anxiety – Dr. Vainder

Are you tired of trying to keep your child on a schedule? The importance of play.

May 20, 2020

As pediatricians, we frequently receive updates regarding topics of interest that the Academy of Pediatrics finds important for us to be aware of. Recently, a new clinical report from the American Academy of Pediatrics caught my attention. They are recommending that doctors write a “PRESCRIPTION FOR PLAY!”.

Yes, a prescription to play. It sounds so simple. Yet, from 1981 to 1997, children’s playtime decreased by 25 %. Children ages 3 to 11 have lost 12 hours per week of free time due to academic pressures and organized after-school activities. The pressures felt from parents to keep up with the daily-changing electronic games and digital devices is real.

Kids whose parents cannot afford the expensive digital toys may feel left out and kids whose parents CAN afford them, think that allowing their kids unlimited access to these objects is healthy and promotes learning. New games and apps come in the guise of claiming to help your child learn his or her ABC’s, math skills and or other didactic academic skills. Yet, studies show that the truth is actually that the opposite of this is true.

Children’s creativity and play is actually improved with inexpensive objects that are found in any household…boxes, spoons, balls, puzzles, crayons, boxes, pots and pans, etc.

The importance of play, it seems, has been lost. Sometimes play is viewed as frivolous or a waste of time. Parents are spending a small fortune and endless hours in a child’s life in organized sports and/or activities. The competition in the academic world is real. Parent’s want their children to be the best and this sometimes comes with the loss of free play.

Yet the studies show that play actually leads to changes in the brain in the molecular, cellular and behavioral levels. It is believed that play can have lasting changes in the brain that help to improve execute functioning and help in processing social interaction.

Executive functioning is the process of learning rather that the actual content. It has been shown to help children with improved self-regulation and self-control, better problem solving skills, filtering of distracting details, and mental flexibility. In fact, countries that offer more free play see greater academic success among children as they mature.

It has even been shown that children have lower levels of cortisol (which indicate lower stress levels) when involved in active play. This is especially important for children dealing with significant toxic stress and adversity in their daily lives, but is also important for decreasing anxiety as well. In fact, countries that offer more free play see greater academic success among children as they mature.

So what can we do? What can we as parents do to help change this? The recommendations are clear.

Encourage free play in your day to day life with your children. You do not necessarily need extra time to play. Incorporate play in your day to day life. Engage your children in helping at home with chores, which can in turn result in role playing or fun games.
Let your child lead with their creativity. If your child gets a new toy resist the temptation to show them how to use it. Let them try to figure it our for themselves. They may actually teach you something you had not even thought about!
Make free play a priority instead of viewing it as a waste of time. Relax and enjoy in watching your child run around yelling “I am a pirate” or “let’s play school”

Free play, without constant supervision, helps children come together. It often brings children from diverse backgrounds together as they make up rules to a game, role-play and learn empathy. Through play, children learn what its like to lose and they are encouraged to come up with strategies to improve their outcomes in up-coming challenges. These interaction help to evolve independent thinking and creativity.

Some of my happiest moments as a mom, was watching my kids build a fort and create their own stories and/or games. It makes me smile just to think about it.

It is up to us as parents to bring free play back into the lives of our children. Our world is changing and our children need the skills necessary to compete in the 21st Century world. We need them to be creative, innovative and problem-solvers. These are the very skills that free-play encourages through the development of executive functioning.
Stop and look around you. Take a long hard look at your child’s life and what his/her daily activities involve. Perhaps you have been feeling over scheduled and stressed with parenting and “keeping up with the jonses”.

Play with your kids. Act silly sometimes and laugh. Enjoy games you played as a child and help your child discover their interpretation of the world around them, free from your interpretation. The truth is that free play will not only help your child but you as well.

Below are age-specific recommendations :

2-3 months- Respond to your infants emergence of a social smile by smiling in response. It helps an infant learn the effects of their behaviors. (making a parent smile when they smile).
4-6 months- Encourage games of peek-a-boo, laughing, and encourage your infant to discover new objects on their own. Instead of teaching an infant how to use a toy, watch them discover it!
9 months- At nine months is when babies begin to develop separation anxiety and stranger anxiety. It is a time when infants begin to learn self-regulation as they begin to use their parents for social refrencing. Your baby is looking at you for guidance. Make sure your facial expressions are encouraging instead of fearful as your baby begins exploring the world.
12 months- At this age, infants really begin to lay the foundation of the development of social skills/interactions. They love the feeling of accomplishment and true joy as they take their first steps or say a new word. Encourage your child taking those baby steps in self-discovery. Again, remember that your facial expression is what your baby is looking for.
2 year olds- Everyone talks about the “terrible twos”. I believe that the reason this is a belief is that this is a difficult time for a toddler. It is a time of emerging independence and they undertand usually a lot more than they are able to communicate. This leads to frustration and tantrums. Try to provide your child with some independence while staying close by providing words of encouragement when they fail or fall. Resist the temptation to scoop them up when they fall. Watch to see what they do and how they begin to problem solve.
3 year olds- By 3 years of age, most children have begun to communicate more effectively and can understand cause and effect. This is when it is critically important to model behavior for your child. Help your child deal with emotionally challenging situations. Guide and lead but do not be so quick to offer solutions. Let them come up with their own ways and help them learn why some solutions may be better than others. Encourage drawing, coloring and creating. Sit back and discuss how wonderful that their elephant is purple and flies, just because… Encourage creativity and take them to the park, beach or outside with no agenda.
4-6 year olds- By 4-6 years of age, most children have started some form of formal teaching in an academic setting. If possible, try to select programs that prioritize free play and recess in these early years. If your income is limiting take the time when possible to find local parks or community centers where your child can simply just play…
7-9 year olds- By 7-9 years of age, many parents are focusing their child’s talents on one sport or another form of specific after-school activity. Many children this age spend sometimes 10-12 hours a week practicing and developing a skill. The pressures to be the best are beginning to become real and many parents with lower means begin to feel that their children are not able to keep up with their more “economically-advantaged” peers. The increase in the use of electronic devices increases significantly in this age group. Yet, studies show that active play for 1 hour per day, allowed kids in this age group to think more creatively and multi-task. These kids were also found to improved social-emotional skills that later are found to correlate with improved academic and economic success. Third grade prosocial behaviors correlated with eighth grade reading and math better than with third grade math and reading levels. So, set up play dates at the park. Set up no-electronic times in your child’s schedule and let them be “bored”. Boredom sparks creativity and taps into their imagination. Do not over-schedule them.
10 and beyond- After the age of 10, most kids are playing electronic games and or watching more TV and videos than interacting in free play. Make a point to go outside (with no electronics) whenever possible. Find activities in your community that encourage free play. Play decreases stress, fatigue, injury and depression. In fact, adult success in later life can be related to the experience of childhood play that cultivated creativity, problem solving, teamwork, flexibility and innovations.
Parents- The benefits of play for parents are too many to list. If your child asks you to play, do it. Enjoy the joy in your child’s face when he/she discovers the world. Go back to childhood, when life was simple, days were long and troubles were few. Create a bond with your child that will only strengthen with time, and have fun doing it!

Elizabeth Vainder, M.D.

The simple way to find out what your child is worried about

April 1, 2020

“Can you read me one more story?” “I’m thirsty”, “Can I go to the bathroom?”

Parents all around the world have heard these same questions right around the time that their kids should really be going to sleep! It can seem frustrating as you struggle to get your little one down and they get that second wind.

The idea of having a few minutes to yourself seems so appealing yet your little one keeps on talking and asking for more.

Tonight I’m encouraging you to stay a little longer and listen.

There is something magical about that time just before bedtime. Kids will talk about so many things jumping from one topic to another. But – if you really listen closely, you will catch a glimpse into what their little minds are actually thinking about.

Over the last few weeks, life has changed in ways that many of us could never have imagined. It has changed for our kids too and they feel it. Everything is different. No one is going to school, they can’t see their friends, school is perhaps on a computer now and there are no more playdates or get-togethers with friends. It is hard. Change is hard.

Kids are not very good at expressing what they are feeling. (some adults aren’t either!)

They will complain of physical symptoms when they feel anxious or afraid. Other times they will misbehave or have tantrums. Pay attention to all of it.

Kids are very good at eavesdropping on adult conversations and listening to the media. They make their own interpretations of what they hear. This can bring about feelings of worry or overwhelm. Sometimes they create ideas in their head that are not even real. Pay attention to what you say in front of your kids. They are listening.

So tonight, when it’s time for your little one to go to bed, snuggle with them a little longer and lay down to listen. Listen with an open heart and validate their concerns and feelings. You don’t need to have all of the answers. Help them to understand what they are feeling and what they have seen and heard. You will learn a lot about your child in these few minutes before they fall asleep and they will know that you cared. You cared enough to listen. That is the greatest gift of all.

Share with a friend that can use this!

Have a wonderful Wednesday and stay safe and healthy

Elizabeth Vainder, M.D.

Look for the helpers….

March 17, 2020

I can still remember as a little girl sitting hours watching Mr. Rogers Neighborhood. There was something about his calm voice that kept me glued to the television. Mr. Rogers would say, “There is only one person in the whole world like you, and people can like you just because you’re you.” He made you feel special. He also had a natural gift to make what were some of the most difficult or scariest of things seem manageable.

Here are some lessons that are just as important today as they were then:

1. “Whatever is mentionable can be more manageable”. Helping children express their emotions can help manage their feelings. It helps us adults too…

2.“You are special and so is everyone else in this world.” Everyone is special in their own way – the beauty is in finding what makes you and others special.

3.“Did you know that when you wonder, you’re learning?”– Wondering can be the beginning of amazing things. We are surrounded by things all around us that began with a thought.

5. “I like to be told” – Mister Rogers was an advocate for preparing children when faced with moments of fear or anxiety. He would help children learn what to expect when visiting the doctor or the dentist. Telling someone what to expect helps with feelings of anxiety, especially if it’s from someone you love or trust.

6. “Some things I don’t understand”– He wasn’t afraid to talk about difficult things that we face in the world. He gave us permission to accept that some things we just don’t understand. He reminded us not to be afraid of talking about what we are worried or thinking about. Journaling or talking to others can help us all with feelings of anxiety or worry.

So today, as we face this pandemic that is Covid 19, I ask that you stop and use Mr. Roger’s messages of hope as we navigate the next few days. Talk to your kids and encourage them to ask questions. Ignoring feelings do not make them go away. Trying to suppress feelings only help them to get stronger. It’s okay to be scared but we should always have hope.

I have faith that we will get through this together. The people of the United States will come together to fight the fight. Each of us with our unique talents will help us all make it through.

I have faith that we will prevail and be stronger and closer because of it.

Illness knows no color, race, religion or culture. Illness does not discriminate. We are in this together and we will get through it together.

So as we face the coming days, remember to keep looking for the helpers. They are always there.

Elizabeth Vainder, M.D.

-Quotes courtesy of misterrogers.org

3 C’s To Help Your Anxious Child

February 12, 2020
Good morning and Happy Wednesday!!
It seems that everywhere you read, you see that rates of anxiety are increasing in both adults and children.
Did you know that children with anxious parents have a greater chance of suffering from anxiety? It’s hard to control our emotions sometimes but it’s important to watch what we say when faced with difficult situations. Children learn more from how we act than how we tell them to act (adults too!!)
So here are three tips to help your anxious child :
1. Communication- Sometimes children overhear conversations or see something on television and interpret what they are seeing with the limited knowledge they have about the world. It’s hard as adults to remember what it’s like to be 7 years old, 13 years old, 18 years old…you get the idea. So we tend to think they are interpreting situations the same way we are! Don’t assume! (We all know what happens when we assume!:)) Instead try open ended questions or ask your child about what they are thinking about when they feel scared or anxious. Their answers may surprise you and you will feel better equipped to help them understand.
2. Consistency – Kids thrive when they know or understand what to expect. Having routines and a schedule that they understand and can follow can do wonders for an anxious child. Consistency gives comfort. Follow through on your promises (don’t promise things that you may not be able to do!). Give consistent responses to your child’s questions. Always be honest. It is important to be honest with your kids. They need to know they can trust you.
3. Care- Sounds obvious right? We always need to show that we care. Try not to say things like “oh it’s nothing” “just forget about it” “try not to think about it”. These kind of responses belittle a child’s fear or anxiety. Instead try to listen to what your child is saying and validate their concerns. Saying things like, “it’s normal to feel scared in new situations but let’s give it a try” is more supportive and more comforting. Walking your child through what to expect can also help. You take away the fear of the unknown.
As always, being present, communicating, being consistent and always showing that you care will always steer you in the right direction.
I hope you’re having a wonderful week!
Elizabeth Vainder, M.D.

Parenting teens

January 29, 2020
It was a regular well visit for a young girl. She was 14 and there was clearly some tension in the room between mother and daughter. It is nothing unusual. The teen years often come with a lot of eye-rolling and resistance as the battle for independence is in full gear. This young girl was a little over weight and had some acne on her face. The mother pointed out that she was concerned about her acne, her weight and said her hair was brittle and thin. We proceeded with the physical exam and then I was able to speak to the young girl alone. In the office, I have the opportunity to speak to both parents and teens separately which is always something I find insightful. Usually the parents and the child are worried about very different things. It is frustrating. It is normal.
If you have a teen, you have experienced the eye-rolls, the quick short answer responses to your questions and the seemingly aloof attitude. It is as if nothing that you say really means anything or matters. I suppose over time this frustration can lead to a sort of “giving up” on talking or giving advice. These feelings can leave a parent worried about their teen and what he/she may not be telling them. Battles for even the silliest of things ensue and the distance grows larger.
The sad thing is that most teens feel alone as they navigate what can be a new and scary world. They are trying so hard to fit in and they are not sure of who they are and what they stand for. Some seem to cruise through the teen years without a bump and others struggle. It is a time of self-doubt and self-exploration. Who am I? Who are my real friends? What is life really about? Teens live in the now. The present consumes them and they think if a certain group of kids doesn’t like them or they are not cool their world is essentially over. Some become obsessed with how they look, their weight or their “persona” on social media.
Parents on the other hand are looking at the overall picture. They have experienced life and want so desperately to protect their teens from the evils in the world. It can become all-consuming. The internet has become a quick resource for teens and they have access to much more information (with videos and images) than most parents have ever had in their lifetime. It is hard to keep up. It is also hard for some parents to remember what it is really like to be a teen. They are so focused on their role as a parent that they do not really stop to put themselves in the place of their teen. This is exactly what was happening with my patient.
When I sat in the room with the young girl, the first thing she said to me was, “my mom hates me”. I paused. She continued and explained that her mother was always telling her that she needed to lose weight, that her skin looked horrible and that her hair looked awful and thin. She told me that her mother was always yelling at her and proceeded to cry.
In the next room the mother was waiting. When I went into the room she started to cry. She explained that she was a single mom and was trying her best to work and provide for her family. She felt alone and worried and didn’t know what to do. She went on to tell me that she was worried about her daughter who was often crying and refusing to leave her room.
This scenario is not uncommon. This the perfect time to bring up the possibility of therapy. Explaining to a family that sometimes what we really need is a neutral person to talk to. Someone that will not judge you and will provide a safe place to speak your mind. I try to explain to teens that there is nothing wrong with them if they see a therapist. There are times in life when we can all use a person to really talk to without the worry of being judged or yelled at. It is also a wonderful time to learn about coping skills and how to find productive and useful ways to manage stress and difficult situations. Often these therapy sessions can also involve the parents when the teen is ready and can prove very useful in helping communication. The earlier intervention begins the better. Studies show that the earlier we provide help the better the outcome.
Do not be afraid to ask for help and do not let your teens lack of attention to your advice stop you from giving it. This is when they need it the most. Even though it seems that they are not listening, they are. Be careful of the words you use and remind your teen that the best way to get through the teen years is to stay true to themselves. Encourage them to find friends that are like them (even if it is only one) and to focus their energy on what makes them truly happy and feels genuine to them.
However, more often than not the best approach is just listening. When you feel like you just can’t find the right words to say, say nothing. When you are considering giving advice but feel that the moment just is not right, say nothing. Many times in life what we all need is just to know that someone really cares. Be that one person for your child.
Have a wonderful week!
Elizabeth Vainder, M.D.