Dr.Silva: Tots,Tweens & Teens™

Are There Test Anxiety Strategies That Can Help?

Test Anxiety Strategies - Photo by Tim Gouw

Yes!  There are many test anxiety strategies on how to deal with test anxiety.  First, I'm going to review the causes, the symptoms,  and who gets it before I discuss what test anxiety strategies to use for managing test anxiety.

What is Test Anxiety?

Test anxiety is a feeling someone gets before or during test taking.  It is a type of performance anxiety, that occurs when someone is typically concerned about getting a good outcome.  The result is physical and psychological symptoms that occur before or during tests.  Test anxiety can negatively affect learning and performance.  The good news is there are test anxiety strategies on how to deal with it.  

What Causes Test Anxiety?

It is caused by fear of failure, poor test preparation and/or problematic test taking history.  There is pressure to perform at your best level.  This can motivate the test taker.  However, it may also create fear of failure.  Good test preparation is important for a good test result.  It is also important to prevent test anxiety.  A calm test taker tends to know they've studied to the best of their ability.  They also tend to have studied over time, and not in just a few days or at the last-minute.  If the test taker has had a history of negative experiences with test or poor grades on test, this can also cause anxiety on future tests.

What Are Symptoms of Test Anxiety?

Symptoms are physical, emotional, and/or behavioral.  They range from mild or very intense. 

The physical symptoms may include: headache, nausea, vomiting, diarrhea, fast heart rate, fast breathing rate, feeling like you can't breathe.  If the anxiety is severe enough, a panic attack may occur.  When someone is having a  panic attack, it is generally very debilitating.  A panic attack can make a person feel paralyzed internally or externally, like they can't move, can't talk, & they may feel like they're having a heart attack.

The emotional symptoms may include crying, feeling fear, feeling sadness, and helpless.

The behavioral symptoms may include negative self talk, inability to think clearly, and inability to function.

Who Gets Test Taking Anxiety?

• Worriers - If your child has a tendency to worry, he/she is more likely to suffer from test anxiety. Even if your child is prepared, your child's worrying could cause test taking anxiety.
• Perfectionists - If your child aims for self perfection, then he/she is more likely to suffer from test anxiety.  Even if your child does wll in school, the very thought of getting questions wrong, or getting less than an A, leads the perfectionist to have test taking anxiety.
• Unprepared People - If your child has not learned the subject matter, not practiced with classwork/homework, and/or studied the material, then he/she is more likely to suffer from test anxiety.

How To Manage or Prevent Test Anxiety ?

There are many ways to help your child manage, prevent, and/or minimize test anxiety.  

    Talk About It

• Ask your child what's making your child feel nervous.
  • Talking about their feelings make children have less anxiety.  Stay calm too as this helps your child stay calm as well
• Accept mistakes
  • This can be a part of you child's life lessons.  Teaching your child to handle things when the outcome is not what they expected will help them in life, not just in test taking.
• Boost your child's confidence.
  • Tell them how wonderful they are.  Ask them to give themselves compliments.  What do they like about themselves? About their great brains?
• Always offer support.
  • Remind your child that you are always there.  Sometimes, they don't want a solution.  Sometimes being a listener is all he/she needs.

    Review Studying Habits & Test Prep

• Have your child practice on sample tests.
  • Having experience with what the test will feel like will prevent anxiety.
• Focus on test preparation.
  • Establish a routine for studying and preparing for the upcoming test is very helpful.  Studying a little bit at a time, over a set time period.  It is usually better than craming it in the day before the test.  It also also for better retention of the facts.  
• Learn your child's best study habits.
  • When does he/she study best?  Is it morning, afternoon, or night?  
  • Does he/she need breaks? 
  • Could hunger be slowing his/her learning/studying? Consider snack breaks in between studying.
  • Does he/she need to do something physical or move around in between studying.
• Review test taking strategies.
  • Teach your child what to do if they are stuck on a test question.  If they can't answer one, then teach them to mark the question and move on.  They can get back to it later.  
• Help your child feel their best the day of an exam 
• Review all methods and test after the test is complete.
  • What were your child's strengths on the test?  Where are their weaknesses?  How could he/she have improved test prep?  What did he/she do that was just right?  What can he/she do again the next time?  Or do differently?  Ask them to evaluate this with you.

    Sleep & Screen Time

• Find your child's best number of sleep hours.
  • Does your child need eight (8) hours a night?  Ten (10)?  Twelve (12)? Try to make sure they get their best sleep before tests.
• Monitor your child's screen time.
  • If your child has too much screen time, especially at night, or the days or week before an important test can do more harm than good.

    Relaxation, Guided Meditation & Affirmations

• Practice relaxation techniques.
  • Deep breathing 
  • Taking a bath
  • Listening to relaxing music
  • Create art.  Drawing and/or coloring is fun and relaxing.
  • Play a board game that's fun with the family the day before the exam.
  • Watch a funny movie with your child.  Sometimes, laughter is the best medicine.
• Use Guided Meditation.
  • I recommend and use, I Am Peace, by Susan Verde.  This is a wonderful book.  It is geared for children.  I think it's a great book for any age.  The last page has a Guided Meditation.  I've read this out loud to my son while he is lying down with his eyes closed.  I must say that both he and I are relaxed at the end, every time.
  • The Balloon
  • Follow the Leader
• Use Affirmations
  • There is more information on Children & Affirmations on this website.
  • There are Daily Affirmations available as well.

Sexual Abuse by MSU’s Former Dean on Medical Students

Gymnastics Sexual Abuse Scandal - Photo by Claudia Soraya on Unsplash

On Tuesday, March 27, 2018, William Strampel, former dean of Michigan State University's (MSU) osteopathic medical school from 2002 to 2017, was arrested Monday evening and taken to jail on four charges — one felony and three misdemeanors.  He was charged with sexual assault and sexual harassment against four (4) former medical students at MSU.  He also failed to deal appropriately with complaints about Larry Nassar.  The Michigan Attorney General’s Office has an ongoing investigation of the role others at the school may have played in crimes committed by Mr. Nassar, the former MSU and USA Gymnastics physician accused by more than 250 girls and women of sexual abuse. 

Nassar Sentencings

In January 2018, Former U.S. Olympics Medical Doctor, Nassar was sentenced to 175 years for sexual abuse of over 250 female athletes.  Prior to that he was sentenced to 60 years jail time for ownership of thousands of images of child pornography.  

Nassar Coverup

How did he do so much to so many young girls and ladies? He sexually abused over 250 girls and women.  Surely, people knew.  Now, Strampel, his ex-boss at MSU Medical School has been charged with sexual assault and harassment of female medical school students.  Nassar was USA Gymnastics' national medical coordinator since 1996 until he was fired in 2015.  In April 2014, when Amanda Thomashow, a MSU student, complained about Nassar's sexual abuse of her on campus, Mr. Strampel stopped Nassar from treating students for two (2) months, then came up with protocols, in order to prevent the same "misunderstanding" from happening again.  However, Strampel never told anyone at MSU or the authorities the accusations, Nassar's conduct, or Strampel's plans.  In August, only two (2) months later, another woman complained again.  Nassar admitted he didn't follow any of Strampel's guidelines. 

Nassar Fired

One has to wonder why?  Simply, Strampel admitted to Michigan State police and the FBI that he never followed up to see if Nassar was following the protocols.  Protecting MSU's reputation may have indeed had something to do with it.  However, Strampel was also protecting himself.  Authorities have since found evidence to Strampel’s own crimes on his work computer.  Allegedly, investigators found about 50 photos of pornography, many of them he solicited from MSU students Also, shockingly, a video of Nassar performing “treatment” on a young female patient. So Strampel knew all along, but did nothing to stop, prevent, or report it.  Clearly, he was protecting himself.

Female Gymnastics Athletes Accuse Nassar

Mr. Nassar's sexual abuse of female athletes was not limited to USA Gymnastics, it also included his time spent with the USA Olympic team at Karolyi Ranch (now closed, former US Women's National Team Training Center and a US Olympic Training Site), MSU, Twistars gymnastics club in Michigan, his office, and his home, sometimes while parents were in the room.  He'd explain that his intravaginal therapy was medical treatment for their hip and physical injuries.  However, even if there weren't hip injuries, he would still perform his intravaginal treatments.  He also didn't use exam gloves.

Female Gymnastics Athletes Resist Nassar’s “Treatment”

These young girls felt uncomfortable with his treatments, but didn't know that it was sexual abuse.  They didn't want his treatments anymore.  Mattie Larson gave herself a head injury in order to avoid going to Karolyi Ranch.  She was abused from the time she was 14 years old for five (5) years until she retired in 2011 at 19 years old.  Olympic Gold medaist, Aly Raisman was one of many young women who confronted Larry Nassar in court prior to his sentencing regarding the sexual abuse.  She had spoken in a most compelling, strong and determined manner.  The video of Aly Raisman's court speech is compelling beyond words.  Other Olympic gold gymnasts, Simon Biles and Gabby Douglas state they were abused by Nassar as well.  Lawsuits by Aly Raisman and another olympic gymnast, McKayla Maroney have been filed against MSU, USOC, and USA Gymnastics. 

First Male Gymnastics Athlete Accuses Nassar

On March 2, 2018, Jacob Moore became the first male athlete to accuse Nassar of sexual abuse. How many other men will follow?  Time will tell; but I wouldn’t doubt that there’s many more.  He and his sister filed a lawsuit against, stating they were sexually abused and harassed by Nassar.  Moore, his sister, along with 200 women filed a federal lawsuit against Nassar, USA Gymnastics and MSU. Moore states that Nassar brought Moore to his basement treating his shoulder injury with genital and pubic acupuncture.

Fallout from the Scandal

In the fallout of the scandal, many more people in position of high authority in their perspective organizations have resigned, been suspended, or fired.  Their involvement, lack of action, suppression of information, ability to ignore and look away, essentially helped  Nassar commit his many crimes against these ladies.  MSU's President Lou Anna Simon and Athletic Director Mark Hollis, USA Gymnastics Board of Directors’ Chairman Paul Parilla, Vice Chairman Jay Binder and Treasurer Bitsy Kelley all resigned after Mr. Nasar'sNasar's sentencing.  USA Gymnastics suspended former U.S. women’s national team coach John Geddert, the owner of the Twistars. US Olympic Committee (USOC) CEO Scott Blackmun resigned as well. How many more will fall?  Undoubtedly many more will fall.  Wait and see.  

Talking to My Patients About Sexual Abuse?

It is important to talk to both our daughters and our sons about sexual abuse.  It’s important to discuss details. Of course, age appropriate conversations need to take place.  As a pediatrician, whenever it’s time to examine genitalia, I’ve always done so with the parent/trusted adult in the exam room.  I talk with children about feeling safe when a parent or a trusted adult is around, that know one should look at you, touch you, or touch your private boy/girl parts, mouth, or bottom alone, not even a girl doctor like me. 

How Do I Talk with My Kids about Sexual Abuse?

On a personal note, we have had this conversation with our son several times since he was seven (7) years old.  The talk has changed over the years.  As his body self-awareness increased, suddenly, I realized I was only discussing his “front” genitalia.  One day, I asked my young son, “What if someone wants to touch you butt?  What if they want to put something in your mouth?”  Shockingly, his young self said, “Okay.”  I had to teach him that it wasn’t okay.  Does Mommy or Daddy every put anything in your mouth?  Your butt? Then, he realized it wasn’t okay.  

Nowadays, I talk with him directly about Larry Nassar, how he groomed these girls and the boys, the horrible secrecy, the bravery of the girls and the boys who tell their stories.   Frankly, he needs to know that these monsters exist, that they don’t look like monsters, that their friendly at first, until they trap you.  But they can be stopped. He can avoid them, and needs to talk about them just like these women and young man did. 

I’ve also taught him that if he sees something happening to someone else, he needs to say something.  Children sometimes don’t want anyone to know what they’ve seen. They may not feel safe.  They may not feel their parents can be safe if they tell.  So, it’s important to let them know that abuse can be reported anonymously by calling 1-800-FL-ABUSE.  Silence is dangerous.  

How to Talk About Sexual Abuse with Your Children

It is so important to talk with our children about sexual abuse.  These brave young girls, women, and young man have helped open doors to this conversation.  No one ever thinks it will happen to their children.  Usually, it's by someone the child knows, as opposed to a total stranger.  In fact, the sexual abuser usually grooms them to make them feel special.  The MeToo Movement showcases exactly how important it is for parents to discuss sexual abuse with their children.  It is an uncomfortable discussion.  But it’s never enough conversation.  Repetition over the different ages is crucial, as children’s understanding increases with age.  Parents are the key.  Reading the AAP article about sexual abuse can help you start this conversation, recognize risk factors, and prevent sexual abuse from happening to your children.  Talk about it, the abuse you talk about today may be the abuse you prevent tomorrow.

Gun Violence in America & March for Our Lives

America had a truly historical moment on Saturday, March 24, 2018.  The March For Our Lives was led by the student survivors of Marjory Stoneman Douglas High School, Parkland, FL.  There were 800,000 teens and adults who attended the March in Washington, DC.  Many more attended in cities across the U.S. to demand change in gun laws and talk about gun violence in America.

Gun Violence in America

A March led by our minors is amazing.  Even more amazing is that they included all others affected by gun violence in America, including domestic gun violence victims, police gun violence victims, and more.  This was not just a march to stop school shootings and school violence.  They made a statement that "Enough is Enough". 

Articulate Teens

They were also incredibly articulate.  In an era when so many think children are just children, it was wonderful to see them show the world that our American children can stand up for themselves, provide valuable statistics to support their positions, and be able to address our Congressional leaders with words and action.  They are stating that when they are eligible to vote, that they will vote based on this sole cause.  Many don't believe they will follow through on their actions.  However, many don't realize that once your voice has been heard, you are a force to be reckoned with always.

Students Speak Up

Several students stood out.  Emma Gonzalez spoke and stood in silence for about 6.5 minutes to honor to victims of the Marjory Douglas High School shooting on February 14, 2018.  This was less than the duration of the school's shooting.  It was symbolic of the time that students and teachers died, were injured, and were hiding in fear.  The silence was deafening and powerful.  

Samantha Fuentes, another Parkland school shooting survivor with gun wounds on both legs and shrapnel on her face stood up for herself and her friend, Nicholas Dworet, who died and would've turned 18 years old on the day of the march.  Overcome with emotion, she vomited behind the podium and persevered with her speech and led the crowd in a Happy Birthday song to her beloved dead friend.  She was courageous and empowered.  David Hogg, another survivor stated, "The people in power are shaking."  The most popular chant at the march was "Vote Them Out." 

Young Children Speak Too

Dr. Martin Luther King Jr.'s granddaughter, 9-year-old, Yolanda Renee King, spoke as well, stating, she dreams of "a gun-free world, period." And 11 year old, Naomi Wadler, stood for the disproportionate number of black females killed by guns.  She said, "For far too long, these names ... have been just numbers. I'm here to say 'never again' for those girls, too." There are many more amazing children that made their voices heard.  Undoubtedly they are coping with tragedy in many ways.  This is their chance to cope and have an active role in shaping and owning their future.

Gun Law Changes the Students Want

The students have detailed explanations in their "Manifesto to Fix America's Gun Laws," as listed in their words, in their guest editorial in the Guardian.  These are the  nine (9) gun law changes they request, as written by the editorial staff students of the Marjory Stoneman Douglas newspaper, the Eagle Eye: 

1. Ban on semi-automatic weapons that fire high-velocity rounds
2. Ban accessories that simulate automatic weapons (e.g. bump stocks)
3. Establish a database for gun sales and universal background checks
4. Change privacy laws to allow mental healthcare providers to communicate with law enforcement
5. Close the gun show loophole and loophole for second-hand gun sales
6. Allow the CDC to make recommendations for gun reform
7. Raise the firearm purchase age to 21
8. Dedicate more funds to mental health research and professionals
9. Increase funding for school security

Democracy at Work

This march shows how a democracy works.  It shows that everyone can use their voice.  It has empowered many of our youth for the future.  The future is in our children.  Wait and watch because gun violence is only the beginning for these children, these future lawmakers, these activists; their future has so much more ahead!

Lead Poisoning

A 9 month old infant girl from Connecticut was found to have lead poisoning.  Doctors discovered that the young infant had a high lead level during her routine physical exam.

CDC Report

According to a report (http://bit.ly/2wBf8LJ) by the Centers for Disease Control & Prevention (CDC) on August 31, 2017, her blood lead level of 41 micrograms per deciliter of lead was much higher than  acceptable.  According to CDC, an acceptable blood level is up to 5 micrograms per deciliter.

Home Investigation

Investigators reviewed the home in detail.  Although there was lead paint on two of the windows in the home, the infant girl was not able to reach those windows, so she couldn't have contracted lead poisoning from them.  In addition, the her 3-year-old and 5-year-old siblings didn't have lead poisoning, so the windows were not the source of the lead.  

Teething Bracelet

The baby girl's parents bought her a homeopathic magnetic bracelet to help with teething pain.  She had used the bracelet for teething relief, chewing on it, causing her to ingest the lead.  The homeopathic community believes magnets help with healing.  Tests on the beads of the bracelet revealed that it contained 17,000 parts per million (ppm). According to the U.S. Consumer Product Safety Commission (CPSC), for the most part, products containing 90 to 100 ppm are considered safe.

Chewing & Lead Poisoning

Please be careful with items that your child may chew on.  Sadly, each year, there are recalls on children's jewelry due to high levels of lead and cadmium poisoning (https://drsilvatotstweensandteens.com/2010/02/cadmium-jewelry-poisoning.html).  Infants and toddlers place objects in their mouths as part of their development and natural curiosity.  They learn about their world orally, in this fashion.  Depending upon the lead level in a child's body, lead poisoning has long-term consequences including, but not limited to lower IQ, speech delay, behavior problems, seizures, and death.  Treatment does not necessarily reverse the negative effects of lead on the brain and body.

Routine Physical Exam & Lead Testing

Please remember to follow-up with your pediatrician for your child's physical exam, as so much is done at these visits, including lead level testing, if recommended.  Consider buying a lead surface test kit for your children's toys or objects they may place in their mouths, as lead poisoning is a nightmare for any family to handle whether from teething bracelet or toys.

Teething Tablets Not Recommended

On April 20, 2017, the FDA recalled Hyland's homeopathic teething tablets.

For many years now, many parents have asked me if I recommend teething tablets and if they even work.  I always told them that didn't recommend them because the ingredient concentrations are not known or clear.

Hyland's website (http://www.hylands.com/products/hyland%E2%80%99s-baby-nighttime-teething-tablets) lists the ingredients and their benefits as follows:

"Calcarea Phosphorica 6X HPUS
Chamomilla 6X HPUS
Coffea Cruda 6X HPUS
Belladonna 12X HPUS (0.0000000000003% Alkaloids)

HPUS indicates the active ingredients are in the official Homeopathic Pharmacopia of the United States."

Belladonna is listed as 12X HPUS.  How much is this?  Is it really safe for our babies? In addition, in 2010, the FDA has also advised against these tablets due to inconsistent dosing of Belladonna alkaloids from bottle to bottle (http://www.cnn.com/2016/10/12/health/hylands-teething-tablets-discontinued-fda-warning/).  If I didn't know what I was really giving to my baby, I wouldn't give it to my baby.  Therefore, if I couldn't give it to my baby, I couldn't recommend it as a pediatrician.

In addition, I used to tell parents that based on parents' feedback, it seemed that these tablets worked about 50% of the time. Given that it wasn't consistently helpful, I didn't recommend them.

Hyland's Teething Tablets Recalled

Now, I say even more. I say absolutely not. There have been ten (10) deaths linked to Hyland's teething tablets.  "The FDA concluded that the products have mislabeled the amounts of belladonna alkaloids they contain."   (http://www.cnn.com/2017/04/14/health/hylands-teething-tablet-fda-recall-bn/)  There have also been seizures linked to them as well. There are of course other homeopathic teething tablets. However, the same problem exists. How much of each ingredient is in each tablet? Unknown.  So, the bottom line is, I don't recommend teething tablets.

What To Do For Teething Pain Relief

So the question remains, what to do to help relieve the pain?  There are several recommendations:

(1) Use a cold wet wash cloth (kept in the fridge) that your baby can chew on.

(2) Have your child chew on a frozen bagel.

(3) Have your child chew on a frozen banana.

(4) Have your child chew on an ice cube.

Be careful with any of these items that your child can chew on.  Always supervise your baby in order to prevent your child choking.  In addition, chewing on a frozen item needs to be for a limited time to prevent physical injury due to prolonged cold.  I recommend using a fresh food feeder.  This is essentially a small mesh bag that your infant can chew on without choking.  As always supervise that as well.  

Teething is a painful time in infants' lives.  However, teething tablets or bells that contain belladonna and/or benzocaine are not recommended.

Suicide in Youth with ADD/ADHD

Of those children who committed suicide, 5 – 11 year olds were more likely to have Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD), as revealed in a recent study in Pediatrics revealed that.  Teenagers 12 – 14 year olds, were more likely to suffer from depression or dysthymia, and one third (1/3) of children had a mental illness.  In order to determine the cause of suicide of children 5 to 14 years old, the study reviewed data from the National Violent Death Reporting System from 2003 to 2012.

National Suicide Prevention Line

Anthony Weiner is in the news again.  Apparently, more photos and conversations from his sexting, sex chatting days have surfaced.  I'm sure this isn't a shock to may people.  While learning about the latest developments, I began to wonder if parents understand that Mr. Weiner represents an ongoing problem among teens.  

This past weekend my family had a great time at Sea World in Orlando. We focused mainly on the kids' section, Shamu's Happy Harbor (http://bit.ly/s1mPnj). It's really great. I highly recommend it.

In particular, I noticed that the way I "do" parks has definitely changed since becoming a mom. No longer do I feel the need to "do it all" in a day. In addition, I'm okay with not going on every ride. I'm more than okay with going for only a few hours. It's more relaxing to just enjoy it.

Not to mention, I have fun staying in one section alone. We spent over an hour in the "Net Climb" section of Shamu's Happy Harbor at Sea World in Orlando. We genuinely enjoyed being kids again. I'm sure our son enjoys it this way too. Having his parents climb through tunnels and on nets is super fun and special.

While I was watching my 6'4" husband net climb & tunnel crawl, at least 4 stories up in the air, I thought to myself, 'Wow ... I never imagined seeing this!'

Then, I thought about how much all of us do, so differently as parents, as compared to our lives before children. Do you notice it too? Granted, your days may not be filled with your husband singing Chipmunks tunes at random hours of the day, when your child is no where near. And you may not have a husband that is addicted to the new adventures of "The Fresh Beat Band." However, you surely have your own stories of parental life. I'd love to hear them.

As an "FYI", we used our Fun Card. For the price of a one day ticket, purchased almost a year ago, we were able to enjoy Sea World for an additional 2 days for free. You can't beat that. Deals are great. But quality time is what it's all about; the bonus was that this time it was at Sea World in Orlando.