The simple way to find out what your child is worried about.

April 1, 2020

“Can you read me one more story?” “I’m thirsty”, “Can I go to the bathroom?”

Parents all around the world have heard these same questions right around the time that their kids should really be going to sleep! It can seem frustrating as you struggle to get your little one down and they get that second wind. 

The idea of having a few minutes to yourself seems so appealing yet your little one keeps on talking and asking for more. 

Tonight I’m encouraging you to stay a little longer and listen. 

There is something magical about that time just before bedtime. Kids will talk about so many things jumping from one topic to another. But – if you really listen closely, you will catch a glimpse into what their little minds are actually thinking about. 

Over the last few weeks, life has changed in ways that many of us could never have imagined. It has changed for our kids too and they feel it. Everything is different. No one is going to school, they can’t see their friends, school is perhaps on a computer now and there are no more playdates or get-togethers with friends. It is hard. Change is hard. 

Kids are not very good at expressing what they are feeling. (some adults aren’t either!)

They will complain of physical symptoms when they feel anxious or afraid. Other times they will misbehave or have tantrums. Pay attention to all of it. 

Kids are very good at eavesdropping on adult conversations and listening to the media. They make their own interpretations of what they hear. This can bring about feelings of worry or overwhelm. Sometimes they create ideas in their head that are not even real. Pay attention to what you say in front of your kids. They are listening. 

So tonight, when it’s time for your little one to go to bed, snuggle with them a little longer and lay down to listen. Listen with an open heart and validate their concerns and feelings. You don’t need to have all of the answers. Help them to understand what they are feeling and what they have seen and heard. You will learn a lot about your child in these few minutes before they fall asleep and they will know that you cared. You cared enough to listen. That is the greatest gift of all.

Have a wonderful Wednesday and stay safe and healthy

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

Are you nurturing your child’s true self?

March 11, 2020

That genuine smile from a baby is enough to melt the toughest of hearts. You know the one…the one that always comes with that twinkle in their eyes. It’s funny because if you really pay attention to babies, you will see that each one is born with their own unique personality. It’s the nature vs nurture that we love to talk about. It’s when people say, “I wonder how those kids are so different, yet they were raised by the same parents!”

It’s funny because this is not the way it is at all! In fact I can tell the happy, smiley babies from the cautious more reserved babies from as little as 4 months. It is truly amazing to witness. I love to see a baby this little with their built in personality and watch them develop into the children and eventually adults of tomorrow. Of course parenting and the outside world influence the way these kids will grow and think, but I can tell you with complete certainty that babies are definitely born with their own programming. As parents, I challenge you and encourage you to be intentional in making sure that that innate programming is what you try to nurture from day one.

It is the little boy that wants to wear rain boots all day or the little girl that insists on dressing herself in whatever way she thinks. It’s challenging as a parent. It’s easy to get caught up in what the world thinks your child should be or how they should think or act. Instead, try to take a step back and allow your child to explore their creativity and uniqueness.

As children begin to learn to read and write, I think it is a wonderful idea to begin the idea of writing down their wildest thoughts and dreams. Even the ones about owning a zoo or world peace. Let their imaginations soar and do not put boundaries on what these dreams can be. Saying things like, “That’s ridiculous!” “That’s never going to happen!” or “Hahahah, that is not the way things are” are definite dream killers. What if parents instead created a wonderful notebook where the child could draw, write and explore these wild and amazing thoughts? Imagine the book you would have at the end of their childhood!

This book would be the perfect gift to give your child at the end of a milestone or the beginning of a new chapter in their life. It would be the gift of their true self. It would serve as a constant reminder of what makes them truly unique in this world and the innate passions that light up their souls. How awesome is that? How many adults do you know that could use one of these?

I can tell you that as parents, we hold the key to unlocking the potential that lives within our children. The world is constantly trying to encourage your child to “fit in” or live their lives based on strict guidelines. In fact, the reason most kids are suffering from anxiety and depression is because they realize that they are not like everybody else. The travesty is that they don’t appreciate that if they are not like everybody else, that is where their magic lies. If we are like everybody else, then we are not true to ourselves.

So the next time you child tells you the sky is purple, hand them some purple paint and get them a canvas. The world needs more purple skies and happy children.

Have a wonderful Wednesday!

Elizabeth Vainder, M.D.

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 in Pediatric News written by Tara Haelle. The Title is A Good Night’s Sleep. 

In the article, Tara quotes Dr. Spinks-Franklin, a pediatrician in Texas Children’s Hospital  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).     Kids 1-2 years old need 11-14 hours and kids ages 3-5 years old need 10-13 hours  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  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 🙂

Elizabeth Vainder, M.D.

“Good Night:Common Problems seen in teens are insomnia and Delayed Sleep Phase Syndrome.” 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.

5 Ways to Give the Gift of Reading to your Child

February 5, 2020

“Imagination is more important than knowledge. Knowledge is limited. Imagination encircles the world.”-Albert Einstein

It is uncertain when babies understand language. We see two month old infants smiling in response to a smile and cooing as they try to communicate. We observe babies as young as 6 months old respond to certain words or songs that are familiar.

I do not think we will ever know when the exact moment comes when a baby understands what you are actually saying. Experts call it baby ease and it is almost instinctual that when you speak to a small baby you speak softly and with a high pitched voice. They seem to love it as they smile and coo in response. It is awesome!

To a baby, it isn’t so much what you say but how you say it. As your child grows what you say becomes more important so pay attention to your words! How lucky are we that we can share the gift of reading with our kids? Endless possibilities lie between the pages of a book. Encourage this always.

1.Read daily – If the idea of reading daily seems daunting, you are not alone. However, establishing routines with your baby from day one is the best way to ensure that you will continue to do so. Reading then becomes automatic and also a special time that your baby/child looks forward to. It doesn’t have to be long either. A simple book or poem can bring with it deep meaning and just the act of sitting down with your child uninterrupted speaks volumes of what you deem important.

2. Read aloud- It is recommended that you read higher level books to your child aloud. Listening to a story without having to focus on the words on the page can be magical. A story can transport you to a different time or place and create new and creative conversations  between you and your child. Ask questions when you read to encourage engagement and see if your child felt the same way you did about the story (you might be surprised!)

3. Escaping into a story – It is no secret that books and stories can take you from your away from the routines of every day life. Those books that are hard to put down sometimes leave you confused between reality and the words in the book. It is powerful. Allow yourself and encourage your child to place themselves in the place of the main character and question the decisions that the characters made and ask if they would have done the same. This exercise is the beginning of understanding empathy and its importance.

4. Choose different types of books – When selecting books to share with your child do some research. Find books that you think your child would enjoy but also get their input! Ask them what they would like to learn about or maybe there is an author that they have enjoyed in the past and would like to read more of their books. If you can sign up for notifications on when your child’s favorite author is in town, do it! One of my favorite memories was taking my boys to listen to Rick Riordan. Listening to how the author created the stories and the reason behind his decision to write stories was magical. I highly recommend this experience if you can make it happen!

5. Encourage creativity and writing – Encourage your child to write his/her story. As we grow, our ideas about life and our perception of the world changes. Imagine if you had written a story through each of these stages. Looking back is a gift in and of itself and you do not need to be a New York Times Best Seller to write a story.  Writing is also a form of therapy and we see in journaling. Teaching your child to express themselves in their writing will help them understand their thoughts and their mind more than anything else.

 

I am sure there are many other creative ways to encourage reading in your home and I hope that whether you are a new parent or a seasoned parent that you know that it is never too late to start. The gift of imagination is better than any money you spend on material things. The gift of your time will be remembered always. 

 

Elizabeth Vainder, M.D.

 

 

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. 

 

10 Strategies for getting babies to sleep through the night

 

January 22, 2020

Good morning! If you just had a baby and you’re wondering how you are ever going to make it through this parenting thing on such little sleep, you are not alone! Having a baby can bring with it so much joy but as the initial stage of bliss begins to wear off, the extreme lack of sleep really starts to break you down. Before you start thinking that you will never sleep again, I am writing 10 strategies to help you get your baby sleeping through the night when he/she is ready.

I will add that newborns need to eat small amounts frequently. It is not appropriate to think that your baby will be sleeping through the night from Day 1, and if they are then something is wrong. So the strategies I am listing below are to help you approach sleep with your baby from Day 1, keeping in mind that you and your baby will change along the way and you need to be willing. Just when you think you found the best way, the baby will do something different. As baby’s grow, their needs change and as they become more and more aware of their surroundings, so do their reactions to what we do in response. This is especially important to understand as it related to sleep.

1. Less is more. When you are setting up a bedtime routine, remember less is more. I know there are many gadgets, sound machines, lullabies, etc out there to get your baby to fall asleep but you need to make it simple. You may not have that gadget when you travel or as your baby grows so remember less is more

2. Establish routines from Day 1. Babies thrive in routines and sleep is no different. Although it is difficult with a newborn it is not impossible. Try to create a pattern that the baby can recognize. For example: Bath, Story, Bed.

3.  Create a quiet time 1 hour before bed. Studies show that it is more difficult to fall asleep and stay asleep when you use computers or electronics before going to bed. Establish this as a rule in your house from Day 1. This is the perfect time for reading and engaging your baby. (This means YOUR phone too…put it down)

4. Help your baby to fall asleep but do not put them to sleep. In other words, you can help your baby relax if he/she is upset but once they appear relaxed, just lay them down. Let them learn from the beginning how to fall asleep without you.

5. Once a baby is between 3-4 months old try to separate feeding from sleeping. You do not want your baby to associate falling asleep with breast feeding or even bottle feeding. Not only does this create a bad habit, but once a baby has teeth, you increase their risk of cavities if they fall asleep drinking milk.

 6. Try to create a clear difference between day and night in your home. Daytime is when we speak freely, sing, dance and our lights are on. In the middle of the night we do not sing and dance! (at least not with a newborn).

7. Do your best to not run to your baby with every little sound. Newborns make lots of sounds and even a slight cry when they are settling in or trying to fall asleep. Let them try to get to sleep without your help after you have checked all your boxes: a.full tummy b. clean diaper. (you will begin to recognize your baby’s cries as you get to know them).

 8. It’s never to early to introduce a “lovey” or a special blanket. While newborns can not sleep with blankets in their crib, older kids can. However, you can place a lovey or special blanket near your baby while you are helping them transition from day to night with your bedtime routine. Just don’t put it in the crib.

9. Say goodnight. Sneaking away from a baby will create anxiety. The earlier a baby learns that he/she is going to sleep alone the less anxious they will be about going to sleep. (imagine if you’re a baby and you fall asleep in your mother’s arms, thinking you are there all night, only to find yourself alone in your crib at 2 am!-ANXIETY!)

10. Setbacks will happen when a baby is sick or you travel. It is totally fine! Somedays you just have to do what you have to do to make it through. Just try to get back into your original routine as soon as you and your baby are ready!

Sleep is one of the most overlooked aspects of health that many of us take for granted. Our bodies need to sleep. Being proactive in creating healthy sleeping habits will not only help your baby but it will also help you. You will be a better parent with a good night’s sleep and it’s never too early to begin preparing for it with your new baby!

Happy zzz’s!

Elizabeth Vainder, M.D.

Pediatrician

DRVCARES