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Simple ADD Behavior Management Skills Every Parent Should Know

Children with A.D.D. or A.D.H.D. can test a parent’s patience to the limits. In the midst of the struggles, it is important to think of A.D.D. NOT as a disorder, rather a way that your child learns and reacts to stimuli in the world around him. Here are some simple ADD behavior management strategies you can implement to help your child be aware of how their actions are impacting those around them.

1. Stop signals.

It’s not enough just to tell your child not to be impulsive. You’ve got to show him how to control his impulses. Give him some “think it through first” tools so he knows what the consequences of his actions will be. Plant this sequence in your child’s mind: Before you do it:

Say to yourself, stop!
Count to ten
Imagine what will happen if you do it.

2. Do it together.

The school-age child with A.D.D. is more likely to cooperate with your request if you do the task together. The three-or four-year- old with A.D.D. is unlikely to complete even small tasks that you assign, since they often can’t pay attention to one task for very long. Don’t be upset! This is a wonderful opportunity to model “helping each other” and teach a positive ADD behavior management strategy.

3. Count your messages.

Remember what we said about how important it is to frame your child in a positive way. Here’s an exercise to help you judge whether you are giving your child predominantly positive or negative messages. Choose a day where you will be spending a lot of time with your child and count the number of positive and negative messages you give. This can be done mentally, on paper, or by using the green counter / red counter technique. Get two golf-score counters, the kind you can wear on your wrist in two different colors. Put one color, say red, on the left wrist and use it to count every time you give a negative message with words, tone of voice, or your actions. Put another color, say green, on your right wrist and count every time you compliment or praise your child or give him any kind of positive message. You can also use this technique to see what kind of messages you and your spouse are giving each other to see what you are modeling for your child. At the end of the day, you may be shocked to see that you scored 20 to 50 red messages, yet only 5 to 10 were green. Now that you’re aware of this, try to change your ways. With thought and effort, you can reverse this! Your child’s self-image will improve, and so will your image of him.

4. Be specific.

A child who has attention differences will experience trouble when given subtle directions, gentle persuasions, and reasoning techniques. When focusing on ADD behavior management changes remember that many children with A.D.D. simply do not understand communication that is not crystal clear and to the point. 5. Identify triggers. Parents of a child with A.D.D. have many job titles, and one of these is detective. Stake out your child’s behavior and, based on your observations, list what situations encourage good behavior and what situations trigger bad behavior. For example, many children behave best in the morning, but behavior may deteriorate when dad goes out of town. Some children do well when playing with one or two friends, but become aggressive in crowds of three or more. Construct a behavior profile to help you recognize in what situations your child behaves best and worst. You might do a behavior profile on yourself. When are you at your best and worst? It helps to know both your child’s limits, and your own.

6. Structure the day.

From your child’s behavior profile you know what situations bring out the best and worst, and you should keep those situations in mind when working on ADD behavior management changes. It’s certainly easier to shuffle your daily schedule than to change the temperament of your child. If your child’s behavior is best in the morning, plan activities such as playgroup, outings, shopping trips, and preschool in the morning. If your child falls apart in the supermarket at 4 p.m., don’t even think about shopping at that time. If your child needs time to unwind after school, save homework for after supper.

Structure the child to fit the day

While it’s often easier to change your plans than change your child, some situations are not very flexible. If dinner at grandma’s house is scheduled for 6 p.m. and that’s not negotiable, play ahead. Think about what you and your child will be doing during the visit and come up with a play-by-play plan for setting your child up for good behavior. Have your child take a late afternoon nap. Talk with your child about what kind of behavior you expect and what activities are going to occur that evening. Take along quiet toys, and be prepared to spend enough time interacting with your child and monitoring his activities, so that your expectations have some hope of being realized. Plan on leaving before your child’s behavior starts to deteriorate.

Occasionally, you may need to lie out the child’s whole day on paper, to create structure where the child sees none. Start with the attitude she has when she gets out of bed, how quickly she dresses herself, brushes her teeth, eats breakfast, gets ready for the school bus, or says “yes” to each of your requests throughout the day. With each step successfully completed, she gets a star or point on a reward chart. Once your child realizes how much happier you both are when a day goes smoothly, this feeling becomes self-motivating.

7. Structure the classroom to fit your child.

If a visit to your child’s classroom reveals distractions in the classroom, see what you can do to restructure his environment. Asking to have your child seated in a less distracting place, away from windows or a distracting classmate, and closer to the teacher are all simple ADD behavior management strategies you can try. If you notice the classroom environment has a rowdy zoo-like atmosphere, ask to have your child transferred to a calmer classroom, where the teacher has a more structured disciplinary system.

8. Hire a model.

When Peter was eight, I hired one of his friends to model some exemplary behavior for him, figuring that if he saw one of his friends acting a certain way, he would be more likely to model it.

9. Match playmates and personalities.

Kids with A.D.D. often choose the wrong friends because they’re attracted to colorful, flashy, interesting things – including people. If you notice Amy plays well with Sara but clashes with Becky, realize that she is not yet ready to cope with a child with Becky’s personality. In time, you can help your child play compatibly with a wide variety of children, but for now, limit play dates with Becky to times when you can supervise the children closely. Remember, circumstances in life are seldom ideal, and you must give your child the tools she needs to succeed. This requires being your child’s facilitator.

10. Match child and toys.

If Brian is a thrower, structure his toy choices. Brian would do best with foam blocks that can’t be turned into dangerous projectiles. If he throws his wood blocks, they get “time out”. If toy squabbles occur between siblings or playmates, time out the toy or teach the children to take turns using a timer.

11. Busy the bored child.

A bored child, especially one with A.D.D., is a set-up for trouble. And a bored child with a busy parent is a high-risk mismatch and sets up the situation for failure instead of being a positive ADD behavior management situation. Many children with A.D.D. are unfairly labeled as behavior problems, when they are simply bored. Busy these bundles of energy with activities that sustain their interest before they deviate into undesirable alternatives. Recognize, too, that the announcement “I’m bored” may mean a child needs your attention, not just something to do.

12. Catch the child in the act of being good.

This commonsense principle is the oldest behavior modification technique around: catch the child in the act of being good and praise him. Your grandmother probably used this technique; you may remember the warm feeling you got as a child when a parent or teacher recognized your good efforts. Yet, this simple technique is often neglected. It’s our human nature to focus on the child’s “bad” way of acting. Bad behavior draws more attention than good behavior. Parents and teachers are more likely to correct or punish misdeeds than they are to praise good ones. To a certain degree, this is defensible. Studies show that parents and teachers are more likely to react negatively to children with A.D.D. than to children without the A.D.D. style. Adults become worn down by the energetic and persistent characteristics of these children. They jump on the negatives, and the positives, which may be infrequent, go unnoticed.

Children must learn that good behavior is expected and that it’s not always praised or rewarded. Yet, they must also learn to like the way they feel when they behave well. Your praise and recognition will help your child prefer good behavior, even when it’s not easy. If only bad behavior draws attention to the child, he will behave badly just to get reassurance that someone is noticing him.The good news is you can change these messages by practicing a few well- chosen words: “Great job!””Way to go!””Yesss!””I like the way you used a lot of color in that picture””Thanks for helping with supper.””That makes me happy.”Basically you are saying to the child, “I like you, I think you’re great!” The child is getting a lot of positive messages from you in the form of genuine praise. And if your child feels that you like him, he will like himself.

13. Try rewards.

Rewards capitalize on the pleasure principle: behavior that’s rewarding continues; behavior that’s unrewarding ceases. Pet trainers use this principle; so do dolphin trainers at Sea World. Kid trainers can use positive reinforcement, too. Yes, rewards are bribes. If the word “bribery” offends you, call them “incentives” or “motivators” instead. You may feel skeptical about reward systems, believing them to be external gimmicks that don’t really change your child from within. This is a valid criticism, since the ultimate goal is to give the child inner motivation and points or prizes alone will not accomplish this. Yet, reward systems are useful as a starting point, especially when nothing else seems to be working. You can use a reward system to redirect a negative child and give him a taste of success. Eventually, the child gets used to the good feelings he gets from all those “points” or “treats”. These good feelings then become the child’s own internal reward and motivate continued good behavior. Eventually, you can reduce the external rewards and just rely on social rewards, like smiles and praise.

A child’s behavior affects the parents’ behavior. Undesirable behavior in children often leads to unrewarding behavior in the parents. You need to shift from that kind of negative spiral to a positive feedback loop. Once your children see how much happier you are when they behave, your attitude toward them becomes another social reward.

MATCHING THE RIGHT REWARD SYSTEM FOR YOUR CHILD

Use social rewards more than material rewards. Choose rewards that bring you and your child together to do something fun. This prevents you from feeling like you’re a behavioral scientist dangling bits of cheese in front of little rats to guide them through the maze, and your child will see that your family values people more than things. Toy rewards seem to be more popular with younger children. As they get older, either combine or replace them with social rewards. Keep the child connected to people (e.g., “This coupon is good for one lunch date with Mommy or Daddy” or “When you finish putting away your toys, we’ll sit down and play a game together.”)
Let your child help choose the rewards. “If you could choose a special place to go or a special thing to do, what would you choose?”
Choose immediate rewards. Children with A.D.D. can’t wait. Rather than a big treat at the end of a week of agreed-upon behavior, issue smaller rewards sooner. You are likely to get better results. The younger the child, the more frequent the payoff should be. Toddlers may need hourly, or at least daily, rewards; preschoolers need daily rewards; school-age children need weekly rewards; teenagers can hit the jackpot at the end of the month.
Use reward games that the child likes. Remember, the child with A.D.D. tends to get bored with the same game. Change the game, or the way you play it, as needed.
Relate the reward to the behavior you want changed. “When you show me you can keep your room tidy for a week, then we’ll get bedroom furniture for your dollhouse.”
Should you take away points? When you’re using positive reinforcement to shape behavior, it’s important to give your child the message that nothing detracts from the good he has done. If you’re making an effort to give your child positive messages rather than negative ones, you may not want to take points off the reward chart. For some children, the two-steps-forward-one-step- back approach may be too frustrating. Others respond well to the “give and take” method. Using both give and take is more realistic in preparing your child for real life.
6 CREATIVE REWARDS THAT WORK

These are systems that we have used in our own families or suggested to parents of children with A.D.D..

Tickets and tokens. Depending on the age and motivation of your child, you may have to give reward tokens every few minutes, hourly, or at the end of the day. Tickets and tokens are particularly useful to keep the wandering little mind on task. Break up a job or a homework assignment into small parcels, and issue a “job done” ticket at the end of each step. Once the goal is reached, present your child with a special double-value ticket.
Connect the dots. This technique provides small, frequent rewards to keep a child on task and to give a visual gauge of how much progress is being made toward the long-term goal. After you have identified the behavior you want to change (“Each time you are dressed and ready for the school bus on time with no nagging…”), have your child draw a picture of the reward you have agreed on. It may be a bike, a toy boat, a doll, a ball or a special outing. Then use dots about an inch apart to outline the picture. With each good behavior, the child connects one of the dots. When all the dots are connected, she collects the treat. You can also use this reward technique to remind children of their responsibilities. Each time they remember to put away their toys, clean up their room, or take out the trash, they can connect a dot. Focus on positive behavior (erasing lines doesn’t work very well). Display the picture in a high visibility location, such as on the refrigerator or on the kitchen cabinet, and at your child’s eye level. This reminds the child of the expected behavior and allows her to proudly display her progress.
Happy and sad faces. Make or buy stickers with happy and sad faces. A grumble or negative response to a parental request gets a sad face on the chart . Cooperation, or a positive response merits a happy face. When happy faces outnumber the sad faces on a predetermined number of days, the child collects the prize. Do not use this approach unless you’re sure the happy faces will prevail. 4. Happy hands. This motivator helps remind the child of his responsibilities and provides rewards for good behavior or a job well done. Place your child’s hands on a piece of paper and draw an outline around each finger. Above each finger write or draw a job (or desired behavior) the child has to complete. The left hand could list morning jobs and the right hand after- school jobs. As the child completes the job he colors in a finger and gets a happy-face sticker above the fingertip. When both hands are filled in, your child gets a special treat for having “so many happy faces on his fingers.” You could also dub this game, “Hands for remembering.”
A behavior bus. Draw a big bus with square windows and write the job (or desired behavior) to be accomplished in each window. The goal is to get a happy face sticker on each window. Once the bus is filled with happy faces, the bus drives on to get the prize.
“Give-and-take” systems. A reward system can be used to accomplish two goals: to encourage desirable behaviors and to get rid of undesirable ones. The give-and-take technique accomplishes both. You put a dime in the jar or a point on the chart for desirable behavior, you take a dime out of the jar or a point off the chart for bad behavior. Or you could start the day with five dimes in the jar, and take one out for every “no” you get from your child and add one for every “yes.” Just be careful you don’t let your child get into a negative balance and end up owing you money.
THE GOOD BEHAVIOR CANDLE

As a Cub scout leader, here’s a trick that I (Dr. Bill) has successfully used to hold the attention of a dozen rowdy nine-year-olds and keep them on task. At the beginning of our meeting, we light the good behavior candle. As long as there are no disruptions the candle stays burning. As soon as someone disrupts the meeting, the candle gets blown out. As soon as the candle burns all the way down the group gets a special treat. Naturally, it’s in everyone’s best interest to keep the candle burning, so they help keep each other in line. You can adapt this technique to get siblings to work together on a job or to improve family table manners at dinnertime. Don’t use this technique, however, if one child is going to be frequently singled out.

14. Shopping strategies.

Supermarket shopping and children with A.D.H.D. is not the best match. Even if you survive the trip up and down the aisles, avoiding the breakables and the junk food, waiting in the checkout line is bound to do you in. Appreciate a basic principle of behavior modification: If there is a major behavior you want to shape, begin with baby steps and progress gradually. Here’s a sequence to set the child up for successful shopping.

Begin with a small store and look in the window before entering to see if it’s busy. Go in the store to purchase one item, say a container of milk. Have the exact change ready when you enter the checkout line and have your child pay the cashier. When the child leaves without whining and has behaved in the store according to the prearranged agreement, he gets a point and a reward. The next day go to the same store and get two or three items.

Generalizing
Many children with A.D.D. have trouble transferring the rules learned in one situation to another situation; they have difficulty generalizing. Your child may know what she may not touch in your house, but don’t expect her to respect the same “no touches” when she goes to Grandmother’s house. You must make your rules exceptionally clear and simple and repeat them when the situation changes. “Just like at home, we don’t put our feet on the furniture at Grandmother’s house.”

Gradually increase the size of the store, the number of items you purchase, the number of points your child gets, and maybe even the size of the reward.
Finally, try the supermarket. Select the time of the day when your child is at his best, usually the mornings. Tell him what you’re going to be doing and the kind of behavior you expect in the store. Set up a point system on your shopping list. List the items you need to purchase on your shopping list in one column and categories of good behavior on the other. You can assign a certain number of points for aisle behavior, checkout counter behavior, and helping behavior. Agree on a reward before you enter the store and write it down and draw a picture of it on your shopping list. This helps prevent tantrums. Let your child help pick out the items, and also let him check off each item on the list. As he does this, award points for good behavior. When you reach the checkout counter, your child will have earned his treat.
Jill, mother of five-year-old Andrew, came in to my pediatric office for counseling and confided to me, “Our whole day is spent in conflict with each other. I find myself constantly saying “no” to him. Andrew won’t obey even when I ask him to do the simplest things. I want to be a happy mother, but I find myself becoming increasingly cranky.”

I suggested she try a reward system. I said, “Tell Andrew exactly the behavior you expect. Say to him: “I want to be a happy Mommy, not a cranky Mommy. Let’s try to have more ‘yes days.’ Then Jill made a chart with Andrew to keep track of yeses and nos. She told him, “Every time I ask you to do something and you say “Yes, Mommy” we’ll put a “yes” on the chart. At the end of the day if there are more yeses than no’s, that’s a “yes day” and we’ll do something special together.” Soon Andrew realized that the happy Mommy was more fun to be with than the cranky Mommy, and they began to have more “yes” days. Also, Jill found that Andrew absolutely hated to lose points, so occasionally she would add a “take-away” slant to the reward system. She began the day with a dish of ten dimes, and for each “no” she took one out. Varying the game and the approach held Andrew’s interest and got more consistent results. Eventually, they were able to have “yes” days without the chart and the reward.

15. Give reminders.

“She’s twelve-years-old! Do I still have to remind her to brush her teeth?”Reminders are words, pictures, checklists, or brief notes that jog a child’s lazy memory and keep them from forgetting rules and routines. Frequent verbal or visual cues can keep an active mind on task. If you know from experience that your child is likely to get sidetracked on the way upstairs to brush her teeth, when she reaches the top of the staircase, call out a gentle prompt, “teeth.” A certain look may remind the about-to-mess-up child that he knows better, or a short verbal cue can steer him toward the expected behavior (“Where do jackets go?”) Reminders could even be in the form of pictures. To remember what he has to take to school help your child draw or paste a picture of a backpack on a piece of paper, and around it draw or paste pictures of items that go into the backpack each day. Tack this poster next to the door he uses in the morning.

Every child needs a few of these prompts every day (so do spouses). The child with A.D.D. just needs more of them. Reminders are more likely to be followed than a barrage of daily orders because they don’t provoke a power struggle. Your child already knows the rules. Your reminders just start the memory process going and prevent a behavior problem from occurring. As you enter the supermarket you say, “Remember, we walk down the aisles.”

“But I forgot.” As lame as this excuse sounds, all children forget. Children with A.D.D. forget more often, so they need more reminders. During a particularly intense day your child may need hourly, sometimes minute-by-minute, reminders. Use all the positive verbal and body language you can muster up: “I need your eyes,” “You’re forgetting…” “You know what to do…” Be sure the art of reminding doesn’t deteriorate into the hassle of nagging. Keep your body language positive, your voice light and happy, and your manner more playful than authoritarian. Then your child is likely to perceive your constant prompts as help rather than nagging.

To avoid nagging, once your child can read, write your reminders on little post-it notes for your child. Try some humor: “Dress the bed, then dress yourself;” “Your lunch is packed and in the refrigerator asking to be eaten.” If you have an artistic flair, illustrate the notes.

16. Count your child.

During your early disciplining, you may have frequently used countdowns, such as, “I’m going to count to three…,” expecting your child to behave positively by the time you hit three. Our four-year-old daughter “hops to” at just the mention of counting. She prefers to behave on her own. She knows that once “three” comes, she’s going to be physically assisted in cooperating, and she will do anything to avoid being picked up and carried like a baby. You can also teach your child to use counting to control his own impulsive behavior. Counting can be a cue to help him “think before he acts.” Help him learn to do this by catching him in the act: “Before you throw the toy, count to five, and then imagine what might happen.” The next time your child is about to act impulsively, issue a reminder, such as, “Count to five,” or “Wait a minute,” or “Imagine what might happen.” Repeat these drills so that eventually he will be able to use this skill on his own.

Remember, one of the main challenges for children with A.D.D. is to teach them to “look before they leap.” Teach your child to internalize his own counting drills and use them to control his impulsive behavior. Psychologists call this process of having an inner dialogue to guide behavior “internal verbal mediation.” Teaching your child to have a dialogue with himself is a useful skill in developing self-control. 17. Card your child. This technique is a sort of warning system that gives your child time and space to change disruptive behavior before it gets worse. It also buys an angry, impulsive parent time to plan a gentler strategy. Get three cards, each a different color, and draw a face on each card, each one sadder than the previous one. You can use these cards as they are, or you can glue a magnetic strip to the back of each one to stick them to the refrigerator. When your child begins a disruptive behavior, give him the first card or stick it on the refrigerator door. If the behavior continues, the second, sadder, card goes up. If this doesn’t prompt him to change his behavior and you have not yet come up with a better strategy, the third and saddest face card goes up. If your child is still misbehaving after all three warning faces are on the refrigerator (or on the table) then it’s time for “time-out” or, preferably, “time-in.” One mother tried a very interesting variation on the three-card method. She let her son put the cards up for her, if she started yelling. She gave her son the message that we all can learn from each other. Big people make mistakes, and they also must correct their errors.

18. Try time-in.

We have noticed that for many children with A.D.D (and other children, too) the classic “time-out” method of behavior modification doesn’t work. Their anger escalates when they are sent to another room for time-out, and they become resentful at being sent away. Time-out reinforces all the negative messages they are accustomed to receiving about themselves. This is why the “time-in” chair works better for many, especially for younger children. In time-in the parent has the child sit in a chair or stand in a corner in the same room as the parent. The child must be silent for a short period of time, but is not isolated. This gives the message that although you will not tolerate the behavior, you are not rejecting your child. Children three and older can be given a count of three to sit down. If your child does not sit, state firmly the one-minute time-in is now two minutes. Repeat this procedure raising the number of minute until the child sits in the chair. Screaming or abusive arguing from the child while sitting adds minutes until it stops. You must decide beforehand how long time-in will last. Obviously, fifteen minutes is too long for younger children. We prefer short times, no more than five minutes.

With the time-in method you don’t have to carry, drag, or otherwise force your child upstairs or into a room. Time-in also spares the child’s room from being trashed out of anger and resentment. While the child is sitting in the time-in chair, stand next to him. This positioning makes it difficult for the child to suddenly move out of the chair. You may even stand behind your child with a hand firmly, but lovingly, on his shoulder. Or you may stand in front of him with your hand on his shoulder. (Some children with A.D.D get upset if they are touched.) The child will find it difficult to get up out of his chair with you standing in front of him. Young children, and particularly young children with A.D.D., dislike doing nothing, even for a very short time. Time-in will get the corrective message across very quickly. One minute for each year of life is a good guideline for the length of a time-in.

Occasionally, parents may have to tell a child in a time-in that they are going to help him by holding him. This gentle, but firm, holding reinforces closeness and caring, not anger and control. This can protect a child from throwing himself into an extreme temper tantrum in which he might hurt himself.

MORE TIME-IN TACTICS

With preschoolers, try the teddy bear chair technique. When a child needs time- in, have her put her teddy bear (or any other favorite doll or stuffed animal) in a chair. Then both of you can talk to the bear about behaving better. This bit of playacting uses “time-in” as simply a break in the action to allow her to think about her undesirable behavior and to change what she is doing. Time-in also gives parents a chance to cool off and plan a better discipline strategy.

The timer alternative. Use a kitchen timer. Tell your child he has to sit quietly for three minutes. Turn the dial on the timer to three minutes. If he fusses or doesn’t sit down by the count of three, then start the timer again. Restart the 3-minute time-in every time the child starts to argue. Children tend to respond to the demonstrative action of restarting the time-in period. Eventually, some children, after acting out, go to their time-in seat and set the timer themselves.

Give bonus points if the child explains his point of view calmly after time- in. Tell your child that you want to understand why he did what he did, but he must sit quietly for one minute first. If he explains his reasons calmly, reward him with points. Then ask: “What would you like to do when we are through?” This may get both of you headed in a more positive direction.

19. Try take-aways.

By the time your child is five years of age, you can increase time-ins to five minutes. Once you reach the five-minute mark, tell the child that you are going to take away something he likes (don’t say what) if he doesn’t sit by the time you count to three. If he continues to be unruly then you say: “I’m now going to take the first ten minutes of your favorite TV program away.” You don’t tell him ahead of time what he is going to lose, because if you do, he will often just snap back that he doesn’t want what you threatened to take away anyway. Think ahead to what you have planned that day. If you are planning to make play dough, that won’t happen. Leave yourself with a lot of ammunition. The privilege you take away should be small. Don’t take away his bicycle for a week for a relatively minor infraction.

20. Assist the child.

“I’m-going-to-do-it-with-you.” Here’s a technique to try that stops short of taking away privileges. If your child is not doing what you’ve asked, try counting to three. If this doesn’t work, say to him, “Do it or I am going to help you do it!” Use a stern voice as if your doing it with him is a very significant happening. Count to three again, and then act by taking his arm or hand and doing the task that was to be done. This method avoids the trap of repeating your request over and over again and the need to make threats about taking things away. It works, in part, because children like to do things themselves and partly because your stern tone has conveyed some urgency.

21. Use consequences to curb impulsiveness.

Choices have consequences, and children must learn this. Because of their impulsiveness, children with A.D.D. are less likely to think before acting. They act before considering the consequences. Making wise choices in life begins with learning one basic lesson: “Think through what you’re about to do.”

“When…then…” “When your teeth are brushed, then we’ll begin the story.””When you finish your homework, then you can go out to play.”

Learning from mistakes. Experience is the best teacher and it’s often the one that makes the greatest impression. Children with A.D.D. often have to learn “the hard way.” If despite your guidance, your child still chooses the wrong path, then let him experience the consequences (as long as there’s no danger). For example, your child leaves his tricycle in the driveway despite repeated admonitions to store it in the garage. The bicycle gets backed over by a car. Let him go without a bike for a while. Your child is dawdling despite your frequent reminders that he is late for his baseball game. He sits on the bench for the first two innings.

Imagining the consequences. Help your child imagine what the consequences of a particular action might be. Natural consequences that you have not arranged are happening in everyday life. You can also set up parent-made consequences, customized for a particular situation, that you hope will have lasting learning value. Here is a logical consequence that parents in my pediatric practice tried:

Judy and Tom had just moved into a new house and their four-year-old son, Aaron, was given his own room. He was feeling very proud and grown-up enjoying the privacy of his new room, but door slamming was becoming a problem, especially when he got angry. His parents repeatedly told him that slamming the door was annoying and must stop. If it didn’t, he would no longer enjoy the privacy of having a door: his dad would remove it. Aaron got a “Yeah, sure, Dad’s going to take the door off” look of disbelief on his face. He continued to slam the door over the next day, so when he went out to play, off came the door. A week later Tom put the door back on, and it hasn’t been slammed since.

22. Teach empathy.

Teaching empathy means helping your child to understand that his deeds have consequences for others. Tell him about the feelings you have as a result of his actions. (“That makes me feel…”) Be sure he makes the connection that positive behaviors from him result in positive feelings in others, and negative behaviors result in negative feelings: “I sure like it when you…” “I feel angry when you…” (Notice we don’t say, “You make me so mad.”) Help your child get behind the eyes of other people, especially those on the receiving end of his behavior. Give your child practice in thinking about his own and others’ feelings: “Do you think she feels sad?” “How would you feel if someone hit you?” Look for the “teachable moments” that crop up nearly every day and give you an opportunity to help your child learn empathy.

One day I saw two eight-year-old neighbor boys perched on the hillside ready to toss water balloons onto cars passing below. Obviously, these children had not thought about the effect of their misbehaviors on the drivers of the cars. This was a teachable moment. I sat down with them and asked them to imagine how they would feel as the driver of a car if a water balloon exploded on their window. They needed to learn to put themselves in someone else’s seat. An accumulation of many such lessons over time will truly “put the child in the driver seat” in terms of being in control of their behavior. You want them to get to the point that they think through what the consequences of their actions will be for others rather than being totally focused on their own immediate fun or needs. You may hear that children with A.D.D. are at increased risk for sociopathic behavior, or just plain winding up in jail. Statistically, this is true. Yet the main quality that separates the child who uses his traits to society’s advantage and the one who gets into big trouble is the quality of empathy – the ability to understand and sympathize with the feelings of another.

23. Give responsibilities.

Giving your child responsible jobs to do is a powerful way to shape behavior. Responsibilities give children direction. When they have jobs to do, they have fewer opportunities for bad behavior. Adults often find their value in their work. They call it “being of use.” Children who are given chores feel they are part of a group. They are depended upon, and the family values them. The child with A.D.D., in particular, needs to feel busy and on the move. Give your child special jobs. The word “special” is a good marketing tool and is likely to promote cooperation. Try these tips:

Give the preschool child jobs around the house: vacuuming, dusting, tearing lettuce for a salad, setting the table, helping with dishes.
School-age children can do their own laundry, help with the cooking, and pack lunches.
Create job charts: some jobs might be for pay, others are done for the privilege of living in the home. Give genuine praise for a job well done. Working alongside children is a useful way to keep them on task.
24. Withdraw privileges.

Besides all the “gives” that shape behavior, taking away luxuries is another way to keep the child on track. For this technique to have the desired result, it’s important that children do not view it as a punishment. If done correctly, what’s taken away should be a logical or natural consequence of the child’s actions: “If you ride your bicycle without a helmet, you lose the use of your bicycle for two days.” Remember to withdraw privileges, not the necessities of life. You don’t deprive the child of a hot meal or a warm, winter jacket, but turning off the TV has never caused lasting harm. Losing privileges teaches the child realistic lessons for later in life: privileges are based on responsibility (e.g., If you want to keep your credit card, you must pay the bills.)

Withdrawing privileges works best as a behavior shaper if you have worked out with your child beforehand a mutually agreed upon consequence: “After you finish your homework, you may watch TV.” Then, if he does not finish his homework, he already knows that he will not be watching television. As your child gets older, the stakes get higher. With increasing maturity come greater responsibilities, which bring greater privileges; however, neglecting these responsibilities brings more serious consequences.

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Five Back to School Health Tips

Dr. Sears’ Five Tips to Keep Your Child Healthy When Going Back to School

As you send your child back to school, follow these tips to keep your child healthy.

1. Begin the Day with a Brainy Breakfast

Above all other organs, the brain is most affected – for better or worse – by what you eat. You put junk food into a child’s brain, you get junk behavior and junk learning. Scientific studies show that children who begin the day with a brainy breakfast:

Made higher grades
Were more attentive and participated better in class
Were less likely to be diagnosed with A.D.D. or learning disabilities
Handled complex learning tasks better
Missed fewer school days because of illness
The main ingredients of a brainy breakfast are:

Protein, which perks up the brain
Fiber-filled carbs, which provide a steady supply of fuel
Omega-3 fats, which build smart brain cells
Minerals, such as calcium and iron, which help brain biochemistry work better
Here are some tips for brainy back-to-school breakfasts from the Sears’ family kitchen:

Whole-grain waffles or pancakes topped with blueberries and peanut butter
Oatmeal with blueberries and yogurt
Whole-wheat banana nut bread and yogurt
½ cup low-fat cottage cheese in a scooped-out cantaloupe half
Whole-wheat tortilla wrapped around scrambled eggs and diced tomatoes
Veggie omelet, whole-wheat toast, and fruit
Peanut butter and banana slices on a whole-wheat English muffin with low-fat milk
Almond-strawberry yogurt cup. Layer the yogurt and strawberries (or another fruit, such as blueberries or chopped apple, peaches, or pineapple) in a small bowl. Drizzle honey over the top if plain yogurt is used. Sprinkle with almonds and/or flax-seed meal.
Zucchini pancakes. This is a long-standing Sears’ favorite that even our toddlers enjoyed. Add a cup of shredded zucchini to whole-wheat pancakes.
A fruit and yogurt smoothie
Besides a brainy breakfast, send your child to school with a healthy snack. Those busy little bodies and brains run out of fuel mid-morning and mid-afternoon, the times when learning and behavioral problems are most likely to appear. Our favorite snack: Go nuts! Nuts are the perfect snack because they provide the perfect balance of healthy fats, healthy carbs, and protein. Make your own trail mix: let your children pick out their favorite nuts and add dried fruit. For school snacks, be safe and avoid peanuts because of possible peanut allergy. A handful of nuts for a mid-morning and mid-afternoon snack is just what the school-doctor orders.

2. Keep Hands Clean

Germs are spread through hand-to-hand contact or coughed into the air. Instead of shaking hands, bow or nod. Instruct your children to wash their hands often. Yet, when soap and water are not available, use an antibacterial wipe, like Wet Ones. These are proven to kill 99.99% of germs and they won’t dry out the skin like alcohol-based hand sanitizers. Put Wet Ones in your child’s lunch box or in their little pockets.

3. Feed Your Child Immune-Boosting Foods

Fruits, vegetables, and seafood are your top three immune-boosters. For simplicity, remember the three S’s: salmon, salads, and smoothies. In my medical practice I have noticed that families who feed their children these three top immune-boosting foods are sick less often, especially during those early back-to-school months and the winter flu season. If your children are not fond of seafood, such as wild salmon, give them a daily omega-3 supplement. Studies have shown that school children’s performance improves when they eat adequate omega 3s. Good science and good sense go together, since omega-3 fats are the top structural component of growing brain cells. Once your children join the back-to-school crowd, they are naturally exposed to more germs, so their immune systems need a boost.

Here’s another tip from the Sears’ family kitchen. If your family’s rush-hour is like our family’s in the morning, sleepy kids and hurried parents are not the recipe for a long sit-down breakfast. On most school mornings I would make a fruit and yogurt smoothie, adding some protein powder, organic Greek yogurt, milk or 100 percent juice as a beverage, and slip in some tofu for extra protein and calcium (they didn’t even realize it was in there). I called this smoothie “school-ade.” Our kids loved this quick brainy breakfast!

4. Keep Little Noses and Sinuses Clear

School-passed germs usually settle first in the nose and sinuses. Dr. Bill’s prescription for flushing these germs out of little noses: a “nose hose” and a “steam clean.” A facial steamer and a netipot are two back-to-school nose-clearers every family should have. At the first sign of a stuffy nose, flush your child’s nose out with a saltwater solution or show your children how to use a netipot for a real thorough “nose hose.” Also show them how to carefully use a facial steamer to loosen those snotty nasal secretions.

5. Keep Your Children Active

School children get labeled with a bunch of “Ds”: ADD, ADHD, LD (learning disabilities), etc. Let me add two more “D” – NDD (nutrition deficit disorder) and MDD (movement deficit disorder). Besides preventing NDD by feeding your children immune-boosting foods, get your children moving. In our family we have an MDD-prevention policy: sitting equals moving. Be sure your kids spend at least as much time moving as they do sitting. Studies show that compared with “sitters,” “movers” showed remarkable improvement in their ADD, especially in their ability to sit still and focus, and they required fewer attention-promoting drugs.

Increased movement of the body increases the blood flow to the brain. I call movement “grow food” for the brain. Increased blood flow to the brain increases the release of a substance called nerve growth factor, which helps those little brains grow. Also, movement mellows the mind. Increased blood flow to the brain releases “happy hormones.”

Encourage activity during school-time recess. Schools are beginning to realize that school children need to get out and enjoy the great outdoors, especially during those back-to-school months when they had been used to lots of summer activities. The sights and sounds of nature both relax the mind and invigorate the body. The colors, the movement, the fresh air, and the sun’s energy are just what the “D” doctor ordered. Motivate your school to move your child by encouraging recess.

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Does allergy begin in utero?

Ιt has been recognized for centuries that allergic disease runs in families, implying a role for genetic factors in determining individual susceptibility. More recently, a range of evidence shows that many of these genetic factors, together with in utero environmental exposures, lead to the development of allergic disease through altered immune and organ development. Environmental exposures during pregnancy including diet, nutrient intake and toxin exposures can alter the epigenome and interact with inherited genetic and epigenetic risk factors to directly and indirectly influence organ development and immune programming. Understanding of these factors will be essential in identifying at-risk individuals and possible development of therapeutic interventions for the primary prevention of allergic disease. In this review, we summarize the evidence that suggests allergic disease begins in utero, together with possible mechanisms for the effect of environmental exposures during pregnancy on allergic disease risk, including epigenetics.

Do You Know the Clues to a Concussion?

Here is a pocket tool:

An x-ray, MRI, or CT scan can’t ‘see’ a concussion. But a parent can often see visible clues.

In addition to the signs and symptoms in the pocket tool, if you see one or more of these, suspect a concussion:

Loss of consciousness/responsiveness
Slowness getting up after the head injury
Grabbing/clutching the head
Unsteadiness on the feet/balance problems/falling/decreased coordination
Dazed, blank, or vacant look
Confused/can’t recall recent events/forgets something you said
Slowed or slurred speech
Repeated vomiting
Mood, behavior or personality changes
Other reasons to pay attention include reports of any of the following:

Seeing stars or flashing lights
Ringing in the ears
Double vision, blurry vision, or vision loss
Sensitivity to light or noise
Bad or worsening headache (or pressure in the head)
Dizziness
Trouble concentrating
After a head injury, any child who exhibits the signs, symptoms, memory problems, or visible clues of a concussion should be evaluated by a health professional.

These symptoms may not show up for a day or two after the injury. “If in doubt, sit them out” until after they have been evaluated. Sitting them out includes sitting out from sports and school. Early rest for the brain is important for healing.

Concussions are big deal. Recognizing possible concussions can help kids get the treatment they need to speed recovery and prevent re-injury.

Σειρά από ερωταπαντήσεις σχετικά με το νέο κύμα γρίπης έδωσε στη δημοσιότητα το Ινστιτούτο Παστέρ. Όπως αναφέρει, μεταξύ άλλων, η επιδημία αναμένεται να κορυφωθεί στις αρχές Φεβρουαρίου, ενώ αναμένεται σχετικά μειωμένη αποτελεσματικότητα του φετινού εμβολίου έναντι του ιού λόγω των νέων μεταλλάξεών του.

Αναλυτικότερα:

Πότε ξεκίνησε η γρίπη στην Ελλάδα και πότε αναμένεται να κορυφωθεί;

To Eθνικό Εργαστήριο Αναφοράς Γρίπης Ν. Ελλάδος, στο Ελληνικό Ινστιτούτο Παστέρ άρχισε να δέχεται αυξημένο αριθμό δειγμάτων για έλεγχο γρίπης λίγο πριν τα Χριστούγεννα και σε μεγαλύτερο ποσοστό συγκριτικά με τις περιόδους 2012-13 και 2013-14. Από την περασμένη εβδομάδα η δραστηριότητα της γρίπης παρουσιάζει σαφή ανοδική τάση. Η κορύφωση της επιδημίας αναμένεται πέντε έως επτά εβδομάδες μετά την έναρξή της και επομένως φαίνεται ότι η γρίπη θα κορυφωθεί στις αρχές Φεβρουαρίου 2015.

Ποιοι τύποι και υπότυποι ιού γρίπης κυκλοφορούν;

Τα δεδομένα του Ελληνικού Ινστιτούτου Παστέρ δείχνουν ότι στον ελληνικό πληθυσμό κυκλοφορούν ταυτόχρονα ιοί γρίπης τύπου Α και Β, αλλά με διαφορετική συχνότητα. Από τον ιό γρίπης Α κυκλοφορεί κατά κύριο λόγο ο υπότυπος Α(Η3Ν2) και σε ελάχιστες περιπτώσεις ο υπότυπος Α(Η1Ν1pdm09), το γνωστό πανδημικό στέλεχος.

Ποιος παρακολουθεί τις γενετικές μεταλλάξεις του ιού;

Tα δύο Eθνικά Εργαστήρια Αναφοράς Γρίπης της Ελλάδος που συμμετέχουν στο δίκτυο εργαστηρίων του Παγκοσμίου Οργανισμού Υγείας.

Είναι τα στελέχη εποχικής γρίπης Α(Η3Ν2) που κυκλοφορούν στην Ελλάδα μεταλλαγμένα;

Με βάση τα εργαστηριακά δεδομένα, τα στελέχη A(H3N2) που έχουν απομονωθεί από ασθενείς στην Ελλάδα, φέτος παρουσιάζουν γενετικές μεταβολές που υποδεικνύουν αντιγονική παρέκκλιση, δηλαδή τάση των στελεχών να διαφέρουν από το στέλεχος του εμβολίου.

Πόσο επηρεάζει η μετάλλαξη την αποτελεσματικότητα του εμβολίου;

Αναμένεται μειωμένη αποτελεσματικότητα του φετινού εμβολίου έναντι του ιού. Ο βαθμός όμως της αποτελεσματικότητας δεν μπορεί να προβλεφθεί από τώρα. Είναι βέβαια αυτονόητο ότι το εμβόλιο διατηρεί την αποτελεσματικότητά του έναντι των ιών γρίπης Α(Η1Ν1) και Β.

Η μετάλλαξη παρουσιάζεται μόνο στην Ελλάδα;

Όχι. Παρόμοια μεταλλαγμένα στελέχη έχουν ανευρεθεί τη φετινή περίοδο στις ΗΠΑ και στις χώρες της Ευρωπαϊκής Ένωσης.

Γιατί το εμβόλιο δεν περιέχει το μεταλλαγμένο στέλεχος;

Η απόφαση για τη σύνθεση του εμβολίου λαμβάνεται από τον Παγκόσμιο Οργανισμό Υγείας τον Φεβρουάριο κάθε έτους. Όταν λήφθηκε η απόφαση για το φετινό εμβόλιο τον Φεβρουάριο 2014, δεν είχαν εμφανισθεί ακόμη μεταλλαγμένα στελέχη σε κανένα μέρος του κόσμου, ώστε να συμπεριληφθεί το κατάλληλο στέλεχος στο φετινό εμβόλιο. Η σύνθεση του εμβολίου δεν μπορεί να αποφασισθεί μετά το Φεβρουάριο, διότι για την παραγωγή του εμβολίου απαιτούνται τουλάχιστον έξι έως οκτώ μήνες.

Έχω κάνει το εμβόλιο. Με προστατεύει από το μεταλλαγμένο στέλεχος;

Ναι. Τα αντισώματα που δημιουργούνται μπορεί μερικές φορές να παρέχουν προστασία σε μεταλλαγμένους, αλλά συγγενικούς ιούς. Έτσι, ακόμη και αν δεν υπάρχει πλήρης ταύτιση ή υπάρχει χαμηλότερη αποτελεσματικότητα, όποιος έχει κάνει το εμβόλιο μπορεί να αποφύγει ή να περάσει ηπιότερα τη γρίπη από τον ιό αυτό. Ο εμβολιασμός θα μας προστατεύσει αποτελεσματικά από τους άλλους ιούς γρίπης.

Δεν έχω κάνει το εμβόλιο. Μπορώ ακόμη να το κάνω;

Ναι, καθόσον είμαστε στην αρχή της εποχικής γρίπης. Θα πρέπει όμως να θυμόμαστε ότι το εμβόλιο χρειάζεται δύο εβδομάδες μέχρι να αναπτυχθεί πλήρως η ανοσία.

Που μπορώ να βρω περισσότερες πληροφορίες για τη φετινή γρίπη;

Tο κοινό μπορεί να ενημερωθεί από την ιστοσελίδα του Κέντρου Ελέγχου και Πρόληψης Νοσημάτων http://www.keelpno.gr

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Kids & smartphones

“Is my kid ready for a smartphone”?

Pediatricians have the opportunity and the responsibility to help parents teach their children how to safely navigate the digital world of smart devices.
December 01, 2014
By Pat F Bass III, MD, MS, MPH
“Mom/Dad, can I have a smartphone?” Children are posing this question to their parents at earlier and earlier ages. If parents wait until they are asked to consider how they will monitor technology and their children, they are already behind.Children today know only a digital world, and technology is a part of that world from their earliest memories. With the advent of products such as LeapPad, children are beginning their electronic journey as early as age 1 year. Nintendo, iPads, and other electronic smart devices are not far behind. However, this is often far from the case for many parents in pediatric practices.
Because parents often do not have a long-standing personal history with smart devices, parent and child often experience this development at the same time—often spearheaded by the child. Parents may be at a much lower developmental level than their children related to technology. As a result, parents do not have an innate sense regarding the risks, where their children might get into trouble, or what risks they need to look for as they experience the digital world with their kids. Adolescents report that many of their own online activities are unmonitored.1
“Mom/Dad, can I have a smartphone?” should be one of the anticipatory guidance topics for parents starting at age 5 years in order to generate a discussion surrounding technology, parenting, and monitoring. Whether pediatricians agree or not, children are getting phones, tablets, and other state-of-the-art technology at younger ages. Parents often fail to consider that this technology is often a small but powerful handheld computer. There are no right or wrong answers, but the pediatrician needs knowledge and education in order to have productive conversations with both parents and patients.
Smart devices often provide unfiltered access to the Internet as well as access to nearly any subject matter or thousands of applications. Often parents who have installed significant monitoring and protection of home computers have no idea what children can access on a handheld smart device. There are, however, a number of topics that pediatricians can discuss with parents to help keep children safe and still allow them age-appropriate freedom and responsibility.

Parents influence both online and offline behaviors

Luckily for parents and pediatricians, a developmental approach similar to “childproofing” the home is appropriate. In the early years, simple barriers in the form of filters and limited access are probably enough. As kids get older, supervision is the best way to prevent children and adolescents from accessing inappropriate or potentially harmful content on the Internet. Technology can help, but not replace, this essential parental responsibility.
Parents have a powerful influence on their children. In areas such as alcohol consumption, sex, and tobacco use, parental monitoring is an effective mechanism for preventing poor decisions by teenagers.2-6 Additionally, clearly communicating expectations is important because adolescents who know their parents disapprove of specific behaviors are less likely to choose those behaviors.7
These concepts can be applied to a child’s online world as well. Children are less likely to get in trouble or display risky behavior online when parents:
Actively monitor where children are going online.
Actively monitor whom their children are interacting with online.
Set clear expectations of acceptable online behaviors.
Regularly check in to see that expectations are being met.
However, parents will never be able to monitor children and technology 24/7. A combination of proactive interaction with children and leveraging technology is likely the best approach.

When are kids ready?
There are currently no standards or recommendations for when children are ready to enter the digital world. Very little research has been done to see how digital information and technology impact children of different ages. Although common questions from parents include “What is the best time/age to allow my child to begin online activity?” and “How much time can my child spend online?”, few evidenced-based answers exist. Some practical questions to guide a conversation with parents may include:
Does the parent believe his or her child is currently responsible enough?
Can the child be trusted to follow rules such as not texting during class?
Do parents want children to be able to directly reach the parent for specific emergency or social situations?
Is the child able to understand parental limits similar to those that might be placed for television viewing or video game playing?
Does the child understand acceptable content and behaviors when using smart devices?
Does the child know with whom it’s appropriate to communicate and with whom it is not?
Because evidence-based answers to these questions do not currently exist, common sense dictates that younger children need more supervision than older children, and monitoring gets more difficult as children get older.
Online activities with offline networks affect behavior
Although parents often believe they need to monitor online activities to help protect their children from predators or exposure to objectionable content, a child’s health is influenced by the online activities of his or her offline social groups. These associations are an important reason for pediatricians to discuss online topics with parents.
Just as parents may have been given a first cigarette or drink by a friend, a child’s online social networking activities impact face-to-face behaviors and risk taking. Peers increasingly impact children’s behavior as they enter adolescence, and social networking sites and online communities can powerfully impact adolescents through modeling and peer norming. Exposure to a friend’s photos of risky behaviors such as smoking or drinking is associated with increased risk of adolescents participating in those same behaviors.8,9
Have a family discussion about technology
Parents often have dual fears about smartphones and similar technology. Commonly, parents justify the decision as one of safety. In a world where parents see all sorts of school shootings and other risks, smart technology provides open communication and the ability to reach out to the parent or call 911 if needed. On the other hand, the same technology puts children at risk for overuse, contact by strangers, and exposure to content and messages parents may believe are inappropriate.
Parents have a great opportunity to collaborate with their children related to smart technology, and each parent will need to decide how long a rope they want to extend to their child. Most adolescents consider smart devices their personal property and do not want parents being intrusive. However, parents may tell their adolescent that this technology is a privilege and that, just as they monitor other aspects of their child’s life, the parents are going to ensure their son or daughter is utilizing smart technology responsibly. This may include periodically looking at texts, e-mails, photos, and other aspects of the child’s online life. I encourage parents to lay groundwork for use of smart technology and set limits very early on so that this does not become a battle in adolescence, but just a routine part of child/parent monitoring.
Limits and a clear understanding of the consequences are especially important. What happens if a child goes over time or data limits? What Internet sites are acceptable? Are the parents going to block certain numbers or sites? Designating acceptable and unacceptable times (eg, not after 10 pm) and behaviors (eg, not during dinner; no devices in bedroom at night; always answer calls/texts from parents immediately) are all part of the discussion that should take place between parent and child.

Trust, but verify. —Ronald Reagan
Pediatricians’ advice to parents is that they need to trust their children, but nearly all children lie to their parents at some point. Parents need to make sure their children are safe and take a proactive monitoring stance.
Ultimately, the decision to tell children whether they are being monitored or not is up to the parents. Not telling children could be potentially detrimental to the parent/child relationship, and being honest about monitoring has some benefits.
When parents choose to lurk and then intervene, children and adolescents are often left with a “gotcha” feeling. This may lead to anger, resentment, and the child deciding to hide things from his or her parents. Being honest, on the other hand, will likely drive behaviors parents desire because the child knows they are watching.
Specific behaviors parents can implement
Whereas vendors and experts promote specific monitoring applications through software and services along with anecdotal evidence of their utility, empirical results through randomized controlled trials or other studies are much less common. Asking children what they are doing on the Internet and having discussions about online activities are effective for promoting safe and responsible Internet use. Additionally, keeping Internet-enabled devices out of children’s bedrooms is another tactic that decreases the risk of undesirable online behaviors.10
Other proactive parenting techniques may include:
Consider a non–smartphone. Believe it or not, parents can get phones without cameras and Internet connections, or turn off these features in hand-me-down phones. Although children may complain, this can be an easier transition into technology, especially if the parents’ reason for the phone surrounds safety.
Watch the phone bill. Some mobile providers provide itemized lists of numbers called and texted. Parents can look to see with whom their child is communicating and ask questions about unfamiliar numbers. Additionally, nearly all Internet and cell-phone providers allow some degree of parental control and monitoring that can be instituted at an account level. Tell parents to contact their Internet/cell-phone provider’s customer service representative for details.
Control access. If a child or adolescent must ask a parent before downloading an application or service, the parent is in much greater control of their child’s experience. Parents can look up games and sites to see if they think the content is appropriate or if it places their child at risk. In order to accomplish this, parents will need to control passwords to accounts and not use passwords easily guessed by their child.
Tell children they must “friend” their parent on social networks. In this manner, parents can monitor what their kids and their friends are doing. Additionally, parents can make rules around these accounts. For example, some parents tell children that the parent must know the passwords for these accounts and there are consequences (eg, losing computer privileges) for changing them without parental notification.
Set alerts. If some of the previous strategies are too intrusive for parents, setting alerts for things such as data use or app downloads can give parents an idea of what their children are doing online.

Consider parental control apps for all devices
Parental control applications allow parents to monitor, limit, or block access, and track what their child is doing with their mobile device. Although parents can monitor significantly with the previously mentioned steps, parental control applications provide assistance in appropriate use of “smart” technology. These applications often make monitoring easier by bringing lots of information into 1 dashboard, but they also are associated with some sort of cost. Parents can easily monitor their child’s use to reward good decisions and step in when their child does something risky or views content that parents believe is inappropriate.
Generally, these applications are installed on the smart device or computer. They provide parents with remote monitoring features through an application or dashboard (Table). Different applications provide different features and have varied costs.
All the services have some reporting component and often allow real-time, historical, or online monitoring. Some services include:
eBlaster;
Lookout;
My Mobile Watchdog;
Net Nanny;
TeenSafe; and
WebWatcher.
Role of the pediatrician
Pediatricians are in a unique position to educate parents and patients about technology and online behaviors. Teaching parents how to develop proactive monitoring plans that encourage parent/child interaction as well as providing parents with strategies to keep children safe online are just part of how pediatricians can help patients and parents navigate an increasingly complex digital world.

REFERENCES
1. Reich SM, Subrahmanyam K, Espinoza G. Friending, IMing, and hanging out face-to-face: overlap in adolescents’ online and offline social networks. Dev Psychol. 2012;48(2):356-368.
2. Li X, Feigelman S, Stanton B. Perceived parental monitoring and health risk behaviors among urban low-income African-American children and adolescents. J Adolesc Health. 2000;27(1):43-48.
3. Choquet M, Hassler C, Morin D, Falissard B, Chau N. Perceived parenting styles and tobacco, alcohol and cannabis use among French adolescents: gender and family structure differentials. Alcohol Alcohol. 2008;43(1):73-80.
4. Markham CM, Lormand D, Gloppen KM, et al. Connectedness as a predictor of sexual and reproductive health outcomes for youth. J Adolesc Health. 2010;46(3 suppl):S23-S41.
5. Cota-Robles S, Gamble W. Parent-adolescent processes and reduced risk for delinquency. The effect of gender for Mexican American adolescents. Youth Society. 2006;37(4):375-392.
6. Brendgen M, Vitaro R, Tremblay RE, Lavoie F. Reactive and proactive aggression: predictions to physical violence in different contexts and moderating effects of parental monitoring and caregiving behavior. J Abnorm Child Psychol. 2001;29(4):293-304.
7. Guilamo-Ramos V, Jaccard J, Dittus P. Parental Monitoring of Adolescents: Current Perspectives for Researchers and Practitioners. New York: Columbia University Press; 2013.
8. Huang GC, Soto D, Fujimoto K, Valente TW. The interplay of friendship networks and social networking sites: longitudinal analysis of selection and influence effects on adolescent smoking and alcohol use. Am J Public Health. 2014;104(8):e51-e59.
9. Huang GC, Unger JB, Soto D, et al. Peer influences: the impact of online and offline friendship networks on adolescent smoking and alcohol use. J Adolesc Health. 2014;54(5):508-514.
10. Law DM, Shapka JD, Olson BF. To control or not to control? Parenting behaviours and adolescent online aggression. Comput Hum Behav. 2010;26(6):1651-1656.

Ιδέες για τους γονείς

Ηλικίες 2-4

► Κάνετε το βούρτσισμα των δοντιών καθημερινή ρουτίνα.
► Αγοράζετε ευκολοφόρετα ρούχα. (φόρμες, αθλητικά παπούτσια)
► Δείξτε στο παιδί σας πως να πετά, να πιάνει (όσο μπορεί) και να κλωτσά
μια μπάλα, να ανεβοκατεβαίνει σκάλες.
► Δείξτε στο παιδί σας πως να χοροπηδά σαν λαγουδάκι, να περπατά στις μύτες σαν πουλάκι, κλπ.
► Μιλάτε του συχνά χρησιμοποιώντας μικρές προτάσεις. Ακόμη να το ρωτάτε αλλά και να το ακούτε.
► Προσθέτετε καινούργιες λέξεις στις προτάσεις που του απευθύνετε, έτσι ώστε να του τις εξηγείτε.
► Μάθετε του το όνομα και το επώνυμό του.
► Ζητήστε του να σας λέει και αυτό παραμύθια (που ξέρει) πριν κοιμηθεί.
► Τραγουδάτε παρέα.
► Μιλάτε του για τα χρώματα, τις ποσότητες, τα μεγέθη μέσα από καθημερινές δραστηριότητες.
► Κοιτάτε παρέα παλιές φωτογραφίες του («Όταν ήσουνα μωρό…….»)
► Ζητάτε του να σας βοηθάει σε απλές δουλειές που είναι μέσα στις ικανότητές του. (πχ. να στρώσει τις χαρτοπετσέτες στο τραπέζι, να βάλει τις κάλτσες στο συρτάρι κλπ.)

Ηλικίες 4-5

► Να του διαβάζετε ιστορίες και παραμύθια και να του ζητάτε να σας τις πει.
► Μιλήστε του και εξηγήστε του τη χρησιμότητα των λέξεων (ως μέσο επικοινωνίας)
► Τραγουδάτε και μαθαίνετε απέξω όσα στιχάκια μπορείτε.
► Παίξτε το παιχνίδι ‘κάνε ότι κάνω’, ‘ακολούθα τον αρχηγό’.
► Κάντε χαρτοκοπτική (από περιοδικά) με διάφορα απλά σχήματα, χρώματα, ζώα κλπ.
► Μάθετε του έννοιες του χώρου. Μιλήστε του για αντικείμενα που βρίσκονται ‘πάνω-κάτω’,
► ‘μέσα-έξω’, εμπρός-πίσω’, ‘δίπλα’, ‘ανάμεσα’, ‘δεξιά-αριστερά’, κλπ.
► Παίξτε τα ‘ζώα’ (λιοντάρια, σκύλοι, πουλιά κλπ.)
► Μετράτε αντικείμενα μέσα από καθημερινές δραστηριότητες (μανάβης πχ. 5 μήλα)
► Ζητάτε από το παιδί να μεταφέρει μικρά απλά μηνύματα στα άλλα μέλη της οικογένειας.
► Μάθετε του να οργανώνει το χρόνο του, δηλαδή να κάνει το πρόγραμμα της ημέρας.
► Μάθετε του τη σωστή χρήση του τηλεφώνου.

Ηλικίες 5-6

Κινητικές Ικανότητες
► Πηδήματα, εμπόδια, σκαρφάλωμα, παιχνίδια με μπάλα (πέταγμα, πιάσιμο, χτύπημα, κλωτσιές)
► Ποδήλατο (με ή χωρίς βοηθητικές)
► Ψαλίδι – Κολλάζ (από περιοδικά)
► Ζωγραφική (ελεύθερο σχέδιο και φιγούρες, περίγραμμα)
► Προγραφή (κατανόηση και αντιγραφή συμβόλων)
► Ξεντύσιμο – Ντύσιμο, φαγητό, τουαλέτα και αυτοεξυπηρέτηση γενικότερα.

Γνωστικά – Γλωσσικά
► Παραμύθια και δραματοποίηση τους με εναλλαγές ρόλων.
► Αριθμοί (αναγνώριση συμβόλου), ποσότητες (κατανόηση έννοιας), σχήματα
► Γρίφοι, παιχνιδοτέστ, τραγούδια.
► Το παιδί πρέπει να γνωρίζει το ονοματεπώνυμό του, διεύθυνση, τηλέφωνο, γενέθλια και τα ονόματα της οικογένειάς του.

Σημείωση: Σε αυτή την ηλικία το λεξιλόγιο του παιδιού σας πρέπει να κυμαίνεται στις 2000-2500 λέξεις, όπως και πρέπει να κατανοεί περίπου 5000-6000 λέξεις.

Συναισθηματικά
► Μάθετε του τι είναι σωστό και τι λάθος. Βοηθήστε το να γίνει πιο ανεξάρτητο.

Σημείωση: Το παιδί πρέπει να μπορεί να διαχωρίζει την αλήθεια από το ψέμα, επιθυμεί να του συμπεριφέρεστε σαν ενήλικα, δέχεται την δικαιολογημένη τιμωρία. (λογική συνέπεια)

Κοινωνικά
► Του αρέσει να κάνει φίλους. (βοηθήστε το οργανώνοντας επισκέψεις σε σπίτια, παιδικές χαρές κλπ.)
► Επιθυμεί την αναγνώριση των ενηλίκων (επιβραβεύστε τον για κάτι καλό, ή για μία καλή προσπάθεια)
► Μάθετε του να ακολουθεί τους κανόνες κάθε δραστηριότητας
(όπως και τους κανόνες σπιτιού, τους οποίους και εσείς θα ακολουθείτε)

Σημείωση: Τα παιδιά σ’αυτήν την ηλικία ξεκάθαρα προτιμούν τους συνομηλίκους τους για παρέα, έχουν χιούμορ και είναι σαφώς πολύ ανταγωνιστικά.

BMJ, 08/20/2014  Evidence Based Medicine Clinical Article

Roy A, et al. – Authors determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon {gamma} release assays (IGRA) in children. BCG protects against M tuberculosis infection as well as progression from infection to disease.

Methods

Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts.
Community congregate settings and households.
Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis.
Children were screened for infection with M tuberculosis with interferon {gamma} release assays.
Study results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta–analysis.
Results

The primary analysis included 14 studies and 3855 participants.
The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children.
The observed protection was similar when estimated with the two types of interferon {gamma} release assays (ELISpot or QuantiFERON).
Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis.
Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77).

Με ποιες νέες καταστάσεις έρχεται αντιμέτωπο το παιδί πηγαίνοντας στο γυμνάσιο και πώς πρέπει να συμπεριφερθεί ο γονέας.
Μερικά παιδιά αισθάνονται έντονο άγχος και φόβο όταν πηγαίνουν για πρώτη φορά σχολείο ή αρχίζει η νέα σχολική χρονιά μετά από τις καλοκαιρινές διακοπές.
Οι γονείς, μέσα στα πλαίσια του ρόλου τους, οφείλουν να βοηθήσουν το παιδί ώστε να ξεπεράσει τα άγχη και τις φοβίες του σχετικά με το σχολείο, προκειμένου να προσαρμοστεί και να αποδώσει καλύτερα. Όταν, μάλιστα, το παιδί έχει αναπτύξει δεξιότητες που είναι χρήσιμες και απαραίτητες κατά τη μαθησιακή διαδικασία, οι πιθανότητες να παρουσιαστούν προβλήματα στο σχολείο ελαχιστοποιούνται.
Σίγουρα η μεγαλύτερη ανησυχία σημειώνεται στους γονείς των οποίων το παιδί θα πάει για πρώτη φορά στην Α΄ Δημοτικού. Ωστόσο, δεν θα πρέπει να παραγνωρίζεται και το πόσο δύσκολη καθίσταται συχνά η μετάβαση από την ΣΤ΄ Δημοτικού στην Α΄ Γυμνασίου.
Η κατάσταση δυσχεραίνεται, ειδικά όταν απαιτείται η αλλαγή σχολείου και κατ’ επέκταση η απομάκρυνση από τους παλιούς και γνώριμους φίλους και συμμαθητές. Το παιδί, λοιπόν, έρχεται αντιμέτωπο με μια σειρά αλλαγών, οι οποίες σε συνδυασμό με τις σωματικές μεταβολές και την προσπάθεια εύρεσης της προσωπικής του ταυτότητας, καθώς η περίοδος αυτή συμπίπτει με την έναρξη της εφηβείας, είναι δυνατόν να διαταράξουν τις ισορροπίες του και να προκαλέσουν σύγχυση.
Πιο συγκεκριμένα, ο νεαρός έφηβος έρχεται αντιμέτωπος με το ότι:
Ενώ είχε καταφέρει να κατακτήσει το ρόλο του «μεγάλου» ως «εκτάκι», που κατευθύνει τα μικρότερα παιδιά, τώρα ξαναγίνεται ο «μικρότερος» του σχολείου, τον οποίο συχνά κοροϊδεύουν και δεν υπολογίζουν
Εισέρχεται εκ νέου σε ένα άγνωστο περιβάλλον, όπου δεν τον γνωρίζουν οι καθηγητές του και συχνά ούτε και οι συμμαθητές του
Συχνά είναι δύσκολο να κερδίσει την προσοχή των καθηγητών του, καθώς αυτοί εναλλάσσονται διαρκώς και οι διδακτικές ώρες μαζί τους είναι περιορισμένες
Πλέον απαιτείται διαφορετικός τρόπος σκέψης, συμπεριφοράς στην τάξη και μελέτης
Οι ανταγωνισμοί εντείνονται λόγω της ηλικίας των παιδιών
Η αντιδραστικότητα σε ζητήματα πειθαρχίας αυξάνει, λόγω της τάσης για αυτονομία που χαρακτηρίζει τη συγκεκριμένη ηλικία, με αποτέλεσμα τις συχνές εντάσεις με τους καθηγητές
Η συμπεριφορά του γονέα κρίνεται για άλλη μια φορά καθοριστική:
Είναι σημαντικό να ενθαρρύνετε και να ενδυναμώνετε το παιδί σας, ώστε να αντιμετωπίζει τις νέες καταστάσεις ως πρόκληση και όχι ως δυσεπίλυτο πρόβλημα
Σε κάθε περίπτωση μην ξεχνάτε να τονίζετε τη θετική όψη της μετάβασής του στη νέα αυτή εκπαιδευτική βαθμίδα
Ενημερώστε το παιδί σας για τη ζωή στο γυμνάσιο, αλλά προσέξτε να μην το τρομοκρατήσετε εν όψει των νέων του υποχρεώσεων
Δώστε ιδιαίτερη προσοχή στα πιο μικροκαμωμένα παιδιά, καθώς για αυτά η προσαρμογή συνήθως είναι δυσκολότερη, λόγω της ανομοιογένειας συγκριτικά με τους συμμαθητές τους, ενώ συχνά χαρακτηρίζονται και από χαμηλή αυτοπεποίθηση
Ενισχύστε την επικοινωνία του παιδιού σας με αγαπημένους φίλους και συμμαθητές, ώστε να νιώθει ότι ανήκει σε μια ομάδα όπου είναι αποδεκτό
Προσπαθήστε η αλλαγή αυτή στην εκπαιδευτική βαθμίδα να μην συνοδεύεται από επιπρόσθετες αλλαγές στα πλαίσια της οικογένειας
Το θετικό είναι πως τα περισσότερα παιδιά προσαρμόζονται αποτελεσματικά τόσο στο γυμνάσιο, όσο και στο σχολείο γενικότερα, μετά από τους πρώτους δυο – τρεις μήνες. Ωστόσο, σε κάθε περίπτωση είναι ιδιαίτερα βοηθητικό για το παιδί όταν ενθαρρύνεται να μιλήσει ανοιχτά για τους φόβους και τα άγχη του και όταν ξέρει πως οι γονείς του είναι δίπλα του προκειμένου να το βοηθήσουν να ξεπεράσει την όποια δύσκολη κατάσταση.

Πηγή: Παναγιωτουνάκου Ελπίδα Ψυχολόγος – Ψυχοθεραπεύτρια

«Μην κάνεις μπάνιο πριν βγεις από το σπίτι, γιατί θα πάθεις πνευμονία». Την επόμενη φορά που θα σου πουν κάτι τέτοιο, απάντησε ότι οι μικροοργανισμοί είναι αυτοί που προκαλούν λοιμώξεις και όχι ο κρύος καιρός. Το μόνο που μπορεί να σου προκαλέσει το κρύο είναι κρυοπαγήματα. Για να κρυολογήσεις πρέπει να κολλήσεις ιό από κάποιον άλλο. Αν κάνεις ποδήλατο ή τρέχεις σε ανοιχτό χώρο, δεν κινδυνεύεις. Γιατί, όμως, αρρωσταίνεις συχνότερα όταν κάνει κρύο; Επειδή με το κρύο αλλάζεις συνήθειες: συγκεντρώνεσαι μαζί με πολλά άτομα σε κλειστούς χώρους και αποφεύγεις να πλένεις τα χέρια σου με κρύο νερό, οπότε διευκολύνεται η μετάδοση των ιών. Φαίνεται, όμως, ότι το κρύο μειώνει τις αντιστάσεις του ανοσοποιητικού σου. Το κρύο, λοιπόν, δεν σου προκαλεί συμπτώματα, αλλά σε κάνει ευάλωτο στις ιώσεις.

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