Be My Valentine

What tools do you rely on to parent your child?

Children are born into this world as perfect beings waiting for connections to be made. Although your child needs food, warmth and protection, mostly your child needs you.

Your ability to connect in a love-filled positive fashion provides a secure attachment which is essential for a healthy mental, physical and spiritual life. The interactions you choose become the grains of sand out of which your child’s social, emotional and cognitive castles are built. Your love and the interdependent relationships you offer teach, inspire and guide your child.

Your child is born with over 100 billion brain neurons and over the next few years hundreds of trillions of neuronal connections are formed. Brain networks form. Connections are pruned. Behaviors and skills modulated by genes and the environment erupt and your child becomes an adult and future potential parent. The parenting strategies and techniques you choose frame your child’s temperament and support your child’s future personality.

Stressed parents filled with fear, anger and guilt often rely on authoritarian parenting techniques built on dominance not love. This is both wrong and dangerous. Parenting is about enticement not force. It is about allowing your child to find and make the right and wrong decisions. It is about genuine praise and heartfelt effort rather than outcome. Parents who focus on demands and criticism command a behavior but run the risk of not teaching cooperation, independence, patience, understanding and acceptance. Providing your child freedom and encouragement are the holy grails of parenting.

One sided conversations do not last. A healthy parent-child relationship must be reciprocal. It must validate on a daily basis that you both value your child and promise to provide the stimulation and interaction fundamental to a secure, stable and organized relationship. For the infant and young child this means love, affection and attention and the fulfillment of basic body needs. For the toddler it means approval of exploration merged with the setting of limits, schedules and routines. For the preschooler the goal is the ability to understand feelings and being able to experience a wide range of emotions.

Your child watches you. Your words, actions and behaviors teach your child you care and are listening to him or her. How you behave teaches your child how to respond and communicate with others. Mirroring your child shows you approve and want those same words, actions and behaviors to continue.

Consider adding some new interactions into your daily routine with your child.  Practice reflection as a skill. Repeat and paraphrase your child’s words.  Invite your child into a conversation with you and see how two-way conversation accelerates both speech and social reciprocity. Report on your child’s behavior by describing what your child is doing. Watch how this increases your child’s attention span and willingness to engage. Imitate your child. Don’t just talk about what your child is doing. Get out of your chair and do it! You will be amazed by the excitement and added effort your physical involvement provides.

These choices are up to you. If you love your child the answer is easy. The power of connection will be the greatest valentine your child will ever receive.

Pregnancy and Influenza

Women who are pregnant and their unborn child are both at increased risk for complications due to influenza. This is due to changes in the immune system, heart and lungs during pregnancy. These changes place pregnant women at risk for complications, hospitalization and even death due to influenza. The unborn child is also at risk for numerous medical problems.

The first step in treatment is always prevention. Everyone six months of age and older should be immunized every year against influenza. Vaccination is the best way to protect you and your unborn baby from the harmful effects of influenza. It is safe for pregnant women to be immunized with the inactivated influenza vaccine during any trimester. It is not recommended for pregnant women to receive the live attenuated influenza vaccine which is also called LAIV. This vaccine is administered via nasal spray.

Receiving the influenza vaccine during your pregnancy decreases the risk your new infant will come down with influenza during the first six months of life. This is especially important since your child cannot receive an influenza vaccine until six months of age. If you are pregnant and you come down with influenza you also place your child at risk for premature delivery or being small for gestational age.

The flu shot is recommended during pregnancy by the Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists. There is a long record of safety for this immunization being given safely and effectively to pregnant women. Millions of pregnant women have been immunized and there is no evidence of harm to the pregnant woman or their baby.

If you are pregnant and come down with influenza you should receive antiviral treatment as soon as possible. You should not wait for a confirmation test. If your doctor suspects you have influenza that suspicion is enough to begin treatment. It is important for treatment to begin within 48 hours of onset of symptoms. This is why it is important for you to see your doctor early in your illness. There is also proven benefits to beginning treatment after this 48 hour period. The medication that is prescribes is called oseltamivir and it has been proven to be safe for your developing baby when given while you are pregnant.

Flu vaccine and antiviral treatment can make a difference for both you and your unborn child. Get vaccinated and seek medical attention if you become ill with influenza symptoms while you are pregnant.


Parent-Directed Parenting

Parent-directed parenting strategies are built upon the parent leading the child. They are most commonly used in the preschooler or early school-aged child. This type of parenting is different from child-directed approaches where the parents follow rather than lead the interaction.  In child-directed intervention the focus is on social attention and nonverbal communication. Self-esteem and a positive parent-child attachment are the goals. In parent-directed intervention verbal communication is primary and the focus is on compliance through contingency management, limit setting and problem solving. Reasoning skills are emphasized and clear, concise and consistent verbal direction is delivered by the parent.

Parent-directed approaches involve telling your child what to do rather than what to stop doing. Children are told and not asked what to do. Directions are broken down into small, specific segmented activities. Parents must avoid multistep directions and the specific behavior that is sought must be concrete and developmentally appropriate. Polite and respectful directions are delivered in a non-threatening normal tone of voice and all directions are explained either before a direction is given or after a direction is obeyed.

When a direction is given and your child does not comply then a time out warning is given. The child is again given the initial command and told he or she will have to go to the time out chair if the command is not obeyed. If the child complies praise is given and the reason for the praise is labeled.

If your child disobeys for the second time then the child must go to the time out chair for several minutes. The child can be released from the chair after this period by giving a command that describes the quiet sitting and asks the child if he or she is now ready to follow the original command. The command needs to be repeated in the same way it was given the prior two times. If the child answers yes or nods that the command will be obeyed then their answer is acknowledged and the child is released from the time out chair and allowed to resume activities.

If your child gets out of the time out chair without your approval then the child is told he or she will go to the time out room. If the three minute timer is restarted and he or she gets out of the time out hair again without your permission the child is taken to a time out room for one minute and then returned to the time out chair to resume the three minute timer. If the child complies or does not comply then the same routines previously described are followed. For each of the successful steps an obeying behavior is always acknowledged and labeled praise is given.

Many parents find it helpful to perform several 5-10 minute sessions each week of parent directed commands for the preschool and early school age child. These sessions reinforce spontaneous parent-directed interventions and speed up your child’s willingness to comply with directions and strengthens the development of problem solving and reasoning skills.

Child-Directed Parenting

Your ability to anticipate and respond to the behavior of your child determines the type of parent leader you are.  Leadership is an essential part of parenting. As a parent leader you must choose parenting responses and an emotional vocabulary that allow you to listen, connect and respond to your child with unconditional love.

Uncertainty of how to respond and interact with a child is a common dilemma for parents. It is a barrier you must and can overcome by following specific child directed responses. These techniques can reshape the way you respond to your child and improve the way your child responds to you.

Toddlers and preschoolers are at the perfect age for child directed parenting. By respecting their choices and providing freedom and encouragement positive behaviors are supported and negative behaviors are eliminated. The foundation of this strategy is to follow your child’s lead and avoid questions, criticism and both direct and indirect commands.  Questions often have hidden commands and criticism suggest disapproval and not listening to your child. Focus on correction without criticism by avoiding authoritarian command words like: “no”, stop”, “quit”, “that’s wrong” and “don’t”. This eliminates unhealthy interactions which damage your child’s self-esteem, self-worth and self-image.

Unless there is a safety or security concern, ignore negative behaviors and use praise, reflection, reporting and imitation to positively influence your child’s behavior. These techniques decrease the risk of negative interaction between you and your child. It is also important to choose words, a tone of speech and gestures that show your love and enthusiasm for being your child’s parent. Your words and actions must say to your child: “I love being your parent and being with you.”

Praise is the most essential parenting response. It increases positive behavior and like enthusiasm generates a positive attachment between you and your child. Make sure praise is genuine and not reflexive. When giving praise, identify or label what you are praising. An example is: “Thank-you for putting your hat and coat on.”

Reflection, reporting and imitation are three other parenting techniques. Somewhat similar to praise each involves a mirroring of your child. Reflection relies on repeating or paraphrasing your child’s words. This invites your child into a conversation with you. It shows your child you are listening and tells your child you understand what he or she is saying. This type of two-way communication enhances speech and social reciprocity skills and helps you connect with your child. Reporting describes what your child’s is doing and improves your child’s attention span. Imitation is the last technique.  In this technique you repeat and perform whatever behavior your child is doing. Each of these techniques shows your child you are interested in and approve of their words, actions or behavior and want them to continue.

If you make these leadership techniques part of your parenting responses you will change the way you relate to your child and the way your child relates to you.  By allowing your child to lead you signal to your child your approval and stimulate positive cooperative and parallel play which support your child’s ability to give, share and take turns. Child directed parenting techniques are simple to master and easy to perform.  By avoiding questions, criticism and commands and utilizing the above techniques you support the development of a positive attachment between you and your child and encourage positive behaviors in your child.

How to Handle Holiday Stress

Focusing on gratitude, having reasonable expectations and giving rather than receiving will help you deal with holiday stress. Common parenting potholes include excessive pressure to perform, succeed or to be perfect. Past memories can also trigger stress.  When you avoid worrying, focus on realistic expectations and practice expressions of gratitude for what you have rather than what you want – stress is reduced.

Look at your holiday plans and don’t allow gift size and cost inflation to make you feel overwhelmed or inadequate. Think small. Allow success to build your energy and positive outlook. Avoid asking “What if?” questions. Such questions increase stress. Do a personal inventory of your stress and focus on taking action that calms you down. By taking care of yourself first and slowing things down the sensory overload of the holiday season can be better controlled and managed.

Road trips and out of home visits also add stress to the holidays. Sleep and meal schedules change and feelings of control decrease. As you lose self-control your ability to cope decreases and you are more prone to be drawn into stressful situations. Stress affects how you think and how well your body works. It leads to chronic illnesses such as hypertension, heart disease, diabetes and obesity and decreases you and your child’s cognitive performance. Although occasional mild stress can improve attention and performance, chronic and toxic stress is never beneficial.

You are the most important model for your child. How you respond and behave during the holidays instills model behaviors in your children.  By slowing things down and learning how to say no to yourself and to others you are teaching your child the importance of respecting oneself as well as others. Saying no allows you to honor and successfully fulfill your existing commitments without over-extending yourself.

The holidays are a time when you will have many opportunities to connect and communicate with your child. Community and family stories of sharing and giving are the perfect way to incorporate gratitude into the life of your family and your child. In these ways your child learns how to express gratitude. Being able to experience gratefulness improves your mood, energy and physical well-being.

The holidays are not a time of total freedom for your child. Responsibilities do not stop on a holiday. Household rules concerning, chores, screen time, video games, homework, exercise, bedtime and self-care all continue. Time must be saved for family meals and family activities and parents must not view a holiday as a time to catch up on home or work responsibilities. Never neglect or overlook a chance over the holidays to sit down and play a game, watch a movie or discuss a topic with your child. These opportunities present the opportunity to make a lasting memory for both you and your child.

Holiday Toy Safety

The holidays are fun but they also are a time for emergency department visits due to injuries from toys. Toys provide children the opportunity to explore the world and develop or refine skills. It is vital every child be given the freedom and encouragement to explore but that does not mean they should be unsupervised. One child in the US is treated in an emergency department every three minutes for toy related injuries. This adds up to over 3 million children receiving treatment from 1990 until 2011 and the number of injuries has increased by 40% since 1990.

The best way to protect your child is by buying toys that are age, interest and skill level appropriate. Read up on the toys you want to purchase before you buy them. Check into the safety record for the toy and make sure there has not been a recall. Make sure all the materials in a toy are labeled non-toxic. This includes lead paint and is especially important when purchasing used toys. Always follow the manufacturer age and restrictions guidelines and never use a toy before you have read all the instructions. This is especially important for all chemistry kit toys that may contain dangerous or toxic chemicals.

Certain types of toys are more risky than others. Toys that must be plugged into a wall outlet are never to be used by a younger child. Electricity can kill your child. Make sure all toys that plug into the wall are UL approved.  Also beware of choking injuries due to objects that are small enough to be swallowed or inhaled and block your child’s airway. Always think big for young children and avoid objects smaller than a ping pong ball. Beware of button batteries, magnets, balloons and plastic tags.  Toys that have a rope, string or ribbon attached can cause strangulation and all riding toys such as a scooter should only be used with supervision and with a properly fitting helmet.

Beware of loud toys that can damage your child’s hearing and be especially careful when using ear buds or head phones.  Always turn on the sound before the ear buds or head phones are placed in or over the ears. Stuffed animals pose the risk of toxic stuffing or stuffing that can be swallowed or aspirated. Loose plastic pellets should never be used for stuffing and beware of toys made of plastic where small pieces can be broken off and choked on. Broken plastic toys often have sharp edges that can cut your child.

Home safety is also important over the holidays. Make sure you properly use safety gates and beware of your child climbing on or falling off of raised surfaces. Electric rockers, exercise machines, recliners and lift chairs can cause entrapment injuries. Extremities and fingers can be caught and crushed. Lastly, be cautious about all furniture and objects that have sharp edges or glass components. These can lead to cuts and blunt trauma injuries.

Most injuries happen when your child is left unattended or unsupervised. Your informed, active and attentive presence is the best protection for your child. Keep all toys organized and in working order. Toys should be cleaned periodically to kill and wash away germs and they should never be used in unintended ways that place your child at risk for injury. Hanging crib toys pose a special risk for choking or strangulation and any toy that shoots objects into the air can cause eye injuries.

A final safety tip is to choose safe places to use a toy. Many toys are safe when used in one location but not in another. Store toys in a location where toys for older children can be kept away from younger children since many toys for older children are very eye catching to young children and can cause injury to a younger child who is not developmentally ready to use that toy.

Follow these guidelines and active play can be safe and a time of discovery and exploration for your child.

Healthier Fast Food

Healthier fast food starts at home. Do your best to pack a meal or snack instead of stopping for fast food. Eating before leaving home is also important. Vacations and road trips are high risk occasions for increased fast food intake. Try to help your child prefer to eat at home rather than out by preparing healthy meals and snacks your child enjoys. A favorite home meal always trumps fast food choices.

Food and portion choice are two other important skills. Portion control and food choice are best taught at home and not when you are at the fast food restaurant. Teach your child that self-control is overrated. It is best to avoid calorie rich and unhealthy food both at home and when you are out. Eating should never be for comfort or distraction. Mindless eating is never healthy.

Make eating a social event rather than an escape or comfort event. Eating healthy is a key component of a healthy lifestyle and when paired with stress reduction, adequate sleep and an active lifestyle it leads to a long and healthy life. By decreasing sedentary time and helping your child stay active you will be making exercise an actual meal portion and reduce excess calorie intake risk.

How can you lower your child’s risk? Downsize food portions and beware of cheese, condiments and side dishes. Skip the fries and choose fruit or nonfat yogurt as a side order. Choose baked or grilled chicken and avoid chicken nuggets that are high in fat and are imposters of real chicken. Avoid liquid calories by choosing water and only drink low fat milk. Lastly, choose fruit and leave the chips and cookies behind.

Compliance with healthy dietary rules is essential. Choosing a children’s meal with healthy substitutions allows your child to participate in food choice. Never ban sweets entirely since this decreases compliance and often increases behavior issues.

Healthy children’s meal alternatives include: Kraft macaroni and cheese with apple slices and bottled water at Arby’s (205 calories).  Veggie or turkey breast delight (without cheese) on whole wheat with apple slices and fruit juice at Subway (285 calories).   Chicken nuggets (4) with sweet and sour sauce and apple slices and unsweetened iced tea at Burger King (265 calories); Grilled chicken nuggets (4) with barbecue sauce and fruit cup and low fat milk at Chick-fil-A (260 calories); Chicken drumstick with green beans and low fat milk and string cheese at KFC (365 calories); Chicken McNuggets (4) with barbecue sauce and a double portion of apple slices and low fat milk at McDonald’s (370 calories); Hamburger with apple slices and low fat milk at Wendy’s (380 calories).

For teenagers choose a fajita with grilled chicken and vegetables or baked or grilled chicken instead of breaded chicken or macaroni. Always leave off the cheese. Order a baked potato instead of French fries and leave off the fat laden trimmings. When in doubt always order a salad with grilled chicken and low fat or fat free dressing. Order non-fat yogurt with fresh fruit instead of dessert or cereal and consider a fruit smoothie instead of a regular milkshake.

Limiting fast food visits and following these guidelines will help your child eat healthier.

Fast Food Risks

Childhood obesity is a common problem in the US. One in three children has high cholesterol and almost 20% of children between the ages of 6 and 11 years are obese. This number has tripled since 1980. The risk of obesity in teens has quadrupled in the last 30 years. Obesity has been linked to heart disease, diabetes, stroke, cancer and an early death.

Every parent needs to know the fast food industry and eating outside the home has grown dramatically in the last few decades. The US has almost one million restaurants and approximately 10,000 new restaurants are added each year. In the US about half a trillion dollars is spent every year by people who eat out and the fast food industry spends about 700 million dollars a year marketing directly to children through advertising and gifts given to children to entice a return for another children’s meal. Children and teens view between three and five fast food ads every day and 75% of these ads focus on unhealthy foods. The fast food industry is now pursuing social media as the new wave of influence to further expand the fast food market for children and teens using deceptive marketing and advertising.

What is the risk of fast food? Fast food choices are high in fat, carbohydrates and salt. The portions are large and sugar-laden drinks are encouraged. These factors lead to excess calorie intake and unhealthy weight gain.

Sugar-laden drinks provide liquid calories with minimal nutritional benefit and increase your child’s risk for obesity and diabetes. Many protein choices increase the risk for heart disease and stroke due to a waxy substance called cholesterol that clogs blood vessels. High fat cheeseburgers, unhealthy fried chicken or chicken nuggets and highly processed meats provide large amounts of saturated fat, low amounts of fiber and increase the risk of cancer, diabetes and heart disease.

Excess salt intake is another risk. Most food choices have a high sodium content which increases the risk for high blood pressure, heart disease and stroke. They also increase the risk for certain types of cancer.  Excessive intake of these types of foods increase your risk of premature death by 20%.

What is the best response for parents? Your best response is to eat outside of the home as little as possible and to choose wisely and healthier when you eat out.  Know the calories and salt content of the foods you choose for and with your child. Remember to downsize the portion, skip the fries, choose your protein wisely, avoid the cheese and condiments and choose water or fat free milk.

Healthier fast food is possible but the best plan is to avoid fast food and plan ahead.

Eating Right

Food choice and learning to deal with stress rather than using food for comfort are essential to eating right. Always choose whole fruit for snacks and desserts and consider adding fruit to your salad. Add beans, peas and lentils to salads, soups and main dishes and try to eat more red, orange and dark green vegetables like tomatoes, sweet potatoes and broccoli. When using canned fruit always choose fruit canned in water or 100% fruit juice and choose canned vegetables with no added salt. Frozen fruit and vegetables are always a good choice as is whole grains for bread, rolls, cereal, bagels, crackers, pasta and rice. Always check to make sure whole grain is first on the ingredient list.

When choosing your protein for a meal, consider substituting seafood, peas, beans and nuts instead of animal protein. When an animal protein is chosen make sure it is 90% lean and trim and drain fat from the meat.

Salt intake must also be managed. Sodium is often hidden in foods. Canned vegetables are often high in sodium. Always choose no salt added canned vegetables. One teaspoon of salt contains about 2,500mg of sodium. The amount of sodium needed per day varies by age. Estimated intake allowances include the following: 1 to 3 years: 1,500mg; 4 to 8 years: 1,900mg; 9 to 13 years: 2,200mg and 14 and up: 2,500mg. Packaged, processed, restaurant and fast food options are high in sodium. Avoid salty snacks and always choose low sodium products.

The golden rules for healthy eating include choosing a luncheon plate rather than a dinner plate for your meals. Half of the plate should be for fruits and vegetables. One fourth of the plate should be for your whole grains and the rest for your protein. Meat should be considered a garnish rather than the main part of your meal. Consider serving low fat cheese and low fat yogurt for two of your three recommended servings of milk products per day and the serving size for milk is only four ounces. Never drink sweetened drinks. The sugar intake for 12 ounces of soda is 10 teaspoons (40 grams) of sugar. The recommended intake of refined sugar per day is 16 grams for children and 32 grams for adults.

Serving sizes must be understood or portions often are over-sized.  A serving of cereal, potatoes, pasta, rice or vegetables is equal to a closed fist or computer mouse (1/2 cup). One serving of leafy vegetables is equal to a baseball or a cupped hand (1 cup). A deck of playing cards or an iPod is the size of one serving of fish, poultry or beef and a checkbook is the size of one serving of a fish fillet. A CD case is one serving of bread and a thumb or two 9 volt batteries is equal to one serving of low fat cheese. A thumb tip or a pair of dice is equal to a 1 teaspoon serving of high fat foods such as mayonnaise or peanut butter. Two handfuls of baked chips or pretzels or one handful of nuts are equal to one serving. The recommended servings per day are 3 to 5 vegetables, 2 to 4 fruit, 5 to 10 whole grains, 3 protein and 3 dairy products.

By following these simple rules you can be a healthy food model for your child and your child will eat right.

Weight and Bullying

One-third of all children in the US are overweight or obese and being overweight is a stigma that leads to teasing and bullying. One study found that over 85% of children report seeing an overweight peer being teased and bullied during gym class. It is more common than gender issues, race, ethnicity, physical disability or religion. Children and especially teenagers are very sensitive to the social effects of being singled out as overweight. Children who are overweight are bullied since they are viewed by others as being different or undesirable. Weight is a visible way to stigmatize children.

Overweight bullying leads to increased stress and social isolation. It diminishes self-esteem and self-worth and causes children to be excluded from social opportunities. It often leads to depression, anxiety, loneliness and sadness. Children who are bullied due to their weight are more prone to become bullies themselves and often rely on binge eating for comfort.

When a parent is told about this type of bullying the focus must be on attentive, sensitive and responsive reflective listening. Parents must be attuned to the feelings and needs of their child and tell the child: “I am sorry this happened, and I am glad you told me.” The child must be told teasing is never right or fair. The parent must explain how teasing hurts others and is always wrong. The focus of the discussion is then pivoted to the fact that how much a person weighs does not define who they are. Weight is only one of many measures of good health, and it is a measure that can be changed and controlled.

The language that is chosen when talking about being overweight is very important. Judgmental or stigmatizing language causes overweight children to shut down and withdraw and hinders discussions. The weight-based terminology you choose will have a lasting effect on your child’s willingness to lose weight. Parents must emphasize how their love is unconditional no matter what the child’s weight is, and how the extra or added weight the child is carrying can make the body work extra hard and cause the child to have less energy. The child should be asked: “How does the extra weight make you feel?” At the same time the parent reaffirms the importance of a healthy lifestyle and why how you feel is more important than how you look. For the final step the parent explains how working together will help the child to lose weight and become healthier.

Losing weight is never easy. It takes time, consistency and effort. Small incremental changes in dietary intake and activity level are essential as are stress reduction and adequate sleep. The modeling of a healthy lifestyle and weight pattern by parents is also essential. By increasing active time and time spent outdoors risk factors such as excessive screen time and sedentary time are decreased. An emphasis on family play time and joint activity time also helps as does shopping together for healthy foods such as fruits and vegetables. Choosing and preparing healthy and favorite recipes together increases compliance and make losing weight a more enjoyable experience.

It is vital for every parent to strive to stop weight based bullying and its consequences. By working with the government, schools, organizations and other parents this stigma can be eliminated as the most common cause of victimization and bullying in the US.