#49: A Story of Two Sisters: The Good Student and the “bad”: Recognizing Anxiety Early

July 29, 2020

In the summer kids usually come in for their check-ups. This is an opportunity for doctors to touch base with families and see how their kids are doing. This day was no different than others, and the next family hurried in. A 14 year old girl, tall and lean, walked in with her little sister. The young girl, turning 12 in a few days, followed closely behind and sat herself on the exam table. The mother followed. 

I love seeing families in the summer. Usually the kids and the parents are more relaxed than during the school year, when they are busy with school, sports and other extracurricular activities. I get to hear about summer vacations and camp. I also get to learn about how things are at school and if there will be any changes in the coming year for the kids. 

The little girl was sitting on the exam table with her head down, fidgeting with her fingers. I smiled at her and asked her about her summer and what she had been doing. She went on to tell me that she had been spending her days cooking and practicing basketball, which she loved. 

I asked her to give me more details about what exactly she was cooking and what kinds of foods she enjoyed the most. Her eyes lit up and she went on and on about how she loved finding new recipes to try on the internet and looked for you-tube videos showing people making different dishes. 

Then I asked her about basketball and she explained how this was her favorite sport. She was enjoying a summer camp that focused on helping kids perfect their skills and she “LOVED IT!”. This year, she was excited because she was trying out for the basketball team at school and she couldn’t wait. 

Finally, I asked her about school. This is when her face quickly changed and her eyes hit the floor. Her mom jumped in. “She isn’t trying very hard in school”, “We know that she can do better, but she doesn’t have any interest in school.” The little girl didn’t say a word. I tried to change her focus and asked her what her favorite subject was. She told me it was Science. 

Ah! A girl after my own heart! She explained to me how she had an amazing Science teacher that loved to teach them about their bodies, nature and the ocean. She told me that this teacher was her absolute favorite teacher ever! 

As we finished her exam and discussed healthy habits, I reminded her to read over the summer and keep her math skill sharp so that when the new school year began, she would be ready. She nodded and jumped off the exam table. 

Her older sister was next and we began her exam in the usual way. Her interests were different and the mom quickly jumped in to tell me how wonderful she was doing in school and how she had achieved the Honor Roll every semester. She smiled and shrugged her shoulders. 

She told me that her passion was History and English and that she was participating in a writing camp over the summer because she loved to write. The mother beamed. She went on to tell me about how proud she was and how she ALWAYS put forth her maximum effort. She then went on to say that she wished that her younger daughter would have at least half the interest in school that her son had. She told me that she knew that she could do better, if she only applied herself. 

The little girl sat next to her mom, staring at her nails. Her nails were chewed and little was left. Her mom then told me about how she wouldn’t stop biting her nails.  That her hands “looked terrible”. 

The visit ended and I spoke to each child and mother alone. I always like to speak to tweens and teens alone to see if they have any concerns or questions about their health. Sometimes they do and sometimes they don’t, but I think they like when a doctor addresses them directly and gives them the opportunity to talk. Sometimes they do reach out, but even when they don’t, they know that they can if they decide to in the future.

I asked the little girl about school and she started crying. She told me that she did try but that school was hard for her. She told me that her older sister was the smart one and that she was just dumb. We talked about how she wasn’t dumb and discussed a little more about what exactly was happening in school. 

I won’t get into the details but I then went to speak to the mother alone, explaining to her that I was worried about how her daughter was feeling. The mom then began to cry. She told me how she had tried everything and that nothing seemed to work. She agreed that she needed help but that she just didn’t know what to do. 

We discussed some options and I encouraged her to have her daughter have a formal evaluation to rule out possible learning challenges. She agreed. At the end of the visit, I explained to the girl how we all learn differently and that she was not dumb. The secret was finding out how SHE learned best so that she too could succeed in school. She wiped away her tears and smiled a tiny smile. 

These visits sometimes feel so rushed, since we only have a few minutes with each patient, but there are so many things that run through my mind when I see a family like this. It’s actually more common than you think and it pains me when I know kids are suffering in silence and well-intentioned parents just don’t know what to do. It’s impossible to fix these issues in a simple well check up and my hope as a pediatrician is to at least begin the process of healing instead of letting these issues spiral out of control. These circumstances can often lead to anxiety and depression later in adolescence and into adulthood.

The take away from this story I’m sharing with you is that we are all unique. We are all born with talents and as we grow, our focus should always be on learning more about ourselves. Finding out what doesn’t work for us is sometimes even more important than figuring out what does. 

The best gift a parent can give a child is to help them figure out what their unique gifts are and resist the use of labels to describe them. We are so much more than those labels, and those labels are sometimes carried for a lifetime. 

Have a wonderful week! 

Elizabeth Vainder, M.D. 

DRVCARES

Some Signs of anxiety in children:

  • Difficulty concentrating
  • Difficulty sleeping, or waking in the night with bad dreams.
  • Not eating properly.
  • Often angry or irritable
  • Constantly worrying or having negative thoughts.
  • Feeling tense and/or fidgety
  • Stomach aches/ Headaches

Symptoms of Generalized Anxiety Disorder:

  • Trouble falling asleep.
  • Fear of being alone.
  • Picking at skin.
  • Nail biting.
  • Strong startle response.
  • Being overly self-critical.
  • OCD-like behaviors (e.g. checking and rechecking the door to make sure it is locked, etc. )
  • Refusing to go to school or having a hard time at school drop-offs
  • Difficulty participating in class and interacting with peers
  • Excessive worry about everyday things
  • Trouble answering questions when called on by the teacher
  • Disruptive behavior
  • Squirming
  • Frequent trips to the nurse (with complaints of headaches, nausea, stomachaches, or even vomiting)
  • Avoiding socializing or group work
  • Not turning in homework

Resources: www.childmind.org

Please remember that like everything, if your child has some of these behaviors, they can be normal ways of managing stress. If you are noticing multiple symptoms or all of the behaviors described above, please talk to you pediatrician.

#47: 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 :

  1. 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).
  2. 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!
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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…
  8. 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.
  9. 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.
  10. 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.

#40: 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. 

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#38: 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

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#31: 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.

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