Q: My 9-year-old is terrified of dying. She doesn’t know anyone who has died, but in the last few months she seems to think about death more and more. Even though she is normally a bright and “spirited” child, about twice a week she breaks into tears saying that she is worried that someone in the family will die. What can I do to help her?
A: It is not unusual for 9-year-olds to suddenly be worried about death. A child’s understanding of death changes as she grows. Young children typically think of death as a long trip from which you can return, but between 8 and 12 children begin to get a sense of the permanency of death, a terrible and sometimes overwhelming thought. Many children go through periods when they worry about death, and, like your child, they get upset on a regular basis. The mind can work in mysterious ways, and just because you don’t see any triggers for her worries, this doesn’t mean that they don’t exist. Perhaps it is the news reports of the war in Iraq, or a book she is reading, or a television show or movie that she has watched. Maybe she has a friend who has experienced a death in her life. Often these kinds of anxieties are “contagious.”Whatever is triggering her fears, you must ask yourself if her worry about death is a symptom of a more serious anxiety disorder. There are several tests which can help you distinguish normal anxiety from clinical anxiety, including the Multidimensional Anxiety Scale for Children (MHS, Inc. 1997), and the Revised Children’s Manifest Anxiety Scale (Western Psychological Services1985). A school psychologist should have access to these or similar standardized ways to measure anxiety. Obviously if an anxiety disorder is discovered, treatment should follow as soon as possible.The most important part of your question is what should you do to help alleviate your child’s worries. Whenever I encounter a psychological or developmental problem in children, I ask myself: “What does this child need to solve the problem herself.” The answer to this question is always a specific emotional intelligence skill.In the case of your daughter, I would say that the two most important skills she needs are to “self-calm” and to be able to communicate her feelings to people who can give her a sense of support and belonging. Every emotional intelligence skill is related to a specific part of the brain’s emotional chemistry. Learning to self-calm (through deep breathing, meditation, guided imagery, and so on) reduces stress biochemicals, including cortisol, adrenaline, and norepinephrine. Practicing using self-calming techniques will train your child’s brain to be able to deal with all kinds of stress and worry. Talking about her feelings to others produces serotonin in the brain, a biochemical that is a mood modulator. These feelings may be about her anxiety, but talking about any concern at all will help her feel a sense of belonging and being cared about. When people say that they “feel better” after talking to a counselor, a family member, or a friend, this feeling actually comes from the increased serotonin in the brain.Although I don’t really think that talking about death will help your daughter, and may temporarily increase her anxiety, there are several books available to help parents open a discussion about this difficult subject. One of my favorite books for children is When Dinosaurs Die by Laurie Krasny Brown and Marc Brown. This illustrated book has a comic book feel, and seems to intrigue children without talking down to them. You may want to read this book yourself to get a better feeling of how a child your daughter’s age thinks about death and what might be appropriate answers to her questions and concerns. Then show the book to your child and suggest that she may want to look at it herself. Let her choose whether this is something she wants to do.
Friday, February 27, 2009
Thursday, February 26, 2009
How Old Should Kids Be Before They Play Video Games?
Q: My 3-year old has been watching his 9 and 11 year old brothers play video games, and wants to start playing games too. I know that there are games out there for kids his age, but is 3 too young for him to start?
A: There are many video games available for three years olds, including one by Fisher Price that has tots pedal a miniature stationary bike to work the game. But I would advise delaying having your son play video games for at least another year. The American Academy of Pediatrics suggests that children under three shouldn’t spend any time in front of the “screen” (TV or video games), although that may be a bit unrealistic. A recent survey from the Kaiser Family Foundation found that half of all four to six year olds play video games, and about 25% play several times a week.As with all children, the real question is: How much time playing video and computer games are we talking about? Beginning at four, children might find some some video games entertaining and educational, but they should really be spending their time in more active and imaginative play. Time spent playing video games becomes much more of a problem beginning at five or six, when there is a significant push to get kids on Internet sites like WebKinz, and many more commercial games are available for the various video consoles. And things don’t get better. In the ‘tween years, many kids add Instant Messaging and social networking sites to their repertoire of time-consuming sedentary interests.
Clearly, being outside on a bike or skiing or playing tennis in the fresh air, with real people, is preferable than doing these activities in a virtual world.As with so many issues in child-rearing, the best answer involves appropriate use of the “L” word. No, I'm not talking about love, the “L” word I’m referring to is limits. Parents need to determine a limit for their children to be in front of the screen (TV, video games, computers) for each child, and don’t exceed it. My recommendations would be: one-half hour or less a day for children ages 3-5, one hour a day or less for children ages 6-12, two hours a day for teens (which hopefully would include using the computer for educational purposes). Of course setting limits is one thing, and getting kids to do things like chores, reading, or sports is another. Responsible parents need to work at both limiting questionable habits and supporting habits which lead to physical and mental health. When it comes to video games other gadgets and gizmos, the sooner you teach good technology habits, the better.
A: There are many video games available for three years olds, including one by Fisher Price that has tots pedal a miniature stationary bike to work the game. But I would advise delaying having your son play video games for at least another year. The American Academy of Pediatrics suggests that children under three shouldn’t spend any time in front of the “screen” (TV or video games), although that may be a bit unrealistic. A recent survey from the Kaiser Family Foundation found that half of all four to six year olds play video games, and about 25% play several times a week.As with all children, the real question is: How much time playing video and computer games are we talking about? Beginning at four, children might find some some video games entertaining and educational, but they should really be spending their time in more active and imaginative play. Time spent playing video games becomes much more of a problem beginning at five or six, when there is a significant push to get kids on Internet sites like WebKinz, and many more commercial games are available for the various video consoles. And things don’t get better. In the ‘tween years, many kids add Instant Messaging and social networking sites to their repertoire of time-consuming sedentary interests.
Clearly, being outside on a bike or skiing or playing tennis in the fresh air, with real people, is preferable than doing these activities in a virtual world.As with so many issues in child-rearing, the best answer involves appropriate use of the “L” word. No, I'm not talking about love, the “L” word I’m referring to is limits. Parents need to determine a limit for their children to be in front of the screen (TV, video games, computers) for each child, and don’t exceed it. My recommendations would be: one-half hour or less a day for children ages 3-5, one hour a day or less for children ages 6-12, two hours a day for teens (which hopefully would include using the computer for educational purposes). Of course setting limits is one thing, and getting kids to do things like chores, reading, or sports is another. Responsible parents need to work at both limiting questionable habits and supporting habits which lead to physical and mental health. When it comes to video games other gadgets and gizmos, the sooner you teach good technology habits, the better.
Wednesday, February 25, 2009
New Guidelines on Children’s Weight
Q: My 5-year old is pretty chubby, but I looked this way too when I was young. Then, when I was a teenager I dieted and remained thin. Should I be worrying about her weight? How old should a child be before going on a diet?
A: With every passing year an overweight child increases the probability that she will have a lifelong struggle with weight. There is a window of opportunity, between 8 and 12, which is the critical developmental period to make a difference in a child’s future weight. This is a time when children are cognitively ready to understand the relationship of good nutrition and exercise to their health, and yet they are still highly influenced by their parents’ rules and values. As they enter their teen years, children eat more meals away from home and they are more susceptible to influences from the media and the barrage of commercials for soda and junk foods. This is also a time that children often cut down on their physical activity (with the exception of children who are in organized sports who tend to remain active through high school).While the tween years are an important time for parents to help their children develop a healthy and permanent lifestyle, we also know that good eating habits must begin in infancy and concern about nutrition and exercise is a concern at every age.A panel convened by government health agencies and the American Medical Association called for improved guidelines for monitoring weight in children including: weight checks at least yearly, counseling about weight even if children aren't overweight, and a four-stage treatment plan that could end in medication or surgery for the most persistently obese children.The study also noted that children need an hour of physical activity a day, along with limits on sweetened beverages, computer and TV time, as well as fast-food meals. Doctors are advised to get a family history of obesity, diabetes and heart disease. Doctors also are advised to check cholesterol levels of overweight children.For overweight kids (85th to 94th percentile) and the obese (95th percentile and above), diet and exercise guidelines are more specific and follow-up times are shorter.Despite concerns about soaring childhood obesity—roughly 17% of American children are considered obese-- diagnosis still lags, with studies showing only half of overweight kids are diagnosed as such by their doctors. While being overweight is a concern for any age child, “dieting” is never recommended for children under 12. Children need good nutrition and should never be put on a diet that restricts any major food group. Less soda and junk food and more exercise is the prescription for most children, but if children are seriously overweight, you should certainly consult your pediatrician or a nutritionist. Dietary guidelines for infants and children can be found at the web site of the American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4575.
Overweight teens may benefit from dieting, but given the risk factors for depression and eating disorders in teens, dieting should always be done with caution and supervision. I strongly recommend a new book based on the highly acclaimed Sierra School (the only high-school in the U.S. specifically designed as a weight loss program): http://www.parentchild411.com/s.nl/it.A/id.803/.f
A: With every passing year an overweight child increases the probability that she will have a lifelong struggle with weight. There is a window of opportunity, between 8 and 12, which is the critical developmental period to make a difference in a child’s future weight. This is a time when children are cognitively ready to understand the relationship of good nutrition and exercise to their health, and yet they are still highly influenced by their parents’ rules and values. As they enter their teen years, children eat more meals away from home and they are more susceptible to influences from the media and the barrage of commercials for soda and junk foods. This is also a time that children often cut down on their physical activity (with the exception of children who are in organized sports who tend to remain active through high school).While the tween years are an important time for parents to help their children develop a healthy and permanent lifestyle, we also know that good eating habits must begin in infancy and concern about nutrition and exercise is a concern at every age.A panel convened by government health agencies and the American Medical Association called for improved guidelines for monitoring weight in children including: weight checks at least yearly, counseling about weight even if children aren't overweight, and a four-stage treatment plan that could end in medication or surgery for the most persistently obese children.The study also noted that children need an hour of physical activity a day, along with limits on sweetened beverages, computer and TV time, as well as fast-food meals. Doctors are advised to get a family history of obesity, diabetes and heart disease. Doctors also are advised to check cholesterol levels of overweight children.For overweight kids (85th to 94th percentile) and the obese (95th percentile and above), diet and exercise guidelines are more specific and follow-up times are shorter.Despite concerns about soaring childhood obesity—roughly 17% of American children are considered obese-- diagnosis still lags, with studies showing only half of overweight kids are diagnosed as such by their doctors. While being overweight is a concern for any age child, “dieting” is never recommended for children under 12. Children need good nutrition and should never be put on a diet that restricts any major food group. Less soda and junk food and more exercise is the prescription for most children, but if children are seriously overweight, you should certainly consult your pediatrician or a nutritionist. Dietary guidelines for infants and children can be found at the web site of the American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4575.
Overweight teens may benefit from dieting, but given the risk factors for depression and eating disorders in teens, dieting should always be done with caution and supervision. I strongly recommend a new book based on the highly acclaimed Sierra School (the only high-school in the U.S. specifically designed as a weight loss program): http://www.parentchild411.com/s.nl/it.A/id.803/.f
Tuesday, February 24, 2009
Kids need to get dirty. Organisms in dirt improve a child’s immune system.
According to a recent article by Jane Brody in the NY Times, researchers are saying that kids need to spend time more in the dirt and that the millions of bacteria, viruses, and especially worms that enter the body along with “dirt” spur the development of a healthy immune system. The studies suggest that our obsession with keeping kids clean may in part explain why immune system disorders like asthma and allergies and even multiple sclerosis and Type 1 diabetes, have risen significantly. This trend is happening in developing countries as well as the U.S. Some doctors believe that the current emphasis on antibacterial products convey a false sense of security for parents and may foster the development of disease-causing bacteria. Plain soap and water are all that kids need to be clean. Psychologists and sociologists also suggest that kids should play more outdoors. Richard Louv, author of “Last Child in the Woods,” claims that spending too much time in front of a screen, and not enough time outdoors, is resulting in more behavioral problems in children. So now that the cold weather is moderating . . get those kids outside!
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