Tuesday, April 12, 2011


My husband sent me this article and it was too moving not to share. Wow! It is about the increasing early maturation of our youth. Girls hit puberty earlier than ever, and doctors aren't sure why By Liz Szabo, USA TODAY "All of our friends told us to cherish every moment," Claudia says. "When I started planning her first birthday party, I remember crying and wondering where the time had gone." Even so, Laila's parents never expected their baby to hit puberty at age 6. They first noticed something different when Laila was 3, and she began to produce the sort of body odor normally associated with adults. Three years later, she grew pubic hair. By age 7, Laila was developing breasts. Without medical treatment, doctors warned, Laila could begin menstruating by age 8 — an age when many kids are still trying to master a two-wheeler. Laila's parents, from the Los Angeles area, asked USA TODAY not to publish their last name to protect their daughter's privacy. Doctors say Laila's story is increasingly familiar at a time when girls are maturing faster than ever and, for reasons doctors don't completely understand, hitting puberty younger than any generation in history. Saving Childhood All week Join @LizSzabo and experts to discuss raising kids and teens using the hashtag #kidschat on Twitter. Also, share your childhood photos here. Monday: How parents can help their daughters stave off puberty -- and cope, when it arrives. Video and advice from families and experts.

Tuesday: What can families do about marketing aimed at kids that promotes sexy images beyond their years? Wednesday: More than half of children in the USA have had a chronic disease such as asthma or obesity. What can communities do to help? Thursday : In just a generation, kids have largely stopped playing outside. Friday: Children are taking more tests but spending less time running around in unstructured play. Are kids being pushed to grow up too fast? Has childhood stopped being fun? About 15% of American girls now begin puberty by age 7, according to a study of 1,239 girls published last year in Pediatrics. One in 10 white girls begin developing breasts by that age — twice the rate seen in a 1997 study. Among black girls, such as Laila, 23% hit puberty by age 7. "Over the last 30 years, we've shortened the childhood of girls by about a year and a half," says Sandra Steingraber, author of a 2007 report on early puberty for the Breast Cancer Fund, an advocacy group. "That's not good." Girls are being catapulted into adolescence long before their brains are ready for the change — a phenomenon that poses serious risks to their health, says Marcia Herman-Giddens, an adjunct professor at the University of North Carolina-Chapel Hill. "This is an issue facing the new generation," says Laila's doctor, Pisit "Duke" Pitukcheewanont, a pediatric endocrinologist at Children's Hospital of Los Angeles, who treats girls with early puberty. "Many parents don't know what is going on." Researchers don't completely understand why the age of puberty is falling, Herman-Giddens says. Most agree that several forces are at work, from obesity to hormone-like environmental chemicals. There's no evidence that boys are maturing any earlier, says Paul Kaplowitz, author of Early Puberty in Girls. But data clearly show that girls once matured much later, probably because poor diets and infectious diseases left them relatively thin, Steingraber says. Girls' lack of body fat may have sent a message to their bodies that they weren't yet ready to carry a pregnancy, she says. In the 1840s, for example, girls in Scandinavia didn't begin menstruating until age 16 or 17, says Kaplowitz, a pediatric endocrinologist at Children's National Medical Center in Washington. As nutrition and living conditions improved, the age at first menstruation occurred two to three months earlier each decade. By 1900, American girls were getting their periods at age 14. Though the age at which girls get their first period has continued to fall slowly since then, the age at which girls begin developing breasts has declined much more dramatically. Early puberty increases girls' odds of depression, drinking, drug use, eating disorders, behavioral problems and attempted suicide, according to the 2007 report. When these girls grow up, they face a higher risk of breast and uterine cancers, likely because they're exposed to estrogen for a longer period of time. Early puberty isn't the only way that childhood is changing. In only a generation, children have become less connected to nature and, in many ways, less free, says pediatrician Chris Feudtner of Children's Hospital of Philadelphia. Today's children rarely, if ever, are permitted to roam wild or play outdoors alone, out of sight of watchful, worried parents. Schools are eliminating recess, even as they install vending machines in school cafeterias. No one should be surprised, Feudtner says, that this generation of children is heavier, less active and more prone to chronic disease and hormonal changes. "It's very concerning that girls are continuing to develop earlier and earlier," Herman-Giddens says. "We need to look at our environment and our culture, and what we're doing to our kids." Maturing too quickly When Laila's parents took her to a doctor, he had disturbing news. One of the causes for their daughter's precocious development, they learned, could be a brain tumor. "That's when you have your sleepless nights," says Laila's father, Joe, an engineer. Although scans showed that Laila did not have a tumor, tests did find that she was maturing at an alarming rate, with the skeletal development of a child several years older. Yet her early maturation was likely to cut short the total amount of time she spent growing, so Laila — who was tall, athletic and slim — probably would wind up much shorter than many of her friends, her father says. Doctors told the family that monthly hormone shots could stop her breast development and prevent Laila from getting her period. Typically, girls get their periods at around the same ages that their mothers did. Claudia says she didn't begin menstruating until 12. Given Laila's fear of needles, the prospect of monthly injections seemed too traumatic, her parents say. "I'd heard horror stories, about three nurses having to hold down an 8-year-old" to administer the shots, Joe says. Laila's parents reconsidered after their doctor learned of a newer type of hormone therapy, which is implanted beneath the skin once a year, during minor surgery. Laila, now 9, has since had two of the implants, with no side effects. The family is considering one more implant before allowing nature to take its course. As in most cases of early puberty, doctors have never pinpointed what caused Laila's precocious development. "She is still our baby," Claudia says. "But to look at her now, and think that she is growing faster than the average, we can't help but to feel like we are being rushed through her primary years." Why is this happening? Like Laila's parents, many people wonder: Why is this happening? While much about early puberty remains a mystery, researchers say that suspects include: •Obesity. The clearest influence on the age of puberty seems to be obesity, Steingraber says. In general, obese girls are much more likely to develop early than thin ones. And the number of heavy girls is growing, with 30% of children overweight or obese, the Centers for Disease Control and Prevention says. Obesity raises the levels of key hormones, such as insulin, which helps regulate blood sugar, and leptin, a hormone made in fat cells that helps regulate appetite, Steingraber says. While leptin may not trigger puberty by itself, research suggests that puberty can't start without it. Scientists aren't yet sure whether insulin — or the body's problems processing it — is a factor in early puberty, Steingraber says. •Prematurity. Rising rates of prematurity — which have increased 18% since 1990 — may contribute to early puberty, as well. Babies born early or very small for their gestational age tend to experience "catch-up growth" that can lead them to become overweight, Steingraber says. Children who undergo rapid weight gain tend to become less sensitive to the hormone insulin, putting them at greater risk for diabetes, Steingraber says. •Genetics. Studies consistently show that black girls in the USA go into puberty earlier than whites, suggesting a possible genetic difference. Yet Steingraber notes that, 100 years ago, black girls actually matured later than whites. And she notes that black girls in Africa enter puberty much later than those in the USA, even when their nutrition and family incomes are comparable. Kaplowitz notes that black girls in the USA tend to have higher levels of insulin and leptin. He notes that researchers are trying to figure out how problems in the body's response to insulin, which are more common among American blacks, might also affect the start of puberty. •Environmental chemicals. A variety of chemicals — found in everything from pesticides to flame retardants and perfume — can interfere with the hormone system, Herman-Giddens says. For example, chemicals used to soften plastic, called phthalates, can act like hormones. In a small study of 76 girls in Puerto Rico, researchers found that 68% of girls who went through early puberty had been highly exposed to phthalates, compared with only 3% of girls developing normally. Steingraber is also concerned about an estrogen-like chemical, called BPA, or bisphenol A, that is found in hard plastics, the linings of metal cans and many other consumer products. Although BPA can cause early puberty in animals, its role in humans isn't as clear. But studies by the CDC show that more than 90% of Americans have BPA in their bodies. The National Institutes of Health is funding research to answer questions about environmental causes of early puberty and hormonal changes, says Frank Biro, director of adolescent medicine at Cincinnati Children's Hospital Medical Center. Biro and colleagues are testing more than 1,200 girls for their exposure to chemicals such as BPA, phthalates, pesticides and chemical flame retardants. The National Children's Study, also funded by the federal government, will study 100,000 children, from before birth through age 21, looking at a variety of environmental exposures. •Screen time. There's no evidence that watching sexy TV images can trigger puberty, but spending too much time in front of the screen can harm kids in other ways, such as causing them to gain weight, Steingraber says. Preliminary research also suggests that screen time may hasten puberty by lowering levels of a critical hormone called melatonin, whose production is regulated by the daily cycles of light and dark, and which appears to keep puberty at bay, Steingraber says. •Family stress. Family relationships also may play a role in the start of puberty. Preliminary research suggests that girls may be more likely to develop early if they experience more family stress, or if they don't live with their biological fathers, says Julianna Deardorff, a clinical psychologist at the University of California-Berkeley's school of public health. Support is key Supporting girls as they go through puberty can help them weather the stress, at any age, says Eleanor Mackey, a child psychologist at Children's National Medical Center in Washington. Laila's mother says her family's faith has sustained them. "We're a prayerful family," Claudia says. "Laila is very secure in who she is and all that God has given her. Our job is to be there for her and support her through it all, and to make sure she is healthy and getting all she needs." While the experience has been frightening at times, Claudia says her daughter has emerged as a more caring person. "At first, as we were going to all these doctors, we tried to keep stuff from her," Claudia says. "Eventually, we had to share what was going on. We'd be at Children's Hospital, and she'd see all of these kids in wheelchairs, and ask, 'Mommy, am I sick? Am I going to get sick like that?' I told her no, but said, 'Consider yourself blessed that this is the only thing that you have to go through.' " Saving Childhood is a week-long series on the changing face of childhood.

Sunday, April 10, 2011

Childhood anxiety

Childhood anxiety and regression

Anxiety is defined as "apprehension without apparent cause." When a child feels scared or threatened, when in fact there's no immediate threat to a person's safety or well being.
Anxiety makes someones heart beat quickly, the child may sweat, and feel "butterflies" in the stomach. However, all children feel a bit of anxiety on a regular basis.  When confronted with new situations and when their vivid imaginations create misconception about events.  This is typical in the hospital.  For example, when a child hears they are going to get a CAT Scan, and vividly imagine a cat or kitty being involved somehow. 
Anxiety is not always a bad thing.  Having some fears or anxieties about certain things can also be helpful because it makes kids act in a safe way. For example, a toddler with a fear of fire or being burned would avoid items that are "HOT" and would certainly avoid playing with matches.
The nature of anxieties and fears change as kids grow and develop:
  • Babies experience stranger anxiety, clinging to parents when confronted by people they don't recognize.
  • Toddlers around 10 to 18 months old experience separation anxiety, becoming emotionally distressed when one or both parents leave.
  • Kids ages 4 through 6 have anxiety about things that aren't based in reality, such as fears of monsters and ghosts.
  • Kids ages 7 through 12 often have fears that reflect real circumstances that may happen to them, such as bodily injury and natural disaster.
As kids grow, one fear may disappear or replace another.  BUT, when a child faces a major life change, or a trauma (such as a hospitalization or illness), regression can occur.  And suddenly your child, who has slept alone in the dark for years, is now afraid of the dark and ends up in your bed every night. It is important to remember that regression is normal when children face a disruption in their normal daily lives and routines.  By disruptions, I mean situations where a child feels a loss of control, when a child or his/her parent becomes ill or hospitalized, if a family member dies or has been involved in a tragedy, and/or a parents divorce.  Parenting a child who shows signs of regression is sometimes confusing and tricky.  Many parents wonder how or what to do to help their child through.  Say your 7 year old shows signs of regression after the lengthy hospitalization of his mother.  After 4 plus years of success in toileting, he is wetting the bed at night.  Do you punish your child or belittle? NO.  Sympathize with the child.  Address what is going on in the child's life. Provide a safe and open place for them to ask questions (by showing them they can ask anything or say whatever they are feeling without being belittled or punished).  Give them opportunity to talk and vent.  AND (although it will be painful I know)  get up with your child and change the sheets and help them into clean PJ's.  Have the child walk the dirty PJ's and sheets down to the wash machine and start a wash.   This conveys, I support you and am here to help you, but it is not ok to wet the bed or sleep in dirty sheets or PJs.  They check in with the child before you go to bed.  Get them up to use the bathroom and monitor late drinks.  Help them with success in overcoming their regression.  If you show support and love, and not punish,  the child should come out of their regression in a few weeks.  If it lasts longer that a month or so, you may consider seeking some professional support.

adapted from Many Anxieties and Fears are Normal at www.kidshealth.org

Sunday, March 27, 2011

What parents can do to help a child through a hospital stay

What Parents Can Do

  • Get the who, what, why, and how about the stay
    get information about who your child will be seeing, what kind of procedure or treatment they will need, why your child needs a procedure, how the procedure or treatment may feel and how long it will last.  Advocate for your child by being with your child during the procedure, if you are told no.  Ask to see a charge nurse and fight for your right to be present for the procedure.
  • Be 100% honest and empathetic
    Explain why they are being hospitalized or why a specific procedure is needed.  Explain to the child what they will feel, hear, smell, and see.  Be honest!  If the procedure will hurt- tell them. 
  • Encourage curiosity and exploration
    Becoming familiar with the medical environment and the equipment that will be used during treatment or procedures is very important to a child ability to cope with the unknown surroundings. They are much less afraid of an object if they have had exposure to it where they felt control some over it.
  • Reassure your child
    Make it clear that their hospitalization or procedure is not a punishment, many children view it as such.  Make sure they understand the reason they are being hospitalized or why they need a proceudre, with the end goal to help their bodies get better so they can feel better and go home.
  • Use simple, soft language
    When describing a medical procedure, try to use words that do not have double meanings or are threatening in any way.  “poke” instead of “stick or prick” and “numb” or “sleepy medicine” instead of “put to sleep”
  • Listen and validate your child’s concerns
    Let your child know that it is okay to ask questions, cry and talk about his or her feelings.  If you really listen to a childs questions, you can see underlying concern and fear behind the question.  Address these fears and concerns openly.
  • Give your child choices
    Allow your child to take more of an active role in their treatment plan.  For example, letting them deciding which arm they want their poke or whether they sit on the examining table or on a parent’s lap.  Giving them a part in these decisions can help lessen the anxiety they feel about the treatment or procedure.
  • Comfort your child
    Touching is an important part of healing. Hold and cuddle your child as often as the child needs.  If medical needs prevent you from holding or rocking your child, it may be possible to still stroke your child or hold his or her hand.
  • Allow and encourage play.  Either in the playroom or at bedside
    Children learn about their world and how to cope with fears and unknowns by playing. Some parents often say, my child is too sick to play.  NO WAY! Play gives children some control and a way to make sense of their feelings. Playing with dolls or toy figures, drawing pictures, or role play are not only a way for a child cope and escape reality, it is a meaningful way to teach children about their health care experiences. Ask if a Child Life Specialist is on staff.  If so, make sure to request one! 

* adapted from "What Parents Can Do To Help", Miller Children's Hospital.  www.millerchildrenshospitallb.org

Tuesday, March 22, 2011

Taking Children to funerals. Yes or No???????????

Today a friend asked me what I thought about bringing children to funerals. I have had a lot if experience in this area so my friends ask me this a lot. I say this.........every human grieves. Whether you are a infant or elderly or in between. Children have a need to grieve, although adults often assume that a child does not grieve because they will most likely not show the outward signs of emotional loss like adults do. I believe that every child has the right to grieve and be given the opportunity to say goodbye on their own terms. This may be making a picture, writing a letter, singing a song, or bringing a gift to the deceased. When you are faced with the question,"Should I bring my child to the funeral?". The answer is....ask them. If they want to go and say goodbye, let them! But, don't force them.

Sunday, March 20, 2011

Do you know how a Child Life Specialist can help you?

A Child life specialist works in both impatient and outpatient medical settings.  Often times parents go through the medical environment with their children not even knowing what a Child Life Specialist (CLS) can do for them.  Many times CLS's are referred to as the "Play lady" or someone who takes kids to the playroom or brings toys.  Did you know that a CLS uses toys as a modality to:
  • Ease a child’s fear and anxiety with both therapeutic and recreational play activities and toys
  • Foster an environment that incorporates emotional support and the individual child's development
  • Provide a means to escape from the realities of their medical situation and just act like a kid
Child Life Specialists also:
  • Encourage understanding and cooperation by providing non-medical preparation and support for children undergoing tests, surgeries, and other medical procedures
  • Advocate for family-centered care.  Meaning that the family is included in decision making, considered part of the team, and welcomed to stay with their children during procedures and tests.
  • Engage and energize children and families by planning and coordinating special events, entertainment, and fun activities.
  • Consider siblings or other children who may also affected by a child’s illness or trauma, work with them and address their needs as well as the patient's
  • Give pre-admission tours and provide resources, and consultations with outpatient families
  • Support children and families confronting grief and bereavement issues
  • Provide information and resources for parents and members of the interdisciplinary team  
* Adapted from the Child Life Council "How A Child Life Specialist Can Help You"  at www.childlife.org

Taking Care of Precious Ones

Welcome to my first blog.  I am a Certified Child Life Specialist who assisted critically ill children and their families in preparing for medical procedures for more than ten years at Kaiser Permanente Hospital in Los Angeles.  My passion for helping children expands globally.  You can help too.  When you purchase a copy of my book called Taking Care of Precious Ones.  Not only will you empower yourself to help your child cope effectively with the medical arena, but half of all profits will be donated to Zoe International's "Zoe Children's Homes".  This incredible charity rescues children from human trafficking and brings them to a safe home to be educated, loved and cared for.

That is it for now!
Thanks for reading