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Give me a break (a summer break, that is)!

School is almost out and your child will soon be on his way to sleep away camp.  By the number of camp physicals I have been filling out recently, I can tell you that a lot of kids are sleeping away from home this summer.  Most are so excited that they are counting the number of days and hours until they leave.   And, believe it or not, their parents are excited, too.  A whole week, or two, or three without being a maid or chauffeur.  Only in my dreams!

Some kids, however, are a little less than enthusiastic.  Summer camp can be a great experience and most kids love it – but only when they are ready.  If your child really doesn’t want to go and has a hard time separating from you, he may not be ready yet.  And, as much as you would love to get a break, you may want to wait until next summer.  Remember that there is no law stating that your child must attend a sleep away camp before becoming an adult.  There are plenty of kids who never go to camp and, guess what?  They grow up to be wonderful, successful, adventurous adults!

However, before you throw away your much needed break this summer, there are some things you can do to make it more likely your less-than-willing child will want to go to camp and will end up loving it.  Below are a few things you can do to ease him into thinking about camp and making him feel less homesick if, in the end, everyone decides to give it a try.
·  Start by having him sleep over at a friend’s or relative’s house.
·  Invite a friend over who has been to sleep away camp and have him tell your child all about it
·  Look for a camp that doesn’t last too long and isn’t too far away from home.
·  Try to find  a friend or a sibling who wants to go with your child
·  Go visit the camp (if possible) and show your child where he will eat, sleep, and do various activities
·  Find a camp that has similar interests to your child’s
·  Send your child to camp with a special shirt, stuffed animal, or something else from home
·  Mail letters and packages early and often so your child knows you are thinking of him (you can even send one in advance so it is there the day your child arrives)

If and when he decides to go, chances are he will have a great time and want to go longer  next year (so be careful of what you wish for!)

When Eating Becomes Disordered

I was thumbing through the newspaper today while my teen was eating breakfast before school.  Watching her measure out a serving size of cereal “just for the fun of it” makes me a tad bit nervous, considering she doesn’t have an ounce of fat on her. I quickly searched for the health section – it gives me an idea of what my patients will ask about during the work day (such as the “swine” flu), and it can also be a good starting point for blog ideas.
The front page of the health section Tuesday had a picture and quote from a beautiful teen who had died of bulimia several years ago.  She looked familiar.  My eyes scanned down to the name below the quote, and upon recognizing the name, my eyes immediately welled with tears.  She had been my patient years ago, and I didn’t know she died.  She was a great, sweet, smart teen who was well aware of her bulimia and the possible consequences.  And she died.
At the very least, eating disorders can ruin their own lives and those of their families.  And they kill.  Although statistics vary based on the study, about 0.5% to 1% of teens and women in the United States have anorexia nervosa, an illness that involves significant weight loss and food refusal.  About  1% to 3% of young American women have bulimia, a condition that includes regular binging and purging.  Over 1 million males have an eating disorder and the numbers are climbing.  Eating disorders are difficult to treat, especially once a pattern has been established and it has become a “way of life.”  The earlier they are recognized, the more likely treatment will be successful.
These days, children have unrealistic expectations of what they should look like and how much they should weigh.  Think about it.   Their role models have changed dramatically over the past several decades.  Girls and teens are exposed to ultra-thin, beautiful women wherever they turn – on TV, in magazines, music videos, and  movies.   And if that weren’t enough, moms, aunts, sisters and other teens and adults they know talk about food all the time – about eating too much, counting their calories, watching their weight, feeling “fat.”  It’s no wonder that almost one-half of first through third grade girls want to be thinner and that over 80% of 10 year olds are afraid of being fat!
Our country’s obsession with food and it’s trickling down effect is readily apparent when we look at the results of the Youth Risk Behavior Survey for middle schoolers, a survey conducted in 10 states in 2005 (see end of blog) .  By 6th grade, almost half of the students surveyed were trying to lose weight (even though only 14 to 18% were actually overweight), 5 to 7% vomited or took laxatives due to weight concerns, and 10 to 20% didn’t eat for at least 24 hours because they wanted to lose or didn’t want to gain weight!  And we can’t forget that boys develop eating disorders, too.  They tend to be diagnosed later than girls, possibly because we aren’t expecting to see males develop these illnesses.
What can we do?  Society must take some responsibility for the large number of teens and adults with eating disorders.  Genetics appears to play a role also.  While these factors are out of our control, others are not.  First of all, we can build our children’s self-esteem and confidence with regards to their academic and moral aptitude, rather than their outer appearance.  We can make sure that we don’t discuss weight and eating around our children and that we act as good role models by eating well and maintaining a normal weight.  We can limit TV, movies, and fashion magazines in our home and spend time together as a family.  We can try to make our expectations for our children realistic and feasible.  We can watch our children and teens closely for signs of an eating disorder, particularly if they are involved in sports, such as ballet, gymnastics, and wrestling, which focus on specific body types.  And, if we are concerned about them, we can immediately make an appointment for them to be seen by their pediatrician and therapist to be weighed and to discuss any concerns.  I can assure you it won’t be a wasted visit, even if your child turns out to have a healthy weight and eating habits.  Don’t ignore signs of an eating disorder, as one of my patients did in the past.  Upon hearing that her daughter weighed a mere 70% of her ideal body weight, her mom said that she was fine and that she, too, had gone through a similar “phase” when she was a teen.  Eating disorders are real, and they kill.

Specific Results of the YRBS for Middle School Students

Across states, the percentage of students who were overweight ranged as follows:
• 6th grade: 14.4% to 18.7% (median: 18.6%)

• 7th grade: 10.0% to 15.8% (median: 14.0%)

• 8th grade: 8.0% to 14.9% (median: 13.0%)
Across states, the percentage of students who described themselves as slightly or very overweight ranged as follows:
• 6th grade: 19.6% to 26.7%
• 7th grade: 24.7% to 29.7%
• 8th grade: 24.2% to 29.7%
Trying to Lose Weight
Across states, the percentage of students who were trying to lose weight ranged as follows:
• 6th grade: 40.7% to 48.4% (median: 46.8%)
• 7th grade: 42.7% to 51.9% (median: 44.2%)
• 8th grade: 41.6% to 49.6% (median: 45.9%)
Ate Less Food to Lose Weight or to Keep From Gaining Weight
Across states, the percentage of students who ever ate less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weight ranged as follows:
• 6th grade: 35.0% to 47.9% (median: 41.4%)
• 7th grade: 39.1% to 47.5% (median: 41.6%)
• 8th grade: 41.1% to 47.5% (median: 46.6%)
Went Without Eating for 24 Hours or More to Lose Weight or to Keep From Gaining Weight
Across states, the percentage of students who ever went without eating for at least 24 hours to lose weight or to keep from gaining weight ranged as follows:
• 6th grade: 10.0% to 19.2% (median: 15.6%)
• 7th grade: 13.9% to 18.3% (median: 16.6%)
• 8th grade: 18.1% to 21.6% (median: 19.5%)
Vomited or Took Laxatives to Lose Weight or to Keep From Gaining Weight
Across states, the percentage of students who ever vomited or took laxatives to lose weight or to keep from gaining weight ranged as follows:
• 6th grade: 4.8% to 7.5% (median: 6.3%)
• 7th grade: 4.0% to 6.2% (median: 4.7%)
• 8th grade: 6.4% to 8.2% (median: 7.3%)

It’s not what you say – or even how you say it

Yesterday I was sure that I wasn’t going to talk “swine.”  Twelve hours ago I had almost, definitely decided on my topic.  And it wasn’t swine flu.  But sometime between then an hour ago, I changed my mind.  I’m allowed to do that.  It’s my blog.  And, guess what.  I changed it again.
I actually began to write about the swine flu but then took a break – for a very important reason.  My sister, daughter and I had to start decorating hats for friends and family members who will join us this weekend to participate in the brain tumor walk in Washington D.C.  Each year we form a team in memory of my husband, who died 4 years ago.  As I was about to start writing my “swine” blog again, a friend and fellow team member emailed me to make sure that I pick up a “yellow” shirt for her tomorrow instead of a white one (when I pick up team members’ shirts for them), indicating that she is a brain tumor survivor.
This weekend always marks the beginning of two weeks of intense emotions.  It begins with the brain tumor walk, moves onto the anniversary of my husband’s death in the Jewish calendar, then his birthday and, the day after that, the anniversary of his death in the common calendar.
This weekend also serves as a reminder of how important friends and family are. Each year I am amazed by the number of people who join me to celebrate my late-husband’s life and to support our family.  While my children have to carry the burden of their father’s death, they also have learned how important life is and how lucky they are that so many people care about them.
It is difficult to know what to say when somebody becomes terminally ill or when a family member dies.  What are the proper words?  For the most part, it is not the exact words that matter.   What does matter is that friends and family are there to show support.  Immediately – and a week later.  And 6 months later.  And 2 and even 4 years later.
Some of my friends began to check on my weekly after my husband died and, to this day, still check on me the same day of every week.  Others called me recently after a religious leader in my synagogue was diagnosed with the same type of tumor my husband had – because they wanted  to make sure I was doing OK.  Likewise, my daughters’ friends, who are now 5th graders, watch out for her.  When a classmate’s father recently died, it upset my daughter greatly.  That evening  I received several phone calls from her friends’ parents, who had heard she was very sad.  I also received a phone call from her guidance counselor, letting me know about the death and making sure my daughter was OK.
We have over 65 people walking with us this Sunday.  Our team is comprised of aunts, uncles, in-laws, and cousins.  It also include teachers, a principal, and an old patient of mine.  Plus, there are friends of my husband’s, good friends of mine who barely or never knew him and, of course, old and new friends of both of my daughters.  Some didn’t even know my daughters when their dad was alive.
I will keep my fingers crossed that most of the people walking this Sunday are accompanied by someone wearing a yellow shirt, rather than just a sea of white.

Important reminders for parents of newborns

A big part of pediatrics is what we call “anticipatory guidance” and preventive medicine.  This is where we get to impart our wisdom on parents, particularly the vulnerable, first-time ones.  For them, everything is new, exciting and, yes, anxiety provoking.  We hope that we can teach and guide them to raise medically and psychologically healthy children.  One of the first and most important things we can do is stress the importance of immunizing children on time.  I know – I have talked about this ad nauseum!!  But that is because when newborns, children and, yes, adults, are not adequately immunized, they are at risk of developing serious illnesses.  As you may recall, I blogged a couple of months ago about the haemophilus influenzae outbreak in Minnesota, where several children became ill and one died.  Well, guess what?  Now there are cases of measles in my hometown, Rockville.  It appears that an unimmunized adult contracted it and has infected several others, including an 8 month old child who is too young to have received the routine immunization.
But, believe it or not, I am not blogging about immunizations today.  It appears that this is just an example of what happens years after a successful plan has been implemented.  Because we don’t see many of these infections anymore, we aren’t routinely reminded of the importance of preventing them.   We seem to have forgotten that the reason we don’t see many of these deadly infections is precisely because children have been vaccinated.  So … the vaccination rate drops, and as the vaccine rate drops, the risk of contracting one of these illnesses rises.  I can guarantee that if we had an epidemic of measles here, with kids dying, parents would be lining up to ensure their kids were adequately immunized.
Well … it’s the same with ALWAYS putting your infant to bed on the back.  Multiple studies have demonstrated a significant increase in the risk of sudden infant death syndrome (SIDS) with placing your infant stomach-side down to sleep.  My recollection from when this recommendation first came out is that almost all parents put their infants on their backs to sleep.  Now, however, more and more parents are telling me that they are putting their infants on their stomachs to sleep because they sleep better.  Or, they are watched by a grandparent during the day, who puts them to sleep on their stomachs.  Well … it is even worse to put an infant on its stomach sometimes rather than always (not that I am EVER recommending stomach sleeping).
A study published in this month’s journal, Pediatrics, evaluated 333 infants in Germany over a 3 year period.  As noted in previous studies, those who were placed prone to sleep were at greater risk of dying from SIDS, particularly those who were not used to sleeping prone.  Other factors which increased the risk of SIDS were covers, sleeping at a friend or relative’s house, and sleeping in a living room.  The only factor which decreased the risk of SIDS was the use of a pacifier at night.   With such compelling evidence which supports many other studies on SIDS risk factors, there is no reason to place our infants on their stomachs to sleep – ever.    This includes when they are with any caretaker, including grandparents, nannies, and other relatives.
So let’s not become complacent about treatments that work.  Continue to immunize.  Continue to place infants on their backs to sleep.

Those Middle School Years …

By Stacy Beller Stryer, M.D.

Those middle school years …
As a parent, we often think these are years to be feared.  Years that we wish we could just blink away.  We hear horror stories from our friends and look at book titles, such as “Parenting 911,” and “The Roller Coaster Years,” with trepidation.  If only we could run away … just for awhile.
But, if we did run away we would be missing out on some of the most rewarding and exciting times we will have with our children.  Sure, I am not going to deny that middle-school age children(referred to as “middlers” by authors Charlene Giannetti and Margaret Sagarese) are emotional, moody and, at times, unreliable.  But, as someone once told me, almost every negative attribute can be turned into a positive one.  I guess that means that maybe, instead of being emotional and unreliable, our middlers are actually passionate and spontaneous.
Developmentally, they are expanding their horizons in many ways.  This is when they develop abstract reasoning, a complex sense of humor (beyond the potty jokes), and the knowledge that there is an entire world out there for them to conquer.  This is when they begin to develop strong interests, likes and dislikes, and when they begin to take greater risks – in a positive way.
Personally, I love being with my middler (8th grade) and my almost middler (5th grade) girls.  They are interesting, exciting, and a blast to be with.  When my 8th grader becomes passionate about something, particularly some social injustice, she can talk a mile a minute.  My 5th grader can be very intense when she practices viola or writes original music for her instrument.  She often performs for me while I am preparing dinner.  Both are becoming much more adventurous –  last month we went to an Asian supermarket and bought several  canned fruits we had never heard of so we could have taste tests.
I have been thinking about these middle years recently, not only because my children are this age, but also because I have been preparing for a lecture on this topic for parents at a local school.  Although I have been counseling patients for years, I have recently read several additional books on the topic in preparation for the talk.  They have been helpful, although my basic parenting principles remain unchanged.  They seem to be important for children and teens of all ages.  I think (“Parenting, according to Dr. Stacy”) that the six key elements of being a good parent of any age child include:
1.     Open communication
2.    Respect and consistent discipline
3.    Compassion
4.    Sensitivity
5.    Awareness
6.    Being a role model
Although the principles remain the same over time, the way we express them varies, depending on the child’s age.  For middlers, there should be a strong emphasis on sensitivity and awareness.  Children in this age range tend to be very emotional and sensitive, and we need to understand and respect this.  For example, they may not want to be kissed or hugged in public anymore.  Or, they may need some private time after school or in the evening.  We should allow them to retreat to their rooms for a certain time period before bombarding them with questions or making other demands.  Respecting their needs ultimately improves communication.  We should also be particularly aware of sudden or extreme changes in our middlers’ behavior, as depression, eating disorders and other problems can appear during these years.

Adapting these six basic parenting skills will certainly not ensure a problem-free middle school experience for you or your child, but it will make it much more likely that he or she will come to you in times of need and will strengthen the relationship that you have with each other.  Consequently, your middler will be less likely to engage in high risk behaviors or succumb to peer pressure which occurs during these years.

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