Developmental Age in ADHD

I’ve been asked what the single best parenting tip I’ve gotten as the parent of a child with ADHD is. After a lot of consideration, I’ve decided that it involves setting expectations. When we re-frame things that are appropriate for their developmental age, it alleviates so many fights and frustrations. These expectations can vary if they’re on medication at the time, how much sleep they’ve had, and more.

What is developmental age?

Kids with ADHD have a delay in brain development that affects the ways they organize, process, and act upon information.

Chronologic age

We typically measure a child’s age by how long it’s been since they were born. This is their chronologic age.

We assume that kids will be able to understand more complex ideas and master new tasks as they get older. There are certain milestones that are associated with various ages, such as a social smile by 2 months or walking by 15 months of age.

Developmental age

Your pediatrician will ask developmental questions at routine well visits to be sure your baby is on track.

These questions help us to identify if your child is developing at a normal rate or if there is a delay. At some ages there are specific standardized developmental screening tools to be administered.

As long as a child meets expectations, their developmental age and chronological age match. If they are delayed, we can give a developmental age to help identify their stage of development.

We know that ADHD is one cause of delay of areas of the brain that are important in executive functioning. At this time there are no standard screening tool recommended at all well visits to assess this development. It is important to bring up any concerns from home or school with your physician.

What are executive functioning skills?

Executive functions are the things we use to help us use and act upon information.

Understood is a great resource for many things related to learning, attention, and behavior. They have a great page about what executive functioning problems look like at different ages – from preschool to high school.

But my child’s smart, not delayed!

Being delayed in executive functioning areas of the brain is not the same as being academically delayed or having a low IQ. Parts of our brains grow at different rates.

Even your child that excels in certain areas can be delayed in others.

A child who can do math several grades ahead of classmates might not be able to remember something as simple as turning the homework in the next day.

Another child who reads grade levels ahead might not be able understand why a certain behavior is considered undesirable.

A child who is gifted in the arts can struggle significantly remembering all the things that must happen to get ready to leave the house in the morning on time.

It’s easy to get angry at kids for having missing assignments, when they forget to brush their teeth, or when they’re always running late. It can be difficult to help kids understand why they cannot blurt out answers or tell others what to do or how to do it.

Negative feedback leads to increasing problems

Unfortunately, kids with ADHD often hear negative feedback when they fail to do what’s expected, which can lead to rejection sensitivity.

Kids often develop unproductive ways to buffer the negativity that follows their failures. They can act out, become the “class clown,” decide to stop trying because of the fear of failure, and more.

It is now recognized that kids with ADHD have a delay in brain development that affects the ways they organize, process, and act upon information. #executivefunction #adhd #adhdkcteen

Setting expectations

I’m asked all the time how to set expectations with kids, especially those with ADHD.

It’s understandably difficult to parent when your child, who otherwise looks and acts like kids of the same age, doesn’t have the same abilities in areas of focus, organizing, prioritizing, completing tasks, and self care issues.

Visible differences are easy to spot

When kids look different due to a genetic or physical condition, it’s easy to see what accommodations are needed.

If a child has an obvious trait that makes it difficult to do a task, we modify our expectations. A wheelchair bound child would never be expected to run upstairs to grab something.

Invisible differences still exist

For those who look “normal” but are neurodevelopmentally different, it’s easy to fall into the trap of setting an expectation based on the typical expectation for their age, not their level of development.

A child who has problems with working memory might also struggle to run upstairs to grab something. It’s not a form of defiance when they go upstairs and forget what they’re supposed to be getting or when they don’t return because they get distracted by something else.

Many kids are simply not there yet.

They can’t act their age because that part of their brain is not at that stage.

Most will get there, but it takes them longer.

Set appropriate expectations, and when they struggle, show patience and help them learn. This is much more effective than setting the bar too high, resulting in punishments and anger.

Delays of executive functioning

Dr. Richard Barkley has shown that kids tend to develop executive functioning skills about 30% slower than neurotypical peers. This adds up to about 3-5 years at most ages.

This might mean that your 12 year old might struggle doing what another 12 year old has already mastered. They might only be able to handle things expected of an 8 year old.

Set expectations according to skills, not age

The single tip that helps de-stress parenting more than any other that I’ve heard is to adjust expectations by skill.

Chronologic age is less important when deciding what a child is capable of and what they’re ready to learn.

this doesn’t mean letting them get by with anything…

As a child grows, you will watch their successes and failures.

You learn what they can and cannot handle. Help them with the things they cannot do while letting them do as much as they can.

SEt expectations and supports

One child can be expected to get dressed and brush teeth without reminders.

Another child of the same age will need a chart listing all the routine things that need to be done.

And yet another child of the same age may need reminders to look at the chart.

All of these same age kids can be smart and have good intentions, but they need different levels of reminders.

Recommended Video

I recommend this video to parents often. It shows very clearly what it means to parent a child who is delayed in executive functioning. Parents of kids with ADHD will most likely identify with it.

Top 10 Quest for Health KC posts of 2018

Have you read all of the most popular 2018 posts from Quest for Health KC?

At the end of the year I like to take a look at which posts were popular to help identify what I should write about in the next year. It also gives me the opportunity to share with readers all the best posts they might have missed along the way.

10. Help! I’m sick and I have a baby at home!

Parenting is a tough job, even when you’re not sick. When you have an infant and you’re sick, not only do you have extra sleep needs, but you have to try to keep your baby healthy despite being around your germs. What can you do when you’re sick with a baby at home?

9. Top 10 reasons a child or teen is tired.

We all know the jokes about that teens sleep past noon, but the truth is they need to catch up on sleep deprivation. Learn the top 10 reasons a child or teen is tired.

8. Summer Penile Syndrome

During the summer months one of the most uncomfortable reasons I see boys is that their penis and/or scrotum is swollen significantly. Learn what Summer Penile Syndrome is and what to do about it.

7. Dark Under Eye Circles

When kids have circles under their eyes, parents worry that something’s wrong. Sometimes there’s a treatable reason, sometimes not. Learn all the most common causes of under eye circles and what to do about them.

6. The flu shot doesn’t work

I’m pro-vaccine, so this title might surprise you. I hear the argument that the flu shot doesn’t work so often that it deserves to be addressed.

5. Flu Season Fears: What should you do?

Every flu season as we start to hear reports of kids dying from influenza the fear surfaces. This was written during one of the worst outbreaks in recent history. Be protected against each flu’s season fear with a flu vaccine and healthy habits!

4. Antibiotic Allergy or Just a Rash?

We see rashes all the time when kids are on antibiotics, but thankfully most do not mean a child is allergic. Learn when to suspect antibiotic allergy versus just a rash.

3. Lip Licker’s Dermatitis

When saliva gets on our skin, it breaks it down. Licking the lips leads to increased cracking and bleeding. Some kids have a wide ring of dry skin around their mouth from lip licker’s dermatitis. Learn what you can do to help them heal their smile.

2. What happens if a vaccine booster is delayed?

There are many reasons that people fall behind on their vaccines. Some are intentional, some due to circumstance. Regardless of the cause, what happens if a vaccine booster is delayed?

1. Bumps, ridges, and soft spots on a baby’s head. When should you worry?

I wrote this because I hear concern about bumps, ridges, and soft spots on baby’s (and older kid’s) heads quite often. Learn when you should worry and when it’s okay.

What was your favorite?

I’m surprised at the popularity of a few of these and sad that some of my personal favorites didn’t make the list.

I wish more people would read what fever is so they worry less about a number. Learning the evolution of illness might also help parents understand why exam findings are different on different days. I hear far too often that an ear infection was missed, but it’s more likely that they developed since the first exam.

I’ve also written a little on insurance and the business of medicine, but it doesn’t surprise me that those are not as popular. Sadly, we all need to understand the intricacies of billing and insurance as well as how the business of medicine works. As more and more private practice physicians sell out to large corporations, we’ll all feel the negative impacts.

Nosebleeds

Nosebleeds can look very scary, but they’re common and usually can be managed at home with a few simple measures. Learn what to do and when to worry.

Many of us remember having a lot of nosebleeds as children, yet they bring fear to parents when their kids have them. Why won’t it stop? Why are they getting so many? Is there a bleeding disorder? Does it need to be cauterized or packed? Most of the time a nosebleed is just that. A nosebleed. I had several myself this past week. I was staying in a hotel and I think the air was dry. Yes, they’re annoying, but not horrible.

What, why, and when?

Unfortunately, nosebleeds are common in kids — especially when they are sick or suffering from allergies (due to swollen nose tissues) or the air is dry.

Nosebleeds often happen at night, when the head is at the level of the heart.

They also start with a forceful blow of the nose, sneezing, or other things that cause sudden pressure in the nose. 

The part of the nose that commonly bleeds is the center part separating the nostrils. If you look carefully up the nose toward the center on both sides, you can often see blood vessels close to the surface. After a bleed you can often see the scab.

Trauma to the nose can cause bleeding higher up, but the most common bleed in kids is very close to the tip of the nose. 

For more causes of nosebleeds, check out Dr. Deborah Burton’s post 12 well-known causes of nasty nosebleeds in children.

Once it bleeds, it is likely to bleed again and again until the skin completely heals. Sometimes it is just a few specks of blood when the nose is blown, other times it is full-on bleeding that seems to keep going and going. 

When the nose is bleeding:

  • Sit or stand. Don’t lay down– that increases the pressure in the head, which increases the bleeding.
  • Don’t tilt the head back — that causes blood to go down the back of the throat. You can tilt it forward slightly.
  • Pinch the nostrils at the highest part the nose is soft (just below the hard part) with a tissue or cloth.
  • HOLD IT FOR 10 MINUTES. Do not peek. Do not check. Do not let go.
  • Seriously, don’t let go for 10 minutes. This is the step kids have a hard time with. One minute seems long. Ten is forever. Hold it for 10 minutes anyway.
  • Some people like to put an ice pack over the nose, but if you do this, still try to hold pressure on the nostrils. Put the ice pack on top of the nose, above your fingers that are holding pressure.
  • AFTER 10 minutes, gently remove the tissue or cloth. If it is still bleeding, hold for ANOTHER 10 minutes. Still don’t peek during this time.
  • If after the two 10 minute holds (20 minutes of pressure total) it is still bleeding, it is time to go to the doctor. If you haven’t tried a real 10 minutes of consistent pressure, that is what they will do first, so save yourself the trip and the money and HOLD IT FOR 10 minutes!

After the bleeding stops:

  • Do not blow the nose for 24 hours if possible to allow the skin to heal under the clot.
  • Add humidity to the air with a humidifier or vaporizer.
  • Do not pick the nose.
  • Add a lubricant to the nostrils. Use a cotton tipped applicator or a tissue. My kids loved the “Vaseline sword” — we put vaseline on the tip of a tissue and pulled it into a sword shape. We put the sword in the nose, plugged it from the outside, and pulled the sword down, coating the inside of the nose with the petrolatum jelly.
  • Treat allergies if needed to decrease the swelling in the nose tissues.

Remember that as long as there is a scab in the nose, it will re-bleed if the scab falls off before the skin completely heals underneath. Keep moisture in the air, the nostrils lubricated, and remind kids to not pick!

Most nosebleeds are simple nosebleeds, despite how scary they look!

Red flags (or things to see a doctor about):

  • Frequent nosebleeds that take 20 minutes of pressure to stop.
  • Bruises that are not explained by injury. (In general, any child with bruises all over the shins is normal. Think of areas that don’t often get bumped or hit — if they are bruising for no reason, that is more of a concern.)
  • Red or purple spots on your skin that don’t blanch with pressure. These are petechia and can be seen when there is a clotting problem.
  • Blood in the stool. While the most common cause of this is constipation, if you have multiple sites of bleeding, you should be evaluated by a doctor.
  • If you think your child stuck something up the nose that might have contributed to the bleed.
  • When trauma to the nose or face leads to the nosebleed, it should be checked out.
  • If your child seems pale, unusually tired or dizzy, or has unexplained weight loss or fevers.
  • Gums bleeding. This is commonly due to poor oral hygiene and gingivitis, but can be due to a clotting problem.
  • If your child takes any medications that thin the blood. (This is unusual in kids, more common in adults, but high doses of fish oil might increase bleeding risks.)

What do doctors do about nosebleeds?

  • Usually all that is needed is home treatment and I simply reassure the parent and child with the above information.
  • If there are frequent bleeds, I will sometimes recommend cauterization of the nose. This sounds scary, but it is a relatively easy procedure. One common method is using silver nitrate. It is applied to the areas where the blood vessels are close to the surface of the nose. In many people a single treatment is all that is needed. Some people require repeat treatments.
  • Treat any underlying allergy to control the nasal swelling.
  • If there is a family history of a bleeding disorder or signs of other bleeding (bruises or petechiae, rectal bleeding, gum bleeding, heavy menstrual bleeding) blood work can be done to see if there is a bleeding disorder.
  • When trauma is the cause of a nosebleed, we make sure there is no hematoma or broken bones.

Developing Responsibility and Resiliency in Our Children

Our goal as parents is to have our kids grow up with responsibility and resiliency so they can leave our home. How can we accomplish that?

As the years go by, I have seen very bright kids struggle with life and average intelligence kids thrive. I often think about how parents could help their kids grow into independent adults or hinder that growth by trying to be a good parent. Good intentions aren’t always the best way to do things, and sometimes the best parents sit back and let kids figure it out themselves. In the end, our goal as parents is to have our kids grow up with responsibility and resiliency so they can leave our home. Our desire to keep kids safe can seem to conflict with the need to let them grow up.

Is it safe?

So often parents attempt to keep their kids safe in the moment, but don’t consider what long the term implications are.

Parents want to keep their kids safe under their wings, at home or in a supervised activity. If their child is not directly in sight, they are at least within reach of a cell phone for immediate access.

Cell phone for “safety”

I often hear that parents buy a phone for their kids “for safety” purposes, but studies are showing the opposite. Cell phones lead to many dangerous situations for young kids and tweens. Smartphone use is associated with anxiety, depression, poor sleep, and more.

Bullying has always been a problem, but now it is more widespread. Kids can’t even escape in their own home due to social media.

Screen time takes away from playing outside, which contributes to obesity.

Smartphones also decrease the time spent interacting with people in real life and getting tasks accomplished. When kids spend excessive time communicating with their friends through apps, they miss out on real interactions that can help develop important social skills. Although it’s not a diagnosis yet, screen behaviors seem to be very addictive. Limiting time can become difficult when kids always carry a device.

Screens interfere with sleep. Sleep is critical to a growing brain and body, so sleep deprivation leads to many problems.

Inappropriate material is easily accessible online. Kids learn how to starve themselves and get encouragement for unhealthy behaviors. They share challenges that are very dangerous. Pornography and sex trafficking are huge issues.

Look into the Wait Until 8th movement for reasons to wait until 8th grade to give your child a smartphone. Gain support from other parents when your child says they’re the “only one” without one. Even teens recognize the problem.

Being out and about

If you never let your child visit a friend’s home or play outside, they will learn to be afraid outside their own home.

Many parents are afraid to let their kids walk to school. Realistically it’s a low risk that their child will become abducted, but a very real risk that the loss of exercise will impact their long-term health.

It’s rare in many neighborhoods to see kids outside playing. Some may be inside unable to go out because parents aren’t home. Others prefer to play video games. There are many at structured after school activities, which don’t allow for child-driven play and problem solving. If other kids aren’t out playing, the incentive for your kids isn’t there to go outside. It isn’t as fun to play alone. Talk to your neighbors to find times that their kids will be home and encourage outdoor fun at that time. This helps to build your neighborhood into a community!

Dr. Peter Gray shows how the decline of free play is directly correlated with dramatically increasing rates of anxiety, depression, suicide, and narcissism in children and adolescents. He discusses why free play is essential for children’s healthy social and emotional development. He also offers suggestions of how we can make this happen while keeping our kids safe. Take 15 minutes to watch it.

Playing sports

As Dr. Gray mentions, it’s the free play that seems to be important to help our kids develop resiliency.

Our kids consider sports their “play” time, but sports are directed by adults. Kids don’t learn what they need to learn about creativity, self motivation, problem solving, and all the other skills learned by kid-directed and kid-initiated play.

Overprotected kids

An article that I read years ago still resonates with me. The Overprotected Kid shows how parents try so hard to keep their kids safe that we sometimes prevent them from learning about real life.

The article is based on allowing kids to roam and play with things that haven’t been engineered to keep them safe. In our litigious society, that seems excessively dangerous to some. There are even stories of parents being turned into authorities for allowing their kids unsupervised time outside or even taking public transportation to school.

In my opinion, too many parents worry that kids aren’t safe when unsupervised. They forget what dangers lurk in too much supervision.

Where’s the right balance?

Building Snowmen from Snowflakes

Dr. Tim Elmore is a recognized speaker and author who focuses on building the next generation. Here’s an excerpt from his post, How to Build Snowmen from a Snowflake Generation:

Too often, our young give up due to “learned helplessness.” This happens, however, in both a surprising and sinister fashion. It’s all about control. Studies reveal that when the activities in their day are controlled by adults (and hence, not in their control), both their angst and hopelessness rise. The more we govern and prescribe the agenda, the less they feel hopeful and the more they feel helpless.

Further, learned helplessness promotes irresponsibility. Kids feel little responsibility to work because it’s “not up to them.” I believe most middle class students assume that if they make a mistake, some adult will swoop in and rescue them. While this may feel good, it hinders development. Feeling that outcomes are in their control gives them a greater sense of hope and ownership.

Established generations must slowly encourage and even insist on giving them control of the “agenda.” This is the only way to build ownership, engagement and responsibility. It requires trust and flexibility, since young people may not perform to our standards. We must decide what we want most: perfection or growth.

He goes on to say:
What message do you suppose it sends a student when the adults in his life continue to swoop in and save him whenever something goes wrong? While it may feel good at first, it communicates: “We don’t think you have it in you to solve this problem. You need an adult to help you.” Consequently, these young people don’t feel like adults themselves until somewhere between ages 26-29. They can remain on their parents’ insurance policy until age 26. In one survey, young adults reported they believe adult-life begins with “having their first child.” Today, this doesn’t happen until long after 18 years old. So while we give them the right to vote, they may have no concept of reality. Rights without responsibilities creates virtual adults and often, spoiled brats.
Teaching children responsibility is like teaching them to ride a bike. Offer less support and finally let go.

Growth Mindset

Did you know that success is not determined by intelligence? Our mindset, grit, and resilience are more predictive of success.

The good news is that we can all learn to have a growth mindset, which is a great start to becoming resilient. See my sister blog for more information on How to Get a Growth Mindset.

Success is correlated with a growth mindset more than intelligence. So how do you get it? It's not as difficult as you might think.
How to get a growth mindset.

Don’t withhold recess!!!

Play is an important part of every child’s day. Recess should never be held for behavior modification. Chris Dendy shares important facts in this post.

I’m amazed at the number of parents who tell me that their child misses recess to finish homework or as a consequence for inappropriate behavior. It seems counterintuitive to restrict play when kids are unfocused or behaving out of line. We now have a lot of research on how kids with ADHD don’t respond to typical behavioral modifications. It’s not really a choice for them to do the behaviors they’re doing, so trying to offer recess as a reward just doesn’t work. With all this accumulated research, it’s surprising that some schools and teachers continue to support restricting recess.

Today’s blog is from Chris Dendy, an expert on ADHD. She is an acclaimed author and speaker. Chris has worked as a classroom teacher, school psychologist and mental health counselor. She’s worked as local and state level mental health administrator, has been a lobbyist and has served as executive director of a statewide mental health advocacy organization and as a national mental health consultant on children’s issues. Her Facebook post below shows the importance of recess.

I have edited her original post to make headlines more visible, but I did not change the content at all. See her original post linked at the bottom of this page.

BOTH AAP & CDC STRESS THE IMPORTANCE OF PLAY

EVERYONE SUFFERS WHEN YOU WITHHOLD RECESS:

When recess is withheld as a punishment for misbehavior or incomplete academic work, both teachers and children suffer. Teachers who know their research never withhold recess and here’s one key reason why:
“misbehavior is higher on days when children with ADHD don’t have recess.”

CHILDREN’S BRAINS WORK BETTER AFTER EXERCISE:

After exercising, students show improved attention, retention of information, working memory, mood and social skills. School officials also report a reduction in school suspensions. Students with better fitness levels earn higher scores on academic achievement tests.

EXERCISE GROWS NEW BRAIN CELLS:

Interestingly, John Ratey, M.D. a well-known psychiatrist, describes exercise as “Miracle-gro” for the brain because it actually builds new neurotransmitters and increases blood flow to the brain. The author of How the Brain Learns, Dr. David Sousa, explains that “down time” is needed to allow the brain to recharge and process new information. Recess provides this much needed recharging time.

IF A STUDENT IS CONSTANTLY MISSING RECESS, LOOK FOR UNIDENTIFIED LEARNING PROBLEMS:

One of the most common reasons for keeping students in during recess is to complete unfinished work. Instead of withholding this important activity, educators must determine the underlying reason for the failure to finish the classwork and implement a preventive strategy: utilize positive interventions instead of punishment!

For example, the culprit may be deficits in executive skills including inattention, difficulty getting started, or slow processing speed. Secondly, many students with ADHD have trouble getting started on their work and must be given an external prompt to start working. Finally, twenty-eight percent of children with ADD inattentive have slow processing speed. Children who struggle with this slow processing should be provided shorter assignments and/or extended time.

Unfortunately, researchers report that many of our children are on doses of medication that are too low for peak academic performance. Even though they are on medication, students with low medication doses will have problems paying attention and working efficiently. Teacher rating scales of classroom performance are available that reflect how well medication is working.

INCREASE MOVEMENT THROUGH “IN-HOUSE FIELD TRIPS:

Veteran teacher Jackie Minniti, suggests giving “in-house field trips” to allow increased movement and subsequent increased blood flow to the brain: for instance, give out supplies, close the door, take a note to the teacher across the hall that simply says, “Hi”, and then the student returns to his class. Doing jumping jacks or dancing to music in the classroom can be very helpful. Minniti’s positive incentives include rewarding timely work completion with five minutes extra recess time or giving stars on a chart toward a class pizza party.

FIND VOICE OF REASON AT SCHOOL OR ASK YOUR DOCTOR OR PSYCHOLOGIST TO WRITE A STATEMENT SAYING RECESS SHOULD NOT BE WITHHELD.

If you have a reasonable teacher, talk with her about trying these positive intervention strategies first instead of punishment. If you think the teacher will not be receptive to your suggestions, then consider getting a note from your physician stating that your child must have recess each day. The next step will be to ask that deficits in executive skills and the need for recess be addressed in an IEP or Section 504 plan. If the teacher fails to comply with these requirements in the IEP, you will have to approach the guidance counselor, special education coordinator, or principal for assistance.

THE CENTER FOR DISEASE CONTROL (CDC) STATES THAT RECESS SHOULD NOT BE WITHHELD AS PUNISHMENT:

Because of growing concerns about obesity and other chronic diseases, Congress passed the “Healthy, Hunger-Free Kids Act” in 2010 that resulted in the Centers for Disease Control in Atlanta developing guidelines in several areas including recess.
Each local school system that has a National School Lunch Program must develop a school wellness policy to address Congressional concerns. The CDC expressly states, “Schools should not use physical activity as punishment or withhold opportunities for physical activity as a form of punishment.” Exclusion from recess for bad behavior in a classroom (including incomplete academic work) “deprives students of physical activity experiences that benefit health and can contribute toward improved behavior in the classroom.”

AMERICAN ACADEMY OF PEDIATRICS (AAP) STATES UNSTRUCTURED FREE PLAY IS CRITICAL:

Here are highlights adapted from their policy statement.

1. Eliminating recess may be counterproductive to academic achievement. Recess promotes not only physical health and social development but also cognitive performance.
2. Creative supporting free play as a fundamental component of a child’s
normal growth and development.
3. Recess is a necessary break in the day for optimizing a child’s social,
emotional, physical, and cognitive development.
4. Recess may help provide the recommended 60 minutes of moderate to vigorous activity per day to fight against obesity.
5. Recess offers the opportunity to build lifelong skills required for communication, negotiation, cooperation, sharing, problem solving.

Updated from Dr. Dendy’s original article published in ADDitude magazine.

For more information:

From the AAP: The Crucial Role of Recess in School

Homework Battle Plan: Prepare Now!

Any parent with school aged children knows that homework can be a battle. Even good students can procrastinate, prefer to play, or have practice after school, leaving little time for homework.  Then there are the kids who struggle…

Student Responsibility

We all know that kids need help with homework. Sometimes parents help too much. Kindergarten projects should not look professionally done. Even when kids hate doing the work, they need to do it. If they cannot, you need to talk to the teacher to get the work scaled to what they can accomplish. Don’t do it for them.

Step back, one step at a time.

As kids get older, parents should offer less and less help.

It makes sense that young elementary school students will need help learning to organize their things and plan the appropriate amount of time to complete homework and projects.

If they are not asked to assume more responsibility over the years, many will never take over the tasks that they can be capable of doing.

The goal is that by the later half of high school teens can organize their work, schedule their time efficiently, and get it done without reminders. I know that sounds impossible for many kids, but if your senior is still needing you to nudge daily for homework, they will not survive when they leave home. Mommy isn’t there to remind anymore.

I’ve written before about what kids need to know to leave the nest if you want to think about all the things they need to be responsible to do.

How can you help your kids with homework without letting it become your problem? 

I am a firm believer that kids are the students, not the parents.

Kids need to eventually take ownership of their homework and all other aspects of school. Of course, for many kids this is easier said than done, but I hear all too often of college kids who have Mommy call the Professor to question a grade.

That is totally unacceptable.

Kids need to practice ownership from early on. Parents need to guide always, but manage less and less as the kids grow.

Not every solution comes from a cookie cutter mold. Kids have different personalities and abilities.

You know your kids best. Think how they work and what makes them tick.

All kids need the basics

Many parents underestimate the problem with missing out on basics: sleep, nutrition, and exercise.

If kids don’t get the amount of sleep they need, healthy foods, and regular exercise, they will not be as successful academically.

After school have a set time for kids to eat a healthy snack and get a bit of exercise. Both help make homework time more productive!

I have blogged on this previously on this site and on a teen site about developing self confidence. I really feel that finding balance is important for everyone for mental and physical health and success.

Find the right solution

Kids have different problems with homework at different times, and they each deserve their own solutions. 

Not one of these “types” fits every child perfectly.

Most kids have more than one of these qualities, but tend to fit into one type best.

Procrastination:

There is always something more fun to do than work.  Kids will put off overwhelming tasks or big projects because, well, there’s a lot to do.

Don’t just ask what homework they have due tomorrow, but also if there are any big projects due in the near or later future. See if they can estimate how much time it will take to do the project and help them plan how much to do each night to get it done on time.

Breaking big assignments or long worksheets into small pieces with short breaks in between can help kids focus. Use a timer for breaks or do a fun quick activity, like silly dance to one song.

Allow kids to have some “down” time after school for a healthy snack (brain food) and to run off energy. Limit this time with a timer to 30 minutes or so. The timer helps kids know there is an end point to the fun, and then it’s time for work. Play can resume when work is done correctly.

For more procrastination avoidance tips, visit Finish Tasks. It was written for teens, but has tips anyone can use!

Poor Self Confidence:

Kids who are afraid they won’t understand their homework might fear even starting.

They might blame the teacher for not teaching it correctly.

Some might complain that they are stupid or everyone else is smarter.

They blame the class for being too loud, causing distraction and therefore more homework.

Or they might complain of chronic headaches or belly aches due to anxiety.

All of these are problems with a fixed mindset. Many kids suffer from the negativity of a fixed mindset, but you can help them learn to have a growth mindset.

Praise kids when they do things right and when they give a good try, even if they have an incorrect answer. Praising effort builds their resilience and growth mindset. If you focus on the outcome, they develop a fixed mindset, which is associated with less success overall.

Be honest, but try to think of something positive to tell them each day. When they don’t meet expectations, first see if they can see the mistake and find a solution themselves.  Guide without giving the solution. Then praise the effort!

Find their strengths and allow them to follow those. If they are poor in math but love art, keep art materials at home and display their projects with pride. Consider an art class.

Remember to budget time. Over scheduling can result in anxiety, contributing to the problems.

Perfectionist:

While the desire to do everything right has its benefits, it can cause a lot of anxiety in kids. These kids think through things so much that they can’t complete the task. See also the “poor self confidence” section above, because these kids are at risk for feeling they are failures if they don’t get a 100% on everything. They can have melt downs if the directions don’t make sense or if they have a lot of work to do.

Help with organization

Help your child learn organizational techniques, such as write down assignments and estimate time to do each project. Plan how much time to spend each day on big projects and limit to that time. Help them review their progress in the middle of big projects to see if they are on track. If not, have them establish another calendar and learn to review why they are behind.

Watch for self-blame

Watch for self-blame when things don’t go well. Is it because one step took longer than projected, they were invited to a movie and skipped a day, they got sick and were not able to work… This helps plan the next project and builds on planning skills. Use failures as growing experiences, not something to regret!

Build self confidence

Remember to give attention and praise for just being your kid. These kids feel pressure to succeed, but they need to remember that they are loved unconditionally.

If you notice they have an incorrect answer,  state “that isn’t quite right. Is there another way to approach the problem?”

Not everything is about the grade. Praise the effort they put into all they do, not the end point. Make positive comments on other attributes: a funny thing they said, how they helped a younger child, how they showed concern for someone who was hurt.

Leave the comfort zone

Encourage them to try something new that is outside their talent. Not only are they exploring life, but they are developing new skills, and learning to be humble if they aren’t the best at this activity. Help them praise others. Model this behavior in your own life.  

Co-dependence:

Helicopter parenting is a term often used to describe the parent hovering over the child in everything they do. This does not allow a child to learn from failing. It does not allow a child to grow into independence.

It involves the parent “owning” the homework. These kids call home when they leave the homework or lunch on the kitchen table for Mommy to bring it to school. They often grow up blaming everyone when things don’t go their way and Mommy can’t fix it. These kids don’t learn to stand up for themselves. They seem constantly immature with life situations.

Slowly give over ownership

Young children need more guidance, but gradually decrease this as they get older. Teachers can help guide you on age appropriate needs. There are kids who need more help than their peers. For example, kids with ADHD are often 3-5 years behind their peers in skills that involve executive functioning. Your 10 year old with ADHD might need the support typically given to 5-8 year olds, but that does not mean they should rely on you to the same degree year after year. They must also continue to grow.

Most parents must sign a planner of younger kids, but as kids get older the kids become more responsible for knowing what the homework is. Many schools now have websites that parents can check homework assignments, but be sure the kids own the task of knowing what is due too.

Have a place that children can work on homework without distraction (tv, kids playing, etc).

Advise, but don’t do it

Be available to answer questions, but don’t do the work for them. If they need help, find another way to ask the question that might help them see the solution. Get a piece of scrap paper that they can try to work through the problem. If they have problems with reading comprehension, have them read a few lines then summarize to you what they read.  They can take notes on their summary, then read the notes after the entire chapter to get a full summary.

Busy, busy, busy:

Some kids are really busy with after school activities, others just rush through homework to get it done so they can play.

Set limits on screen time

Set limits on how much screen time (tv, video games, computer time) kids can have each week day and week end.

If they know they can’t have more than 30 minutes of screen time, they are less likely to rush through homework to get to the tv or computer.

It used to be recommended no more than 10 hours a week for screen time, but newer guidelines are more flexible. This is because the quality of screen time can vary considerably and it is constantly changing. Many kids require screen time for homework.

The big thing is that kids need balance. They should still have the opportunity to play with friends in real life. Kids need exercise. They should learn to problem solve through interactions with friends. Too many hours on a screen diminish the time with real people and in active play.

Do it right

Ask kids to double check their work and then give to you to double check if you know they make careless mistakes.

Don’t correct the mistakes, but kindly point them out and ask if they can find a better answer.

Once they learn that they have to sit at the homework station until all the work is done correctly, they might not be so quick to rush.

Avoid overscheduling

If kids have after school activities the time allowed for home work and down time are affected. Avoid over scheduling, especially in elementary school.

Be sure they have time for homework, sleep, healthy meals, and free time in addition to their activities.  

Are the activities really so important that they should interfere with the basic needs of the child? Is the child mature enough to handle the work load?

It is generally recommended to allow kids to do up to their age in number of hours of extra curricular activities. A 10 year old can do up to 10 hours of extra curriculars per week. This means they really shouldn’t take dance class 3 hours a day 4 days a week. That’s too many hours. And remember it all adds up: sports, music lessons, scouts – don’t over schedule!

When they can’t sit still

Kids who are in constant motion can’t seem to sit still long enough to do homework. Be sure they have the proper balance of sleep, nutrition, and exercise or all else will fail.

Praise their efforts when they are successful.

Schedule breaks

Set a timer after school to let them play hard for 30 minutes, but then make them get work done.

Help little ones organize what needs to be done and break homework into several smaller jobs.

Set regular 5 minute breaks every 30 minutes so they can release energy. Set a timer to remind them to get back to work and compliment them when they get back on task.

For more organization tips, see this blog on finishing tasks..

Don’t require sitting still

Some kids do better staying focused if they can stand to work. If you have a table, counter or desk that fits their height when standing, let them use it. When standing helps, try to problem solve places that they can do it to help with productivity!

If your kids need movement, let them wiggle. Kicking the legs or constant wiggling helps some kids.

Fidget items can help, so let your child use them as long as they don’t become a play item that distracts.

If you have an exercise ball, let them sit on it. No ball? Try a pillow on a chair.

Time matters

If kids wait to do homework until evening hours, it might not be as productive and it can interfere with getting to sleep.

When we’re tired, we don’t stay as focused, so everything takes longer. We constantly need to refocus. We don’t learn as well, so studying is less effective.

If homework requires getting on a computer or tablet, the light exposure suppresses the melatonin level. Melatonin is needed to feel tired and go to sleep. If kids are on a screen too close to bedtime, they will struggle to fall asleep. Try to get them to do all work that requires a computer done first. Ideally all screens will be off at least 1-2 hours of bedtime.

I see far too many teens who stay up far to late studying. They need to find a way to start homework earlier if at all possible. I know this is difficult with work and extracurricular schedules, but that brings us back to avoiding over scheduling…

Kids with ADHD

Timing matters even more if kids need medicine to help them stay focused. Don’t let them try to do homework after medicine wears off.

They’re not focused and a little homework takes a long time, which is frustrating to the child. They also won’t retain as much information they’re studying and they’re more likely to make silly mistakes or have unreadable handwriting. If the medicine doesn’t last late enough in the day, talk to your child’s doctor.

Struggling despite help:

There are many reasons kids struggle academically.  Reasons vary, such as behavior problems, anxiety, illness, learning disabilities, bullying, and more.

Work with the teacher

If they are struggling academically, talk with the teacher to see if there are any areas that can be worked on in class or with extra help at school.

Can the teacher offer suggestions for what to work on at home?

Talk to your child’s physician

If kids have chronic pains or school avoidance, ask what is going on.

Depression and anxiety aren’t obvious and can have vague symptoms that are different than adult symptoms.

Bullying can lead to many consequences, and many kids suffer in silence.

If your child won’t talk to you, consider a trained counselor.

Talk with your pediatrician if your child is struggling academically despite resource help at school or if he suffers from chronic headaches or tummy aches. Treating the underlying illness and ruling out medical causes of pain is important. Depression, anxiety, ADHD, and other learning disorders can be difficult to identify, but with proper diagnosis and treatment, these kids can really succeed and improve their self confidence!

Will Standing Hurt a Baby’s Feet or Legs?

“Will standing hurt my baby’s legs?”

I’m surprised how often I’m asked if having a baby “stand” on a parent’s lap will make them bow-legged or otherwise hurt them. Standing and jumping while being held and supported is a natural thing babies do, so why do so many parents worry if standing will cause bow legs or other problems?

Old Wives Tales are ingrained in our societies and because they are shared by people we trust, they are often never questioned.

Bowed legs from allowing babies to stand with support is one of those tales.

If an adult holds a baby under the arms and supports the trunk to allow the baby to bear weight on his legs, it will not harm the baby.

Many babies love this position and will bounce on your leg. It allows them to be upright and see the room around them.

Supported standing can help build strong trunk muscles.

Other ways to build strong muscles in infants:

Tummy time

tummy time, prevent flat heads
Supervise tummy time when Baby’s awake!

This is a simple as it sounds. Place your baby on his or her tummy. Be sure s/he’s on a flat surface that is not too soft.

I think the earlier you start this, the better it’s tolerated. You can even do it before your newborn’s umbilical cord stump falls off!

Initially babies will not lift their head well, so be sure they don’t spend too much time face down. This can cause problems with their breathing. A brief time doing this is safe though as long as they aren’t laying on fluffy stuff. This is a major reason to never leave your baby alone on his stomach.

Use this as a play time.

Move brightly colored or noisy objects in front of your baby’s head to encourage your baby to look up at it. Older siblings love to lay on the floor and play with “their” baby this way!

Many babies will look like they’re taking off trying to fly. Others will put their hands down and look like they’re doing push ups. Around  4 months they can support their upper body weight on their elbows. All of these are good for building muscles.

Parents often avoid tummy time because their babies hate it. It’s hard to hear babies cry, I know. You can progressively make it harder for your baby without being a mean drill sergeant! Increase the time on their tummy as they gain strength. Start with just a minute or two several times a day. If you never do it, they’ll never get better.

Bonus: Tummy time helps to prevent flat heads!

Chest to chest:

From day one babies held upright against a parent’s chest will start to lift their heads briefly. You will most likely go to this position to burp your baby sometimes.

The more babies hold their head up, the stronger the neck muscles get. Chest to chest isn’t as effective as floor tummy time for muscle strength development, but it’s a great cuddle activity!

The more reclined you are, the more they work. Think of yourself doing push ups. If you do push ups against the wall, it’s pretty easy. If you put your hands on a chair, they get a little harder. Then if you put hands and feet on the floor, they’re even harder. Lift your feet onto a higher surface and it’s even harder.

Chest to chest time can be an easy version of tummy time, but I don’t want it to replace tummy time completely. Make time for both each day!

Lifting gently:

When your baby is able to grasp your fingers with both hands from a laying position, gently lift baby’s head and back off the surface. This can usually start around 6 weeks of age.

Babies will get stronger neck muscles by lifting their head and strong abdominal muscles by tightening their abs even though you’re doing most of the lifting. You could call these baby sit ups!

Be careful to not make sudden jerks and to not allow the baby to fall back too fast.

Kicking:

Place your baby on his back with things to kick near his or her feet.

Things that make a noise or light up when kicked make kicking fun!

You can also give gentle resistance to baby’s kicks with your hand to build leg muscles.

Bicycling:

When you ride a bike, you get exercise, You can help your newborn stretch and strengthen leg muscles by making the bicycle motion with his or her legs.

When babies are first born they are often stiff from being in the womb. They will learn to stretch their legs, but you can help by moving them in a bicycle pattern. They usually find this to be great fun!

I also suggest doing this after they get their first few vaccines to help with muscle soreness, much like you move your arm around after getting shots. Generally by 4 months, babies kick enough that they can do this on their own.

Sitting:

Allow your baby to sit on your lap or on the floor with less and less support from you.

You can start this when your baby has enough head and trunk control to not bop around constantly when you hold him or her upright for burping. Don’t wait until 6 months to start – by this age some babies can already sit for brief periods alone if they were given the opportunity to practice when younger.

A safe easy position is with the parent on the floor with legs in a “V” and baby at the bottom of the “V” – this offers protection from falling right, left, and back.

When your baby is fairly stable, you can put pillows behind him or her and supervise independent sitting. Never leave babies unattended sitting at this stage.

Big benefits

“Will standing hurt my baby’s legs?” is the wrong question.

Parents should ask more about what you can do to help your baby develop strong muscles. Standing with proper support is not only safe, but also beneficial!

What are your favorite activities to help your baby grow and develop strong muscles?
Will standing hurt a baby's feet and legs? What about hips?

Can I talk to you privately?

Every once in a while a parent will tell the nurse that they want the child out of the room to discuss an issue with the doctor privately. This is usually something they perceive as a negative thing for the child to hear. Some of the most common concerns are about the child’s weight or behaviors. Sometimes it relates to a change in the family dynamics, such as divorce or a parent having a significant illness.

Secrets should never be kept…

While I understand the parent’s intentions, I find this to be disruptive and counter productive. As much as I try to find an excuse to have a child leave, it is usually obvious that the nurse keeps them out longer than needed.

If we have the child leave the room, he knows something is up. We are talking about him.

But not sharing with him.

What could possibly be so bad that we won’t talk to him about it?

How do you feel when you suspect people are talking about you?

When people talk secretively it hurts.
When people talk secretively it hurts.

And we should always live by example.

I teach kids from early on that there should be no secrets in families.

Why then should parents and doctors keep things from the child?

That doesn’t mean kids need to know everything.

We all know that as adults that we do shield our kids from things.

Kids do not need to know our financial worries. We can teach them financial responsibility without increasing their anxieties.

They do not need the burden of knowing about extramarital affairs. If there are problems in a relationship, they will know there are problems, but they do not need to know details.

I don’t think that kids need to know everything, but that doesn’t mean that we should make it obvious that we’re hiding something. Especially when it pertains to them.

What does the child know?

Any patient needs to know what the issues are so they can be addressed. This includes most kids.

My guess is most of these kids already know what the concerns are.

They may need help working on the concern or help adjusting to the home life situation.

If they are overweight, we need to talk about what they eat, how they exercise, and how they sleep.

When there are behavior problems, they need to give insight into how they feel and what leads to the behaviors.

Regardless of the issue, they need to be a part of the plan to fix the problems. If they aren’t on board, they won’t change their habits. I can talk about weight (or behavior, or drugs, or whatever the concern is) sensitively and in an age appropriate manner with the child. The kids at school are likely talking about it in a not-so-sensitive manner, so it’s best to not make it worse by secretly discussing it.

What if it really needs to be said?

If a parent really wants to let a physician know specific points without the child present, there are ways to do that without making the child feel left out.

  • Send in a letter or secure electronic message with your concerns before the appointment. Be sure it’s at least a few days before the appointment so the doctor has a chance to review it!
  • Schedule a consult appointment for just parents to come in without the child.
  • Call in advance to note your concerns so the physician can address it as needed during the visit.
  • Slip a note in with all the paperwork you’re turning in during check in so the physician can read it before coming into the room. Be sure whoever you give it to realizes it’s included with the standard paperwork so they can pass it on.
  • Don’t bring siblings to an appointment where you want to discuss a private matter with your child.
All of these help the physician know your concerns without blatantly kicking a child out to talk about something privately.

Your child will appreciate it.

Teens at the doctor’s office: developing independence

Teens are at a time of life that they need to develop independence. They need to master several things before leaving the nest, such as how to manage time, cook a simple but healthy meal, do simple home repairs, spend and save money wisely, and how to live with healthy habits. Allowing them to grow more independent with each passing year can help prepare them for life on their own. This includes letting them take charge of their healthcare in late teen years.

Independence at the doctor’s office

One important skill includes relying less on parents when they’re at the doctor’s office.

You don’t want them to show up at another health clinic for treatment without knowledge of their medical history. This is especially true for chronic issues, medications and drug allergies. Let them help fill out the paperwork and answer the questions from the nurse and doctor.

Teens need to learn how to summarize their concerns so the doctor can make a proper assessment. If parents do all the talking, they don’t learn how to do it themselves.

Questions, questions, questions!

Most parents have the best interest for their children at heart when they answer questions and want to be in the room for their teen’s visit. But if you really want to help them, it’s best to let them take more responsibility each year.

As kids get older, they should take more responsibility filling out forms and answering questions. They should even have an opportunity to spend time alone asking private questions.

Parents speak up then sit back.

We certainly want to hear parental concerns, but a teen should be allowed to do most of the talking. Over time this allows them to eventually visit a physician alone competently.

They will then be able to take care of their health when they move away from home and establish care with an adult doctor.

If they don’t know their medical history, current medications, allergies, or simply how to talk to a medical provider, they won’t be able to take care of themselves.

You won’t realize how much they don’t know unless they try to handle it themselves.

Let them fill out forms and ask if they need your help. You’ll learn what they don’t know and you can inform them as well as find a place for them to store that information for next time.

Privacy.

As kids get older, they need some time alone with the doctor at least yearly.

Even if they have nothing to hide, it’s a good idea to allow teens some private time alone with the physician. This allows them to develop a trusting relationship with the doctor. If something personal and private does develop, they are comfortable talking with that physician. This is one reason I strongly encourage a well visit once a year with the same person as much as possible. Routine visits allow a healthy doctor- patient trust to develop.

It’s hard as a parent to not know everything that your child talks to their doctor about. I know – I have two teens. And to complicate things, I work in the same office as their physician. I never ask her about my own kids unless I’m still in the room with them. I trust that she will take care of my kids and help to direct them into healthy healthcare decisions.

Teens should understand that they can talk to their physician openly without fear of judgement. While it is possible that the physician might ask to share the information, they usually will not if the teen does not allow it. Teens should be aware when the confidentiality will stand and when a physician must share their concerns. Most physicians will attempt to maintain the trust of a teen so that they will continue to discuss difficult health concerns. If the physician is afraid that the teen is at risk of being hurt or of hurting someone else, things change. We must ensure safety. This will mean other adults will learn of the issue, but the teen will be told first.

“But I’m the parent. I have a right to know.”

Many parents feel this way, but the reality is the law protects a teen’s privacy. Even when the parent carries the insurance and pays the bills, teens have the right to privacy.

And for good reason.

The problem is that if our kids don’t feel confident that the doctor will maintain confidentiality, they will not tell us important things that can help us help them. If they’re afraid to say that they’ve started vaping or that they are considering becoming sexually active, we can’t help them make smart and safe choices.

If they hide symptoms of an illness, whether it’s a sexually transmitted disease or depression, they won’t get the help they need.

We need them to be able to tell us those things that they don’t want their parent to know. It’s not that we want them to do these things, but we need to be able to help them stay as safe and healthy as possible.

We want them to talk with you, and you can certainly foster that at home. They still need to be able to be completely open with their physician without  the threat of a breach of confidence.

Be careful of assumptions.

It is natural to fear the worst if your child wants to talk to the doctor privately, but in the majority of cases it’s all pretty benign stuff that they want to talk about.

You will of course get bills from the insurance company that might suggest certain diagnoses or tests. We cannot verify or deny why those charges occur.

Let kids start taking responsibility at the doctor's office, but don't make presumptions when they need privacy.
Don’t make presumptions…

Don’t assume your child is having sex just because a pregnancy or STD test is done. There are many criteria that flag when a teen should have testing. Remember that guidelines are developed to not miss situations, so they are broad. For instance, many girls will get a pregnancy test done before certain procedures, even if they deny being sexually active. This is because we know that some kids lie and we don’t want to put an unborn child at risk, so all girls of a certain age will be tested before the procedure.

Encouraging communication.

Despite the fact that I will maintain confidentiality as required, I usually attempt to talk teens into talking to their parents.

If the teen agrees to us telling their parent together, it usually ends up bringing them closer as a family. This requires that the parents are able to not judge or punish a child for his or her decisions.

Teens often feel uncomfortable discussing it initially, but once they know that parents know whatever it is, they are often relieved. If the parent accepts the situation without harsh judgement, even if they are disappointed in their child, they can learn to work on things together.

If the parent responds inappropriately, it can damage the relationship. As with anything, if you can’t say something supportive, don’t say anything other than, “thank you for sharing. I need some time to think.” Give yourself time to reflect what you learn and then prepare what you will say.

They still might make bad choices.

Even with confidential communication, teens still will make bad choices.

The teen brain is well known to be impulsive and to not recognize consequences. We all know good teens who make bad choices. Caring adults will attempt to help the teen make smarter choices, but no one can change a teens behavior except the teen.

Be sure your teens know that you love them unconditionally. This will help them feel more comfortable coming to you if they need to talk. Let them know your expectations for behavior. If they open up to you about problems or bad situations, listen without judgement and offer help and support where you can. Be supportive and help them find ways to bring about positive change. There can be negative consequences, such as taking away their phone or not being allowed to go to a party, but do not belittle them. Belittling shuts the door of communication and they might not open it again.

Legal issues.

We legally cannot tell a parent about these things under most circumstances. State laws vary, but unless we think a child is in danger or will harm someone else, we must maintain privacy.

We know that teens have not established independence from parents fully. Teens usually still live under your roof and must abide by your rules. Parents usually support teens financially. But teens also are legally protected to be able to talk about sexual health, their feelings, and more without concern that parents will be told what is discussed.

There are exceptions to this confidentiality, which varies by state law. Typically if the teen is being abused, is involved in non-consensual sex, is at risk of self harm or if they are at risk for hurting others, the physician must notify others.

Watch them grow…

Parenting has its challenges, but in the end most parents want their kids to be healthy, happy, productive members of society. In order for this to happen, they have to allow their kids to gain a little more independence and accept a little more responsibility each year.

Enjoy the times!

My child won’t eat!

I hear from worried parents often that their kids won’t eat. There are many reasons for this. Usually as long as a child is hydrated, gaining weight appropriately, and getting a variety of nutrients, I’m not worried.

Some reasons kids don’t eat:

They’re really getting enough food, parents just have unrealistic expectations.

This is very common.

Portion sizes are smaller than many parents think. They vary with age and size of a child as well as his activity level. If your child is growing well and has plenty of energy throughout the day, why should he eat more?

Kids tend to eat small meals frequently and even on holidays they don’t overeat like the adults tend to do.

When offering snacks, think of them as mini meals to help balance out the nutrients of the day. Don’t let them snack all day long though or they’ll never really be hungry.

Schedule meals and snacks and allow water in between.

We have an obesity epidemic in this country, so if you’re comparing your child to another child, chances are that your thin child is healthy and normal, but the other one is one of the 30% who is overweight.

Or maybe not.

It doesn’t matter. Just be sure your child is getting a proper variety of nutrients. Parents can choose what foods are offered, but kids should determine how much to eat.

Talk to his doctor about growth at regularly scheduled well visits (more often if you’re concerned) to be sure it’s appropriate.

They’re sick and it’s temporary.

When kids are sick they lose their appetites.

This is normal.

It usually returns with a vengeance when they’re feeling better. They need to drink to stay hydrated and can eat what they feel up to it, but don’t force it. See their doctor if you’re worried.

It’s a new food and they just aren’t sure yet. 

I encourage that kids over 3 years old take one bite of a food.

Kids often hear me say, “taste a bite without a fight.” The bite needs to be enough that they taste it. If they like it, they can keep eating. If they don’t want more, resist trying to convince them to eat more.

Allowing them to take ownership of the decision of what to eat empowers them. Kids like power, right. Give it to them while modeling healthy eating behaviors yourself. They learn from what you do, not what you say — and not from what they’re forced to do.

When preparing a new dish, include familiar foods they like to balance out the meal so they can enjoy at least something on the plate.

They’re picky eaters.

Aren’t they all?

Most kids go through phases where they love a food, then they suddenly dislike it. They might dislike a certain texture or a whole food group. While there are kids with real problems eating, most picky eaters can be encouraged to eat a healthy variety of foods as described above.

Some children really suffer from being overly restrictive. Children with autism, sensory problems, food allergies, and other issues are not included in this “typical” picky eater category.

A great series of blogs on picky eaters (typical and more concerning) is found on Raise Healthy Eaters.

They’re more interested in something else. 

Make meals an event in itself.

Sit together and talk. Turn off the television. Put away your phone.

Have everyone focus on the meal, which includes the food and the conversation. Try to keep the conversation pleasant and not about the food. Take the pressure off eating!

They’ve filled up already.

If kids have access to snacks all day, they won’t be hungry for meals.

Make sure they have set meal and snack times, but no foods between. They’ll come to the table hungry if they haven’t snacked all day.

Some kids drink too much milk, juice, or other calorie-filled drinks. While it might seem that milk or juice are healthy, the reality is that they do not have a variety of nutrients that our kids need. Milk at least has protein, but it’s missing iron and other key nutrients. Juice is mostly sugar and really should be avoided. Don’t let your kids fill up on drinks.

When they’re hungry, they’re more likely to eat what’s offered.

A medicine makes them not hungry.

Some kids take medicines that decrease their appetite.

If your child is on one of these, their physician will need to follow their growth carefully, but it doesn’t automatically mean they shouldn’t take the medicine. Most kids can get the calories they need for healthy growth despite these medicines.

In summary…

In general, parents should choose what foods kids are offered so that there’s a balance of nutrients, but kids determine how much they eat.

If they’re hungry, they’ll eat. If they’re not hungry, they shouldn’t eat. Learning to eat when not hungry is something that causes many of us to struggle with weight. Most kids are able to limit intake to needs. Don’t force them to change that great quality!

If you’re worried about your child’s appetite, talk to your pediatrician. The physician will need to see your child to check the growth pattern and to examine him or her for signs of illness. Labs are usually not needed, but can be done if there are concerns for some medical conditions. Medicines are rarely used to stimulate the appetite.

For more, see my related blogs:

If your child doesn't eat as much as you think he should, check out this list of possible reasons.
If your child doesn’t eat as much as you think he should, check out this list of possible reasons.