Hectic Holidays and Schedule Shenanigans

You’ve heard the advice:

  • Slow down this holiday season.
  • Less is more.
  • Saying “no” to something is saying “yes” to something else: yourself.

Believe it or not, children need you to heed this advice more than you realize. Children of all ages (even teenagers) crave routine. Doing one super special, magical thing through the holidays is great, but trying to do something every weekend day is too much for many kids. They need downtime. Kids want time with you at home, snuggling and reading. Home time or play time can be more fun for kids than another festive event when that one follows Winterfest, Santaland, and a weekend at the in-laws for early holiday celebrations.

Parents want to make the holiday season special for their family and with so many events to choose from, it’s tempting to experience as many as possible. We want to enjoy the holiday season and bringing our kids along can make it a win-win. But think about your kids when you are strolling around or sitting at these “special” events. Are they content or are you constantly having to corral them into behaving? If you ask them a week later, do they really remember all the different things you did? Do you?

Sometimes our desire to make childhood memories ends up overscheduling the family. Add in the family holiday celebrations (and the routine shenanigans that come along with those) and the holiday time can get maddening rather than magical.

If you know that your holidays will have later nights, nap disruptions, and hectic socializing, plan some downtime. Do less. Snuggle up at home with hot cocoa and pajamas. Do a puzzle, read books, play a game, or listen to music together. If you can keep other routines in place, do so. Keep bedtime the same whenever possible, keep mealtime routines in place. If young children are in daycare, that routine is great to keep.

Memories are made with people, with family. Special events are great but too many can lead to stress and crankiness. Less really is more. Slowing down really is better. Saying no to something really is saying yes to your kids and yourself.

Happy holidays!

Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.

Sibling Rivalry and Bullying: Parents Have More Influence Than They Think

image: Mindaugas Danys, Flickr. CC license.

You hear the scream from the other room and run in to find one kid crying and the other child holding a treasured toy. The accusations and explanations fly back and forth while the tears flow. After a few minutes you realize you’ll never really know the whole story so you:

  1. Take the treasured toy away for a while so it’s not a source of conflict.
  2. Give both the kids a time-out since they need to be separated for a while to cool off.
  3. Throw up your hands and go cry in the other room since this is the fourth time today you’ve had to mediate a dispute.
  4. Yell at the kids since you are so frustrated that they can’t share and get along.

Sound familiar?

Every parent with more than one child is faced with sibling disputes all the time. Whether its toy stealing, physical stuff like pushing/poking, or verbal trash talk that drives the sibling to anger or tears, sibling rivalry is a feature in every family at one time or another. Understanding what drives the behavior will help parents address it appropriately.

Sibling rivalry

Sibling rivalry is triggered for a reason. The child who is acting out wants or needs something. Sometimes he is looking for a parent’s attention. Sometimes she is looking to cure boredom, and sometimes they are looking to get a reaction from their sibling. Figuring out which is the main trigger is very important as it will guide the intervention.

Young children under 5, who are arguing with their siblings, are almost always looking for parental attention. If you really think about it, they aren’t getting any “joy” per se out of their sibling’s reaction but will amp up the behavior if you don’t intervene. They want you. If you don’t run in, the screams get louder and the tussling gets more pronounced.

Another sign that kids are looking for your attention rather than the sibling’s is when they look over at you for your reaction when they are about to do something to their brother or are in the middle of the fight with their sister. They are less engaged with each other than they are interested in your response. A sure sign that the interaction is all about you!

The challenge is realizing that by paying attention to these little scuffles you are reinforcing them and creating a pattern of behavior between the children that can lead to bigger issues down the road. With young children, often ignoring your children’s interactions rather than negotiating, punishing them, or trying to play referee can allow them to work things out on their own and prevent you from become the object of their attention.

The time to help teach children how to negotiate with each other, share well, and be kind is when you are playing with them, not by intervening when they are arguing on their own. Comment on and model these behaviors with your children when you are playing together. You can even role play and practice what to do when you are upset when they aren’t mad; you can give them tools to use at other times.

Another strategy that works well with kids of all ages is to be a play-by-play announcer when you see something happening between your children. Sometimes you don’t want to ignore what you see but know you shouldn’t solve the problem for them. Instead, by describing what you see (the actions and the feelings), you give voice to both of the children in the scuffle and allow them to work things out themselves, perhaps even seeing the other child’s point of view. Here’s an example: You walk in and find 4-year-old, Joey, holding the 2-year-old’s, Jimmy, favorite stuffed animal and he’s crying. Say something like: “Jimmy, you sure seem sad and mad. Joey, you’re holding Jimmy’s best friend. He seems sad and upset. Jimmy is reaching for the toy. Joey, you are keeping it from him. That seems to be making Jimmy even more sad and upset. What are you both going to do?” and then walk away.

When rivalry becomes bullying

As children get older, sometimes what may have started off as an attempt to get the parent’s attention has turned into something more. One sibling has begun to enjoy the “rise” she gets out of the other. Instead of wanting to get the parent’s attention, now the child enjoys the emotional drama that the sibling shows when verbally triggered or egged on in other ways. When this sort of behavior occurs, it can become more serious and, if frequent and unchecked, it is no different than bullying in any other environment.

Most children wouldn’t want to think of themselves as bullies or be labeled as such, but somehow bullying behavior at home isn’t thought of in the same way. Parents have a responsibility to intervene differently when they start to see behaviors that are targeted, affect self-esteem, are power/dominance driven (regardless of which child is older), and persistent. Ignoring these sorts of exchanges can lead to an aggressor-victim dyad in the family that can persist for a lifetime. If one sibling consistently taunts (especially when the verbal taunting is personal and drives the other child to feel insecure or inadequate), intervention is required. Managing both the bully and the bullied in this scenario is key. Both parties are fragile and need support. Bullies often lack self-esteem, are anxious or depressed, or are looking to get attention in unhealthy ways. Getting them help is essential. The child who is being bullied needs strategies to disengage, as well as support to feel secure and safe at home. This last bit can be challenging since the child was the victim of bullying in the place that should feel the safest.

Many parents downplay sibling bullying. “Kids will be kids.” “All kids fight.”
You have to develop a thick skin.” “Siblings will always be meanest to each other.” All of these are examples of things parents say to themselves. And the occasional argument between siblings is normal. But when these interactions become taunting, physically targeted, humiliating, or dehumanizing, it is not normal anymore and intervention is necessary.

The relationships within our family are the best practice we have for relationships in the rest of our life. How we learn to talk to each other and treat each other is the key to our success in friendships, work relationships, love affairs, and as parents later. Teaching your child how to solve his or hew own problems through proper attention to the stuff that matters, ignoring the stuff that doesn’t, creating a culture of positivity in your home, and intervening early if any sign of bullying rears its ugly head is the key to raising kids who will be friends for a lifetime.

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.

What Zit All About? Acne 101

image: Kjerstin Michaela Haraldsen, Pixabay

Blackheads, whiteheads, pimples, and oily skin are the hallmarks of acne. Most of us had our fair share of acne over the years and we heard a lot of advice about how to manage it. From basic advice of washing twice a day with soap to using expensive skin care products you can get delivered to your door every month to prescription medicines, acne remedies abound.

The reason there are so many strategies out there is that acne is embarrassing for teenagers and adults alike. Often the thought of going to the doctor to talk about skin issues (or even bringing up the topic with parents) is too difficult for most teenagers. Parents need to take the lead and ask teenagers if they are interested in doing something about their acne. Some teens are interested in working on their skin while others aren’t.

Before discussing the skin care regimes that work, it makes sense to understand the different components of acne.

  • Blackheads and whiteheads: These are pores that are blocked with debris (i.e., dead skin, oils, bacteria) but don’t have much inflammation (swelling or redness). What makes them black or white is whether the pore is still open (blackhead) or closed at the top (whitehead).
  • Pimples: These are blackheads or whiteheads that have gotten inflamed. Usually they are still close to the skin’s surface so the inflammation (i.e., swelling, redness and pus accumulation) come to a head quickly and resolves. Sometimes pimples will scar but if they are left alone and there are few of them scarring is less common.
  • Cystic acne: These are pimples deep under the skin as well as large inflamed pimples near the surface. What differentiates cystic acne from regular pimples is size of the swelling and depth of the inflammation. Because some of these acne lesions are so deep, they don’t come to a head and those that do are so large that they may leave scars.

Once parents have broached the subject with their tween or teen, what strategies work?

For mild acne that is made up of mostly blackheads and whiteheads and only a few pimples here and there, washing twice a day with a mild soap and using benzoyl peroxide 10% (available in a variety of over-the-counter preparations) once a day makes sense.

Once pimples are the main attraction, benzoyl peroxide probably won’t cut it. Talking to your pediatrician is the best first step. When pimples are the main issue, retinoids in the form of a cream used once-a-day (along with skin hygiene) is the best approach. Retinoids take about eight weeks to work and your teenager’s skin will actually look a little worse before it starts to look better. Once the improvement starts though, it’s a big improvement!

Because retinoids can be harsh on the skin, some doctors start with topical benzoyl peroxide and antibiotic combo creams or gels. These are not as effective but may be enough for mild acne.

Cystic acne is different. Because of its scarring nature and because many of the pimples are so deep, topical management doesn’t work well. Heading the dermatologist makes sense. Accutane is the best management strategy for cystic acne. Even with all of its challenges (including monthly lab tests, appointments, and side effects), this pill is by far the most effective approach. It is taken for nine months or so and then many people need a second course a year or two later for another three to six months. All in all it’s easier than years-long skin regimes and far more effective.

The biggest challenge though in any acne treatment plan is compliance. Many teenagers get frustrated or bored with the skin regime of washing twice a day and applying product. Because so few solutions are foolproof and all require continuous participation to gain continued results, teenagers are at risk for falling off the skin regime bandwagon when results aren’t as good as they had hoped, or when their skin is looking better for a week or so. Either way their lack of commitment is the Achilles’ heel of any approach parents and doctors put forth. That’s why opening the conversation with your teens and getting a real sense of how interested they are in addressing their skin health is key to moving forward.

Many families ask about commercially available skin regimes that they see engaging advertising for. Many of these products do work and if they teen is coming to you engaged by the sales pitch, he or she may be more committed to the regime which is really the “magic” that ensures the success of the product.

As a final comment, let’s cover some common myths and truths about what makes acne worse.

  • Myth: Never use moisturizer on your face.
    • Moisturizing acne-prone skin can get tricky. You want to be sure to choose an oil-free moisturizer. Many products now will even say “non-comedogenic” on the label, which is good sign it’s acne friendly.
  • Myth: Chocolate (or milk, or fatty foods) makes acne worse.
    • Eating a healthy diet and drinking plenty of water is great for your body and your skin. Eating certain foods though won’t make your acne worse. All kinds of old wives’ tales surround food and acne, but research shows that what you eat makes no real difference in how your acne progresses.
  • Truth: Hair products, like gels and hair oils, increase acne.
    • Any oils, gels or even your hair’s own natural oils (if on your forehead all the time) can worsen your acne. If your forehead is your main problem area, keep your hair off your face and keep hair care products far away!

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.

Stumbling blocks that can increase childhood obesity

image: David Goehring, Flickr. CC license.

September is National Childhood Obesity Awareness Month. No parent starts off feeding their kids with the hope of creating an unhealthy or overweight child. Every parent wants to be the very best parent in all ways and along the way we realize how hard it is to be perfect at everything. Sometimes maintaining healthy eating habits for just ourselves is tough, so keeping them going for our kids can seem like a lot of work! With a little effort though, parents can avoid some of the stumbling blocks that create unhealthy eaters and reduce the risk of obesity.

Parents of infants spend a lot of time thinking about, choosing, and preparing food for their new solid-food eater. Most babies gobble up virtually everything they are offered and parents feel great about what they are doing. Then something happens though along the way.

By the time children are 3 years old, many are “picky eaters” and parents report that their children will “only eat” carbs with a smattering of fruit and dairy. Unsurprisingly, parents lose their confidence (and their will) to lead the charge of healthy eating; by the time children are in grade school (or even sooner), snacks for soccer are convenience foods like single-serve chips or cookies, a Lunchable and sugar-laden Go-Gurt® comprise lunch, and desserts are nightly as a treat for eating a single broccoli spear.

This may be a bit of an exaggeration, but only a bit.

After almost 30 years as a pediatrician, I’ve seen some common stumbling blocks along the way. If parents can avoid tripping over these, kids have a better chance of remaining healthy eaters and avoiding obesity.

Stumbling block #1: Parents reinforce picky eating

This toddler slide from “eager” eater to a “picky” one may be the critical point in the process for child and parent that, if weathered successfully, can set the stage for obesity prevention. If a parent can make it through the toddler “picky” stage and continue to offer healthy foods all along (without falling prey to the culture pressure of junk food), healthy eating patterns can be sustained. Here’s how picky eating happens:

Since baby’s growth slows dramatically after he or she turns one, appetite will decrease sometime between 12 and 24 months. Sometimes that decrease is dramatic and whole meals are skipped because your sweet pea will consume all the calories needed by the time dinner comes along. Because their appetites slow, children can afford to get “choosy” and just eat what they prefer. It’s not that they don’t like the other foods, it’s more that they aren’t as hungry so they don’t need to eat everything just to satisfy their need to grow. Parents worry when they see their little one not eating much and resort to all sorts of strategies: feeding their children, offering preferred foods when dinner isn’t eaten, offering smoothies with veggies because a child isn’t eating them otherwise, offering pouches of purees, continuing bottles longer to make sure their baby gets something before bed, offering food throughout the day (not just at meals), turning on the TV or screen to distract their child to eat. You get the idea. All of these strategies will ultimately send the message to the child that they shouldn’t be listening to their own body’s messages of “full” or “hungry.” The other message a child receives is that if you won’t eat what is in front of you, you will be given fatty, concentrated sweet, or carb laden food as an alternative (read: pureed foods, mac and cheese, chicken nuggets, snack crackers, sweetened yogurt, etc.). These messages sent so early and often create habits that can be hard to change.

What to do: When your toddler’s low-eating phase presents itself, relax! Keep offering whole fruits and veggies, lean proteins, carbs and dairy in healthy proportions. Eliminate between meal snacking if your child isn’t coming to the meal hungry, since snacks typically aren’t “meal worthy” foods. Only offer milk and water to drink—and only with meals and snacks (as opposed to having a cup available all the time). By limiting access to fluids, you won’t dehydrate your child and you won’t allow your child to fill up on fluids sending a “full” message to his brain when it’s mealtime.

Don’t worry if he doesn’t eat a single veggie or fruit. If you keep offering them when he gets hungry, he will. Don’t resort to pouches or purees which are really just concentrated veggie and fruit sugars and don’t provide much mouth experience with the food. Give a multivitamin instead during this time.

If you are concerned about skipping snacks, only offer whole veggies and fruits for snacks during this low-eating phase. If your child is truly hungry she will eat them. If she’s not hungry enough, she’ll pass on them and will come to the meal readier to eat.

I promise your child will still sleep through the night even if he doesn’t eat dinner. If he gets hungry later (before bed), offer part of the dinner again rather than a preferred food.

Stumbling block #2: Snack time is all the time

I don’t know when it began, but it seems that our culture has decided that kids need snacks all the time. Three-year-old soccer practice for 30 minutes assigns a snack parent now. Kids are getting food with every activity whether they really ‘need’ to eat or not. Children go to preschool for three hours in the morning and have a snack part way through. Parents give kids food to quiet them down in the car (or perhaps worse: a screen to watch).

Kids don’t really need to eat all the time. They do need to eat breakfast, lunch and dinner of course. Many kids will need a snack if the time between those meals is greater than five hours and especially if meals are lacking protein. In reality, most kids need an afternoon snack added to the three meals and that’s about it. If they are having a snack with an event, they don’t need an additional one too. We have gone a little snack crazy in our society and some kids are now expecting to eat all the time.

What to do: Set routines in your house for meals and snacks. Send healthy snacks (e.g., fruits, veggies, 1 ounce of cheese about the size of one die) with your child rather than have a bag of chips. Avoid sugar-laden snacks like fruit rolls-ups (even the all-fruit ones are still all fruit sugar and real fruit is much better), Go-Gurt, and chips even though they are convenient.

Talk to other parents. You aren’t alone in wanting to limit sugar or snacks and even in offering healthy snacks. Figure out if you even need to have a “snack parent” at soccer, for example. Of course, some kids will need a snack due to their metabolisms or family schedules but their parents can provide it. No need for the whole group to get in the habit every time.

Stumbling block #3: Eating out/Carrying In

This is a tough one, especially as kids get older and schedules get hectic. The data is clear that the more that families eat homemade food, the less obese their children are. Sitting down as a family for dinner is not going to be possible during the super crazy days of multiple kids in sports/dance/music, but that doesn’t mean that you can’t eat healthy food on the go.

What to do: Meal plan as a family. Kids as young as 8 years old can help with plan and prep. Take time on the weekend to get a plan for the week. Even if you are all eating sandwiches, fruit and bringing milk in a Thermos, this is dramatically healthier than anything else you will eat out on the go. When you take the time to plan together, meal prep and even pack dinners for the week on the weekend, and the busy week will go much more smoothly. You will also help your kids see the importance of healthy eating and budgeting.

Final comments

Notice I didn’t mention anything about exercise. Although being physically active is super important for heart health and kids who are sedentary are more likely to be obese, weight management is almost completely about what you eat. Sedentary kids eat dramatically more than active kids. Sedentary kids also eat much less healthy food which accounts for the vast majority of the weight difference. Please be active but understand the key to healthy weight is healthy eating.

Lastly, no parent is perfect. No parent can do it all. Do your best, offer fruits and veggies all the time, eat homemade food as much as you can, and don’t turn food into a reward and you just might create a healthy eater.

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.

The skinny on rashes and skin care

image credit: Sage Ross, Flickr. CC license.

Baby soft skin.

Isn’t that what the ads for skin care products all promise? The reality is that most babies have skin issues of some sort at one time or another. Whether it’s infant acne, seborrhea, cradle cap, eczema, heat rash, diaper rash, or rashes due to illness, babies and young children have lots of skin issues. Here’s the lowdown on your child’s skin and your best strategies for getting that “baby soft skin.”

Baby acne. Like teenage acne, infant acne is hormone triggered. As babies withdraw from the influence of pregnancy hormones, sometimes their skin responds with pimples. Infant acne is seen on the nose, cheeks, forehead, and occasionally the chest and back (think those T-zone, teenage acne locations). The good news is that infant acne doesn’t last too long: usually only a few weeks. Mild soap is all you need since the hormones aren’t a constant player at this age. Patience and time are the biggest strategies.

Seborrhea. This bumpy, reddish, greasy (moist-looking), and occasionally flaky rash is in the “beard and bib” regions, typically sparing the cheeks, nose and midface. When it shows up in the scalp, eyebrows and behind the ears, it’s called cradle cap. Seborrhea is caused by sebum (an oily substance) from the skin glands being over secreted and drying on the skin, causing irritation. Sebum is greasy, so the skin is flaky, red, bumpy, and yet looks greasy at the same time. On the scalp, cradle cap can get thick enough to form a scaly clump that embeds the hair. Sometimes when the clump comes off the scalp, the embedded hair comes off at the same time, but it will grow back. When seborrhea on the sides of the face gets very red and irritated, it may be worth treating; a 1% hydrocortisone cream used once or twice a day for a week or two is usually enough to quiet the skin irritation down. Only time will resolve seborrhea completely. For cradle cap, loosening the scale with an emollient like oil and then brushing the area to loosen it before shampooing can decrease the thickness of it. Only time will resolve cradle cap completely. Usually by a year of age seborrhea and cradle cap have faded away.

Eczema. Dry, rough, red and somewhat itchy skin in patches is eczema. Unlike seborrhea which has poorly defined margins, eczema tends to come in patches. Sometimes eczema may not be red but may just feel like a rougher skin patch that itches. In infants and young children eczema is very common and may not indicate a specific allergy but rather just an “awakening” of the immune system in general. However if eczema in an infant under 1 year of age is extensive or difficult to control, then allergies, especially food allergies, should be considered. Aggressive moisturizing with a cream (rather than a lotion) is a terrific first strategy. Applying a moisturizing cream two or three times a day for two weeks is a great start; if there’s no real improvement, head to the pediatrician to confirm eczema is the issue. If you already know eczema is the problem, an over the counter 1% hydrocortisone cream twice a day is a strong next step in addition to moisturizing three times per day. If your child’s skin is still not improving after that an appointment with your pediatrician makes sense.

Diaper rash. I’ve yet to see a baby who hasn’t had some sort of diaper rash in their early years. Most diaper rashes are due to irritants (e.g., in the stool or urine, or from wipes, soap, etc.) coming in contact with the skin. No matter what the skin looks like (e.g., excoriated, lightly red, puffy, etc.), most of the time using a thick coat of a barrier like petroleum jelly will buy you time while the contact issue works itself out and the skin heals. The exceptions are yeast and bacterial infections. If you’ve been using a thick coat of petroleum jelly with every diaper change for a week and the rash isn’t improving much, then a visit to your pediatrician makes sense to figure out what the next step should be.

Other rashes on the body. Heat rashes tend to be on the torso in areas where the body might sweat. These typically have no symptoms other than the little red dots you see. Heat rashes occur commonly in the summer on babies in car seats or strollers who end up sweating. Once in a while, we will see a baby who has been bundled in a snow suit with a heat rash in the wintertime too.

Rashes during illness are common as well and occasionally may be the only sign of a virus. Hives, an itchy rash with vague blotches all over the body that come and go, are commonly seen with viruses in childhood. Parents often worry that hives are due to allergy but viral illness (even with no other symptoms) is almost always the cause. Hives will typically last three to seven days. Benadryl helps with the itching but only time will cure hives.

Rash with a fever of 101°F or higher, rash in a child acting sick, or any rash that looks like bruising and isn’t a bruise warrants a visit to the pediatrician right away.

Skin issues in kids are very common and almost never worrisome but common sense should always rule the roost. Here are some take-away messages:

  • Bathing with mild soap every couple of days is enough unless your baby or child is dirty or stinky! Follow up the bath with a good moisturizer while your child’s skin is just barely damp to lock-in the moisture.
  • Moisturize your child’s skin every day at least once with a cream-based lubricant. Increase to two or three times a day if your child has eczema.
  • Use petroleum jelly as a barrier in the diaper area for most rashes.
  • Any rash that isn’t getting better in a week despite home management warrants a visit to the pediatrician—sooner if your child is acting sick in any way.
  • Last but not least, a good rule of thumb is this: if you had no idea anything was wrong until you undressed your child, the rash isn’t anything to worry about. If your child is acting sick, scratching at the rash, or is very fussy, then the rash warrants attention and management.

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.

Vaccine answers every parent needs

image credit: CDC, James Gathany

August is Vaccine Awareness Month and unless you’ve been living on a deserted island you are very aware of vaccines! Between the nationwide measles outbreak this year and the constant arguments for and against vaccination on social media, vaccines are big news these days.

Convincing you to vaccinate your children isn’t the focus of this piece. Discussions around vaccination are better suited to the office setting where you can have an honest dialogue with your trusted resource: your pediatrician. Instead, here are some less frequently considered questions and answers around vaccination that every parent should be aware of.

Why are vaccines given to infants even if they aren’t going to daycare?

Vaccines (small, inactive doses of dangerous bacteria and viruses) were created against specific illnesses because those diseases result in severe illness, and rarely death, especially in infants and young children. A baby’s ability to fight infection is limited because the immune system is still encountering the world and building defenses as it goes along. By providing vaccines, the body gets a head start building a suit of armor against disease. Getting the infections themselves would induce immunity of course, but with the potential “high cost” of severe illness or possibly death, vaccines are a great opportunity for “low cost” immunity in comparison.

An infant’s immune system is on the prowl for new things and primed to generate immunity to protect the growing child. Children benefit from repeated exposure to new things for acceptance and tolerance and vaccines are no different. Repeatedly giving small-dose vaccines allows for robust response that gets reinforced and generates sustained immunity.

Delaying vaccines until school-age or older decreases the likelihood of achieving robust response from vaccines. Older children, teenagers and adults often need higher doses to achieve immunity compared to infants. Adults, for example, have much poorer response to everything from the flu vaccine to the shingles vaccine (which is just a super-high dose of the chicken pox vaccine) compared to infants.

Giving vaccines in infancy also improves the chances of lifelong immunity.

Why is the Hepatitis B vaccine given to infants? I thought Hep B was sexually transmitted.

You’re right (in part) about how Hep B is transmitted. Hep B is a virus that can also be transmitted through blood transfusion, breast milk, and human bite. Virtually all mothers are now tested during pregnancy to see if they are silently infected with the Hep B virus, so we know which babies are at greatest risk from that standpoint. However, risk still exists since fathers aren’t tested. Here’s how: Dad has undiagnosed, chronic, asymptomatic Hep B virus in his body. He and mom are still having sex. Mom is breastfeeding. Mom becomes infected and is asymptomatic too. Mom then gives baby Hep B.

Other Hep B risk scenarios exist, too. Scenario #2: Child goes to childcare/school and gets bitten by another child who is not vaccinated and whose Hep B status is unknown. Scenario #3: Due to some sort of an accident or medical condition, your child needs a blood transfusion. Your child then is at risk for Hep B from the blood needed to save his life.

Since Hep B exposure is so haphazard and unpredictable, and because immunity is best achieved in infancy, vaccination is recommended in the first few months of life.

Is the flu vaccine worth it? Won’t my child still get the flu?

Each spring, the world’s smartest infectious disease experts collaborate to determine which strains of the flu should be included in that fall’s influenza vaccine. Most of the time, those experts are very good at predicting which strains will affect the world later that year. Occasionally though, Mother Nature throws a curve ball and an influenza strain morphs (the H1N1 strain was one of those). Even in the worst possible case, as evidenced in the year H1N1 wreaked havoc, getting the flu vaccine diminishes the severity of illness no matter which strain you get.

Infants and children respond better to the vaccine than adults. About 70 to 80% of the time the vaccine works in children, which means that 70 to 80% of children who get the vaccine don’t get influenza. The 20 to 30% who still catch the flu have milder illness, fewer hospitalizations, and almost never die from influenza (compared to those children who didn’t get the vaccine). Bottom line: Still worth it.

And no, you can’t get the flu from the flu shot: it’s a dead vaccine.

What about HPV vaccine for my teenager? Does it cause (fill in the blank)?

The HPV vaccine has been reputed to cause infertility, multiple sclerosis, migraines, ovarian failure, hypersexuality, chronic fatigue syndrome, etc.

Here’s the lowdown: Europe and the United States had huge population studies that were not funded by pharmaceutical companies. Those studies showed that teenagers who got the HPV vaccine were no different in their disease profiles after receiving vaccine than teenagers who didn’t. HPV vaccine doesn’t cause any of that bad stuff but it does prevent all sorts of cervical, anal and oral cancers.

Here’s the rub: The vaccine is most effective if given before age 15 and before any sexual initiation (oral sex or intercourse). For these reasons, giving the first dose at 11 and getting the second dose at 12 makes sense. The data is clear that this does not result in earlier initiation of sex. In fact, it seems that the tweens who got HPV vaccine at 11 and 12 were slightly later at first sexual contact that children who received the vaccine later or never received it. Of course, it isn’t the vaccine delaying things but may instead reflect the fact that parents who are comfortable with the HPV vaccine are also comfortable talking about sex with their children.

Can I let my kids play with/be around unvaccinated children?

Giving your children vaccines provides them with a suit of armor of sorts. No protection is perfect, but vaccinations done on time and in the usual way confers excellent protection. Once a baby has received the primary series (by six months for all vaccines but MMR and chicken pox), he is in very good shape. Even after a single vaccine, the immune system is stimulated and immunity to the disease begins, so being around others shouldn’t be feared.

Of course, common sense needs to prevail. For very young infants or for those who can’t be immunized, if the children you are going to be around have signs of illness or were exposed to serious contagious illness and are not vaccinated themselves, being cautious makes sense.

Final thoughts

I’m sure some of you have other questions, like whether there is mercury in vaccines (there’s not) or whether aluminum is a concern (nope) or if preservatives are a concern (vaccines have been preservative-free for years now).

Another question parents ask is if the number of vaccines is too much for a baby’s immune system. This is a long answer, but the short answer is no. The antigen load was much higher when I was a kid than infants receive now because vaccine doses were so much higher back then.

I wish I had the space and time to answer every vaccine question, but I don’t. However, Beaumont provides this information and I can also direct you to this additional resource for answers.

I also encourage parents who have concerns about vaccine safety to talk to their pediatricians about them. We won’t vaccinate a child who is too fragile or for whom vaccines are risky. Avoid Googling information since it can be difficult to discern what is “good” science from “bad” science. Instead, trust that we pediatricians, like you, have your child’s best interest at heart. We are your best partners for the health of your child.

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.

Back to school tips for kids of all ages

Summertime is great isn’t it? Firefly catching, s’mores eating, late-night fireworks, family barbecues, swimming until your skin turns wrinkly, and sleeping in. As August rolls around and the back-to-school clothes, notebooks, and ready-made lunch options flood the aisles, you slowly start to plan for the new academic year.

Some parents are eager for the start of school. Getting back into a routine is a relief for some while others love the lazy days of summer with its freedom and spontaneity. Understanding your nature in this way will help you get your kids ready for school. If you’re naturally a routine-lover, enforcing the new routine of getting to bed earlier and getting up earlier over the week or two before school makes sense and will be easier for you than will a parent for whom routine is a hassle not a joy. Either way, by the time school starts, like it or not, a new routine will need to be in place and waiting until the night before can make it tough for kids of all ages.

Switch your child’s sleep and wake routines

It’s the wake-up time that matters most. For every hour that your child’s sleep routine is currently off, it will take four to seven days to adapt. In other words, if your child is getting up at 9 a.m. and will need to get up at 7 a.m. for school, it will take 8 to 14 days for the new routine be in place and for your child to wake up well-rested. For teenagers, who might be waking at 11 a.m. and will need to get up at 6 a.m., that five-hour switch will take a couple of weeks.

Here are the steps:

  1. Wake your child at the new wake time (the time they need for school in a couple weeks). This generates a sleep debt since they won’t have slept enough and will make them sleepier earlier at night.
  2. If you are a routine-oriented parent: Move the bedtime earlier by 15-30 minutes per day until you reach the new bedtime (See the How much sleep does my child need? chart)
  3. If you are a less routine-oriented parent: Watch closely for “tired” clues in your younger child and adjust the bedtime. Most kids will start falling asleep earlier within three days of the adjusted wake time. Note: Restlessness, agitation, and hyperactivity may mean you missed the sleepy clues.

Even though it may take four to seven days for each hour of time that the wake-up time adjusts for your child to feel rested when she wakes up, the bedtime will likely adjust sooner.

Bully-proof your child

Of course, you can’t actually bully-proof your child but you can give your kids of all ages scripts to use in a variety of circumstances that will empower them. Before school starts back up, role play with kids of all ages and all abilities to not just bully-proof them but encourage them to be an active bystander when they see other kids being picked on. Here are some age-appropriate scripts to practice with your child.

  • Preschoolers/Early elementary
    • If someone is making you feel sad or bad, or says. “I don’t want to play with you,” you can say, “I don’t like what you said. I’m going to play over there instead.” Then walk away. Or you could also say, “I don’t like what you did. I’m going over there.” And walk away.
    • If you see someone else whose feelings are being hurt and you want to help them, you can say to the kid being hurt. “Come play with me right now.” Or “I want to play with you. Come here.
  • Mid-elementary
    • When someone makes you feel sad or bad about yourself or is picking on you, you can say, “I have something else to do now. See you later,” and walk away. Let your children now they can talk about their feelings later with you or their pediatrician. If the same person keeps at it, he or she will stop pestering you if you keep ignoring them and walking away.
    • If you’re uncomfortable with how someone else is being treated, step in and say to the person being treated poorly, “Let’s go do something else together”. If this is happening among your friends, you may feel comfortable saying, “Stop it, I don’t like the way you are talking to _______. It makes me feel bad.” If they don’t stop then ask the person being treated badly leave with you. If they choose not to, you can say, “I don’t like the way this feels, I’m leaving now.”
  • Middle school/High school
    • You can be stronger with your friends now in middle school if they are treating you or other people poorly. Say “Stop it. Now. Talk to me (or the other kid’s name) nicer than that”. If they get all snooty or tease you about it, you can make a joke, stand firm or walk away. But if it keeps happening, think about whether you want to be friends with that person.
    • If the person treating you poorly isn’t a friend, just walk away and ignore them. If they are treating someone else poorly rescue the person being treated poorly. Engaging the bully won’t help.

Reduce first-day jitters

Whether it’s the first day of a new school or a new grade, many kids worry. Some worry about where their classroom is or where they will put their books, while others worry about whether they are smart enough to handle the work that third grade or seventh grade or tenth grade demands. Regardless of age, new school years bring new worries for many kids. Here are some strategies to help calm those anxious minds:

  • Do a dry run. Most schools are open the week before school starts as teachers are prepping their classrooms. Take some time to wander the halls, find your child’s locker, check out the cafeteria, find the nearest bathroom, whatever it takes to get familiar with the physical space and reduce the worries of day one.
  • Pull out some of your child’s best work from last school year. Remind your child of his strengths as a student. Whether they are an artist, musician, writer, or athlete, find the evidence from last school year that can reassure them that they are ready for this next step in the academic, social, and physical ladders of life.
  • Follow the bus route, walk to school, or ride bikes together: whatever the route to school, practice! Doing something in advance builds confidence and makes it easier the next time around.
  • Finish summer homework early. Don’t leave the summer reading, essay writing, or math packet to the last minute. By finishing it a week or more ahead of time you reduce anxiety the weekend before school starts.
  • New school means making new friends. Try to connect with other kids before school starts (no matter your child’s age) so the first day of school starts with at least one familiar face. For middle and high school kids, ask the school if there is a mentor program, a buddy system, or an orientation time for new students where they can meet current students before the first day of classes. For younger kids, school playgrounds are great places to hang out the week before school to meet other families.

Final words of advice: Each new school year is a new beginning for you and your child. Try to leave behind last year’s baggage and successes and allow this year to start fresh. The beauty and magic of childhood is the fact that kids are constantly changing, growing, and developing. Last year was last year. This year can hold the promise of joy and success for every child and every parent, too!

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.