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.


ADHD Medications: Starting out and titrating

I have spent many days covering a lot about learning and behavioral problems. Topics covered include why and how to get these issues diagnosed, who is involved in the diagnostic process, and treatment options with diet, supplements, and alternative treatments. Yesterday I covered what prescription medications are typically used and side effects they may cause. Today I’ll discuss common ways to choose a medicine, how to titrate it to a proper dose, and when to change to something else.

Tomorrow will discuss final thoughts on how to remember medicines, if it’s okay to take days off, and what to do if parents disagree about the treatment plan.

Getting Started


starting ADHD medicinesThe first step in treating ADHD is getting a proper diagnosis. This should be done with input from parents and teachers since symptoms should be present in at least two settings. ADHD symptoms overlap with many other conditions, and if the diagnosis is not correct, medications are more likely to cause side effects without benefit.

Do not jump into medication until the symptoms have been fully evaluated and a proper diagnosis is made according to DSM criteria.

Stimulant medicines

Stimulant medicines are considered first line treatment for ADHD in kids over 5 years of age.

There are short acting and long acting formulations available for each type of stimulant. There are advantages and disadvantages to each.

Short acting medications tend to last about 4 hours, so can be given at breakfast, lunch, and after school, allowing for hunger to return as each wears off to help kids maintain weight. Short acting stimulants are often used later in the day after a long acting stimulant wears off for teens who need longer coverage.

Long acting medicines tend to last between 6 and 12 hours, depending on the medicine and the person’s metabolism. The benefit is that people don’t need a mid-day dosing, which for school kids means avoiding a daily trip to the school nurse. This can be socially unacceptable for older children. It is also easier to remember once/day medication versus multiple times/day dosing. The downside is that some children don’t eat well midday with long acting medicines.

Which stimulant medicine to choose?

Methylphenidate vs Amphetamine

While some children respond better to methylphenidates, others to amphetamines, some do equally well on either, and some cannot tolerate either.

It is not possible to predict which children will do best on any type, but if there is a family history of someone responding well (or not) to a medicine, that should be taken into consideration of which to start first.

Swallowing Pills

Another thing to consider is whether or not a child can swallow a pill.

Some of the medicines must be swallowed whole.

If you aren’t sure if your child can swallow a pill, have them try swallowing a tic tac. Use a cup with a straw, since the throat is narrowed when you tilt your head back to drink from an open cup.

Another option is to put it in a spoonful of yogurt or applesauce and have your child swallow without chewing.

If your child cannot swallow a tic tac, you can choose a medicine that doesn’t need to be swallowed.

Some come in liquid or chewable formulations. Some capsules can be opened and sprinkled onto food, such as applesauce or yogurt. There is a patch (placed on the skin) available for the methylphenidate group.

Genetic testing

I’ve met many parents who request “the lab to say which medicine will work best.”

There is no lab that does this.

Many companies promote that their genetic test can predict which medicine will be best tolerated, but in truth they do not predict which will work best to maximize treatment and minimize side effects.

There are pharmacogenetic tests that will help to identify if a person has an issue with metabolism that would require a higher or lower than typical dose, but it does not tell which medicine will work best. It also doesn’t verify the diagnosis, so if the diagnosis is incorrect, no medicine is the right one.

Pharmacogenetic testing for ADHD (and other conditions) is still relatively new. It has the potential to significantly change the medication treatment process, a term called Personalized Medicine. Personalized medicine needs to be further validated and its precision improved before it becomes mainstream.

Insurance

I would love to say that cost shouldn’t matter, that we pick the medicine based purely on medical benefit, but cost does matter. Insurance often dictates which medicine we choose. 

Before you go to the doctor to discuss starting medicine look at the formulary from your insurance company. All other things being equal, if one medicine is not covered at all (or is very expensive) and another is covered at a lower tier, it is recommended to try the least expensive option first.

Of course, if the least expensive medicine fails, then a more expensive one might be the right choice. 

Not knowing which will work best in any individual, choosing the least expensive makes sense. Sometimes all approved medications for ADHD are expensive. If that’s the case, see Affording Medications for tips on finding the best price.

Generics historically have been the least expensive, but that isn’t always the case. You must know your insurance formulary to know the cost.

The ADHD Medication Guide is a great resource to look for generics (marked with a “G”), which must be swallowed whole or can be opened or chewed (see the key on page 2).

Age indications

The age indications listed on page 2 of the ADHD Medication Guide are those that have FDA approval at the ages listed, but there are many times that physicians use medicines outside the age range listed.

Some do not even have an age indication listed. These ages are due to testing results, and can be limited because one age group might not have been tested for a specific medicine.

Note that the 17 year and adult medicines are different. Is there really a difference between a 17 and an 18 year old? Not likely.

start low and titrate to best effect

In general it is recommended to pick one of the stimulant medicines and start low and titrate to best effect without significant side effects.

Feedback on how the child is able to focus and stay on task, and reports of other behavioral issues that were symptoms in the first place should be received from teachers and parents, as well as the child if he is able.

There are many things to consider that affect focus and behavior that are not due to the medicine: sleep, hunger, pain, illness, etc. It takes at least a few days to identify if the medicine is working or not or if other issues are contributing to the focus and behaviors.

The younger the child is the longer I usually advise staying on a dose so a parent has a chance to hear from the teacher how things are going. I usually don’t increase faster than once/week in younger kids.

I rely more on the student’s report in middle and high school, since those students can be more insightful and they have so many teachers throughout the day that most teachers are not as helpful. Older students who are in tune with their problems and how they are responding to the medicine might be able to increase every few days, as long as there are no confounding factors that could influence symptoms, such as change in sleep pattern, big test or other stressor, or illness.

Finding the right dose

It is recommended to start with one of the two main classes of stimulants with a low dose, and slowly increase to find the best dose.

Continue to increase until either symptoms are well controlled without significant side effects or side effects won’t allow another increase.

If that stimulant doesn’t work well or has side effects that are not tolerated, then change to the other class of stimulant.

If that one does not work, you can try a different medicine from the class of stimulant that worked best.

If the third medicine doesn’t work, then a non-stimulant can be tried.

I recommend re-evaluating the original diagnosis if the third medicine doesn’t work, since ADHD might not be the cause of the issues and finding the right cause can lead to a better treatment.

Titrating the medicine goes something like this:
  • If symptoms are well controlled and there are no significant side effects, the medicine should be continued at the current dose.
  • If symptoms are not well controlled and there are no side effects that prohibit increasing, the dose should be increased as tolerated.
  • If symptoms are not well controlled (i.e. room for improvement) but there are side effects that prohibit increasing the medicine, consider a longer period of watching on this dose versus changing to a new medicine.

 

Before your visit:

Before you meet with your physician to discuss a new ADHD diagnosis or a possible change in treatment plan, be sure to get the following information and have it available at the visit or the visit will not be as productive as you desire:

  • Insurance formulary
  • Standardized testing from teachers, parents, and other significant adults
  • Verify if your child can swallow a tic tac or pill
  • Any contributing family history (family member responses to medications, family history of heart issues, etc)
Tomorrow there will be more on fine tuning ADHD medications.

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


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Alternative Treatments for ADHD

I’ve covered why you should get your child evaluated for learning and behavior issues, who does the evaluations, and what the evaluation process involves in my previous posts. I’ve also covered specific diets and supplements. Today I want to talk about alternative treatments for ADHD. If parents aren’t ready to use medicines yet or if they want to supplement medications with additional treatments, there are many alternatives.

Natural treatments, psychological and occupational therapies, and complementary alternative therapy for the treatment of ADHD are available. Some of these are more effective than others.

Alternative Treatments

Nutritionalternative treatments for ADHD

Nutrition is very important for learning and behavior in all kids, not just those with a diagnosis of some sort. My next blog will be dedicated to more on components of nutrition and elimination diets, then the following blog will cover vitamins and supplements.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is a way to change thinking from negative to positive and focuses on finding solutions to current problems. It has been proven to be effective in the treatment of ADHD.

The first treatment for ADHD in children under 5 years should be cognitive behavioral therapy (CBT) with a licensed therapist trained in this area.

CBT can help those of all ages learn techniques to control behaviors, screen thoughts before speaking, organize things, and more.

Studies show that the best benefits for ADHD are a combination of medication and CBT for those over 5 years of age.

Child or parent training

Parent skills training provides parents with tools and techniques for managing their child’s behavior. Behavior therapy rewards appropriate behavior and discourages destructive behavior.

This training has been shown to improve ADHD symptoms among children, but studies show it does not change academic performance when used alone.

social skills group

Many kids with ADHD struggle socially. They tend to lag behind peers by a few years developmentally. Their impulsivity and inattention leads to poor behavior and trouble making good friends. They may also have trouble managing their emotions.

Joining a professionally run social skills group can help kids learn and practice important skills for interacting with others. Some school counselors can do this during school hours and many therapists offer groups outside of school.

School resources

Schools have various abilities in helping kids with unique needs. They can offer special seating (or standing desks), extra time for tests, fidget items, and other accommodations. To learn more about school resources, Understood.org has much needed information about what is available and what you can do to legally get accommodations with IEPs or 504Plans.

Exercise

Getting kids outside and moving has many benefits for all kids – including those with ADHD.

First, they are off all screens, which have been shown to increase aggressiveness and impulsivity.

Second, they are getting exercise. Studies show that when kids play outside their focus, attention, and behavior improve.

Exercise helps to elevate the same neurotransmitters that are increased with stimulant medications, which helps with executive functioning skills (sequencing, working memory, prioritizing, inhibiting, and sustaining attention).

Any exercise helps, but studies show the best are martial arts, ballet, ice skating, gymnastics, yoga, rock climbing, mountain biking, skateboarding, and whitewater paddling (I know not all of these are practical on a regular basis, but most are). These activities require sustaining attention, balance, timing, fine motor adjustments, sequencing, evaluating consequences, error correction, and inhibition.

Sleep

Sleep problems are common in many children, especially those with ADHD. Fixing the sleep cycle can have extreme benefits in learning and behavior.

Sometimes it’s as easy as getting a routine for sleep to ensure the proper number of hours for a child, but often they suffer from insomnia, nightmares, sleep apnea, restless leg, or other medical conditions that impair sleep time and/or quality.

Symptoms of chronic sleep deprivation in kids are hyperactivity, poor focus, and irritability. There are many kids who can have all of their ADHD symptoms relieved when they simply get better sleep. I see this in many teens who suddenly “develop ADHD”- only it’s really not ADHD at all. They are running on 4-5 hours of sleep a night. If your child has sleep troubles not improved with these Sleep Tips, talk to your child’s doctor.

Occupational Therapy and Sensory Training

There are many kids with ADHD who benefit from using techniques that occupational therapists use with sensory processing disorder (SPD). In some kids, SPD might be the real diagnosis causing symptoms of ADHD, but in others they may co-exist.

Treating SPD is usually fun for the kids, and there is no harm in doing their techniques even if a child doesn’t have the disorder.

Schools have started integrating these ideas into their classrooms as needed, such as having kids sit on stability balls or using tactile objects at their desks.

Therapy for SPD involves playing in ways that use sensory input (such as with sand or play doh, rolling down a hill, manipulating tactile objects, and more).

For a great list of ideas visit Sensory Integration Activities, but working with an occupational therapist is recommended.


Biofeedback and Neurofeedback

Biofeedback and neurofeedback are often not covered by insurance due to inconclusive evidence that they work. Children and adults with ADHD often have abnormal patterns of brain electrical activity on electroencephalographic (EEG) testing. EEG biofeedback is aimed at normalizing EEG activity by correcting the brain’s state of relative under-arousal and optimizing cognitive and behavioral functioning.

Neurofeedback trains kids to become more aware of their physiological responses and improve their executive functioning. Each neurofeedback session lasts 30-60 min and children usually need 10-20 sessions. Patients wear a cap that measures their brain activities, and it helps them train their brain to maintain focus during video games specific to this purpose.

The significance of most findings on neurofeedback and EEG biofeedback is limited by study design flaws that include small study sizes, heterogeneous populations, absence of a control group, inconsistent outcome measures, self-selection bias, and limited or no long-term follow-up. While this doesn’t mean they don’t work, I would like to see more studies showing their benefit. You might invest a lot of time and money only to find out it doesn’t work.

Working memory training

Working memory training has been shown in studies to help with symptoms of ADHD, though there are some conflicting studies out there.

Cogmed is the company that has studies showing benefit. It’s a computer program that kids play like a video game, but it reportedly trains their brain to remember things. Cogmed is intensive: 1 hour a day, 5 days a week for 5 weeks, but can be done at home. It can be expensive and is often not covered by insurance. About 70-80% of children show improvement immediately after the training, and of those who improved, 80% maintained the benefit over a 6 – 12 month window. Cogmed is designed to be used with medication, such as stimulants.

Herbs and other supplements

There are some studies supporting nutritional supplements or herbal medicines for ADHD, but many reported treatments have not been found effective. I will cover these in a separate blog.

ADHD Coaching

Just like anyone who needs help improving a skill, working with a coach with experience helping others in that area can be a big help.

Working with an ADHD coach can help many with certain aspects of their life. ADHD coaches can help with organization, motivate a person with ADHD to finish tasks, or help them learn techniques that makes them more effective at life skills.

Coaches do not do psychotherapy or counseling. This can be beneficial for people who are against therapy but need help to improve their skills.

It does not work if the parent makes the child go. The child must be motivated to make changes in his or her life and be willing to work on things, then coaching can be great.

Tips on finding an ADHD coach can be found on PsychCentral.

Mindfulness

I recommend mindfulness for many issues, especially anxiety (which often co-exists with ADHD). Mindfulness is thought to help with ADHD as well. It is a process of being focused on the present moment and is more fully explained on Understood.org’s Mindfulness page.

There are many free apps that can help kids (and adults) learn mindfulness.

No evidence exists for these treatments

There are many alternative treatments out there that do not have scientific proof that they help. Many parents try these treatment programs in hope that their child’s symptoms will go away.

In general, if it sounds too good to be true, it probably is.

Don’t be fooled into thinking “alternative” or “natural” treatments are without risk. There are always risks, including the lost time not being on a proven therapy, leading to a child falling further behind academically and suffering emotionally from symptoms related to ADHD.

“Train the brain” games 

There are claims that games designed to train the brain can improve memory, attention and other skills, but there is no research that supports this claim. Kids may get good at playing the game and seem to learn, but studies have found no improvements that generalize to their daily life or learning. For more, see what experts say about “train the brain games” for kids with ADHD.

Brain Balance has a center in our city, and I’ve seen more than a few parents who waste time and money on their program. I don’t know of any that noted significant and continued benefit. Although their website might look like there’s impressive evidence to use it, there really isn’t. Please see Science Based Medicine: Brain Balance for more information.

Caffeine

Caffeine is a stimulant but since it is available from grocery stores instead of pharmacies some parents feel more comfortable using it instead of a medication.

If you’re using it as a drug, it is a drug.

Whether it comes in a beverage or a pill, it is a chemical with properties that act like other drugs in our bodies.

Unfortunately studies don’t really support its use. It’s difficult to dose since it comes in so many forms, and most people develop a tolerance for it, requiring more and more, which can increase side effects.

For details, see Science Based Medicine: Caffeine for ADHD.

chiropractic medicine, Vision therapy, and Applied kinesiology

I have not been able to find any valid scientific studies for chiropractic medicine, vision training, and applied kinesiology for the treatment of ADHD.

Insurance usually does not cover these and they can be quite expensive. I do not recommend them.

Essential oils and aromatherapy

Essential oils are all the rage now. It seems they can cure everything if you do a quick online search. The problem is that research hasn’t shown that to be true. Dr. Chad Hayes does a good job of discussing what they are and why they aren’t recommended.

Remember…

There is no alternative medicine. There is only medicine that works and medicine that doesn’t work. ~ Richard Dawkins

If it stays alternative, that must say something. Once an alternative treatment is shown to work, it becomes a preferred treatment, no longer an alternative…

Things to consider when choosing treatment plans:

  • First, be sure your child is properly assessed to make the best diagnosis on which to base the treatment plan.
  • Natural isn’t necessarily safe. Evaluate all the risks and benefits known before making a decision. Even exercise (which is always recommended) comes with risks, such as injury and at times sleep problems due to scheduled activity times.
  • Talk with your doctor about any treatments you are doing with your child. Don’t forget to mention vitamins, supplements, herbs, brain training, therapies, etc.
  • Choosing one treatment doesn’t mean you are married to it. If response doesn’t prove to be beneficial, re-think your approach.
  • There is no cure for ADHD known at this time. If someone claims that they can cure your child, don’t buy into it.
  • Learn your costs. Does insurance cover it? Insurance companies often prefer certain treatments due to their cost and other factors. They also do not cover many treatments. Sometimes this is again due to cost, but other times it is because there is no evidence to show the treatment is effective. (Hint: This is a good clue to look at other treatments!)
  • Is the treatment something your child can do and is your family willing to put in the time? CBT is proven to help, but it doesn’t work if the child and parents don’t work on the techniques at home. Neurofeedback and Cogmed take many hours of treatment over weeks of time and are not guaranteed to work in all children.  Medications must be titrated to find the most effective dose that limits side effects. This requires frequent follow up with your doctor until the best dose is found.

Sources:

The ADDitude Guide to Alternative ADHD Treatment

WebMD: Attention Deficit and Hyperactivity Disorder: Alternative Treatments 

American Psychological Association: Easing ADHD Without Meds
Psych Central: Neurofeedback Therapy an Effective, Non-Drug Treatment for ADHD

Psychiatric Times: Integrative Management of ADHD: What the Evidence Suggests

Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents


 

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


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Supplements for ADHD: Do Vitamins, Herbs, and Fatty Acids Work?

Parents often ask if they can treat their child’s ADHD without prescription medication. There are many alternative treatments in addition to prescription medications – some of which are more effective than others.  I will cover ADHD treatment with supplements today.

Supplements for ADHD – general

If you’re giving your kids supplements for any reason, be sure to tell their physician and pharmacist to avoid any known complications or interactions with other treatments.

Supplement use in general is gaining popularity. All you have to do is visit a pharmacy or specialty store and you will see various products marketed to treat ADHD.

There are some studies that show people with ADHD have low levels of certain vitamins and minerals. More studies are being done to determine if supplementing helps symptoms. There is growing evidence for vitamin supplementation, but there are no standard recommendations yet.

Should you use high dose vitamins?

Clinical trials using various combinations of high dose vitamins such as vitamin C, pantothenic acid, and pyridoxine show no effect on ADHD.

I don’t recommend high dose vitamin supplements unless a specific deficiency is identified. I don’t routinely screen for deficiencies at this time because there are no standard recommendations for this. We still have a long way to go before we know enough to make recommendations.

For children without a known vitamin deficiency, a standard pediatric multivitamin can be used, but effectiveness is not proven. I have no problems with anyone taking a multivitamin daily. However, I cannot recommend any specific brand since none of them are regulated by the FDA and there are many reports that show the label often misrepresents levels of what is really in the bottle. There have been instances of higher or lower than listed amounts of ingredients as well as unlisted ingredients in supplements.

My advice is to buy a brand that allows independent lab testing of their products if you choose to buy any vitamin or supplement.

Vitamins & minerals

The following is adapted from the University of Maryland Medical Center with the help of ADDitude Magazine and Natural Medicines Comprehensive Database.

Magnesium

Symptoms of magnesium deficiency include irritability, decreased attention span, and mental confusion.

Some experts believe that children with ADHD may be showing the effects of mild magnesium deficiency. In one preliminary study of 75 magnesium-deficient children with ADHD, those who received magnesium supplements showed an improvement in behavior compared to those who did not receive the supplements.

Too much magnesium can be dangerous and magnesium can interfere with certain medications, including antibiotics and blood pressure medications.

Talk to your doctor before supplementing with magnesium.

Vitamin B6

Adequate levels of vitamin B6 are needed for the body to make and use brain chemicals called neurotransmitters. These include serotonin, dopamine, and norepinephrine, the chemicals affected in children with ADHD.

One preliminary study found that B6 pyridoxine was slightly more effective than Ritalin in improving behavior among hyperactive children – but other studies failed to show a benefit. The study that did show benefit used a high dose of B6, which could cause nerve damage, so more studies need to be done to confirm that it helps.

If B6 is found to help, we need to learn how to monitor levels and dose the vitamin before this can be used safely.

Because high doses can be dangerous, do not give your child B6 without your doctor’s supervision.

Vitamin C

Vitamin C can help modulate the dopamine levels in the brain. Dopamine is a neurotransmitter that helps control the reward and pleasure centers in the brain.

Vitamin C can affect the way your body absorbs medications (especially stimulants for ADHD) so it is suggested to avoid vitamin C supplements and citrus fruits that are high in vitamin C within the hour of taking medicines.

Preliminary evidence suggests that a low dose of vitamin C in combination with flaxseed oil twice per day might improve some measures of attention, impulsivity, restlessness, and self-control in some children with ADHD. More evidence is needed before this combination can be recommended.

Vitamin D

Vitamin D is the one vitamin that is recommended to take as a supplement by many experts.

As we have gotten smarter about sun exposure, our vitamin D levels have decreased. Vitamin D deficiency has been linked to many problems, including ADHD.

Zinc

Zinc regulates the activity of brain chemicals, fatty acids, and melatonin. All of these are related to behavior.

Several studies show that zinc may help improve behavior.

Higher doses of zinc can be dangerous, so talk to your doctor before giving zinc to a child or taking it yourself.

Iron

Iron deficiencies commonly occur in children due to inadequate dietary sources since kids are so picky. Other causes include blood loss or excessive milk intake.

Iron is needed for the synthesis of dopamine, norepinephrine, and serotonin- all neurotransmitters in the brain.

Low iron has been linked to learning and behavior problems.

Too much iron can be dangerous, so talk with your doctor if you want to start high dose supplements. (Regular multivitamins with iron should not cause overdose if used according to package directions.)

If you’re using high doses of iron, it is important to follow labs to be sure the iron dose is not too high.

Essential fatty acids

Fatty acids, such as those found in fish, fish oil, flax seed (omega-3 fatty acids) and evening primrose oil (omega-6 fatty acids) are “good fats” that play a key role in normal brain function.

In a large review, Omega-3/6 supplementation made no difference in ADHD symptoms, but there are other benefits to this supplement and it carries little risk.

If you want to try fish oil to see if it reduces ADHD symptoms, talk to your doctor about the best dose. Some experts recommend that young school aged kids take 1,000-1,500 mg a day, and kids over 8 years get 2,000-2,500 mg daily.

For ADHD symptom control it is often recommended to get twice the amount of EPA to DHA.

L-carnitine

L-carnitine is formed from an amino acid and helps cells in the body produce energy.

One study found that 54% of a group of boys with ADHD showed improvement in behavior when taking L-carnitine. More research is needed to confirm any benefit.

Because L-carnitine has not been studied for safety in children, talk to your doctor before giving a child L-carnitine.

L-carnitine may make symptoms of hypothyroid worse and may increase the risk of seizures in people who have had seizures before. It can also interact with some medications. L-carnitine should not be given until you talk to your child’s doctor.

 

Proteins

Proteins are great for maintaining a healthy blood sugar and for keeping the brain focused.

They are best eaten as foods: lean meats, eggs, dairy, nuts and seeds, legumes, and fish are high protein foods. Most people in our country eat more protein than is needed.

If your child does not eat these foods in good quantity, there are supplements available. Talk with your doctor to see if they are appropriate for your child. Many of the supplements are high in sugar and other additives. Some have too much protein for children to safely eat on a regular basis.

Herbs

There are some studies supporting nutritional supplements or herbal medicines for ADHD, but many reported treatments have not been found effective.

Pinus marinus (French maritime pine bark), and a Chinese herbal formula (Ningdong) showed some support.

Current data suggest that Ginkgo biloba (ginkgo) and Hypercium perforatum (St. John’s wort) are ineffective in treating ADHD.

Summary

In general I think we all should eat a healthy diet that is made up primarily of fruits, vegetables, lean proteins, and complex carbohydrates.

If children are on a restricted diet due to allergy or sensitivities to foods or additives (or extreme pickiness), discuss their diet with your doctor. Consider working with a nutritionist to be sure your child is getting all the nutrition needed for proper growth.

If supplements are being considered, they should be discussed with your doctor. Talking about risks and benefits can help decide which are right for your child.


Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health

 

Evaluation Process to Diagnose Learning & Behavioral Issues

I have talked about why kids should be evaluated if they have learning or behavioral issues and who is involved in this evaluation in the past few posts. Today I want to talk about what to expect during an evaluation. Not all kids need every test available. It depends on what their specific concerns are as to what will be tested, but a proper diagnosis can’t be made without standardized testing and a complete evaluation.

What types of things are evaluated?

Evaluation Process to Diagnose Learning & Behavioral IssuesThe evaluation includes several types of assessments because there are many things that can cause learning or behavioral issues.

There are no specific laboratory or imaging tests available to determine a diagnosis on a routine basis. It’s important to do a thorough standardized evaluation to get the right diagnosis.

Contributing issues include but are not limited to: ADHD, anemia, anxiety, bullying or abuse, chronic illness, depression, hearing or vision problems, learning disabilities, malnutrition, oppositional defiant disorder, sensory integration disorder, and sleep deprivation.

Symptom overlap

Having one diagnosis does not mean you can’t have a second. Actually many of these issues go hand-in-hand and co-exist.

ADHD, anxiety, neurodiversity, learning disorders
There is a lot of overlap of symptoms of many similar conditions.

Standardized questions

A big part of the diagnosis lays in the symptoms noted at home and school, so there are a lot of questions about how your child fares at each.

Both parents and teachers and any other significant adults should fill out standardized questionnaires as recommended by the clinician doing the evaluation for many behavioral issues. Older kids (and adults) can do self assessments.

It’s important to answer each question as honestly as possible to avoid misrepresentation of symptoms, which can lead to an improper diagnosis.

History

Reviewing the child’s story can give clues. This includes the current concerns of parents and teachers in addition to historical facts and events.

If there were developmental delays in motor skills or language development, further evaluation in those areas might be insightful.

It’s important to review the family history, since many of these issues run in families.

Sleep patterns are often insightful since sleep deprivation can decrease executive functioning and mimic many conditions.

Other issues, like a history of anemia or elevated lead levels should be discussed.

Exam findings

A physical exam should be done to help identify any physical symptoms that can contribute to learning or behavioral problems, such as large tonsils leading to sleep apnea.

Behavior evaluation

Some clinicians will go to your child’s classroom to observe behaviors. This is sometimes provided through the school district but might also involve a private therapist.

Neuropsychological testing

Neuropsychological testing might be recommended. It can assess learning disorders and attention issues, identify strengths and weaknesses, and help determine what interventions will work best for your student. Understood.org has information about neuropsychological testing.

Vision and Hearing

If your child has not had a vision and hearing screen done previously or there are concerns, it is recommended to do those screens. When a child cannot see the white board or hear the instructions, learning and behavior are both impacted.

Evaluation Process

As you can see, there are many things to consider when evaluating learning and behavioral concerns. A proper diagnosis usually takes more than one visit. More than one person should be involved in the screenings in many cases. Do not attempt to shortchange this process. Without a proper assessment, the wrong treatment might be advised, leading to poor outcome.

The next few blogs will discuss treatment options for ADHD, including dietary changes, supplements, alternative and additional treatments and medications.


Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health