Juice Recommendations for Children

Expert Panel: Milk, Water, & Juice Recommendations

for Children

Juice recommendations & recommendations for other drinks for children have been updated by a health experts panel. Under the leadership of nutrition research organization Healthy Eating Research, this panel formed to update parents, caregivers and health care providers on what should be provided with drink-wise for a healthy start for children from birth through age five (5) years old. The panel consisted of experts from the Academy of Nutrition and Dietetics, the American Academy of Pediatrics, the American Academy of Pediatric Dentistry and the American Heart Association. They reviewed current domestic and international policy statements and evidence-based recommendations.

Breat Milk, Milk, Water & Juice Recommendations:

Birth to Five Years Old:

0-6 Months Old:

Breast milk or infant formula.

No juice.

6-12 Months Old:

Breast milk or infant formula

Small amounts of plain drinking water introduced once solid foods become part of diet.

No juice.

12-24 Months Old:

Whole milk

Plain drinking water.

Maximum 100% juice 4 oz daily.

2-5 Years Old:

Skim or low-fat milk

Plain drinking water. Maximum 100% juice 4 oz daily.

What About Soy Milk?

The panel did not recommend plant-based milk or non-dairy beverages for "exclusive consumption in place of dairy milk," unless there is a medical necessity.  Non-dairy milks are missing of important nutrients that are typically obtained from dairy milk.

Fruit or Juice?

Are juice recomendations the same as for fruit?  Fresh fruit is always preserved over 100% fruit juice.  Furthmore, parents and children need to be educated about the benefits of the fruit as compared with juice.  Fruit has natural dietary fiber and less sugar than juice.  Juice has lots of sugar which has a tendency to add to excessive weight gain.

Fresh, Canned, or Dried Fruit?

Fruit recommendations are important.  While fresh fruit is best, it is not always practical, in that it doesn't work for everyone.  Fresh fruit is healthier, but it is more costly than canned or dried fruit.  In addition, fresh fruit also takes time to ripen.  Another thing to consider is that some young children have food texture issues that makes eating fresh fruit more difficult that eating softened canned fruit.  Reality is that fruit in any form is healthier and preferred over drinking juice.

What About Flavored Water and Flavored Drinks?

The panel did not recommend offering young children any caffeinated beverages, beverages with low-calorie sweeteners, sugar-sweetened beverages, toddler milk or flavored milk – such as strawberry or chocolate milk – at any stage during early childhood as part of a healthy diet. Personally, I do make one exception to the recommendation against flavored milk.  If your child has food issues, refusing  unflavored milk and other dairy (cheese, yogurt), then flavored milk an  acceptable alternative, so as to ensure your child has at least three calcium servings daily.

These sweetened drinks are the large daily source of added sugar for most children, resulting in excess calories and weight gain.

Other Times Not to Use Juice

In addition, unpasteurized juice products are not recommended for children as there is an increase of life threatening infections, such as E.coli O157 and O111, Salmonella, Cryptosporidium, norovirus, Vibrio cholerae, Clostridium botulinum, yeast, and hepatitis A.

Children who take specific forms of medication should not be given grapefruit juice, as it could make the medication less effective.  There are many medications that can be less effective with grapefruit juice, many are for cardiac conditions.  However, a common allergy medicine, Allegra (Fexofenadine) is weakend by grapefruit juice.  It's a good practice to ask the prescribing doctor your child's medication could be negatively affected by grapefruit juice.

Tooth decay is common when anything other than water is kept in sippy cups, if they use them throughout the day.  Constant exposure to non-water drinks leads to the carbohydrates in them to cause tooth decay, as well.  Children should have their teetch brushed twice daily.  And especially before bedtime.  After brushing their teeth, they should only have water before bedtime to protect their teeth.

Lastly, it important to know that if your child is dehydrated, then juice will make it worse.  Rehydration needs to be done without all the sugar in juice. Apple sauce is the only fruit product that is recommended depending on the cause of dehydration.

More On Healthy Lifestyle Choices

Healthy Choices Affirmation, Healthy Dining, and Healthy Eating & Steps at the Holidays are also provides additional information about healthy eating and drinking.

Self-care Affirmation

Self-care is loving myself enough to not feel responsible for others.                          I am celebrating the person responsible for herself.

Additional information about Children & Affirmations is available at this website where more detailed informations and applications of affirmations can be used and applied for you and your child.

There are also Daily Affirmations available where this affirmation and others have been adapted for both parent and child.

Lastly, 101 Best Louise Hays Affirmations of All Time is an excellent resource.

Best Christmas TV Variety 2018

The best Christmas TV shows are a great time for family time. There are multiple opportunities to get together, share, and talk about family values and learn some valuable life lessons while watching them.  There are many options to choose from: Freeform's 25 Days of Christmas, ABC, NBC, Disney Channel, Hallmark channel's Countdown to Christmas, AMC, Lifetime & even Netflix has stunning Christmas original programming!  With so many options, where do you start?  Which are age appropriate?  Moreover, Common Sense Media does great review that includes their recommendations for age appropriate viewing.  Therefore, I've included those links for many of the best Christmas TV shows and movies below.  Here's my guide!       

Netflix

The Christmas Chronicles

Netflix

I'm going to start by telling you our first watched Christmas TV show for 2018.  I happened to see Netflix had a new Christmas show called The Christmas Chronicles starring a very entertaining Kurt Russel as Santa Claus.  I figured we'd take a chance with something new.   Plus it was an older brother & younger sister story.  Frankly, this was right up our alley as that is exactly our household sibling dynamic.  We LOVED it!  Why?  For instance, Santa rocks in the jailhouse while he has the brother-sister duo help save the very Christmas that they accidentally set on a course to be the Christmas that might not happen!  These siblings helping Santa while coming to some personal revelations about growing up & making us laugh along the way. 

Angela's Christmas

Then, there's Angela's Christmas.  It's a tear jerker about the family, loss, poverty & the chaos created when a little girl tries to warm the Baby Jesus, taking it from the church.  She had good intentions, but things go awry.  Above all, her family is there to help and support her.  My little girl really loved this one.  That is to say, she connected with special little Angela's her big heart and fierce determined personality.  

Other Netflix Christmas TV Originals

Likewise, some other entertaining Netflix originals include The Princess Switch and A Christmas Prince: The Royal Wedding.  

Freeform's 25 Days of Christmas

Above all, Freeform has the best Christmas TV show schedule that is includes Christmas movies too!  I really like that there is a great variety of non-Christmas shows & movies.  They are shown on the Freeform Channel, ABC & the Disney Channel.  What programming do they offer?  Here's a sampling with some of our family's favorites!  On December 11, 2018 they are showing Mickey's Once Upon a Christmas, Mickey's Twice Upon a Christmas, & Disney's A Christmas Carol.  On December 12, 2018, there are some repeats & a few different options such as Call Me Claus, Deck the Halls & The Santa Clause.  To sum it up, their schedule is great with a lot of variety aside from the Holidays, such as Disney's Finding Nemo, Brave & Tangled.  The whole family has an opportunity to pick a couple of favorites.  

ABC

Elsa & Anna

ABC has their Christmas TV show  schedule that includes some very special kid shows that are great to re-watch.  Here's a sampling are some of my family's favorites!  On December 19, 2018, the Disney geek in me is happy to see Olaf's Frozen Adventure!  There will also be Dreamworks' Shrek the Halls.  On December 20, 2018 there will be the classic A Charlie Brown Christmas.  On December 23, 2018, they will air Disney's Prep & Landing and Prep & Landing 2: Naughty vs. Nice.  To sum it up, I  can't resist those two elves.  One is funny & anxiety ridden & the other a bit of a daredevil in my opinion!                                                                          

NBC

It's a Wonderful Life

How the Grinch Stole Christmas is another absolute best Christmas TV show that NBC is scheduled to air on Christmas Day! To be honest, we own the cartoon original & the movie.  As a child, I was scared of the Grinch.  Then, my son came along.  As a result, I love the Grinch now.  Therefore, we plan to go see The Grinch movie soon too!  On December 24, 2018, NBC will also air It's a Wonderful Life.  This is the best Christmas show in Black & White.  And it never gets old!  It teaches so much about life, love, struggle, self-worth, self belief, community & that one person really makes a HUGE difference in so many unknown ways.  I grew up watching this one.  

Tampa Theatre

Ultimately, this year we're going to watch It's a Wonderful Life at the Tampa Theatre with showtimes are from Friday, December 14th through Thursday December 20th.  The Tampa Theatre is a wonderful experience is known as Tampa's Non-Profit Movie Palace & a National Historical Landmark.  My kids haven't been there yet, so this will be an extra special magical treat.   

AMC

Elf

This year, AMC has achieved a great trifecta!  They are exclusively showing Elf, National Lampoon's Christmas Vacation, & The Polar Express.  My family favorite filled with the magical ride to the North Pole is definitely The Polar Express.  Elf is one of the best Christmas TV movie comedies that makes me laugh and laugh!  AMC has a Christmas movie lineup of over 40 movies sure to satisfy the Christmas movie fan!                                                                                                                                                    

Hallmark & Lifetime Original Movies

Hallmark's Countdown to Christmas lineup does not disappoint either!  They have a Christmas movie lineup of 22 new original movies!  Lifetime's Christmas movie lineup has 14 new original movies!   While I wouldn't call these the best Christmas TV shows, I would say they have some ice entertainment value.  In addition, they are family friendly which is a plus!

The Original Christmas Specials

Rudolph the Red Nosed Reindeer

Three of the best Christmas TV shows are Rudolph the Red Nosed Reindeer, Santa Claus Is Comin' To Town (on Freeform Christmas lineup) & Frosty the Snowman.  A classic, Rudolph is the longest running Holiday special in TV history, broadcasting for 54 years!  I loved these every year since I was a little girl.  It was always special because I didn't get a chance to spend much time with my dad since he worked nights.  Christmas movies with my dad will never be forgotten!  They give my inner child a special warmth and a lifetime memories.      

FX

Jack Frost from Rise of the Guardians

Rise of the Guardians is another one of the best Christmas TV movies.  However, it seems the FX channel is the only one playing it.  Magic is in the air when Jack Frost, the Easter Bunny, the Tooth FAiry, the Sandman and Santa Claus need to save the world from Pitch Black, the Boogeyman, who is the nightmare maker.  Will the children still believe?  There are scary parts for the little ones.  Consider this before allowing to children to watch.  However, at the coreof the movie is Jack's search for his center  Santa's is his sense of wonder.  While watch, it made each of us think, 'What's my center?'

Family Time

In conclusion, what matters most about Christmas TV shows & movies is not just their content or quality.  Most importantly, too much TV is not a good thing.  Certainly, a few good shows is all it takes to have some memories & some good times.  The family time is the best part!  We have movie nights with popcorn, blankets, and all lights off, except for the Christmas tree. How do you create Christmas TV & movie memories?  Do you still believe?  While you're at it ... What's your center?  Please share it with yourself, your loved ones, and here as well.

Positive Talk with Children

Positive talk with children can be elusive.  Often, we get lost in the busy "to do list' of our lives.  When our children don't follow directions or listen to us, we fall into the usual negative talk.  "Stop that now."  "Don't touch that." "Leave me alone." Arguments, yelling, and fighting can take place. 

Positive Talk with Children
- Photo by Anna Kolosyuk

It's impossible to stop all the frustrating times with our children.  However, remembering that sometimes we can change our reaction or approach, can prevent us from feeling bad.  And positive talk prevents some of the negative feelings our children develop from constant negative talk.  In addition positive talk with children involves the crucially important skill of listening.  Other important aspects of positive talk with children include remembering that you're talking with a child, asking questions, acknowledging feelings, teaching alone time, giving praise, and making apologies.

Remember That You're Talking with a Child

Talk to children at eye level.  When children are always looking up, especially when they've done something wrong, this is intimidating to them.  Plus talking at eye level shows your children you have some respect for them.

Speak simply.  A short sentence can go a long way.  Responding to questions or misbehavior with one simple sentence will help a child stay on task and understand more clearly.  Avoid a lecture.  Avoid going on and on.  At some point, they aren't listening.

Offer two choices, either of which you approve.  When children are given options, it encourages independence.  When you approve of either of the two choices that you offer, it creates an opportunity for happiness and not frustration.  For example, "Would you like to eat peaches or pears?"  They still may want chocolate chip cookies, but you have not asked them, "What do you want to eat?"  which incorrectly leads them to believe they can pick their meal or snack.

Ask questions only if you want your child's opinion/answer.  Asking, "Are you ready to go now?" gives a child the impression that if they are not easy, then you will wait.  If you are not willing to wait, then tell them, "It's time to go now," so that there is no confusion.  This allows them to know that there are times when their opinion matters.  Accordingly, it lets them know that other times you are the one in charge, making the decisions.

Listen To Your Child

Stop and listen.  We are often busy.  Day in day out, there's a lot to do.  There's laundry, meals, dishes, hosehold cleaning, work outside the home, family needs, and more keep us busy.  However, none of those tasks help us to listen.  Intentionally making the time to listen to our children can have a huge impact.  There are techniques on how to listen to your child that can be learned easily.  Our children can learn they are important by our interactions with them, not just what we do for them.

Set aside a time to listen.  When we don't have the time to talk, then it's good to be honest. We can let our children know that, "Right now is not a good time for me to talk with you.  I want to hear what you have to say.  I'll make some time to talk with you later."  Remember to tell your child a specific time when you will talk.  then stick to your word.  That way they will respect your time.  And they will still feel important.

Repeat or restate what you heard.  Often, we hear what our children said, but we interpret it incorrectly.  Other times, when we repeat it to them, and they realize that they misspoke.  This encourages our children to develop great communication skills.

Ask Questions

Ask open-ended questions.  "How are you feeling?" allows our children to express whatever is on their mind.  "You didn't like that, did you?" limits what they will say.  sometimes we need to hear all aspects of what their thinking, so that we can best help them.

Ask specific questions.  If there is a specific issue, open-ended questions may not give a parent the answer needed.  "What was your favorite part of today?"  "What upset you the most?" "Did you understand what you learned in math class today?"  These are some examples of questions that allow our children to narrow the conversation enough so that they know their specific positive or negative emotions and experiences are important.  You are less likely get short answers, such as "Good," "Okay,"  "Bad," which are conversation enders.

Feelings Are Important

Encourage all feelings.  It's okay to feel sad.  We often say, "Don't be sad," as if it's a bad thing.  This is hard to watch.  Sometimes children just need to be held until the emotion passes and/or they express their feelings.  Instead of pushing away unpleasant feelings, they will learn how to deal with their emotions, making them healthier children.  Encouraging our children to feel their emotions gives them mental strength as adults too.  

Share your feelings.  "You made me sad when you lied to me."  "I had a hard day at work today."  This teaches them to think of others.  It also shows them you are human too.  However, make sure you keep this simple, as a child can easily be overwhelmed by adult emotions and their wish to please their parents.  You want to share your feelings without making them feel responsible for your complete happiness.

Teach Alone Time

Teach our children to play by themselves. This will encourage independence which is essentially for their growth and development.  It will also allow parents to act independently while getting our own tasks done.

Teach children that parents need alone time too.  If you've ever been interrupted while on the toilet by your child, then you know the importance of your alone time.  Shouting, "Leave me alone!" is not pleasant.  Our children don't like it, sometimes getting their feeling hurt.  And we don't feel good about ourselves afterwards.  Explaining to our children that we need "alone time" for a certain amount of time and to carry out a specific task is important.  Our children will model after what we do, not just what we say.  They will learn from us that our time is valuable which will lead to the eventual realization that their time is valuable too.  It also teaches them that they are not the center of the universe.  We will not stop to fulfill their every need every moment of the day.  It teaches them that there is a time and place for everything.  Lastly, it also teaches them to appreciate everyone's need for alone time.  In addition, this helps teach them to be considerate of other people's time.  This form of positive talk with children explains actions and validating our children.

Praise Children

General praise is good.  "Good job!" is a form of positive talk.  However, it leaves some room for interpretation.  What exactly made it a good job?

Specific Positive Praise is better because it is an improved form of positive talk with children.  Let them know exactly what behavior or speech that did that you liked and why you like it.  This helps encourages positive behavior, and decreases negative behavior, improve self-esteem, and improves the parent-child relationship.  "I like how you sat quietly and completed your homework," is more likely to result in the child repeating the same specific behavior.  

Apologize

Admit when we are wrong.  There are times that we have gone too far.  We have said something that we shouldn't have said or did something we shouldn't have done.  Children seem to know exactly how to overwhelm us when we are already overwhelmed.  Simply saying, "I'm sorry.  I was wrong to say/do that specific behavior."  Then offer the change you'll make next time.  "I'm sorry I yelled at you.  Next time, I will tell you to stop playing video games or else I will turn off your device."  In addition, consider asking our children what consequence they would like for their behavior.  Usually kids know what they've done wrong.  They will come up with an appropriate consequence.  This is self empowering because they came up with the consequence.  This helps our children know what to expect and the consequences of their action if they don't listen.

Apologize simply.  "I'm sorry.  You were right and I was wrong.  And I'm so sorry."  This validates our children.  They learn that they have good behaviors.  Then learn their parents are human, make mistakes, and apologize when appropriate.  They also learn that it's okay to make mistakes.  No one is perfect.  In addition, parents are role models on how to apologize when we make a mistake.

Additional Resources

• Winning Ways to Talk with Young Children by Virginia State University, Cooperative Extension Service - Dr. Valia Vincell, Child Developmental Specialist.

• 25 Ways To Talk So Children Will Listen by Dr. Sears

• 20 Ways To Talk So Your Kids Will Listen by Robert Myers, PhD

• This blog also has information on Children & Affirmations and Daily Affirmations & Quotes that are helpful in general.

Coming Out To Your Doctor - Difficult & Private

Coming out to your doctor may be difficult, especially for if you are a teen.  Often, a teenager comes out with a million thoughts running

Coming Out To Your Doctor - Photo by Sharon McCutcheon

through their head.  Will my doctor accept me?  Will my doctor help me?  Does my doctor understand me?  Will my doctor tell my parents/keep my secret?  According to poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, 18% of all LGBTQ Americans refrain from seeing a physician for fear of discrimination. 

What If I'm Scared of Coming Out to My Doctor?

Coming out to you doctor may feel very scary and unsafe.  Consider asking your doctor if their office is a safe office where acceptance is commonplace.  Whenever the LGBTQ child is suffering, the most important thing I can say to them is, "You are safe.  You are safe here."  Because every child is special.  After all, one of the best gifts a pediatrician can give to any child, especially the LGBTQ child/teen is letting them know they are special and wonderful just as they are.  It is not my job to help the child/teen figure out their sexual orientation.  It is my job to make them feel comfortable enough so that I can help them with any health issues they may have to date. 

Come Out When You Are Ready

Coming out to your doctor can help you in many ways.  However, given the difficulty that this may involve, you may want to consider calling your/any doctor's office first to ask if they care for any LGBTQ patients.  Remember, you don't have to give your name out at the first call.  Ultimately, this may help you feel more comfortable and ready.  

How To Come Out To Your Doctor

There are many conversation starters you can use, such as "There's a conversation I need to have with you" or "How do you handle patient confidentiality?"  Consider telling the doctor in a matter-of-fact way.  Chances are, you are not the first LGBTQ patient they have ever had.  Follow up with a prepared list of questions that you have for your appointment.  There is a "Do Ask, Do Tell" brochure that may help answer questions about coming out to your doctor.  It is also important to know that there are laws that protect you and your doctor, so that your information is kept private.  Ask about confidentiality will make you feel safe as well.  In addition, you may consider bringing a friend, partner, or family member for support.

Doctors Can Offer Support in Many Ways

I've had teens come out to me as their doctor, some have been painful to witness.  Painful for me, because it incredibly hard to see someone suffer and be in such tremendous emotional turmoil and/or physical pain) for simply saying their sexual orientation and/or gender identity.  In the past, I reassured a transgender child in the midst of an immediate, intense, and severe panic attack by continually repeating, "You are safe.  It's okay.  You are safe here.  You don't have to talk about it, but if you do, I'm here for you."  I have had patients who became successful adults with great careers who thanked me for accepting them because I was the first person they came out to or that I cared for them and their issues with compassion and maybe even some tough love.  Most recently, I held and rocked a child that I cared for over 15 years until they stopped their uncontrollable shaking because they couldn't face themselves and their sexual orientation.   That child motivated me to write this blog.  I want to help other LGBTQ youths know that they don't have to suffer, that their doctor can help them.  Chances are your doctor cares and wants to help you in your journey to physical and mental health and peace.  

Do I Have to Tell My Doctor I'm LGBTQ?

It's best if you do tell your doctor.  Your doctor can't give you the best medical care if he/she doesn't know that you are a LBGTQ person.  A doctor needs to know a patient's sexual orientation, gender identity, and sexual activity history, to best help that patient and their medical and psychological needs. 

Medical Help & Disease Prevention Available

Sexual history will help me test for, diagnose and treat STDs.  Also, a pediatrician or internist will be able to teach you how to prevent HPV and offer the HPV vaccine to prevent this cancer and wart causing disease.  In addition, if you are HIV negative, but at high risk for developing HIV, then your doctor may start PrEP medication.  What is PrEP?  Pre-Exposure Prophylaxis (PrEP) is Truvada, which is a daily pill that when taken helps prevent HIV in people who are high-risk by up to 92%.  Your doctor may start this medication, if you agree to take it every day and follow-up with appointments every three (3) months.  Consider bringing a List of Top Ten Issues LGBTQ People Can Discuss with Their Doctor with you to your appointment.  In addition, if you are a transgender youth or adult, your doctor, yes, even your pediatrician, can refer you to a specialist for hormonal treatment.

Psychological Help Available

A doctor will also be able to make some psychological recommendations, if needed.  LGBTQ teens are more likely to suffer from anxiety, depression, have increased risk of suicide, abuse, may need referral to a psychologist, a psychiatrist, and/or a support group, like the Gay Straight Alliance (GSA), and GSA Network.  GSA is a student-led or community based organization.  GSA is an important resource on social media on Twitter (@GLSEN)  and Facebook.  GSA Network is also a resource available on Twitter (@GSANetwork) and Facebook.  Local support groups area usual available for GSA and GSA Network on social media and in as clubs many schools.  Lastly, your doctor is a source of support, simply be accepting you and caring for you.

Doctors Willing to Learn LGBTQ Issues & Needs

Your doctor may be comfortable with caring for you as a LGBTQ patient.  However, we are not classically trained to care for LGBTQ patients, so there usually is a learning curve.  However, if your doctor says, "I don't know how to care for that issue, but let me do my research; I'll get back with you on that particular issue," then you have a great doctor indeed.  A doctor that's willing to learn, cares for you, and is honest is the best kind of doctor.

Additional Resources for LGBTQ Teens & Parents

• Coming Out: Information for Parents of LGBTQ Teens is a helpful resource from the American Academy of Pediatrics. 

• How To Support Your Child Who is Questioning Their Sexual Orientation by Everyday Feminism which includes definitions of many LGBTQ+ terms.

• Transgender Children & Youth: Understanding the Basics by the Human Rights Campaign.

• Teens & Gender from an NPR interview which includes many gender terms, such as gender questioning, gender queer, gender fluid, agender, etc.

• Sexual Attraction & Orientation by Kids Health.

• This blog also has information on Children & Affirmations and Daily Affirmations & Quotes that are helpful in general.

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

Olympics Sexual Abuse -  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.