The only thing guaranteed is change…

March 27, 2020

โ€œIn the light of the moon, a little egg lay on a leafโ€ฆ.โ€ -Eric Carle 

The Little Hungry Caterpillar by Eric Carle is one of the books that I loved reading to my kids when they were little. 

โ€œOne sunday morning the warm sun came up and -pop! – out of the egg came a tiny and very hungry caterpillar.โ€ 

The caterpillar in the story is so simple and has no idea of what the future will bring. It is born hungry and spends most of its time eating and crawling around. A simple life. One would argue maybe even insignificant. You wonder if it even thinks about the future. It just goes through life until one dayโ€ฆ.

โ€œHe built a small house, called a cocoon, around himself. He stayed inside for more than two weeks. โ€œ

You wonder what goes on in the mind of a caterpillar in this moment. Is it scared? Does it think that life is over? Does it think that it is dead? I imagine that all of these uncertainties and fears can be extraordinarily frightening for a little caterpillar. Yet, we all know how the story ends, 

โ€œThen he nibbled a hole in the cocoon, pushed his way out and… he was a beautiful butterfly!โ€

The story of the Little Caterpillar is a story of change and of hope. The only thing ever guaranteed in this life is change. Nothing ever stays the same. This is true for all of us. Most of us, like the little caterpillar, go through life hungry for a deeper meaning of why but all the while feeling small or insignificant. A small voice in the howling winds. Perhaps afraid to take chances on becoming who we know in our hearts we want to be. 

So we build walls around us and we stay in there for weeks, months or even years, afraid. Comfortable in our cocoon.  Afraid to evolve, and frightened of the unknown. What a shame to be the caterpillar that stays in the cocoon. It will never know how beautiful it can be. 

So as we face the coming days of uncertainty and fear in our cocoons, I hope that we will use this time like the caterpillar and transform into our best selves with hope for better tomorrows. I hope that we can all become the butterflies we were always meant to be. 

Elizabeth Vainder, M.D.

Look for the helpers….

March 17, 2020

I can still remember as a little girl sitting hours watching Mr. Rogers Neighborhood. There was something about his calm voice that kept me glued to the television. Mr. Rogers would say, “There is only one person in the whole world like you, and people can like you just because you’re you.” He made you feel special. He also had a natural gift to make what were some of the most difficult or scariest of things seem manageable.

Here are some lessons that are just as important today as they were then:

1. Whatever is mentionable can be more manageable”. Helping children express their emotions can help manage their feelings. It helps us adults too…

2.You are special and so is everyone else in this world.” Everyone is special in their own way – the beauty is in finding what makes you and others special.

3.Did you know that when you wonder, you’re learning?”– Wondering can be the beginning of amazing things. We are surrounded by things all around us that began with a thought.

5. “I like to be told” – Mister Rogers was an advocate for preparing children when faced with moments of fear or anxiety. He would help children learn what to expect when visiting the doctor or the dentist. Telling someone what to expect helps with feelings of anxiety, especially if it’s from someone you love or trust.

6. Some things I don’t understand”– He wasn’t afraid to talk about difficult things that we face in the world. He gave us permission to accept that some things we just don’t understand. He reminded us not to be afraid of talking about what we are worried or thinking about. Journaling or talking to others can help us all with feelings of anxiety or worry.

So today, as we face this pandemic that is Covid 19, I ask that you stop and use Mr. Roger’s messages of hope as we navigate the next few days. Talk to your kids and encourage them to ask questions. Ignoring feelings do not make them go away. Trying to suppress feelings only help them to get stronger. It’s okay to be scared but we should always have hope.

I have faith that we will get through this together. The people of the United States will come together to fight the fight. Each of us with our unique talents will help us all make it through.

I have faith that we will prevail and be stronger and closer because of it.

Illness knows no color, race, religion or culture. Illness does not discriminate. We are in this together and we will get through it together.

So as we face the coming days, remember to keep looking for the helpers. They are always there.

Elizabeth Vainder, M.D.

-Quotes courtesy of misterrogers.org

Is it a mental health disorder, a physical disorder or simply a lack of SLEEP?

February 19, 2020

Happy Wednesday! Today I wanted to share with you an article I read inย Pediatric News written by Tara Haelle. The Title isย A Good Night’s Sleep.ย 

In the article, Tara quotes Dr. Spinks-Franklin, a pediatrician in Texas Children’s Hospital ย in Houston as explaining that “social media and electronics are not the only barriers to a good night’s sleep for teens.”

Lets review what is the recommended hours of sleep for children:

infants – 12-16 hours (Oh to be a baby!) including naps (for those ages 4-12 months). ย  ย ย Kids 1-2 years old need 11-14 hours and kids ages 3-5 years old need 10-13 hours ย including naps. By the ages of 6-12 years the amount drops to 9-12 hours/night.

Most of us can control how many hours of sleep our little ones get (there are exceptions!), however, the teen years can sometimes pose a challenge when it comes to sleep! Many parents fall asleep before their teens do! Did you know that teens actually need 8-10 hours of sleep? Yet, statistics show that 75 % of seniors get less than 8 hours of sleep!

It’s true that social media, TV and computers contribute to this lack of sleep but a rigorous academic load with extracurricular activities can also play a large role. Some teens work after school and this too feeds into their hours of homework and other responsibilities. Another factor is drinking caffeine in the afternoons. Many teens quickly learn that drinking caffeinated drinks will help keep them up to study but what they don’t realize is how it affects them the following day!

I will also note that sleep apnea can also result in the symptoms discussed below. If you notice that your teen is snoring loudly or has pauses in their breathing during sleep discuss this with your doctor and consider a referral to an ENT (Ears, Nose and Throat specialist). This is a treatable disorder than can truly change a child’s life.

I for one believe in later start times for teens. Enforcing early start times in schools leads to a decrease in sleep overall and as a result increases the levels of irritability and other problems as I will explain.

According the Dr. Spinks-Franklin, there are 2 kinds of sleep problems in teens: insomnia and delayed sleep phase syndrome. Both are very important since they can lead to short ย and long term physical and mental health issues.

In the short term, a lack of sleep leads to poor judgment, poor executive functioning and even depression.

The interesting part of the article addresses the similarity in symptoms between ADHD and a lack of sleep:

  1. Depression, feeling sad, or emotional hypersensitivity.
  2. Mood swings, crankiness (this happens to parents too!)
  3. Difficulty concentrating, fidgeting in one’s seat or daydreaming
  4. Unable to complete tasks or stay on task. Problems with memory
  5. Difficulty in social situations, such as with others in school or friends
  6. Daytime sleepiness
  7. Behavioral issues like impulsivity, aggression or hyperactivity
  8. Frequent careless mistakes
  9. Feeling lethargic or lack of motivation
  10. Easily distracted

The problem with insomnia is that once it starts it is difficult to break the cycle as anxiety and school or social stressors seem worse with the lack of sleep. What can be small hills can feel like mountains impossible to climb.

The second issue mentioned is that of delayed sleep phase syndrome. This is when someone has a delay in the secretion of melatonin and just can’t seem to fall asleep when they want to. In teens this is made worse by sleeping in on the weekends (to catch up on sleep) since this interferes with the body’s circadian rhythm (our body’s physical, mental and behavioral daily cycles) making the problem worse!

So what can we do???

  1. No screen time 1 hour before bed! I try to tell patients to leave reading or project based learning for right before bed and encourage them to do their computer work as soon as they get home from school or activities
  2. No caffeine at least 5 hours before bedtime.
  3. Consistent schedule for sleep (including weekends!)

While all of these can seem difficult to implement, if you are noticing any of the above symptoms with your teen, sit them down and have a discussion about it. If your teen is struggling they may consider your advice. It is worth a try!

Making small changes can have big impacts. Instead of treating the symptoms, let’s try to focus on the why of how we feel instead.

I hope you’re having a wonderful week!

Happy zzzzzzz’s ๐Ÿ™‚

Elizabeth Vainder, M.D.

“Good Night:Common Problems seen in teens are insomnia and Delayed Sleep Phase Syndrome.”ย Pediatric News Volume 54, No.2 February 2020., Tara Haelle, expert analysis from AAP 2019.

** If you suspect that insomnia is affecting your child’s ability to function in school or their day to day life, speak to your pediatrician. Consider cognitive behavioral therapy which can also help with insomnia.

Parenting teens

January 29, 2020

It was a regular well visit for a young girl. She was 14 and there was clearly some tension in the room between mother and daughter. It is nothing unusual. The teen years often come with a lot of eye-rolling and resistance as the battle for independence is in full gear. This young girl was a little over weight and had some acne on her face. The mother pointed out that she was concerned about her acne, her weight and said her hair was brittle and thin. We proceeded with the physical exam and then I was able to speak to the young girl alone. In the office, I have the opportunity to speak to both parents and teens separately which is always something I find insightful. Usually the parents and the child are worried about very different things. It is frustrating. It is normal.

If you have a teen, you have experienced the eye-rolls, the quick short answer responses to your questions and the seemingly aloof attitude. It is as if nothing that you say really means anything or matters. I suppose over time this frustration can lead to a sort of “giving up” on talking or giving advice. These feelings can leave a parent  worried about their teen and what he/she may not be telling them. Battles for even the silliest of things ensue and the distance grows larger.

The sad thing is that most teens feel alone as they navigate what can be a new and scary world. They are trying so hard to fit in and they are not sure of who they are and what they stand for. Some seem to cruise through the teen years without a bump and others struggle. It is a time of self-doubt and self-exploration. Who am I? Who are my real friends? What is life really about? Teens live in the now. The present consumes them and they think if a certain group of kids doesn’t like them or they are not cool their world is essentially over. Some become obsessed with how they look, their weight or their “persona” on social media.

Parents on the other hand are looking at the overall picture. They have experienced life and want so desperately to protect their teens from the evils in the world. It can become all-consuming. The internet has become a quick resource for teens and they have access to much more information (with videos and images) than most parents have ever had in their lifetime. It is hard to keep up. It is also hard for some parents to remember what it is really like to be a teen. They are so focused on their role as a parent that they do not really stop to put themselves in the place of their teen. This is exactly what was happening with my patient.

When I sat in the room with the young girl, the first thing she said to me was, “my mom hates me”. I paused. She continued and explained that her mother was always telling her that she needed to lose weight, that her skin looked horrible and that her hair looked awful and thin. She told me that her mother was always yelling at her and proceeded to cry.

In the next room the mother was waiting. When I went into the room she started to cry. She explained that she was a single mom and was trying her best to work and provide for her family. She felt alone and worried and didn’t know what to do. She went on to tell me that she was worried about her daughter who was often crying and refusing to leave her room.

This scenario is not uncommon. This the perfect time to bring up the possibility of therapy. Explaining to a family that sometimes what we really need is a neutral person to talk to. Someone that will not judge you and will provide a safe place to speak your mind. I try to explain to teens that there is nothing wrong with them if they see a therapist. There are times in life when we can all use a person to really talk to without the worry of being judged or yelled at. It is also a wonderful time to learn about coping skills and how to find productive and useful ways to manage stress and difficult situations. Often these therapy sessions can also involve the parents when the teen is ready and can prove very useful in helping communication. The earlier intervention begins the better. Studies show that the earlier we provide help the better the outcome.

Do not be afraid to ask for help and do not let your teens lack of attention to your advice stop you from giving it. This is when they need it the most. Even though it seems that they are not listening, they are. Be careful of the words you use and remind your teen that the best way to get through the teen years is to stay true to themselves. Encourage them to find friends that are like them (even if it is only one) and to focus their energy on what makes them truly happy and feels genuine to them.

However, more often than not the best approach is just listening. When you feel like you just can’t find the right words to say, say nothing. When you are considering giving advice but feel that the moment just is not right, say nothing. Many times in life what we all need is just to know that someone really cares. Be that one person for your child.

Have a wonderful week!

Elizabeth Vainder, M.D. 

 

Living with intention

January 8, 2020

The end of a year always brings with it mixed emotions. It often makes you pause and reflect on the year that passed. It is interesting how certain moments or specific events seem to stand out. I’ve always wondered why some things are given more meaning in my mind than others. I can experience something with someone and they may focus on completely different emotions and remember entirelyย  different things. So the reality is that a moment in time and the memories of the year that passed are created by the thoughts in our minds. It plays like a movie in your mind, but who is the director of that movie? Are you living your life or are you just going through the motions?

Sometimes, the thoughts are there and we barely take notice, and other times the ideas are all consuming. One thing I know for certain is that once you become a parent, the thoughts and ideas you play over and over in your head are almost replaced or overpowered by thoughts of your children.

This comingย  year, I challenge you to pause and try to live your life with intention.

1. Identify the moments in 2019 that made you happy.

2. Focus on the people that loved you and were there forย  you and seem to always be.

3. Think about what brings you a feeling of fulfillment and consider spending some time on whatever that may be.

4. Glance at your screen time (that your phone just loves to remind you of) and think of that the next time you say you don’t have time to do something.

5. Find 3 things you want to work on in the coming year and make a commitment to yourself to honor those promises you make to yourself.

Parenting can be overwhelming and all-consuming. It’s easy to get lost in the world of diaper changes, sick kids, feeding kids the perfect foods, school, homework, projects, setting up playdates and sleepless nights. I am encouraging you to dedicate 5 min, 10 min, 30 min, an hour every day…whatever you can to spend time nurturing YOU.

Your baby and your kids will benefit much more from a happy parent than a perfect one, so do things that make you happy and try to take life a little less seriously in 2020.

Try to repeat more of the moments that made you happy in 2019. Appreciate the people that love you and care for you (send a simple text – it’s better than nothing). Find things that bring you a sense of fulfillment outside of parenting and make the time to do this several times a week. You always show up when your kids need you.ย  Start showing up for yourself and begin living your life with intention.

Happy New Year!

Elizabeth Vainder, M.D.

 

Like vs Love – There is a difference!

November 12, 2019

Those eyes! Its hard not to look into the eyes of a baby and immediately feel the intense love that comes from knowing that you had a big part in making this little person that is now completely dependent on you. It can feel overwhelming. You want to get everything right and that means no mistakes allowed. You read every book you can get your hands on and you prepare for the most important job of your life.

You look around at other parents and find yourself saying things like, “I would never do that!”, “I would never let my child do that!”, “Wow, how can parents be so mean?”, you get the idea. In your mind you think that if you love your baby that everything will just fall into place. If you find yourself thinking these thoughts, I urge you to pause. You do not know the story of that parent or that child and the complexities of a parent-child relationship. What you witness may be a five minute snippet of a deeper issue or situation, so do not judge.

Each parent is living their own unique life with individual circumstances that we may know nothing about. Focus on your relationship with your child instead and try to remember to keep an open mind. Life has a way of making you see things in a different light and perhaps even changing your mind. If you have two or ten children, each one of them will be “an original” and you will be a different mom for each of them.ย  You too will change as a person and grow as you parent each of your kids. Somehow the things that seemed so important with your first child seem almost insignificant with your third. The idea is to parent and embrace change. The only thing guaranteed in life is change. We have to accept change and use it as a tool to help us create new circumstances and opportunities.

In fact, as a parent, you will be challenged time and time again as your child makes his or her “mistakes” and comes to you for guidance. Some of their “mistakes” may even directly affect you. This is where the difference between like and love comes into play, so always choose your words wisely.

You can love someone unconditionally but not like what they did. You can love someone unconditionally and not like what they said. This is one of life’s lessons that can teach your child the importance of respecting others and their opinions even if you disagree.

So the next time your child does something that you disapprove of, whether they are three or sixteen,ย  remind them that you love them, but you didn’t like what they did. This will open up a conversation between the two of you that will help build a relationship based on love and mutual respect instead of leaving you both feeling judged or misunderstood. Communication is the key to a healthy and loving relationship. Chances are you will be the first relationship your child has, and teaching the difference between love and like is one of the most important.

Elizabeth Vainder, M.D., F.A.A.P

 

A healthy mind is the key to a healthy child.

October 22, 2019

It’s no secret that anxiety increases as we get older. Why is that? Why do we spend so much time dealing with anxiety and why is it so common?

If you look at a newborn or even a toddler you realize that their happiness comes from their needs being met. They are simple. If you feed them when they are hungry, respond to them when they cry, change them when they are dirty and help them to go to sleep when they are tired, they are for the most part “happy”. It is really that simple. Yet, millions of dollars are spent marketing to parents things to make their lives easier or more colorful. Marketing preys on the insecurities of the new parent as they stroll through the millions of options there are for car seats, high chairs, blankets, bottles, pacifiers, etc etc. The list is endless. Babies though, are happy with the simple. They don’t care what they are wearing or what stroller they are riding in. They really don’t. Yet parents spend a small fortune to keep up with what society has decided is cool or en-vogue. It’s fine I guess, if you can afford it and want to, but it is completely unnecessary.

Then come the childhood years when kids start going to school and begin comparing themselves to others. All of a sudden they become aware of the difference in each others appearances, homes, cars, clothes, etc. They begin to compare themselves academically, socially, and physically to their peers. It is during this time that the incidence of behavioral problems increases significantly. The reason for this could be because of these comparisons. All of a sudden, the child with the learning disability thinks they are stupid, or the child that acts silly realizes that this makes kids laugh so he/she does it more, or perhaps they feel like kids are excluding them in play groups or parties and they wonder if their is something wrong with them.

This is the window of opportunity that parents are given. This is when the window is open and all you need to do is reach in. If you think it is more than you can handle, seek help. Set up a meeting with the teacher, the principal, and gather information about your child and what they are observing in the school setting. Everything is important. Is your child going to the nurse everyday? Is your child giving you a hard time when you drop them off at school? Is your child struggling to read or having difficulty with math? Everything is important. Do not dismiss it or think that it is a phase or that your child just needs to mature. Your child’s social-emotional well being is developing during this time and just like you spend so much time worrying about what your child is eating and ways to ensure their bodies are healthy, we also need to pay attention to the health of their minds.

One of the best ways to do this is by encouraging kids to feel what they feel. Do not dismiss their feelings by saying things like, “you’re fine”, “you’re too sensitive”, “forget about it”, “get over it”, “stop crying”, etc. Instead, let your child feel what they feel. Hold them when they feel sad, explain to them that it is okay to be angry sometimes or to feel overwhelmed. There will most definitely be times in their lives when they are disappointed, upset or angry. Give them permission to feel those feelings in their entirety in their own way. Allowing a feeling helps lessen the intensity of that feeling. The opposite is also true. If you dismiss a feeling or tell them they are over-reacting, that feeling is still there, inside them, with no where to go. It needs a way out, so it presents itself with outbursts, sleep disturbances, physical symptoms,ย  behavioral problems, tantrums, or anxiety.

Anxiety is one of the most prevalent mental health disorders affecting society today. Many adults are dealing with this on a day to day basis. Some turn to drugs, smoking or alcohol to help alleviate their feelings of anxiety. Others take it out on those they love or closest to them (even their children). It’s the worst feeling ever when you lash out at someone you love or yell at your kids. This cycle of anxiety and anger is all too familiar in our society and one that needs our attention.

What if you actually admitted to your kids that you were having a bad day and really needed their help. What if you came home from work and told your kids that something at work upset you and that you wanted to go for a walk to clear your mind or talk to a friend. Modeling coping mechanisms that are constructive instead of destructive not only will help you but it will help your child understand that a) You are not perfect b) you have days that are tough and that its okay to feel upset c) How to support those that you love when they need you (empathy).

Encouraging communication with your children by sharing a story of something that has happened to you, is a great way to start a conversation. In fact, you may be surprised how much you will benefit from the talks with your kids as well. You will remember perhaps your childhood with its ups and downs and this will help you identify with your children even more. Kids love to hear stories about their parents! The realization that you too struggled with life’s issues is comforting to your child or teen. They probably never stopped to think about you that way. They are so worried about how life is affecting them that when we shift their thinking to something they can relate to, all of a sudden, their perspective changes.

This brings me to my last point. Most people spend 99% of their day worried about themselves and their immediate world around them. Perhaps they are thinking about work, home responsibilities, their health, their friends, their family, etc. Yes, the general population is trapped in their minds replaying the same thoughts day after day. Sometimes these thought are destructive and are filled with feelings of inadequacy. This is the foundation of anxiety, our thoughts. It is our responsibility to change our way of thinking and what we focus on. If you really stop to look around, you realize that most of what you worry about never even happens. What a waste! All that worry, all those sleepless nights and all that anxiety, for nothing!

What if, instead of just allowing our thoughts to control us, we actually actively thought about positive things throughout our day. What if we tried to see the good in people instead of complaining about the bad? We all have the power to do this. This is the secret to decreasing anxiety in your life. Teach your kids the power of gratitude, the magnitude of their thoughts and the gift of appreciation and empathy. A healthy mind is the key to a healthy child.

Elizabeth Vainder, M.D., F.A.A.P