Category Archives: Parenting

The first 1,000 days: Brains are built, not born

Maxine Hayes, MD, MPH, speaks to an audience at Children's Hospitals and Clinics of Minnesota in September.

Maxine Hayes, MD, MPH, speaks to an audience at Children’s – Minneapolis in September.

Maxine Hayes, MD, MPH

Maxine Hayes, MD, MPH

By Maxine Hayes, MD, MPH

The first 1,000 days, from birth to age 3, have the most pronounced impact on a person’s life-long health and well-being. I had the privilege of discussing strategies to make the most of these first 1,000 days when I visited Children’s Hospitals and Clinics of Minnesota in September.

Children born today face the prospect of growing up less healthy, living shorter lives and being less equipped to compete and lead in a world economy than previous generations. For the first time, we are expecting less of our children and letting them down. We should do better, and the good news is we can if we work together.

The opportunity resides in how we impact the first 1,000 days of every child’s life. We know more now than ever about brain science, which shows that by age 3, 80 percent of our brain is developed. We also know that:

  • Brains are built (not born) over time – prenatally to young adulthood.
  • Brain development is integrated. The areas underlying social, emotional and cognitive skills are connected and rely on each other.
  • Toxic stress, in the form of poverty, poor nutrition, inadequate housing, exposure to violence and limited positive and nurturing behaviors, disrupts brain development and can have a lifelong effect on learning, behavior and health.
  • Positive parenting and creating the right conditions can buffer toxic stress and build resilience.

Subscribe to MightyFrederick Douglass once said, “It is easier to build strong children than to repair broken men.”  This is a motivating principle behind many states’ efforts to bolster early child development through policy and practice. In the state of Washington, this is our mission. State leaders are using a collective impact1 initiative to provide a structure for cross-sector stakeholders, including state departments, foundations, social service agencies and pediatricians, to forge a common agenda around the shared vision that all children in Washington will thrive in safe, stable, nurturing relationships and environments, beginning with a focus primarily on the first 1,000 days.

It all begins with a conversation. That’s why the discussions convened by Children’s among pediatric clinicians and state leaders are so valuable. It sends a signal that pediatricians and primary care providers as well as policymakers have important roles to play in this work. By working together and focusing on our youngest at the most critical points in time, we can change the course of life and set our children on a path toward good health and academic success.

Maxine Hayes, MD, MPH, is clinical professor of pediatrics at the University of Washington School of Medicine.

Reference

1 Stanford social innovations review 2013, “How collective impact address complexity” — John Kania and Mark Kramer.

Managing your child’s sleep when the clocks ‘fall’ back in November

Bright light in the morning helps a child’s internal brain clock to maintain a good rhythm, which helps the body transition easier from wake to sleep that night. (iStock photo / Getty Images)

Bright light in the morning helps a child’s internal brain clock to maintain a good rhythm, which helps the body transition easier from wake to sleep that night. (iStock photo / Getty Images)

By Karen K. Johnson, RN, CNP

On Nov. 2, clocks are turned back by an hour, marking the end of Daylight Saving Time. Any disruption to the sleep patterns caused by the time change will be temporary. But if you want to be proactive to minimize the disruption to your child’s sleep pattern, here are a few things to consider.

For babies

Two weeks before the time change, start to put your children to bed 10 minutes later than usual, increasing by 10 minutes every other night until they are going to sleep about an hour later than their normal bed time. It often takes a few days for a new sleep pattern to establish itself.

Toddlers and older

  • Put them to bed a little later than usual the night of the time change. There are behavioral tools available to help with these schedule changes (Good Night clock).
  • If they wake up at their usual time (an hour earlier), you should encourage them to remain in bed until a set time. This may be a digital alarm clock or the visual cue of the night light.
  • When they remain in their bed until the “sun” appears on the clocks or when you inform them it is time to get up, they should be happily praised.
  • The following day, provide a generous amount of physical activity to tire them out and then put them to bed at the new earlier bed time.
  • The next morning, set the clock for the new morning wake time.

On the whole, it is easier for children to fall asleep in the winter months because it is darker and the environment is likely cooler at bedtime. The difference in light levels between day and night encourage the production of the sleep hormone melatonin in the evening when the light is dim, as there is a rise in melatonin and sleep is invited. Bright light in the morning helps a child’s internal brain clock to maintain a good rhythm, which helps the body transition easier from wake to sleep that night. Adjusting the sleep-wake cycle in November is easier to manage than when advancing the clocks forward in springtime.

In the spring, Mighty will have tips to manage your child’s sleep schedule when we “spring” the clocks forward March 8, 2015.

Karen Johnson is a certified nurse practitioner in the Children’s Sleep Center.

Serving up strategy at meal time

Kids are born wanting to eat. And they know when they’re hungry. It’s our job as parents to provide structure, support and opportunities.

Kids are born wanting to eat. And they know when they’re hungry. It’s our job as parents to provide structure, support and opportunities.

By Maggie Sonnek

We’ve tried peas. We’ve tried broccoli. We’ve even tried Brussels sprouts. Alas, our 2-year-old continues to ignore that pile of “green stuff” on his plate and reach for the carbs instead (just like his mother).

After chatting with Janie Cooperman, MS, RD, LD, CDE, Pediatric Clinical Dietitian at Children’s Hospitals and Clinics of Minnesota, I now can come to the table feeling a little more prepared to take on a toddler at dinnertime. (Sounds like a thrilling TV show, doesn’t it?). I feel so enthused with what I’ve learned that I just had to share. 

Keep offering

Cooperman suggests offering specific foods 12-15 times before retiring them from the household menu. That’s a lot of peas! She also touts variety when planning the weekly carte du jour. For example, instead of plain bread, try whole wheat tortillas or pita pockets.

Division of responsibility

Kids are born wanting to eat. And they know when they’re hungry. It’s our job as parents to provide structure, support and opportunities.

Cooperman sites Ellyn Satter, an expert on the topic of the division of responsibility in feeding. Basically, this means we the parents are responsible for what, when and where our kids eat. They’re responsible for how much and whether they eat.

Yep. I said “whether.”

Cooperman suggests offering three scheduled meals a day with two or three snacks in between. “Eventually the child begins to understand the schedule and expectations,” she said. “Since he is not receiving food other than at the scheduled meals and snacks, he will soon get hungry enough and realize that he has no other option but to eat what’s being offered.”

Subscribe to MightyMake it a non-issue

You know the old standby, “You can’t leave the table till your plate’s clean”? Well, turns out, forcing a clean plate prevents kids from learning to pick up on their own hungry and satiety cues. Apparently most of us unlearn the natural inclinations of when we’re full and hungry sometime between the ages of 3 and 5.

Cooperman suggests making the amount of food your child eats a non-issue. She dissuades from offering rewards for eating. “If they refuse to eat, let it go,” she said. “But keep offering it at future meals. Try not to let kids get power and control.” (Writer’s note: I’m totally guilty of bribing my son with a chocolate chip cookie for taking a bite of broccoli. Oops.) 

Eat mindfully 

Eating dinner together as a family has a lot of benefits. The Family Dinner Project, a grassroots movement driven by insights and experiences of families, says recent studies find regular family dinners can help lower rates of substance abuse, teen pregnancy and depression. Studies show that dinner conversation can help improve vocabulary more than reading.

But let’s focus on the obvious: eating together. Parents modeling healthy habits, like munching on fruits and veggies, provide a good example for kids. Cooperman touts the importance of eating mindfully.

“Slow down, connect and enjoy what you’re eating,” she said. “Appreciate the food and your time together; it’s a more-balanced way of eating and living.” 

Maggie Sonnek is a writer, blogger, lover-of-outdoors and momma to two young kiddos. When she’s not kissing boo-boos or cutting up someone’s food, she likes to beat her husband at Scrabble.

Physical punishment of children not a long-term, healthy solution

(iStock photo / Getty Images)

(iStock photo / Getty Images)

Alice Swenson, MD, is a child abuse pediatrician at the Midwest Children’s Resource Center, a clinic which is dedicated to the medical evaluation of suspected child abuse and neglect.

Alice Swenson, MD

Alice Swenson, MD

There has been much conversation in the media regarding corporal punishment and physical abuse of children. We at Children’s Hospitals and Clinics of Minnesota have an obligation to protect the health and safety of all children in our community and to respond to questions about discipline and abuse. The American Academy of Pediatrics (AAP) reaffirmed its statement on discipline in 2012. The statement concludes that the purpose of discipline is to “teach or instruct” a child to prepare him or her to “achieve competence, self-control, self-direction, and caring for others.”

And while physical punishment of a child may be immediately effective in stopping an unwanted behavior, it is less useful in the long term. Spanking or hitting a child “models aggressive behavior as a solution to conflict and has been associated with increased aggression” in children. In addition, parents who resort to physical discipline are more likely to escalate the severity of the punishment in order to continue to achieve the desired effect, resulting in serious injury and abuse. We share the position of the AAP, that physical punishment of a child is not the optimal approach to discipline.

Additional resources and information:

Getting ready for school… 5 years in advance

(iStock photo / Getty Images)

Eighty percent of brain growth occurs by age 3. (iStock photo / Getty Images)

Gigi Chawla, MD

Gigi Chawla, MD

By Gigi Chawla, MD

As summer winds down and kids start filling desks and lining hallways at school, it’s a good time to talk about child development. And while this year is the first year that all children will have access to all-day kindergarten, I’m also reminded that not all children arrive to school ready to learn. In fact, getting a healthy start begins long before kids step onto a school bus. As a mom and pediatrician, I know that healthy development and school readiness occur well before children are reading and writing. They occur in those early years, as children are beginning to experience all of their firsts – first smile, first word, first step.

As advocates for children, Children’s Hospitals and Clinics of Minnesota recognizes that health and wellness play a critical role in being ready to learn and that we have a part to play in helping children get a strong start – not only in school but in all areas of life.

We have embarked on an even more deliberate focus on early childhood development, and know that it’s the earliest years in life when the most difference can be made. Consider:

  • Eighty percent of brain growth occurs by age 3.
  • In early childhood, physical, cognitive, emotional and social development occurs at a rate that far exceeds any other stage of human life. This has a significant impact on long-term health and wellness.
  • Toxic stress – including poverty, poor nutrition, inadequate housing, exposure to violence and the absence of attentive caregivers – can be devastating to an infant’s developing brain, thus setting children far behind before they’ve had a chance to start.

Subscribe to MightyGiven the obstacles to healthy child development, we at Children’s decided we needed to venture beyond our walls to address these issues and work with others engaged in protecting the health and well-being of children. We’ve engaged in an effort to build greater awareness about the importance of a child’s development in the earliest years and are working towards identifying collaborative methods to reach more children at this critical time in life.

Every day, I have the privilege to care for children when they are sick and to support ways to make them healthy. And that includes engaging in and elevating the discussion around the value of investments in programs that give kids the start in life that they deserve; please join us.

Read more about the importance of early childhood development and our investment in our children. Read our paper, “Foundation for Life: The Significance of Birth to Three,” to learn more about our efforts.

Gigi Chawla, MD, is senior medical director of primary care for Children’s Hospitals and Clinics of Minnesota.

Trauma: When it’s critical, so is your choice

Why would you take your child to Children’s emergency room over any other hospital? Our team members are on staff, not on call. Your child gets treated immediately.

When it’s critical, so is your choice. Children’s Level I Pediatric Trauma Center, Minneapolis.

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Define safe boundaries for kids and play

Encouraging the learning and exploration process will increase your child’s confidence and creativity, and defining safe boundaries and rules will keep you both happy. (iStock photo / Getty Images)

Encouraging the learning and exploration process will increase your child’s confidence and creativity, and defining safe boundaries and rules will keep you both happy. (iStock photo / Getty Images)

By Dex Tuttle

Not long ago, I watched my toddler daughter, Quinnlyn, as she played with her favorite blocks. She picked one up, stacked it carefully on top of another, and repeated until she had a tower four or five blocks high. Without warning, she pummeled the tower while sounding her signature high-pitched battle cry, sending blocks flying in all directions. She immediately seemed to regret not having a tower and ran to pick up the blocks to start the process over.

Young children begin to understand their world by cause-and-effect experimentation. Psychologist Jean Piaget was one of the first to put this concept into organized thought.

This behavior is apparent with my daughter: “If I stick my hand in the dog’s water dish, my shirt gets wet. This pleases me and I must do this each morning, preferably after mommy helps me put on a clean shirt.”

Then, something occurred to me as I watched Quinnlyn build and destroy her tower; there is a trigger missing in her young mind that could change her behavior: She does not understand consequence, the indirect product of an effect.

I began to notice this in her other activities as well. At dinnertime, we give her a plastic fork and spoon so she can work on her motor skills. If she’s unhappy with how dinner is going, she throws her fork and spoon on the floor in a fit of toddler rage. She is then immediately puzzled by how she’ll continue her meal now that her utensils are so far away.

Subscribe to MightyAs frustrating as toddler tantrums can sometimes be for parents, I’d love to be in my daughter’s shoes. Who wouldn’t want the satisfaction of taking all those dirty dishes that have been in the sink for two days and chucking them against the wall? That decision, of course, would be dangerous and reckless and I have no desire to clean up such a mess. And, with no dishes in the house, I’d be forced to take a toddler to the store to shop for breakable things; not a winning combination.

There’s an important lesson here for safety-minded parents: Kids will explore their environment in whatever way they can. It’s like the feeling you get when you find a $20 bill in the pocket of a pair of pants you haven’t worn in months, or when you discover the newest tool, gadget or fashion. For toddlers (and us adults), it’s fun finding new things and learning new skills; it’s motivating and creates a feeling of accomplishment. However, the cognitive skills of a toddler haven’t developed beyond that cause-effect understanding.

This is why we need to consider the environment in which our young children play. I recommend giving them plenty of space and opportunity to experiment without worry of the consequence:

  • Make sure stairs are blocked off securely and unsafe climbing hazards are eliminated; encourage kids to explore the space you define.
  • Create a space to explore free of choking hazards, potential poisons and breakable or valuable items; leave plenty of new objects for children to discover, and change the objects out when the kids seem to grow tired of them.
  • Allow children to fail at certain tasks; be encouraging and positive without intervening as they try again.
  • If possible, discuss their actions and consequences with them to help them understand the reason for your rules.

Encouraging the learning and exploration process will increase your child’s confidence and creativity, and defining safe boundaries and rules will keep you both happy.

At Children’s Hospitals and Clinics of Minnesota, we care for more pediatric emergency and trauma patients than any other health care system in our region, seeing about 90,000 kids each year between our St. Paul and Minneapolis hospitals. Children’s Hospital in Minneapolis is the area’s only Level I pediatric trauma center in a hospital dedicated to only kids, which means we offer the highest level of care to critically injured kids. When it’s critical, so is your choice – Children’s Level I Pediatric Trauma Center, Minneapolis.

Dex Tuttle is the injury prevention program coordinator at Children’s Hospitals and Clinics of Minnesota and the father of a curious and mobile toddler. He has a Master of Education degree from Penn State University.

Life jackets greatly reduce risk of drowning

(iStock photo / Getty Images)

(iStock photo / Getty Images)

By Dex Tuttle

According to the Minnesota Water Safety Coalition, it’s estimated that half of all drowning events among recreational boaters could have been prevented if life jackets were worn.

As a parent, it doesn’t take much to convince me that the safety of my daughter is important, and more specifically, directly my responsibility. This statistic is alarming. Especially since drowning is the second-leading cause of unintentional injury-related death among children ages 14 and younger.

My daughter, Quinnlyn, loves the water. It’s easy to get caught up in her excitement and joy as she splashes around and giggles that addicting toddler laugh, so much so that I often forget the dangers inherent in water for a child who is oblivious to them.

Subscribe to MightyStill, as an attentive parent, it’s hard for me to believe that drowning is an ever-present danger for my little one. That’s why it’s important to consider the staggering statistics around near-drowning incidents.

Since 2001, an average of 3,700 children sustained nonfatal near-drowning-related injuries.  To spare you the details, check out this article.

When protecting your children around water, there’s little to nothing that can supplement uninterrupted supervision. However, a life jacket will provide significant protection for your little ones and help instill a culture of safety in your family. Here’s how to know if it fits right (thanks to the United States Coast Guard):

  • Make sure your life jacket is U.S. Coast Guard-approved on the label on the inside of the jacket.
  • Ensure that the jacket you select for your child is appropriate for his or her weight, and be sure it’s in good condition. A ripped or worn-out jacket can drastically reduce its effectiveness.
  • Football season is here again (YES!), so consider the universal signal for a touchdown – after the life jacket is on and buckled, have your child raise his or her arms straight in the air. Pull up on the arm openings and make sure the jacket doesn’t ride up to the chin; it’s best to find out that it’s too loose before getting in the water.

At Children’s Hospitals and Clinics of Minnesota, we care for more pediatric emergency and trauma patients than any other health care system in our region, seeing about 90,000 kids each year between our St. Paul and Minneapolis hospitals. Children’s Hospital in Minneapolis is the area’s only Level I pediatric trauma center in a hospital dedicated to only kids, which means we offer the highest level of care to critically injured kids. From the seriously sick to the critically injured, we’re ready for anything.

When it’s critical, so is your choice – Children’s Level I Pediatric Trauma Center, Minneapolis.

Dex Tuttle is Children’s injury prevention program coordinator.

New Minnesota immunization requirements take effect in September

Minnesota’s new immunization requirements take effect Sept. 1, and with August serving as National Immunization Month, we urge parents to get their children’s vaccinations updated ahead of the upcoming school year.

The Minnesota Department of Health's statewide requirement changes were made to protect kids from measles, whooping cough and other preventable diseases. (iStock photo / Getty Images)

The Minnesota Department of Health’s statewide requirement changes were made to protect kids from measles, whooping cough and other preventable diseases. (iStock photo / Getty Images)

The Minnesota Department of Health’s statewide requirement changes were made to protect kids from measles, whooping cough and other preventable diseases.

Getting vaccinated before September is important.

“Vaccines take about a month or so, in general, to really be full force and working for your body effectively,” Pamela “Gigi” Chawla, MD, Children’s senior medical director for primary care, said in an interview with KARE-TV. “We want kids to be ready for their school year.”

The new requirements include:

  • Hepatitis A and B vaccinations for children enrolling in child care or school-based early childhood programs
  • Pertussis vaccine added to tetanus-diphtheria vaccine for seventh-graders
  • Meningococcal meningitis vaccine for seventh-graders

According to the Centers for Disease Control and Prevention, vaccinations given to children in the past 20 years will prevent an estimated 732,000 deaths and save $295 billion.

Looking to schedule an appointment? Contact one of our 12 clinic locations.

Changes to state’s immunization law (KARE-TV):

Collaborative caring in eating disorders

(iStock photo / Getty Images)

(iStock photo / Getty Images)

By Pam Macdonald and Janet Treasure

Eating disorders have a profound impact on individuals, as well as the people who care for them.

Eating disorder symptoms have immense social and emotional ramifications for families and loved ones. Symptoms vary and can be frightening, intrusive, antisocial, anxiety provoking and frustrating. The behaviors involved in limiting calorie intake, increasing calorie expenditure, or uncontrolled calorie intake, take many forms. The physical consequences are alarming and distressing. All semblance of normality disappears, social life evaporates, future plans are put on hold and interactions around food increasingly dominate family relationships. It can feel akin to living within a maelstrom.

Promoting beliefs that sustain hope and empower families may be an important step in reducing caregivers’ feelings of helplessness and interrupt unhelpful interactions.

Subscribe to MightyResearchers at King’s College London are equipping caregivers with tools aimed at reducing distress and boosting care-giving efficacy to support their loved ones on the road to recovery. Headed by world eating disorder specialist Dr. Janet Treasure, who will be speaking at Children’s Hospitals and Clinics of Minnesota on Monday, Aug. 4, the caregiver skills training is intended as an adjunct to the individual’s treatment program. The skills training program is the result of several empirical research studies and has been designed to provide caregivers with information on treatment goals, prognosis and maintenance factors to which they are entitled, without breaching patient confidentiality.

Utilizing a “dolphin-like” approach of warmth, gentle nudging and negotiation caregivers are taught how to listen to and analyze their emotional responses while reflecting upon what they might need to change in their own situation. Dr. Treasure’s interventions incorporate basic motivational interviewing techniques. The goal is for caregivers and professionals to work in partnership to promote the following:

  • Strengthen the caregivers’ belief in their own abilities to make change possible
  • Give caregivers the opportunity to express concerns about the cause and effects of the illness
  • Discuss the basic principles of behavior change
  • Teach good communication skills (the ability to express and process emotions)
  • Promote respect, satisfaction and a unified approach within the family (and extended family) unit
  • Learn the skills of problem solving
  • Maximize caregiver skills (warmth with limits and boundaries)
  • Highlight those factors which may be aggravating the problem
  • And, above all, encourage caregivers to practice self-care.

Are you a dolphin parent?

The skills training intervention uses a series of lighthearted animal analogies to encourage the caregiver to reflect upon his or her default caring style; for example, a kangaroo does everything to protect, keeps their loved one firmly in the pouch in an effort to avoid any upset or further stress, while the rhinoceros, fueled by stress, exhaustion and frustration, or simply one’s own temperament, attempts to persuade and convince by argument and confrontation. Emotional responses are captured with the help of the ostrich, who avoids talking and thinking about the problem, frequently due to the difficulty in coping with the distress of challenging eating disorder behaviors. The jellyfish becomes engulfed in intense emotional responses. These may include high levels of self-blame or perfectionist tendencies with regards to parenting skills or expectations of what it is to be a “good parent.” As illustrated above, the goal of the intervention is to promote a dolphin-like behavioral approach to caring and a St. Bernard emotional approach, responding consistently – reliable and dependable in all circumstances.

Dolphin parenting presentation

Children’s Center for the Treatment of Eating Disorders is sponsoring a short presentation by Dr. Treasure from 5:30-6:30 p.m. Monday, Aug. 4, at the John Nasseff Conference Center, 333 Smith Ave. N., in St. Paul. No registration or fee is required to attend.

The Center for the Treatment of Eating Disorders

The Center for the Treatment of Eating Disorders delivers the leading evidence-based treatments to patients of all ages and with all types of eating disorders. After a comprehensive assessment, the team develops an individualized approach for each patient. We offer customized inpatient and outpatient treatment for children, adolescents and adults. We use the latest evidence-based treatments, including: family-based therapy (FBT) and Cognitive Behavioral Therapy – Enhanced (CBT-E).

Everyone on the team — including psychiatrists, psychologists, hospitalists, dietitians and social workers — has special training in motivational strategies and the core treatments for helping children, adolescents and adults with anorexia, bulimia and other eating disorders. We offer inpatient treatments for young patients through college age at Children’s – Minneapolis, and for adults at Abbott Northwestern Hospital.

Janet Treasure, Ulrike Schmidt and Pam Macdonald co-edited “The Clinician’s Guide to Collaborative Caring in Eating Disorders.”