Parenting Through Puberty

I know when my oldest let me know about the changes, I wasn’t ready.  I had prepared my child with what to expect, gotten her some nice books about it that we read together. But, when the time arrived, I thought, “already?”

The changes of puberty are different for every child, but there are some points that help know what’s ahead, just around the corner.

Physical Changes

 

For girls, the changes of puberty start between 8 and 13 years old.  Usually the first sign is breast development.  It commonly takes about two years to get from there to the first menses, or period.  Along the way, development of pubertal hair and a growth spurt usually ensue as well.  When girls start menses, it can be irregular in the first year, but it tends to become more regular with time.

For boys, the changes of puberty start between 9 and 14 years of age.  This starts with genitals enlarging, followed by pubertal hair.  Then they will develop increased muscle mass and voice changes, with the start of these averaging at 13 ½ years old. The peak height for boys is usually reached by 17 years old, 2 years past that for girls.

Both girls and boys will have other changes as well, including hair growth, acne, and body odor.  If you have questions or concerns about whether your child’s patterns are normal, it’s important to ask your healthcare provider.

Emotional Changes

 

Along with the physical changes, there are many emotional changes with puberty as well. Adolescent youth begin to become more independent and less interested in having the attention of their parents.  Some will lose their temper more easily and have more mood swings.  It’s important to keep the conversation open with these changes, both physical and emotional.  Being positively and proactively involved in your child life, even when it’s not invited, helps them know you support them when they need it.

Puberty is Starting Earlier

 

Despite the normal ranges of puberty described above, the onset of puberty has gotten earlier over the years. The cause is unclear, but we know several factors can lead to an earlier start.  Trends from lifestyle factors include an earlier start for girls with more sugar intake (independent of weight), also an earlier start for girls with obesity.  There are differences in the start of puberty with different racial background as well, with puberty often occurring earlier in African-American children.


Booklist

 

Some books that may help open the conversation with you and your child include “The Care and Keeping of You: A Body Book for Girls” by Valerie Lee Schafer and “Guy Stuff: the Body Book” by Dr. Cara Natterson.  These are appropriate for kids 8 years old and up according to Common Sense Media, a website with recommendations on books and movies for kids that are age appropriate.


Are My Child’s Changes Normal?

 

If your girl starts showing signs of puberty before 8 years old or your boy before 9, it’s worth bringing up with your provider to discuss further.  Similarly, if your girl has not started these changes by the time she reaches 13 or your boy by 14, that’s a good reason to discuss as well. Your annual well-child visits are a great opportunity for providers to evaluate these development milestones and make sure things are on track. Please make sure to keep up-to-date on these important visits.

Entering into the next stage can be an intimidating phase for parents and kids alike, but it’s all about being there for your child in an open and honest way.

By Dr. Deborah Wiser, Chief Medical Officer

Rise and Shine! It’s Breakfast Time

Mornings are busy! Often times the last thing we think of before we rush out the door is breakfast. We are hurried getting the kids to school and ourselves to work on-time, maybe the kiddos are complaining they aren’t hungry, maybe they are hungry but nobody is in the mood for cold cereal, we haven’t been able to get to the grocery store and there aren’t many options…the list goes on. Yet, we know that breakfast really is the most important meal of the day. So, what can we do to make sure our children get their day started with full bellies and fueled brains?

• Take advantage of the school breakfast program: Typically,
school breakfast begins serving about 30 minutes before school
starts. Not only is it a time-saver, but it is a cost effective and healthy
option. Free and reduced meal costs are available to families who
qualify (see your child’s school for an application).

• Plan ahead: Think about breakfast the night before and even have
the kids help in breakfast planning. Put together a crockpot breakfast
meal, pre-cut fruit or veggies, assemble breakfast burritos or bake a
breakfast casserole that only needs reheating in the morning.

• Keep it simple: Whole grain toast with peanut butter, fruit
smoothie with Greek yogurt and leafy greens, bagel and cream
cheese, oatmeal with fruit, hard boiled eggs with whole grain English
muffin, and yogurt parfaits with granola and fruit are nutritious and
portable options that can be made in less than 10 minutes.

• Think outside the box: Breakfast does not have to be limited to
typical breakfast food! Dinner leftovers, quick grilled cheese and
fruit, veggie wrap, reheated pizza or even a mug of chicken soup can
be a healthful morning breakfast choice!

• Make breakfast a family habit: Be a positive role model for
your child by eating breakfast yourself every day, create breakfast
meals together and try to develop a morning routine that allows you
to sit down and have a breakfast meal together.

By Annette Anderson
RDN, CD

 

Autism, what is it?

Autism spectrum disorder (ASD) is a complex developmental disability; signs typically appear during early childhood and affect a person’s ability to communicate, and interact with others. Your Pediatrician can start to recognize these symptoms between 1-2 years old and should be testing for concerns. ASD is defined by a certain set of behaviors and there is a wide spectrum as to how it impacts each child’s life.

There is no known single cause of autism, but increased awareness and early diagnosis/intervention and access to appropriate services/supports lead to significantly improved outcomes.

Many of the early signs of Autism deal with difficulties with social interaction. 

The range and severity of symptoms can vary widely. Common symptoms include:

  • difficulty with communication
  • difficulty with social interactions
  • obsessive interests
  • repetitive behaviors
  • difficulty making eye contact
  • poor motor skills’ and sensory sensitivities (overly sensitive to the feel of clothing or texture of foods).

A person with ASD may follow many of these behaviors or just a few, or many others as well. The diagnosis of autism spectrum disorder is applied based on analysis of all behaviors and their severity and how they impact that child life and learning.

Autism is treatable.

Children do not “outgrow” autism, but studies show that early diagnosis and intervention lead to significantly improved outcomes. For more information on developmental milestones, visit the CDC’s “Know the Signs. Act Early” site.

  • Lack of or delay in spoken language
  • Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)
  • Little or no eye contact
  • Lack of interest in peer relationships
  • Lack of spontaneous or make-believe play
  • Persistent fixation on parts of objects

Early recognition, as well as behavioral, educational, and family therapies may reduce symptoms and support development and learning.

Spring Allergies- Symptoms and Treatment

Spring season brings the blooming of many plants and flowers and that means the blooming of spring allergies. What are allergy symptoms and how can you treat them? The most common allergy symptoms to look for are:

  1. Runny nose
  2. Watery eyes
  3. Sneezing
  4. Coughing
  5. Itchy eyes and nose
  6. Dark circles under the eyes

If you experience these symptoms during the spring allergy season, you should visit your primary care provider who can refer you to an allergist for tests. There are two forms of common allergy tests including a skin test, also known as a prick test or a blood test.

The skin test involves either a pricking of the skin with a tiny amount of allergen, or injecting a small sample of a diluted allergen under the skin of your arm and back. If you are allergic to the substance, a small red bump, also known as a hive, will form. The blood test is also another common option for an allergen test.

If the symptoms are caused by an allergy, there are over the counter prescriptions and medications that a provider can prescribe to ease the symptoms.

This is the 3rd part in a 4 part allergy series, be sure to follow for more!

By Sarah Giomi, Communications Intern and Bill Bomberger, PA-C

Gestational Diabetes: Do I HAVE to drink that?

 

Short Answer:  Yes.

Long Answer:  You actually don’t HAVE to do anything you don’t want to do.  We won’t MAKE you do anything you don’t want to do.  This concept supports your autonomy as a patient.

However, you trust us to be the lifeguard of your pregnancy.  Throughout your pregnancy, we will monitor your blood work, vital signs, and the baby’s growth and development by using ultrasound, drawing your blood, listening to your baby’s heartbeat, and measuring the size of the uterus.  Trust us when we say that the second trimester glucose screen is very important to the health of both you and your baby.  We might even recommend it earlier in the first trimester if we are concerned about impaired glucose tolerance.

One complication of pregnancy that we screen for and treat is called gestational diabetes.  Gestational diabetes can occur in women of any size, even without a personal history of family history of diabetes.  Insulin is a hormone produced by the pancreas, and the body uses insulin to help transport blood glucose (sugar) from the bloodstream into the cells of the body.  The hormones of pregnancy can cause you to be resistant to insulin.  If you become resistant to insulin, your blood glucose levels become elevated and the glucose easily transports across the placenta to your baby.  This can cause the baby to grow very large, and at the same time it impairs the development of the baby’s lungs.  You can end up with a very large baby who, at the same time, has very immature lungs and needs help breathing after birth.

Maternal Complications of Gestational Diabetes:

  • You have a 70% chance of developing Type 2 Diabetes within 10 years
  • You are at a higher risk of high blood pressure or preeclampsia in pregnancy
  • You might require medication to help manage your blood glucose
  • You are at higher risk of miscarriage or stillbirth

 

Fetal Complications of Gestational Diabetes:

  • Your baby can grow very large
  • Your baby might experience a shoulder dystocia at delivery, which is an emergency situation where the head delivers but the large body is stuck behind your pelvic bones.  We might have to break the baby’s collar bone to help your baby deliver.
  • Your baby might require assistance breathing at delivery or in the first few days
  • Your baby might need to be observed or treated in the special care nursery for low blood glucose.

What happens if your one hour glucose screen comes back elevated? 

We will ask you to take a three hour glucose screen.  If the three hour glucose screen comes back elevated, you will have the diagnosis of Gestational Diabetes.  At that time, we will send you for a consultation with a Maternal Fetal Medicine physician called a Perinatologist.  These physicians are specially trained in high-risk pregnancy and obstetric ultrasound.  They can help us monitor the growth of your baby.  In addition, a diabetic educator will teach you how to test your blood glucose daily.  They will also teach you how to eat well to keep your blood glucose as stable as possible.  You will also be asked to increase your daily exercise, which will help your body be more sensitive to insulin and help you regular your blood glucose.

 

The glucose screen is usually done at the 24-28 week visit.  We ask that you eat normally that day, with good protein and not a heavy carbohydrate load.  Plan for the visit to take at least an hour because we have to draw your blood one hour after you finish drinking the liquid.  Pack a healthy snack with protein for the ride home.

 

So… yes.  Your midwives are aware that the glucose screen can cause nausea and discomfort.  You may not like the taste of the drink.  However, it is an important screening test that can help us provide the very best care for you and your baby.

 

For more information:

http://www.diabetes.org/diabetes-basics/gestational/

http://www2c.cdc.gov/podcasts/player.asp?f=11504&loc=WhatIsGestational

By: Kirsten Johnson | Certified Nurse Midwife

5 Rules for Screen Time.

 

 

 

 

 

 

 

 

 

 

Everyone loves screen time.  Whether it is watching a movie, playing a video game, reading the news, or talking with friends, technology is at the center of all of our lives.  Media and screen time, like most things, should be used in moderation.  While technology use is important in most facets of life today, too much screen time has been linked to obesity, difficulty sleeping, problems in school, aggressive behavior, and bullying.  It is important to help your child find a healthy balance.  A few simple guidelines can help keep screen time in check for you and your family:

  1. Remove all screens from the bedroom. Kids with TVs in the bedroom have been found to watch 1 ½ hours more TV than kids without TVs in the bedroom.  TVs in the bedroom have also been linked to obesity.  Availability of internet and texting in your child’s bedroom gives them unmonitored access to anything on the internet.  Keep all screens (including your own) out of the bedroom.  Try setting up a charging station for all devices in a common area.
  2. Monitor what your children are doing during their screen time! Just like you would ask who they are spending time with on the weekend, ask who they are spending time with on social media.  It is important to teach children what is and is not appropriate to share on social media.  Also, be aware of the websites they are going to and the apps they are using.  Play apps and video games with them!  Then you know what they are doing and if it is appropriate.
  3. Make sure screen time is age appropriate and educational. Not sure if a movie or video game is good for your child? Check out commonsensemedia.org.  This website is run by a nonprofit organization that provides independent ratings for movies, TV shows, video games, and apps.  It provides you with a summary of the game or video and suggested ages for appropriate use.
  4. Limit screen time for everyone in the family. All children should spend no more than 2 hours in front of a screen for non-school purposes.  Think of things you can do as a family that does not involve a screen: go for a walk, play a board game, go to the park, or read a book together.  Any activity that provides family interaction is preferred to screen time!
  5. No screens after dinner. We know that looking at a screen keeps your body from releasing melatonin.  Without melatonin you don’t feel sleepy when bedtime comes.  Sleep is important to help with mood, concentration, and learning.  If sleep is a problem for your child, try a screen fast (by eliminating electronic device use for a few weeks) to see if this helps restore a good sleep pattern.

 

Screen use is here to stay.  Help your child form good, healthy screen habits!

-Ashlee Mickelson, MD Pediatrician

Birth Plans!

Should I write a Birth Plan?

Many women want to write out a birth plan to clarify the care they hope to receive while they are in labor.  A birth plan can be a short wish list or a long explanation of your circumstance, such as if you are adopting the child out or if there are known anomalies incompatible with life.

Is a Birth Plan required?  No.  The nurses, midwives, and physicians are highly trained professionals who will take care of you to the best of their abilities.  We have not performed routine shaves, enemas, or episiotomies for over 25 years, so you do not need to request that we refrain from these procedures.  We have many tools in our bag of tricks to help your labor progress well and hopefully avoid complications.

In addition, every woman and every labor is different.  It is a good idea for you to relax, let go, and accept the labor that comes to you.  There really is no other choice but to deal with the reality of the moment.  Your care providers will help you.  Honest.  That’s what we have chosen to do for our career.  We want the best outcome for you and your family.

I do recommend that my mammas write up a short, one-page wish list that gives the labor team a frame of reference of what experience you are hoping for in labor and delivery.  It is a good idea to designate one person to speak for you if you are unable to speak for yourself due to an intense labor.  It tells us if you have specific requests, such as dad cutting the umbilical cord or your desire to avoid an epidural or even GIVE ME THE EPIDURAL THE MOMENT I WALK IN THE DOOR!

Bring your birth plan to one of your prenatal visits to discuss with your midwife or physician.  Then when you have a final draft, bring a printed copy for the nurse caring for you in labor and delivery.  That way, your entire team is on board with the plan and works with you!  Remember to keep it short and flexible.

Some ideas of what women specify in a birth plan:

  • Who will be present for the birth?
  • Are you bringing a doula?
  • Will there be siblings present?
  • Do you want mobility or do you want to stay in bed?
  • What activities or positions do you plan to use (walking, birthing ball, standing, tub, squatting, etc)?
  • What is your plan for pain relief (massage, hot packs, position changes, hypnobirthing, Lamaze breathing, jacousi tub, medication)?
  • How do you feel about fetal monitoring?
  • Who will care for the baby?
  • What is your plan to feed your baby?
  • Do you want to wear your own clothing and listen to music?

 

You can always google “birth plans” on the internet for more ideas, remembering to keep your wish list to one page!

-Kirstin Johnson, Certified Nurse Midwife

Preventing Pertussis or “Whooping Cough” in the newborn.

whopping-cough-babies-2160x1200

 

Pertussis, also called “Whooping Cough” is a bacterial infection that you or your baby can catch when an infected person coughs or sneezes.  Infected droplets can travel through the air, and if you inhale the droplets you can become infected with pertussis.  Whooping cough begins like a cold, with a mild fever and runny nose.  Most adults do not have severe symptoms, but they can pass pertussis on to a newborn very easily without realizing it.

Whooping cough is especially dangerous for a newborn because their immune system is not fully mature and they cannot fight this infection.  Babies cannot get the vaccine for pertussis until they are two months old.  Even after they start the vaccinations, they are not fully protected by the vaccines until they are a year old and have had three vaccinations for pertussis.  Whooping cough in a newborn is a very serious illness, and it often requires that the baby be admitted to the hospital for breathing problems or pneumonia.  Some babies who get whooping cough do not cough at all – they just stop breathing.  Newborns can die from whooping cough.

The entire family can help protect your newborn from whooping cough.  All teenagers and adults who are around your baby should get a pertussis booster, called Tdap.  The Tdap shot is a tetanus vaccine that includes pertussis.  If you are pregnant, the best time to get the Tdap vaccine is between 27-36 weeks of pregnancy.  Your body will have time to make antibodies against pertussis.  These antibodies are passed through the placenta to protect your baby.  You can protect your baby with antibodies long before your baby is old enough to get the pertussis vaccine.  After the baby is born, the antibodies are passed through your breast milk.

For more information:  http://www.cdc.gov/features/pertussis

-Kirstin Johnson, Certified Nurse Midwife

The Force (for health) Awakens!

May the force be with you this winter, here are some great tips on staying healthy from our Jedi Knights on the dental team and our fun loving Darth Moorman. Be sure that these are not “a trap” and this is the advice “you’re looking for” this holiday season.

CHAS_KidsNews_Dec2015_DocTalk_PRINT1

-Written by Darth Moorman and team

Hello November! Tips for a festively healthy fall.

Gobble, Gobble!

The turkey has spoken and November is in!

Turkey

  1. Brr, It’s Cold Out There

As colder weather approaches, remember to layer up and keep warm. Use earmuffs to protect your ears, and gloves or mittens to protect your hands as flu season is very much upon us. If you haven’t already received your flu shot, stop by your local retail pharmacy or doctor’s office and keep those germs at bay by continuing to wash your hands throughout the day. No one likes a sick turkey!

  1. Be Thankful

Thanksgiving is right around the corner. We all love a holiday meal with our families – a warm turkey or ham just out of the oven, mashed potatoes covered in creamy gravy, stuffing and don’t forget those veggies – just remember to show your thanks to your body by maintaining a healthy diet through the holidays.

  1. Friendship Never Gets Old

As the days get shorter with the new season, it’s important to remember to use the buddy system when walking or biking to and from places. Carpooling is also a great way to save on gas and help keep the environment healthy! Make new friends, and keep the old.

  1. Get Up and Get Out

Stay healthy by getting regular exercise and spending time with family. Go outside during half-times and toss the ball around; do a little jig when your team makes a touchdown; or even join your family on a stroll through the park while you pick out your favorite leaves. Whatever it may be, doing 30 minutes of regular exercise will keep your mind, body and heart happy and strong!

  1. Take Care of Your Teeth

As you just spent weeks eating all of your Halloween candy, your teeth are certainly feeling it. Be sure to brush and floss at least twice daily, and especially after eating that delicious kettle corn you’ve been looking forward to. Avoid chewing on kernels as they can get stuck in your gums and cause discomfort, tooth breakage, and sometimes even infection.

Author: Katiah Peterson