble latching on the breast after using an artificial nipple (either a pacifier or a bottle) then stop the artificial nipples and focus on breastfeeding. (If you need to supplement, you can use a syringe, a supplementing system, a spoon, or other methods.) Continue avoiding artificial nipples until breastfeeding is going well.

Work with a lactation consultant if you have continued problems.

Pacifiers can spread infections.

Ear infections and other illnesses can spread easily from pacifier use.

Wash them regularly.

Keep them in the crib for babies over 6 months of age to avoid exposing it to germs from other kids.

Choking risks.

Pacifiers can crack and come apart as they age. Be sure to check it regularly to make sure it’s not damaged. You don’t want it to become a choking risk.

What about teeth?

After permanent teeth come in, sucking can cause problems with the proper alignment of the teeth. It can also cause changes in the shape of the mouth.

Both finger or thumb-sucking and pacifiers can affect the teeth in the same ways, but pacifier use is often an easier habit to break.

General recommendations about stopping the sucking habit

Be careful how you approach stopping a thumb-sucking habit or pacifier use. If you are too harsh or negative it will probably make the habit worse.

Use positive rewards.

Have your child come up with goal ideas and things to earn. Rewards don’t have to be expensive. It can be a trip to a special park or the ability to pick dinner or what book to read. You can also get stickers, trinket toys, an

Sticker charts are a great way to keep track of times that there was no sucking!

For thumb-sucking

Think about making it more difficult for your child to suck his thumb. Keep the hands busy with crafts, toys, etc.

For the older child, talk about germs and how important it is to keep the thumb out of the mouth unless she just washed her hands.

Consider sewing socks or mittens onto long sleeve pajama tops. This will keep the thumb out of reach. (Unless your Houdini takes the PJs off.)

Using a “bad” tasting polish or tabasco doesn’t really keep kids from not sucking their thumbs unless it’s only a reminder to stop. If they really want to suck, they don’t care about the taste. But if they do want to stop and need reminders throughout the day to keep it out of their mouth, the bad tasting nail polishes can help.

For pacifiers
Plan a countdown to not using the pacifier any longer.

Make getting rid of the pacifier a big deal, like any other special event. Find a fun name for the day, like “Big Kid Day” or “Give to baby day”.

Put the chosen date on the calendar and do a count down every day by crossing off dates. Or make a paper chain and tear off one chain daily until the big day.

Find a replacement for the pacifier, such as a new stuffed animal or blanket. The stuffed animal can even be from Build-A-Bear. Put the pacifier inside so the child knows it’s there when he hugs his bear. Whatever you choose, be sure it can be snuggled or used to replace the pacifier for comfort.

Fill a box with all the pacifiers on the big day and leave it out for the “binky fairy” to take to new babies. The fairy can leave the new comfort item. Or you can just have your child put all the binkies in the box and seal it shut with tape when he’s ready to earn the new comfort item.

The big thing is you need to get rid of all the pacifiers. If your child finds one hiding somewhere, he will sneak it and return to the habit quickly.

Books that might be helpful

Note: These are Amazon Affiliate links and I do get paid a small amount for the referral.

In this book for toddlers,Little Brown Bear finds some tricks to help him stop sucking his thumb. It can help put the idea into your child’s head.

This is not specific to thumb-sucking, but the Berenstain Bears always teach kids in a fun way. Sister bear has trouble biting her nails in this story.

Thumb Love is appropriate for the older child who wants to stop sucking his or her thumb. If your school aged child has been the object of teasing due to thumb-sucking, he or she will relate.



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Teen Dating Violence Prevention & Treatment

As discussed earlier, teen dating violence is a relatively common problem that can occur in any socioeconomic circle. It’s important to recognize teen dating violence, but it’s even better to learn teen dating violence prevention and what to do if you recognize trouble!

Family relationships

How we raise our children from infancy and continuing throughout their lives helps set the expectations for relationships.

Abusive home increases the risk

Teen Dating Violence Prevention & Treatment.Children who are raised in homes with abusive behaviors are much more likely to grow up to be in an abusive relationship.

If your home is not safe make every attempt to make it so.

Stop the cycle!

SEcurity

We need children to feel loved and secure.

Children who feel unloved might look for love in all the wrong places, trying to please others and end up being taken advantage of.

Love unconditionally!

Parenting

Kids need defined limits, but an ability to learn and grow into independence with experience. Being firm and setting boundaries is an important part of being a loving parent.

Parents are NOT their child’s friend.

You don’t need to be a friend to be an effective, loving, parent who is well loved and respected.

As your child grows and matures, it is important that you allow them to take more responsibility for their plans and actions.

Be a role model

Kids need help learning to stand up for themselves and to deal with anger and disappointment in a healthy way. Set an example for this. Life typically presents many opportunities to model these behaviors.

Show healthy communication in your relationships. Use positive phrases, respectful words, and compliment one another.

Don’t let one partner dominate. Take equal share of responsibilities and decisions.

Do things with your significant other and with other people. Expect that your partner will also spend time with others. Don’t be overly jealous. Relationships need trust. Always spending time together isn’t healthy and doesn’t allow you to each follow your own interests.

Respect others in your life and be sure they also respect you.

If you have not learned to control your temper, learn.

Ensure enough sleep for everyone at home, as we are all more short-tempered when tired.

There are many self-help books on this topic and counseling is available if you struggle in your own relationships.

Peer relationships

Friendships and dating relationships provide an opportunity for teens to learn and practice healthy communication, social skills, and managing strong feelings.

Teens need to develop independence while the trusted adults around them provide support and help them stay safe.

Talk to your kids about healthy choices and as they mature, allow them to make more decisions about what they do, when they do things, and who they are around. If you feel they aren’t making safe choices, let them know why.

Don’t be judgemental in how you approach things. There’s no faster way to turn a teen off to a conversation than putting him or her down or by making them feel like they’re being lectured.

Respect

Respect self

Kids should be taught to respect themselves in all they do: eat nutritionally, exercise, get enough sleep, wear helmets, buckle up, stay away from drugs, etc.

Respect others

Kids should be taught to respect others: say nice things, don’t ask others to do things that might cause them harm, respect their personal space and things, etc.

Demand respect

Teens should enforce that others treat them with respect.

If a friend does not treat them with respect, they can try first to talk with the friend about it if they feel safe doing so. If the friend does not change behaviors, they should take a break from the friendship.

Talking to teens

Start before they’re dating

It’s best to start talking about healthy relationships before your child starts dating.

Set expectations for how old they will be when they are allowed to go out in groups of boys and girls as well as when they will be allowed to go on an actual date. How well do you need to know the person they will date?

Talk about what they should do if they find themselves in a scary situation.

Discuss rules for friends coming to the house if you’re not home. Or if they’re allowed to go to a private area or if they must stay in the family room.

Talk about what to look for in a romantic partner, qualities that are important and not just superficial.

Ask how they would like to be treated and how they will treat their date.

Talk about sex. Kids who have sex at young ages are more likely to have multiple partners. Having multiple partners increases the risk of infections and dating violence.

Drugs and alcohol increase risk

Remind kids that alcohol and drugs impair our abilities to handle our emotions and actions. They do not excuse our actions, but we tend to not make good choices when we’re under the influence.

We also put ourselves at risk of a forced sexual encounter when we’re under the influence of drugs or alcohol.

Date rape can also occur if someone slips a substance into a drink, so they should always carry their drink or get a new one from a trusted source.

Starting the conversation

Use opportunities that present themselves to trigger conversations.

If you see people arguing in a television show, talk about what was and was not effective in how they handled the situation. Ask what your kids would have done differently.

If the news reports another #MeToo story, ask what your teen’s thoughts are on the subject. Talk about recognizing unhealthy relationships and how to get out of abusive situations.

Answering questions

If your child asks questions, don’t shy away. Don’t assume they’re too young to hear the answer because if they’re asking, there’s a reason.

You can certainly ask where they’re coming from to help guide your answer, but answer honestly.

If you don’t know what to say, offer to talk about it at a specified time in the near future, such as after dinner that night. That gives you time to think and plan what to say but let’s your child know you want to talk. Don’t forget!

Emotional support

Be there to just listen if your child needs an ear. Offer encouragement and advice. Do this routinely, not just if you’re concerned about a specific issue.

If you always offer an ear without harsh judgement or unsolicited advice, your kids are more likely to keep talking. (Note: Just because they want to talk doesn’t mean they’re ready to accept advice. Ask if you can offer advice and wait until they say yes.)

Remind teens that they are never to blame if someone forces them to do something sexually they don’t want to do. They need to feel open to share this pain with you or another trusted adult so they can get the help and support they need.

preventing teen violence
Preventing Teen Dating Violence. Source: VetoViolence

What if there is an unsafe relationship?

It can be frustrating if your child’s in an unhealthy relationship but isn’t ready or willing to leave.

It can be difficult to enforce ending a relationship. Be careful in how you approach the situation. Consider working with professionals at the school or in the community.

Advice to get out of a relationship will be better received if your teen understands how their relationship is not healthy. Help them understand the difference between healthy and unhealthy relationships.

They need to know it isn’t their fault and it isn’t under their control how another person acts. Ideally, your teen will be able to make the decision to leave the relationship.

I’ve actually seen a teen get pregnant on purpose because her parents refused to let her see her boyfriend. She decided that they’d have to allow him to see his baby (and by default, her). Of course it didn’t work as planned. She did get pregnant, but it didn’t help her relationship.

If you think they’re in immediate danger, you need to seek professional help.

There are many ways to get help

Abusers often monitor computer and phone use, so use caution.

SafeHome (KC Area)

From a safe computer, click here if you’re in the KC area.  From a safe phone call 913-262-2868. (Phones answered 24/7 confidentially at SafeHome).

Safety Plan (Love is respect)

Love Is Respect has a great safety plan for teens who are planning on leaving an abusive relationship.

DATING MATTERS®

Dating Matters is a free, online course available to educators, school personnel, youth mentors, and others dedicated to improving teen health. Learn what teen dating violence is and how to prevent it through graphic novel scenarios, interactive exercises, and information gathered from leading experts.

National Teen Dating Abuse Helpline

These resources are designed specifically for teens and young adults. It is managed by the National Domestic Violence Hotline (NDVH) and offers  support from trained Peer Advocates.

Call: 1-866-331-9474 Calls are answered 24 hours a day, 365 days a year.

Text: “loveis” to 22522

TTY: 1-866-331-8453

Web: www.loveisrespect.org

 

Teen dating infographic

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Teen Dating Violence: Recognition

Would you recognize signs of dating violence? Many teens don’t report it to friends or family. It can be difficult to recognize despite the significant prevalence. Victims might not say anything out of fear for their safety, embarrassment, low self-esteem, or not recognizing the abusive behaviors. Whatever the reason for the under-reporting, parents and other adults who interact with teens must recognize signs of dating violence to help protect our kids.

Relationships

Teen Dating Violence: RecognitionWe want our kids to develop healthy relationships where they can have fun, grow in their own identity, and be true to their own values. Healthy relationships are founded on honesty, trust, and communication. There is mutual respect.

Dating abuse can happen in any unhealthy relationship. It happens to smart people, rich people, girls, guys, LGBT, and can happen in any community. We see news stories of abusive relationships but it doesn’t always seem real. A new bride murdered.  A teen raped.  A sports figure accused.

Failed recognition

Unfortunately we don’t even know about most abusive relationships. People suffer silently.  How is a parent to know?

Can a teen see risk factors before becoming involved with a risky personality?

Abuser characteristics

Parents might look for the “type” of teen that they want their child to steer away from, but unfortunately, the abusers are not easily identified.

Abusers do not look like drug dealing, tattoo covered, pierced people in tattered clothing.

They are difficult to recognize on first glance because they tend to be popular, smart, good looking, and personable.

They are often good at reading people and responding to other’s desires, making them seem “perfect” initially.

Abusers manipulate others. Have you heard of gaslighting? It’s a common means to make the victim feel responsible.

They gain trust.

They weave deception.

Traits to watch for in an abuser:

  • Blames others for all problems
  • Jealous
  • Impulsive
  • Wants to move quickly into a relationship
  • Criticizes others
  • Does not respect personal boundaries
  • Denies responsibility for actions
  • Takes risks
  • Insulting (you’re fat, you’re stupid, no one else would love you like I do)
  • History of hitting or hurting others
  • Tries to monopolize your time and life – wants to control what you do, who you’re with, even what you’ll wear
  • Seems perfect initially (no one’s perfect!)
  • Mood swings or can’t manage anger or frustration well

What an abusive relationship might look like

Starting out – all seems great!

The relationship typically starts out well. A lot of laughs, good times.

If it didn’t, people would leave.

Power and Control cycle

Abusers have a power and control cycle that builds over time. They gain a little trust, then test with a little control.

Bit by bit they become more controlling and abusive. It builds so slowly many people miss the early warning signs and then are so swept by the cycle that it’s hard to leave.

Abusers want to know your every move, which at first might even seem flattering, but it is a control tactic. They might choose what you wear or where you go. Abusers monitor your phone calls to see who you talk to. They isolate you from your friends and even family so you lose your support group. They put you down so you feel no one else would like you or want you.  Abusers make you feel less of a person and they are “good” to put up with you.

They get jealous (again, flattering on the outset because they “care”). Abusers often apologize for hurting you, but then claim it is your fault that they behave that way.

In truth, they blame others for most of their behaviors and only take credit when things make them look good.

Cool tool

Breakthecycle.org has a really cool interactive wheel to see the relationship between words and actions. Move your cursor around the wheel to get more information on each topic in the orange part of the wheel.

Signs of an unhealthy relationship:

  • One or both people try to change the other
  • Control: one person makes most or all of the decisions
  • Isolation: one or both people drop friends and interests outside of the relationship
  • Fighting: one or both people yell, threaten, hit, or throw things during arguments
  • Verbal abuse: one or both people make fun of the other’s opinions or interests
  • Jealousy and control: one or both people keep track of the other all the time by calling, texting, or checking in with friends
  • Relationship moves quickly to “serious”
  • Mood swings, anxiety, depression, personality changes
  • Physical signs: bruises, cuts, scrapes, showering immediately when coming home
  • Abused feels guilty and “at fault” and makes excuses for their partner
  • Drug or alcohol use
  • Multiple sexual partners

Follow your instincts

If you suspect something is not right, act on your hunch and take action to address issues and leave the relationship early if problem behaviors persist.

 

If your teen is in a relationship with someone who is violent, your teen may:

  • Avoid friends, family, and school activities
  • Make excuses for a partner’s behavior
  • Look uncomfortable or fearful around a partner
  • Lose interest in favorite activities
  • Get lower grades in school
  • Have unexplained injuries, like bruises or scratches

If you think your teen might be an abusive person:

Teens who use physical, emotional, or sexual violence to control their partners need help to stop. Don’t make excuses if you think your child has a problem.

If your teen is abusive, he or she may have these characteristics:

  • Jealous and possessive
  • Blames other people for anything that goes wrong
  • Damages or ruins other people’s things
  • Wants to control a partner’s decisions
  • Constantly texts or calls a partner
  • Posts embarrassing information or pictures about a partner online

Next up:

How to prevent and seek help for teen abusive relationships.



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Teen Dating Violence: Stats to Know

Teen dating is an important way for kids to learn about themselves and others, but it can open them up to risky behaviors, heartache, and more. Violence in teen relationships is more common than you might realize, but recognizing warning signs can help protect our kids in their relationships.

Teen Dating Violence Awareness Month

teen dating violence statsFebruary is Teen Dating Violence Awareness Month, so it is a great time to learn about this all too common problem.

Today I’ll review the statistics to show just how prevalent it is.

Tomorrow I’ll cover how to recognize unhealthy relationships.

A third post will talk about what you can do to prevent abusive relationships and what to do if you recognize one.

What is teen dating violence and why should we care?

Definition

Teen dating violence is the physical, sexual, psychological, or emotional violence within a dating relationship, including stalking.

It can occur in person or electronically and can occur between a current or former dating partner.

Lasting effects

Youth who are victims are more likely to experience symptoms of depression and anxiety, engage in unhealthy behaviors (use of tobacco, drugs, and alcohol).

They often show antisocial behaviors and think about suicide.

Teens who are victims of dating violence in high school are at higher risk for victimization as an adult.

Dating apps

Dating apps isn’t what this post is about, but it deserves at least a mention. Certainly there’s a lot of teen dating violence with teens who meet in class or through a common friend, but this “service” opens up a Pandora’s Box of risky possibilities.

Teen dating apps?

Sadly, in researching this subject, the first many posts that showed up on my Google search for “teen dating” were teen dating apps. Not adults-only apps, or even apps that pretended to be adult-only.

Apps with “teen” and “dating” in the title.

One of the top search findings was a men’s website with an article about the “best” and “safest” teen dating apps. Yikes! This is on a website designed to attract adult men.

Another advertised that it was for kids 13-17 years of age. I’m not a fan of early teenage kids dating in general, but certainly a 13 year old is too young to safely navigate an online dating service!

As a mother of two teens, this is incomprehensible and scary to me. Why can’t kids meet the old fashioned ways ~ through friends, classmates, clubs, and activities?

On the other hand, I see the draw. So many teens of today haven’t mastered social skills. Kids of all ages today rely on texting to communicate with friends. They aren’t sure how to approach someone they don’t know. Teens find it hard to carry on a verbal conversation.

It’s easy to put your profile out there and search for someone with like-minded personalities. Easy, but not safe!

Thankfully, CommonSenseMedia.org had a high-ranking result to my search. Check out Tinder and 5 More Adult Dating Apps Teens Are Using, Too to see their stats and warnings. I highly recommend Common Sense Media in general for parents to help them moderate their children’s media intake: movies, games, apps, and more.

Dating violence: a very difficult and complex topic  

When teens find themselves in an abusive relationship, they often can’t find an easy way out. Sometimes they’re not even sure if the relationship is healthy or not.

How to separate?

Teens might share friends with their abusive partner. Their friends might think the abuser is wonderful, lending to peer pressure to stay together.

They typically go to school together, so it is difficult to avoid each other entirely.  

Teens might fear trying to leave the relationship safely.  

Victims often have feelings of love and attachment to the abuser, and hope that behaviors will change.

Drawing the line

If teens have lived with domestic abuse at home, they might think the abuse is normal.  

The abusive behaviors tend to lower the victim’s self esteem, making leaving feel less desirable since they feel no one else will ever care about them and a bad relationship is preferable to being alone.  

Guilt

Victims are often confused and made to feel like the abuse is their fault. They are told again and again that “if you didn’t do ___, I wouldn’t have had to ___.” They believe the abuser’s words.

Sometimes the abuse starts so gradually, it takes time to recognize that it’s there. By the time a victim realizes it, he or she may feel that if they say anything or get out of the relationship, others will think they’re stupid for not seeing it earlier. They continue to play the game of happy couple.

Bullying

Teens can experience cyberbullying even when not with their (ex-) partner.

There are no physical signs with verbal or online abuse, but the emotional scars can last a lifetime.

Even physical abuse (pinching, hitting, shoving, slapping, punching, or kicking) doesn’t always leave physical marks. If marks are visible, victims often make up stories to explain how they got there to cover for their partner.

Learn about abuse to help save someone you love from a dangerous relationship!

Stats- in other words, it’s a problem!

2015 National Youth Risk Behavior Survey

The CDC performs surveys of many risk factors on our children every other year. The 2015 National Youth Risk Behavior Survey is the latest reported. The 2017 report is expected to be published later this spring.

Nearly 70% of students nationwide dated or went out with someone during the 12 months before the survey. The statistics below represent a percentage of these 70% in the 12 months prior to the survey.

  • About 10% had been physically hurt on purpose (counting hit, slammed into something, or injured with an object or weapon) by their date or someone they had dated.
  • Over 10% of students had been forced to do sexual things they did not want to do by someone they were dating or going out with. These included being kissed, touched, or physically forced to have sexual intercourse.

The prevalence of physical teen dating violence did not change significantly from 2013 (10.3%) to 2015 (9.6%).

Other stats

Nearly 1.5 million high school students in the United States are physically abused by dating partners every year.

Females are more likely to be the victims (1 in 4 women have been assaulted by a partner).

Men are also at risk: 1 in 14 men report being victims.

Regardless of sex, it is likely that abusive relationships are underreported due to the nature of the problem.

Tomorrow: How to Recognize Teen Dating Violence 



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Show Your Kids Love On Valentine’s Day and Every Day

In honor of Valentine’s Day, I’m sharing 14 ways to show your child love.

1. Make time to be together

make time to be together
Make special memories and have daily routines together.

It goes without saying that the more time you spend with your family, the more bonding you can enjoy. This photo is from a time that I agreed to be in a show with my theatrical daughter, but not all family time has to be such a huge commitment.

Make a family game night once a week. Volunteer in your child’s class or participate in their extracurricular activities. Take walks. Go to the park. Build a puzzle together. Turn off electronics in the car and just talk.

Make little moments count!

2. Help kids learn from their mistakes

learn from mistakes
We learn best from our mistakes.

Kids make mistakes often. This means they have many chances to learn.

If we try to fix it all for them, it teaches them that they’re not good enough to do it themselves.

Don’t be harsh with your words when kids mess up. Harsh words scar and might keep kids from trying the next time!

Support kids and help them learn what went wrong. Try role-playing to see how they could have done it differently and maybe next time they can practice how to make a better choice.

Check out Bright Futures for more information on learning from mistakes.

3. Turn off screens and tune in

screen timeThere are many studies that show parents are distracted by their phones and computers.

Turn your screens off to be able to give full attention to your kids. Make sure they have screen time limits too.

I’m on my computer a lot now, but when my kids were young I only worked online when my kids were in bed. (Now they stay up later than I do, but they’re not home in the evenings.)

Even when I’m on call I don’t answer my phone during family meals because I wanted to model to my kids that family time should not have interruptions from phones. (Note: there are physicians who have to answer immediately due to true emergency calls, but they calls I get should not be emergencies.)

4. Assign chores

chores for kids

My daughter actually laughed at this one when she was reviewing my blog.

I’ve never been really good at enforcing chores on a regular basis despite the fact that I know they help kids build self confidence and grow into productive adults.

Be a better parent than I’ve been in this regard and have your child do daily or weekly chores. I know it’s faster and easier to just do things yourself, but your kids will benefit from the work!

5. Set limits

set limitsMy daughter also laughed at this one. She is totally the child who will debate any rule. She will follow them if they’re set, but she will attempt to show why the rule should be stretched. I’m proud of her for that characteristic. I don’t want kids that will just follow the leader, but I know that I can’t be an effective parent if there are no limits.

Kids need structure and limits so they can feel secure and learn within safety boundaries.

There are tips on limit setting for strong-willed kids on Aha Parenting that I really like.

6. Eat family meals together

eat as a family
Eating together has so many benefits. Make the time regularly!

Families that eat together stay together. There are studies showing that when families eat meals regularly together, kids benefit in many ways.

We tend to eat healthier if we eat home cooked meals. This leads to a healthier overall body.

Meal times also provide time for bonding. This can lead to less drug use and depression. It makes sense. If kids are connected to their parents, they will have less need to find other ways to make themselves feel good.

Studies show that kids actually do better academically if they eat with their family at least 5 days a week.

All this and it’s less expensive to eat at home. Bonus!

7. Read together

Read reading together

Okay, I’m cheating with this photo a bit. I didn’t ever take pics of reading with my kids, but took one a few years ago when my daughter was reading to her cousin during a car trip.

Despite not having photos of our nighttime rituals, books were the best part of bedtime when my kids were young.

They loved hearing stories. Sometimes we’d play “I spy” with the book we’d read so many times they had it memorized. Sometimes they’d read to me – more and more as they got older. They’d often try to bargain for more reading time. Reading was a great motivator for them to get dressed and brush teeth so we could get started!

Reading together is not only a great bonding time, but it also helps to set the stage for loving a great skill. Many studies over the years continue to  show that reading with children starting when they’re infants helps them learn to speak, interact and bond with parents. They will be more likely to be early readers. Reading with kids who already know how to read helps them feel close to you, understand the world around them and be empathetic citizens of the world.

8. Serve together

serve others
Serving others not only helps those you’re serving, but has also been shown to help the giver.

Doing community service or volunteering to help others has been shown to benefit not only the persons being served, but also those serving.

Kids can develop pride, learn new skills, gain empathy for others, and live new experiences by helping others.

Studies show that those who volunteer have lower mortality rates, greater functional ability, and lower rates of depression later in life than those who do not volunteer.

Volunteering allows families doing things together working on something productive. They can learn about themselves and each other through helping others.

9. Make physical contact

physical contact
Healthy physical contact can show love.

One of the love languages is physical touch. Sometimes we hear of improper touches and it can negatively impact the way we are able to interact with the kids around us. While I feel very strongly that we need to protect our kids against abusive touches, I also know that kids (and adults) need healthy and safe physical touch.

Never invade a child’s personal space if they don’t want you in it, but physical touch can be reassuring to kids. Give a hug or pat on the back. Tickling and playful roughhousing are fun ways to give physical touch. Dance. Hold hands or make up a fun handshake. Tousle hair as you walk by.

10. Don’t minimize worries

anxiety worry
Don’t minimize your child’s worries.

It’s tempting to just say that everything’s okay and to not worry, but when you say that your child just feels like he’s not heard. Over time he will stop talking to you about his worries.

If you have a hard time understanding your child’s anxieties (or anyone’s anxieties) read this great metaphor from Karen Young at HeySigmund.

Acknowledge the fears and teach your kids how to overcome them.

HeySigmund is one of my favorite blogs. It has great articles on helping kids learn to manage their anxieties.

11. Praise the effort

praise
Praise the effort, not the end result.

Our society tends to reward everything. Participation trophies are not helpful at growing resilient kids.

Poorly worded and empty praise can reduce children’s desires to take on challenges, lower achievement, reduce motivation and even make kids more interested in tearing others down.

Learn to show your kids that you’re attentive with phrases that show you acknowledge their effort or character traits without praising results.

For more on giving helpful praise, see Michelle Borba’s 6 New Rules for Praising to Raise Kind, Successful Kids.

12. Let them learn independence

independence
Let kids do things independently so they can grow into independent adults.

It can be hard to watch kids grow up and take things into their own hands, but it can be rewarding to watch them become independent.

Allowing kids to take on more responsibilities as they grow is a great way to show confidence in them. It can be hard to worry that your child will not remember all aspects of things required or that they will fail at something new, but allowing them to take ownership of things as they get older helps them learn not only the skill to accomplish things, but it also gives them the confidence that they can do things on their own.

13. Let them know you’re always thinking of them

thinking of the ones you love
Do little things to show you’re always thinking of them.

Giving gifts is a great way to show love and affection, but don’t overdo this one.

Not all gifts have to be costly or extravagant.

Leave a little note in the lunch box.

Buy a token gift for no reason occasionally.

Be there to cheer at their game or performance.

It can be that easy.

14. Say “I love you” every day

Saying “I love you” in words is also important. Some people aren’t good at saying it, but try.

I love you
Say “I love you” often!

I also encourage you to not only share moments, but get in front of the camera with your kids. I’m usually behind the camera taking the pictures, so there are very few photos of me with my kids at various life stages. Be in the photos so you can all walk down memory lane together.


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Remembering Medications

Compliance taking a daily medication (or vitamin) can be troublesome for many.  I find myself counseling parents and kids how to remember medicines often.

Here are my favorite tips:

Use a pill box for pills

Pill boxes come in various sizes and either single daily dosing or am/pm dosing, depending on your needs.

Pill boxes allow you to:

  • be sure you have enough for the upcoming week
  • remember if they were taken today
  • keep several types of pills for each day together if taking more than one pill

Liquid medicines

Wash the syringe after each use.

Put it where you’ll see it. Remember the medicine needs to be out of reach from kids… not necessarily the syringe!

Empty the dish drain of all contents daily so you find the syringe and remember to use it.

Or put a clean syringe in visible sight where you often look. Tape it to the milk jug. Put it in a glass next to the kitchen sink or in a glass near your coffee pot.

Grab a pen/marker and draw a “calendar” (Mon am/pm, Tues am/pm, …) on the bottle with space to check off when you’ve given the medicine each day.

Refrigerated medicines

Put the medicine on a shelf that is eye-level, right in front. Don’t let it get pushed to the back.

Return the bottle to the fridge before giving the medicine to lessen the chance you leave it on the counter.

Remind older children who can access the refrigerator that the bottle is off limits!

Keep it where you’ll see it – but out of hands of kids

Keep medicine next to something you do daily (coffee, toothbrush) only if your kids are old enough to respect that it’s medicine. Use associations if you can’t put the medicine itself there.

Make associations with other objects

Use a specific glass that is unique that goes from table to dishwasher to table and never is put away.

Every time you empty the dishwasher, put water in the glass and set it on the table for medicine.

Refill the medicine 1 week before you run out

This allows you flexibility in case you forget to pick it up.

It also allows recognition that there are no refills if that was missed, giving one week to see your doctor.

You can have enough for vacations if you routinely do this, since you can only fill one week earlier than the last fill… plan ahead if traveling!

Keep tabs on number of refills left

The pharmacist should let you know with each refill how many are left. If there are none, call right then to set your next appointment if you haven’t already.

Regular prescription medications goes hand in hand with regular follow up with your doctor to manage the medication dosing. This is important for many reasons, so I try to give as many refills that will be needed until the next visit.
Ask your doctor how they handle refills before the medicine runs out so there are no delays in treatment.

Travel

If you travel often, it helps to keep an empty pill box in your toiletry bag, so when packing it you see the empty box that needs to be filled.

Or you could put a sticky note in the toiletry bag reminding you to pack them.

Use technology

Set your phone or watch to alarm at the times the medicine is due.  Change the tone to one that is unique to remind you.

There’s an app for that! You knew there was, right? There’s an app for everything. Search your app store for a medication reminder.

Put a reminder on your calendar to call for refills and/or schedule appointments before the last minute.

Leave sticky notes around the house or in your bathroom and kitchen if you’re more old school!

If forgetting’s a problem…

Keep some medication in your purse (or at the school nurse) to take if forgotten in the morning if this might still be a problem.

Remember to not leave your purse in the car or other places the medicine will get too hot or cold or in a place your children have access to it. We don’t want them sneaking into your purse for mints and getting a medicine instead.

If the school nurse will keep some, be sure to ask for a nurse’s note when getting the prescription.

Remember to schedule your next visit!

 If able, schedule the next visit before you leave the doctor’s office.  Bring your calendar to each visit!

Call as soon as you can to schedule if you don’t have your calendar available at the doctor’s office or you were unable to schedule for any reason.

If you notice no more refills on the bottle when picking up your medicine, call that day to schedule an appointment. The later you wait, the fewer appointment times will be available. Early morning and later in the day fill first!

If you always forget to call when your doctor’s office is open, look for options for them to call you. Leave a message on their office voicemail and be sure to leave the best time frame and number to call when they return your call. Utilize online appointment requests if available.

More reminders

  • Once habits form, it is easier to remember, but until then be sure to set reminders– especially if the medication must be taken at a certain time each day or if missed doses can be dangerous.
  • Learn what to do if you forget a dose by talking with your doctor or pharmacist. Some medicines are fine to skip a dose, others are not so forgiving and must be taken as soon as remembered.