Febrile Seizures

Young children are prone to frequent viral illnesses and ear infections that are often associated with fever. When a young child has a fever he or she is at risk for having a febrile seizure. We consider a child to have had a febrile seizure of they have a seizure between age 6 months and 5 years that is associated with fever but not accompanied by any evidence of a central nervous system infection such as meningitis or encephalitis. About 5% of all children will have a febrile seizure. Most of these seizures are brief and last less than 1-2 minutes but can last up to 15 minutes and consist of sudden stiffening with some twitching of the extremities. This is called a generalized seizure. Rarely focal components may be present with one part of the body showing more involvement then another. Your child’s eyes may deviate upward and skin color may become pale but usually not blue. Your child will not respond to voice or touch and when the episode stops your child usually will go to sleep.

If your child has a seizure the most important response is to maintain your child’s airway and seek help. Turn your child on his side in a recovery position and maintain head and neck control so the upper windpipe does not close off. This also prevents your child from aspirating stomach contents if vomiting occurs. Vomiting is uncommon with febrile seizures. Call 911 or contact your doctor directly if the seizure has stopped and your child is resting comfortably. Your child will require a medical evaluation unless you are experienced with febrile seizures and your child has a history of similar febrile seizures in the past that you are comfortable handling. In most situations for the first febrile seizure and for all seizures in children under preschool years a medical evaluation and examination are needed.

If your child is under age 1 year and has not been immunized fully with HIB or Prevnar vaccines or has been receiving antibiotic that could be masking symptoms then a spinal tap may be needed. If your child shows any signs of a central nervous system infection then a spinal tap will be needed.

An EEG is not needed if a neurologically healthy child has a febrile seizure unless that seizure is complex. Laboratory testing is also rarely needed and should only be done if an evaluation of the cause of the fever is required. There is no need to pursue neuroimaging (CT or MR scans) are also not needed.

If your child has a febrile seizure there is a 30% risk of another febrile seizure before age 6 years. If a second seizure then there is a 50% risk. Seizure medications are not prescribed for the chronic management of children with febrile seizures. On rare occasions the use of a prophylactic benzodiazepine medication is considered for recurrent febrile seizures.

The Parenting Puzzle

In order to maintain a bond with your child that will not unravel or suddenly separate it is important to follow some specific guidelines. Imagine that you and your child fit together like two complex shaped puzzle pieces. Your Parent-Child fit will be strongest when you minimize the forces that pull and push you away from one another and increase the attractive forces that push you together. As a parent, the greater the separation from your child the greater the repulsion forces to separate you further and make you grow apart. You must allow the fit to be voluntary and separable since your child must be allowed to mature into an adult who is not dependent on her parent. Dependency and co-dependency must not be fostered or supported.

The key steps for a good Parent-Child fit include the following: Do not attend to what your child seeks when she is seeking your attention or exhibiting behavior aimed at delaying what you are seeking. Always be consistent in your discipline strategies. Be cautious not to show your hand in terms of what your breaking point is for “giving in”. In order to meet these goals you must set your priorities and establish a parenting budget that allows you to act and not react. This allows you to choose your own battles. Never bluff. Talk without action does not work. Take time to see situations from your child’s perspective and avoid the blame and bitterness game. Start every day fresh and never live in the world of if and when. Live in the world of now.

The strongest forces of attraction for you and your child include the following: Provide and set immediate and specific consequences for her behavior. Make sure the consequences are consistent and focus on rewarding positive behaviors. Punishment should be avoided but if punishment is given try to choose positive punishment rather than negative punishment. A positive punishment concerns giving something to your child rather than taking something away. Generally, punishment creates many problems and it is better to use positive strategies if possible. Focus on rewarding positive behavior and always have a plan in place for how you will respond to misbehavior.

Managing Aggressive Behavior in Children

Aggressive behavior by a child is a major problem for families. When a pattern of aggressive behavior is seen intervention must be sought. The first step is a thorough assessment as to why the behavior may be occurring. Are specific antecedents or associations evident? Are the behaviors specific to certain people or surroundings? Have there been any recent social, emotional or personal events that may have triggered the onset of the aggressive behavior? Often these issues are complex and difficult for you to assess on your own. In these situations seek out the help of a knowledgeable and experienced professional.

After a determination of possible cause has been made a decision about therapeutic intervention is the next step. Numerous types of interventions may be appropriate. It is important to choose an intervention that is evidence based and reasonable in terms of financial, emotional and personal cost to the family. It is best to avoid the use of medication as a first line treatment unless the severity of aggression warrants.

After initiating an intervention you must monitor the behavior as it relates to the chosen therapeutic intervention and you must perform an ongoing assessment of environmental effects of both the aggression and the therapeutic intervention. Treatments and your child’s response to the intervention do not just affect the child, siblings, parents and the family. After considering each of these issues all negative and positive effects must be monitored in an ongoing fashion.

Throughout this entire process utilizing supportive services to foster communication and relationship building, while at the same time decreasing moderate and toxic stress must be pursued. Every parent and family who deals with aggressive behavior needs support. All levels of stress cannot be eliminated but the moderate, severe forms must be managed and the toxic forms that hinder and prevent interpersonal relationships must be eliminated. This may involve routine self-care strategies such as progressive relaxation techniques or guided positive imagery as well as non-traditional activities including taking long walks, quieting the mind with a good book, getting more sleep, enjoying the arts, eating healthier or spending more time with a beloved pet. Options are as varied as your interests and willingness to explore allow.

In terms of direct intervention for your child you must find a professional you trust to give you advice. Non-pharmacologic behavioral interventions for your child can be beneficial. Psychotherapy that is insight directed and based on cognitive and behavioral principles should be considered and pursued as appropriate. You may also find family directed services that alter the way you interpret and respond to your child’s behavior are not only reasonable but effective. Some children due to their age or temperament have patterns of self-regulation, reactivity and flexibility that lead to explosive patterns of behavior including aggression. These patterns make it hard for you to be attuned to their needs with the sensitivity, attention and responsivity needed. For these children changing the way you understand, relate and respond can bring dramatic positive results.

If pharmacologic intervention is determined to be necessary then the medication should be evidence based and chosen to target and treat the underlying condition. Be clear about what behaviors you have targeted and monitor these patterns before and after the medication is initiated. Some medications require time to build up in the blood stream so discuss the response profile of the medication with the physician who prescribes the medication. It is important your expectations match the bioavailability profile for the specific medication. Since children are not the same size appropriate dosages must be prescribed and at all times an understanding and awareness of possible side-effects identified, explained and discussed. Multiple drugs should be avoided due to potential interaction issues as well as increasing the difficulty of interpreting responses.

Cognition in the Teen Years

The teenage brain is different in function from the brain of children and adults. Teens react and respond differently than adults and children. During the teen years there is an increase in risk taking and sensation seeking and an interest in greater peer affiliation. Historically from an evolutionary perspective this leads to greater physical separation between family members and a decreased risk of genetic inbreeding and a preference for genetic diversity. This period allows us to adapt and respond to changes that have forced us to grow and react in an active yet plastic fashion. Although this process occurs throughout our lives it is especially evident during the teen and young adult years. It is felt that critical periods of rapid change may relate to various ages of rapid learning and that various areas of the brain mature relatively late. Your brain reaches 93% of its size by age 6 years. Learning comes not from getting bigger but rather from specializing and getting better in connectivity. The brain improves in function by becoming more specialized in relation to its response to the environment.

Teenagers have a fundamental ability to adapt to change in their environment. They have an ability to learn, interact and respond to the environment. In recent years the rapidity of exposure to new experiences has increased as has the ability to interact and respond to these changes. It is this plasticity that provides adolescents and young adults’ opportunity and vulnerability.

Each cubic millimeter of brain contains about 2 miles of axons, 90,000 neurons, one quarter mile of dendrites and 4,500,000 synapses. Clarity from an understanding of the function of this complex structure can be very difficult and it is easy to over interpret the information. As a child ages into adulthood the white matter called myelin increases in a linear fashion and the speed of transfer of information increases. White matter is the same throughout the brain. White matter allows information to be encoded into the brain in a much faster fashion. Chemicals are released that decrease arborization (growing extra branches and roots) and the formation of new connections. This pruning of synapses allows us to integrate and tie information together as we age. The pruning and arborization occurs throughout our entire lives. As we progress from newborn to toddler and then preschool and school age years the growth permits maturation and connectivity that improves brain function and behavioral responses. During these periods genetic and environmental factors facilitate or inhibit the process.

This connectivity which is both modular (chapters in a book) and local (the letters with words and sentences or a paragraph) allows for differentiation between the convergence between specific pieces of data and our responses to stimuli.

The gray matter in the brain reaches a peak in the early teen years and follows an inverted u shape from preschool to age 21 years. The gray matter curve is different for different parts of the brain. For the frontal lobe which is involved in decision making and executive function it reaches a peak for girls at about age 11 ½ years and for boys at 13 ½ years. It appears that this rise and fall is seen in all components of brain function including synaptic density. This is consistent with the general pattern of function in nature where there is an initial overproduction and then a weaning of structural components. This culling allows for functional improvements in responses seen by adults compared to teens for judgment, long range planning and impulse control.

As the brain ages from childhood through puberty and into young adult years there is an overall change in the balance of frontal lobe and limbic system activity with the limbic system showing its highest response pattern during puberty and the frontal lobes appearing later with enhanced decision making in terms of increased delayed gratification capability. Activation patterns change from diffuse to focal and there is evidence of increased integration of brain function and decision making and there is an increase in connectivity speed and efficiency.

The roles of nature (genes) and nurture (environment) are being studied intensely throughout all periods of brain growth. This is a complex issue due to potential sexual variations and time mediated responses. In addition, since many genes may be activated at certain ages, this time mediated activation has implications in terms of the mechanism and trajectory of brain changes and functions. Although the brain trajectory for boys and girls is different the ultimate trajectory is similar. Girls seem to peak from 18 to 30 months earlier than boys in terms of most structural measures of brain function and male brains seem to be more variable than female brains. Overwhelmingly males and females are more similar than different in terms of ultimate brain functioning and the roles of the sex chromosomes, environment and hormones are still being determined and may be complexly mediated by the individual’s age.

Bullying and Obesity

Bullying is the name given to actions where a child is being exposed repeatedly over time to negative behavior from one or more persons. These negative behaviors can be emotional, verbal or physical. Due to publicity and public awareness more people are aware of bullying. It is due to this awareness that more people are discussing the importance of recognizing bullying and pursuing ways to teach social reciprocity and communication to allow children to interact without leaving one child feeling “bad.” When a child repeatedly feels “bad” after an interaction with one or more people this is a sign of bullying.

Children tend to be bullied when they are perceived as outliers. This may be due to what they eat, how they act and how they look. One specific component of appearance is weight. Studies have shown children who are obese are more likely to be bullied then children who are not obese. It is not clear whether being bullied causes children to gain weight, but even with more children being identified as being obese this has not lessened the risk for obese children being bullied. Obese children continue to be bullied.

Children who bully tend to have deficiencies in healthy social skills or have learned how to manipulate social situations to their advantage to attain what they desire. These patterns may have been learned at home where parents use bullying tactics to motivate their child are it may have been learned outside the home. Bullying is done at the expense of another’s self-esteem. Children who bully often turn to obese children to perform their bullying upon. It is also important for parents, doctors and teachers not to become partners to bullying behavior. The risk of being bullied should never be used as a threat or fear tactic to eliminate obesity. The pursuit of a healthy lifestyle and not the fear of obesity or illness must be the prime messages given to every child who is obese or overweight.

Obese children and teens are often taught obesity is their fault and is a sign of laziness and a lack of interest in being healthy. Obesity is not a sign of failure and does not signify failure or lack of effort. It does signal the need for comprehensive encouragement to eat healthy and exercise more often.

Don’t Let Control Fool You

As a parent you are confronted with difficult decisions. Caring and providing for your family are not easy. Responsibilities at home and work multiply in an endless progression. The size of your family, the age of your children, your experience as a parent and your financial situation all increase your demands. Although you seek control most of your life events are not under your control.

Parents chase this perception of control not only your own life but also the fate of your child. This pursuit of control is built upon innate parental intuition and directed decision-making. In this process you convince yourself how time and effort can make every decision you make right. This security is a mirage. A charade built upon control replacing fear and anxiety with avoidance.

This sense of control enables a parent to rise from bed in the morning and fall asleep at night. It requires intense effort to weave a tale of deceit and half-truths and stresses you throughout the day. Projecting control forces you to expend time and energy on people and events you do not control and prevents you from spending time with those you love and wish to protect. Surrounded by a capsule of false perceived control life shrouded by control becomes invisible to you and the joys of acceptance and unlimited expectation are lost. This price is too high.

So how do you stop this process of retreat, always defending your thoughts and actions? Every day you must be led by your expectations to the endless opportunities fueled by love and fulfillment that are within your reach every day.

Recite these affirmations daily and prepare yourself for the success expectation based parenting provides:

  • My child is born from endless and all powerful love.
  • Love provides the energy and knowledge my child and I need to make life decisions.
  • The skills I need to be a good parent are always available to me when and where I need them.
  • People enter and leave my life when I am weak or in need to help guide me and support my decisions.
  • I have the power to change my life.
  • I give the power of choice to my child.
  • I am always at my child’s side.
  • I support my child’s endless power and opportunities.
  • I am led by the endless opportunities the power of choice provides.

Social Media is Your Friend

Whether you like it or not social media is here to stay. Parents have two choices. Either close your eyes and wish it away or learn about it so you are able to educate your children directly and indirectly about the value and risks of social media.

This does not mean you have to become an active user of Facebook,Twitter or any of the other platforms. You do have a responsibility, however, to become comfortable and familiar with how it is used, when it is used, who it is used by and why it is used.

Parents set boundaries. You decide when to allow your child to cross the street alone, ride the bus alone, go to the bathroom alone, babysit, have a cell phone and go to the mall or library alone. Each parent judges readiness differently but all parents believe their child should not do these things until they are ready.

The definition of ready differs not only by age and experience but also by culture and generation. Certainly there are children who are more capable intellectually or physically and have the emotional and judgment self-awareness skills to allow them to perform any number of skills earlier than other children. Although each of you will set the ages for when your child is allowed to explore and begin “risky” activities every parent should also include a period of joint performance of these skills before moving on to a period of parental observation and external time constraints.

As parents we must encourage our children to explore the world. We must give them the freedom to find out that every time they fall down they do not fail and recognize getting hurt does not mean the world is a mean, fearful and angry place where people are out to get them. Every child deserves the opportunity to make choices and explore. If they do not have this power of choice they will exchange exploration and experimentation with self-doubt and self-respect and self-esteem will not develop.

By having opportunities to stretch and extend boundaries your child can learn the importance of giving and sharing with other, of not being judgmental and learning to accept things as they are while learning to strive for things as they wish them to be. These learning experiences interwoven with a tolerance for change and transitions allow your child to recognize and express their divine being and become an adult who is able to seek, accept and understand the meaning of self-love. Young children and young adults who are shackled by doubt and fear do not have this opportunity.

So what about social media? Don’t run and hide. Embrace and acknowledge the experiences and opportunities it provides. Allow social media to entertain, enhance, expand and empower your child to seek questions and answers. Here are some tips:

  • Learn how to partner with technology in an ever expanding digital world.
  • Set limits for the use of social media.
  • Enforce these rules consistently.
  • Commit to this process and monitor your child’s social media use.
  • Recognize the creative and work related capabilities of social media.
  • Set risk limits you can live with.
  • Show your child you respect her thoughts, words and actions, and learn how to slow down if they move too fast.

Handling Emotions

You interact with your child in many ways and at many times. It is important you choose an interaction style that facilitates and improves your child’s ability to make and maintain relationships in a way that supports trust and mutual understanding. To be successful in laying this foundation parents must teach children how to value their emotions and you must show your child how you value your own emotions.

Attunement is the name given to the ability to respond to the communication and needs of another. It includes the ability to recognize and respond to cues and by being aware of the needs of others you provide a foundation of trust and security for your child. This response is intertwined with consistent, confident, competent and committed care.

Attunement must be done in a sensitive way with an understanding of one’s own emotions. Understanding how you think about feelings and emotions is very important and is usually the result of the way you were raised. Ask yourself how you feel when you are told you are not going to get a raise you expected. Your reaction to the frustration, anger and disappointment you feel from not getting the raise may include a sense of guilt that you did not work hard enough or that you are not smart enough to deserve a raise. These feelings are often irrational and not justified but they are part of your response pattern in ways more fundamental then the expected frustration, anger and disappointment.

Teaching children how to recognize and handle their emotional response to emotions is the best way to teach them how to handle their own emotions in rational and conscious ways rather than being led by unconscious feelings and experiences that often are based on unhealthy patterns. The first step in this process is to teach and show children there are no bad emotions, only badly handled ones. Children must realize there is a difference between an emotion and how a person responds to the emotion.

By modeling appropriate responses to emotions you are in the perfect position to show your child that feelings are normal and often cannot be controlled but they can be managed and acceptable responses can be learned.

Self-Regulation

Self-regulation is the term used to describe a person’s ability to control their own behavior. This ability effects social, emotional and cognitive development and includes strategies to self soothe, problem solve and manage personal emotions. It brief it is the general ability to control one’s own feelings, thoughts, word and actions.

Various factors influence self-regulation. The first factor is age. Infants are unable to self-regulate during the first six months of life. During this period infants rely on adults to identify, respond to and meet their needs. Specific needs include food, sleep, warmth, comfort and interaction.

Another factor important to self-regulation is the ability to form and maintain stable, loving and caring relationships built on trust and understanding. It is important that all children have relationships with adults who are attentive and responsive to their needs and are attuned and sensitive to their wants and desires.

The last factor to influence self-regulation is cognition. As children grow they use language to name their emotions and identify their wants and needs to others. These emotions can range from excitement to frustration for toddlers and for preschool and older children who have already developed various naming skills they need to learn how to use those skills at the right time and in the right way.

The long term goal of self-regulation is the ability to delay gratification and suppress the need for immediate attainment of what is desired. This skill allows a connection between feelings and behavior to develop and is fundamental to building future reciprocal interpersonal relationships based on trust and understanding.

The skills learned during this process include coping skills and the ability to pursue goals by using intrinsic motivation as the primary driving force rather than external “pushes” and encouragement. This is the catalyst for the encouragement of self-worth and benefits also include improved academic performance, problem solving skills and peer interaction skills.

Children learn self-regulation by watching you and seeing how you respond to not only them but the world around both of you. Set your developmental expectations appropriately and let the fun begin.

Tips on Praise

Praise should be sincere and age appropriate. It should never be vague and should not be overused for everyday tasks, chores or actions that are expected to be completed. School age children are able to “see through” praise. If a child already enjoys a task then praise is not needed. The focus should be on the intrinsic reward from the performance of the activity. In this way the intrinsic value is the motivator. Excess praise can easily be confused with bribes and if always expected the lack of praise can serve as negative stimuli to decrease the frequency of the desired positive behavior. Make sure you are praising what you think you are praising and do not set the bar too high for praise. Each of these can result in conflict.

Opposite of praise is criticism. Criticism is not effective in the long term in changing behavior. Criticism always hurts. The ability to tolerate criticism is a positive skill but the use of criticism to enact and encourage change in a child’s behavior is riddled with negative short and long term effects. When someone criticizes another they are saying: “I know something you don’t.”

General feedback is similar to praise but is more neutral and informative. As with praise it should be timely and specific. Feedback that does not focus on a particular act or pattern is ineffective. It must be genuine and heartfelt and expressed with a tone of excitement. Be wary of having a hidden agenda to the feedback where direction is given for another purpose and never add a wish list at the end of positive feedback. “You did a great job on your spelling test today. I know you will do just as well on you math test tomorrow.” Lastly, when giving feedback never make it personal. Always target an event. Instead of saying: “You gave too much food to the dog last night” consider saying: “I worry we may be feeding our dog too much food. How could we be sure to measure out the right amount of food for every feeding?”

When giving feedback make sure to balance negative feedback positive feedback or praise. A rule of thumb is to recognize through words of fondness or admiration positive behaviors five times more frequently than negative. Most parent praise patterns come from patterns they learned in their upbringing.

Praise is best when it increases a child’s own internal excitement and allows and encourages them to internalize reinforcement to repeat a future act or behavior.