Lee Savio Beers, MD

As the year comes to an end, I have decided – after 9 years of writing for Pediatric News – to bring my column to a close. It has been a great joy to be a part of the pediatric community in this way, and I have been grateful for those of you who approach me at meetings, saying, “Hey, I recognize you – I really like your column!” or tell me you appreciated a particular topic or piece of advice.

As I reflected on the columns I have written, I realized there were two themes that repeatedly emerged as most meaningful to me. While these thoughts are nothing new, I thought they would be a fitting way to sum up my writings over the years.

First, and most important, is that patients and families are the best partners we have in the care we give. When we take the time to listen to them, involve them in decision making and think past what we see on the surface, kids are healthier. This is just as true for preventative “well-baby” care as it is for acute and specialty care. Understanding a family’s priorities, values, and the context in which they live is just as important as our medical knowledge and skills when taking care of patients. Pediatricians are expert at bringing all of these things together, grounded in the best and most up-to-date evidence available, and in doing so elevate the care of children.

Which leads me to the second theme – pediatricians are a strong and important voice for children, and it is important for us to learn to lead. Through our work, we have a window into the lives of children, both when they are healthy and when they are sick. That is a great privilege but also a great responsibility. We see the things that work well in our systems and the things that do not. We see the amazing things children are capable of, but also troubling and pervasive inequities in care, access, and education. We see children who aren’t having their basic needs met – things like food, shelter, and a safe place to play. We see how these inequities impact health and wellness – both now and as children grow into adults. These observations, and the things we learn by caring for children and families day in and day out, can be translated into action. For each of us that will mean something different, but it is imperative that we develop our talents as advocates and leaders so that we can catalyze change. Our best hope for making things better is if we each do our part to create solutions. And when that happens, children – a lot of children – are healthier.

Since I began my first column 9 years ago, a lot has changed for me, and I suspect for many of you. When I first began writing, my now tall, confident tween (who already wears the same shoe size as me!) was barely walking. Thank you to all who have listened and encouraged me along the way – it has been a fun journey, and I’ve appreciated your time.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, both in Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics.

As the year comes to an end, I have decided – after 9 years of writing for Pediatric News – to bring my column to a close. It has been a great joy to be a part of the pediatric community in this way, and I have been grateful for those of you who approach me at meetings, saying, “Hey, I recognize you – I really like your column!” or tell me you appreciated a particular topic or piece of advice.

As I reflected on the columns I have written, I realized there were two themes that repeatedly emerged as most meaningful to me. While these thoughts are nothing new, I thought they would be a fitting way to sum up my writings over the years.

First, and most important, is that patients and families are the best partners we have in the care we give. When we take the time to listen to them, involve them in decision making and think past what we see on the surface, kids are healthier. This is just as true for preventative “well-baby” care as it is for acute and specialty care. Understanding a family’s priorities, values, and the context in which they live is just as important as our medical knowledge and skills when taking care of patients. Pediatricians are expert at bringing all of these things together, grounded in the best and most up-to-date evidence available, and in doing so elevate the care of children.

Which leads me to the second theme – pediatricians are a strong and important voice for children, and it is important for us to learn to lead. Through our work, we have a window into the lives of children, both when they are healthy and when they are sick. That is a great privilege but also a great responsibility. We see the things that work well in our systems and the things that do not. We see the amazing things children are capable of, but also troubling and pervasive inequities in care, access, and education. We see children who aren’t having their basic needs met – things like food, shelter, and a safe place to play. We see how these inequities impact health and wellness – both now and as children grow into adults. These observations, and the things we learn by caring for children and families day in and day out, can be translated into action. For each of us that will mean something different, but it is imperative that we develop our talents as advocates and leaders so that we can catalyze change. Our best hope for making things better is if we each do our part to create solutions. And when that happens, children – a lot of children – are healthier.

Since I began my first column 9 years ago, a lot has changed for me, and I suspect for many of you. When I first began writing, my now tall, confident tween (who already wears the same shoe size as me!) was barely walking. Thank you to all who have listened and encouraged me along the way – it has been a fun journey, and I’ve appreciated your time.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, both in Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics.

As the year comes to an end, I have decided – after 9 years of writing for Pediatric News – to bring my column to a close. It has been a great joy to be a part of the pediatric community in this way, and I have been grateful for those of you who approach me at meetings, saying, “Hey, I recognize you – I really like your column!” or tell me you appreciated a particular topic or piece of advice.

As I reflected on the columns I have written, I realized there were two themes that repeatedly emerged as most meaningful to me. While these thoughts are nothing new, I thought they would be a fitting way to sum up my writings over the years.

First, and most important, is that patients and families are the best partners we have in the care we give. When we take the time to listen to them, involve them in decision making and think past what we see on the surface, kids are healthier. This is just as true for preventative “well-baby” care as it is for acute and specialty care. Understanding a family’s priorities, values, and the context in which they live is just as important as our medical knowledge and skills when taking care of patients. Pediatricians are expert at bringing all of these things together, grounded in the best and most up-to-date evidence available, and in doing so elevate the care of children.

Which leads me to the second theme – pediatricians are a strong and important voice for children, and it is important for us to learn to lead. Through our work, we have a window into the lives of children, both when they are healthy and when they are sick. That is a great privilege but also a great responsibility. We see the things that work well in our systems and the things that do not. We see the amazing things children are capable of, but also troubling and pervasive inequities in care, access, and education. We see children who aren’t having their basic needs met – things like food, shelter, and a safe place to play. We see how these inequities impact health and wellness – both now and as children grow into adults. These observations, and the things we learn by caring for children and families day in and day out, can be translated into action. For each of us that will mean something different, but it is imperative that we develop our talents as advocates and leaders so that we can catalyze change. Our best hope for making things better is if we each do our part to create solutions. And when that happens, children – a lot of children – are healthier.

Since I began my first column 9 years ago, a lot has changed for me, and I suspect for many of you. When I first began writing, my now tall, confident tween (who already wears the same shoe size as me!) was barely walking. Thank you to all who have listened and encouraged me along the way – it has been a fun journey, and I’ve appreciated your time.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, both in Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics.

Back to school brings, as it does every year, an increased focus on school issues. Parents and children may feel uncomfortable discussing many of these concerns or may not realize that their pediatrician can be a source of help and support. One topic in particular, bullying, is an important and difficult issue that affects a large number of children and adolescents, yet unfortunately, often goes undetected.

More than half of teens have been either the victims or perpetrators of some type of bullying; for one in five, this takes the form of actual physical bullying or violence. Bullying can happen to anyone, from any socioeconomic status, in any school or neighborhood. Even children who are seemingly well adjusted and “popular” at school can be victimized. The dramatic increase in technology use, smartphones and social media only increases the vulnerability of youth to bullying – cyberbullying can be incredibly damaging and difficult to detect and address.

©monkeybusinessimages/Thinkstock.com

Pediatric providers can help in many ways. First, don’t hesitate to bring up the issue of bullying during well visits or sports physicals when discussing school performance or school readiness. While I admit – given the large range of topics that need to be covered – I don’t discuss this at every visit, I often do ask about friendships at school and have a low threshold for bringing up the issue of bullying with families.

Second, be alert to possible signs that your patients may be bullied. Nonspecific symptoms – such as headaches, stomach pains, fatigue, or behavior or mood changes – can be manifestations of the distress associated with being bullied. When evaluating children for these concerns, it is important to take a detailed history that includes potential psychosocial stressors or changes, such as bullying. Equally as important is to approach this history-taking in a culturally sensitive and trauma-informed way and to recognize that your patients may not immediately disclose concerns. However, by demonstrating that you are a trusted source of support, you can open the door for future conversations.

Lastly, be prepared to respond in a nonthreatening and nonjudgmental way when concerns arise. These are very challenging situations, and it is important to engage families – and the child or teen – in the best way to address them. Youth may feel a great loss of control in the bullying relationship, and thus, to avoid further trauma, it is critically important for their family and professionals to give them as much control as possible in dealing with it. Of course, there are times when the child’s safety could be compromised, and more directive intervention is needed, but even in those situations the provider and family can help by being open and communicative.

Typically, other support systems will also need to be involved – for example, the school (if that is where the bullying is taking place) or trained mental health providers. Families may need help thinking about the best way to approach or initiate these discussions, especially as they themselves may be angry or in denial. Providers can even serve as a resource to schools and communities in thinking about the best way to prevent and address bullying, either in individual situations or more generally. The U.S. Department of Health & Human Services offers comprehensive resources to providers and families faced with the issue of bullying (www.stopbullying.gov).

As partners with the family, patient, and community, pediatric providers can play an important role in preventing and addressing bullying, which can have a lifelong impact on the health of a child.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, both in Washington.

Back to school brings, as it does every year, an increased focus on school issues. Parents and children may feel uncomfortable discussing many of these concerns or may not realize that their pediatrician can be a source of help and support. One topic in particular, bullying, is an important and difficult issue that affects a large number of children and adolescents, yet unfortunately, often goes undetected.

More than half of teens have been either the victims or perpetrators of some type of bullying; for one in five, this takes the form of actual physical bullying or violence. Bullying can happen to anyone, from any socioeconomic status, in any school or neighborhood. Even children who are seemingly well adjusted and “popular” at school can be victimized. The dramatic increase in technology use, smartphones and social media only increases the vulnerability of youth to bullying – cyberbullying can be incredibly damaging and difficult to detect and address.

©monkeybusinessimages/Thinkstock.com

Pediatric providers can help in many ways. First, don’t hesitate to bring up the issue of bullying during well visits or sports physicals when discussing school performance or school readiness. While I admit – given the large range of topics that need to be covered – I don’t discuss this at every visit, I often do ask about friendships at school and have a low threshold for bringing up the issue of bullying with families.

Second, be alert to possible signs that your patients may be bullied. Nonspecific symptoms – such as headaches, stomach pains, fatigue, or behavior or mood changes – can be manifestations of the distress associated with being bullied. When evaluating children for these concerns, it is important to take a detailed history that includes potential psychosocial stressors or changes, such as bullying. Equally as important is to approach this history-taking in a culturally sensitive and trauma-informed way and to recognize that your patients may not immediately disclose concerns. However, by demonstrating that you are a trusted source of support, you can open the door for future conversations.

Lastly, be prepared to respond in a nonthreatening and nonjudgmental way when concerns arise. These are very challenging situations, and it is important to engage families – and the child or teen – in the best way to address them. Youth may feel a great loss of control in the bullying relationship, and thus, to avoid further trauma, it is critically important for their family and professionals to give them as much control as possible in dealing with it. Of course, there are times when the child’s safety could be compromised, and more directive intervention is needed, but even in those situations the provider and family can help by being open and communicative.

Typically, other support systems will also need to be involved – for example, the school (if that is where the bullying is taking place) or trained mental health providers. Families may need help thinking about the best way to approach or initiate these discussions, especially as they themselves may be angry or in denial. Providers can even serve as a resource to schools and communities in thinking about the best way to prevent and address bullying, either in individual situations or more generally. The U.S. Department of Health & Human Services offers comprehensive resources to providers and families faced with the issue of bullying (www.stopbullying.gov).

As partners with the family, patient, and community, pediatric providers can play an important role in preventing and addressing bullying, which can have a lifelong impact on the health of a child.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, both in Washington.

Back to school brings, as it does every year, an increased focus on school issues. Parents and children may feel uncomfortable discussing many of these concerns or may not realize that their pediatrician can be a source of help and support. One topic in particular, bullying, is an important and difficult issue that affects a large number of children and adolescents, yet unfortunately, often goes undetected.

More than half of teens have been either the victims or perpetrators of some type of bullying; for one in five, this takes the form of actual physical bullying or violence. Bullying can happen to anyone, from any socioeconomic status, in any school or neighborhood. Even children who are seemingly well adjusted and “popular” at school can be victimized. The dramatic increase in technology use, smartphones and social media only increases the vulnerability of youth to bullying – cyberbullying can be incredibly damaging and difficult to detect and address.

©monkeybusinessimages/Thinkstock.com

Pediatric providers can help in many ways. First, don’t hesitate to bring up the issue of bullying during well visits or sports physicals when discussing school performance or school readiness. While I admit – given the large range of topics that need to be covered – I don’t discuss this at every visit, I often do ask about friendships at school and have a low threshold for bringing up the issue of bullying with families.

Second, be alert to possible signs that your patients may be bullied. Nonspecific symptoms – such as headaches, stomach pains, fatigue, or behavior or mood changes – can be manifestations of the distress associated with being bullied. When evaluating children for these concerns, it is important to take a detailed history that includes potential psychosocial stressors or changes, such as bullying. Equally as important is to approach this history-taking in a culturally sensitive and trauma-informed way and to recognize that your patients may not immediately disclose concerns. However, by demonstrating that you are a trusted source of support, you can open the door for future conversations.

Lastly, be prepared to respond in a nonthreatening and nonjudgmental way when concerns arise. These are very challenging situations, and it is important to engage families – and the child or teen – in the best way to address them. Youth may feel a great loss of control in the bullying relationship, and thus, to avoid further trauma, it is critically important for their family and professionals to give them as much control as possible in dealing with it. Of course, there are times when the child’s safety could be compromised, and more directive intervention is needed, but even in those situations the provider and family can help by being open and communicative.

Typically, other support systems will also need to be involved – for example, the school (if that is where the bullying is taking place) or trained mental health providers. Families may need help thinking about the best way to approach or initiate these discussions, especially as they themselves may be angry or in denial. Providers can even serve as a resource to schools and communities in thinking about the best way to prevent and address bullying, either in individual situations or more generally. The U.S. Department of Health & Human Services offers comprehensive resources to providers and families faced with the issue of bullying (www.stopbullying.gov).

As partners with the family, patient, and community, pediatric providers can play an important role in preventing and addressing bullying, which can have a lifelong impact on the health of a child.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, both in Washington.

With lots of opportunity to run and play, and an abundance of fresh, seasonal fruits and vegetables, summer is the perfect time to talk with families about developing healthy habits for a lifetime. Add to that the large volume of children seen in the summer for school physicals, and the string of recent reports about the importance of fostering good habits, and this is a timely topic to bring up in your practice.

In July, the American Academy of Pediatrics released a clinical report, “The Role of the Pediatrician in Primary Prevention of Obesity,” encouraging the support of healthy eating, exercise, and good screen time habits from an early age, with practical tips for the pediatrician (Pediatrics 2015 [doi:10.1542/peds.2015-1558]).

As an illustration of why these things are important, just 1 month earlier an article in Pediatrics, “Active Play Opportunities in Child Care,” demonstrated decreased opportunities for preschoolers in child care to engage in active play (Pediatrics 2015 [doi:10.1542/peds.2014-2750]). Earlier this winter, another paper described how televisions and “small screens” (for example, smartphones and tablets) in the room at night can decrease sleep duration and restfulness (Pediatrics 2015 [doi:10.1542/peds.2014-2306]).

Understandably, many parents – myself included – have a lot to worry about every day and cringe at the thought of just one more thing to do or think about. I think it is helpful to have a few key tips you can share with parents to help them make small but meaningful changes, or – even better – set up good habits from the start. I share a few of my own below, and I am sure all of you have many more great ideas!

• No (or, realistically, very little) juice. This is a hard one, and often an uphill battle, as juice is available at child care centers, through the WIC program, and at every birthday party or class celebration you go to. This is advice I give parents very early on, given that if their child develops the habit from the beginning of drinking water and milk only, and doesn’t have regular access to juice, it is much easier to make it just an occasional, special thing. I tell parents that juice is high in sugar and calories, but because it tastes good, kids (and adults) are prone to drink way too much of it. I also share tips for making water taste a little more appealing – add a lemon slice, a squirt of lemon juice, or a sprig of mint, or offer sparkling water (without added sugar – all drinks except milk should be 10 calories or less per serving) as a treat.

• Limit screen time. Really. I know as much as anyone how hard that is to do, and sometimes there are times when your kids watch way more TV than you know they should, but that should be the exception rather than the rule. Make sure there are lots of books available, all the time. Books can be expensive, so regular library trips are a great way to keep a wide variety of interesting books around the house. Stash little buckets or baskets of small toys and puzzles throughout the house so that no matter where you are, when your kids say “I’m bored,” you can say, “Why don’t you pull out that basket over there and find something to play with?” (And be willing to listen to a little whining while your kids do find something else to do). Get out of the house – if you are not in the room with the TV, it is easier to say no – even if it is just to take the kids grocery shopping, get the car washed, or run a few errands (but don’t let them play with your phone while you are out…). Think long and hard about when your children need their own phones, and if it has to be a smartphone or can just be an old-fashioned flip phone. You will find it is probably not as soon as you think. Keep “small screens” and TVs out of your kid’s room. And – this one is hard for me too – put your own devices down anytime you can while your kids are awake.

• Stay active. Find time every day to move a little. Think about how you can alter your schedule to walk places instead of drive, stop by the playground after school, or find after-school activities that keep kids moving (many of these activities, especially if they are sponsored by the school, are free, so definitely take advantage of them). My daughter and I have started running together every Sunday morning; it is wonderful exercise for both of us and has been a really nice opportunity to have some quiet time together, talking about her week and the things going on in her life.

I think it also is important to tell parents that no one is perfect all the time. They should do their best to implement and model healthy habits, but should not beat themselves up if they find they are not where they want to be. They should just regroup, make a few changes, and keep moving forward. Then, not only will they model healthy habits for their kids, but they will model for them how to manage the expected ups and downs of life, another important lifelong lesson!

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected].

With lots of opportunity to run and play, and an abundance of fresh, seasonal fruits and vegetables, summer is the perfect time to talk with families about developing healthy habits for a lifetime. Add to that the large volume of children seen in the summer for school physicals, and the string of recent reports about the importance of fostering good habits, and this is a timely topic to bring up in your practice.

In July, the American Academy of Pediatrics released a clinical report, “The Role of the Pediatrician in Primary Prevention of Obesity,” encouraging the support of healthy eating, exercise, and good screen time habits from an early age, with practical tips for the pediatrician (Pediatrics 2015 [doi:10.1542/peds.2015-1558]).

As an illustration of why these things are important, just 1 month earlier an article in Pediatrics, “Active Play Opportunities in Child Care,” demonstrated decreased opportunities for preschoolers in child care to engage in active play (Pediatrics 2015 [doi:10.1542/peds.2014-2750]). Earlier this winter, another paper described how televisions and “small screens” (for example, smartphones and tablets) in the room at night can decrease sleep duration and restfulness (Pediatrics 2015 [doi:10.1542/peds.2014-2306]).

Understandably, many parents – myself included – have a lot to worry about every day and cringe at the thought of just one more thing to do or think about. I think it is helpful to have a few key tips you can share with parents to help them make small but meaningful changes, or – even better – set up good habits from the start. I share a few of my own below, and I am sure all of you have many more great ideas!

• No (or, realistically, very little) juice. This is a hard one, and often an uphill battle, as juice is available at child care centers, through the WIC program, and at every birthday party or class celebration you go to. This is advice I give parents very early on, given that if their child develops the habit from the beginning of drinking water and milk only, and doesn’t have regular access to juice, it is much easier to make it just an occasional, special thing. I tell parents that juice is high in sugar and calories, but because it tastes good, kids (and adults) are prone to drink way too much of it. I also share tips for making water taste a little more appealing – add a lemon slice, a squirt of lemon juice, or a sprig of mint, or offer sparkling water (without added sugar – all drinks except milk should be 10 calories or less per serving) as a treat.

• Limit screen time. Really. I know as much as anyone how hard that is to do, and sometimes there are times when your kids watch way more TV than you know they should, but that should be the exception rather than the rule. Make sure there are lots of books available, all the time. Books can be expensive, so regular library trips are a great way to keep a wide variety of interesting books around the house. Stash little buckets or baskets of small toys and puzzles throughout the house so that no matter where you are, when your kids say “I’m bored,” you can say, “Why don’t you pull out that basket over there and find something to play with?” (And be willing to listen to a little whining while your kids do find something else to do). Get out of the house – if you are not in the room with the TV, it is easier to say no – even if it is just to take the kids grocery shopping, get the car washed, or run a few errands (but don’t let them play with your phone while you are out…). Think long and hard about when your children need their own phones, and if it has to be a smartphone or can just be an old-fashioned flip phone. You will find it is probably not as soon as you think. Keep “small screens” and TVs out of your kid’s room. And – this one is hard for me too – put your own devices down anytime you can while your kids are awake.

• Stay active. Find time every day to move a little. Think about how you can alter your schedule to walk places instead of drive, stop by the playground after school, or find after-school activities that keep kids moving (many of these activities, especially if they are sponsored by the school, are free, so definitely take advantage of them). My daughter and I have started running together every Sunday morning; it is wonderful exercise for both of us and has been a really nice opportunity to have some quiet time together, talking about her week and the things going on in her life.

I think it also is important to tell parents that no one is perfect all the time. They should do their best to implement and model healthy habits, but should not beat themselves up if they find they are not where they want to be. They should just regroup, make a few changes, and keep moving forward. Then, not only will they model healthy habits for their kids, but they will model for them how to manage the expected ups and downs of life, another important lifelong lesson!

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected].

With lots of opportunity to run and play, and an abundance of fresh, seasonal fruits and vegetables, summer is the perfect time to talk with families about developing healthy habits for a lifetime. Add to that the large volume of children seen in the summer for school physicals, and the string of recent reports about the importance of fostering good habits, and this is a timely topic to bring up in your practice.

In July, the American Academy of Pediatrics released a clinical report, “The Role of the Pediatrician in Primary Prevention of Obesity,” encouraging the support of healthy eating, exercise, and good screen time habits from an early age, with practical tips for the pediatrician (Pediatrics 2015 [doi:10.1542/peds.2015-1558]).

As an illustration of why these things are important, just 1 month earlier an article in Pediatrics, “Active Play Opportunities in Child Care,” demonstrated decreased opportunities for preschoolers in child care to engage in active play (Pediatrics 2015 [doi:10.1542/peds.2014-2750]). Earlier this winter, another paper described how televisions and “small screens” (for example, smartphones and tablets) in the room at night can decrease sleep duration and restfulness (Pediatrics 2015 [doi:10.1542/peds.2014-2306]).

Understandably, many parents – myself included – have a lot to worry about every day and cringe at the thought of just one more thing to do or think about. I think it is helpful to have a few key tips you can share with parents to help them make small but meaningful changes, or – even better – set up good habits from the start. I share a few of my own below, and I am sure all of you have many more great ideas!

• No (or, realistically, very little) juice. This is a hard one, and often an uphill battle, as juice is available at child care centers, through the WIC program, and at every birthday party or class celebration you go to. This is advice I give parents very early on, given that if their child develops the habit from the beginning of drinking water and milk only, and doesn’t have regular access to juice, it is much easier to make it just an occasional, special thing. I tell parents that juice is high in sugar and calories, but because it tastes good, kids (and adults) are prone to drink way too much of it. I also share tips for making water taste a little more appealing – add a lemon slice, a squirt of lemon juice, or a sprig of mint, or offer sparkling water (without added sugar – all drinks except milk should be 10 calories or less per serving) as a treat.

• Limit screen time. Really. I know as much as anyone how hard that is to do, and sometimes there are times when your kids watch way more TV than you know they should, but that should be the exception rather than the rule. Make sure there are lots of books available, all the time. Books can be expensive, so regular library trips are a great way to keep a wide variety of interesting books around the house. Stash little buckets or baskets of small toys and puzzles throughout the house so that no matter where you are, when your kids say “I’m bored,” you can say, “Why don’t you pull out that basket over there and find something to play with?” (And be willing to listen to a little whining while your kids do find something else to do). Get out of the house – if you are not in the room with the TV, it is easier to say no – even if it is just to take the kids grocery shopping, get the car washed, or run a few errands (but don’t let them play with your phone while you are out…). Think long and hard about when your children need their own phones, and if it has to be a smartphone or can just be an old-fashioned flip phone. You will find it is probably not as soon as you think. Keep “small screens” and TVs out of your kid’s room. And – this one is hard for me too – put your own devices down anytime you can while your kids are awake.

• Stay active. Find time every day to move a little. Think about how you can alter your schedule to walk places instead of drive, stop by the playground after school, or find after-school activities that keep kids moving (many of these activities, especially if they are sponsored by the school, are free, so definitely take advantage of them). My daughter and I have started running together every Sunday morning; it is wonderful exercise for both of us and has been a really nice opportunity to have some quiet time together, talking about her week and the things going on in her life.

I think it also is important to tell parents that no one is perfect all the time. They should do their best to implement and model healthy habits, but should not beat themselves up if they find they are not where they want to be. They should just regroup, make a few changes, and keep moving forward. Then, not only will they model healthy habits for their kids, but they will model for them how to manage the expected ups and downs of life, another important lifelong lesson!

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected].

As my children grow older, our family is increasingly drawn into the world of preteen youth sports. As both kids love playing, and have significantly more athleticism and coordination than I ever did, we – and many of the families around us – are being faced with the question: How much is too much? Especially during this season of travel team tryouts and summer training camps, parents may seek your guidance as they try to navigate an increasingly competitive and intense environment.

While there are no easy answers to many of these questions, which are in many ways highly individualized, there are a few guiding principles that I have applied with my own family, and when giving advice to parents.

First and foremost, sports should be fun. Whether your child is an aspiring Olympic athlete or the clumsiest recreational player, they should be having fun. Sports are a wonderful way to teach children the rewards of hard work, physical exercise, teamwork, and perseverance, but it will all be lost on them if they are miserable and dread going to practice. Likewise, even the most talented athlete will burn out and move on to other things if it is not intrinsically enjoyable and rewarding to play. Every child has moments of whining or complaining, but if they are consistently telling you they don’t want to go to practice or seem unhappy, you should listen. On the flip side, if you have a child who seems to love training, who looks forward to practice, and who asks to play more and more competitively, then a more intense environment may be suitable. Just be sure it is really the child, and not the parent, who is having the most fun!

Second, the coaches (and the parents) should be encouraging, positive, and train their athletes in age- and developmentally appropriate ways. It is absolutely reasonable for coaches to require the team to come to practice reliably, pay attention, work hard, and push themselves to do their best. What is not developmentally appropriate – or even productive or motivating in the long term – is for coaches to yell, criticize, or make demeaning comments. After one game where the opposing coach continuously shouted statements to the players such as “What were you thinking?” and “Listen to what I tell you to do, not to the little voice in your head!” my daughter commented, “I don’t think I could play for that team. It would make me too nervous with the coach yelling like that all the time.”Even for the very best and most talented players, the goals of youth sports (in addition to having fun!) should be to develop skills, good sportsmanship, and the ability to understand and implement the strategy of the game. These are the core skills you need whether you ultimately become a professional athlete or a weekend warrior, but they are not things children can learn if they are afraid of being yelled at for making a wrong move, or losing a game or race. On the contrary, it may decrease a child’s confidence and even reinforce opposite behaviors. When considering where and when a child should play, parents should carefully assess the coaching and league environment. Kids should feel more confident as a result of their involvement in sports, not less. The most elite teams may actually have an environment that can do more harm than good in the long run – not only for a child’s skills, but for their self-esteem and character. On the flip side, a less intense team with good and positive coaching may develop a child’s skills in a way that leads to greater long-term success in sports and in life!

Lastly, for children of all ages, but especially prepubertal children, be alert to the dangers of over training. Every child develops differently and can tolerate different levels and amounts of training, but be sure to advise parents on what activities (for example, weight lifting) are and aren’t appropriate for kids of different ages. Children should increase their level of training gradually, be monitored carefully for signs of overuse injuries, and they, their parents, and their coaches need to be willing to back off if injuries begin recurring. Parents should be very wary of teams and coaches who push children through injuries or who are not patient about letting children take time to recover before they return to play. These are the bodies children will have for their whole lives; repeated and chronic injuries at young ages ultimately can be quite harmful.

Youth sports can be an incredibly positive experience for many children, with lifelong benefits. Unfortunately, it sometimes also can be overly competitive and frankly a little crazy! Like anything, our role as pediatricians is to provide the guidance and information to help parents and their children make both physically and emotionally healthy decisions every step of the way.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. 

As my children grow older, our family is increasingly drawn into the world of preteen youth sports. As both kids love playing, and have significantly more athleticism and coordination than I ever did, we – and many of the families around us – are being faced with the question: How much is too much? Especially during this season of travel team tryouts and summer training camps, parents may seek your guidance as they try to navigate an increasingly competitive and intense environment.

While there are no easy answers to many of these questions, which are in many ways highly individualized, there are a few guiding principles that I have applied with my own family, and when giving advice to parents.

First and foremost, sports should be fun. Whether your child is an aspiring Olympic athlete or the clumsiest recreational player, they should be having fun. Sports are a wonderful way to teach children the rewards of hard work, physical exercise, teamwork, and perseverance, but it will all be lost on them if they are miserable and dread going to practice. Likewise, even the most talented athlete will burn out and move on to other things if it is not intrinsically enjoyable and rewarding to play. Every child has moments of whining or complaining, but if they are consistently telling you they don’t want to go to practice or seem unhappy, you should listen. On the flip side, if you have a child who seems to love training, who looks forward to practice, and who asks to play more and more competitively, then a more intense environment may be suitable. Just be sure it is really the child, and not the parent, who is having the most fun!

Second, the coaches (and the parents) should be encouraging, positive, and train their athletes in age- and developmentally appropriate ways. It is absolutely reasonable for coaches to require the team to come to practice reliably, pay attention, work hard, and push themselves to do their best. What is not developmentally appropriate – or even productive or motivating in the long term – is for coaches to yell, criticize, or make demeaning comments. After one game where the opposing coach continuously shouted statements to the players such as “What were you thinking?” and “Listen to what I tell you to do, not to the little voice in your head!” my daughter commented, “I don’t think I could play for that team. It would make me too nervous with the coach yelling like that all the time.”Even for the very best and most talented players, the goals of youth sports (in addition to having fun!) should be to develop skills, good sportsmanship, and the ability to understand and implement the strategy of the game. These are the core skills you need whether you ultimately become a professional athlete or a weekend warrior, but they are not things children can learn if they are afraid of being yelled at for making a wrong move, or losing a game or race. On the contrary, it may decrease a child’s confidence and even reinforce opposite behaviors. When considering where and when a child should play, parents should carefully assess the coaching and league environment. Kids should feel more confident as a result of their involvement in sports, not less. The most elite teams may actually have an environment that can do more harm than good in the long run – not only for a child’s skills, but for their self-esteem and character. On the flip side, a less intense team with good and positive coaching may develop a child’s skills in a way that leads to greater long-term success in sports and in life!

Lastly, for children of all ages, but especially prepubertal children, be alert to the dangers of over training. Every child develops differently and can tolerate different levels and amounts of training, but be sure to advise parents on what activities (for example, weight lifting) are and aren’t appropriate for kids of different ages. Children should increase their level of training gradually, be monitored carefully for signs of overuse injuries, and they, their parents, and their coaches need to be willing to back off if injuries begin recurring. Parents should be very wary of teams and coaches who push children through injuries or who are not patient about letting children take time to recover before they return to play. These are the bodies children will have for their whole lives; repeated and chronic injuries at young ages ultimately can be quite harmful.

Youth sports can be an incredibly positive experience for many children, with lifelong benefits. Unfortunately, it sometimes also can be overly competitive and frankly a little crazy! Like anything, our role as pediatricians is to provide the guidance and information to help parents and their children make both physically and emotionally healthy decisions every step of the way.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. 

As my children grow older, our family is increasingly drawn into the world of preteen youth sports. As both kids love playing, and have significantly more athleticism and coordination than I ever did, we – and many of the families around us – are being faced with the question: How much is too much? Especially during this season of travel team tryouts and summer training camps, parents may seek your guidance as they try to navigate an increasingly competitive and intense environment.

While there are no easy answers to many of these questions, which are in many ways highly individualized, there are a few guiding principles that I have applied with my own family, and when giving advice to parents.

First and foremost, sports should be fun. Whether your child is an aspiring Olympic athlete or the clumsiest recreational player, they should be having fun. Sports are a wonderful way to teach children the rewards of hard work, physical exercise, teamwork, and perseverance, but it will all be lost on them if they are miserable and dread going to practice. Likewise, even the most talented athlete will burn out and move on to other things if it is not intrinsically enjoyable and rewarding to play. Every child has moments of whining or complaining, but if they are consistently telling you they don’t want to go to practice or seem unhappy, you should listen. On the flip side, if you have a child who seems to love training, who looks forward to practice, and who asks to play more and more competitively, then a more intense environment may be suitable. Just be sure it is really the child, and not the parent, who is having the most fun!

Second, the coaches (and the parents) should be encouraging, positive, and train their athletes in age- and developmentally appropriate ways. It is absolutely reasonable for coaches to require the team to come to practice reliably, pay attention, work hard, and push themselves to do their best. What is not developmentally appropriate – or even productive or motivating in the long term – is for coaches to yell, criticize, or make demeaning comments. After one game where the opposing coach continuously shouted statements to the players such as “What were you thinking?” and “Listen to what I tell you to do, not to the little voice in your head!” my daughter commented, “I don’t think I could play for that team. It would make me too nervous with the coach yelling like that all the time.”Even for the very best and most talented players, the goals of youth sports (in addition to having fun!) should be to develop skills, good sportsmanship, and the ability to understand and implement the strategy of the game. These are the core skills you need whether you ultimately become a professional athlete or a weekend warrior, but they are not things children can learn if they are afraid of being yelled at for making a wrong move, or losing a game or race. On the contrary, it may decrease a child’s confidence and even reinforce opposite behaviors. When considering where and when a child should play, parents should carefully assess the coaching and league environment. Kids should feel more confident as a result of their involvement in sports, not less. The most elite teams may actually have an environment that can do more harm than good in the long run – not only for a child’s skills, but for their self-esteem and character. On the flip side, a less intense team with good and positive coaching may develop a child’s skills in a way that leads to greater long-term success in sports and in life!

Lastly, for children of all ages, but especially prepubertal children, be alert to the dangers of over training. Every child develops differently and can tolerate different levels and amounts of training, but be sure to advise parents on what activities (for example, weight lifting) are and aren’t appropriate for kids of different ages. Children should increase their level of training gradually, be monitored carefully for signs of overuse injuries, and they, their parents, and their coaches need to be willing to back off if injuries begin recurring. Parents should be very wary of teams and coaches who push children through injuries or who are not patient about letting children take time to recover before they return to play. These are the bodies children will have for their whole lives; repeated and chronic injuries at young ages ultimately can be quite harmful.

Youth sports can be an incredibly positive experience for many children, with lifelong benefits. Unfortunately, it sometimes also can be overly competitive and frankly a little crazy! Like anything, our role as pediatricians is to provide the guidance and information to help parents and their children make both physically and emotionally healthy decisions every step of the way.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. 

After a long, cold, snowy winter, I actually cheered at the first site of a purple crocus emerging from my front yard. Spring brings with it warmer weather, outdoor sports, blooming flowers, and trees full of leaves. Unfortunately, it also brings some less-desirable plants with it as well, such as poison ivy, poison oak, and poison sumac. As your patients happily emerge from their houses to play outside, some will inevitably end up in your offices itching and uncomfortable from contact dermatitis. As many as 50% of people who come in contact with these plants will have a reaction.

As with most illnesses, prevention is the best cure. Once a child (or adult, for that matter) has been exposed to poison ivy, oak, or sumac, from the genus Toxicodendron, the best you can do is try and relieve symptoms until the dermatitis resolves on its own.

CDC/ Dr. Edwin P. Ewing, Jr.

The first step in prevention is recognition. The old adage, “Leaves of three, let them be” – describing three leaflets, often with small black dots, arising from a reddish stem – is generally accurate; however, there are some exceptions to this rule depending on the type of plant (particularly poison sumac) and geographic location. If you aren’t already aware of the species in your area, it is worth spending a few minutes researching what types of plants are common locally (www.cdc.gov/niosh/topics/plants).

Avoiding all contact with these plants is best; long pants, shirt sleeves, and gloves help avoid exposure, but this is often not practical for a child playing outside, and urushiol (the allergenic substance on the surface of these plants) adheres to clothes, and pets, and other things. … If known or potential exposure has happened, it is best to wash all areas of your skin as soon as possible, particularly focusing on hands and under your fingernails. There are a variety of products such as Tecnu, Zanfel, and Goop Hand Cleaner, which are effective at preventing reactions after exposure has occurred (and, in the case of Zanfel, can also relieve symptoms if a reaction occurs); however, these products can be pricey and not always on hand when you need them. Topical dish washing soap has been found in one study to be an effective alternative (Dial Ultra Dish washing Soap [no longer available] was the product used, but any surfactant-based dish washing detergent is likely effective).*

However, speaking from experience, even the best efforts to avoid or minimize exposure are not always successful. Symptoms usually occur within the first 4 days of exposure, with lesions cropping up at different times depending on the location and type of skin and intensity of exposure to urushiol. Lesions are typically very itchy and can be plaques, papules, vesicles, or bullae. It is commonly believed that the lesions can be “spread” through contact with the fluid inside these vesicles or other parts of the lesions; however, this is not in fact true. This misperception likely stems from the fact, as noted, that the lesions do appear at different times after exposure to the plant, which can make it seem as if they are spreading from one site to another. Reactions can peak anywhere from 1 day to 2 weeks after exposure and can last for several weeks. Again, speaking from experience, this is a long time to be itchy and uncomfortable, especially for young children, so management of symptoms is very important.

There are many strategies and commercial products that can help reduce itching and irritation. First, it is important to keep the skin clean and not to cause breaks in the skin through itching, hard as that may be, in order to avoid bacterial superinfection. Gentle interventions such as oatmeal baths or cool wet compresses may be helpful; swimming may also provide relief. Topical medications can play a role – topical corticosteroids, particularly higher dose, can be helpful in relief of symptoms. Calamine lotion, products containing menthol, and topical astringents are other effective options. Oral antihistamines are not terribly effective, as the itching is not caused by histamine, however, the sedating effects can help patients get some rest at night. For severe cases, oral corticosteroids are sometimes used, but care must be taken to give a long enough course to avoid rebound. And, perhaps most importantly, provide reassurance that this will get better eventually! As with most things in pediatrics, preventative measures and supportive care are key to making sure your patients enjoy their spring and summer without too much discomfort!

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected].

* This story was updated 3/26/2015.

After a long, cold, snowy winter, I actually cheered at the first site of a purple crocus emerging from my front yard. Spring brings with it warmer weather, outdoor sports, blooming flowers, and trees full of leaves. Unfortunately, it also brings some less-desirable plants with it as well, such as poison ivy, poison oak, and poison sumac. As your patients happily emerge from their houses to play outside, some will inevitably end up in your offices itching and uncomfortable from contact dermatitis. As many as 50% of people who come in contact with these plants will have a reaction.

As with most illnesses, prevention is the best cure. Once a child (or adult, for that matter) has been exposed to poison ivy, oak, or sumac, from the genus Toxicodendron, the best you can do is try and relieve symptoms until the dermatitis resolves on its own.

CDC/ Dr. Edwin P. Ewing, Jr.

The first step in prevention is recognition. The old adage, “Leaves of three, let them be” – describing three leaflets, often with small black dots, arising from a reddish stem – is generally accurate; however, there are some exceptions to this rule depending on the type of plant (particularly poison sumac) and geographic location. If you aren’t already aware of the species in your area, it is worth spending a few minutes researching what types of plants are common locally (www.cdc.gov/niosh/topics/plants).

Avoiding all contact with these plants is best; long pants, shirt sleeves, and gloves help avoid exposure, but this is often not practical for a child playing outside, and urushiol (the allergenic substance on the surface of these plants) adheres to clothes, and pets, and other things. … If known or potential exposure has happened, it is best to wash all areas of your skin as soon as possible, particularly focusing on hands and under your fingernails. There are a variety of products such as Tecnu, Zanfel, and Goop Hand Cleaner, which are effective at preventing reactions after exposure has occurred (and, in the case of Zanfel, can also relieve symptoms if a reaction occurs); however, these products can be pricey and not always on hand when you need them. Topical dish washing soap has been found in one study to be an effective alternative (Dial Ultra Dish washing Soap [no longer available] was the product used, but any surfactant-based dish washing detergent is likely effective).*

However, speaking from experience, even the best efforts to avoid or minimize exposure are not always successful. Symptoms usually occur within the first 4 days of exposure, with lesions cropping up at different times depending on the location and type of skin and intensity of exposure to urushiol. Lesions are typically very itchy and can be plaques, papules, vesicles, or bullae. It is commonly believed that the lesions can be “spread” through contact with the fluid inside these vesicles or other parts of the lesions; however, this is not in fact true. This misperception likely stems from the fact, as noted, that the lesions do appear at different times after exposure to the plant, which can make it seem as if they are spreading from one site to another. Reactions can peak anywhere from 1 day to 2 weeks after exposure and can last for several weeks. Again, speaking from experience, this is a long time to be itchy and uncomfortable, especially for young children, so management of symptoms is very important.

There are many strategies and commercial products that can help reduce itching and irritation. First, it is important to keep the skin clean and not to cause breaks in the skin through itching, hard as that may be, in order to avoid bacterial superinfection. Gentle interventions such as oatmeal baths or cool wet compresses may be helpful; swimming may also provide relief. Topical medications can play a role – topical corticosteroids, particularly higher dose, can be helpful in relief of symptoms. Calamine lotion, products containing menthol, and topical astringents are other effective options. Oral antihistamines are not terribly effective, as the itching is not caused by histamine, however, the sedating effects can help patients get some rest at night. For severe cases, oral corticosteroids are sometimes used, but care must be taken to give a long enough course to avoid rebound. And, perhaps most importantly, provide reassurance that this will get better eventually! As with most things in pediatrics, preventative measures and supportive care are key to making sure your patients enjoy their spring and summer without too much discomfort!

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected].

* This story was updated 3/26/2015.

After a long, cold, snowy winter, I actually cheered at the first site of a purple crocus emerging from my front yard. Spring brings with it warmer weather, outdoor sports, blooming flowers, and trees full of leaves. Unfortunately, it also brings some less-desirable plants with it as well, such as poison ivy, poison oak, and poison sumac. As your patients happily emerge from their houses to play outside, some will inevitably end up in your offices itching and uncomfortable from contact dermatitis. As many as 50% of people who come in contact with these plants will have a reaction.

As with most illnesses, prevention is the best cure. Once a child (or adult, for that matter) has been exposed to poison ivy, oak, or sumac, from the genus Toxicodendron, the best you can do is try and relieve symptoms until the dermatitis resolves on its own.

CDC/ Dr. Edwin P. Ewing, Jr.

The first step in prevention is recognition. The old adage, “Leaves of three, let them be” – describing three leaflets, often with small black dots, arising from a reddish stem – is generally accurate; however, there are some exceptions to this rule depending on the type of plant (particularly poison sumac) and geographic location. If you aren’t already aware of the species in your area, it is worth spending a few minutes researching what types of plants are common locally (www.cdc.gov/niosh/topics/plants).

Avoiding all contact with these plants is best; long pants, shirt sleeves, and gloves help avoid exposure, but this is often not practical for a child playing outside, and urushiol (the allergenic substance on the surface of these plants) adheres to clothes, and pets, and other things. … If known or potential exposure has happened, it is best to wash all areas of your skin as soon as possible, particularly focusing on hands and under your fingernails. There are a variety of products such as Tecnu, Zanfel, and Goop Hand Cleaner, which are effective at preventing reactions after exposure has occurred (and, in the case of Zanfel, can also relieve symptoms if a reaction occurs); however, these products can be pricey and not always on hand when you need them. Topical dish washing soap has been found in one study to be an effective alternative (Dial Ultra Dish washing Soap [no longer available] was the product used, but any surfactant-based dish washing detergent is likely effective).*

However, speaking from experience, even the best efforts to avoid or minimize exposure are not always successful. Symptoms usually occur within the first 4 days of exposure, with lesions cropping up at different times depending on the location and type of skin and intensity of exposure to urushiol. Lesions are typically very itchy and can be plaques, papules, vesicles, or bullae. It is commonly believed that the lesions can be “spread” through contact with the fluid inside these vesicles or other parts of the lesions; however, this is not in fact true. This misperception likely stems from the fact, as noted, that the lesions do appear at different times after exposure to the plant, which can make it seem as if they are spreading from one site to another. Reactions can peak anywhere from 1 day to 2 weeks after exposure and can last for several weeks. Again, speaking from experience, this is a long time to be itchy and uncomfortable, especially for young children, so management of symptoms is very important.

There are many strategies and commercial products that can help reduce itching and irritation. First, it is important to keep the skin clean and not to cause breaks in the skin through itching, hard as that may be, in order to avoid bacterial superinfection. Gentle interventions such as oatmeal baths or cool wet compresses may be helpful; swimming may also provide relief. Topical medications can play a role – topical corticosteroids, particularly higher dose, can be helpful in relief of symptoms. Calamine lotion, products containing menthol, and topical astringents are other effective options. Oral antihistamines are not terribly effective, as the itching is not caused by histamine, however, the sedating effects can help patients get some rest at night. For severe cases, oral corticosteroids are sometimes used, but care must be taken to give a long enough course to avoid rebound. And, perhaps most importantly, provide reassurance that this will get better eventually! As with most things in pediatrics, preventative measures and supportive care are key to making sure your patients enjoy their spring and summer without too much discomfort!

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected].

* This story was updated 3/26/2015.

Over the past year I have learned about numerous new (or newish) initiatives focused on early childhood – literacy, mental health, and identifying and addressing toxic stresses. Evidence and experience increasingly point to the importance of the early years in shaping a child’s future – no surprise to pediatricians, who can and do play an important role in supporting this development. Yet, as children are clearly dependent on their caregivers to create and encourage the type of nurturing, caring, and stimulating environments that will help them grow to be healthy and happy adults, pediatricians also play a role in supporting parents during this time.

Up to one-fifth of mothers may experience significant symptoms of depression or anxiety during the first year of their baby’s life. Perinatal mood and anxiety disorders (PMADs, also known as postpartum depression) are incredibly common yet often hard to detect; cross all racial, ethnic, and socioeconomic barriers; and are often highly treatable.

As pediatricians, we see parents often during this first year of life, are trusted sources of care, and have strong connections in our communities. Caregivers with PMADs often struggle to engage and bond with their infants despite their strong desire to do so. This makes us a safe and ideal place for parents to seek help. However, as we all know, this is not as easy as it sounds. During a busy well visit with lots of things to discuss, it can be hard to take the time to truly elicit how a parent may be doing or feeling. On top of that, many parents are afraid to admit they aren’t doing well. As one social worker I know said, sharing her own story of her experiences with PMADs, “I could hardly do anything, but when I went to the pediatrician, I made myself shower, put on clean clothes and makeup, smiled and acted as all was well. It was the only time the whole month I was able to pull myself together.”

As pediatricians, there are a few things we can do. First, ask. Parents will rarely volunteer that they are struggling, but if we make a point to ask, they are more likely to feel comfortable sharing. Even if they don’t say anything right at that moment, they will start to hear the message that we are somewhere they can come for advice or help. Some practices use formal screening tools, such as the Edinburgh Postnatal Depression Scale.

Next, identify some resources in your community where you can refer families if concerns arise. This may be tricky, as access to these resources can be poor, but having a plan for what advice you will give to parents if concerns arise will make this process run more smoothly. Postpartum Support International is a good place to start. The website has access to local resources, references, and general information for families. Parents also can be referred back to their primary care providers or local mental health service providers. For parents who may be in very acute distress, knowing the local psychiatric and emergency department availability is important so you know where to send someone in a crisis. All of these things are easier researched and identified before you actually need them – perhaps a nurse or other allied health professional in the practice may want to take this on.

Lastly, educate your office staff on the prevalence, signs, and importance of PMADs. Parents who pull it together while in the exam room may be in the waiting room in tears before you see them, and an astute and caring practice team can alert you if they see anything out of the ordinary. A nurse taking calls for your practice may notice parents who have a high level of anxiety when they frequently call for low-level concerns and are hard to reassure. Pediatricians care for and support families in so many ways, across childhood. Special thought and attention to this vulnerable time for parents can have significant impact on a child’s long term health and development.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected]. 

Over the past year I have learned about numerous new (or newish) initiatives focused on early childhood – literacy, mental health, and identifying and addressing toxic stresses. Evidence and experience increasingly point to the importance of the early years in shaping a child’s future – no surprise to pediatricians, who can and do play an important role in supporting this development. Yet, as children are clearly dependent on their caregivers to create and encourage the type of nurturing, caring, and stimulating environments that will help them grow to be healthy and happy adults, pediatricians also play a role in supporting parents during this time.

Up to one-fifth of mothers may experience significant symptoms of depression or anxiety during the first year of their baby’s life. Perinatal mood and anxiety disorders (PMADs, also known as postpartum depression) are incredibly common yet often hard to detect; cross all racial, ethnic, and socioeconomic barriers; and are often highly treatable.

As pediatricians, we see parents often during this first year of life, are trusted sources of care, and have strong connections in our communities. Caregivers with PMADs often struggle to engage and bond with their infants despite their strong desire to do so. This makes us a safe and ideal place for parents to seek help. However, as we all know, this is not as easy as it sounds. During a busy well visit with lots of things to discuss, it can be hard to take the time to truly elicit how a parent may be doing or feeling. On top of that, many parents are afraid to admit they aren’t doing well. As one social worker I know said, sharing her own story of her experiences with PMADs, “I could hardly do anything, but when I went to the pediatrician, I made myself shower, put on clean clothes and makeup, smiled and acted as all was well. It was the only time the whole month I was able to pull myself together.”

As pediatricians, there are a few things we can do. First, ask. Parents will rarely volunteer that they are struggling, but if we make a point to ask, they are more likely to feel comfortable sharing. Even if they don’t say anything right at that moment, they will start to hear the message that we are somewhere they can come for advice or help. Some practices use formal screening tools, such as the Edinburgh Postnatal Depression Scale.

Next, identify some resources in your community where you can refer families if concerns arise. This may be tricky, as access to these resources can be poor, but having a plan for what advice you will give to parents if concerns arise will make this process run more smoothly. Postpartum Support International is a good place to start. The website has access to local resources, references, and general information for families. Parents also can be referred back to their primary care providers or local mental health service providers. For parents who may be in very acute distress, knowing the local psychiatric and emergency department availability is important so you know where to send someone in a crisis. All of these things are easier researched and identified before you actually need them – perhaps a nurse or other allied health professional in the practice may want to take this on.

Lastly, educate your office staff on the prevalence, signs, and importance of PMADs. Parents who pull it together while in the exam room may be in the waiting room in tears before you see them, and an astute and caring practice team can alert you if they see anything out of the ordinary. A nurse taking calls for your practice may notice parents who have a high level of anxiety when they frequently call for low-level concerns and are hard to reassure. Pediatricians care for and support families in so many ways, across childhood. Special thought and attention to this vulnerable time for parents can have significant impact on a child’s long term health and development.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected]. 

Over the past year I have learned about numerous new (or newish) initiatives focused on early childhood – literacy, mental health, and identifying and addressing toxic stresses. Evidence and experience increasingly point to the importance of the early years in shaping a child’s future – no surprise to pediatricians, who can and do play an important role in supporting this development. Yet, as children are clearly dependent on their caregivers to create and encourage the type of nurturing, caring, and stimulating environments that will help them grow to be healthy and happy adults, pediatricians also play a role in supporting parents during this time.

Up to one-fifth of mothers may experience significant symptoms of depression or anxiety during the first year of their baby’s life. Perinatal mood and anxiety disorders (PMADs, also known as postpartum depression) are incredibly common yet often hard to detect; cross all racial, ethnic, and socioeconomic barriers; and are often highly treatable.

As pediatricians, we see parents often during this first year of life, are trusted sources of care, and have strong connections in our communities. Caregivers with PMADs often struggle to engage and bond with their infants despite their strong desire to do so. This makes us a safe and ideal place for parents to seek help. However, as we all know, this is not as easy as it sounds. During a busy well visit with lots of things to discuss, it can be hard to take the time to truly elicit how a parent may be doing or feeling. On top of that, many parents are afraid to admit they aren’t doing well. As one social worker I know said, sharing her own story of her experiences with PMADs, “I could hardly do anything, but when I went to the pediatrician, I made myself shower, put on clean clothes and makeup, smiled and acted as all was well. It was the only time the whole month I was able to pull myself together.”

As pediatricians, there are a few things we can do. First, ask. Parents will rarely volunteer that they are struggling, but if we make a point to ask, they are more likely to feel comfortable sharing. Even if they don’t say anything right at that moment, they will start to hear the message that we are somewhere they can come for advice or help. Some practices use formal screening tools, such as the Edinburgh Postnatal Depression Scale.

Next, identify some resources in your community where you can refer families if concerns arise. This may be tricky, as access to these resources can be poor, but having a plan for what advice you will give to parents if concerns arise will make this process run more smoothly. Postpartum Support International is a good place to start. The website has access to local resources, references, and general information for families. Parents also can be referred back to their primary care providers or local mental health service providers. For parents who may be in very acute distress, knowing the local psychiatric and emergency department availability is important so you know where to send someone in a crisis. All of these things are easier researched and identified before you actually need them – perhaps a nurse or other allied health professional in the practice may want to take this on.

Lastly, educate your office staff on the prevalence, signs, and importance of PMADs. Parents who pull it together while in the exam room may be in the waiting room in tears before you see them, and an astute and caring practice team can alert you if they see anything out of the ordinary. A nurse taking calls for your practice may notice parents who have a high level of anxiety when they frequently call for low-level concerns and are hard to reassure. Pediatricians care for and support families in so many ways, across childhood. Special thought and attention to this vulnerable time for parents can have significant impact on a child’s long term health and development.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected]. 

As the holidays approach and school breaks loom on the horizon, many families are preparing to travel. Some are seasoned travelers, but some may be preparing for their first long trip with children. Whether by car or air (or bus or train), families may ask your advice on how to travel safely and with the least amount of difficulty. Additionally, every opportunity for travel – no matter where you are going – is an opportunity for children to learn.

First, I think it is important to remember that the same safety precautions that apply while home also apply while traveling, with particular emphasis on car safety. Having struggled to carry a large bulky car seat through the airport on more than one occasion, I’m sympathetic to the fact that this isn’t always easy. However, the risks of car travel remain the same no matter where you are (and, no matter what the laws of the state or country you are in). Families may want to think about simple ways they can make things easier for themselves. First, there are a variety of different carrying bags for car seats, which can make transport much less cumbersome. Our family purchased a fairly inexpensive backpack-style carrier that was very convenient to use, but there are many other options as well, including one that transforms a convertible car seat into a stroller. Rental car companies typically can also provide car seats if you’d rather not wrestle yours onto the plane or pay the luggage fee. When traveling around cities when my own children were very young, we often chose to take public transportation rather than a taxicab so we didn’t have to make the choice between dragging the car seat around all day or not using a car seat in the cab. The added benefit to this was that our children got a bit more walking in, saw a different view of the city, and had fun learning how to read the subway maps. And, of course, even on long car rides, older children and adults should always wear their seat belts throughout the entire trip.

Another consideration to make travel safe and easy is being prepared for the unexpected. Particularly during the winter when weather is unpredictable, delays can happen at any time and without warning. Advise parents to travel with snacks and a simple meal (peanut butter sandwiches are our standby) because sometimes food won’t be available for immediate purchase, and restless hungry children are much crankier than simply restless children. On that note, it is also wise to travel with books, small activities, and diversions. Electronics are popular, but I don’t recommend relying only on electronics. From a practical standpoint, batteries may run out, but more importantly having a variety of activities to choose from is intellectually stimulating, keeps children occupied for longer, and helps them learn how to entertain themselves without a screen. When our children were little, we would often wrap small gifts for them (like coloring books) that we would parse out at critical moments on the trip. Parents should be sure to travel with (and carry on if they are flying) any essential medicines. For children with special health care needs, it is a good idea to also travel with a summary medical history, and the names and contact information for their regular pediatrician and any specialty providers.

Finally, travel should be fun and interesting. No matter where a family is traveling to, there are unique things to see and learn along the way – and once you get there. A trip to the library or bookstore before you go (or once you get where you are going if you’re like my family and are scrambling to get everything ready at the last minute) to find both nonfiction and fiction books that have something to do with the area you are visiting, even if they are just set in the state or country, can make even seemingly boring things much more intriguing. For example, my children have spent much more time in museums than they otherwise would have after reading books about paintings or history, which sparked their interest (and then finding the painting or person described in the book in the actual museum). Talking about the states they travel through, reading maps as they go, or even making short stops along the way will allow children to experience new things that will keep them interested, make travel exciting to them, and broaden their perspective of the country or world. Some of this you can plan in advance, some you may come across completely spontaneously – with your smart phone you can find out just about anything, anywhere, at any time. With a little patience and planning, families can have safe and fun holiday travel, and keep learning happening even when school is out.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. 

As the holidays approach and school breaks loom on the horizon, many families are preparing to travel. Some are seasoned travelers, but some may be preparing for their first long trip with children. Whether by car or air (or bus or train), families may ask your advice on how to travel safely and with the least amount of difficulty. Additionally, every opportunity for travel – no matter where you are going – is an opportunity for children to learn.

First, I think it is important to remember that the same safety precautions that apply while home also apply while traveling, with particular emphasis on car safety. Having struggled to carry a large bulky car seat through the airport on more than one occasion, I’m sympathetic to the fact that this isn’t always easy. However, the risks of car travel remain the same no matter where you are (and, no matter what the laws of the state or country you are in). Families may want to think about simple ways they can make things easier for themselves. First, there are a variety of different carrying bags for car seats, which can make transport much less cumbersome. Our family purchased a fairly inexpensive backpack-style carrier that was very convenient to use, but there are many other options as well, including one that transforms a convertible car seat into a stroller. Rental car companies typically can also provide car seats if you’d rather not wrestle yours onto the plane or pay the luggage fee. When traveling around cities when my own children were very young, we often chose to take public transportation rather than a taxicab so we didn’t have to make the choice between dragging the car seat around all day or not using a car seat in the cab. The added benefit to this was that our children got a bit more walking in, saw a different view of the city, and had fun learning how to read the subway maps. And, of course, even on long car rides, older children and adults should always wear their seat belts throughout the entire trip.

Another consideration to make travel safe and easy is being prepared for the unexpected. Particularly during the winter when weather is unpredictable, delays can happen at any time and without warning. Advise parents to travel with snacks and a simple meal (peanut butter sandwiches are our standby) because sometimes food won’t be available for immediate purchase, and restless hungry children are much crankier than simply restless children. On that note, it is also wise to travel with books, small activities, and diversions. Electronics are popular, but I don’t recommend relying only on electronics. From a practical standpoint, batteries may run out, but more importantly having a variety of activities to choose from is intellectually stimulating, keeps children occupied for longer, and helps them learn how to entertain themselves without a screen. When our children were little, we would often wrap small gifts for them (like coloring books) that we would parse out at critical moments on the trip. Parents should be sure to travel with (and carry on if they are flying) any essential medicines. For children with special health care needs, it is a good idea to also travel with a summary medical history, and the names and contact information for their regular pediatrician and any specialty providers.

Finally, travel should be fun and interesting. No matter where a family is traveling to, there are unique things to see and learn along the way – and once you get there. A trip to the library or bookstore before you go (or once you get where you are going if you’re like my family and are scrambling to get everything ready at the last minute) to find both nonfiction and fiction books that have something to do with the area you are visiting, even if they are just set in the state or country, can make even seemingly boring things much more intriguing. For example, my children have spent much more time in museums than they otherwise would have after reading books about paintings or history, which sparked their interest (and then finding the painting or person described in the book in the actual museum). Talking about the states they travel through, reading maps as they go, or even making short stops along the way will allow children to experience new things that will keep them interested, make travel exciting to them, and broaden their perspective of the country or world. Some of this you can plan in advance, some you may come across completely spontaneously – with your smart phone you can find out just about anything, anywhere, at any time. With a little patience and planning, families can have safe and fun holiday travel, and keep learning happening even when school is out.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. 

As the holidays approach and school breaks loom on the horizon, many families are preparing to travel. Some are seasoned travelers, but some may be preparing for their first long trip with children. Whether by car or air (or bus or train), families may ask your advice on how to travel safely and with the least amount of difficulty. Additionally, every opportunity for travel – no matter where you are going – is an opportunity for children to learn.

First, I think it is important to remember that the same safety precautions that apply while home also apply while traveling, with particular emphasis on car safety. Having struggled to carry a large bulky car seat through the airport on more than one occasion, I’m sympathetic to the fact that this isn’t always easy. However, the risks of car travel remain the same no matter where you are (and, no matter what the laws of the state or country you are in). Families may want to think about simple ways they can make things easier for themselves. First, there are a variety of different carrying bags for car seats, which can make transport much less cumbersome. Our family purchased a fairly inexpensive backpack-style carrier that was very convenient to use, but there are many other options as well, including one that transforms a convertible car seat into a stroller. Rental car companies typically can also provide car seats if you’d rather not wrestle yours onto the plane or pay the luggage fee. When traveling around cities when my own children were very young, we often chose to take public transportation rather than a taxicab so we didn’t have to make the choice between dragging the car seat around all day or not using a car seat in the cab. The added benefit to this was that our children got a bit more walking in, saw a different view of the city, and had fun learning how to read the subway maps. And, of course, even on long car rides, older children and adults should always wear their seat belts throughout the entire trip.

Another consideration to make travel safe and easy is being prepared for the unexpected. Particularly during the winter when weather is unpredictable, delays can happen at any time and without warning. Advise parents to travel with snacks and a simple meal (peanut butter sandwiches are our standby) because sometimes food won’t be available for immediate purchase, and restless hungry children are much crankier than simply restless children. On that note, it is also wise to travel with books, small activities, and diversions. Electronics are popular, but I don’t recommend relying only on electronics. From a practical standpoint, batteries may run out, but more importantly having a variety of activities to choose from is intellectually stimulating, keeps children occupied for longer, and helps them learn how to entertain themselves without a screen. When our children were little, we would often wrap small gifts for them (like coloring books) that we would parse out at critical moments on the trip. Parents should be sure to travel with (and carry on if they are flying) any essential medicines. For children with special health care needs, it is a good idea to also travel with a summary medical history, and the names and contact information for their regular pediatrician and any specialty providers.

Finally, travel should be fun and interesting. No matter where a family is traveling to, there are unique things to see and learn along the way – and once you get there. A trip to the library or bookstore before you go (or once you get where you are going if you’re like my family and are scrambling to get everything ready at the last minute) to find both nonfiction and fiction books that have something to do with the area you are visiting, even if they are just set in the state or country, can make even seemingly boring things much more intriguing. For example, my children have spent much more time in museums than they otherwise would have after reading books about paintings or history, which sparked their interest (and then finding the painting or person described in the book in the actual museum). Talking about the states they travel through, reading maps as they go, or even making short stops along the way will allow children to experience new things that will keep them interested, make travel exciting to them, and broaden their perspective of the country or world. Some of this you can plan in advance, some you may come across completely spontaneously – with your smart phone you can find out just about anything, anywhere, at any time. With a little patience and planning, families can have safe and fun holiday travel, and keep learning happening even when school is out.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. 

As summer has come to a close and children are settling into their new classrooms and routines, there is one thing certain about back to school season – pediculosis capitis, more affectionately known as lice. My own children hadn’t been back in school 3 days when they came home with the dreaded note in their backpacks alerting parents that there had been cases of head lice identified in the school. While there are some variations in susceptibility (males and black children tend to be affected less frequently than are females and children of other races), head lice infestations are incredibly common in children, and are one of the most frequently seen communicable diseases in elementary school settings.

©CDC/Reed & Carnrick Pharmaceuticals

Many parents will appropriately treat their children with home remedies and/or over-the-counter medications, so most of these children aren’t seen in our offices. However, families frequently have questions about the best or most effective methods of treatment, or need help with cases that are difficult to resolve. So, what is the best method of treatment? As with many conditions, the answer is that it depends on parent preference and the resistance patterns in the community.

The first step in the process is twofold – make sure that treatment is needed, and reassure the parent if it is. The best way to diagnose head lice is visualization of a live, active louse. This is best done using a small, fine-toothed comb to systematically examine all areas of the scalp and hair at least twice over. Visual inspection without systematically combing through the hair misses a large number of cases. Relatedly, the presence of nits (or eggs – small whitish, oval capsules that firmly adhere to the base of the hair shaft) does not definitively indicate infection. A sizable percentage of children with nits do not go on to develop active lice infections, and nits may be present several months after effective treatment. That said, a high concentration of nits over a relatively small area (1/4 inch) makes the incidence of active infection more likely. Lastly, the presence of itching alone does not indicate active infection (as evidenced by the large number of you who are likely itching your heads just reading this article). If treatment is in fact needed, parents should be reassured that this is a very common condition, unrelated to cleanliness of the home or school, and something that almost everyone faces at sometime during their school years.

The most common first line treatments are the topical pediculicides, including the pyrethroids (available over the counter), malathion, benzyl alcohol, spinosad, and topical ivermectin. These medications are generally safe and well tolerated (alternately, lindane is only recommended as a second line treatment, and not recommended in children, because of its possible toxic side effects). The Centers for Disease Control and Prevention website has a nice summary of the available medications, their indications, and common side effects to help guide your decision making. The pyrethroids are generally well tolerated and are available over the counter and thus, despite increasing resistance, are commonly used first line medications. Malathion is also frequently used and recommended, especially as it likely has greater efficacy than the pyrethroids, but the fact that it requires a prescription and has a very strong odor can make it a less tolerable choice for families. Oral medications are available for use as a second line therapy or in recalcitrant cases.

For families who prefer not to use topical pediculocides, or for very young children, wet combing is a possible alternative. This technique involves wetting the air with a lubricant such as hair conditioner or olive oil and systematically combing the hair with a fine tooth comb until no lice are found. This should be repeated every 2-4 days and continue for 2 weeks after the last live louse is found. This technique also can be a useful adjunct to topical pediculocide treatment. The downside to this technique, as anyone who has ever done it can attest to, is that it is time consuming and difficult to get small children to sit still through it. Using topical agents such as petroleum jelly or Cetaphil cleanser to attempt to suffocate the lice is a common, but not well studied or validated approach. It is certainly harmless and possibly effective, but parents should be aware that there is not strong evidence to support this technique.

Additionally, at the time of diagnosis and treatment for all families, any bedding or towels the infected child has had contact with in the past 48-72 hours should be washed in very hot water and anything (such as stuffed animals or pillows) that can’t be washed should be put in an air-tight bag for 2 weeks. Vacuuming of carpets in the home also may be helpful. Close household contacts should be carefully monitored for infection, and any contacts who share a bed should be considered for prophylactic therapy. Children should be allowed to return to school as soon as they are treated. “No-nit” policies are not recommended or helpful, and if your school or school district has them it is an opportunity for education and advocacy to minimize the number of days children unnecessarily miss school.

This tiny parasite can be an enormous pest to parents, schools and physicians alike. With a calm, reassuring common sense approach, pediatricians can help kids get back to school itch free.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics.

As summer has come to a close and children are settling into their new classrooms and routines, there is one thing certain about back to school season – pediculosis capitis, more affectionately known as lice. My own children hadn’t been back in school 3 days when they came home with the dreaded note in their backpacks alerting parents that there had been cases of head lice identified in the school. While there are some variations in susceptibility (males and black children tend to be affected less frequently than are females and children of other races), head lice infestations are incredibly common in children, and are one of the most frequently seen communicable diseases in elementary school settings.

©CDC/Reed & Carnrick Pharmaceuticals

Many parents will appropriately treat their children with home remedies and/or over-the-counter medications, so most of these children aren’t seen in our offices. However, families frequently have questions about the best or most effective methods of treatment, or need help with cases that are difficult to resolve. So, what is the best method of treatment? As with many conditions, the answer is that it depends on parent preference and the resistance patterns in the community.

The first step in the process is twofold – make sure that treatment is needed, and reassure the parent if it is. The best way to diagnose head lice is visualization of a live, active louse. This is best done using a small, fine-toothed comb to systematically examine all areas of the scalp and hair at least twice over. Visual inspection without systematically combing through the hair misses a large number of cases. Relatedly, the presence of nits (or eggs – small whitish, oval capsules that firmly adhere to the base of the hair shaft) does not definitively indicate infection. A sizable percentage of children with nits do not go on to develop active lice infections, and nits may be present several months after effective treatment. That said, a high concentration of nits over a relatively small area (1/4 inch) makes the incidence of active infection more likely. Lastly, the presence of itching alone does not indicate active infection (as evidenced by the large number of you who are likely itching your heads just reading this article). If treatment is in fact needed, parents should be reassured that this is a very common condition, unrelated to cleanliness of the home or school, and something that almost everyone faces at sometime during their school years.

The most common first line treatments are the topical pediculicides, including the pyrethroids (available over the counter), malathion, benzyl alcohol, spinosad, and topical ivermectin. These medications are generally safe and well tolerated (alternately, lindane is only recommended as a second line treatment, and not recommended in children, because of its possible toxic side effects). The Centers for Disease Control and Prevention website has a nice summary of the available medications, their indications, and common side effects to help guide your decision making. The pyrethroids are generally well tolerated and are available over the counter and thus, despite increasing resistance, are commonly used first line medications. Malathion is also frequently used and recommended, especially as it likely has greater efficacy than the pyrethroids, but the fact that it requires a prescription and has a very strong odor can make it a less tolerable choice for families. Oral medications are available for use as a second line therapy or in recalcitrant cases.

For families who prefer not to use topical pediculocides, or for very young children, wet combing is a possible alternative. This technique involves wetting the air with a lubricant such as hair conditioner or olive oil and systematically combing the hair with a fine tooth comb until no lice are found. This should be repeated every 2-4 days and continue for 2 weeks after the last live louse is found. This technique also can be a useful adjunct to topical pediculocide treatment. The downside to this technique, as anyone who has ever done it can attest to, is that it is time consuming and difficult to get small children to sit still through it. Using topical agents such as petroleum jelly or Cetaphil cleanser to attempt to suffocate the lice is a common, but not well studied or validated approach. It is certainly harmless and possibly effective, but parents should be aware that there is not strong evidence to support this technique.

Additionally, at the time of diagnosis and treatment for all families, any bedding or towels the infected child has had contact with in the past 48-72 hours should be washed in very hot water and anything (such as stuffed animals or pillows) that can’t be washed should be put in an air-tight bag for 2 weeks. Vacuuming of carpets in the home also may be helpful. Close household contacts should be carefully monitored for infection, and any contacts who share a bed should be considered for prophylactic therapy. Children should be allowed to return to school as soon as they are treated. “No-nit” policies are not recommended or helpful, and if your school or school district has them it is an opportunity for education and advocacy to minimize the number of days children unnecessarily miss school.

This tiny parasite can be an enormous pest to parents, schools and physicians alike. With a calm, reassuring common sense approach, pediatricians can help kids get back to school itch free.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics.

As summer has come to a close and children are settling into their new classrooms and routines, there is one thing certain about back to school season – pediculosis capitis, more affectionately known as lice. My own children hadn’t been back in school 3 days when they came home with the dreaded note in their backpacks alerting parents that there had been cases of head lice identified in the school. While there are some variations in susceptibility (males and black children tend to be affected less frequently than are females and children of other races), head lice infestations are incredibly common in children, and are one of the most frequently seen communicable diseases in elementary school settings.

©CDC/Reed & Carnrick Pharmaceuticals

Many parents will appropriately treat their children with home remedies and/or over-the-counter medications, so most of these children aren’t seen in our offices. However, families frequently have questions about the best or most effective methods of treatment, or need help with cases that are difficult to resolve. So, what is the best method of treatment? As with many conditions, the answer is that it depends on parent preference and the resistance patterns in the community.

The first step in the process is twofold – make sure that treatment is needed, and reassure the parent if it is. The best way to diagnose head lice is visualization of a live, active louse. This is best done using a small, fine-toothed comb to systematically examine all areas of the scalp and hair at least twice over. Visual inspection without systematically combing through the hair misses a large number of cases. Relatedly, the presence of nits (or eggs – small whitish, oval capsules that firmly adhere to the base of the hair shaft) does not definitively indicate infection. A sizable percentage of children with nits do not go on to develop active lice infections, and nits may be present several months after effective treatment. That said, a high concentration of nits over a relatively small area (1/4 inch) makes the incidence of active infection more likely. Lastly, the presence of itching alone does not indicate active infection (as evidenced by the large number of you who are likely itching your heads just reading this article). If treatment is in fact needed, parents should be reassured that this is a very common condition, unrelated to cleanliness of the home or school, and something that almost everyone faces at sometime during their school years.

The most common first line treatments are the topical pediculicides, including the pyrethroids (available over the counter), malathion, benzyl alcohol, spinosad, and topical ivermectin. These medications are generally safe and well tolerated (alternately, lindane is only recommended as a second line treatment, and not recommended in children, because of its possible toxic side effects). The Centers for Disease Control and Prevention website has a nice summary of the available medications, their indications, and common side effects to help guide your decision making. The pyrethroids are generally well tolerated and are available over the counter and thus, despite increasing resistance, are commonly used first line medications. Malathion is also frequently used and recommended, especially as it likely has greater efficacy than the pyrethroids, but the fact that it requires a prescription and has a very strong odor can make it a less tolerable choice for families. Oral medications are available for use as a second line therapy or in recalcitrant cases.

For families who prefer not to use topical pediculocides, or for very young children, wet combing is a possible alternative. This technique involves wetting the air with a lubricant such as hair conditioner or olive oil and systematically combing the hair with a fine tooth comb until no lice are found. This should be repeated every 2-4 days and continue for 2 weeks after the last live louse is found. This technique also can be a useful adjunct to topical pediculocide treatment. The downside to this technique, as anyone who has ever done it can attest to, is that it is time consuming and difficult to get small children to sit still through it. Using topical agents such as petroleum jelly or Cetaphil cleanser to attempt to suffocate the lice is a common, but not well studied or validated approach. It is certainly harmless and possibly effective, but parents should be aware that there is not strong evidence to support this technique.

Additionally, at the time of diagnosis and treatment for all families, any bedding or towels the infected child has had contact with in the past 48-72 hours should be washed in very hot water and anything (such as stuffed animals or pillows) that can’t be washed should be put in an air-tight bag for 2 weeks. Vacuuming of carpets in the home also may be helpful. Close household contacts should be carefully monitored for infection, and any contacts who share a bed should be considered for prophylactic therapy. Children should be allowed to return to school as soon as they are treated. “No-nit” policies are not recommended or helpful, and if your school or school district has them it is an opportunity for education and advocacy to minimize the number of days children unnecessarily miss school.

This tiny parasite can be an enormous pest to parents, schools and physicians alike. With a calm, reassuring common sense approach, pediatricians can help kids get back to school itch free.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics.

Coming to the end of yet another school physical season, my mind is focused on anticipatory guidance and well child care. Inevitably, nutrition is a main focus of these back to school visits – a very common question is, "Should my child take a vitamin?" While there are relatively clear recommendations for vitamin supplementation in infancy, there seems to be less clear consensus regarding vitamin supplementation in toddlers and school-aged children. Over my years of practice, I have developed a few guiding principles for my recommendations, which have definitely evolved over the years as more evidence becomes available.

• I always ask if a child is taking any kind of vitamin or other supplementation. Routine supplementation with a standard children’s multivitamin is very safe, and I essentially never discourage it. However, high doses of vitamins can be dangerous. Without being asked, most parents don’t think to mention vitamin use, but it is definitely something I want to know.

• For children who are not taking vitamins, but whose parents have concerns about their diet, I recommend a standard chewable multivitamin with iron. The risks of this type of vitamin supplementation are low, and the potential benefits great if a child isn’t getting everything he or she needs through the diet. Of course, I also take the opportunity to discuss strategies for improving diet and nutrition, since that is the best way to get your vitamins and minerals! For children who seem to have healthy well-balanced diets, I suggest it to parents as an option to consider. My recommendation in this situation is less strong, and more driven by parent preference. That said, I do let parents know that even children with seemingly good diets can sometimes not be getting enough of particular vitamins or minerals, most typically vitamin D, iron, or calcium.

• If a child is taking vitamins, or the parent is considering starting the child on vitamins, I recommend standard chewable children’s multivitamins (whatever brand is on sale) rather than gummy vitamins. Many brands of gummy vitamins have lower amounts of vitamin D or other vitamins than do their chewable counterparts. If a child really prefers gummy vitamins, I recommend that parents carefully compare the nutritional information to be sure that if they are going through the expense and trouble of giving a daily vitamin the child is getting all the vitamins and minerals that he or she needs. Lastly, parents should be reminded that vitamins are medications and should be safely stored! Thoughtfully used, vitamin supplements can be an important part of a healthy child’s nutrition.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at pdnews@ frontlinemedcom.com.

Coming to the end of yet another school physical season, my mind is focused on anticipatory guidance and well child care. Inevitably, nutrition is a main focus of these back to school visits – a very common question is, "Should my child take a vitamin?" While there are relatively clear recommendations for vitamin supplementation in infancy, there seems to be less clear consensus regarding vitamin supplementation in toddlers and school-aged children. Over my years of practice, I have developed a few guiding principles for my recommendations, which have definitely evolved over the years as more evidence becomes available.

• I always ask if a child is taking any kind of vitamin or other supplementation. Routine supplementation with a standard children’s multivitamin is very safe, and I essentially never discourage it. However, high doses of vitamins can be dangerous. Without being asked, most parents don’t think to mention vitamin use, but it is definitely something I want to know.

• For children who are not taking vitamins, but whose parents have concerns about their diet, I recommend a standard chewable multivitamin with iron. The risks of this type of vitamin supplementation are low, and the potential benefits great if a child isn’t getting everything he or she needs through the diet. Of course, I also take the opportunity to discuss strategies for improving diet and nutrition, since that is the best way to get your vitamins and minerals! For children who seem to have healthy well-balanced diets, I suggest it to parents as an option to consider. My recommendation in this situation is less strong, and more driven by parent preference. That said, I do let parents know that even children with seemingly good diets can sometimes not be getting enough of particular vitamins or minerals, most typically vitamin D, iron, or calcium.

• If a child is taking vitamins, or the parent is considering starting the child on vitamins, I recommend standard chewable children’s multivitamins (whatever brand is on sale) rather than gummy vitamins. Many brands of gummy vitamins have lower amounts of vitamin D or other vitamins than do their chewable counterparts. If a child really prefers gummy vitamins, I recommend that parents carefully compare the nutritional information to be sure that if they are going through the expense and trouble of giving a daily vitamin the child is getting all the vitamins and minerals that he or she needs. Lastly, parents should be reminded that vitamins are medications and should be safely stored! Thoughtfully used, vitamin supplements can be an important part of a healthy child’s nutrition.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at pdnews@ frontlinemedcom.com.

Coming to the end of yet another school physical season, my mind is focused on anticipatory guidance and well child care. Inevitably, nutrition is a main focus of these back to school visits – a very common question is, "Should my child take a vitamin?" While there are relatively clear recommendations for vitamin supplementation in infancy, there seems to be less clear consensus regarding vitamin supplementation in toddlers and school-aged children. Over my years of practice, I have developed a few guiding principles for my recommendations, which have definitely evolved over the years as more evidence becomes available.

• I always ask if a child is taking any kind of vitamin or other supplementation. Routine supplementation with a standard children’s multivitamin is very safe, and I essentially never discourage it. However, high doses of vitamins can be dangerous. Without being asked, most parents don’t think to mention vitamin use, but it is definitely something I want to know.

• For children who are not taking vitamins, but whose parents have concerns about their diet, I recommend a standard chewable multivitamin with iron. The risks of this type of vitamin supplementation are low, and the potential benefits great if a child isn’t getting everything he or she needs through the diet. Of course, I also take the opportunity to discuss strategies for improving diet and nutrition, since that is the best way to get your vitamins and minerals! For children who seem to have healthy well-balanced diets, I suggest it to parents as an option to consider. My recommendation in this situation is less strong, and more driven by parent preference. That said, I do let parents know that even children with seemingly good diets can sometimes not be getting enough of particular vitamins or minerals, most typically vitamin D, iron, or calcium.

• If a child is taking vitamins, or the parent is considering starting the child on vitamins, I recommend standard chewable children’s multivitamins (whatever brand is on sale) rather than gummy vitamins. Many brands of gummy vitamins have lower amounts of vitamin D or other vitamins than do their chewable counterparts. If a child really prefers gummy vitamins, I recommend that parents carefully compare the nutritional information to be sure that if they are going through the expense and trouble of giving a daily vitamin the child is getting all the vitamins and minerals that he or she needs. Lastly, parents should be reminded that vitamins are medications and should be safely stored! Thoughtfully used, vitamin supplements can be an important part of a healthy child’s nutrition.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at pdnews@ frontlinemedcom.com.

Living in Washington, a very multicultural community, I am regularly asked by parents about bilingual language development. Sometimes this is when the parents’ primary language is something other than English, and sometimes it is when parents are considering bilingual school placements (including, in full disclosure, my children’s own school). Frequently, families raise concerns about the impact bilingual education will have on their young child’s language development, their ability to attain fluency in the English language, or to even to learn in other languages.

First, and foremost, I am able to reassure parents that the preponderance of research – an evidence base that is rapidly growing – suggests that bilingual education does not cause language delays or problems with English fluency. In fact, there is increasing evidence that bilingual education actually has linguistic and cognitive advantages for children’s education and ability to learn. That said there are some unique things for parents and providers to be aware of during the period of language acquisition. One area that causes frequent confusion is that young children – younger than age 2 years – may appear to be language delayed if both languages are not assessed. For a typically developing bilingual child, some of his or her emerging words may be in one language, some may be in the other. Assessed independently, delays may appear to be present, but assessed together language development is right on track. Not uncommonly, young children "mix and match" vocabulary and grammatical syntax in both languages – again, this is a normal part of bilingual language development. As with children in monolingual environments, it is important to provide many and varied stimulating experiences – lots of talking and books no matter how many languages are spoken!

Families whose dominant home language is something other than English should feel comfortable speaking their primary language at home. Children are language sponges and will develop their English language skills normally with routine exposure outside the home and a high-quality school environment. Additionally, there is evidence that English-language learners learn English better and more fluently in a bilingual environment. All of that said, for children whose speech development does not seem to be typical, every effort should be made to have a speech and language evaluation (and therapy if needed) done in the child’s primary language. This can be a challenge in any community, and often requires advocacy and persistence on the part of the pediatrician to identify possible options.

Lastly, bilingual education takes time. The research shows – and my experience as the parent of one bilingual and one emerging bilingual child supports this – that proficiency can take several years and perhaps longer, depending on the richness and intensity of exposures. Parents should be encouraged to ask questions and work closely with their children’s doctors and teachers if there are any questions. Every child is different, and different children may require different supports or approaches.

Finally, my personal observation has convinced me that there are intangible benefits of bilingualism in children. The richness of experience and pride in the accomplishment of learning another language, and the greater understanding my children and their peers have of other cultures and the global community is remarkable. I see them apply these lessons in other and unexpected places (and sometimes dubious ones ... such as when my son’s elementary school soccer team decided to call plays to each other in Spanish in order to outsmart the other team). Both the research and my own personal experience make me very comfortable in reassuring and supporting parents who are hoping to promote bilingual language acquisition in their children.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at pdnews@ frontlinemedcom.com.

Living in Washington, a very multicultural community, I am regularly asked by parents about bilingual language development. Sometimes this is when the parents’ primary language is something other than English, and sometimes it is when parents are considering bilingual school placements (including, in full disclosure, my children’s own school). Frequently, families raise concerns about the impact bilingual education will have on their young child’s language development, their ability to attain fluency in the English language, or to even to learn in other languages.

First, and foremost, I am able to reassure parents that the preponderance of research – an evidence base that is rapidly growing – suggests that bilingual education does not cause language delays or problems with English fluency. In fact, there is increasing evidence that bilingual education actually has linguistic and cognitive advantages for children’s education and ability to learn. That said there are some unique things for parents and providers to be aware of during the period of language acquisition. One area that causes frequent confusion is that young children – younger than age 2 years – may appear to be language delayed if both languages are not assessed. For a typically developing bilingual child, some of his or her emerging words may be in one language, some may be in the other. Assessed independently, delays may appear to be present, but assessed together language development is right on track. Not uncommonly, young children "mix and match" vocabulary and grammatical syntax in both languages – again, this is a normal part of bilingual language development. As with children in monolingual environments, it is important to provide many and varied stimulating experiences – lots of talking and books no matter how many languages are spoken!

Families whose dominant home language is something other than English should feel comfortable speaking their primary language at home. Children are language sponges and will develop their English language skills normally with routine exposure outside the home and a high-quality school environment. Additionally, there is evidence that English-language learners learn English better and more fluently in a bilingual environment. All of that said, for children whose speech development does not seem to be typical, every effort should be made to have a speech and language evaluation (and therapy if needed) done in the child’s primary language. This can be a challenge in any community, and often requires advocacy and persistence on the part of the pediatrician to identify possible options.

Lastly, bilingual education takes time. The research shows – and my experience as the parent of one bilingual and one emerging bilingual child supports this – that proficiency can take several years and perhaps longer, depending on the richness and intensity of exposures. Parents should be encouraged to ask questions and work closely with their children’s doctors and teachers if there are any questions. Every child is different, and different children may require different supports or approaches.

Finally, my personal observation has convinced me that there are intangible benefits of bilingualism in children. The richness of experience and pride in the accomplishment of learning another language, and the greater understanding my children and their peers have of other cultures and the global community is remarkable. I see them apply these lessons in other and unexpected places (and sometimes dubious ones ... such as when my son’s elementary school soccer team decided to call plays to each other in Spanish in order to outsmart the other team). Both the research and my own personal experience make me very comfortable in reassuring and supporting parents who are hoping to promote bilingual language acquisition in their children.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at pdnews@ frontlinemedcom.com.

Living in Washington, a very multicultural community, I am regularly asked by parents about bilingual language development. Sometimes this is when the parents’ primary language is something other than English, and sometimes it is when parents are considering bilingual school placements (including, in full disclosure, my children’s own school). Frequently, families raise concerns about the impact bilingual education will have on their young child’s language development, their ability to attain fluency in the English language, or to even to learn in other languages.

First, and foremost, I am able to reassure parents that the preponderance of research – an evidence base that is rapidly growing – suggests that bilingual education does not cause language delays or problems with English fluency. In fact, there is increasing evidence that bilingual education actually has linguistic and cognitive advantages for children’s education and ability to learn. That said there are some unique things for parents and providers to be aware of during the period of language acquisition. One area that causes frequent confusion is that young children – younger than age 2 years – may appear to be language delayed if both languages are not assessed. For a typically developing bilingual child, some of his or her emerging words may be in one language, some may be in the other. Assessed independently, delays may appear to be present, but assessed together language development is right on track. Not uncommonly, young children "mix and match" vocabulary and grammatical syntax in both languages – again, this is a normal part of bilingual language development. As with children in monolingual environments, it is important to provide many and varied stimulating experiences – lots of talking and books no matter how many languages are spoken!

Families whose dominant home language is something other than English should feel comfortable speaking their primary language at home. Children are language sponges and will develop their English language skills normally with routine exposure outside the home and a high-quality school environment. Additionally, there is evidence that English-language learners learn English better and more fluently in a bilingual environment. All of that said, for children whose speech development does not seem to be typical, every effort should be made to have a speech and language evaluation (and therapy if needed) done in the child’s primary language. This can be a challenge in any community, and often requires advocacy and persistence on the part of the pediatrician to identify possible options.

Lastly, bilingual education takes time. The research shows – and my experience as the parent of one bilingual and one emerging bilingual child supports this – that proficiency can take several years and perhaps longer, depending on the richness and intensity of exposures. Parents should be encouraged to ask questions and work closely with their children’s doctors and teachers if there are any questions. Every child is different, and different children may require different supports or approaches.

Finally, my personal observation has convinced me that there are intangible benefits of bilingualism in children. The richness of experience and pride in the accomplishment of learning another language, and the greater understanding my children and their peers have of other cultures and the global community is remarkable. I see them apply these lessons in other and unexpected places (and sometimes dubious ones ... such as when my son’s elementary school soccer team decided to call plays to each other in Spanish in order to outsmart the other team). Both the research and my own personal experience make me very comfortable in reassuring and supporting parents who are hoping to promote bilingual language acquisition in their children.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at pdnews@ frontlinemedcom.com.