Health Support

Motivating Kids to Be Active

2009-02-09T13:51:00.001+08:00

If you've ever watched young children on a playground, you know that most are naturally physically active and love to move around. But what you might not realize is that climbing to the top of a slide or swinging from the monkey bars can be a child's first steps toward a lifetime of being active.

As kids get older, it can be a challenge for them to get the amount of activity they need every day. Reasons abound: the increasing demands of school, a feeling among some kids that they aren't good at sports, a lack of active role models, and busy working families.

And even if kids have the time and the inclination to be active, parents may not feel comfortable letting them freely roam the neighborhood as kids once did. So their opportunities might be limited. Despite these barriers, though, parents can instill a love of activity and help kids fit it into their everyday routines. Doing so can establish healthy patterns that will last through the years, even into adulthood.
Benefits of Being Active

When kids are active, their bodies can do the things they want and need them to do. Why? Because regular exercise provides these benefits:
strong muscles and bones
weight control
decreased risk of developing type 2 diabetes
better sleep
a better outlook on life

Not only that. Healthy, physically active students are more likely to be academically motivated, alert, and successful. And physical competence builds self-esteem at every age.
What Motivates Kids?

So there's a lot to gain through regular physical activity, but how do you encourage kids to do it? The three keys are:
Choosing the right activities for a child's age: If you don't, the child may be bored or frustrated.
Giving a child plenty of opportunity to be active: Kids need parents to make activity easy by providing equipment and taking them to playgrounds and other active spots.
Keeping the focus on fun: Kids won't do something they don't enjoy.

When kids enjoy an activity, they want to do more of it. Practicing a skill — whether it's swimming or riding a tricycle — improves a child's abilities. The child feels accomplished, especially when the effort is praised. These good feelings often make the child want to continue the activity and even try others.
What's Age-Appropriate Activity?

The best way for kids to get physical activity is by incorporating regular exercise into their daily routine. Toddlers to teens need at least 60 minutes on most (preferably all) days. This can include free play at home, active time at school, and participation in classes or organized sports.

Here's some age-based advice:

Preschoolers: Preschooler need play and exercise that helps them continue to develop important motor skills — kicking or throwing a ball, playing tag or follow the leader, hopping on one foot, riding a bike, freeze dancing, or running obstacle courses.

Although some sports leagues may be open to children as young as 4, organized and team sports are not recommended until a child is a little older. Preschoolers can't understand complex rules and often lack the attention span, skills, and coordination needed to play sports. Instead of learning to play a sport, preschoolers should work on fundamental skills.

School-age: With school-age kids spending more time on sedentary pursuits like watching TV and playing computer games, the challenge for parents is to help them find physical activities they enjoy and feel successful doing. Activities can range from traditional sports like baseball and basketball to scouting, camping, hiking, and other outdoor pursuits.

In the early school-age years, while kids are learning basic skills and simple rules, there may be only a few athletic standouts. As kids get older, differences in ability and personality become more apparent. Commitment and interest level often go along with ability, which is why it's important to find an activity that's right for your child. Schedules start getting busy during these years, but don't forget to set aside some time for free play.

Teenagers: Teens have a wide array of choices when it comes to being active — from school sports to after-school interests, such as yoga or skateboarding. With teenagers, it's important to remember that physical activity must be planned and often has to be sandwiched between various responsibilities and commitments.

Do what you can to make it easy for your teen to exercise by providing transportation and the necessary gear or equipment. And don't overlook workout clothes. In some cases, the right clothes and shoes might help a shy teen feel comfortable biking or going to the gym.
Your Child's Fitness Personality

In addition to your child's age, it's important for parents to understand a child's fitness personality. Personality traits, genetics, and athletic ability combine to influence a child's attitude toward participation in sports and other physical activities, particularly as they get older. Which of these three types best describes your child?

The nonathlete: This child may lack athletic ability, interest in physical activity, or both.

The casual athlete: This child is interested in being active but isn't a star player and is at risk of getting discouraged in a competitive athletic environment.

The athlete: This child has athletic ability, is committed to a sport or activity, and likely to ramp up practice time and intensity of competition.

If you understand the concepts of temperament and fitness types, you'll be better able to help your child find the right activities and get enough exercise — and find enjoyment in physical activity. Some children will want to pursue excellence in a sport, while others may be perfectly happy and fit just being casual participants.

The athlete, for instance, will want to be on the basketball team, while the casual athlete may just enjoy shooting hoops in the playground or on the driveway. The nonathlete is likely to need a parent's help and encouragement to get and stay physically active. That's why it's important to encourage kids to remain active even through they aren't top performers.

Whatever your child's fitness personality, remember that all kids can be physically fit. Your positive attitude will help the kid who's reluctant to exercise. Be active yourself and support your child's interests. If you start this early enough, your child will come to regard activity as a normal — and fun — part of your family's everyday routine.

Exercising During Pregancy

2009-02-09T13:48:00.001+08:00

Although you may not feel like running a marathon, most women benefit greatly from exercising throughout their pregnancies. But during that time, you'll need to discuss your exercise plans with your doctor or other health care provider early on and make a few adjustments to your normal exercise routine. The level of exercise recommended will depend, in part, on your level of pre-pregnancy fitness.

Benefits of Exercising During Pregnancy

No doubt about it, exercise is a big plus for both you and your baby (if complications don't limit your ability to exercise throughout your pregnancy). It can help you:
feel better. At a time when you wonder if this strange body can possibly be yours, exercise can increase your sense of control and boost your energy level. Not only does it make you feel better by releasing endorphins (naturally occurring chemicals in your brain), appropriate exercise can:
relieve backaches and improve your posture by strengthening and toning muscles in your back, butt, and thighs
reduce constipation by accelerating movement in your intestine
prevent wear and tear on your joints (which become loosened during pregnancy due to normal hormonal changes) by activating the lubricating fluid in your joints
help you sleep better by relieving the stress and anxiety that might make you restless at night
look better. Exercise increases the blood flow to your skin, giving you a healthy glow.
prepare you and your body for birth. Strong muscles and a fit heart can greatly ease labor and delivery. Gaining control over your breathing can help you manage pain. And in the event of a lengthy labor, increased endurance can be a real help.
regain your pre-pregnancy body more quickly. You'll gain less fat weight during your pregnancy if you continue to exercise (assuming you exercised before becoming pregnant). But don't expect or try to lose weight by exercising while you're pregnant. For most women, the goal is to maintain their fitness level throughout pregnancy.

While the jury's still out on the additional benefits of exercise during pregnancy, some studies have shown that exercise may even lower a woman's risk of complications, like preeclampsia and gestational diabetes.
What's a Safe Exercise Plan During Pregnancy?

It depends on when you start and whether your pregnancy is complicated. If you exercised regularly before becoming pregnant, continue your program, with modifications as you need them.

If you weren't fit before you became pregnant, don't give up! Begin slowly and build gradually as you become stronger. The U.S. Department of Health and Human Services recommends at least 150 minutes (that's 2 hours and 30 minutes) of moderate-intensity aerobic activity each week for healthy women who are not already highly active or doing vigorous-intensity activity. If you're healthy, the risks of moderate-intensity activity during pregnancy are very low, and do not increase risk of low birth weight, preterm delivery, or early pregnancy loss.

Before you continue your old exercise routine or begin a new one, you should talk to your doctor about exercising while you're pregnant. Discuss any concerns you may have.

You may need to limit your exercise if you have:
pregnancy-induced high blood pressure
early contractions
vaginal bleeding
premature rupture of your membranes, also known as your water (the fluid in the amniotic sac around the fetus) breaking early
Exercises to Try

That depends on what interests you and what your doctor advises. Many women enjoy dancing, swimming, water aerobics, yoga, Pilates, biking, or walking. Swimming is especially appealing, as it gives you welcome buoyancy (floatability or the feeling of weightlessness). Try for a combination of cardio (aerobic), strength, and flexibility exercises, and avoid bouncing.

Many experts recommend walking. It's easy to vary the pace, add hills, and add distance. If you're just starting, begin with a moderately brisk pace for a mile, 3 days a week. Add a couple of minutes every week, pick up the pace a bit, and eventually add hills to your route. Whether you're a pro or a novice, go slowly for the first 5 minutes to warm up and use the last 5 minutes to cool down.

If you were a runner before you were pregnant, in many cases, you can continue running during your pregnancy, although you may have to modify your routine.

Whatever type of exercise you and your doctor decide on, the key is to listen to your body's warnings. Many women, for example, become dizzy early in their pregnancy, and as the baby grows, their center of gravity changes. So it may be easy for you to lose your balance, especially in the last trimester.

Your energy level may also vary greatly from day to day. And as your baby grows and pushes up on your lungs, you'll notice a decreased ability to breathe in more air (and the oxygen it contains) when you exercise. If your body says, "Stop!" — stop!

Your body is signaling that it's had enough if you feel:
fatigue
dizziness
heart palpitations (your heart pounding in your chest)
shortness of breath
pain in your back or pelvis

And if you can't talk while you're exercising, you're doing it too strenuously.

It also isn't good for your baby if you become overheated because temperatures greater than 102.6° Fahrenheit (39° Celsius) could cause problems with the developing fetus — especially in the first trimester — which can potentially lead to birth defects. So don't overdo exercise on hot days.

When the weather is hot, try to avoid exercising outside during the hottest part of the day (from about 10 AM to 3 PM) or exercise in an air-conditioned place. Also remember that swimming makes it more difficult for you to notice your body heating up because the water makes you feel cooler.
Exercises to Avoid

Most doctors recommend that pregnant women avoid exercises after the first trimester that require them to lie flat on their backs.

Unless your doctor tells you otherwise, it's also wise to avoid any activities that include:
bouncing
jarring (anything that would cause a lot of up and down movement)
leaping
a sudden change of direction
a risk of abdominal injury

Typical limitations include contact sports, downhill skiing, scuba diving, and horseback riding because of the risk of injury they pose.

Although some doctors say step aerobics workouts are acceptable if you can lower the height of your step as your pregnancy progresses, others caution that a changing center of gravity makes falls much more likely. If you do choose to do aerobics, just make sure to avoid becoming extremely winded or exercising to the point of exhaustion.

And check with your doctor if you experience any of these warning signs during any type of exercise:
vaginal bleeding
unusual pain
dizziness or lightheadedness
unusual shortness of breath
racing heartbeat or chest pain
fluid leaking from your vagina
uterine contractions
Kegel Exercises

Although the effects of Kegel exercises can't be seen from the outside, some women use them to reduce incontinence (the leakage of urine) caused by the weight of the baby on their bladder. Kegels help to strengthen the "pelvic floor muscles" (the muscles that aid in controlling urination).

Kegels are easy, and you can do them any time you have a few seconds — sitting in your car, at your desk, or standing in line at the store. No one will even know you're doing them!

To find the correct muscles, pretend you're trying to stop urinating. Squeeze those muscles for a few seconds, then relax. You're using the correct muscles if you feel a pull. Or place a finger inside your vagina and feel it tighten when you squeeze. Your doctor can also help you identify the correct muscles.

A few things to keep in mind when you're doing Kegel exercises:
Don't tighten other muscles (stomach or legs, for example) at the same time. You want to focus on the muscles you're exercising.
Don't hold your breath while you do them because it's important that your body and muscles continue to receive oxygen while you do any type of exercise.
Don't regularly do Kegels by stopping and starting your flow of urine while you're actually going to the bathroom, as this can lead to incomplete emptying of your bladder, which increases the risk of urinary tract infections.
Getting Started

Always talk to your doctor before beginning any exercise program. Once you're ready to get going:
Start gradually. Even 5 minutes a day is a good start if you've been inactive. Add 5 minutes each week until you reach 30 minutes.
Dress comfortably in loose-fitting clothes and wear a supportive bra to protect your breasts.
Drink plenty of water to avoid overheating and dehydration.
Skip your exercises if you're sick.
Opt for a walk in an air-conditioned mall on hot, humid days.
Above all, listen to your body.

Emergency Treatment For Bug Bites and Stings

2009-02-08T09:26:00.000+08:00

Bug bites and stings usually are just nuisances. They bring momentary alarm, temporary discomfort and pain, but no serious or lasting health problems. But on occasion, they can cause infections that require treatment and allergic reactions that can be serious, even fatal.

Parents should know the signs of an infection or allergic reaction, and when to get medical attention. Inform all caregivers if a child has any history of complications so they know what to do in the event of a bug bite or sting.

What to Do About:
Bee and Wasp Stings
A bee will leave behind a stinger attached to a venom sac. Try to remove it as quickly as possible. (Wasps don't leave their stingers in the skin after stinging, which means they can sting more than once.)
Wash the area carefully with soap and water. Do this two to three times a day until the skin is healed.
Apply an ice pack wrapped in a cloth or a cold, wet washcloth for a few minutes.
Give acetaminophen or ibuprofen for pain.
For pain and itching, give an over-the-counter oral antihistamine if your child's doctor says it's OK; follow dosage instructions for your child's age and weight. You could also apply a corticosteroid cream or calamine lotion to the sting area.
A sting anywhere in the mouth warrants immediate medical attention because stings in oral mucous membranes can quickly cause severe swelling that may block airways.
Seek medical care if you notice a large skin rash or swelling around the sting site, or if swelling or pain persists for more than 3 days, which could indicate an infection.
Get medical help right away if you notice any of the following signs, which may indicate a serious or potentially life-threatening allergic reaction:
wheezing or difficulty breathing
tightness in throat or chest
swelling of the lips, tongue, or face
dizziness or fainting
nausea or vomiting

Spider Bites
Wash the area carefully with soap and water. Do this two to three times a day until skin is healed.
Apply cool compresses.
Give acetaminophen or ibuprofen for pain.
To protect against infection, apply an antibiotic ointment and keep the child's hands washed. If you have any reason to suspect a bite by a black widow or brown recluse spider, apply ice to the bite site and take your child to the emergency room. Even if a child doesn't show any symptoms, get medical attention right away.

Most spiders found in the United States are harmless, with the exception of the black widow and the brown recluse spider. The brown recluse spider — a tiny oval brown spider with a small shape like a violin on its back — is found mostly in midwestern and southern parts of the United States. The bites usually don't hurt at first, and a child might not even be aware of the bite, but in some cases they cause swelling and changes in skin color and a blister.

The black widow spider, which is found all over North America, has a shiny black body and an orange hourglass shape on its underbelly. The venom (poison) in a black widow bite can cause painful cramps that show up within a few hours of the bite. The cramps can start in the muscles around the bite and then spread. The bite may also lead to nausea, vomiting, chills, fever, and muscle aches. If your child has any of these symptoms — or you know that he or she has been bitten — go to the emergency room right away.

In the southwest United States, an unidentified bite may be caused by a scorpion. Take your child to the emergency room immediately.
Tick Bites

Check kids and pets for ticks carefully after you've been in or around a wooded area. Common types of ticks include dog ticks and deer ticks (deer ticks may be carriers of Lyme disease).

If you find a tick on your child:
Call your doctor, who may want you to save the tick after removal (you can put it in a jar of alcohol to kill it).
Use tweezers to grasp the tick firmly at its head or mouth, next to the skin.
Pull firmly and steadily on the tick until it lets go, then swab the bite site with alcohol.
Don't use petroleum jelly or a lit match to kill and remove a tick.

BURNS? What Should We Do?

2009-02-07T09:17:00.000+08:00

From kids washing up under a too-hot faucet to an accidental tipping of a coffee cup, burns are a potential hazard in every home. In fact, burns, especially scalds from hot water and liquids, are some of the most common childhood accidents. Babies and young children are especially susceptible — they're curious, small, and have sensitive skin that needs extra protection.

Although some minor burns aren't cause for concern and can be safely treated at home, other more serious burns require medical care. But taking some simple precautions to make your home safer can prevent many burns.

Common Causes

The first step in helping to prevent your child from being burned is to understand the common causes of burns in children:
scalds, the number-one culprit (from steam, hot bath water, tipped-over coffee cups, cooking fluids, etc.)
contact with flames or hot objects (from the stove, fireplace, curling iron, etc.)
chemical burns (from swallowing things, like drain cleaner or watch batteries, or spilling chemicals, such as bleach, onto the skin)
electrical burns (from biting on electrical cords or sticking fingers or objects in electrical outlets, etc.)
overexposure to the sun

Types of Burns

Burns are often categorized as first-, second-, or third-degree burns, depending on how badly the skin is damaged. Each of the injuries above can cause any of these three types of burn. But both the type of burn and its cause will determine how the burn is treated. All burns should be treated quickly to reduce the temperature of the burned area and reduce damage to the skin and underlying tissue (if the burn is severe).

First-degree burns, the mildest of the three, are limited to the top layer of skin:
Signs and symptoms: These burns produce redness, pain, and minor swelling. The skin is dry without blisters.
Healing time: Healing time is about 3 to 6 days; the superficial skin layer over the burn may peel off in 1 or 2 days.

Second-degree burns are more serious and involve the skin layers beneath the top layer:
Signs and symptoms: These burns produce blisters, severe pain, and redness. The blisters sometimes break open and the area is wet looking with a bright pink to cherry red color.
Healing time: Healing time varies depending on the severity of the burn.

Third-degree burns are the most serious type of burn and involve all the layers of the skin and underlying tissue:
Signs and symptoms: The surface appears dry and can look waxy white, leathery, brown, or charred. There may be little or no pain or the area may feel numb at first because of nerve damage.
Healing time: Healing time depends on the severity of the burn. Deep second- and third-degree burns (called full-thickness burns) will likely need to be treated with skin grafts, in which healthy skin is taken from another part of the body and surgically placed over the burn wound to help the area heal.
What to Do
Seek Medical Help Immediately When:
You think your child has a second- or third-degree burn.
The burned area is large, even if it seems like a minor burn. For any burn that appears to cover more than 10% of the body, call for medical assistance. And don't use wet compresses because they can cause the child's body temperature to drop. Instead, cover the area with a clean, soft cloth or towel.
The burn comes from a fire, an electrical wire or socket, or chemicals.
The burn is on the face, scalp, hands, joint surfaces, or genitals.
The burn looks infected (with swelling, pus, increasing redness, or red streaking of the skin near the wound).
For First-Degree Burns:
Remove the child from the heat source.
Remove clothing from the burned area immediately.
Run cool (not cold) water over the burned area (if water isn't available, any cold, drinkable fluid can be used) or hold a clean, cold compress on the burn for approximately 3 to 5 minutes (do not use ice, as it may cause the burn to take longer to heal).
Do not apply butter, grease, powder, or any other remedies to the burn, as these increase the risk of infection.
If the burned area is small, loosely cover it with a sterile gauze pad or bandage.
Give your child acetaminophen or ibuprofen for pain.
If the area affected is small (the size of a quarter or smaller), keep the area clean and continue to use cool compresses and a loose dressing over the next 24 hours. You can also apply antibiotic cream two to three times a day, although this isn't absolutely necessary.
For Second- and Third-Degree Burns:
Seek emergency medical care, then follow these steps until medical personnel arrive:
Keep your child lying down with the burned area elevated.
Follow the instructions for first-degree burns.
Remove all jewelry and clothing from around the burn (in case there's any swelling after the injury), except for clothing that's stuck to the skin. If you're having difficulty removing clothing, you may need to cut it off or wait until medical assistance arrives.
Do not break any blisters.
Apply cool water over the area for at least 3 to 5 minutes, then cover the area with a clean white cloth or sheet until help arrives.
For Flame Burns:
Extinguish the flames by having your child roll on the ground.
Cover him or her with a blanket or jacket.
Remove smoldering clothing and any jewelry around the burned area.
Call for medical assistance, then follow instructions for second- and third-degree burns.
For Electrical and Chemical Burns:
Make sure the child is not in contact with the electrical source before touching him or her or you may also get shocked.
Flush the burned area with lots of running water for 5 minutes or more. If the burned area is large, use a tub, shower, buckets of water, or a garden hose.
Do not remove any of your child's clothing before you've begun flushing the burn with water. As you continue flushing the burn, you can then remove clothing from the burned area.
If the burned area is small, flush for another 10 to 20 minutes, apply a sterile gauze pad or bandage, and call your child's doctor.
Chemical burns to the mouth or eyes require immediate medical evaluation after thorough flushing with water.

Although both chemical and electrical burns might not always be visible, they can be serious because of potential damage to the child's internal organs. Symptoms may vary, depending on the type and severity of the burn and what caused it and may include abdominal pain.

If you think your child may have swallowed a chemical substance or an object that could be harmful (for instance, a watch battery) first call poison control and then the emergency department. It is helpful to know what chemical product the child has swallowed or has been exposed to. You may need to take it with you to the hospital. It's a good idea to have the number for poison control, (800) 222-1222, in an easily accessible place, such as on the refrigerator.
Preventing Burns

Although you can't keep your child free from injuries all the time, taking some simple precautions can reduce the chances that your child will be burned in your own home.
In General
Keep matches, lighters, chemicals, and lit candles out of your child's reach.
Put child-safety covers on all electrical outlets.
Get rid of equipment and appliances with old or frayed cords and extension cords that look damaged.
If you need to use a humidifier or vaporizer, use a cool-mist model rather than a hot-steam one.
Choose sleepwear that's labeled flame retardant (either polyester or treated cotton). Cotton sweatshirts or pants that aren't labeled as sleepwear generally aren't flame retardant.
Make sure older children are especially careful when using irons or curling irons.
Prevent house fires by making sure you have a smoke alarm on every level of your home and in each bedroom. Check these monthly and change the batteries twice a year.
Don't smoke inside, especially when you are tired, taking medications that can make you drowsy, or in bed.
Don't use fireworks or sparklers.
Bathroom
Set the thermostat on your hot water heater to 120° Fahrenheit (49° Celsius) or lower, or use the "low-medium setting." A child can be scalded in 2 to 3 seconds if the temperature is only 5 degrees higher than 120° Fahrenheit (49° Celsius). If you're unable to control the water temperature (if you live in an apartment, for example), install an anti-scald device, which is relatively inexpensive and can be installed you or by a plumber.
Always test bath water with your elbow before putting your child in it.
Always turn the cold water on first and turn it off last when running water in the bathtub or sink.
Turn children away from the faucet or fixtures so they are less likely to play with them and turn on the hot water.
Kitchen/Dining Room
Turn pot handles toward the back of the stove every time you cook.
Block access to the stove as much as possible.
Never let a child use a walker in the kitchen (the American Academy of Pediatrics strongly discourages the use of walkers overall).
Avoid using tablecloths or large placemats. A small child can pull on them and overturn a hot drink or plate of food.
Keep hot drinks and foods out of reach of children.
Never drink hot beverages or soup with a child sitting on your lap or carry hot liquids or dishes around your child. If you have to walk with hot liquid in the kitchen (like a pot of soup or cup of coffee), make sure you know where your child is, so you don't trip over him or her.
Never hold a baby or small child while cooking.
Never warm baby bottles in the microwave oven. The liquid may heat unevenly, resulting in pockets of breast milk or formula that can scald your baby's mouth.
Screen fireplaces and wood-burning stoves. Radiators and electric baseboard heaters may need to be screened as well.
Outside/In the Car
Use playground equipment with caution. If it's very hot outside, use the equipment only in the morning, when it's had a chance to cool down during the night.
Remove your child's safety seat or stroller from the hot sun when not in use because children can get burns from hot vinyl and metal. If you must leave your car seat or stroller in the sun, cover it with a blanket or towel.
Before leaving your parked car on a hot day, hide the seatbelts' metal latch plates in the seats to prevent the sun from hitting them directly.

Safely Storing Breast Milk

2009-02-07T00:07:00.000+08:00

How do I store my breast milk?

You can freeze and/or refrigerate your pumped (or expressed) breast milk. It's important, though, to store it in clean and sterile bottles with screw caps, hard plastic cups that have tight caps, or nursing bags (pre-sterilized bags meant for breast milk). Also make sure to put a label on each indicating when the milk was pumped. You should not add fresh milk to milk that is already frozen.

How long, exactly, can I store my breast milk?

For healthy full-term infants:
You can store it at room temperature:

for 4 to 8 hours (at no warmer than 77° Fahrenheit, or 25° Celsius)
You can store it in the refrigerator:

for up to 2 to 3 days at 32°–39° Fahrenheit (0°–3.9° Celsius)
You can store it in the freezer (be sure to leave about an inch of space at the top of the container or bottle to allow for expansion of the milk when it freezes):

for up to 2 weeks in a freezer compartment located inside the refrigerator
for 3 to 4 months in a freezer that's self-contained and connected on top of or on the side of the refrigerator and is kept at 0° Fahrenheit (–18° Celsius). But be sure to store the milk in the back of the freezer, not in the door)
for 6 to 12 months in a deep freezer that's always 4° Fahrenheit (–20° Celsius)

If you thaw frozen milk, you can refrigerate it and use it within 24 hours, but do not refreeze it. And don't save milk from a bottle that your baby already drank out of.

It's also important to note that different resources provide different variations on the amount of time you can store breast milk at room temperature, in the refrigerator, and in the freezer. Talk to your doctor if you have any concerns or questions.
How much of my milk should I store in the freezer?

Although some women may choose to pump large volumes to be frozen, it's a good idea to actually store the breast milk in small portions so as not to waste any. Label the bottles, cups, or bags 2 oz. or 4 oz. (59.1 or 118.2 milliliters), then freeze them.

You could also pour the milk into ice cube trays that have been thoroughly cleaned in hot water, let them freeze until hard, store them in freezer bags, then count up the amount of cubes needed to make a full bottle.
Why does my refrigerated and frozen breast milk look weird?

Breast milk that's been frozen or refrigerated may look a little different from fresh breast milk, but that doesn't mean it's gone bad. It's normal for breast milk to look slightly blue, yellow, or brown when refrigerated or frozen. And it may separate into a creamy looking layer and a lighter, more milk-like layer.
How do I clean my breast milk bottles and pump parts?

You'll need to boil the nipples, bottles, and washable breast pump supplies (i.e., the breast shields and any other part that touches your breasts or your milk) for 5 to 10 minutes. Check the manufacturer's recommendations for the length of time to boil the parts. (You also can sterilize them with a store-bought countertop or microwaveable sterilizer, but boiling works just as well and costs nothing.) Then you'll need to wash the bottle and pump supplies in hot, soapy water (or run them through the dishwasher) after every use after that. Bottles and nipples can transmit bacteria if they aren't cleaned properly.
Is it safe to microwave my baby's bottles?

The microwave can create dangerous "hot spots" in bottles of formula or breast milk, so you should never microwave them. Instead, you can run the bottle or freezer bag under warm water for a little bit, swirl the bag or bottle around in a bowl of warm water, or thaw the milk in the refrigerator. You can also put your baby's bottles in a pan of warm water (away from the heat of the stove) and then test the temperature by squirting a drop or two on the inside or your wrist before feeding your baby. You also can get bottle warmers for use at home or in the car.

Getting Started For Breastfeeding

2009-02-06T00:02:00.000+08:00

Whether you're a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are some answers to common inquiries that mothers — new and veteran — may have.

When will my milk come in?

During the first few days after the birth of your baby, your body will produce colostrum, a sort of pre-milk. For some women, colostrum is thick and yellowish. For others it is thin and watery. Colostrum contains many protective properties, including antibacterial and immune-system-boosting substances that are so important to your baby and aren't found in infant formula. The flow of colostrum is very slow, which allows your baby to learn how to nurse and also how to coordinate sucking, breathing, and swallowing.

After about 3 to 4 days of nursing, your breasts will start to feel less soft and more firm as your milk changes from colostrum to milk that looks kind of like skim milk. Your milk will be transitional for the first 10 to 14 days, after which it's considered to be mature milk.

During this time, the amount of milk your body produces will increase, responding to your baby's nursing. Your milk supply is determined by the stimulation your body receives. In other words, the more you breastfeed, the more milk your body produces.

Mothers who deliver by Caeserean section (C-section) may find it takes longer for their milk supply to increase. Sometimes, for no apparent reason, a mother's milk may take longer than a few days to come in. This is perfectly normal and is usually no cause for concern, but make sure to let your doctor know. While babies don’t need much more than some colostrum for the first couple days, the doctor may need to make sure the baby is getting enough to eat. It can help to breastfeed more frequently, putting the baby to the breast every 2 to 3 hours.

If your milk still hasn't come in within 72 hours after the birth of your baby, you may want to talk to your doctor about temporarily supplementing with formula (just until your milk supply is up) so that your baby gets enough nutrients and doesn't lose weight unnecessarily.

Don't be alarmed if your baby drops a little weight at first. Most babies typically lose up to 7% of their body weight in the first few days.
How soon after my baby is born should I start trying to breastfeed?

If possible, try to start nursing within an hour after the birth. This timing takes advantage of the wakefulness of your newborn after birth. Many babies will instinctively take to the breast, even if it's their first time. After the initial period of being alert, a newborn will spend much of the next 24 hours sleeping. So, it may be more difficult to get your baby to latch on after the first few hours.

Even if your baby doesn't officially latch on (or correctly attach to your breast), starting early helps you and your little one to practice and get used to the idea of breastfeeding.

It may take a few times before getting it right, but it's important that your baby nurses with a wide-open mouth and takes as much as possible of your areola (the dark-colored area of the breast) in his or her mouth (not just the tip of the nipple). If your baby is sleeping at the breast, try to wake him or her up by tickling the feet or undressing the baby. Frequent attempts to burp and changing the diaper between breasts can also be helpful.

To help both you and your baby get used to breastfeeding, try to feed about every 3 hours, even overnight. In many hospitals, you can ask for your baby to "room in" (or stay in the hospital room with you). For moms who want — and need — the extra shut-eye during those first couple of days after the birth, you can have your baby stay in the nursery at night and ask the staff to bring your newborn to you to feed.
Should I let the nurses give my baby a bottle or pacifier in the hospital?

If you're committed to trying to exclusively breastfeed, let the nurses know early on that you're breastfeeding and that you don't want your baby to suck on a pacifier or a bottle. This will allow your baby to practice and perfect breastfeeding without being confused by a bottle or a pacifier. Some experts feel that if you start giving bottles too early — before your baby is used to breastfeeding — your little one might have "nipple confusion" and may decide that the bottle is the quicker, better option than the breast. While some babies experience this confusion, others have no problem transitioning between a bottle and the breast.

If a pacifier is occasionally needed in the nursery (such as during a circumcision, when baby boys are often given pacifiers with sugar water), it won't disrupt your nursing. If the doctor tells you the baby needs a little supplementation with formula, it can be given with a bottle or through a nursing system in which the formula goes through a small tube that attaches to your nipple.
What are the signs that my baby is hungry?

Despite what some new moms might think, crying is a late sign of hunger. You should try to nurse before your baby is so hungry that he or she gets really upset and becomes difficult to calm down.

Signs that babies are hungry include:
moving their heads from side to side
opening their mouths
placing their hands and fists to their mouths
puckering their lips as if to suck
nuzzling again their mothers' breasts
stretching
showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)
How can I tell that my milk is coming in for a feeding?

Many women can feel the milk ejection reflex (or let-down) — when the milk starts coming into their breasts for a feeding. When and how it happens is different for everyone, though.

During the first few days to weeks after delivery, you may feel strong cramps in your uterus when your milk lets down. Let-down may also begin before you start nursing (some women experience let-down from simply seeing their baby or hearing a baby cry). Or, it may happen after your baby is latched on and has sucked a few times (you may notice your baby starting to gulp).

You may also feel a sense of engorgement, like your breasts are filling up and becoming firm, or a sort of tingling sensation in your breasts. You also may feel or see some milk leaking from your nipples. Some women, however, never have a feeling of let-down, which is OK, too. Even if you don't feel it, you should still see milk coming from your nipple and hear your baby swallowing.
How do I make sure my baby is latched on correctly?

This is often the No. 1 reason that new mothers have a hard time with breastfeeding — their babies aren't latched on to their breasts properly, which can be frustrating for the babies and downright painful for their mothers.

Here's how you can make sure your little one is latched on correctly every time:
Make sure your baby's mouth is opened wide and his or her tongue is down when latching on.
Support your breast with your hand, positioning your thumb on top and your fingers at the bottom, keeping your thumb and fingers back far enough so that your baby has enough of the nipple and areola (the circle of skin around the nipple) to latch onto.
Gently glide your nipple from the middle of your baby's bottom lip down to his or her chin to help prompt your baby to open his or her mouth.
When your baby opens his or her mouth wide and the tongue comes down, quickly bring your baby to your breast (not your breast to your baby). Your baby should take as much of your areola into his or her mouth as possible.
Make sure your baby's nose is almost touching your breast (not pressed against it), his or her lips are turned out (or flanged), and you see and hear your baby swallowing. (You should be able to tell by seeing movement along your baby's lower jaw and even in your baby's ear and temple.)

When properly latched on, you may have 30 to 60 seconds of latch-on pain (this is caused by the nipple and areola being pulled into your baby's mouth) then the pain should subside. It will then feel like a tug when your baby is sucking. If you continue to feel pain, stop feeding momentarily and reposition your baby on your breast. If you still feel pain during feeds even after repositioning, talk to your doctor to make sure something else isn’t going on, such as an infection.

Your baby will often give four to five sucks, followed by a 5- to 10-second pause. Your baby's sucks will increase in number as the quantity of your milk increases. As the milk flow slows, your baby's pattern will probably change to three or four sucks and pauses that last longer than 10 seconds.

Most babies will release the breast on their own. If your baby doesn't release your breast but the sucks now seem limited to the front of his or her mouth, you can slip your finger in the side of your baby's mouth (between the gums) and then turn your finger a quarter turn to break the suction. Then, try to burp your baby and switch him or her to the other breast.
How can I tell if my baby is latched on wrong?

If your baby tends to suck on the tip of your nipple, without getting much of your areola, he or she is latched on incorrectly. Babies who tend to latch on wrong will also frequently sleep at the breast and may not seem satisfied because they may not be getting enough. If either of these occurs, break the suction and reposition your baby onto your breast to include the nipple and areola.

Call your doctor or a lactation consultant if:
you're unable to nurse your baby without pain (you may just need help getting your baby to latch on correctly, or it could be a sign of a breast infection)
your baby consistently sleeps at the breast
your baby is nursing but doesn't seem satisfied when feedings are over
I'm having a hard time getting the hang of breastfeeding. What can I do?

This is completely normal. Whereas nursing may come easily for some women, it can take some adjustment and practice time for many others. Breastfeeding your baby may be one of the most challenging but rewarding things you'll do as a mother.

While you're in the hospital, don't hesitate to use the expertise of the nursing staff and your OB-GYN. They can be very helpful in answering any questions you might have, as well as walking you through the dos and don'ts of breastfeeding. The nurses can even watch and coach you as you try to breastfeed your baby. The hospital also may have a lactation consultant on staff who may be able to offer some guidance and reassurance.

Doctors usually want to weigh infants and evaluate breastfeeding within 48 to 72 hours after a mother and newborn leave the hospital. But if you have any concerns or difficulties before then, make sure to talk to your doctor.

Whatever you do, try not to become too discouraged. With a little patience and some practice, it will likely become easier for both you and your baby in the coming weeks. Like the old saying goes, practice makes perfect!
Is there more than one way to hold my baby during nursing?

Yes. You can experiment with several different nursing positions (or holds) to figure out which one is the most comfortable for both you and your baby. They include the:
Cradle Hold: This is the traditional hold many mothers will try from the get-go, holding the baby across the chest and using the arm on the same side as the nursing breast to support the baby.
Clutch (or Football) Hold: This position holds the baby at the side, and is good for the mom who's had a C-section (because the baby doesn't put pressure on the mother's belly), as well as for mothers with large breasts or twins.
Cross-Cradle (or Crossover) Hold: Similar to the cradle hold, this position involves using the arm on the opposite side as the nursing breast to support the baby. Some mothers find that this hold makes it easier to control how their babies latch on.
Side-Lying Position: This position, in which mom lies on her side facing the baby, allows moms to get some rest during feedings and is also a common choice for mothers who've had C-sections.
How can I make breastfeeding as comfortable as possible?

Again, it's mostly about finding a comfortable nursing position and proper latch-on — once you've gotten those down, it can make for a truly rewarding bonding experience. Here are some other things you can do that might also help you to relax and enjoy the experience:
Keep a breastfeeding goodie bag or basket near all of your regular nursing areas at home (next to the bed, on the couch, etc.). Fill it with bottled water, some healthy snacks, a few magazines, your portable home phone or cell phone (so you don't have to get up to answer or make calls), plenty of burp cloths or cotton diapers for dribbles and spit-up, and the remote controls if you want to use a TV, DVD player, VCR, or stereo nearby.
Find the most comfortable seating arrangement and stick to it so that your baby gets comfortable with — and looks forward to — the routine. Many mothers like to sit in a glider or in a cozy chair with armrests.
Give your feet and back a break. Footstools and pillows can provide extra support. Pillows that some women find helpful are the donut-type nursing pillows or the "husband" back pillows with arms on each side for nursing in bed.
How long should I plan to breastfeed my baby?

The American Academy of Pediatrics (AAP) now recommends that babies should be breastfed exclusively (without offering formula, water, juice, non-breast-milk, or food) for the first 6 months and that breastfeeding should continue until 12 months (and beyond) if it's working for both the mother and baby.

Studies on infants show that breastfeeding can lower the occurrence or severity of diarrhea, ear infections, and bacterial meningitis. Breastfeeding may also protect children against sudden infant death syndrome (SIDS), diabetes, obesity, and asthma.

About Teen Suicide

2009-02-05T00:32:00.000+08:00

When a teen commits suicide, everyone is affected. Family members, friends, teammates, neighbors, and sometimes even those who didn't know the teen well might experience feelings of grief, confusion, guilt — and the sense that if only they had done something differently, the suicide could have been prevented.

So it's important to understand the forces that can lead teens to suicide and to know how to help.

About Teen Suicide

The reasons behind a teen's suicide or attempted suicide can be complex. Although suicide is relatively rare among children, the rate of suicides and suicide attempts increases tremendously during adolescence. Suicide is the third-leading cause of death for 15- to 24-year-olds, according to the Centers for Disease Control and Prevention (CDC), surpassed only by accidents and homicide.

The risk of suicide increases dramatically when kids and teens have access to firearms at home, and nearly 60% of all suicides in the United States are committed with a gun. That's why any gun in your home should be unloaded, locked, and kept out of the reach of children and teens. Ammunition should be stored and locked apart from the gun, and the keys for both should be kept in a different area from where you store your household keys. Always keep the keys to any firearms out of the reach of children and adolescents.

Suicide rates differ between boys and girls. Girls think about and attempt suicide about twice as often as boys, and tend to attempt suicide by overdosing on drugs or cutting themselves. Yet boys die by suicide about four times as often girls, perhaps because they tend to use more lethal methods, such as firearms, hanging, or jumping from heights.
Which Kids Are at Risk for Suicide?

It can be hard to remember how it felt to be a teen, caught in that gray area between childhood and adulthood. Sure, it's a time of tremendous possibility but it can also be a period of great confusion and anxiety. There's pressure to fit in socially, to perform academically, and to act responsibly. There's the awakening of sexual feelings, a growing self-identity, and a need for autonomy that often conflicts with the rules and expectations set by others.

A teen with an adequate support network of friends, family, religious affiliations, peer groups, or extracurricular activities may have an outlet to deal with everyday frustrations. But many teens don't believe they have that, and feel disconnected and isolated from family and friends. These teens are at increased risk for suicide.

Factors that increase the risk of suicide among teens include:
a psychological disorder, especially depression, bipolar disorder, and alcohol and drug use (in fact, approximately 95% of people who die by suicide have a psychological disorder at the time of death)
feelings of distress, irritability, or agitation
feelings of hopelessness and worthlessness that often accompany depression (a teen, for example, who experiences repeated failures at school, who is overwhelmed by violence at home, or who is isolated from peers is likely to experience such feelings)
a previous suicide attempt
a family history of depression or suicide (depressive illnesses may have a genetic component, so some teens may be predisposed to suffer major depression)
physical or sexual abuse
lack of a support network, poor relationships with parents or peers, and feelings of social isolation
dealing with homosexuality in an unsupportive family or community or hostile school environment
Warning Signs

Suicide among teens often occurs following a stressful life event, such as a perceived failure at school, a breakup with a boyfriend or girlfriend, the death of a loved one, a divorce, or a major family conflict.

A teen who is thinking about suicide might:
talk about suicide or death in general
talk about "going away"
talk about feeling hopeless or feeling guilty
pull away from friends or family
lose the desire to take part in favorite things or activities
have trouble concentrating or thinking clearly
experience changes in eating or sleeping habits
self-destructive behavior (drinking alcohol, taking drugs, or driving too fast, for example)
What Can Parents Do?

Most teens who commit or attempt suicide have given some type of warning to loved ones ahead of time. So it's important for parents to know the warning signs so that kids who might be suicidal can get the help they need.
Watch and Listen

Keep a close eye on a teen who seems depressed and withdrawn. Poor grades, for example, may signal that your teen is withdrawing at school.

It's important to keep the lines of communication open and express your concern, support, and love. If your teen confides in you, show that you take those concerns seriously. A fight with a friend might not seem like a big deal to you in the larger scheme of things, but for a teen it can feel immense and consuming. It's important not to minimize or discount what your teen is going through, as this can increase his or her sense of hopelessness.

If your teen doesn't feel comfortable talking with you, suggest a more neutral person, such as another relative, a clergy member, a coach, a school counselor, or your child's doctor.
Ask Questions

Some parents are reluctant to ask teens if they have been thinking about suicide or hurting themselves. Some fear that by asking, they will plant the idea of suicide in their teen's head.

It's always a good idea to ask, even though doing so can be difficult. Sometimes it helps to explain why you're asking. For instance, you might say: "I've noticed that you've been talking a lot about wanting to be dead. Have you been having thoughts about trying to kill yourself?"
Get Help

If you learn that your child is thinking about suicide, get help immediately. Your doctor can refer you to a psychologist or psychiatrist, or your local hospital's department of psychiatry can provide a list of doctors in your area. Your local mental health association or county medical society can also provide references. In an emergency, you can call (800) SUICIDE or (800) 999-9999.

If your teen is in a crisis situation, your local emergency room can conduct a comprehensive psychiatric evaluation and refer you to the appropriate resources. If you're unsure about whether you should bring your child to the emergency room, contact your doctor or call (800) SUICIDE for help.

If you've scheduled an appointment with a mental health professional, make sure to keep the appointment, even if your teen says he or she is feeling better. Suicidal thoughts do tend to come and go; however, it is important that your teen get help developing the skills necessary to decrease the likelihood that suicidal thoughts and behaviors will emerge again if a crisis arises.

If your teen refuses to go to the appointment, discuss this with the mental health professional — and consider attending the session and working with the clinician to make sure your teen has access to the help needed. The clinician might also be able to help you devise strategies to help your teen want to get help.

Remember that any ongoing conflicts between a parent and child can fuel the fire for a teen who is feeling isolated, misunderstood, devalued, or suicidal. Get help to air family problems and resolve them in a constructive way. Also let the mental health professional know if there is a history of depression, substance abuse, family violence, or other stresses at home, such as an ongoing environment of criticism.
Helping Teens Cope With Loss

What should you do if someone your teen knows, perhaps a friend or a classmate, has attempted or committed suicide? First, acknowledge your child's many emotions. Some teens say they feel guilty — especially those who felt they could have interpreted their friend's actions and words better.

Others say they feel angry with the person who committed or attempted suicide for having done something so selfish. Still others say they feel no strong emotions. All of these reactions are appropriate; emphasize to your teen that there is no right or wrong way to feel.

When someone attempts suicide and survives, people may be afraid of or uncomfortable about talking with him or her about it. Tell your teen to resist this urge; this is a time when a person absolutely needs to feel connected to others.

Many schools address a student's suicide by calling in special counselors to talk with the students and help them cope. If your teen is dealing with a friend or classmate's suicide, encourage him or her to make use of these resources or to talk to you or another trusted adult.
If You've Lost a Child to Suicide

For parents, the death of a child is among the most painful losses imaginable. For parents who've lost a child to suicide, the pain and grief may be intensified. Although these feelings may never completely go away, survivors of suicide can take steps to begin the healing process:
Maintain contact with others. Suicide can be a very isolating experience for surviving family members because friends often don't know what to say or how to help. Seek out supportive people to talk with about your child and your feelings. If those around you seem uncomfortable about reaching out, initiate the conversation and ask for their help.
Remember that your other family members are grieving, too, and that everyone expresses grief in their own way. Your other children, in particular, may try to deal with their pain alone so as not to burden you with additional worries. Be there for each other through the tears, anger, and silences — and, if necessary, seek help and support together.
Expect that anniversaries, birthdays, and holidays may be difficult. Important days and holidays often reawaken a sense of loss and anxiety. On those days, do what's best for your emotional needs, whether that means surrounding yourself with family and friends or planning a quiet day of reflection.
Understand that it's normal to feel guilty and to question how this could have happened, but it's also important to realize that you might never get the answers you seek. The healing that takes place over time comes from reaching a point of forgiveness — for both your child and yourself.
Counseling and support groups can play a tremendous role in helping you to realize you are not alone.

What Is Cerebral Palsy?

2009-02-03T22:33:00.000+08:00

Cerebral palsy (CP) is a disorder that affects muscle tone, movement, and motor skills (the ability to move in a coordinated and purposeful way). Cerebral palsy can also lead to other health issues, including vision, hearing, and speech problems, and learning disabilities.

CP is usually caused by brain damage that occurs before or during a child’s birth, or during the first 3 to 5 years of a child’s life. There is no cure for CP, but treatment, therapy, special equipment, and, in some cases, surgery can help a child who is living with the condition.

What Is Cerebral Palsy?

Cerebral palsy is one of the most common congenital (existing before birth or at birth) disorders of childhood. About 500,000 children and adults of all ages in the United States have the condition.

The three types of CP are:
spastic cerebral palsy — causes stiffness and movement difficulties
athetoid cerebral palsy — leads to involuntary and uncontrolled movements
ataxic cerebral palsy — causes a disturbed sense of balance and depth perception

Cerebral palsy affects muscle control and coordination, so even simple movements — like standing still — are difficult. Other vital functions that also involve motor skills and muscles — such as breathing, bladder and bowel control, eating, and learning — are also affected when a child has CP. Cerebral palsy does not get worse over time.
Causes of Cerebral Palsy

The exact causes of most cases of CP are unknown, but many are the result of problems during pregnancy in which the brain is either damaged or doesn't develop normally. This can be due to infections, maternal health problems, or something else that interferes with oxygen reaching the fetal brain. Problems during labor and delivery can cause CP in some cases.

Premature babies — particularly those who weigh less than 3.3 pounds (1,510 grams) — have a higher risk of CP than babies that are carried full-term, as are other low birth weight babies and multiple births, such as twins and triplets.

Brain damage in infancy or early childhood can also lead to CP. A baby or toddler might suffer this damage because of lead poisoning, bacterial meningitis, malnutrition, being shaken as an infant (shaken baby syndrome), or being in a car accident while not properly restrained.
Diagnosing Cerebral Palsy

CP may be diagnosed very early in an infant known to be at risk for developing the condition because of premature birth or other health problems. Doctors, such as pediatricians and developmental and neurological specialists, usually follow these kids closely from birth so that they can identify and address any developmental delays or problems with muscle function that might indicate CP.

In a baby carried to term with no other obvious risk factors for CP, it may be difficult to diagnose the disorder in the first year of life. Often doctors aren’t able to diagnose CP until they see a delay in normal developmental milestones — such as reaching for toys by 4 months or sitting up by 7 months — which can be signs of CP. Abnormal muscle tone, poorly coordinated movements, and the persistence of infant reflexes beyond the age at which they are expected to disappear can also be signs. If these developmental milestones are only mildly delayed, the diagnosis of CP may not be made until the child is a toddler.
Preventing Cerebral Palsy

In many cases the causes of CP are unknown, so there’s no way to prevent it. But if you’re having a baby, you can take steps to ensure a healthy pregnancy and carry the baby to term, thus lowering the risk that your baby will have CP.

Before becoming pregnant, it’s important to maintain a healthy diet and make sure that any medical problems are managed properly. As soon as you know you’re pregnant, proper prenatal medical care is vital.

Controlling diabetes, anemia, hypertension, and nutritional deficiencies during pregnancy can help prevent some premature births and, as a result, some cases of cerebral palsy.

Once your baby is born you can lower the risk of brain damage, which could lead to CP. Never shake an infant, as this can lead to shaken baby syndrome and brain damage. If you’re riding in a car, make sure your baby is properly strapped into an infant car seat that’s correctly installed — if an accident occurs, the baby will be as protected as possible. Be aware of lead exposure in your house, as lead poisoning can lead to brain damage.
How Cerebral Palsy Affects Development

Children with CP have varying degrees of physical disability. Some have only mild impairment, while others are severely affected.

Associated medical problems may include visual impairment or blindness, hearing loss, food aspiration (the sucking of food or fluid into the lungs), gastroesophageal reflux (spitting up), speech problems, drooling, tooth decay, sleep disorders, osteoporosis (weak, brittle bones), and behavior problems. Seizures, speech and communication problems, and mental retardation are also common among kids with CP. Many have problems that may require ongoing therapy and devices such as braces or wheelchairs.
Treatment of Cerebral Palsy

Currently there's no cure for cerebral palsy, but if your child is diagnosed with it, a variety of resources and therapies can provide help and improve the quality of your child’s life.

Therapies can help kids with CP achieve maximum potential in growth and development. As soon as CP is diagnosed, a child can begin therapy for movement, learning, speech, hearing, and social and emotional development. In addition, medication, surgery, and braces can help improve muscle function. Surgery can help repair dislocated hips and scoliosis (curvature of the spine), which are common problems associated with CP. Severe muscle spasticity can sometimes be helped with medication taken by mouth or administered via a pump (the baclofen pump) implanted under the skin.

If your child has CP, a team of professionals will work with you to meet your child's medical needs. That team may include therapists, psychologists, educators, nurses, and social workers.

Many resources are available to help and support you in caring for your child. Talk to your doctor about finding those in your area.

What Is ADHD?

2009-02-03T00:27:00.000+08:00

Lisa's son Jack had always been a handful. Even as a preschooler, he would tear through the house like a tornado, shouting, roughhousing, and climbing the furniture. No toy or activity ever held his interest for more than a few minutes and he would often dart off without warning, seemingly unaware of the dangers of a busy street or a crowded mall.

It was exhausting to parent Jack, but Lisa hadn't been too concerned back then. Boys will be boys, she figured. But at age 8, he was no easier to handle. It was a struggle to get Jack to settle down long enough to complete even the simplest tasks, from chores to homework. When his teacher's comments about his inattention and disruptive behavior in class became too frequent to ignore, Lisa took Jack to the doctor, who recommended an evaluation for attention deficit hyperactivity disorder (ADHD).

ADHD is a common behavioral disorder that affects an estimated 8% to 10% of school-age children. Boys are about three times more likely than girls to be diagnosed with it, though it's not yet understood why.

Kids with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what's expected of them but have trouble following through because they can't sit still, pay attention, or attend to details.

Of course, all kids (especially younger ones) act this way at times, particularly when they're anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and occur in different settings. They impair a child's ability to function socially, academically, and at home.

The good news is that with proper treatment, kids with ADHD can learn to successfully live with and manage their symptoms.
Symptoms

ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD and broken down into three subtypes, each with its own pattern of behaviors:

1. an inattentive type, with signs that include:
inability to pay attention to details or a tendency to make careless errors in schoolwork or other activities
difficulty with sustained attention in tasks or play activities
apparent listening problems
difficulty following instructions
problems with organization
avoidance or dislike of tasks that require mental effort
tendency to lose things like toys, notebooks, or homework
distractibility
forgetfulness in daily activities

2. a hyperactive-impulsive type, with signs that include:
fidgeting or squirming
difficulty remaining seated
excessive running or climbing
difficulty playing quietly
always seeming to be "on the go"
excessive talking
blurting out answers before hearing the full question
difficulty waiting for a turn or in line
problems with interrupting or intruding

3. a combined type, which involves a combination of the other two types and is the most common

Although it can be challenging to raise kids with ADHD, it's important to remember they aren't "bad," "acting out," or being difficult on purpose. And they have difficulty controlling their behavior without medication or behavioral therapy.
Diagnosis

Because there's no test that can determine the presence of ADHD, a diagnosis depends on a complete evaluation. Many children and adolescents diagnosed with ADHD are evaluated and treated by primary care doctors including pediatricians and family practitioners, but your child may also be referred to one of several different specialists (psychiatrists, psychologists, neurologists) especially when the diagnosis is in doubt, or if there are other concerns, such as Tourette syndrome, a learning disability, anxiety, or depression.

To be considered for a diagnosis of ADHD:
a child must display behaviors from one of the three subtypes before age 7
these behaviors must be more severe than in other kids the same age
the behaviors must last for at least 6 months
the behaviors must occur in and negatively affect at least two areas of a child's life (such as school, home, day-care settings, or friendships)

The behaviors must also not only be linked to stress at home. Kids who have experienced a divorce, a move, an illness, a change in school, or other significant life event may suddenly begin to act out or become forgetful. To avoid a misdiagnosis, it's important to consider whether these factors played a role in the onset of symptoms

First, your child's doctor will take a medical history by performing a physical examination and asking you about any concerns and symptoms, your child's past health, your family's health, any medications your child is taking, any allergies your child may have, and other issues.

The doctor may also check hearing and vision so other medical conditions can be ruled out. Because some emotional conditions, such as extreme stress, depression, and anxiety, can also look like ADHD, you'll fill out questionnaires to help rule them out.

You'll be asked many questions about your child's development and behaviors at home, school, and among friends. Other adults who see your child regularly (like teachers, who are often the first to notice ADHD symptoms) probably will be consulted, too. An educational evaluation, which usually includes a school psychologist, may also be done. It's important for everyone involved to be as honest and thorough as possible about your child's strengths and weaknesses.
Causes of ADHD

ADHD is not caused by poor parenting, too much sugar, or vaccines.

ADHD has biological origins that aren't yet clearly understood. No single cause has been identified, but researchers are exploring a number of possible genetic and environmental links. Studies have shown that many kids with ADHD have a close relative who also has the disorder.

Although experts are unsure whether this is a cause of the disorder, they have found that certain areas of the brain are about 5% to 10% smaller in size and activity in kids with ADHD. Chemical changes in the brain also have been found.

Recent research also links smoking during pregnancy to later ADHD in a child. Other risk factors may include premature delivery, very low birth weight, and injuries to the brain at birth.

Some studies have even suggested a link between excessive early television watching and future attention problems. Parents should follow the American Academy of Pediatrics' (AAP) guidelines, which say that children under 2 years old should not have any "screen time" (TV, DVDs or videotapes, computers, or video games) and that kids 2 years and older should be limited to 1 to 2 hours per day, or less, of quality television programming.
Related Problems

One of the difficulties in diagnosing ADHD is that it's often found in conjunction with other problems. These are called coexisting conditions, and about two thirds of kids with ADHD have one. The most common coexisting conditions are:
Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)

At least 35% of kids with ADHD also have oppositional defiant disorder, which is characterized by stubbornness, outbursts of temper, and acts of defiance and rule breaking. Conduct disorder is similar but features more severe hostility and aggression. Kids who have conduct disorder are more likely to get in trouble with authority figures and, later, possibly with the law. Oppositional defiant disorder and conduct disorder are seen most commonly with the hyperactive and combined subtypes of ADHD.
Mood Disorders

About 18% of kids with ADHD, particularly the inattentive subtype, also experience depression. They may feel inadequate, isolated, frustrated by school failures and social problems, and have low self-esteem.
Anxiety Disorders

Anxiety disorders affect about 25% of kids with ADHD. Symptoms include excessive worry, fear, or panic, which can also lead to physical symptoms such as a racing heart, sweating, stomach pains, and diarrhea. Other forms of anxiety that can accompany ADHD are obsessive-compulsive disorder and Tourette syndrome, as well as motor or vocal tics (movements or sounds that are repeated over and over). A child who has symptoms of these other conditions should be evaluated by a specialist.
Learning Disabilities

About half of all kids with ADHD also have a specific learning disability. The most common learning problems are with reading (dyslexia) and handwriting. Although ADHD isn't categorized as a learning disability, its interference with concentration and attention can make it even more difficult for a child to perform well in school.

If your child has ADHD and a coexisting condition, the doctor will carefully consider that when developing a treatment plan. Some treatments are better than others at addressing specific combinations of symptoms.
Treating ADHD

ADHD can't be cured, but it can be successfully managed. Your child's doctor will work with you to develop an individualized, long-term plan. The goal is to help a child learn to control his or her own behavior and to help families create an atmosphere in which this is most likely to happen.

In most cases, ADHD is best treated with a combination of medication and behavior therapy. Any good treatment plan will require close follow-up and monitoring, and your doctor may make adjustments along the way. Because it's important for parents to actively participate in their child's treatment plan, parent education is also considered an important part of ADHD management.
Medications

Several different types of medications may be used to treat ADHD:
Stimulants are the best-known treatments — they've been used for more than 50 years in the treatment of ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There's currently no evidence of long-term side effects.
Nonstimulants were approved for treating ADHD in 2003. These appear to have fewer side effects than stimulants and can last up to 24 hours.
Antidepressants are sometimes a treatment option; however, in 2004 the U.S. Food and Drug Administration (FDA) issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. If an antidepressant is recommended for your child, be sure to discuss these risks with your doctor.

Medications can affect kids differently, and a child may respond well to one but not another. When determining the correct treatment, the doctor might try various medications in various doses, especially if your child is being treated for ADHD along with another disorder.
Behavioral Therapy

Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when combined with behavioral therapy.

Behavioral therapy attempts to change behavior patterns by:
reorganizing a child's home and school environment
giving clear directions and commands
setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones

Here are examples of behavioral strategies that may help a child with ADHD:
Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime. Post the schedule in a prominent place, so your child can see what's expected throughout the day and when it's time for homework, play, and chores.
Get organized. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
Avoid distractions. Turn off the TV, radio, and computer games, especially when your child is doing homework.
Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn't overwhelmed and overstimulated.
Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.
Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child's efforts. Be sure the goals are realistic (think baby steps rather than overnight success).
Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior. Younger kids may simply need to be distracted or ignored until they display better behavior.
Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it's sports, art, or music — can boost social skills and self-esteem.
Alternative Treatments

Currently, the only ADHD therapies that have been proven effective in scientific studies are medications and behavioral therapy. But your doctor may recommend additional treatments and interventions depending on your child's symptoms and needs. Some kids with ADHD, for example, may also need special educational interventions such as tutoring, occupational therapy, etc. Every child's needs are different.

A number of other alternative therapies are promoted and tried by parents including: megavitamins, body treatments, diet manipulation, allergy treatment, chiropractic treatment, attention training, visual training, and traditional one-on-one "talking" psychotherapy. However, scientific research has not found them to be effective, and most have not been studied carefully, if at all.

Parents should always be wary of any therapy that promises an ADHD "cure." If you're interested in trying something new, speak with your doctor first.
Parent Training

Parenting a child with ADHD often brings special challenges. Kids with ADHD may not respond well to typical parenting practices. Also, because ADHD tends to run in families, parents may also have some problems with organization and consistency themselves and need active coaching to help learn these skills.

Experts recommend parent education and support groups to help family members accept the diagnosis and to teach them how to help kids organize their environment, develop problem-solving skills, and cope with frustrations. Training can also teach parents to respond appropriately to a child's most trying behaviors with calm disciplining techniques. Individual or family counseling can also be helpful.
ADHD in the Classroom

As your child's most important advocate, you should become familiar with your child's medical, legal, and educational rights.

Kids with ADHD are eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. Keep in touch with teachers and school officials to monitor your child's progress.

In addition to using routines and a clear system of rewards, here are some other tips to share with teachers for classroom success:
Reduce seating distractions. Lessening distractions might be as simple as seating your child near the teacher instead of near the window.
Use a homework folder for parent-teacher communications. The teacher can include assignments and progress notes, and you can check to make sure all work is completed on time.
Break down assignments. Keep instructions clear and brief, breaking down larger tasks into smaller, more manageable pieces.
Give positive reinforcement. Always be on the lookout for positive behaviors. Ask the teacher to offer praise when your child stays seated, doesn't call out, or waits his or her turn instead of criticizing when he or she doesn't.
Teach good study skills. Underlining, note taking, and reading out loud can help your child stay focused and retain information.
Supervise. Check that your child goes and comes from school with the correct books and materials. Sometimes kids are paired with a buddy to can help them stay on track.
Be sensitive to self-esteem issues. Ask the teacher to provide feedback to your child in private, and avoid asking your child to perform a task in public that might be too difficult.
Involve the school counselor or psychologist. He or she can help design behavioral programs to address specific problems in the classroom.
Helping Your Child

You're a stronger advocate for your child when you foster good partnerships with everyone involved in your child's treatment — that includes teachers, doctors, therapists, and even other family members. Take advantage of all the support and education that's available, and you'll help your child navigate toward success.

About Teen Suicide

2009-02-02T00:32:00.000+08:00

10 Things That Might Surprise You About Being Pregnant

2009-01-31T23:57:00.000+08:00

Pregnancy is a subject that generates a lot of paper. Bookstores and libraries devote not just shelves but entire aisles to it. At your first prenatal visit, your doctor will likely load you down with armfuls of pamphlets that cover every test and trimester. But despite all this information, pregnancy can take any soon-to-be parent by surprise.

What the Doctor May Leave Out

If your doctor hasn't mentioned the following topics during your visits, he or she isn't purposefully omitting the information. More likely, your doctor hasn't brought them up because pregnancy affects women in different ways. For example, some pregnant women experience morning sickness in the morning, some feel it all day, and some never have it. Or your doctor might not mention something because it doesn't have a medical focus — a doctor may not have any more insight into your increasing shoe size than your neighbor does! Also, some women may think questions about breast size or hemorrhoids are too personal or embarrassing to ask their doctors.

Any concerns you have about your or your baby's emotional or physical health, regardless of how unrelated or trivial they may seem, should be discussed with your doctor. He or she has seen many expectant parents, some less worried and some more worried than you, and can reassure you when there is no problem or give you more information when there is one. And if your doctor doesn't take the time to listen to your concerns or doesn't seem to take them seriously, you should feel free to get a second opinion.
Altered States

Pregnancy doesn't just change your body — it affects the rest of you, too.
1. The Nesting Instinct

Many pregnant women experience the nesting instinct, a powerful urge to prepare their home for the baby by cleaning and decorating. Or perhaps you'll want to tackle projects you haven't had time to do, like organizing your garage or closets.

As your due date draws closer, you may find yourself cleaning cupboards or washing walls — things you never would have imagined doing in your ninth month of pregnancy! This desire to prepare your home can be useful because it will give you more time to recover and nurture your baby after the birth. But be careful not to overdo it.
2. Inability to Concentrate

In the first trimester, fatigue and morning sickness can make many women feel worn out and mentally fuzzy. But even well-rested pregnant women may experience an inability to concentrate and periods of forgetfulness. A preoccupation with the baby is partially the cause, as are hormonal changes. Everything — including work, bills, and doctor appointments — may seem less important than the baby and the impending birth. You can combat this forgetfulness by making lists to help you remember dates and appointments.
3. Mood Swings

Premenstrual syndrome and pregnancy are alike in many ways. Your breasts swell and become tender, your hormones fluctuate, and you may feel moody. If you suffer from premenstrual syndrome, you're likely to have more severe mood swings during pregnancy. They can make you go from feeling happy one minute to feeling like crying the next. You may be irrationally angry with your partner one day, then a coworker may inexplicably irritate you the next.

Mood swings are incredibly common during pregnancy, although they tend to occur more frequently in the first trimester and toward the end of the third trimester.

About 10% of pregnant women experience depression during pregnancy. If you have symptoms such as sleep disturbances, changes in eating habits (a complete lack of appetite or an inability to stop eating), and exaggerated mood swings for longer than 2 weeks, you should talk to your doctor.
Unexpected Effects of Pregnancy
4. Bra Size

An increase in breast size is one of the first signs of pregnancy. Breasts usually become swollen and enlarged in the first trimester because of increased levels of the hormones estrogen and progesterone. That growth in the first trimester isn't necessarily the end, either — your breasts can continue to grow throughout your pregnancy!

In addition to the size of your breasts, your bra size may be affected by your rib cage. When you're pregnant, your lung capacity increases so you can take in extra oxygen for yourself and the baby, which may result in a bigger chest size. You may need to replace your bras several times over the course of your pregnancy.
5. Skin

Are your friends saying you have that pregnancy glow? It's only one of many skin changes you may experience during pregnancy due to hormonal changes and the stretching of your skin to accommodate a larger body. Pregnant women experience an increase in blood volume to provide extra blood flow to the uterus and to meet the metabolic needs of the fetus. They also have increased blood flow to their other organs, especially the kidneys. The greater volume brings more blood to the vessels and increases oil gland secretion.

Some women develop brownish or yellowish patches called chloasma, or the "mask of pregnancy," on their faces. And some will notice a dark line on the midline of the lower abdomen, known as the linea nigra (or linea negra), as well as hyperpigmentation (darkening of the skin) of the nipples, external genitalia, and anal region. These are the result of pregnancy hormones, which cause the body to produce more pigment. The body may not produce this increased pigment evenly, however, so the darkened skin may appear as splotches of color. Unfortunately, chloasma can't be prevented, but wearing sunscreen and avoiding UV light can minimize its effects.

Acne is common during pregnancy because the skin's sebaceous glands increase their oil production. And newly formed pimples might not be the only evolving spots on your face or body — moles or freckles that you had prior to pregnancy may become bigger and darker. Even the areola, the area around the nipples, becomes darker. Except for the darkening of the areola, which is usually permanent, these skin changes will likely disappear after you give birth. Many women also experience heat rash, caused by dampness and perspiration, during pregnancy.

In general, pregnancy can be an itchy time for a woman. Skin stretching over the abdomen may cause itchiness and flaking. Your doctor can recommend creams to soothe dry or itchy skin.

6. Hair and Nails

Many women experience changes in hair texture and growth during pregnancy. The hormones secreted by your body will cause your hair to grow faster and fall out less. But these hair changes usually aren't permanent; most women lose a significant amount of hair in the postpartum period or after they stop breastfeeding.

Some women find that they grow hair in unwanted places, such as on the face or belly or around the nipples. Others experience changes in hair texture that make hair drier or oilier. Some women even find their hair changing color.

Nails, like hair, can change noticeably during pregnancy. Extra hormones can make them grow faster and become stronger. Some women, however, find that their nails tend to split and break more easily during pregnancy. Like the changes in hair, nail changes aren't permanent. If your nails split and tear more easily when you're pregnant, keep them trimmed and avoid the chemicals in nail polish and nail polish remover.

7. Shoe Size

Even though you can't fit into any of your prepregnancy clothes, you still have your shoes, right? Maybe — but maybe not. Because of the extra fluid in their pregnant bodies, many women experience swelling in their feet and may even have to start wearing a larger shoe size. Wearing slip-on shoes in a larger size will be more comfortable for many pregnant women, especially in the summer months.
8. Joint Mobility

During pregnancy, your body produces a hormone known as relaxin, which is believed to help prepare the pubic area and the cervix for the birth. The relaxin loosens the ligaments in your body, making you less stable and more prone to injury. It's easy to overstretch or strain yourself, especially the joints in your pelvis, lower back, and knees. When exercising or lifting objects, go slowly and avoid sudden, jerky movements.
9. Varicose Veins, Hemorrhoids, and Constipation

Varicose veins, which are usually found in the legs and genital area, occur when blood pools in veins enlarged by the hormones of pregnancy. Varicose veins often disappear after pregnancy, but you can lessen them by:
avoiding standing or sitting for long periods of time
wearing loose-fitting clothing
wearing support hose
elevating your feet when you sit

Hemorrhoids — varicose veins in the rectum — frequently occur during pregnancy as well. Because your blood volume has increased and your uterus puts pressure on your pelvis, the veins in your rectum may enlarge into grape-like clusters. Hemorrhoids can be extremely painful, and they may bleed, itch, or sting, especially during or after a bowel movement. Coupled with constipation, another common pregnancy woe, hemorrhoids can make going to the bathroom downright unpleasant.

Constipation is common throughout pregnancy because pregnancy hormones slow the rate of food passing through the gastrointestinal tract. During the later stages of pregnancy, your uterus may push against your large intestine, making it difficult for waste to be eliminated. Constipation can contribute to hemorrhoids because straining may enlarge the veins of the rectum.

The best way to combat constipation and hemorrhoids is to prevent them. Eating a fiber-rich diet, drinking plenty of fluids daily, and exercising regularly can help keep bowel movements regular. Stool softeners (not laxatives) may also help. If you do have hemorrhoids, see your doctor for a cream or ointment that can shrink them.
Birth Day Surprises
10. Things That Will Come Out of Your Body

So you've survived the mood swings and the hemorrhoids, and you think your surprises are over. Guess again — the day you give birth will probably hold the biggest surprises of all.

Only 1 in 10 mothers' water breaks before labor contractions begin. Some women never experience it — a doctor may need to rupture the amniotic sac (if the cervix is already dilated) when they arrive at the hospital. How much water can you expect? For a full-term baby, there are normally about 2.1 to 5.9 cups of amniotic fluid. Some women may feel an intense urge to urinate that leads to a gush of fluid when their waters break. Others may have only a trickling sensation down their leg because the baby's head acts like a stopper to prevent most of the fluid from leaking out. In any case, amniotic fluid is generally sweet-smelling and pale or colorless and is replaced by your body every 3 hours, so don't be surprised if you continue to leak fluid, about a cup an hour, until delivery.

Other unexpected things may come out of your body during labor in addition to your baby, blood, and amniotic fluid. Some women experience nausea and vomiting. Others have diarrhea before or during labor, and flatulence (passing gas) is also common. During the pushing phase of labor, you may lose control of your bladder or bowels. A birth plan can be especially helpful in communicating your wishes to your health care providers about how to handle these and other discomforts of labor and delivery.

Lots of surprises are in store for you once you become pregnant — but none sweeter than the way you'll feel once your newborn is in your arms!

Anxiety, Fears, and Phobias

2009-01-30T00:12:00.000+08:00

Everyone, from the youngest child to the oldest adult, experiences anxieties and fears at one time or another. Feeling anxious in a particularly uncomfortable situation never feels very good. However, with kids, such feelings are not only normal, they're also necessary. Experiencing and dealing with anxieties can prepare young people to handle the unsettling experiences and challenging situations of life.

Anxieties and Fears Are Normal

Anxiety is defined as "apprehension without apparent cause." It usually occurs when there's no immediate threat to a person's safety or well being, but the threat feels real.

Anxiety makes someone want to escape the situation — fast. The heart beats quickly, the body might begin to perspire, and "butterflies" in the stomach soon follow. However, a little bit of anxiety can actually help people stay alert and focused.

Having fears or anxieties about certain things can also be helpful because it makes kids behave in a safe way. For example, a kid with a fear of fire would avoid playing with matches.

The nature of anxieties and fears change as kids grow and develop:
Babies experience stranger anxiety, clinging to parents when confronted by people they don't recognize.
Toddlers around 10 to 18 months old experience separation anxiety, becoming emotionally distressed when one or both parents leave.
Kids ages 4 through 6 have anxiety about things that aren't based in reality, such as fears of monsters and ghosts.
Kids ages 7 through 12 often have fears that reflect real circumstances that may happen to them, such as bodily injury and natural disaster.

As kids grow, one fear may disappear or replace another. For example, a child who couldn't sleep with the light off at age 5 may enjoy a ghost story at a slumber party years later. And some fears may extend only to one particular kind of stimulus. In other words, a child may want to pet a lion at the zoo but wouldn't dream of going near the neighbor's dog.
Signs of Anxiety

Typical childhood fears change with age. They include fear of strangers, heights, darkness, animals, blood, insects, and being left alone. Kids often learn to fear a specific object or situation after having an unpleasant experience, such as a dog bite or an accident.

Separation anxiety is common when young children are starting school, whereas adolescents may experience anxiety related to social acceptance and academic achievement.

If anxious feelings persist, they can take a toll on a child's sense of well being. The anxiety associated with social avoidance can have long-term effects. For example, a child with fear of being rejected can fail to learn important social skills, causing social isolation.

Many adults are tormented by fears that stem from childhood experiences. An adult's fear of public speaking may be the result of embarrassment in front of peers many years before. It's important for parents to recognize and identify the signs and symptoms of kids' anxieties so that fears don't get in the way of everyday life.

Some signs that a child may be anxious about something may include:
becoming clingy, impulsive, or distracted
nervous movements, such as temporary twitches
problems getting to sleep and/or staying asleep longer than usual
sweaty hands
accelerated heart rate and breathing
nausea
headaches
stomachaches

Apart from these signs, parents can usually tell when their child is feeling excessively uneasy about something. Lending a sympathetic ear is always helpful, and sometimes just talking about the fear can help a child move beyond it.
What's a Phobia?

When anxieties and fears persist, problems can arise. As much as a parent hopes the child will grow out of it, sometimes the opposite occurs, and the cause of the anxiety looms larger and becomes more prevalent. The anxiety becomes a phobia, or a fear that's extreme, severe, and persistent.

A phobia can be very difficult to tolerate, both for kids and those around them, especially if the anxiety-producing stimulus (whatever is causing the anxiety) is hard to avoid (e.g., thunderstorms).

"Real" phobias are one of the top reasons children are referred to mental health professionals. But the good news is that unless the phobia hinders the everyday ability to function, the child sometimes won't need treatment by a professional because, in time, the phobia will be resolved.
Focusing on Anxieties, Fears, or Phobias

Try to answer the following questions honestly:

Is your child's fear and behavior related to it typical for your child's age? If the answer to this question is yes, it's a good bet that your child's fears will resolve before they become a serious cause for concern. This isn't to say that the anxiety should be discounted or ignored; rather, it should be considered as a factor in your child's normal development.

Many kids experience age-appropriate fears, such as being afraid of the dark. Most, with some reassurance and perhaps a night-light, will overcome or outgrow it. However, if they continue to have trouble or there's anxiety about other things, the intervention may have to be more intensive.

What are the symptoms of the fear, and how do they affect your child's personal, social, and academic functioning? If symptoms can be identified and considered in light of your child's everyday activities, adjustments can be made to alleviate some of the stress factors.

Does the fear seem unreasonable in relation to the reality of the situation; and could it be a sign of a more serious problem? If your child's fear seems out of proportion to the cause of the stress, this may signal the need to seek outside help, such as a counselor, psychiatrist, or psychologist.

Parents should look for patterns. If an isolated incident is resolved, don't make it more significant than it is. But if a pattern emerges that's persistent or pervasive, you should take action. If you don't, the phobia is likely to continue to affect your child.

Contact your doctor and/or a mental health professional who has expertise in working with kids and adolescents.
Helping Your Child

Parents can help kids develop the skills and confidence to overcome fears so that they don't evolve into phobic reactions.

To help your child deal with fears and anxieties:
Recognize that the fear is real. As trivial as a fear may seem, it feels real to your child and it's causing him or her to feel anxious and afraid. Being able to talk about fears helps — words often take some of the power out of the negative feeling. If you talk about it, it can become less powerful.
Never belittle the fear as a way of forcing your child to overcome it. Saying, "Don't be ridiculous! There are no monsters in your closet!" may get your child to go to bed, but it won't make the fear go away.
Don't cater to fears, though. If your child doesn't like dogs, don't cross the street deliberately to avoid one. This will just reinforce that dogs should be feared and avoided. Provide support and gentle care as you approach the feared object or situation with your child.
Teach kids how to rate fear. A child who can visualize the intensity of the fear on a scale of 1 to 10, with 10 being the strongest, may be able to "see" the fear as less intense than first imagined. Younger kids can think about how "full of fear" they are, with being full "up to my knees" as not so scared, "up to my stomach" as more frightened, and "up to my head" as truly petrified.
Teach coping strategies. Try these easy-to-implement techniques. Using you as "home base," the child can venture out toward the feared object, and then return to you for safety before venturing out again. The child can also learn some positive self-statements, such as "I can do this" and "I will be OK" to say to himself or herself when feeling anxious. Relaxation techniques are helpful, including visualization (of floating on a cloud or lying on a beach, for example) and deep breathing (imagining that the lungs are balloons and letting them slowly deflate).

The key to resolving fears and anxieties is to overcome them. Using these suggestions, you can help your child better cope with life's situations.