What you need to know about Juuling (and other electronic cigarettes)!

Juuling has quickly become very popular in our high schools, colleges, and even middle schools.  While electronic cigarettes were created to help people quit smoking, in young people they are actually becoming the introduction to tobacco use.  Here are some key things to know:

Safer does not equal safe.  Yes there are no studies linking e-cigarettes to cancer.  Just because e-cigarettes are safer than traditional cigarettes does not mean they are safe.  They still contain many chemicals that we know are airway irritants and carcinogens.  They contain nicotine.   We have no long term studies of the safety of e-cigarettes.

Nicotine is addictive. The Juul pods contain the same amount of nicotine as a pack of cigarettes.    Some e-cigarettes juice is even stronger.  Studies have shown e-cigarette fluid that claims to be nicotine free often contains nicotine.  We also know nicotine affects the developing brain leading to difficulties with attention, learning, impulse control, and mood.

Teens are the target of advertisement. Juul, the most common e-cigarette used among teenagers, began advertising on Youtube, Instagram, and Twitter.  There is a huge social media presence of Juul and Juul is starting to show up in TV shows and movies.  #doitforJuul is a common hashtag that people use to show them using a Juul.  This affects teens, even if they do not realize.

People vape a variety of substances. On youtube you can find videos of people using a variety of fluids including caffeine, alcohol, and Marijuana. Anytime someone is breathing in a substance, it is likely to irritate the airwyas.  There have even been cases of people dying after vaping synthetic cannabinoid.

Juul use is increasing tobacco use among teens. Starting in the 1990s there was a steady decline in tobacco use among teenagers, reaching as low as 12% of all teenagers ever using tobacco.  With the advent of Juul, as many as 35% of teenagers admit to using nicotine containing products.  Unfortunately, many of these Juul users go on to smoke traditional cigarettes.

Juul and other ecigarette companies create fruit flavored fluids that appeal to young users.  Juul can be easily concealed and has become a trend among high school students.  Our teens are getting addicted to nicotine and we must do our best to prevent this!

By Dr. Ashlee Mickelson

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.

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

Who needs sleep?

What is the one thing we spend the most time doing?  Sleeping!  Sleeping is a very important part of our life and contributes to our health.  Getting a good amount of sleep gives our body time to rest, and our brain time to make new connections.  When we don’t get enough sleep we can see the effects in many areas of our lives:  difficulty concentrating, poor attention, poor judgment, decreased ability to learn, depressed mood, and even obesity, heart disease, and a depressed immune system.

Do you think your children are getting the sleep that they need to be successful in school and in relationships with friends and family?  A National Sleep Foundation study recently found that 85% of teens do not get adequate sleep!  Adequate sleep means 8-10 hours every night for a teenager and 9-11 hours a night for a school age child.

Poor sleep has become a larger problem over the last 20 years.  What can you do to help ensure your child gets enough sleep?  Here are a few sleep tips to try:

  1. Maintain a consistent bedtime.  It is important for your body to always get up and go to bed around the same time, trying to limit fluctuations to 1 hour or less.  This includes the weekends, holidays, and summer break.  For older kids, avoid naps.  Naps make it more difficult to fall asleep at bedtime.
  2. Make sure the room is cool, dark, and quiet. Use your bed only for sleep, not for playing or punishment.
  3. Eliminate caffeine or nicotine from your diet, especially after noon. The effects of caffeine on sleep can last for 8 hours!
  4. Try to spend some time outside in the sun during the day. Spending time in a dark house confuses the brain into thinking it is nighttime.  Natural light during daytime is the best way to make sure your circadian rhythms are on track.
  5. Make up a relaxing bedtime routine. Try to always follow the same schedule so your kids know what to expect.  Some good ideas are a shower, story time, listening to calm music, or writing in a journal.
  6. Eliminate one of the biggest enemies of sleep from the bedroom: The Screen!  Looking at screens, especially screens from phones or tablets actually make your brain believe it is day and not night so your brain doesn’t release the sleep inducing hormone melatonin.  Studies have shown people who have tvs in their bedroom get less sleep on average each night.  It takes longer to fall asleep and you are less likely to stay sleep when there is a TV in your bedroom.  Remove technology from the bedroom!

Try the above tips and see if you and your children start getting better sleep.

Sleeping_angel

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

Football Season is Here!!! Let’s Play…

Spokane Football

Fall sports have started and it’s time to get those kids in for their annual Well-child exams/sports physicals (please call their doctors office today if this hasn’t happened yet). We want to make sure all kids and adolescents are healthy enough to play sports and that they continue to stay healthy throughout the school year.

Injuries can happen to any child at any time and a concussion can happen in just about all sports. Statistically, girls are at a higher risk of suffering concussions in their chosen sports than boys are; however, concussions can impact any student athlete. Striving for scholarships, championships, and social acceptance drives kids to make a choice about continuing to play when injured, despite their lack of readiness. It is your job as a parent, and our job as your child’s Doctor, to convince our kids that if they have not recovered 100% from a head injury then they are not ready to jump back into the game. Going back early places them at increased risk for severe bodily injury, permanent brain injury, or, in rare cases, even death. If your child has had a head injury and is having any symptoms at all, please get them in to their doctor for an assessment.

Concussion is a clinical diagnosis and you do not have to be KNOCKED OUT to have a concussion…this only happens 10% of the time. The most common symptoms to develop after injury to the head are headaches, dizziness, nausea or vomiting, disorientation, confusion, and loss of coordination. Severe symptoms can result in changes to your child’s personality, grades or academic effort, and their friendships.

There are 4 R’s for concussion to consider:

  1. Recognition- You have to recognize that a concussion has occurred.
  2. Remove- You need to remove that athlete from the risk of repeat injury.
  3. Recovery- Athletes need time to be symptom free before going back to activity.
  4. Return- To cognitive activity as well as return to play.

Diagnosis after injury should be done by your child’s primary care provider so they can follow up during and after the recovery period. There are many tools and tests people use to diagnose a concussion, but the symptoms should be followed closely by a medical provider to help prevent re-injury as well as to educate the athlete about risks of a second concussion. This typically results in worse symptoms, much longer recovery times and potential removal from the activity entirely. Missing a week for 100% recovery is certainly better than missing the entire season due to repeat injury.

With a single concussion, 85% of high school athletes have full symptom recovery within 2-3 weeks. When an athlete is highly symptomatic they should take a couple of days (48 hours) off from school. Their doctor can help make a plan as to the speed of their return to school and sports based in the extent of the concussion and symptoms. Returning to light aerobic activity that does not put the athlete at risk for repeat injury can help maintain fitness and mental health during the recovery period. In the past, athletes were strongly advised to avoid all physical activity until recovery had reached 100%. But new evidence shows that physical activity can help with brain growth and repair while doing nothing may prolong the recovery time.

So when should your child stop their activity or be disqualified from sports?

Three concussions in a lifetime requires having a serious conversation about risks associated with repeat head injury. Things that should disqualify your child from continued activity are increasing length of or severity of symptoms, concussions caused by less trauma then the first or second, decreased time in between concussion or prolonged post-concussive symptoms.

Remembering to help your child place their overall health and wellness above their sports performance may just help keep them playing sports for years to come.