Monday, June 26, 2017

IpadAndIphoneRVAMayJun2017click here for the latest digital edition of OurHealth magazine

Featured Stories

Growing Emotionally Healthy Children

Written by  Susan Dubuque

What more could a parent ask for than a happy, well-adjusted child? Today, health and family magazines abound with valuable information on children’s mental health issues — from attention deficit hyperactivity disorder and autism spectrum disorder to bipolar disorder and youth suicide. But let’s approach the subject from a different perspective. We will explore tips and techniques to help parents, grandparents and educators nurture the development of emotionally healthy and resilient children.

“At the foundation of emotional health you will find the combined effects of our genes and environment — nature and nurture," says Martin Buxton, MD, chief of psychiatry at Chippenham and Johnston-Willis hospitals. "We can’t control our genetic makeup, but there are many ways we can influence a child’s state of emotional well-being through our behaviors, interactions, communications and the environment we create at home, at school and in our communities.”

Look in the mirror

Children tend to reflect the emotional status of their parents, and it goes beyond the hereditary implications. “Make an honest assessment of your own emotional status. Are you generally happy, stable and able to cope with the trials and tribulations of everyday life? Or are you depressed, anxious, angry or struggling with some other form of mental distress? In any case, you serve as an emotional role model for your child,” says Dr. Buxton.

When you gaze into the emotional looking glass, if you don’t like what you see, get help. If you had diabetes, cancer or the flu, you wouldn’t hesitate to seek medical attention so you could be there for your family. Only if you are mentally healthy can you truly be available to your child. And your child will learn an important lesson too — that it is OK to ask for help when life becomes emotionally overwhelming.

Focus on the whole child

“A child’s physical and emotional health are intertwined. In fact, they are really one in the same,” says Aradhana “Bela” Sood, MD, a pediatric psychiatrist with the VCU Medical Center's Virginia Treatment Center for Children.

So let’s start with the basics — the things your grandmother would have endorsed.

Nutrition

The relationship between a balanced diet and emotional well-being has been recognized for a number of years. The literature is filled with articles on the consequences of inadequate nutrition, including social withdrawal, decreased concentration, sleep disturbances, irritability, apathy and depression.

According to national nutritional expert and registered dietitian Eileen Meyers, “Perhaps the best rules to follow regarding your child’s nutrition are driven by common sense.”

  • Provide three well-balanced meals a day. That may sound too fundamental to even bother mentioning, but it's essential to make this point in light of the busy schedules that many families maintain.
  • Allow some sugar and fats, but not in excess or in place of a wholesome diet.
  • Watch out for caffeine, sodium and chemical additives, which are abundant in kids' favorite snack foods. But don’t be a fanatic — an occasional Twinkie is really all right.
  • Serve as a role model for good eating habits.
  • Stock your refrigerator and cupboards with healthy, fun treats like fresh fruit, yogurt, carrot sticks and fruit juice.
  • Don’t use food as a means of nurturing your child. Rather than rewarding your child with a cookie, give him a hug. Instead of a piece of cake, take a walk together.
  • Most importantly, don’t allow food to become a source of stress in your child’s life. Mealtime should be relaxed and enjoyable. This is a time for sharing the day’s events, not fighting over uneaten Brussels sprouts.

Forty winks

Inadequate and poor sleep can lead to mood swings and behavioral problems, as well as difficulty concentrating and poor performance at school. But how much sleep is enough? While every child is different, the National Sleep Foundation offers the following guidelines:

 

Newborns (0-3 months)                 Up to 18 hours around the clock on an irregular schedule

 

Infants (4-11 months)                    9-12 hours at night and 30 minute to two-hour naps, one to four times a day, fewer as the child reaches age 1

Toddlers (1-2 years)                       11-14 hours of sleep in a 24-hour period; when the child reaches about 18 months of age, naps will decrease to once a day, lasting about one hour

Preschoolers (3-5 years)                11-13 hours per night; most children do not nap after 5 years of age

School-aged children (6-13 years)            9-11 hours per night

Teens (14-17 years)                        8-10 hours per night

Tips for avoiding the bedtime drama include

  • Encourage your baby to fall asleep independently and to become a "self-soother."
  • Allow toddlers and young children to use a security object such as a blanket or stuffed toy.
  • Develop regular daytime and bedtime schedules.
  • Create a consistent and enjoyable bedtime routine, such as reading a book or sharing a story.
  • Establish a sleep-friendly environment — cool, quiet and dark.
  • Keep TVs and computers out of the bedroom.
  • Avoid caffeine.

Just do it

Provide your child with plenty of opportunities for exercise. Physical exertion releases natural endorphins that have an emotionally uplifting effect. And there are lots of other benefits from specific activities, so find one that meets your child’s needs.

  • Martial arts can help children gain confidence as well as self-control and discipline.
  • Soccer, softball and baseball are great sports that children of any age, size and physique can play. There are plenty of youth leagues that emphasize skill development, fitness, teamwork and sportsmanship.
  • Weightlifting can help teens who aren’t particularly competitive build self-esteem while they build muscles.
  • Running and walking are activities that can be done pretty much anywhere, anytime.
  • When your child is feeling stressed or anxious, suggest a five-minute “power break.” Jumping rope, running around the block or bouncing a ball 100 times can provide a needed bit of relief, especially during a demanding homework session.

“Without mental health, there is no health,” says Dr. Sood. Perhaps this should be our new mantra.

Express yourself

Help your child develop a “feeling vocabulary” so she can express what’s really going on inside. Otherwise she is may resort to throwing a temper tantrum, acting out, sulking or just holding it all inside and feeling miserable.

Feelings are neither good nor bad, they just are. Acknowledge and accept your child’s feelings even when she is sad, angry, hurt, jealous, insecure, lonely, afraid — whatever. “Build a safe place where your child is free to openly express her full range of emotions,” says Evelyn Frazier, MD, developmental behavioral pediatrician with Bon Secours Richmond Health System.

While all feelings are OK, the behaviors that follow may or may not be. “Let your child know that while she is entitled to be angry when her little brother breaks her favorite toy, it is not OK to retaliate by hitting him or breaking his toys,” says Dr. Frazier.

As a parent, you are entitled to your feelings too. If you are sad, it is fine to share that with your child. In fact, it gives you the perfect opportunity to demonstrate the best way to deal with negative feelings. For example you could share, “I am very disappointed that we didn’t get to go to the beach today because it rained. But let’s see what else we can do that’s fun. Why don’t we bake some cookies or make a dress for your doll.” Show your child how to look for plan B — a great tool to build resiliency.

While it is important for your child to understand and express his own feelings, it is equally important that he learn to interpret other people’s feelings. In the aftermath of a dispute between your child and a sibling or friend, take a moment for a little lesson in empathy. Ask your child, “How do you think that made Billy feel when you called him a fatty pants? How does it make you feel when someone calls you a name?” There are excellent books, posters, games and even flashcards devoted to decoding other’s feelings.

Children will adopt the family’s attitudes toward other people. “Be aware of disparaging comments — even when made in jest — regarding others. Show respect for people who may be different than your family, and your child will acquire a sense of acceptance and openness,” says Dr. Buxton.

Be an active listener

“Busy parents are often half-hearted listeners. Take a few minutes to really connect with your child,” says Dr. Sood. Here are the components of active listening:

  • Eye contact. Look at your child, not the TV, your phone or the morning newspaper.
  • Attentive body language. Lean toward your child. Sit close. Nod your head to let him know you're listening.
  • Be quiet. Resist the temptation to offer an immediate solution. Ask your child if she would like a suggestion or if she just wants you to be a sounding board.
  • Verbal following. Make little “I’m listening” sounds, like “oh,” “really?” or "hmm.” Or restate what you heard your child say, like, “It made you feel really sad when Becca didn’t invite you to her party.” Simply paraphrase, rather than getting into deep interpretations. This lets your child know you are really hearing her and allows her to clear up any miscommunications.
  • Make sharing time a priority. Set aside time to talk with your child on a regular basis — not just when something’s wrong. It may only be 15 minutes every Saturday morning over a cup of hot chocolate, but make sure that time is sacred. Even if you child isn’t in the mood to talk, let her know that time is reserved just for her.

Look for the positives

How will your child know what good behavior looks like if you only tell him when he is being bad? “Make it a point to catch your child in the act of being good,” says Dr. Frazier. “Reinforce the behaviors you would like to see with praise. Thank your child for not interrupting you while you were on the phone or remark how nice it was to see him share with a friend.”

When your child does slip, as all kids will, provide opportunities to turn things around. Give him a chance to succeed.

Help your child find activities or talents where she can succeed and shine. If your daughter has two left feet, don’t insist that she continue with the ballet classes that she dreads. Instead, find something that will help her build her sense of accomplishment and self-confidence.

Instead of praising your child for his accomplishments and achievement, you can also emphasize

  • Intrinsic goodness. Your child’s goodness comes from within and is not attached to any external measure of success. Reinforce positive attributes like kindness, patience, gentleness and humor. Give love unconditionally. Like Mr. Rogers used to say, “I like you just the way you are."
  • Effort. Praise your child for trying something new or sticking with a tough assignment, regardless of the outcome.
  • Intentions. Your daughter drops and breaks a dozen eggs along with your favorite serving dish. OK, so you want to scream. Before sending her to her room, take a deep breath and ask what she was doing. Her answer: She wanted to make breakfast for Mrs. Smith next door who is sick in bed. There isn’t a plate in the world worth more than that act of kindness. Give her a hug and work together to clean up the mess and make Mrs. Smith’s breakfast.

A routine matter

Children find comfort in knowing what to expect, and they can thrive when they understand the boundaries. Establish clear and consistent rules and routines with preset consequences, such as bedtime, and then stick to them. “But this doesn’t mean you should be rigid or dictatorial,” notes Dr. Frazier. “You want your home to feel like a fair place. And as your child grows, you will want him to assume more responsibility and control over his destiny.”

Author’s note: When I was a teenager, my parents did not give me a set curfew. Instead they told me to “be home at a reasonable hour.” When I asked what that hour was, they would reply, “We trust you to use good judgement.” I came home an hour before any of my friends. Of course, I had to earn their trust, but that lesson stuck with me all these years.

Establish family traditions

“Children enjoy a sense of belonging when they experience family traditions,” says Dr. Frazier. “It doesn’t have to be anything elaborate, just something that is unique to your family.” Perhaps you each tell a joke at dinnertime, or every Saturday morning you visit the farmers market and stop for an ice cream cone on the way home. Invite your children to help determine what your traditions should be. These small moments make your family special and help create warm memories for your child.

All together now

“Children are not born with a work ethic; it must be taught,” says Dr. Buxton. “They can contribute to the household in an age-appropriate way, from picking up their toys when they are toddlers to mowing the grass as teens. Even very young children can learn to complete their “work” before playtime.”

“As children get a little older, they can also be encouraged to contribute to their community,” adds Dr. Frazier. “A child can recycle, donate money to a charity or volunteer to work for a worthy cause. These are wonderful ways to foster giving, build empathy and help children to be less self-centered.”

Natural consequences

Your child is late for dinner for the fifth night in a row, and you’re tired of being treated like a short-order cook. First, you lecture him for 15 minutes about being inconsiderate. Next, you take away a privilege or ground him after school. Then you cook dinner — all while continuing the verbal assault. Finally, you swear this will be the last time you will ever prepare a second meal if he is late. Sound familiar?

Next time this happens, allow natural consequences to prevail. If your child misses dinner, either he doesn’t eat or he prepares his own meal and cleans up afterward. He made the choice; let him live with the consequences. It is a far less combative approach. It puts your child in control of the outcome and removes you from being "the enforcer.”

Maybe yes, maybe no

“Help your child build a tolerance for hearing ‘no,’” recommends Dr. Buxton. “Allow him to experience small frustrations so his fuse can grow, and he will be able to deal with larger frustrations and disappointment as he gets older.”

In her book, "Stop Struggling With Your Child," Evonne Weinhaus offers a simple suggestion for parents who are tired of arguing with their children over every little thing — just say “yes.” Instead of saying, “No, you can’t have a cookie because we will be eating dinner in 15 minutes,” say, “Yes, you can have a cookie — right after dinner.”

At the mere mention of the word “no,” your child is suddenly prepared for battle. But there isn’t a lot to argue with when you say “yes.”

Limit screen time

Let’s face it. We’re living in a digital age, surrounded by gadgets. We even refer to our children as “digital natives.” But what are the effects of spending hours each day in front of a computer or television? And how much screen time is too much?

Dr. Frazier offers guidance from the American Academy of Pediatrics on this important subject. “Children under age 2 should have no screen time at all. Older children should limit their screen time to less than two hours a day total. This includes computers, video games, phones and, of course, TV.”

In a recent study conducted at UCLA, results indicate a relationship between screen time and social skill development in children. When screen time was limited, the children’s ability to read other peoples’ emotions improved. Other studies suggest that screen time can have a variety of negative effects on kids, including childhood obesity, irregular sleep patterns and behavioral problems.

As an alternative to screen time, provide opportunities for children spend more time interacting with the family. “There really is value in game night, throwing a ball or just chatting about the day,” says Dr. Frazier. “And when you are watching TV, engage with your child during the activity. Discuss the program with your child and make it a teachable moment.”

Cut your losses

Even a happy, well-adjusted child can face a very real and devastating loss such as the death of a beloved grandparent or family pet. Or it may be less obvious, such as the loss of self-esteem when your daughter does not make the cheering squad. You can help your child through the grieving process by

  • Letting her know that losing someone or something special hurts. Give her permission to grieve.
  • Encouraging your child to talk about her full range of feelings, such as anger, sadness, denial, guilt, jealously and fear.
  • Holding on to the good feelings. Help your child create a memory box or memory book. Give him photos of his grandfather and memorabilia like a class ring or medals from military service. Help him capture and preserve the warm loving feelings he had for his loved one.
  • Taking on the positive characteristics of a loved one. Let’s say a close friend or relative dies or moves away. Or perhaps your child is feeling the loss of a favorite teacher when it's time to move to the next grade. Ask your child what he liked or admired most about that person. Then encourage him to adopt that trait. Your child can keep the memory alive by being as nice as grandma, as funny as Jason or as courageous as Mr. Jones.
  • Letting go. If your daughter is deeply saddened that she didn’t make the basketball team, help her let go of those feelings and move on. Rather than dwelling on the loss, encourage her to focus her energies on a new activity. While it is important to recognize the pain your child is feeling, it is equally important to help her learn coping mechanisms and regain her sense of control.

Pull together, even when you’re apart

When parents separate or divorce, children suffer. “If you and your spouse have made the decision to end your marriage, do not drag your child into the battleground. Allow him to maintain a close and loving relationship with both parents,” advises Dr. Buxton.

A child’s self-image is in large part a reflection of both parents. If you tell a child that Mommy is bad, he will think he is bad. If tell him that Dad is a creep, he will assume he is one too. “Your child is a miracle that you both created,” says Dr. Buxton, “so set aside your differences and put the needs of your child first.”

Here are some ways to be good co-parents:

  • Refrain from making disparaging comments about each other.
  • Avoid blaming and finger-pointing.
  • Give your child free access to the other parent.
  • Try to maintain consistency in parenting styles and household rules.
  • Make major decisions about your child as a team.

The concept of positive co-parenting is not limited to parents who live apart; they also apply to intact families. Even moms and dads who live together can unknowingly pull and tug at their child’s emotions.

Bullying

Bullying in any form — physical, verbal, emotional or relational — can be deeply hurtful to a child, leaving her feeling frightened, angry, helpless, embarrassed and even guilty that the bullying is somehow her fault, says Dr. Buxton. “Children who are bullied can also experience depression.”

Encourage a child who is being bullied to

  • Understand bullying. Explain that bullies are really unhappy, frustrated and insecure people. They try to make themselves feel better by controlling other people and making them feel lousy.
  • Walk away.Bullies want to know they have control over your emotions, so don’t react with anger or retaliate with physical force. If you walk away, ignore them or calmly and assertively tell them you’re not interested in what they have to say, you’re demonstrating that they don’t have control.
  • Find the humor. If you relax and comment on the bullying situation with humor, you’ll likely no longer be an interesting target for a bully.
  • Control what you can. Many things in life are beyond our control, including the behavior of other people, so focus on the things you can control such as the way you choose to react to bullies.
  • Report the bullying to a trusted adult. Unless bullies are reported and stopped, they may become even more aggressive.

If your child is not able to resolve the bullying on her own, get involved. Tell the teacher, contact the bully’s parents, and if you have to, call the police. Your child must feel confident that you will step in to protect her.

“There is no simple recipe for raising an emotionally healthy child,” says Dr. Sood. “The best advice I can offer is to love and accept your child unconditionally. Focus on your child’s strengths and positive attributes. Keep your sense of humor. And, finally, remember: Before you blink, your child will be grown. So enjoy every moment of the toughest job you will ever love.”