Archive of ‘Parenting’ category

Make bedtime a fun routine

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Child getting ready to sleep

As a doctor for children, I often talk about sleep during wellness and sick visits.

Sleep is an important life skill. It teaches children how to calm themselves and rest. Parents have an important role in helping children to healthy sleep habits. Improved amount and quality of sleep affect children’s behavior and abilities to think.

Below I will discuss some tips that parents can practice for healthy sleep habits.

  • Decide with your family when is a good time to start sleep training.
  • Decide how many hours of sleep your children need. Infants sleep for 12-14 hours. Hours decrease gradually as children get older. On average, children need 10 hours of sleep. If they nap during the day, do not forget to account for nap time to the total daily sleep time. For example; 2 hours nap in the afternoon will leave your children with only 8-10 hours of sleep at night. That can be a reason why children go to bed late at night or wake up very early and refreshed.
  • Talk to your children about (tonight’s plan). For example “we will take a bath, read a story, and then it is bedtime”. Change the language based on your children’s understanding. Young children would benefit from (first…then strategy). For example “first we take a bath then we read a story”. Use picture books to share stories about sleep.
  • Use a reward system. Rewards can be increased or spaced out. Rewards can be an activity the children will enjoy, for example spending play time with parents, or reading a favorite book together.
  • Do not get discouraged quickly if some attempts are not successful. Experimenting is a key. Some plans do not work the first time or at all. Try different things. For example, some children may prefer bedtime stories and some may prefer bedtime song. Other different options parents can try; white noises, a night light, a security object/blanket or all of them.
  • Avoid high affect games or TV before bedtime. Bath and stories can help to relax your children.
  • Remind your children that bedtime is soon. For example “5 more minutes to bedtime”. Some children do not tolerate transitions quickly. You can use a fun or colorful alarm clock as a reminder.
  • Increase their Melatonin Dark room, with no TV or electronic devices.
  • Create sleep associations. Children like their routines. It is ideal if they go to sleep in similar conditions every night (same bed, room, lights off etc.).
  • For younger children, put them to bed semi-awake. Allow time for them to calm themselves. This way they learn to go back sleep if they woke up the middle of the night.
  • If your children cry in the middle of the night, attend to their needs. Comfort them, but avoid picking them up or bringing them to your bed.

Helpful Resources

My child does not want to go to school

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Children walking to school

Children walking to school

As a doctor for children, I often talk to parents about school refusal. There are many reasons  why children do not want to go to school and the reasons change with age.

Here I summarize a list for the most common causes of school refusal. Some are typical for age and some require help and support.

Separation anxiety. Children who become very sad and worry when their parents leave. It can start at 6-7 months of age. Peaks at age 15-18 months. Most children cry when parents leave, but can calm fast and they are happy to see their parents at pick up time. Children who cannot calm down, refuse to play with other kids, may need help.

Light bulbWhat parents can do;

  • Talk to your children about school in simple words “its School time, play time”.
  • Remind them of things they like to do at school.
  • Use rewards. A reward can be a fun activity that you do together.

Performance Anxiety. Definition: Children who escape certain class activities. Examples are; reading in front of the class or being called on to answer questions.

Light bulbWhat parents can do;

  • Talk to teachers, they will give important information about how your children are doing in the classroom.
  • Work with the teachers to make a plan, for example; allow time for them to raise hand or practice reading before the class starts.
  • Use stars reward system for “reading out loud”.
  • Tell them you are happy with their hard work, even if they were not successful.

Learning Disability (LD). Definition: difficulties with school academics. Difficulties can be in; reading, writing, math or in more than one topic.

Light bulbWhat parents can do;

ADHD. Definition: It is a medical condition that makes it difficult to listen and pay attention. It is due to changes in the brain chemicals. ADHD is more noticed when children move to higher grades. Children with ADHD can be misunderstood. As a result, making friends can be hard.

Light bulbWhat parents can do;

  • Talk with the teachers. Ask if your children act same at home and school?
  • Talk to your doctor. ADHD is very common and can be treated with medications and some additional help at home and school.
  • Schools can help and support children with ADHD. Know your rights, students with ADHD

Bullying. Definition: when a person or a group repeatedly harm someone. It can be; physical, calling out names or using the social network to post bad things.

Light bulbWhat parents can do;

  • Ask Children if they ever get hurt in school or called names.
  • Ask the school counselor and the teacher to help you find out more if you have any reason to think about your children being bullied.
  • Get children help through therapist, share with your school and your doctor.

 

Depression. Definition: low mood and loss of interest in fun activities. It is more common among older children/teenagers. Depressed children can be irritable or angry not sad. It is important to notice any other changes to your children mood and behaviors at home.

Light bulbWhat parents can do;

  • Talk to the school counselor, your doctor or someone in your community to help you with resources.
  • Always look for expert help.

Resources:

Make the Morning Run Smooth Strategies for Developing a Morning Routine

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As a pediatrician, I work with all children including those with disabilities. I hear how difficult it can be to get out the door in the morning. In this blog, I share tips for creating a morning routine to get out the door on time and with less stress. Most children do better when there are routines that are predictable and consistent, including children with Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorders.

Learning a morning routine can be especially challenging for children with disabilities. They often need more directions, practice, and patience to learn these skills.   Each family will need to change these tips to work in their home.

Plan Ahead:backpack

  • Have your child pack his/her backpack and place it by the door at night. Make sure homework and projects are in the backpack. Creating a homework folder makes this easier.
  • When possible, pack lunches the night before.
  • Help your child pick out clothes the night before. This helps stop disagreements about what to wear.

Wake Up

  1. Start backwards. Figure out what time you need to leave.  Decide how long the morning routine will take. Give 10 to 15 minutes of extra time. That amount of time determines when to wake your child up.
  2. Pleasant wake up. Have the alarm play a favorite song or wake your child up gently with a hug and cuddle. Harsh alarms or abrupt wake ups can start the day off poorly.

Getting ready

  • Create a get ready routine: Wake Up, Get dressed, Eat breakfast, Brush teeth, Review the day and backpack, Leave for school.
    1. Get dressed first as this is often the biggest hurdle in the morning
  • Post a visual chart or checklist of each step. Laminate it or hang it in a plastic folder. Your child can use a dry erase marker to check things off when done.
    1.  Can use pictures of your child doing each step
  • If your child is more interested in music, create a playlist of songs. Each song goes with a different task in the morning routine.
  • Use a timer showing your child the time left for each step.

Getting Out the Door

  1. Use a silly sound (a wolf howl) to warn your child 5 minutes before it is time to leave.
    1. At first, you will need to use the sound and a warning “five more minutes”. Eventually just the silly sound will work.
  2. Use a different silly sound (duck quacking) for when it is time to leave.
    1. At first, you will need to use the sound and a warning “Time to go”.

Make It Funreward ribbon

  • Praise your child for completing steps in the routine. At first, the praise should be IMMEDIATE.
  • Create rewards for following the routine.  This can be a sticker chart or small prizes.
  • Your child can do a favorite activity as a reward if finish early.  This can be very motivating.
    1. No TV or tablet until your child is dressed and ready for school. If your child is ready early, he/she could watch a short clip.

Stick to It

    • Creating a new routine or habit takes 3 weeks.  Work towards the same goal for 3 weeks.
    • Once you have mastered the morning routine, create a bedtime or homework routine.

Additional Information and References:

Mindfulness and Children with ADHD – Tools for Parents

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children doing yoga

I am a pediatrician.  I often work with children who have attention deficit hyperactivity disorder (ADHD).  Medication often can help. But there are other ways to help too.  One is mindfulness.

What is Mindfulness?

The idea of mindfulness is to focus on what is going on in the moment, on purpose, with no judgement (Kabat-Zinn, 1994).

Research shows that these activities can help children with ADHD. This includes the following.

  • Focusing on important thoughts while ignoring others.
  • Help with the behaviors that get children into trouble.
  • Help with control over their emotions

How Can Parents Teach This To Their Children

There are lots of ways to learn to be more mindful.  One activity may work well for your child and others may not.  You might have to try more than one thing with your child.

Some schools teach mindfulness activities. But not every school does.  There are classes, such as children’s yoga, that can teach these skills.  However, classes can be costly and hard to find.  Below are some tools for parents.  Many can be done at home.

 Yoga

Yoga is a good way to help an active child focus.  For young children, I like books that show simple poses.

Older children and teens should start with a live class.  This is to make sure:

  • their form is correct;
  • they learn how to change a hard pose to make it work for their body; and
  • they know which poses should not be tried alone at home.

This helps lower the chance of injury.  You should always talk to your child’s doctor before starting a new exercise program.

There are low-cost options for yoga. These include non-profit studios and community classes.  These options will be different based on where you live.

Once children know how to do yoga safely, they can use online videos.  There are free classes on YouTube.  Do Yoga with Me is a free website.

Mindfulness Apps

Breathing exercises can also aid a child.  These can help calm and focus the mind.  Many only take a few minutes.

Common Sense Media has a list of apps for children.  You can sort them by age.

Other Ideas

These are some ideas that can be done without technology.

More info on the research behind mindfulness and ADHD is discussed in the article Exercising the Mind to Treat Attention Deficits. 

Works Cited

Kabat-Zinn, J. (1994). Wherever you go there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.

“Time to Potty”: Tips for Toilet Training

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As a pediatrician, I work with all children including those with disabilities. This blog shares tips for toilet training. Toilet training can be difficult for all families. It can be especially challenging for children with disabilities. They often need more time, directions, practice, and patience to learn these skills. Each family will need to change these tips to work in their home.

Strategies for Toilet Training:picture of toilet arrow pointing to car

Create a Schedule

  1. Schedule toilet times, with a goal of 4-6 sits a day.
  2. Use a visual schedule or pictures to help your child understand toileting.
    1. Pictures of your child doing each step: going into the bathroom, sitting on the toilet, reaching for the toilet paper, flushing, and washing hands.
  3. Use first…then statements. First toilet then something your child enjoys doing. “First toilet then play with cars”.
    1. Create a picture board with simple pictures (see example)
  4. Instead of asking if your child needs to go to the bathroom say, “Time for the toilet.”

Sitting on the Toilet

  1. At first, the sits on the toilet are short (5 seconds per trip) with one long trip to stopwatchpractice having a bowel movement. Over time increase the sitting time (e.g., up to 5minutes).
      1. Setting a visual timer lets your child know when the sitting ends.
  2. Sits at first can be in clothes. Then underwear. Then without underwear.
    1. If your child uses the toilet then your child can get up right away.
    2. Boys are taught to sit on the toilet to urinate until regularly having bowel movements on the toilet.
  3. Keep track of bowel habits to create your schedule. Watch for signs that your child needs the bathroom (crossing legs and dancing or going to a corner)
      1. 20-30 minutes after dinner or a snack, your child should go to the bathroom and sit on the toilet.
  4. Drinking more fluids and eating more fiber will help your child toilet more.

Make It Fun

award ribbon

  1. Move to underwear. It helps your child realize when he/she is wet or soiled. If able, have your child pick out the underwear.
  2. Bring a favorite book or sing a favorite song that is only read/sung in the bathroom.
  3. If your child does to the bathroom, give IMMEDIATE praise. At the end of the timer, praise your child for sitting on the toilet.
  4. Create rewards for toilet training, one for sitting and two for going. Can use sticker charts or small prizes only used for toileting. Give the reward IMMEDIATELY after the bathroom trip. Reward even small successes.
  5. After sitting on the toilet, your child can do a preferred activity. Using first then statements (above).
  6. Read fun books about toilet training with your child at bedtime.

Stick to It

      1. Accidents happen. Let your child know it is no big deal. Change your child in the bathroom to learn the bathroom is for toileting.
      2. Work towards the same goal for 3 weeks.

Create a Team

      1. Make toileting a team goal with school teachers, therapists, and your doctor.
      2. Working on toileting at home and school will increase learning.
      3. Watch for constipation and talk to your pediatrician. Constipation can slow toilet training progress

Additional Information and References: