The value of free play: How to raise confident, comfortable kids

This article was written by Katie Vaughan and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine as part of a larger series on independence. 

Illustration by Brave the Woods

Illustration by Brave the Woods

Free play constitutes any time when kids can use their imagination without constraints. Yet, when kids play on their own, parents often have a hard time not commenting. Though it may be difficult at first, try to simply notice what your kids do and refrain from making comments, even if it’s a compliment or a seemingly harmless suggestion.

Be curious, open and state only the obvious: “I notice that you picked up the red block,” or “I’d love to know more about what you’re building.” This allows children to indulge their own creativity and build problem-solving skills.

Over the past few decades, kids have experienced less and less free play time. Recess has long been a primary place for free play, but recess time at school has diminished in recent years. In fact, in 2013, the AAP released a study emphasizing the importance of recess, and called on schools to allow more unstructured time for kids to explore and imagine. The benefits for kids include reduced stress, improved social skills and increased cognitive performance. (Good news for grown-ups: It’s good for us, too!)

Free play can include spending time outside in nature, playing with friends or simply sitting and daydreaming. Dr. Craigan Usher advises parents to “set up a space where kids can access their own toys and crafts so they can engage in free play when they feel like it.”

He recommends generic toys that encourage imagination and exploration, like building blocks or art supplies that don’t require adult supervision.

“The longer children can enjoy play without the kind of monitoring that leads to self-criticism and self-doubt, the better,” Dr. Usher said.

The lesson here is one we can all benefit from: Turn off that screen and go play!

More resources to help raise confident, comfortable kids:
Body image
Dealing with anxiety
Screen time

On screen: How to raise confident, comfortable kids

This article was written by Katie Vaughan and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine as part of a larger series on independence. 

Illustration by Brave the Woods

Illustration by Brave the Woods

When it comes to kids and screens, today’s parents are entering uncharted territory. The very devices we use for education and productivity are the same ones we use for gaming, socializing and fretting about the latest news. Children and adults alike are more exposed to electronic devices now than ever before, and the ways we interact with them can have a big impact on development. Dr. Craigan Usher, an assistant professor of child and adolescent psychiatry at OHSU Doernbecher Children’s Hospital, emphasizes the importance of self-control.

“It’s not that electronics are bad,” he says. “It’s more about building the skills to be able to pick up and put down screens when necessary.”

By taking time away from group playtime or physical activity, too much screen time may negatively impact how kids develop social skills, build empathy and improve motor skills.

But how much is too much?

The American Academy of Pediatrics (AAP) advises no screens for children under 18 months, but it’s up to you to decide what’s right for your family.

“Start low and always supervise young kids with electronics,” Dr. Usher advises. “Remember that parents are the boss of screen time.”

It’s important to establish clear rules about what kinds of apps and how much screen time is allowed in your family, and hold everyone accountable – including parents!

Kids benefit from learning self control, and this is especially true with electronics. The ability to put down a device and move on to other activities is valuable throughout our lives. So, if your child throws a fit or feels overwhelmed when it’s time to stop playing video games, it might be a good idea to reevaluate whether your child is ready for electronics.

For older children, it’s important to encourage a balance of electronics and face-to-face experiences, like going for a walk, cooking, chatting or drawing together.

To bridge the divide, parents can play video games with their kids, ask about their favorite websites and inquire about their thoughts and feelings about their digital lives.

More resources to help raise confident, comfortable kids:
Body image
Dealing with anxiety
The value of free play

Dealing with anxiety: How to raise confident, comfortable kids

This article was written by Katie Vaughan and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine as part of a larger series on independence. 

Illustration by Brave the Woods

Illustration by Brave the Woods

Would it surprise you to learn that anxiety disorders affect 25 percent of American teenagers?

“Occasional anxiety and worry is normal; it helps us notice our environment and adjust our behavior,” says Dr. Kyle Johnson, child psychiatrist at OHSU Doernbecher Children’s Hospital. “But when that worry causes distress or impairment and hinders a kid’s development, then it’s a problem.”

Anxiety disorders range from social anxiety to PTSD and OCD. According to Dr. Johnson, it’s especially important for young kids with an anxiety disorder to seek professional treatment because they have a higher risk of developing a depressive disorder in adolescence.

Not sure if your child is dealing with an anxiety disorder? Children often have a hard time verbalizing their anxious feelings, so Dr. Johnson suggests keeping an eye out for changes in their behavior. Maybe your child has a sudden reluctance to do certain things, or has started avoiding school and social situations that they once enjoyed. The good news is that if your child struggles with anxious feelings, you can still help them on a day-to-day basis.

“We as parents can always help our kids by modeling means of coping,” says Dr. Johnson.

Talk to them about the times that you’ve ben anxious or worried and the healthy ways you learned to cope, like relaxation or mindfulness techniques.

“Let them know that it’s OK to feel that way and that it usually gets easier each time you do something that makes you anxious,” he advises.

More resources to help raise confident, comfortable kids:
Body image
Screen time
The value of free play

Body image: How to raise confident, comfortable kids

This article was written by Katie Vaughan and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine as part of a larger series on independence. 

Illustration by Brave the Woods

Illustration by Brave the Woods

When it comes to confidence, children and teens have a particularly difficult time overcoming issues with their bodies: acne, weight gain, developing later or earlier than peers, etc.

“Adolescents experience dramatic physical changes at a time when their emotions are elevated and they’re extremely relationship-focused. It’s a lot to deal with,” says Dr. Ajit Jetmalani, a child and adolescent psychiatrist at OHSU Doernbecher Children’s Hospital.

A negative body image can sometimes lead to more extreme diagnoses, like eating disorders and depression. In these cases, parents should certainly consider professional help.

Luckily, kids can start combating negative body issues before it reaches a critical level. Encourage your child to think about their body with compassion. When they critique themselves internally, remind them to ask, “Would I talk to a friend that way?” Dr. Jetmalani emphasizes that health and appearance are not the same thing, and encourages kids (and adults!) to think about what their bodies can do, instead of how they look. It takes practice, but this kind of mindfulness can make a big impact on body image throughout our lives.

As a parent or caregiver, be thoughtful of how you speak about your own body or others’ bodies. Do you often critique your weight or appearance? Most of us do it without realizing, and kids will learn those behaviors. You don’t have to censor every word you say; just maintain an open dialogue with your children and make it clear that you’re their ally when it comes to body issues.

More resources to help raise confident, comfortable kids:
Dealing with anxiety
Screen time
The value of free play

 

 

 

 

2017 in review: Doernbecher’s top stories

We rounded up 10 of the most-read blog posts from 2017. Take a look to see if there are any that you missed!

1. ’13 Reasons Why’ poses risk to Oregon youth
The television series “13 Reasons Why” focuses on very real issues that affect youth and young adults. The show’s graphic depiction of the traumatic life events that led to the suicide of a young woman may have already adversely affected Oregon’s youth. This post originally ran as a guest opinion piece in The Oregonian and was written by Dr. Ajit Jetmalani and other contributors.

2. The healing power of art: CHAP at OHSU Doernbecher
Children’s Healing Art Project (CHAP) has been spreading joy at OHSU Doernbecher Children’s Hospital for 10 years. We asked CHAP Lead Hospital Art Teacher Sharon Jaye Perrins to tell us more about CHAP’s mission and impact at OHSU Doernbecher.

3. Spring forward, fall back: time change tips
Adjusting to a new sleep schedule can be tricky, but a little help and a few days of preparation can make all the difference. Sleep expert Dr. Elizabeth Super provides some tips to make sleep transitions easier on the whole family.

4. Baby in a box? What you need to know about safe infant sleep
A quick Google search about infant sleep will yield a number of products that have not been evaluated or approved by the CPSC as safe. Tom Sargent Safety Center Medical Director Dr. Ben Hoffman shares his concerns about products that may be preying on the anxiety and exhaustion of parents and caregivers.

5. Five ways to help prevent eczema this winter
While we can adjust to the fast-changing weather, we sometimes forget our skin needs help to catch up. Lara Clayton shares some helpful hints to prevent itchy, dry skin (often referred to as eczema) in kids’ skin as we enter the winter months.

6. 2o17 Gifts for good
From holiday ornaments to AmazonSmile, we rounded up several simple ways you can help support OHSU Doernbecher Children’s hospital this holiday season.

7. Doctors Day Q&A with Dr. Casey Seideman
A pediatric urologist, Dr. Casey Seideman takes care of kids and young adults with diseases and disorders of urination, reproductive organs and/or testes. In celebration of Doctors Day, Dr. Seideman tells us more about her career path and why she loves caring for kids and families at OHSU Doernbecher Children’s Hospital.

8. Four water safety tips everyone should know
With the joy and beauty of water comes the potential for tragedy. So what can we do to prevent drowning and keep our children safe? Dr. Laura Waagmeester shares four important things to keep in mind.

9. Lice do’s and don’ts
Lice happens. Dr. Ellen Stevenson shares six tips for treating the itchiest of childhood problems.

10. Meeting Julia: representing autism in the media 
Beloved children’s television program “Sesame Street” recently welcomed a new Muppet on the air. The character’s name is Julia, and she has autism. We sat down with Dr. Lark Huang-Storms to get her take on Julia’s addition to the cast and what this means for families in the autism community.

Five ways to help prevent eczema this winter

We’re having a beautiful fall this year! In true Oregon style, our weather went from warm and dry to cold and rainy. The cold weather brings changes to our daily lives. Inside, we’ve turned the heaters on, which dries out the air. At school, our children go from outside recess to indoor heated classrooms throughout the day. While we can adjust to the fast-changing weather, we sometimes forget our skin needs help to catch up. Here are some helpful hints to prevent itchy, dry skin (often referred to as eczema) in our kiddos’ skin as we enter the winter months.

  • Bath time is a great time for children to calm down before bedtime and we definitely can continue to include it in our nightly routine. Keep the bath lukewarm and try to limit long, hot showers. It’s helpful to use gentle, unscented, cleansers such as Cetaphil, Cerave, Vanicream or Dove at the end of the bath. Avoid scrubbing as this can further dry out the skin. We usually recommend not allowing children to sit in soapy water as this can dry the skin and disrupt the skin barrier.
  • After bathtime is a great time to apply a thick moisturizer or emollient to help seal in the water your child’s skin absorbed during bathing. Lightly pat dry and then begin applying a generous amount of a thick cream to their face and body. The tubs of cream like Cetaphil, Cerave, and Vanicream are usually recommended. I like to get children involved in this process by letting them “finger paint” the cream on their body while a parent or caregiver works on the rest of the body. The key is to make it fun and quick!
  • Add in an extra five minutes before getting them dressed in the morning to apply a thick moisturizer before they go to school.
  • Lips and hands also tend to suffer during the cold weather. Send your children with gloves to protect those little hands from the cold weather. Placing a pump cream by the bathroom sink can increase the opportunity to moisturize after handwashing. If it’s permitted at school, have your children take a small Aquaphor or Vaseline tube to help moisturize their lips at school and home. Children often continually lick their lips to hydrate them, which increases dryness and can lead to inflammation.
  • Although children love fragranced lip balms and lotions, try to avoid them as they often dry out their skin rather than moisturize, and we sometimes see irritation secondary to these.

Tell your provider if your child is having increasing dry skin or inflammation, and bring them in to see one of us in Pediatric Dermatology if they are starting to have sleep disturbance, itching or signs of infection (i.e., honey colored crusting, blistering). We have multiple locations to help serve you better. Lara Clayton primarily practices out of Lake Oswego, but we can also see you at the Center for Health & Healing on OHSU’s South Waterfront campus or on the Marquam Hill campus at OHSU Doernbecher Children’s Hospital.

To schedule an appointment, please call 503 418-3376.

 

Lara Clayton, M.P.A.S., P.A.-C.
Instructor of Dermatology
OHSU Doernbecher Children’s Hospital

2017 Gifts for good

Looking for a way to support OHSU Doernbecher Children’s Hospital this holiday season?

First of all – thank you! We put together a list of ways you can help that will directly benefit patients and families at our hospital. We invite you to consider the items below as you finish up your holiday shopping to make your gifts count!

AmazonSmile
With every purchase of products through AmazonSmile, you’ll donate a percentage of the purchase to OHSU Doernbecher! Learn how it works here, or simply start your Amazon shopping at smile.amazon.com, then select Doernbecher Children’s Hospital Foundation – it’s the one listed as “Hospital (Specialty).”

Cards for Kids
This program, now in its 25th year, transforms artwork collected from OHSU Doernbecher patients, siblings and professional artists into classic cards for every occasion (not just the holidays). Purchase online or by phone – start shopping here. Our committee is also looking for new artwork – if you know a current or former OHSU Doernbecher patient or friend, family member or professional artist, invite them to submit their work here!

Child Life wish list
Patients make more than 140,000 visits to OHSU Doernbecher every year. Our wonderful Child Life team consistently needs new books, toys, art supplies and other items to help patients and families feel more welcome, so they put together this Wish List to help guide your shopping. Items purchased for adolescents and teens are particularly appreciated! Please call ahead if you have a large donation: 503 418-5388. If you’d prefer to shop online and have items shipped directly to OHSU Doernbecher, we have an Amazon list set up here.

Friends of Doernbecher – Dru’s Chapter Ornament Sales
New this year: an ornament featuring Dolly Doernbecher and beloved Hospital Facility Dog Hope! Just what your tree needs! Order here.

Make a donation
For 90 years, OHSU Doernbecher Children’s Hospital has provided the best, most comprehensive pediatric health care services in the region – saving countless kids’ lives. Your support makes that possible! Please consider making a tax-deductible gift here.

 

 

The power of immunization

I am a millennial, and as a member of the generation that includes the children of baby boomers, I’ve been spoiled. Our generation hasn’t seen the kids wearing braces as a result of polio. We haven’t seen the devastating neurologic effects of a measles infection. We’ve been spared the agony of watching haemophilus influenza B (HIB) meningitis drain the life out of a child. We haven’t seen these diseases, and we forget how lucky we are. Most of us don’t acknowledge the incredible and powerful impact that immunizations have had on us because they’re doing exactly what they’re supposed to be doing: preventing horrible diseases. Our success has allowed us to forget.

Vaccines, at their best, cause nothing. It’s a beautiful thing. As kids, we go through vaccination schedules, experience the typical ups, downs, colds and sports injuries as expected, and grow up into adulthood. It’s easy to ignore the silent protection our immunizations give to us, the absence of harm that they make possible. In this case, it’s a boatload of disease that has been successfully kept at bay by immunizations.

So over time, we’ve gotten lulled into complacency by this beautiful void by the epidemic of health and well-being that’s been created. Maybe this allows us the time to ponder things we see, and things we know we should be scared about. We know that immunizations can hurt and cause babies to cry. Often, there are multiple pokes in multiple extremities in one visit. And then there are the components of the vaccines, some of which have been linked to scary things. Despite the substantial body of evidence that has never found a connection to autism or brain damage or cancer, the fears seem to linger. We’re given lots of paperwork with long lists of possible side effects and adverse reactions. It’s complicated. Then there’s the cornucopia of blogs, some reputable and evidence-based, many not, at our fingertips as soon as we Google “immunization” or “vaccine” or the name of any disease we’re trying to prevent. This is a dangerous world that we live in, with so many people and entities trying to take advantage or take our rights or take control.

The problem is, when we are seemingly inundated with these thoughts and doubts and concerns, we don’t readily see the most powerful argument against all of that. And it’s one thing to know that there were millions of hours of research, testing and science behind immunizations, but this isn’t enough.

The real power is in the absence of disease. It’s the infant making it to toddlerhood without needing to be in the intensive care unit with a breathing tube to get through a bout of pertussis. It’s the grandmother who blows out candles on her 90th birthday because she didn’t get influenza. It’s the man who just became a new father because he never got mumps. There are so many things that can bring someone into a hospital that are unavoidable. But we need to remember the things we can prevent, and keep fighting to keep those diseases a memory instead of a reality.

 

Emily Houchen-Wise, M.D.
Resident in Pediatrics
OHSU Doernbecher Children’s Hospital

 

 

Demystifying headaches: Kids suffer from migraines, too

This article was written by Scott Henjum and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

Like adults, children can suffer from migraine headaches. 

“Migraines are the leading cause of recurring headaches in kids,” says Dr. Yoon-Jae Cho, a pediatric neurologist at OHSU Doernbecher Children’s Hospital. “There are signs and symptoms of migraine headaches that differentiate them from other types of headaches. These include aversion to bright lights and loud noises, nausea and sometimes vomiting, and chronic abdominal pain.”

Dr. Cho adds that migraines tend to run in families. Boys tend to develop migraines at a younger age – around 5 to 10 years old – and they often grow out of them. Girls, however, tend to develop them when they are a little older, often in adolescence, and have migraines into adulthood.

“When kids have migraines, they usually want to go to their room turn off all the lights, put a pillow over their head, and sleep it off, which often helps. Unfortunately, that takes kids out of their normal routine and often results in missed school,” Dr. Cho says.

Children, like adults, can get relief from migraines with medications.

Over the past two decades, several drugs have been developed that are quite effective at treating migraines, and some of these have been approved for use in children.

People often have specific triggers for their migraines, says Dr. Cho. “For some, it might be consumption of certain foods, such as sharp cheeses or dark chocolate, or additives such as MSG,” he says. “For others, it might stress, or not getting enough sleep.”

It is often very informative for patients to keep a headache journal and make note of dietary and other activities the day of, or prior to, suffering from a headache.

Kids who claim to be experiencing the “first and worst” headache of their lives should be evaluated, says Dr. Cho. Other red flags include headaches and vomiting that only occur first thing in the morning and improve throughout the day, as well as associated changes in personality or problems with strength, balance or coordination.

Children may also experience tension headaches, which can be common among school-age kids. The primary symptom of a tension headache is aches on both sides of the head, which can be caused by stress, eye strain and poor posture.

To avoid both types of headaches, Dr. Cho recommends staying hydrated, eating healthfully, exercising regularly and getting plenty of sleep.

 

If your child is experiencing headaches, talk with your pediatrician or call OHSU Doernbecher Children’s Hospital at 503 346-0644.

Matters of the heart

This article was written by Scott Henjum and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

To test or not to test? 

Parents of teen athletes face this question every year as they debate whether to sign up their children for heart screenings along with pre-season physical exams. Also known as electrocardiograms, EKGs measure the electrical activity of the heart in order to identify heart defects, but results are rarely conclusive.

The number of heart screening clinics has grown over the past decade as media attention has spotlighted sudden death in athletes. Along the way, the debate about the accuracy and efficacy of the EKG testing has intensified.

“EKG testing can generate false positive and false negative results,” explains Dr. Seshadri Balaji, a pediatric cardiologist at OHSU Doernbecher Children’s Hospital. “An athlete may have an underlying heart problem, but the EKG can miss it. In other cases, the EKG may show something that looks abnormal, and the athlete is subjected to a battery of tests that are risky and expensive, only to generate results that show the heart is normal.”

Dr. Balaji notes that sudden death rates in teens and teen athletes are minuscule, especially compared to deaths from other causes like car accidents or suicide.

Two prominent medical organizations, the American Heart Association (AHA) and the American College of Cardiology (ACC), don’t support EKG screening of young athletes. They contend that no accepted standards exist for what constitutes an abnormal EKG in young athletes, and that there is no evidence that EKG screenings would lower mortality rates.

Dr. Balaji says it’s critical for teen athletes (and all teens) to disclose to their medical providers if members of their family have heart conditions, especially if anyone has died from a sudden or unexplained death at an age younger than 35.

Athletes who experience fainting, lightheadedness or shortness of breath should also be examined by a medical provider, Dr. Balaji says. These symptoms could be explained by asthma, but heart conditions need to be considered as well.

What’s not up for debate, however, is the usefulness of automatic external defibrillators (AEDs). Instead of EKG testing of young athletes, the AHA and ACC recommend wider distribution of defibrillators that can treat an athlete in sudden cardiac arrest. Defibrillators have proven effective in saving young lives on the athletic field and elsewhere.

 

If you are unsure about whether your child should be screened for a heart defect, talk with your pediatrician or call OHSU Doernbecher Children’s Hospital at 503 346-0640. 

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