Good quality, restorative sleep is essential for optimal health and well-being. Insufficient sleep can cause problems with irritability, decreased daytime alertness and poor academic performance, and can contribute to depression, anxiety, ADHD and other mental health issues. Most parents know that sleep is important at all ages, yet in recent years I hear more patients tell me that they often do not sleep well.
Our society has become increasingly dependent on electronics to function in our daily lives. Most parents and children use computers at work and school, and at home we are texting on our smart phones or keeping up with friends on social media. Our children often study and complete assignments online, but recently, more evidence indicates that an increase in sleep problems may be related to these electronic devices. Light receptors in the retina transmit messages to the brain, and the brain responds with an increase in alertness. The particular type of light associated with i-pads, computers, smart phones, video games, e-readers, and other electronic devices with a lighted screen, seems to be particularly stimulating to the "awake" centers in our brains. Some people are more susceptible to this than others.
Making it a habit to turn off electronic devices at least an hour before bedtime can be of great benefit in improving sleep. Some children who are very sensitive may require longer than this, even several hours. Encourage your child to complete their online schoolwork first, so they can read (actual books, not e-readers) and do other non-computer based assignments later in the evenings. Parents should always make sure that their children's access to social media is adequately monitored and developmentally appropriate, but it is also important that electronics not be routinely used late in the evenings and into the night-time hours. Several families have told me that they have instituted a "turn-off, turn-in" policy and at an agreed upon time, their children are to turn their devices off and leave them in a specific location (not in their bedroom, where they may be tempted)
For children that struggle with sleep issues, having a regular bedtime routine can help them "wind down." Depending on the age of the child, bath or shower, getting schoolwork and lunches ready, story-time or reading a book, listening to soothing music or guided relaxation/meditation may be calming and beneficial. Avoid caffeinated beverages and concentrated sweets, especially late in the day. Most of my patients will tell me that they sleep better and feel better when they are involved in sports or other regular exercise. Over-the-counter and prescription sleep aids are not recommended for most children, and should be used only after consulting with your childs' pediatrician.
Some older children and teens tend to fall into bad sleep habits over the summer, staying up late and sleeping in. They then struggle with getting up early for school. Although it can be difficult, try to maintain a consistent bedtime and avoid napping after school, then staying up late again at night. It may take some time to get back into a good routine. If you suspect that a medical issue such as asthma or sleep apnea might be the cause of your child's sleep problem, please call our office to set up a consult appointment to discuss this with us. If you are concerned that your child is suffering from a mental health issue such as depression or a significant anxiety disorder, or if you suspect a substance abuse issue please call for a referral to a qualified mental health provider.
by Dr. Kathleen Maurer
Not too many years ago, children got most of their shots before they started kindergarten, and older children only needed an occasional tetanus booster . Things have changed over the past decade, and several important vaccines are now recommended for 11-18 year olds. Your pre-teen or teen-ager may be less than enthusiastic about getting vaccines when they come if for a sports physical or yearly exam, but it may help if they are prepared and understand the benefits of being protected from some very serious diseases.
1. Hepatitis A - This vaccine protects against a virus that affects the liver and can easily be transmitted person to person. There have also been a number of outbreaks through contaminated food or food handlers. International travel is also a risk factor, but with a more global society, community outbreaks have become more common. About 10-11 years ago, we began routinely giving Hepatitis A vaccine at 15 months and 2 years of age, so most of our younger patients have already had this vaccine, but many over 12 have not had this. Beginning in 2018, Kentucky Schools are requiring this vaccine for all students, so those who have not had it will need to get it. Students will need to have 2 doses of Hepatitis A vaccine at least 6 months apart. If your child has not had both doses of Hepatitis A vaccine, please call our office to schedule an appointment.
2. Pertussis (whooping cough) - Although this vaccine is included in the routine baby shots and preschool boosters, immunity tends to wane over time, and community outbreaks have become common. Older children and adults with pertussis may only have a very persistent and annoying cough, but this disease can be very dangerous and even fatal for vulnerable newborns and babies who are too young to be fully vaccinated. Beginning about 6 years ago, the Center for
Disease Control (CDC) and American Academy of Pediatrics (AAP) recommend all 11 year olds receive a dose of pertussis vaccine which is combined with tetanus vaccine (Tdap). This is now required for all Kentucky School children. (also recommended for all women during pregnancy, close contacts of all newborns and infants, childcare workers, and healthcare providers)
3. Meningitis A vaccine (meningitis A, C, W, Y) -This vaccine protects against several strains of bacteria that can infect the blood, brain and spinal cord and cause serious and life threatening illness. It is most common in teens and young adults, and can spread quickly. The scary thing about this devastating and potentially deadly infection is that it can infect otherwise healthy young people, and its onset tends to be very rapid. A dose of Meningitis A vaccine is required at age 11, with a booster dose at age 16. (Certain high-risk patients may need to get this vaccine before age 11)
4. Meningitis B vaccine - This vaccine protects against a serogroup of the meningitis bacteria that is not included in the required Meningitis A vaccine. Within the past 5 years, multiple college campuses have experienced outbreaks of Meningitis B. The symptoms are identical to the other strains of meningitis, causing serious illness or deaths. Two doses of this vaccine are recommended for 16-18 year olds, and especially encouraged for those who will be heading to college.
5. HPV - Human Papilloma Virus is very prevalent in the population in general and is the cause of almost all cases of cervical cancer in women and some genital and head and neck cancers in men, as well as genital warts. Although its primary means of transmission is through sexual contact, it is not only careless people who contract this infection. Most people have no symptoms at all from this virus and it eventually clears on its own, but some cases will persist and lead to cancers. The first HPV vaccine, which covered for the most common cancer-causing strains, was approved in 2006. The current Gardasil 9, which has expanded protection against more strains of the virus, was approved in 2014. HPV vaccine is recommended for both boys and girls, ages 11 and up (approved down to age 9) Those who receive the first dose of vaccine prior to their 15th birthday only need 2 doses, 6 months apart, while those 15 and older will need 3 doses.
Earlier this year my blog discussed various diets, their common characteristics and best current recommendations. This month, I wanted to begin discussing the individual components and how much we need in our diets.
The first question onmivorous (eat everything) people ask vegetarians is "where do you get your protein?" Most Hindus would beg to differ. They are healthy and enjoy a vegetarian diet or a Lacto (milk products) vegetarian diet. So maybe we don't have to eat meat protein; vegetables, dairy, legumes, eggs, grains and nuts can be rich sources of protein. Humans need less than half a gram of protein per pound of their healthy weight daily or making it real, a 22 pound toddler needs about 8 grams of protein. A single egg contains around 6, a piece of bread 2-4 or more, a 4 ounce glass of milk is 4 grams. So that meal for breakfast would give the child all the protein or a minimum of 12 in that meal alone for the day. Recent studies have shown that children who eat an egg per day in the second year of life are taller generally (similar findings are out there about whole cow's milk vs. plant milks). How should this information form our habits? A typical 110 pound woman needs around 40 grams of protein per day. If we take in about a third of that for breakfast, it will keep us satisfed until lunch compared to a similar breakfast in calories but without enough protein.
Some foods and their protein amounts: Cooked meats and fish are about 7 grams per ounce, 1 egg is 6 grams, 8 ounce glass of milk is 8 grams, 1/2 ounce nuts is 6 grams, 1 tablespoon of peanut or other nut butter is 7 grams, 1/4 cup of cooked beans, peas or tofu is 7 grams, 1/3 cup of cottage or ricotta cheese is 10 grams, 1 cup of cooked oatmeal is 7 grams, 1 ounce of cheese (the harder tend to be higher) is 4-12 grams, breads or a bagel is 2.5 - 10 grams (variable), cerieals, cold per serving are very variable, pasta is 12.5 grams, Quinoa, teff, amaranth are variable but rich sources of protein.
I wrote about the toddler's breakfast; how about for grown ups? If we try to get a quarter or a third of our protein for breakfast, how about a peanut butter sandwich on whole grain bread, an egg cheese and veggie omelet, greek yogurt with fruit, nuts or a quality granola topping, a breakfast burrito? Cereals can be a good breakfast but many are short on protein. Where are these gram amounts shown? On all food labels it's listed. On another blog, I will discuss fats, carbohydrates, fiber and some of the micro nuturients we should get in a varied, balanced diet. Remembering the 5-2-1-0 plan recommended for children (and adults) 5 servings of fruits and bvegetables per day, 2 hours max of screen time (except for school work), 1 hour of exercise and 0 sugared drinks, but getting a good breakfast with enough protein is an excellent start and enough protein the rest of the day is essential.
Did you know Food and Allergy Awareness Week was May 14-20, 2017? Well, it’s never too late to be aware of Peanut Allergies.
One of the most common food allergies in children is peanuts, and the prevalence in the United States is increasing. Food allergies most often begin in the first 2 years of life. In countries, including the United States, where peanut introduction is delayed, peanut allergies have more than doubled in young children. The Learning Early about Peanut Allergy (LEAP) trial was the first randomized trial to show the benefit of early introduction of peanut into a child’s diet resulting in a decreased risk of developing peanut allergy.
Children who are at increased risk for developing a peanut allergy include:
The American Academy of Pediatrics (AAP) recently introduced new guidelines for the introduction of peanuts.
There are two methods for allergy testing: blood testing for peanut-specific IgE or skin prick testing.
When introducing peanuts to an infant, remember whole nuts and peanut butter can be a chocking hazard. We suggest adding water to smooth peanut butter and make a puree. Put the puree on the tip of the spoon and feed your child. Wait and watch for any reactions. Allergic reactions to peanuts can include hives (raised, red areas of skin that are itchy), swelling of the tongue, trouble breathing/wheezing, vomiting or diarrhea.
For further information on food allergies visit
- FARE (Food Allergy Research and Education) foodallergy.org
I have been a Family Nurse Practitioner for almost seventeen years. I worked at Kosair Hospital (now known as Norton Children's Hospital) for six years, prior to that as an Onocology/Renal/Transplant nurse. I also worked at Norton Hospital while attending nursing school at the University of Louisville. I have spent all of my professional years working with children and families. I cannot imagine doing anything else. But the face of healthcare and insurance and its cost has changed dramatically in my years of practice.
The ever changing dilemma of health insurance coverage for ourselves and our family affects us all. As a mother and wife keeping up with what is covered in my plan, annual deductibles, pharmacy benefits, co-pays and in and out of network providers is a huge undertaking. Once you think you have it down a new enrollment period is upon you and it changes again. One thing that I am certain of is you need to understand your plan and be an advocate for yourself. Take advantage of the programs your insurance company has in place to keep costs down, ask questions, be friendly with your health insurance representatives and ASK QUESTIONS. With the passage of "Obamacare" a few years back one of the most beneficial components is wellness benefits for all at no or minimal cost. This is especially important for our children as they grow. They need to be seen at each recommended and scheduled time for Well Baby-Child/Adolescent/College Age student visits. The importance of seeing a trusted and well informed Pediatrician/Osteopath/Nurse Practitioner/Physician Assistant is imperative for health guidance and illness prevention in our next generation of adults. The rise in healthcare costs and a US population that seems to get less fit each year should be a concern for us all. Our children truly are our future and how we raise them and teach them will impact who they are as adults. I believe healthcare is a basic right but the idea that it should come without financial responsibility and accountability is a reality we likely will not see again in our lifetime. So plan and prepare, realize that health insurance is part of a famly budget. Here are some websites to help you begin to get informed. A healthy mind and body is essential for us all.
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