What's Going Around?

Chickenpox is back!

Chickenpox is a viral illness that is caused by a very contagious virus, varicella zoster. To contract chickenpox, a child usually is exposed to another child with it.

Parent Tips

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    Adoption: Guidelines for Parents

    Adopting a child into your family can create many different emotions—from excitement and delight to concern or fear. While adopting a child is a unique and wonderful experience, it can bring special issues and challenges to your family. Read on to get a better understanding about how adoption plays a role in your child's life and how you can help your child understand his or her history of adoption.

    Start at the beginning

    Many parents want to know when is the best time to tell a child she is adopted. The answer is that it is never too early to talk to your child about adoption. Before age 3, include age-appropriate children's books on adoption as part of your child's reading routine. Give your child information little by little, as much as she can understand. It may take years for your child to fully understand what adoption means. These early talks will give you practice in talking about adoption. They will also show your child that it is OK to bring up the topic.

    Here are some tips on how to talk about adoption in your everyday life.

    Tell the story. Just as any child delights in the story of the day she was born, a child who is adopted will love to hear the details of how she came into the family. Share with your child the joy you felt at bringing her home that very first day. Talk with her about the many ways children join families—whether by adoption or birth, or in foster care or stepfamilies.

    Share the memories. During the adoption process, keep a scrapbook or journal the same way an excited mother does during pregnancy. Keep track of important dates and steps in the process. Take pictures of the people and places involved in your child's earlier life. These details will help make the adoption easier for your child to understand. You may want to place pictures in your child's room to encourage her to ask questions about her adoption. If you have an open adoption, you could frame a picture of her birth parents. If she was adopted internationally, maybe frame a picture from her place of origin.

    Use the words. The word adopted should become a part of your child's vocabulary early on. Find other words that everyone in your family is comfortable with. The terms birth mother and birth father are very common. Biological parents is also used frequently. Let your child know that the words mother and father have more than one meaning. A mother is someone who gives birth to a child, but a mother is also someone who loves, nurtures, and guides a child to adulthood. Being a father also can have different meanings.

    Adoptive parents often tell their child she is special because she was "chosen" or that she was "given up out of love." Though the parents mean well, these statements may be very confusing to a child. Some children may feel that being chosen means they must always be the best at everything. This can lead to problems when they start to realize this is not possible. Telling your child she was given up out of love may raise questions about what love is and whether others will give her up too. Some families use the term "making an adoption plan" instead of "giving up" their child.

    Don't wait. The longer you wait to talk about adoption with your child, the harder it will be. Any level of openness you can build when your child is young will help encourage her to ask more questions about her adoption as she gets older.

    Ask for help. If talking with your child about adoption is difficult, talk with your pediatrician. He or she can be a valuable source of support, understanding, and resources.

    Questions your child might ask

    Even if you talk about adoption early and openly, at some point your child may begin to ask questions such as

    • "Did I grow in your body, Mommy?"

    • "Why did my birth mother give me away?"

    • "Did she and my birth father love each other?"

    • "What was my name before I was adopted?"

    • "What nationality am I?"

    • "Do I have brothers or sisters?"

    • "How much did it cost to adopt me?"

    Be honest and open. If your child feels that you are not telling the whole story, he may look for answers somewhere else, like from a relative or friend who may not know or may not share accurate information. Show your child that you are willing to talk about the adoption. Tell him it's OK to bring it up with you.

    Avoid responding with your own worries like "Why do you want to know?" or "Are you unhappy with our family?" Your child's curiosity is healthy and natural. It should not be discouraged or seen as a threat to you. Also be sure to only answer the questions the child has asked, not what you think he should know.

    Don't force the issue on your child. Some children are curious from the very beginning. Others may be afraid to bring it up. The best you can do is let your child know it is OK to talk about it. When your child is ready to know more, he will ask.

    Questions others may ask

    Other people might ask questions that your child will not be able to answer, from innocent questions like

    • "Where did you get those big, blue eyes?"

    • "Do you look more like your mom or your dad?"

    to important medical questions such as

    • "Do you have a family history of heart disease, cancer, or diabetes?"

    • "What is your ethnic background?"

    Questions from strangers can be tricky. You do not have to tell everyone your child is adopted. However, if a question comes up about differences in appearance or ethnicity, offer a simple but honest explanation. When you are proud of your child's identity, she too will learn to appreciate her own value. Be aware that your attitude about adoption will show in your answers. How you respond can set an example as to how your child may choose to answer these questions in the future. Also, let your child know that she does not have to give specific answers to strangers if she does not feel comfortable. It is her choice to share whatever information about her adoption that she chooses. It is fine for children to learn that information about their adoption is theirs to share over time.

    International adoptions

    Parents who adopt children from other countries need to be aware of the special medical needs their child may have. Your pediatrician recommends the following:

    • Immunizations should meet US standards.

    • Tests for infectious diseases (such as HIV, hepatitis B and C, syphilis, tuberculosis, and parasites) and nutritional disorders (such as lead poisoning, anemia, rickets, and iodine deficiency), even if testing was done in another country before the adoption.

    • Vision, hearing, and developmental (such as language) assessments.

    Adopting an older child

    Adopting an older child can have challenges as well. An older child may bring both positive and negative experiences from his past into your family. He may have lived in a number of foster homes, each affecting him in some way. He may have lived with one or both birth parents for a time. There may be a history of abuse. He may have been separated from siblings. Many factors could have affected your child's life before he came to your home. The following are some suggestions that will help you deal with them:

    Learn as much as you can about your child's background and that of his birth parents. The adoption agency can help you gather as much information as possible. Learning about your child's past may help you be more aware of what lies ahead.

    Keep a connection to your child's past. It is important that your child feel connected in a positive way to the life he had before coming to your home. If possible, keep in touch with someone he knew, like a grandparent, relative, friend, or neighbor. Put together a "life book" by collecting mementos and photos of your child's previous home and school and people he was close to. These things will be important to your child over time.

    Don't be afraid to seek help. Love can work wonders for most children; however, in some cases, love may not be enough. Adoptive parents should understand that an older child with mild or serious problems may need professional help to resolve issues.

    Don't blame yourself. An older child may rebel against his new family. This anger is usually because of the child's past experiences. These problems are not your fault. Remind yourself that you are part of the solution as you help your child work out his issues. Most of all, be patient.

    Talk with your pediatrician. He or she may be able to help or suggest counselors or support groups.

    Searching for birth parents

    While it may be painful for you to think or talk about your child's past, many adopted children get to a point where they want to know where they came from and why they were placed for adoption.

    As your child gets older, make sure she knows where to look for information about the adoption. It is a good idea to keep copies of your child's adoption papers and share them with her at an appropriate time. She may want to look them over in private or read through them with you, or she may never want to see them at all. But it is important that she have the choice.

    At some point your child may begin thinking about searching for her birth family. Some states have programs available to help adults who were adopted get information about their adoption. Only a few states have open records. Check with your state government to find out about the laws concerning adoption records.

    Birth mothers and fathers also may conduct searches to reconnect with a child placed for adoption. Many have gone on to raise other children and may feel a need for information or be very concerned about the well-being of the child they placed for adoption years earlier.

    It is important for you to consider the possibility that the birth parents may one day play a role in your child's life. An open and loving relationship with your child will help you face these issues. Search and reunion can bring pain and joy for everyone involved. Each child, no matter what age, needs the continuing love and support of her adoptive family.

    Open adoptions

    An open adoption is when there is contact between birth parents and adoptive parents during the adoption process. This can mean simply exchanging names and addresses or, in fully open adoptions, the birth parents may have ongoing communication with or even visit the adoptive family and child.

    In an open adoption, your young child may not understand the relationships between the 2 sets of parents. While there are fewer secrets in an open adoption, there may be just as many difficult questions. It is important to address the issues mentioned in this brochure and provide your child with the guidance and support he needs.

    The gift of each other

    Raising a child who is adopted can present unique challenges. If the child misbehaves, gets into trouble, or has problems at school, it is tempting to blame her history of adoption. The fact is, all children sometimes misbehave or get into trouble. It is possible your child's problems have nothing to do with adoption at all. They may simply be a normal part of growth.

    As your child grows, she is influenced by family, the community, friends, school, and society in general. She is also influenced by the genes passed to her from her birth mother and father. There is no research that can tell us which is more important, but we know that both are powerful. Adoption is an important part of who your child is, but keep in mind that many other factors will affect who she becomes.

    Helping your child accept the fact that she is unique, yet just like everyone else, may not sound easy, but it is important to try. Talking openly and truthfully with your child about her history of adoption, her birth parents, and her feelings is the key. Adoption gives both you and your child a tremendous gift—the gift of each other. With love, honesty, and patience, you and your child will form a relationship that is as deep and meaningful as any bond between a parent and child.

    For more information

    There are many quality resources available to find out more about adoption. The following are just a few:


    Adopting the Hurt Child: Hope for Families With Special-Needs Kids by Gregory C. Keck and Regina M. Kupecky (Pinon Press, 1998)

    The Adoption Triangle by Arthur D. Sorosky, Annette Baran, and Reuben Pannor (Corona, 1989)

    Being Adopted: The Lifelong Search for Self by David M. Brodzinsky, Marshall Schechter, and Robin Marantz Henig (Anchor, 1993)

    Birthmothers: Women Who Have Relinquished Babies for Adoption Tell Their Stories by Merry Bloch Jones (Chicago Review, 1993)

    How It Feels to Be Adopted by Jill Krementz (Knopf, 1988)

    Journey of the Adopted Self by Betty Jean Lifton (BasicBooks, HarperCollins, 1995)

    Let's Talk About It: Adoption by Fred Rogers (Paper Star, 1998)

    Raising Adopted Children by Lois R. Melina (HarperCollins, 1998)

    Real Parents, Real Children by Holly van Gulden and Lisa M. Bartels-Rabb (Crossroad, 1995)

    Talking With Young Children About Adoption by Mary Watkins and Susan Fisher (Yale University Press, 1995)


    • Adoptive Families Magazine

    • 800/372-3300

    • www.adoptivefamilies.com

    • American Adoption Congress (AAC)

    • 202/483-3399

    • www.americanadoptioncongress.org

    • Child Welfare League of America (CWLA)

    • 202/638-2952

    • www.cwla.org

    • North American Council on Adoptable Children (NACAC)

    • 651/644-3036

    • www.nacac.org

    Please note: Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this publication. Phone numbers and Web site addresses are as current as possible, but may change at any time.

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    Babysitting Reminders

    Important Phone Numbers






    POISON CENTER_____________

    HOME PHONE___________

    HOME ADDRESS___________

    Parents Should

    • Meet the sitter and check references and training in advance.

    • Be certain the sitter has had first aid training and knows CPR.

    • Be sure the sitter is at least 13 years old and mature enough to handle common emergencies.

    • Have the sitter spend time with you before baby-sitting to meet the children and learn their routines.

    • Show the sitter around the house. Point out fire escape routes and potential problem areas. Instruct the sitter to leave the house right away in case of fire and to call the fire department from a neighbor's house.

    • Discuss feeding, bathing, and sleeping arrangements for your children.

    • Tell your sitter of any allergies or specific needs your children have.

    • Have emergency supplies available including a flashlight, first aid chart, and first aid supplies.

    • Tell the sitter where you will be and when you will return.

    • Be sure any guns are stored unloaded in a locked cabinet, and lock and store the ammunition in a separate place.

    Sitters Should

    • Be prepared for an emergency.

    • Always phone for help if there are any problems or questions.

    • Never open the door to strangers.

    • Never leave the children alone in the house — even for a minute.

    • Never give the children any medicine or food unless instructed to do so by the parents.

    • Remember that your job is to care for the children. Tender loving care usually quiets an unhappy child.

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    Bedtime - The Four B's

    We try to stick to a bedtime ritual by remembering the "4 B's":

    • Kids under 2 years: Bath, Breast, Book, then Bed
    • Kids 2 to 6 years: Bath, Brush (Teeth and Hair), Book, then Bed

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    Beyond Screen Time: A Parent’s Guide to Media Use

    Media in all forms, including TV, computers, and smartphones, can affect how children and teens feel, learn, think, and behave. How-­ever, parents (you) are still the most important influence.

    The American Academy of Pediatrics (AAP) encourages you to help your children develop healthy media use habits early on. Read on to learn more.

    Media use and your children

    You can decide what media use is best for your family. Remember, all children and teens need adequate sleep (8–12 hours, depending on age), physical activity (1 hour), and time away from media. (See the “Media Use Guidelines” chart for general guidelines for media use based on age.)

    Because children today are growing up in a time of highly personalized media use experiences, parents must develop personalized media use plans for their children. Media plans should take into account each child’s age, health, personality, and developmental stage. Create a Family Media Use Plan online at HealthyChildren.org/MediaUsePlan. By creating a Family Media Use Plan, parents can help children and teens balance their media use with other healthy activities.

    Why use digital media?

    • Digital media use can

      • Expose users to new ideas and information.

      • Raise awareness of current events and issues.

      • Promote community participation.

      • Help students work with others on assignments and projects.

    • Digital media use also has social benefits that

      • Allow families and friends to stay in touch, no matter where they live.

      • Enhance access to valuable support networks, especially for people with illnesses or disabilities.

      • Help promote wellness and healthy behaviors, such as how to quit smoking or how to eat healthy.

    Why limit media use?

    Overuse of digital media may place your children at risk of

    • Not enough sleep. Children with more media exposure or who have a TV, computer, or mobile device in their bedroom sleep less and fall asleep later at night. Even babies can be overstimulated by screens and miss the sleep they need to grow. Exposure to light (particularly blue light) and stimulating content from screens can delay or disrupt sleep, and have a negative effect on school.

    • Delays in learning and social skills. Children who watch too much TV in infancy and preschool years can show delays in attention, thinking, language, and social skills. One of the reasons for the delays could be because they interact less with parents and family. Parents who keep the TV on or focus on their own digital media miss precious opportunities to interact with their children and help them learn. Children and teens often use entertainment media at the same time they’re doing other things, such as homework. Such multitasking can have a negative effect on school.

    • Obesity. Watching TV for more than 1.5 hours daily is a risk factor for obesity for children 4 through 9 years of age. Teens who watch more than 5 hours of TV per day are 5 times more likely to have over­weight than teens who watch 0 to 2 hours. Food advertising and snacking while watching TV can promote obesity. Also, children who overuse media are less apt to be active with healthy, physical play.

    • Behavior problems. Violent content on TV and screens can contribute to behavior problems in children, either because they are scared and confused by what they see or they try to mimic on-screen characters.

    • Problematic Internet use. Children who overuse online media can be at risk for problematic Internet use. Heavy video gamers are at risk for Internet gaming disorder. They spend most of their free time online and show less interest in off-line or real-life relationships. There may be increased risks for depression at both the high and low ends of Internet use.

    • Risky behaviors. Teens’ displays on social media often show risky behaviors, such as substance use, sexual behaviors, self-injury, or eating disorders. Exposure of teens through media to alcohol, tobacco use, or sexual behaviors is associated with earlier initiation of these behaviors.

    • Sexting and privacy and predators. Sexting is sending nude or seminude images, as well as sexually explicit text messages, using a cell phone. About 12% of youth 10 to 19 years of age have sent a sexual photo to someone else. Teens need to know that once content is shared with others, they may not be able to delete or remove it completely. They may also not know about or choose not to use privacy settings. Another risk is that sex offenders may use social networking, chat rooms, e-mail, and online games to contact and exploit children.

    • Cyberbullying. Children and teens online can be victims of cyberbullying. Cyberbullying can lead to short- and long-term negative social, academic, and health issues for both the bully and target. Fortunately, programs to help prevent bullying may reduce cyberbullying.

    More media use tips for parents, families, and caregivers

    • Do not feel pressured to introduce technology early. Media interfaces are intuitive, and children can learn quickly.

    • Find out what type of and how much media are used and what media behaviors are appropriate for each child—and for you. Place consistent limits on hours of media use as well as types of media used.

    • Select and co-view media with your child so your child can use media to learn, be creative, and share these experiences with your family.

    • Check your children’s media use for their health and safety.

    • Stop use of devices or screens for 1 hour before bedtime. Do not let your children sleep with devices such as smartphones.

    • Discourage entertainment media while doing homework.

    • Plan media-free times together, such as family dinners.

    • Decide on media-free, unplugged locations in homes, such as bedrooms.

    • Engage in family activities that promote well-being, such as sports, reading, and talking with each other.

    • Set a good example. Turn off the TV and put your smartphone on “do not disturb” during media-free times with your family.

    • Use sites like Common Sense Media (www.commonsensemedia.org) to help you decide if movies, TV shows, apps, and videos games are age and content appropriate for your children and your family values.

    • Share your family media rules with caregivers or grandparents to help ensure rules are consistent.

    • Talk with your children and teens about online citizenship and safety. This includes treating others with respect online, avoiding cyberbullying and sexting, being wary of online solicitations, and safeguarding privacy.

    • Remember that your opinion counts. TV, video games, and other media producers, airers, and sponsors pay attention to the views of the public. For more information from the Federal Communications Commission (FCC), visit http://reboot.fcc.gov/parents.

    • Encourage your school and community to advocate for better media programs and healthier habits. For example, organize a Screen-Free Week in your town with other parents, teachers, and neighbors.

    Media Use Guidelines
    Age Description Tips
    Younger than 2 years Children younger than 2 learn and grow when they explore the physical world around them. Their minds learn best when they interact and play with parents, siblings, caregivers, and other children and adults. Children younger than 2 have a hard time understanding what they see on screen media and how it relates to the world around them.However, children 18–24 months of age can learn from high-quality educational media, IF their parents play or view with them and reteach the lessons.
    • Media use should be very limited and only when an adult is standing by to co-view, talk, and teach (for example, video chatting with family along with parents).

    For children 18–24 months, if you want to introduce digital media,

    • Choose high-quality programming.

    • Use media together with your child.

    • Avoid solo media use.

    2–5 years of age At 2 years of age, many children can understand and learn words from live video chatting. Young children can listen to or join a conversation with their parents.Children 3–5 years of age have more mature minds, so a well-designed educational program such as Sesame Street (in moderation) can help children learn social, language, and reading skills.
    • Limit screen use to no more than 1 hour per day.

    • Find other activities for your children to do that are healthy for their bodies and minds.

    • Choose media that is interactive, nonviolent, educational, and prosocial.

    • Co-view or co-play with your children.

    5 years and older Today’s grade-schoolers and teens are growing up immersed in digital media. They may even have their own mobile device and other devices to access digital media.
    • Make sure media use is not displacing other important activities, such as sleep, family time, and exercise.

    • Check your children’s media use for their health and safety.

    Tweens and teens Tweens and teens are more likely to have some independence in what they choose and watch, and they may be consuming media without parental oversight.
    • Parents should engage tweens and teens in conversations about their media use, digital citizenship, what they’ve seen or read, who they are communicating with, and what they have learned from their media use.

    See “More media use tips for parents, families, and caregivers.” Also, create a Family Media Use Plan online at HealthyChildren.org/MediaUsePlan. A Family Media Use Plan is useful to set consistent expectations and limits on media use for parents, children, and teens.

    Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

    The persons whose photographs are depicted in this publication are professional models. They have no relation to the issues discussed. Any characters they are portraying are fictional.

    The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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    Brushing Your Toddler's Teeth

    Your self-determined toddler can sometimes present a challenge when it comes to brushing her teeth. Try this: Sit on the floor cross-legged, placing your child on her back, resting herself on your leg. You are now looking down at her, while she is looking up at you. Let your child brush your teeth while you brush hers. You'll get loads of cooperation, as well as a good look at those molars! Connie Giarratana, M.D.

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    Bullying: It's not ok

    Bullying Affects All Children

    CONNECTED KIDS: Bullying is when one child picks on another child again and again. Usually children who are being bullied are either weaker or smaller, are shy, and generally feel helpless. Bullying most commonly takes place at school, when adults are not watching, or through email or instant messages. Whether your child is the one being bullied, doing the bullying, or simply a bystander, there are a number of measures you can take as a parent to improve their social skills and decrease their involvement in this detrimental practice.

    • Victims of bullying can learn how to respond safely to physical, verbal, and social bullying.

    • Children who are bullies can change their behavior. When bullies are allowed to continue, it often leads to future problems.

    • Bystanders—children who watch the bullies pick on others—can help stop bullying.

    • Concerned and involved adults can reduce bullying in schools and neighborhoods.

    Bullying is when one child picks on another child again and again. Usually children who are being bullied are either weaker or smaller, are shy, and generally feel helpless.

    Facts About Bullying

    • Both girls and boys can be bullies.

    • Bullies target children who cry, get mad, or easily give in to them.

    • There are 3 types of bullying.

      • Physical—hitting, kicking, pushing, choking, punching

      • Verbal—threatening, taunting, teasing, hate speech

      • Social—excluding victims from activities or starting rumors about them

    • Bullying happens:

      • At school—in the halls, at lunch, or in the bathroom, when teachers are not there to see what is going on.

      • When adults are not watching—going to and from school, on the playground, or in the neighborhood.

      • Through e-mail or instant messaging—rumors are spread or nasty notes are sent.

    Bullying is Different From Fighting or Teasing

    • A bully has power over another child.

    • Bullies try to control other children by scaring them.

    • Being picked on over and over can make your child a victim.

    • Bullying usually happens when other children are watching.

    Talk With Your Child About Bullying

    Even if you don't think your child is bullied, a bully, or a bystander, you will be helping to protect your child just by asking these questions:

    • “How are things going at school?”

    • “What do you think of the other kids in your class?”

    • “Does anyone get picked on or bullied?”

    When Your Child is Bullied

    Talk with your child about how to stay safe. Bullies always pick on smaller or weaker children. If there is a fight, and the bully “wins,” this will only make matters worse for your child.

    Help your child learn how to respond.

    “Let's talk about what you can do and say if this happens again.”

    Teach your child how to:

    • Look the bully in the eye.

    • Stand tall and stay calm in a difficult situation.

    • Walk away.

    Teach your child how to say in a firm voice:

    • “I don't like what you are doing.”

    • “Please do NOT talk to me like that.”

    • “Why would you say that?”

    Just telling your child to do and say these things is not enough. For many children, these skills do not come naturally. It is like learning a new language—lots of practice is needed. Practice so that, in the heat of the moment, these skills will come to your child naturally.

    Teach your child when and how to ask for help.

    Your child should not be afraid to ask an adult for help when bullying happens. Since some children are embarrassed about being bullied, parents need to let their children know that being bullied is not their fault.

    Encourage your child to make friends with other children.

    There are many adult-supervised groups, in and out of school, that your child can join. Invite your child's friends over to your home. Children who are loners are more likely to get picked on.

    Support activities that interest your child.

    By participating in activities such as team sports, music groups, or social clubs, your child will develop new abilities and social skills. When children feel good about how they relate to others, they are less likely to be picked on.

    Alert school officials to the problems and work with them on solutions.

    • Since bullying often occurs outside the classroom, talk with the principal, guidance counselor, or playground monitors, as well as your child's teachers. When school officials know about bullying, they can help stop it.

    • Write down and report all bullying to your child's school. By knowing when and where the bullying occurs, you and your child can better plan what to do if it happens again.

    • Some children who are bullied will fear going to school, have difficulty paying attention at school, or develop symptoms like headaches or stomach pains.

    Make sure an adult who knows about the bullying can watch out for your child's safety and well-being when you cannot be there.

    When Your Child is the Bully

    If you know that your child is bullying others, take it very seriously. Now is the time when you can change your child's behavior.

    In the long run, bullies continue to have problems. These problems often get worse. If the bullying behavior is allowed to continue, then when these children become adults, they are much less successful in their work and family lives and may even get in trouble with the law.

    Set firm and consistent limits on your child's aggressive behavior.

    Be sure your child knows that bullying is never OK.

    Be a positive role model.

    Children need to develop new and constructive strategies for getting what they want. Show children that they can get what they want without teasing, threatening, or hurting someone. All children can learn to treat others with respect.

    Use effective, nonphysical discipline, such as loss of privileges.

    When your child needs discipline, explain why the behavior was wrong and how your child can change it.

    Help your child understand how bullying hurts other children.

    Give real examples of the good and bad results of your child's actions.

    Develop practical solutions with others.

    Together with the school principal, teachers, counselors, and parents of the children your child has bullied, find positive ways to stop the bullying.

    Supervise your child and help develop individual skills and interests.

    Children with too much “time on their hands” are more likely to find themselves in violent or dangerous situations.

    Ask for help.

    If you find it difficult to change the behavior, reach out to a professional, like a teacher, counselor, or pediatrician.

    When Your Child is a Bystander

    Most children are neither bullied nor bullies— they just watch. There are things that your child can do to help stop bullying.

    Tell your child not to cheer on or even quietly watch bullying.

    This only encourages the bully who is trying to be the center of attention.

    Encourage your child to tell a trusted adult about the bullying.

    Talking to an adult is not “tattling.” Standing up for another child by getting help is an act of courage and safety. To make it easier, suggest taking a friend.

    Help your child support other children who may be bullied.

    Encourage your child to include these children in activities.

    Encourage your child to join with others in telling bullies to stop.

    Knowing what to say is important. If your child feels safe, the following statement may help to stop the bully: “Cool it! This isn't going to solve anything.”

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    Choosing Quality Child Care: What's Best for Your Family?

    Finding high-quality child care is very important but not always easy. Your choice will play a key role in your child's health and development. Read on for more information from the American Academy of Pediatrics (AAP) about child care options to help you in your search for what's best for your family.

    Types of child care

    Center-based care, family child care, and in-home care are 3 types of child care.

    • Center-based care takes place in a location staffed by caregivers. Center-based care has many names—child care center, preschool, nursery school, child development program, or learning center. Center-based care also may have different sponsors, including churches, schools, colleges, universities, hospitals, social service agencies, Head Start, independent owners and businesses, and employers.

    • Family child care takes place in the caregiver's home. Many family child care providers have young children of their own. They may care for children who are the same age as their own children or for children of different ages.

    • In-home care takes place in the child's home. The caregiver comes to or lives in the home. For many families, this is very convenient because caregivers often can arrange their schedules to match your needs. Because your child stays at home, he does not have to adjust to a new setting. Your child may also be exposed to fewer illnesses because he will not be with groups of children. He may receive more individual attention, especially if the caregiver's main job is to care for your child. This type of caregiver is not monitored or supervised, and there is no formal licensure or regulation process.

    Note for parents of children with special needs: Finding programs and caregivers to meet the needs of children with disabilities or other special needs can be challenging. Your child's doctor can help you and your child's caregiver plan for your child's special needs, development, activities, health, safety, and any problems that come up while you are using child care.

    Questions for all caregivers

    The right child care option for your family may be based on many factors, including work schedules, budget, and personal preferences. Answers to the following questions may help you in your search.

    • Hours. What are the hours? What if you are late in picking up your child? How are vacations and holidays scheduled?

    • Fees and services. What is the cost? How are payments made? Are there other services available in addition to child care? Is there an extra cost?

    • Qualifications and training. What education, training, and experience does the child care provider(s) have? Is the child care provider certified in CPR?

    • Discipline. Is the caregiver(s) policy on discipline the same as yours? Center-based care should have a discipline policy.

    • Communication. How often does the child care provider give feedback about your child? Does the child care provider seem approachable?

    • Transportation. Are the proper car safety seats, booster seats, and seat belts used? Center-based care should have a transportation policy.

    • References. Does the caregiver have current references from parents you can contact?

    Other questions for center-based care

    • Policies. The center should have a written policy for each of the following areas: health standards, illness, medication, nutrition, ­discipline, transportation, media, and outdoor play.

    • Licensing/accreditation. Is the center licensed or registered with the appropriate local government agencies? Are there any outstanding violations? Is the program currently accredited or in the process of becoming accredited?

    • Health professional. Is there a qualified health professional, such as a doctor or nurse, for the program? (The national standard recommends that center-based infant-toddler programs should be visited by a health professional at least once a month, and all other child care programs should be visited at least once every 3 months.)

    • Visiting policy. Can you visit the center before your child is enrolled? If your child is enrolled, can you visit the center anytime it is open? Can you see all the areas that your child will use? Are visitors screened or is their identification checked so that only approved adults can visit the center and pick up children?

    • Qualifications and training. What type of additional training have the staff had during the past year? Do outside experts provide training? How long have the staff worked at the center? How much experience do they have with children of your child's age?

    • Staffing. Are there enough trained adults available on a regular basis? What happens if staff are ill or on vacation? Are children supervised by sight and sound at all times, even when they are sleeping? Are children cared for in small groups? Are activities proper for their age group? Is there a daily schedule? Do the child-staff ratios and the size of groups of children fall within nationally recognized standards? For example, in a room with 4 children aged 13 to 35 months, there should be 1 trained caregiver. In a room with 5 to 8 children aged 13 to 35 months, there should be 2 trained caregivers. There should be no more than 8 children aged 13 to 35 months in a room. (See chart.)

    Age Maximum Child-Staff Ratio* Maximum Group Size*
    12 months 3:1 6
    13–35 months 4:1 8
    3-year-olds 7:1 14
    4-year-olds 8:1 16
    5-year-olds 8:1 16
    6- to 8-year-olds 10:1 20
    9- to 12-year-olds 12:1 24

    *As recommended by the AAP. See Caring for Our Children listed in "Resources."

    Other questions for family child caregivers

    • Others in the home. Who lives in or visits the home (children, teens, and adults)? Are they family, what are their backgrounds, and how may they interact with your child?

    • Number of children. What is the total number of children being cared for? The AAP recommends that a family child care home should not have more than 6 children per adult caregiver, including the caregiver's own children. (Some states allow more children when at least 2 adults are available at all times in larger family child care homes.) The total number of children should be fewer when infants and toddlers are included. No caregiver who works alone should care for more than 2 children younger than 2 years.

    • Staffing. Does the caregiver plan to leave the home during the day to go to the store or drive children to school? If so, find out what the plan is for who will care for your child during this time. Because there usually is only one adult, backup care in an emergency situation must be nearby. In some areas, caregivers belong to a network of family child care providers who may provide training, shared toys, and backup help.

    • Qualifications and training. Look for caregivers who are licensed or registered with the state. These caregivers will have unannounced visits by an inspector. Some family child care providers have earned accreditation as well. Does the caregiver continue to receive training?

    • Environment. Is there an outdoor play area? Is the home free from hazards, such as lead and mold? Are there any pets?

    Guidelines for in-home caregivers

    When you are interviewing in-home caregivers it is important that your expectations are clear. Your caregiver will need to respect and follow your parenting rules and assigned duties. For example,

    • Your child's schedule. Include such things as typical mealtimes, hand washing, toilet training, teeth brushing, and nap time.

    • Discipline. Let your caregiver know what types of discipline you approve of and what rules and limits you have set for your child.

    • Activities. Discuss reading, playtime, and fun ways to be active inside and outside. Be sure to talk about what types of outings are acceptable for your child. Let your caregiver know how long your child is allowed to watch TV or videos or play computer games or other media. The AAP strongly discour­ages TV viewing for children 2 years and younger, and encourages interactive play. For older children, the AAP recommends no more than 1 to 2 hours per day of educational, nonviolent programming.

    • Duties. Write down and review what the caregiver will and will not do in your home. If your caregiver will also have housekeeping duties, stress that your child's needs must come first. Also discuss what you expect the caregiver to do if your child has a minor injury or if there is an emergency.

    • Transportation. Be sure your caregiver knows how to use the proper car safety seat, booster seat, or seat belt for your child.

    • Communication. The caregiver should give you a daily report of what occurred. (You may want to arrange for frequent, unannounced visits by a friend or family member who can observe how the caregiver interacts with your child.)

    Note: You will need a backup plan for times when the caregiver is sick, needs time off, or goes on vacation. In some areas, child care resource and referral agencies or other community organizations can give you names of temporary in-home caregivers.

    A checklist to help rate your choice

    "Is This the Right Place for My Child? 38 Research-Based Indicators of High-Quality Child Care" is a checklist put together by Child Care Aware of America (formerly the National Association of Child Care Resource & Referral Agencies [NACCRRA]) that you can use to evaluate child care programs. This checklist is on the Child Care Aware of America Web site at http://www.naccrra.org/sites/default/files/publications/naccrra_publications/2012/15991003_38_indicators_checklist.pdf and available through a link from the American Academy of Pediatrics Healthy Child Care America Web site at www.healthychildcare.org/ResourcesFamilies.html. All of the questions are based on research about what is important to your child's health, safety, and development.

    Planning for child care costs

    Child care can be expensive, so families must budget ahead of time. While the cost may seem high, think about how little the caregiver is actually earning per hour for the responsibility of caring for your child. Be sure to budget for your backup care during those times when your child or caregiver is ill. You may qualify for state subsidies or assistance from your employer. Ask about

    • Direct payment through cafeteria plans (a type of flexible benefit plan)

    • Dependent-care spending accounts (tax savings)

    • Voucher programs

    • Employer discounts

    High-quality child care is a critical investment for your child. When care is consistent, developmentally sound, and emotionally supportive, there is a positive effect on the child and family. In some areas your local child care resource and referral agency can help you find licensed child care or apply for subsidies. For more information, visit www.naccrra.org or www.childcareaware.org.

    Preparing your child

    Most infants, up to 7 months of age, adjust well to good child care. Older infants may get upset when left with strangers. They will need extra time and your support to get to know the caregiver and to understand that you will pick them up at the end of the day. Starting new child care is often harder on the parents than it is on the child.

    Being prepared makes any new experience easier. You can help your child adjust to a new child care arrangement. Try the following:

    • Arrange a visit with in-home caregivers while you are at home or when you need child care for a short time.

    • Visit the center or home with your child before beginning care. Show your child that you like and trust the caregiver.

    • Check with the caregiver or center staff about the best time of the month or year for children to begin attending the program.

    • Allow your child to carry a reminder of home to child care. A family photograph or small toy can be helpful.

    • Talk with your child about child care and the caregiver.

    • Read books about child care. (Check with your local library.)

    Sudden changes in caregivers may be upsetting to a child. This can happen even if the new care­giver is kind and competent. You may want to arrange a meeting with the new caregiver or ask your child's doctor for advice. Parents need to help caregivers and the child deal with any changes in the child's routine at home or child care.

    When your child gets sick

    Children sometimes get sick or are injured while in child care. Talk with your child's caregiver in advance so that you both know what to expect and are prepared. Make sure that your caregiver can always reach you. Confirm a plan for emergency care in advance.

    Many times, mildly ill children are allowed to stay with their caregiver as long as they can participate in most of the activities and don't require more care than their caregiver can provide. If the child needs extra rest, there must be a place for her to rest and still be observed.

    Sometimes children need medicine while they are at child care. Every state and program will have different rules about what is allowed. Prescription and over-the-counter medicines should be labeled with the child's name, dosage, and expiration date. The caregiver should have the parent's written permission to give the medicine, know how to give it safely, and properly record each dose. Depending on the regulations in your state, sometimes a doctor's note or instructions are required.


    The following is a list of early education and child care resources. Check with your child's doctor or local child care resource and referral agency for resources in your community.

    Web sites

    AAP Healthy Child Care America Early Education and Child Care Initiatives

    This AAP site has a useful parent section and links to all the other Web sites listed here.



    Child Care Aware of America (formerly National Association of Child Care Resource & Referral Agencies [NACCRRA])

    703/341-4100 or 800/424-2246

    www.naccrra.org or www.childcareaware.org

    National Association for the Education of Young Children (NAEYC)



    National Association for Family Child Care (NAFCC)



    National Resource Center for Health and Safety in Child Care and Early Education (NRC)

    800/598-KIDS (800/598-5437)


    Books from the American Academy of Pediatrics

    Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs

    Caring for Your Baby and Young Child: Birth to Age 5

    Caring for Your School-Age Child: Ages 5 to 12

    Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide

    Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide

    Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this publication. Phone numbers and Web site addresses are as current as possible, but may change at any time.

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    Connecting With your Community

    Why Should you be Involved with your Community?

    • Participating in community activities gives you more opportunities to become an independent and successful adult.

    • It provides you with a group of friends who can help you learn more about yourself and your talents and help you make better decisions.

    • By connecting with your community, you are never alone. You have a place to go and people to talk with when you need it.

    • The more you help others, the better you feel and the more likely that someone will be there for you.

    Teens can—and do!—improve the communities they live in.

    While families provide the love and support needed for teens to become more independent, teens active in their community will:

    • Do better in school.

    • Find it easier to stay out of trouble.

    • Be less likely to become depressed or suicidal.

    Making Community Connections

    Help others.

    • Ask about service projects. Check with your school or where you worship about volunteering at homeless shelters, soup kitchens, nursing homes, or child care centers.

    • Work for a political campaign.

    • Tutor children at the library or become a coach.

    • Help clean up the neighborhood.

    Do what you love.

    Try different things until you discover your passion. Art, music, writing, drama, or sports are just some examples.

    Keep in touch with family members.

    Learn about your family—both near and far. Ask about family stories and history. Get in touch with family you have not met or have not seen for a while or plan a family reunion.

    Get to know your neighbors.

    Talk with people who have different cultural backgrounds, religious or spiritual beliefs, and political values.

    Nobody Succeeds Alone— Everyone Needs Help

    There are many adults in your community who can help.

    • A teacher, coach, or counselor at school can help point you in the right direction.

    • A neighbor, relative, friend's parent, or your boss can give you the advice you need to make decisions.

    • A spiritual leader or an adult at an after-school activity or club can help you through a hard time.

    Find people who can stay calm and listen, understand you, and give you practical advice.

    It is hard to talk with parents about some topics. Find other trusted adults who can help. They also can help teens and parents figure out how to talk with each other.

    Your Parents' Job

    You are now old enough to start making your own decisions and taking care of yourself, but parents are still there to help keep you safe and guide you in becoming an independent adult.

    For safety reasons, parents will ask about:

    • Where you are going

    • Whom you will be with

    • What you will be doing

    • When you will return

    Parents need to know the names of friends.

    They also will want to meet your friends as well as meet and talk to your friends' parents.

    Parents still can help solve problems.

    This includes correcting you when you make a mistake, without making you feel bad.

    Parents can help you get involved with community activities.

    Being involved with your community will help you become independent, develop new skills, and help others.

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    Consequences for Actions

    Sometimes, consequences are obvious; other times, parents struggle to come up with one for a troublesome behavior. Try this: ask your child to come up with the consequence of a particular behavior. It may not be the most effective solution, but it is rewarding (and sometimes quite entertaining!) as a parent to listen to his ideas. Together, you might just find a solution that works. Alternatively, explain to your child that parenting is a hard job, and parents don't know all the answers. Then, ask your child what he would do if he were a parent and had to solve this problem. Again, you may hear responses that you will treasure forever, and also might just work!

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    Contact Information

    Make sure your child care provider or baby sitter has immediate access to critical information in case of an emergency: Make a copy of your child's insurance card, and on the back attach a typed list of emergency phone numbers where you can be reached, as well as the number for your local poison control center. You may also want to note any allergies or medical conditions your child may have. Have this two-sided emergency card laminated at your local copy center, place it in a pocket of your child's diaper bag or backpack, and remember to tell the sitter where it can be found.

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    Dinnertime Conversation Strategies

    At dinnertime, try stimulating conversation with your children by asking, "What one good thing happened to you today?" Let everyone - including Mom and Dad - take turns answering. This question is better than "How was school?" or other similar questions that children tend to answer with a simple word, like "okay," which quickly ends the conversation.

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    Divorce and Children

    Every year, more than 1 million children in the United States experience the divorce of their parents. Because the average divorce takes place within the first 7 years of marriage, many of these children are very young. For many children, divorce can be as difficult as the death of a parent. Children need the guidance, patience, and love of both parents to help them through.

    Put your child first

    How much a divorce will affect your child's life depends largely on how you and your spouse treat each other before, during, and after the divorce. Parents must work together to make the transition as easy as possible. Even though the marriage ends, your role as a parent continues. Set aside your differences and put your child first. Try the following suggestions:

    • • Never force your child to take sides. Every child will have loyalties to both parents.

    • • Do not involve your child in arguments between the two of you.

    • • Do not criticize each other in front of your child or when your child might overhear you. If this happens, explain to your child that when people get angry they sometimes say things that are hurtful.

    • • Discuss your concerns and feelings with your child's other parent when and where your child cannot hear.

    • • Avoid fighting in front of your child.

    Help your child adjust

    As a parent, there are many things you can do to help your child adjust to the changes in your family.

    Talk with your child early and often

    The earlier you tell your child what is happening and the more often you talk, the more comfortable he will feel. Also, allow your child to share his fears, worries, and feelings with you. This can help make him feel safe and special. When talking with your child about the divorce, follow these guidelines.

    • • Be completely honest and open about what is going to happen. Talk about the divorce in simple terms. For example, "Your dad and I are having some trouble getting along," or "Your mother and I are thinking we may need to separate."

    • • Make sure your child knows the divorce is not his fault. Also tell him that he can't fix the problems or make the two of you stay together. Reassure your child that you love him and will not leave him.

    • • Try not to blame your ex-spouse or show your anger. Explain that parents sometimes need to live separately.

    • • Be patient with questions. You do not need to have all the answers. Sometimes just carefully listening to your child is more helpful than talking. Follow­ing are questions your child might ask:

      • —Why are you getting divorced?

      • —Will you ever get back together again?

      • —Where am I going to live?

      • —Will we have to move?

      • —Will I need to change schools?

      • —Was the divorce my fault?

      • —How often will I see Daddy/Mommy?

      • —Are we going to be poor?

    Reassure your child that he is safe and loved. If needed, don't hesitate to get help from your pediatrician or a family counselor.

    Allow your child to be a child

    Resist using your child as a replacement for your spouse. Avoid putting pressure on your child with statements like, "You are the man in the family now," or "Now I have to depend on you." Children have a right to enjoy childhood and grow up at a normal pace. As they grow older, they will be able to take on more responsibility and help around the house. Don't expect too much too soon.

    Respect the relationship between your child and the other parent

    It is important to let your children show their love to both parents. Unless your ex-spouse is unfit to parent, try not to let your differences keep your children away from him or her. Children should be allowed to spend time with their other parent without feeling guilty. Reassure your children that you both still love them even though they may only be living with one parent at a time.

    Keep your child's daily routine

    Try to keep your child's routine, friends, school, and environment as unchanged as possible. Schedule meals, chores, and bedtime at regular times so that your child knows what to expect each day. Parents living separately should agree on a set of consistent rules for both households. It is also very important to live up to your promises to visit or spend time with your child. A routine weekly or monthly schedule may be comforting to your child.

    How children react to divorce

    Reactions to a divorce can vary depending on your child's age, gender, temperament, past experiences, and family support. The following are normal ways that your child may react. If any of these behaviors become excessive, talk with your pediatrician.

    Preschool-aged children may

    • • Be sad

    • • Be afraid of others

    • • Not want to be separated from one parent

    • • Have problems eating or sleeping

    • • Have trouble with toilet training

    • • Have outbursts or tantrums

    • • Act more "babyish"

    • • Blame themselves for the divorce—especially children between 3 and 5 years of age

    School-aged children may

    • • Be moody or angry

    • • Have problems eating or sleeping

    • • Seem distracted and faraway

    • • Not do as well in school

    • • Have tantrums

    • • Revert to more immature behavior

    • • Be more aggressive or angry

    • • Express their sadness and wish for parents to get back together

    • • Worry they may be the cause of the divorce

    • • Worry about divided loyalty to their parents

    Adolescents may

    • • Withdraw emotionally from family and/or friends

    • • Become aggressive or angry

    • • Engage in risky behaviors such as sex or use of drugs

    • • Try to become an adult and take charge of the family

    • • Worry about the financial effects of divorce on the family

    • • Have problems eating or sleeping

    • • Feel depressed

    Use help from the outside

    Children often turn to neighbors, grandparents, and friends for comfort and attention. These relationships can offer support and can be very helpful to children as they adjust to a divorce. Teachers or school social workers should be made aware of a divorce so they can let you know if any problems arise in school. It's also important for your child's school to know whom to contact for permission for special activities or in an emergency.

    Divorce is not always easy for parents either. Don't be afraid to see a counselor if you are having trouble adjusting to a divorce. It is important for parents to stay healthy so they can be available to their children during this difficult time. Social agencies, mental health centers, women's centers, and support groups for divorced or single parents are helpful. There are also many informative books and articles about divorce for both parents and children (see "For more information"). Your pediatrician is very aware of the effects that separation and divorce may have on emotions and behavior. He or she can help you find ways to cope with the stress you and your children are feeling.

    Child support

    According to the US Department of Health and Human Services, millions of female-headed house­holds do not receive child support. In some cases, one parent does not want money from the other parent. In others, the parent may not be able or willing to pay or perhaps cannot even be found. Many times the parent with custody simply does not enforce the child support agreement.

    The financial burden of raising a child should not fall on one parent alone. Both parents have a financial obligation to their child. Unfortunately, even when child support is paid, money issues may still be a problem. Remember, if either parent uses money as a weapon, it is the child who gets caught in the middle.

    Contact your state's child support agency for information on what parents must pay for child support. If your child's other parent does not cooperate, you may be able to take action to force payment. State agencies can also help if your child's other parent has moved and you do not know where he or she is living. In most cases, it is often helpful to talk with an attorney.

    • For more information, contact

    • US Department of Health and Human Services

    • Office of Child Support Enforcement

    • 202/401-9373

    • http://www.acf.hhs.gov/programs/cse/

    About custody

    Custody can be one of the most difficult issues in a divorce. Today parents are able to work out a wide variety of custody and visitation arrangements. Physical custody is where the child lives and can be split between both parents. Legal custody allows a parent to share in key decisions such as a child's schooling, medical treatment, and religion.

    Although mothers are still more likely to maintain custody, more and more fathers are now taking on this role. While there is no proof that one form of custody is better than another, all children need a stable place where they feel secure.

    If you are having custody disagreements, con­sider calling a mediator to help settle them. Mediators can be found by contacting a lawyer or family court.

    For more information

    There are many excellent books available on coping with divorce for both you and your children. Here are just a few to look for at your local library or bookstore.


    The Dinosaurs Divorce: A Guide for Changing Families by Laurene Krasny Brown and Marc Brown (Little, Brown & Co, 1988)

    It's Not Your Fault, Koko Bear by Vicki Lansky (Book Peddlers, 1998)

    Let's Talk About It: Divorce by Fred Rogers and J. Judkis (GP Putnam & Sons, 1996)

    School-aged children

    The Boys and Girls Book About Divorce by Richard Gardner (Bantam, 1970)

    How It Feels When Parents Divorce by Jill Krementz (Knopf, 1988)

    Why Are We Getting a Divorce? by Peter Mayle (Crown Publishers, 1988)

    What Can I Do? A Book for Children of Divorce by Danielle Lowry (Magination Press, 2001)


    Mom's House, Dad's House: Making Two Homes For Your Child by Isolina Ricci (Fireside, 1997)

    Vicki Lansky's Divorce Book for Parents by Vicki Lansky (Book Peddlers, 2005)

    Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this brochure. Phone numbers and Web site addresses are as current as possible, but may change at any time.

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    Encouraging Your Child

    Our hectic, busy lives often leave us with little time to appreciate the magic of encouragement in our children's development of self-esteem. Positive strokes and expressions of love often are forgotten and replaced with negative reprimands. Here's a sure way to remember the importance of praise: take your wrist watch (or other piece of jewelry) and place it on the opposite hand from which you are accustomed to wearing it. Throughout the day, when you look at your watch (or jewelry) on the "wrong" hand, you will be reminded to say something supportive and positive to your child. Dan Feiten, M.D.

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    Establishing Chores and Routines

    Children learn more easily to do personal chores (e.g., making a bed) when there is spare time. Put some time aside for melding the chores into the routine. The time will come when the chores will have to be performed quickly, efficiently, and without assistance, but it will go more smoothly if they are second nature and already part of the established routine.

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    Getting Children to Listen the First Time

    When children do not seem to pay attention or listen to what you are saying, you may find yourself repeating everything you ask, often raising your voice with each repetition. Instead, the first time that you calmly make your request, make sure that your child has direct eye contact with you. Then, ask him to repeat what you said so that you know he understood. Sometimes, this will prevent the familiar cycle of repeating yourself! Kathleen Traylor, M.D.

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    Giving Children the Responsibility for their Own Dinner

    Once children are preschool age and older, have each child take one night a week, or one night a month, as dinner night. Let him decide what he wants to serve, shop with him, and let him direct you in helping with the preparations. Children love doing it, and it gives you fewer dinners to plan yourself!

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    Giving Eye drops to your Toddler

    Administering eye drops can be uncomfortable to a toddler. Have your child lie on his back and shut his eyes as tight as he can. Place one to two drops in the inner corner of each eye. Tell him to relax his eyes. The liquid will seep into the eye without tears or fuss! Wipe off the excess with a clean cloth or tissue. Connie Giarratana, M.D.

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    Giving Positive Suggestions Rather Than Negative Reprimands

    Whenever you open your mouth to say the words "don't," "no," "not," "stop," or any other similar negative word, pause. Then, replace the negative word with a positive alternative. This way, your words convey a positive suggestion, rather than a negative reprimand. For example, if you are about to say, "Stop teasing your sister!", pause, and instead say, "You can either come help me in the kitchen, or you may go upstairs and play on the computer until dinner is ready." If he is not convinced, then add, "Do you want to decide which you will do by yourself, or should I decide for you?" This usually works if you stick with it! Kathleen Traylor, M.D.

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    Handling Stressful Situations with your Child Effectively

    On some days, disciplining your children seems to go smoothly; on other days, it seems to be a complete disaster. If you are at your wit's end, tired, and literally ready to scream, think of a person that you respect, and then pretend that he/she is watching you. It is amazing how this can help you to handle the situation more calmly and effectively, rather than being angry and losing your cool. Kathleen Traylor, M.D.

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    Help Stop Teenage Suicide

    Teen Suicide—What you can do

    • Learn and watch out for the warning signs of possible suicide.

    • Get help for teens who need it. Many teens who attempt suicide do not know how to reach out for help.

    • Keep guns out of young people's homes.

    • If you are unsure about what to do, call the National Suicide Prevention Lifeline at 1-800-273-TALK (273-8255). It is available 24 hours a day, 7 days a week, from anywhere in the United States.

    Teenagers are passionate and emotional. For most teens, intense feelings—of either joy or pain—usually pass quickly.

    While many teens have these emotional ups and downs, for some, the downs can be fatal. Sadly, every year in the United States, thousands of teenagers are unable to deal with these feelings and commit suicide.

    Teen Suicide in America

    Suicide is one of the 3 leading causes of death for 13- to 19-year-olds.

    Many teenagers who attempt or commit suicide have serious problems:

    • Depression or other mood disorder

    • Drug or alcohol abuse

    • Being overly anxious

    Often, these teens have had problems for some time and can be very good at hiding these problems. This is why family and friends are shocked when suicide occurs.

    How Does It Happen?

    Suicide is often triggered by some small, everyday event, such as:

    • Getting in trouble.

    • Arguing with a parent, boyfriend, or girlfriend.

    • Receiving a bad grade on a test.

    • Not making the team.

    Though many suicidal teens think about suicide on and off, most teens do not spend much time planning how to kill themselves.

    Teenagers often attempt suicide within a few hours after deciding to do so.

    Suicide is thought of as the only way out.

    Teenagers who try to kill themselves see it as the only way to escape their emotional pain. They want the pain and suffering to stop.

    Myths and Facts

    MYTH: “You would think one of her friends would have known about her problems. At the very least, someone in her family should have noticed that she was depressed before she killed herself.”

    FACT: Teens are often very good at hiding their problems. People around them may not know they are depressed. Adults usually seem depressed and stay depressed for a while. Depressed teens may seem happy for much of the time. Parents are sometimes the last to know. Friends may have a sense that things are not right, but not know how to help.

    MYTH: “I heard him talk about killing himself. But people who talk about suicide do not do it.”

    FACT: Talk of suicide or wanting to die should never be ignored. Teens who talk about suicide or wanting to die are much more likely to kill themselves than those who do not.

    MYTH: “If she really wanted to kill herself, she would have done something more deadly.”

    FACT: A suicide attempt that does not end in death the first time may be followed by one that does. Sometimes teens don't know how many pills are enough to be fatal. What is considered a “gesture” may be a miscalculation. All suicide attempts need to be taken seriously.

    MYTH: “He's just doing it to get attention.”

    FACT: This is true at times, but the attempt can still be deadly. If the suicide attempt is a call for attention, it needs to be answered.

    Warning Signs for Suicide

    In addition to talking or writing about suicide or death, some other warning signs to watch out for are:

    Change in activities

    A drop in grades, neglect of personal appearance or responsibilities, or losing interest in things that used to be fun.

    Change in emotions

    Appearing sad, hopeless, bored, overwhelmed, anxious, worried, irritable, or very angry. While this may sound like many teenagers, changes that make you worried could be very serious.

    Getting in trouble

    Acting rebellious, aggressive, or overly impulsive; running away or withdrawing from friends or family.

    Confusion about sexual feelings and identity

    Teenagers who think they may be gay, lesbian, bisexual, or transgender are at an especially high risk for suicide.

    Changes in behaviors or patterns

    Some teens may become very depressed, withdraw from old friends, hang out with a different group, or want to be alone all the time. Some others may withdraw and listen to music or write. Others may stay up until the early morning and then stay in bed much of the day.

    Use of drugs or alcohol

    For depressed teens, drugs or alcohol can be fatal.

    Preventing Teen Suicide

    In an emergency

    If you are concerned about an immediate risk of harm, take the teen to a hospital emergency room. Even if you are not sure, the hospital staff is trained to figure out if someone is serious about suicide. Talk with a doctor about treatment and an evaluation by a mental health professional.

    If you think suicide is possible

    If you notice that someone is “in trouble” or feels very negative, listen to the whole story and try not to judge. Show that you care and are always ready to listen.

    Talk with teens. This is harder than it sounds. It is important to just listen and not offer suggestions on how to “fix” problems or seem like you are judging in some way. Ask teens what is bothering them and whether they have been feeling sad or down. Ask whether they have ever thought of suicide or not wanting to live anymore. Asking will not make someone attempt suicide—it may actually stop it.

    Try to be understanding if teens are “in trouble” or feel very badly about themselves. Let them know that whatever trouble they are in at the moment, you have faith in who they are and their future.

    Gay, lesbian, bisexual, or transgender teens

    Teenagers questioning their sexual identity are at an especially high risk for suicide. Listen, be supportive, and get them help. Every teenager needs to know that life is better than death.

    If you know of a teen struggling with this and fear there is a risk for suicide, there are local, state, and national resources that can provide information and advice. Parents, Families and Friends of Lesbians and Gays (PFLAG), at 202/467-8180 or www.pflag.org, can help connect teens with resources.

    How other teens can help.

    Talk with teens and let them know that if any of their friends talk about suicide, they need to get help from an adult right away! This may be a matter of life and death and is too much for even a close friend to handle alone. Let them know that even if they have been “sworn to secrecy” by a friend, telling—no matter how wrong it feels—is better than having to live with a friend's death.

    When you're concerned about mental health issues

    Depression or other mental health problems can come on suddenly or be present on and off for most of a teen's life. If you are worried, talk with someone, like your pediatrician, a school counselor, a mental health professional, or a suicide prevention hot line.

    The good news is that treatments—medications and therapy—are available. They make a difference.

    Homes with Guns

    Remove all guns from the home.

    The risk of teen suicide is 4 to 10 times higher in homes with guns than in homes without. Studies have shown that even in homes where the guns are locked up, teens are much more likely to kill themselves than in homes without guns.

    Guns can turn a moment of despair into a tragedy.

    Teenagers who attempt suicide with a gun are more likely to succeed in killing themselves than those who attempt suicide in many other ways.

    When teenagers attempt suicide without using a gun, many can recover with therapy. If a gun is used, they will never get that chance.

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    Helping Children Help Themselves

    When your child spills something, drops something, or creates a mess, pause before getting upset. Then, calmly ask your child what she was trying to do. You might be surprised at her answers, and you might learn things about your child and her thinking that you would never have known if you had gotten upset. Sometimes, your child really is just trying to help! Once you know what she was trying to accomplish, you can talk calmly about ways that it might work better next time.

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    How to Teach Children About Rules

    Establishing rules with children is an opportunity to teach the meaning behind them. For example, rather than telling your child "no running" at the swimming pool, point out the sign. Explain that this rule is necessary because the lifeguards are in charge of everyone's safety, and that water makes the surface next to the pool slippery. Some children may want to discuss possible injuries; other children may want to discuss why water makes cement slippery; and still other children may agree to follow the rule just so they can go swimming.

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    Humor Even for Vomiting Illnesses

    Children can be miserable with many common illnesses, but viral stomach flu can be particularly miserable for both the child (who feels so poorly) and the parent (who must clean up another episode of vomiting or diarrhea). Since vomiting is a given of childhood, try to add humor to it. Pick out a bucket or other similar container. Then, give it a name (e.g., the purple puke bucket) that children will find funny and will brighten their spirits. Use the bucket solely for this essential and honorable task, and you will know what it means when your child yells for it!

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    Internet and Your Family, The

    The Internet can connect you and your family to all types of resources. At your computer, you and your family can read the latest news, look up information, listen to music, play games, buy things, or e-mail friends. The possibilities for learning and exploring on the Internet are endless. However, not all information and resources are safe and reliable. Read more about how to make sure you and your family's experience on the Internet is safe, educational, and fun.

    About the Internet

    The Internet (or the Net) is a vast network that connects people and information worldwide through computers. It's sometimes called the information superhighway. The World Wide Web (WWW or the Web) is a part of the Internet that includes pictures and sound as well as text. Online means being connected to the Internet. Surfing the Web means browsing or searching for information on the Internet.

    When you and your family surf the Web it's important to keep the following in mind:

    • • Online information is usually not private.

    • • People online are not always who they say they are.

    • • Anyone can put information online.

    • • You can't trust everything you read online.

    • • You and your family may unexpectedly and unintentionally find material on the Web that is offensive, pornographic (including child pornography), obscene, violent, or racist.

    Setting the rules

    It's important to have a set of rules when your children use the Internet. Make sure your children understand what you consider appropriate and what areas are off limits. Let them know that the rules are for their safety.

    Safety first

    The following are tips you can teach your children about online safety:

    • • NEVER give out personal information unless a parent says it's OK. This includes your name, address, phone number, age, race, school name or location, or friends' names.

    • • NEVER share passwords, even with friends.

    • • NEVER meet a friend you only know online in person unless a parent says it's OK. It's best if a parent goes along and to meet in a public place. (Older teens that may choose not to tell a parent and go alone should at least go with a friend and meet in a public place.)

    • • NEVER respond to messages that make you feel uncomfortable or hurt your feelings. Ignore these messages, stop all communication, and tell a parent or another adult you trust right away.

    Good behavior

    The following is what you can teach your children about how they should act online:

    • • NEVER send mean messages online. NEVER say something online that you wouldn't say to someone in person. Bullying is wrong whether it's done in person or online.

    • • NEVER use the Internet to make someone look bad. For example, never send messages from another person's e-mail that could get that person into trouble.

    • • NEVER plagiarize. It's illegal to copy online information and say that you wrote it.

    Time limits

    Surfing the Web should not take the place of other important activities, including homework, playing outside, or spending time with friends. The American Academy of Pediatrics recommends limiting total screen time in front of a TV or computer to no more than 1 to 2 hours a day for children older than 2 years. An alarm clock or timer can help you keep track of time.

    Other steps you can take

    In addition to setting clear rules, you can do the following to create a safer online experience:

    • • Surf the Web with your children.

    • • Put the computer in a room where you can monitor your children. Computers should never be placed in a room where a door can be closed or a parent excluded.

    • • Use tracking software. It's a simple way to keep track of where your children have been on the Web. However, nothing can replace supervision.

    • • Install software or services that can filter or block offensive Web sites and material. Be aware, however, that many children are smart enough to find ways around the filters. Also, you may find that filters may be more restrictive than you want.

    • • Find out what the Internet use policies are at your child's school or at your library.


    If you or your children come across anything illegal or threatening, you should report it to the National Center for Missing & Exploited Children's CyberTipline. For more information, call 800/THE-LOST (800/843-5678) or visit the Web site at http://www.cybertipline.com.

    Communicating on the Net

    The following are some ways people can communicate with one another on the Internet. Keep in mind that information that is shared may not always be appropriate for children. Also, information on the Internet is often not monitored.

    Blog (or Web log). An online journal or diary that can include images. They can be found on social networking Web sites and are becoming more popular than chat rooms.

    Chat rooms. Chat rooms are a way for a number of computer users to communicate with each other instantly in "real time." For example, if you type a message and send it, everyone else will see it instantly in the chat room and they can respond just as quickly.

    E-mail (electronic mail). Messages sent and received electronically between computers.

    Instant messaging (IM). Sending and receiving messaging instantly in "real time" over the Internet.

    Surfing the Net

    When you go to the Internet, you may have a specific address in mind or you may browse through the Web, just as you would a library or a catalog. This is often called "surfing the Net." Following are several ways to get information on the Web:

    • • Web addresses. Every Web site has its own unique address. By typing the address in the space provided, your Web browser will take you there. Make sure you type the exact Web address. Any missing or incorrect characters could create an error or bring you to a totally different Web site. The last 3 letters in a Web site address can tell you what type of organization or company set up the site, for example: .gov (government), .org (nonprofit organizations), .edu (academic or education), .com (commercial).

    • • Links (or hyperlinks). Many Web sites link to information on other sites. By clicking on the highlighted area, you can connect to another Web site without having to type its address.

    • • Search engines. Search engines are programs that can enable you to search the Internet using keywords or topics. For example, to find information about Abraham Lincoln, simply click on a search engine and type "Abraham Lincoln." A list of several Web sites will come up for you to select from.

    Keep in mind—The Internet can be a helpful source of information and advice, but you and your children can't trust everything you read. Anyone can put information on the Internet, and not all of it is reliable. Some people and organizations are very careful about the accuracy of the information they post, others are not. Some give false information on purpose.

    Begin your search for information with the most reliable, general information Web sites and expand from there. The Web site for the American Academy of Pediatrics (AAP), http://www.aap.org, is a good starting point.

    AAP age-based guidelines for children's Internet use

    Up to age 10

    Children this age need supervision and monitoring to ensure they are not exposed to inappropriate materials. Parents should use Internet safety tools to limit access to content, Web sites, and activities, and be actively involved in their child's Internet use.

    Ages 11 to 14

    Children this age are savvier about their Internet experience; however, they still need supervision and monitoring to ensure they are not exposed to inappropriate materials. Internet safety tools are available that can limit access to content and Web sites and provide a report of Internet activities. Children this age also need to understand what personal information should not be given over the Internet.

    Ages 15 to 18

    Children this age should have almost no limitations on content, Web sites, or activities. Teens are savvier about their Internet experience; however, they still need parents to define appropriate safety guidelines. Parents should be available to help their teens understand inappropriate messages and avoid unsafe situations. Parents may need to remind teens what personal information should not be given over the Internet.

    Source: US Department of Education booklet "Parents Guide to the Internet."

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    Listening to Kid Logic for a Compromise

    Most children rarely get the chance to change an adult's mind using their own logic. However, developing logical thoughts is important to their decision-making and communication abilities. For example, dinner is taking longer than expected to prepare. A half-hour before it, your child asks for a snack. Usually, he hears, "Not so close to dinner." However, appetizers or sampling the dinner fare is not uncommon as an adult's hunger builds. Similarly, your child is hungry. You do have a legitimate concern that sweet snacks will ruin his appetite. Try stating it in a way that will elicit a logical response: "My only worry is that fruit snacks will keep you from eating your dinner." Listen to your child's response. Then, come to a compromise that allows a small nutritional snack, and keeps you both in good spirits when dinner is served.

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    Making Morning Struggles More Enjoyable

    Sometimes, waking children up in the morning to get ready for school or daycare can be frustrating and stressful, especially if they are grumpy and resistant. Try this: Have the children take turns being the first one awakened, and let that child go and wake up the other child or children. Sometimes, this simple strategy makes a child more excited about waking up, and it makes mornings more enjoyable. It is amazing how nice the children can be to each other in the process. Since they are taking turns, they realize what kind of wake-up call they would like to experience when it is the other child's turn!

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    Media History

    Please check one answer for each question. If the question does not apply to your family (ie, you do not own a computer or mobile device), leave that section blank.

    Child's Name __________

    Date __________

    Television (including on mobile screens)
    Does your child watch more than 1 to 2 hours of TV per day? □ Frequently □ Sometimes □ Never
    Do you watch TV with your child or know what your child is watching? □ Frequently □ Sometimes □ Never
    Do you discuss TV shows with your child? □ Frequently □ Sometimes □ Never
    Does your child have a TV in his or her room? □ Yes □ No
    Do you limit your child's watching of TV shows that often contain violence, sex, foul or explicit language, or images of tobacco or alcohol use? □ Frequently □ Sometimes □ Never
    Do you have rules about when TV can be watched? □ Yes □ No
    Do you allow your child to eat meals or snacks while watching TV? □ Yes □ No
    Does your child ask you to buy products he or she sees advertised on TV? □ Frequently □ Sometimes □ Never
    Movies and Videos
    Do you allow your child to watch movies or videos that are R-rated? □ Frequently □ Sometimes □ Never
    Do you read movie reviews to know the content of PG-13 movies? □ Frequently □ Sometimes □ Never
    Does your child have nightmares or trouble sleeping after watching movies? □ Frequently □ Sometimes □ Never
    How often does your child watch music videos on TV? □ Frequently □ Sometimes □ Never
    Are you familiar with the type of music your child listens to? □ Yes □ No
    Have you talked to your child about lyrics that you object to? □ Yes □ No
    Do you set limits on the types of music your child listens to? □ Yes □ No
    Video Games (including handheld)
    Are you familiar with the types of games your child plays? □ Yes □ No
    Do you check a game's rating before you rent or buy it? □ Yes □ No
    Do you allow your child to own or download games with violent content? □ Frequently □ Sometimes □ Never
    Do you limit the number of hours your child plays these games? □ Frequently □ Sometimes □ Never
    Internet (Web sites, including social networking sites accessible by computer and handheld devices)
    Do you monitor Internet use? □ Frequently □ Sometimes □ Never
    Does your child have a computer in his or her room? □ Yes □ No
    Are you familiar with the types of Web sites your child visits? □ Yes □ No
    Do you talk to your child about the best use of the Internet? □ Frequently □ Sometimes □ Never
    Have you purchased blocking software that prevents your child from visiting inappropriate/pornographic Web sites? □ Yes □ No
    Do you read to your child or does your child read at least once a day? □ Yes □ No
    Do you provide your child with a variety of reading materials? □ Yes □ No
    Do you talk to your child about the books that you read together or that your child is reading on his or her own? □ Frequently □ Sometimes □ Never
    Do you have any specific concerns about:
    Your child's use of tobacco, alcohol, or illicit drugs? □ Yes □ No
    Your child's own sense of body image or sexuality? □ Yes □ No
    Displays of aggressive behavior or use of foul language? □ Yes □ No
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    Medications, Administration of

    Getting preschoolers and school-age children to take medicine can be very challenging for parents. Try this: pour the medicine into a small medicine cup, measuring out the exact amount prescribed by your doctor. Then, "top it off" with several teaspoons of either strawberry or chocolate syrup. You also can try this for medicine in tablet form. First, using two spoons, crush the pill into a fine powder. Then, put the powder into the medicine cup, and fill it with flavored syrup. Stir until the powder is dissolved, and let your child drink it up! Kathleen Traylor, M.D.

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    No Rewards for Crying

    Most rules can, and should, be discussed within a family. In many homes, a rule not up for discussion is that there are no rewards for crying. For example, your child really wants something, and it is refused. Then, your child starts to cry, often very dramatically. As soon as the tears start, the child gives up any negotiating power. Calmly saying, "I'm sorry, we can't even discuss this now," will quickly take the steam out of the crying tactic.

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    Normal Weight and Height Guidelines

    Parents often wonder about the normal growth of their children. While general guidelines can be followed, always remember variations are the norm with kids! Typically, height doubles between 3 and 4 years old; then, it triples by 13 years old (based on height at birth). Weight usually doubles by about 5 months of age, triples by 12 months of age, and quadruples from 2 to 2 1/2 years of age (based on weight at birth).

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    Not Giving In

    Sometimes, as a parent, yielding to your child's desires (e.g., getting in bed with you at 2 a.m., or crying for candy in the grocery store) by saying "yes" is much easier than saying "no." However, holding firm to your standards of discipline, while maintaining consistency by not changing your mind, will prove far easier for both you and your child in the long run. Reviewed 9/5/2009 By Daniel Feiten MD Greenwood Pediatrics

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    Pacifier, Weaning from

    Weaning from the pacifier can be a dreaded chore of parenting. The longer a child is attached to the pacifier, the harder it becomes to get rid of it. Between six to nine months of age, limit the pacifier to the car and the crib. Between 12 to 15 months of age, take your child to a toy store and let him pick out a new, cuddly, security item. Tell him it is time to say "bye" to his pacifier, while frequently reminding him of his new security object. Then, throw away all of the pacifiers. The child will object, and a few nights may be difficult, but the pacifier is usually quickly forgotten.

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    Picky Eaters

    As concerned parents, it's hard for us to not plead with our picky eater to "please eat one more bite". Yet, this approach often leads to frustration and resistance. Change your focus. Instead of putting food on his plate in the quantity that you think he will eat, put one bite of each item on his plate. When he asks for more, give him more from your own plate or a family platter. It's a wonderful opportunity to encourage rather than discourage! Dan Feiten, M.D.

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    Positive Reinforcement/Rewards

    Rewarding children for doing the right thing, for good behavior, or for doing something positive can be a powerful strategy for parents. Sometimes, though, we may feel as though we are bribing our children—that is true if you choose to look at it that way. If you remind yourself to always call it positive reinforcement, rather than bribery, it works, and you feel good about it!

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    Potty Training for Boys

    Put a few drops of liquid hand soap or dish soap into the toilet. Let your son make bubbles by aiming for the colored soap. We let our older son demonstrate it for our younger son and they loved it!

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    Potty Training for Girls

    We used an anatomically correct Emma Doll (Corolle) to help our daughter use play to learn how to go potty. It comes with a book that gives you some tips on how to interact with your child while they are training.

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    Predicting your Child

    Parents often are very curious about predicting their child's adult height. You can try to estimate it using one of the following methods: (1) Review your child's height growth curve with your pediatrician once your child is older than 2 years, and extrapolate it out to 18 years of age on the growth curve. (2) Try this: Girls are half of their adult height at 18 months of age, while boys are half of their adult height at 24 months of age. (3) If you like mathematical formulas, calculate this: For girls, take the father's height in inches and subtract 2.5 inches; then, add it to the mother's height in inches, and divide this sum by 2 to get a predicted height in inches. For boys, take the mother's height in inches and add 2.5 inches; then, add it to the father's height in inches, and divide this sum by 2 to get a predicted height in inches.

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    Reading to Infants

    Reading with children is one of the most influential activities that parents can do; it has a permanent impact on their cognitive development and their learning potential. Daily reading time can, and should, be started around six months of age. Infants do best with simple board books where you point out something on each page. Don't worry if they would rather just chew on the books - they are curiously exploring, and that is learning too! Books with simple flaps that open on each page also are enticing to children of this age. Kathleen Traylor, M.D.

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    Reading to Toddlers

    When reading to toddlers, have them name the items on each page of familiar books, rather than you naming the items. If your child has a favorite book, try to pick a different theme each time you read the book. For example, go through and point out all the animals; the next time, point out the colors; the next time, talk about the shapes; and so on. This keeps the child endlessly learning, and you stay interested too! Kathleen Traylor, M.D.

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    Sibling Relationships

    Almost 80% of children grow up with at least one brother or sister. Brothers and sisters teach each other how to get along with others. Even if they do not always get along with each other, siblings play very positive roles in each other's lives.

    Read on to learn more about how siblings get along the way they do and how you can help them learn to live together in peace.

    What is a sibling?

    In today's world there are many types of families. Besides the traditional mother-and-father family, children are being raised by grandparents, other relatives, foster parents, single parents, or same-sex parents. As a result, brothers and sisters come in many forms.

    Traditional siblings are brothers and sisters with the same mother and father. Half siblings share either the same mother or the same father. Stepsiblings are brothers and ­sisters who are not related biologically, but whose ­parents are ­married to each other. No matter what type of ­siblings they are, their relationships with each other are important.

    Why siblings get along the way they do

    Many things affect relationships between brothers and sisters. Some of these are

    Personality. Parents often wonder how children from the same parents growing up in the same home can be so different. In fact, siblings are sometimes more different than alike. Even if siblings are alike in some ways, it is important for parents to recognize the unique personality of each of their children.

    Age. Children of different ages behave differently. For example, younger children may fight in more physical ways. As they get older, their fighting may be more like arguments.

    Gender. Gender affects relationships as well. Many parents find that children of the same sex compete with each other more than do opposite-sex children.

    Family size, spacing, and birth order. No two children view the family the same way. An only child's experience is different from that of a child in a larger family. Children who are less than 2 years apart sometimes have more conflict than children who are spaced further apart.

    A new sibling

    A new baby brings joys and challenges to a family. Parents are excited but they are also nervous about how their older children will react to the newborn. All sorts of questions come up: How should we tell our older children that they are going to have a baby brother or sister? Will they be jealous of the new baby? How can we help them get along?

    Children of different ages will react differently to a new baby. Knowing what to expect from each age group will make it easier to handle the changes in your family.

    Ages 1 to 2 years

    Children of this age will not understand much about what it means to have a new brother or sister. However, let your child hear you talk about the "new baby" and feel your excitement. She may not understand why you are excited, but your attitude will rub off on her and she will feel excited too.

    Keep in mind, you may not be able to satisfy the needs of both children all the time—especially not by yourself. If you feel overwhelmed, look to your spouse, other relatives, and friends for support and an extra set of arms.

    Other ideas to help prepare your very young child for a new sibling include

    • Look at picture books about a new baby. At the very least, your child will become familiar with words like "sister," "brother," and "new baby."

    • When the new baby arrives, try to do something special for your older child to reassure her she is still loved. Some ideas include giving her a special gift; letting her spend some time alone with dad, grandma, or another special adult; or taking her someplace special.

    Ages 2 to 4 years

    At this age, your child is still very attached to you and does not yet understand how to share you with others. Your child also may be very sensitive to change and may feel threatened by the idea of a new family member. Here are some suggestions that may help ease your preschooler into being a big brother or big sister.

    • Wait a while before telling your preschooler about the baby. Explain it to your child when you start buying nursery furniture or baby clothes or if he starts asking about mom's growing "stomach." Picture books for preschoolers can be very helpful. So can sibling classes (ask your hospital if it offers them). Try to tell your child before he hears about the new baby from someone else.

    • Be honest. Explain that the baby will be cute and cuddly but will also cry and take a lot of your time and attention. Also, make sure that your older child knows that it may be a while before he can play with the new baby. Reassure your child that you will love him just as much after the baby is born as you do now.

    • Involve your preschooler in planning for the baby. This will make him less jealous. Let him shop with you for baby items. Show him his own baby pictures. If you are going to use some of his old baby things, let him play with them a bit before you get them ready for the new baby. Buy your child (boy or girl) a doll so he can take care of "his" baby.

    • Time major changes in your child's routine. If you can, finish toilet training or switching from a crib to a bed before the baby arrives. If that is not possible, put them off until after the baby is settled in at home. Otherwise, your child may feel overwhelmed by trying to learn new things on top of all the changes caused by the new baby.

    • Expect your child to regress a little. For example, your toilet-trained child might suddenly start having "accidents," or he might want to take a bottle. This is normal and is your older child's way of making sure he still has your love and attention. Instead of telling him to act his age, let him have the attention he needs. Praise him when he acts more grown-up.

    • Prepare your child for when you are in the hospital. He may be confused when you leave for the hospital. Explain that you will be back with the new baby in a few days.

    • Set aside special time for your older child. Read, play games, listen to music, or simply talk together. Show him that you love him and want to do things with him. Also, make him feel a part of things by having him cuddle next to you when you feed the baby.

    • Ask family and friends to spend a little time with your older child when they come to see the new baby. This will help him feel special and not left out of all the excitement. They might also give him a small gift when they bring gifts for the baby.

    • Have your older child spend time with dad. A new baby presents a great opportunity for fathers to spend time alone with older children.

    School-aged children

    Children older than 5 years are usually not as threatened by a new baby as younger children are. However, they may resent the attention the new baby gets. To prepare your school-aged child for a new baby,

    • Tell your child what is happening in language she can understand. Explain what having a new baby means and what changes may affect her—both the good and the not so good.

    • Have your older child help get things ready for the new baby by fixing up the baby's room, picking out clothes, or buying diapers.

    • If possible, have your older child come to the hospital soon after the baby is born so she feels part of the growing family.

    • When you bring the new baby home, make your older child feel that she has a role to play in caring for the baby. Tell her she can hold the baby, although she must ask you first. Praise her when she is gentle and loving toward the baby.

    • Do not overlook your older child's needs and activities. Let her know how much you love her. Make an effort to spend some time alone with her each day; use that as a chance to remind her how special she is.

    Stepsiblings and half siblings

    When two families become one, children who barely know each other may all of a sudden share bedrooms and bathrooms. This can cause fights over personal space and other things that they may need to share like toys, clothes, and what to watch on TV. At the same time, children are trying to get used to their parents' new marriage, new stepparents, and maybe a new house. Also, parents may decide to have more children, introducing half siblings into the family. It is not always an easy adjustment.

    Here are some ideas to cut down on problems in stepfamilies and families with half siblings.

    • Do not expect stepsiblings to spend all of their time together.

    • Each child should spend some time alone with her own parent.

    • Whenever possible, stepsiblings and half siblings should have their own rooms. If they have to share a room, each child should have her own toys and other possessions; do not force them to share all their things.

    • If you and your new spouse decide to have a child together, you should be open and honest about it with your other children. Reassure them that your decision to have a child together does not mean you will love them less. Involve them in planning for the new baby as much as possible.

    In some blended families, the new parent may find it difficult to discipline the spouse's children. This may require much family discussion to work out and occasionally even professional help. Of course, you should always feel free to raise your concerns and challenges with your pediatrician.

    Managing sibling rivalry

    No matter how hard you try to keep the peace, your children are likely to fight over toys, tattle on one another, and tease and criticize each other. Sibling rivalry is a natural part of growing up. Here are some tips on managing conflict between your children.

    • Remember that each child's needs are different. Some parents feel it's important to treat their children the same way. Yet children often complain that things are "not fair" and that they are not receiving what the other sibling gets. Treating your children differently doesn't mean you are playing favorites. It's a way of showing that you appreciate how special they are.

    • While it's natural to notice differences between your children, try not to comment on these in front of them. It is easy for a child to think that he is not as good or as loved as his sibling when you compare them. Remember, each child is special. Let each one know that.

    • As much as possible, stay out of your children's arguments. While you may have to help younger children find ways to settle their differences, do not take sides. If your children try to involve you, explain that they need to figure out how to get along. Of course, you must get involved if the situation gets violent. Make sure your children know that such behavior is not allowed. If there is any reason to suspect that your children may become violent, watch them closely when they are together. Preventing violence is always better than punishing after the fact, which often makes the rivalry worse. Praise your children when they solve their arguments, and reward good behavior.

    • Be fair. If you must get involved in your children's arguments, listen to all sides of the story. Also, give children privileges that are right for their ages and try to be consistent. If you allowed one child to stay up until 9:00 pm at 10 years of age, the other should have the same bedtime when he is 10.

    • Respect your child's privacy. If it is necessary to punish or scold, do it with the child alone in a quiet, private place. Do not embarrass your child by scolding him in front of the others.

    • Family meetings can be a great way to work out sibling issues. Some parents find that sharing some of their own experiences about growing up can help too. Just listening to your children can also help. Remember, this is their opportunity to learn about the give-and-take of human relationships.

    Raising twins

    From the very start it is important twins are treated as individuals. If they are identical, it is easy to treat them as a package, giving them the same clothing, toys, and attention. But even though they may look alike, emotionally they are very different. Thus, you may wish to consider sending them to different schools or having them enroll in different classrooms in the same school, if possible. To grow up happy and secure as individuals, they need you to support their differences.

    Identical and fraternal twins compete with each other and depend on each other as they grow. Sometimes one twin acts as the leader and the other the follower. Either way, most twins develop very close relationships early in life simply because they spend so much time with each other.

    If you also have other children, your twins may make your older children doubly jealous. Twins need huge amounts of your time and energy and will get a lot of extra attention from friends, relatives, and strangers on the street. You can help your other children accept this by offering them "double rewards" for helping with the babies. If you have twin newborns, it is even more important that you spend some special time alone with the other children, doing their favorite things.

    As your twins get a little older, especially if they are identical, they may choose to play only with each other. This may make their other siblings feel left out. To keep the twins from leaving other children out, urge them to play separately with other children. Also, set up times when you play with just one twin, while the other plays with a sibling or friend.

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    Sibling Rivalry

    Sibling squabbles are almost a right of passage of childhood. The next time your children are fighting over a toy, a game, or a food, pause before getting angry. Then, calmly take away the prized item and positively tell the children that they can have it back once they have solved their differences. Seeing the children look at each other - trying to decide if they should actually figure it out together or if they should just part their ways and go do something else - is actually rewarding as a parent. Your children may even surprise you by deciding among themselves to share or take turns!

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    Single Parenting

    Single-parent families are more and more common in today's society. While raising children alone isn't easy, children in single- parent homes can grow up just as happy as children in 2-parent homes. Read on to find out how single parents can better cope with the special challenges of raising children on their own.

    Ways to cope

    Single parenthood can bring added pressure and stress to the job of raising children. With no one to share day-to-day responsibilities or decision-making, single parents must provide greater support for their children while they themselves may feel alone. The following suggestions may help reduce stress in your family:

    Get a handle on finances. Learn how to budget your money. Know when your paycheck or other income will arrive, and keep track of household bills. Do what you can to improve your finances. If you need a job, contact employment and temporary agencies for help. If you need more education, consider getting your high school diploma, a college degree, or other special training.

    Talk early and often. Let your children know about the changes in the family. Sit quietly with your children and allow them to talk about their feelings.

    Find support and use it. Don't try to handle everything by yourself. You will need the support that family and friends can give. Get to know other single parents through support groups. Your pediatrician can also be a great source of help and information.

    Take time for family. Being a single parent can be overwhelming. Set aside some time each day to enjoy your children. Spend quiet time playing, reading, working on arts-and-crafts projects, or just listening to music together. Your time is one of the most important things you can give to your children.

    Take time for yourself. Time spent away from your children is important for you and for them. Being a single parent doesn't mean you can't have an adult life. Get a babysitter and enjoy some time alone or with friends. Do things that you like. Go to a movie. Find a hobby.

    Keep a daily routine. Schedule meals, chores, and bedtimes at regular times so that your children know what to expect each day. A routine will help them feel more secure.

    Maintain consistent discipline. Divorced or separated parents should work together to discipline their children the same way. Check your local library for books on parenting. Local hospitals, the YMCA, and church groups often sponsor parenting classes. Learning good ways to handle your children's behavior will reduce stress for all of you.

    Treat kids like kids. Though being a single parent can get lonely, try not to treat your children like substitutes for a partner. Try not to rely on them for comfort or sympathy.

    Stay positive. Be aware that your children will always be affected by your mood and attitude. They will need your praise and your love through hard times. It's okay to be honest about your feelings of sadness and loss, but let them know better times lie ahead for all of you.

    Take care of yourself. This is a difficult time for you, too. Exercise regularly, eat healthy, and get enough rest so you can better deal with stress. Visit your own doctor on a regular basis.

    Find good child care. Good child care is essential for your children's well-being and your peace of mind. Finding quality child care may be one of the most difficult tasks you will face. Keep the following in mind:

    • Never leave your children home alone. Find someone you trust to take care of them while you are working.

    • Don't rely on older brothers and sisters to babysit for younger siblings.

    • Be careful about asking new friends or partners to watch your children, even for a short time. They may not have the patience, especially if a child's behavior becomes difficult.

    • Children need to be cared for by an adult with proven experience in child care. The best way to make sure your child is getting good care is to visit the child care center or watch your babysitter when he or she is with your children.

    Your pediatrician can offer advice on finding the best child care for your family. Your local city or county government may also have a list of licensed child care centers or homes.

    Divorce and separation

    Most single-parent families are the result of a divorce or separation. For some children, divorce can be just as hard as the death of a parent. It can take a long time for children to heal. Some children may feel they are the reason for the divorce and dream about getting their parents back together.

    The age of your children may also make a difference. Preschoolers may regress in such things as toilet training or may have nightmares. School-aged children may feel angry, guilty, or sad. Teens may worry about moving away from friends or not having money for college.

    If you are considering separation or divorce, you may find it helpful to discuss it with your pediatrician. A visit with a counselor may also help by giving you and your children a chance to talk about any problems and to plan for the changes ahead.

    Dating and the single parent

    Be choosy about which dates meet your children. Try to form a solid relationship before bringing someone new into your home. Overnight guests may confuse your children. If you are dating someone special, talk to your friend about your children before they meet. When you feel the time is right, let your children meet your new partner. Don't expect them to be close right away. Give them time to become friends.

    If your partner is new to child rearing, he or she may feel awkward with your family. Watch how your friend gets along with your children. Your partner should be patient and understanding. Before leaving your children with a new partner, be sure that he or she can be trusted.

    Talking with your children

    Talking with your children is a very important way for you to help each other through tough times. Being able to share fears, worries, and feelings can make your children feel safe and special. The more often you talk, the more comfortable you all will feel. While your children may have lots of questions, don't feel you have to have all the answers. Sometimes just listening is more helpful than giving advice. If needed, don't hesitate to get help from your pediatrician or a family counselor.

    The following suggestions may be useful in talking with your children about the changes in your family:

    Be honest. If your spouse has died, your children may not understand what has happened. Young children often see death as a temporary situation. It is very important not to talk about death as "going away" or "going to sleep." Your children may believe that the parent will come back or wake up or that they will die while asleep. If you are going through a divorce, talk about it in simple terms. Try not to blame your ex-spouse or show your anger. Explain that parents sometimes choose to live separately. Give your children all the comfort they need to feel safe and loved.

    Make sure your children know they are not at fault. After a separation, divorce, or death of a parent, children may blame themselves. They may feel alone, unwanted, or unloved. Let them know the changes are not their fault, that you love them and won't leave them.

    Talk with your children about their fears. Confusion about a parent leaving or dying can be scary for children. In their minds, if one parent can leave, maybe the other one can too. They may think that if they behave better, the parent will come back. It is important to talk about these fears and to be as reassuring as possible.

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    Sleep Problems in Children

    Sleep problems are very common during the first few years of life. Problems may include waking up during the night, not wanting to go to sleep, nightmares, sleepwalking, and bedwetting. If frantic upset persists with no apparent cause, call your child's doctor.

    All children differ in how much sleep they need, how long it takes them to fall asleep, and how easily they wake up. Read on for more information from the American Academy of Pediatrics on how parents can help their children develop good sleep habits, even at an early age.


    Babies do not have regular sleep cycles until about 6 months of age. While newborns sleep about 16 to 17 hours per day, they may only sleep 1 or 2 hours at a time. As babies get older, they need less sleep. However, different babies have different sleep needs. It is normal for a 6-month-old to wake up during the night but go back to sleep after a few minutes.

    Here are some suggestions that may help your baby (and you) sleep better at night.

    • Keep your baby calm and quiet when you feed or change her during the night. Try not to stimulate or wake her too much.

    • Make daytime playtime. Talking and playing with your baby during the day will help lengthen her awake times. This will help her sleep for longer periods during the night.

    • Put your baby to bed when drowsy but still awake. This will help your baby learn to fall asleep on her own in her own bed. Holding or rocking her until she is com­pletely asleep may make it hard for her to go back to sleep if she wakes up during the night.

    • Wait a few minutes before responding to your child's fussing. See if she can fall back to sleep on her own. If she continues to cry, check on her, but don't turn on the light, play with her, or pick her up. If she gets frantic or is unable to settle herself, consider what else might be bothering her. She may be hungry, wet or soiled, feverish, or otherwise not feeling well.

    Toddlers and preschoolers

    Many parents find their toddler's bedtime to be the hardest part of the day. Children this age often resist going to sleep, especially if they have older siblings who are still awake. Use the following tips to help your toddler develop good sleep habits:

    • Set up a quiet routine before bedtime to help your child understand that it will soon be time to go to sleep. Use this time to read him a story, listen to quiet music, or give him a bath. It may be tempting to play with your child before bed. However, active play may make your child too excited to sleep.

    • Be consistent. Make bedtime the same time every night. This helps your child know what to expect and helps him establish healthy sleep patterns.

    • Allow your child to take a favorite thing to bed each night. It's OK to let your child sleep with a teddy bear, special blanket, or some other favorite toy. These often help children fall asleep—especially if they wake up during the night. Make sure the object is safe. Look for ribbons, buttons, or other parts that may be choking hazards. Stuffing or pellets inside stuffed toys can also be dangerous.

    • Make sure your child is comfortable. He may like to have a drink of water, a light left on, or the door left slightly open. Try to handle your child's needs before bedtime so that he doesn't use them to avoid going to sleep.

    • Do not let your child sleep in the same bed with you. This can make it harder for him to fall asleep when he is alone.

    • Do not return to your child's room every time he complains or calls out. Instead, try the following:

      • Wait several seconds before answering and make your response time longer each time he calls. This will give him a chance to fall asleep on his own.

      • Reassure your child that you are there. If you need to go into the room, do not turn on the light, play with him, or stay too long.

      • Move farther from your child's bed every time you go in, until you can reassure him verbally without entering his room.

      • Remind him each time he calls that it's time to go to sleep.

    • Give it time. Helping your child develop good sleep habits can be a challenge, and it is normal to get upset when a child keeps you awake at night. Try to be understanding. A negative response by a parent can sometimes make a sleep problem worse.

    Safe Sleep and Your Baby

    Many infants die during sleep from unsafe sleep environments. Some of these deaths are from entrapment, suffocation, and strangulation. Some infants die from sudden infant death syndrome (SIDS), which is the sudden, unexplained death of a baby younger than 1 year. However, the following are ways for parents to keep their sleeping baby safe.

    • Place your baby to sleep on his back for every sleep until he is 1 year old. If your baby has rolled onto his side or stomach, he can be left in that position if he is already able to roll from tummy to back and back to tummy. If your baby falls asleep in a car safety seat, stroller, swing, infant carrier, or infant sling he should be moved to a firm sleep surface as soon as possible.

    • Place your baby to sleep on a firm sleep surface. The crib, bassinet, portable crib, or play yard should meet current safety standards. Do not put blankets or pillows between the mattress and the fitted sheet. Never put your baby to sleep on a chair, sofa, waterbed, cushion, or sheepskin.

    • Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the crib. These objects include pillows, quilts, comforters, sheepskins, bumper pads, and stuffed toys. Note: Research has not shown us when it's 100% safe to have these objects in the crib; however, most experts agree that after 12 months of age these objects pose little health risk to healthy babies.

    • Place your baby to sleep in the same room where you sleep but not the same bed. This is the safest sleep arrangement for your baby. Put your baby's crib close to your bed, so that you can easily watch and feed your baby.

    • Breastfeed your baby if possible.

    • Make sure that your baby gets all recommended immunizations.

    • Keep your baby away from smokers and places where people smoke.

    • Do not let your baby get too hot. In general, dress your baby in no more than one extra layer than you would wear. Your baby may be too hot if she is sweating or if she feels hot. If you are worried that your baby is cold, you can use infant sleep clothing.

    • Offer a pacifier at naptime and bedtime. This helps to reduce the risk of SIDS. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. It's OK if your baby doesn't want to use a pacifier. If the baby's pacifier falls out after he falls asleep, you don't have to put it back in.

    Note: These recommendations are for healthy babies up to 1 year of age. A very small number of babies with certain medical conditions may need to be placed to sleep on their stomachs. Your baby's doctor can tell you what is best for your baby.

    Common sleep problems

    There are many things that can cause a child to wake up during the night. Most of these happen when children are overtired or under stress. Keeping your child on a regular sleep schedule may help prevent many of these problems. If your child's sleep problems persist or get worse, talk with your child's doctor.


    Nightmares are scary dreams that often happen during the second half of the night when dreaming is most intense. Children may wake up crying or feeling afraid and may have trouble falling back to sleep.

    What you can do

    • Go to your child as quickly as possible.

    • Assure her that you are there and will not let anything harm her.

    • Encourage her to tell you what happened in the dream. Remind her that dreams are not real.

    • Allow her to keep a light on if it makes her feel better.

    • Once your child is ready, encourage her to go back to sleep.

    • See if there is something that is scaring your child, like shadows. If so, make sure they are gone.

    Night terrors

    Night terrors occur most often in toddlers and preschoolers and take place during the deepest stages of sleep. Deepest sleep is usually early in the night, often before parents' bedtime. During a night terror, your child might

    • Cry uncontrollably

    • Sweat, shake, or breathe fast

    • Have a terrified, confused, or glassy-eyed look

    • Thrash around, scream, kick, or stare

    • Not recognize you or realize you are there

    • Try to push you away, especially if you try to hold him

    While night terrors can last as long as 45 minutes, most are much shorter. Most children fall right back to sleep after a night terror because they actually have not been awake. Unlike a nightmare, a child will not remember a night terror.

    What you can do

    • Stay calm. Night terrors are often more frightening for the parent than the child.

    • Do not try to wake your child.

    • Make sure your child cannot hurt himself. If he tries to get out of bed, gently restrain him.

    Remember, after a short time your child will probably relax and sleep quietly again. If your child has night terrors, be sure to tell babysitters what they are and what to do. If night terrors persist, talk with your child's doctor.

    Sleepwalking and sleep talking

    Like night terrors, sleepwalking and sleep talking happen when a child is in a deep sleep. While sleepwalking, your child may have a blank, staring face. She may not respond to others and may be very difficult to wake up. Most sleepwalkers return to bed on their own and do not remember getting out of bed. Sleepwalking tends to run in families. It can even occur several times in one night among older children and teens.

    What you can do

    • Make sure your child doesn't hurt herself while sleepwalking. Clear the bedroom of things your child could trip or fall on.

    • Lock outside doors so your child cannot leave the house.

    • Block stairways so your child cannot go up or down.

    • Do not try to wake your child when she is sleepwalking or sleep talking. Gently lead her back to bed and she will probably settle down on her own.


    Bedwetting (also called enuresis) at night is very common among young children. Although all of the causes of bedwetting are not fully understood, the following are some that are possible:

    • Your child is a deep sleeper and does not awaken to the signal of a full bladder.

    • Your child has not yet learned how to hold and empty urine well. (Communication between the brain and bladder may take time to develop.)

    • Your child's body makes too much urine at night.

    • Your child is constipated. Full bowels can put pressure on the bladder and lead to problems with holding and emptying urine well.

    • Your child has a minor illness, is overly tired, or is responding to changes or stresses going on at home.

    • There is a family history of bedwetting. (Most children that wet the bed have at least one parent who had the same problem as a child.)

    • Your child's bladder is small or not developed enough to hold urine for a full night.

    • Your child has an underlying medical problem.

    What you can do

    • Do not blame or punish your child for wetting the bed. Bedwetting is not your child's fault. Reassure him that it will get better in time.

    • Have your child use the toilet and avoid drinking large amounts of fluid just before bedtime.

    • Put a rubber or plastic cover over the mattress to protect against wetness and odors.

    • Encourage your child to help change the wet sheets and covers. This teaches responsibility. It can also keep your child from feeling embarrassed if the rest of the family knows. However, if your child sees this as punishment, it is not recommended.

    • Set a no-teasing rule in the family.

    Bedwetting usually disappears as children get older. If you are concerned about your child's bedwetting, talk with your child's doctor. There are treatments available.

    Teeth grinding

    It is common for children to grind their teeth during the night. Though it makes an unpleasant sound, teeth grinding is usually not harmful to your child's teeth, but you may want to check with your child's dentist to make sure. It may be related to tension and anxiety and usually goes away in a short while. However, it may reappear when your child is stressed.

    What you can do

    • Try to help your child deal with stress.

    • Talk with your child's doctor to rule out any medical problems that may be causing the problem.

    Keep a sleep diary

    If you are concerned about your child's sleep habits, talk with your child's doctor. Keep a sleep diary to help track your child's problem that includes the following:

    • Where your child sleeps

    • How much sleep she normally gets at night

    • What she needs to fall asleep (for example, a favorite toy or blanket)

    • How long it takes her to fall asleep

    • How often she wakes up during the night

    • What you do to comfort and console her when she wakes up during the night

    • The time and length of naps

    • Any changes or stresses in the home

    Track this information for 1 to 2 weeks and bring it with you when you talk with your child's doctor. Keep in mind that sleep problems are very common, and with time and help from your child's doctor, you and your child will overcome them.

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    Start Reading to Your Child Early

    How to Help Your Child Learn to Read

    A baby can enjoy books by 6 months of age! Here are things you can do with your child at different ages to help your child learn to love words and books.

    Birth to Age 1

    • Play with your baby often. Talk, sing, and say rhymes. This helps your baby learn to talk.

    • Talk with your baby, making eye contact. Give your baby time to answer in baby talk.

    • Give your baby sturdy board books to look at. It's OK for a baby to chew on a book.

    • Look at picture books with your baby and name things. Say “See the baby!” or “Look at the puppy!”

    • Babies like board books with pictures of babies and everyday objects like balls and blocks.

    • Snuggle with your baby on your lap and read aloud. Your baby may not understand the story, but will love the sound of your voice and being close to you.

    • Don't let your child watch TV until age 2 or older.

    1 to 3 Years of Age

    • Read to your child every day. Let your child pick the book, even if it's the same one again and again!

    • Younger toddlers (1 to 2 years of age) like board books with pictures of children doing everyday things (like eating and playing). They also like “goodnight” books and books with rhymes. Books should only have a few words on each page.

    • Older toddlers (2 to 3 years of age) like board books and books with paper pages. They love books with rhymes and words that are repeated. Books about families, friends, animals, and trucks are also good.

    • Let your child “read” to you by naming things in the book or making up a story.

    • Take your child to the library. Celebrate your child getting a library card!

    • Keep talking, singing, saying rhymes, and playing with your child.

    • Don't let your child watch TV until age 2 or older.

    Reading Tips

    • Set aside time every day to read together. Reading at bedtime is a great way to get ready for sleep.

    • Leave books in your children's rooms for them to enjoy on their own. Have a comfortable bed or chair, bookshelf, and reading lamp.

    • Read books your child enjoys. Your child may learn the words to a favorite book. Then, let your child complete the sentences, or take turns saying the words.

    • Don't drill your child on letters, numbers, colors, shapes, or words. Instead, make a game of it.

    3 to 5 Years of Age

    • Read ABC books with your child. Point out letters as you read.

    • Preschool children like books that tell stories. They also love counting books, alphabet books, and word books. Like toddlers, they love books with rhymes and words they can learn by heart.

    • Help your child recognize whole words as well as letters. Point out things like letters on a stop sign or the name on a favorite store.

    • Ask your child questions about the pictures and story. Invite him or her to make up a story about what's in the book.

    • Some public TV shows, videos, and computer games can help your child learn to read. But you need to be involved too. Watch or play with your child and talk about the program. Limit TV time to 1 or 2 hours per day. Avoid violent shows and movies. Try to stick to educational shows.

    • Give your child lots of chances to use written words. Write shopping lists together. Write letters to friends or family.

    Read Aloud With Your Child

    Reading aloud is one of the best ways to help your child learn to read. The more excited you act when you read a book, the more your child will enjoy it.

    • Use funny voices and animal noises!

    • Look at the pictures. Ask your child to name things in the pictures. Talk about how the pictures go with the story. Ask what is happening in the story.

    • Invite your child to join in when a line is repeated over and over.

    • Show your child how things in the book are like things in your child's life.

    • If your child asks a question, stop and answer it. Books can help children express their thoughts and solve problems.

    • Keep reading to your child even after he or she learns to read. Children can listen and understand harder stories than they can read on their own.

    Listen to Your Child Read Aloud

    Once your child starts reading, have him or her read out loud. Take turns reading.

    If your child asks for help with a word, give it right away. But let your child sound out words if he or she wants to.

    Know when your child has had enough. Stop if your child is tired or frustrated.

    Most of all, give lots of praise! You are your child's first, and most important, teacher!

    The American Academy of Pediatrics (AAP) is grateful for the Reach Out and Read program's help with this handout. Reach Out and Read works with children's doctors to make promoting literacy and giving out books part of children's basic health care. This program is endorsed by the AAP. To learn more about Reach Out and Read, go to www.reachoutandread.org.

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    Staying Cool When Things Heat Up

    Don't Let Being Angry Turn into a Fight

    • Anger is normal, but fighting isn't the way to deal with it.

    • Treat people with respect, even when you’re angry.

    • Find the courage to walk away from a fight.

    • Help keep others safe by not staying to watch a fight.

    • Get help from a trusted adult when others are fighting.

    It's important to know how to settle an argument before it gets physical. You can learn ways to control your anger.

    Being Angry Without Losing your Temper

    Anger is normal. It is natural to feel this way when you or someone you care about has been treated badly. It's up to us to decide how to act when we get angry.

    Everyone gets angry.

    Being angry does not have to lead to a fight. But, when we lose our temper, we are more likely to get into a fight or say something we will later wish we did not say.

    Once you lose your temper, it takes about 30 minutes to calm down and think clearly.

    If you think you are about to “lose it,” leave, find something to relax your mind, and come back later.

    This saves a lot of trouble. It may even save your life! You can say, “I'm starting to get mad. Can we talk about this later when I’ve cooled down?”

    Have a Good Attitude—Treat Everyone with Respect

    Telling yourself that all people, even those you don't know, have a decent side makes it possible to treat them with respect. Then, when you feel angry or upset with someone, your first reaction would be not to fight.

    Talk to a Person's Decent Side

    Don't crowd.

    Some people get afraid when others get too close. Stay an arm's length away from the other person.

    Find out why this person is upset.

    “Why are you saying this?”

    Explain your side.

    “This is how I see it. What I think happened is _________.”

    Try to make things right.

    “I don't want us to be enemies over this. What can we do to make this right?”

    If you Feel Fear, Leave

    Being afraid of snakes and bears has kept human beings alive for thousands of years. Being around people who are angry or who want to start a fight can be scary.

    If you feel fear, even if you don't know why, you need to leave. Your body is telling you something is wrong when:

    • Your heart speeds up.

    • Your stomach feels funny.

    • You get hot and sweaty.

    “I'm not sure what's going on, but I'm out of here.”

    Walking Away Does not Mean you are Weak

    If you cannot connect with someone's decent side and this person still wants to fight, get away. When both people are so upset, it is hard to think clearly.

    Not fighting is a sign of self-respect and maturity.

    It takes more courage to leave than to stay and fight.

    Friends Don't Let Friends Fight

    Even if you are not the one who is fighting, how you act is very important. Some people would rather fight than lose face in a crowd. Here are ways you can help stop a fight:

    Tell them to “talk it out” when they have calmed down.

    • “This is not worth fighting about.”

    • “Don't let a fight happen over this.”

    Leave them alone.

    If you and others leave, the fight most likely will not happen. Many fighters want and need people watching. You can say, “Let's get out of here. They can work this out as long as we leave them alone.”

    If there is a weapon, get help right away!

    • You and others need to leave as fast as you can.

    • Find a trusted adult at once.

    • Call 911—it can save a life.

    You can Help Keep the Peace

    Do not watch or encourage the fight. Get help.

    Supporting the fight with yelling, teasing, cheering and pushing only makes things worse. Get help from an adult. But first, tell someone that this is what you are doing.

    If you feel safe, say in a clear, firm voice, “Stop!”

    Let the fighters and those watching know that besides getting hurt, there is a chance of:

    • Getting kicked out of school

    • Being thrown off the team

    • Having the whole group punished

    • Getting grounded

    • Being arrested

    Getting help is not tattling.

    You are not trying to get anyone in trouble. You are trying to stop someone from getting hurt.

    • If you hear that someone is planning to harm someone else, tell an adult.

    • If someone is threatening you or someone else, ask an adult for help.

    Stand up for those who are being bullied.

    This takes a lot of courage. Try to get others to help. Together you can make a difference.

    Get to know the person being picked on.

    When the victim is not your friend or is unpopular, it's just as important to care about what happens. You may be able to help this person become more involved with school activities.

    Help your friends learn how to settle arguments and conflicts without fighting.

    Share what you know about not getting into fights.

    Learn the truth about weapons.

    A gun or other weapon does NOT make anyone safer. It only means that someone may be seriously hurt or killed.

    Learn how to stay cool before things heat up!

    Talk with friends and understanding adults about what to do before something happens. By talking about it now, you will know what to say and do in the future. Think about what you would do if:

    • You are challenged to a fight and your friends want you to fight back.

    • A friend of yours is being picked on and asks for your help.

    • You know that some kids are taking knives to school.

    • You hear about plans to “jump” someone.

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    Talking With Your Teen: Tips for Parents

    Be an Involved Parent

    • Show interest in your teenager's activities and friends.

    • Talk openly, honestly, and respectfully with your teenager.

    • Set clear limits and expectations.

    • Know what's going on at school and after school.

    • Teach your teenager how to safely avoid violence.

    Teenagers are no longer children, but they are not yet adults. While teenagers are developing more independent thoughts, feelings, and values, it is only natural for them to question their parents' rules, beliefs, and expectations. During this time of change, parents often worry about their teenager's safety.

    Encourage independence while teaching safety.

    As teenagers are testing their new independent roles, it's not an easy time for parents. But if teens don't get love, security, and a feeling of safety from their family, they might look elsewhere, even toward friends who are a bad influence, such as gang members. One of the best ways parents can help their teenagers stay safe is to teach them how to avoid violence.

    Talking with your teen is one of the most important things you can do to help keep your child safe.

    Know What's Going on

    It's important to understand some of the typical behaviors and feelings of teenagers, even if your teenager thinks you don't!

    Teens are very interested in:

    • New ways of doing things.

    • The present, with little interest in the future. With maturity, the future becomes more important.

    Teens often:

    • Feel awkward and believe they don't fit in.

    • Behave childishly when stressed.

    Teens want:

    • Role models for themselves.

    • To be capable and needed.

    Set Clear Limits and Expectations

    Talk about limits to which you can both agree:

    • Homework completion and school progress

    • How many nights out each week, and how late

    • After-school activities or jobs

    • Allowance or money

    • Safety in and around motor vehicles

    Clearly communicate any change in the original limits.

    You have specific reasons for deciding to change what was agreed to. You aren't simply giving up because your teen didn't follow the rules.

    Positive Communication

    Good communication—talking and listening—with your teenager may be the most important part of your relationship.

    Since teens are forming their own identity and testing limits, some conversations may lead to disagreements and become uncomfortable. Your goal is to have open, respectful, and honest conversations. Teens need to feel loved and that their point of view is respected, even when you disagree.

    Positive communication gives teenagers a chance to:

    • Learn how to talk honestly and respectfully with others, even when they disagree.

    • Feel more confident in discussing their needs and feelings.

    • Know that a positive attitude can keep them safe and out of fights.

    Make a habit of talking about whatever makes your teen happy.

    No matter what your teen's interest—sports, music, clothing, TV, video games, friends, school—ask questions and learn what's going on.

    Try to eat together whenever possible.

    Mealtimes are good times to talk and listen.

    Answer questions directly and honestly.

    If you have made a mistake, admit it.

    “I'm sorry” are very powerful words for a teenager to hear from parents.

    Notice your teen's feelings.

    “You seem upset about your relationship with

    Be aware of your own reactions and emotions.

    Teenagers are great at saying or doing things that annoy their parents. Take time to think about your responses and decisions to your teen's requests.

    Offer your opinion without lecturing or judging.

    Know that you may hear something with which you disagree. Avoid statements like, “That's stupid.” or “You're wrong.” Try saying, “I hear you, but this is how I see it…”

    Give all of your attention.

    If the phone rings, don't answer it. It also is difficult to talk while doing other things, like watching TV.

    Offer assistance.

    “Is there something I can do to help?”

    When Talking is Difficult

    Yelling, threatening, blaming, and name-calling can only make matters worse. Sometimes teens just don't want to talk with their parents.

    Consider helping your teen find other caring adults who share your values. It may be easier to hear advice from one of these other adults.

    Keeping Your Teen Safe

    Know where your child is after school.

    The most common time for teenagers to get into trouble is between 2:00 and 6:00 pm. If not supervised, this is often when teens fight, use drugs, and have sex.

    Talk with your child about carrying a weapon.

    Carrying a weapon makes people feel bold, leading to foolish behaviors. Carrying a weapon gives a false sense of protection and makes your teen less safe.

    Teach your child that it takes more courage to walk away from a fight than to fight.

    Most young people hurt in fights have been fighting with someone they know. Teach your child how to resolve problems without fighting. Your example is the best way for your child to learn this.

    Let your teen know that it is more important to know how to walk away from a fight than how to win one, and that it is possible to stand up for yourself without fighting.

    If Your Teen Gets into a Fight

    Often teenagers who get into a fight are just in the wrong place at the wrong time. Sometimes fighting is the only choice they know.

    Talk about what happened:

    • Find out what caused the fight. This helps avoid future fights. Did it start with an argument? An insult? Was it revenge? Did it result from being robbed? Getting jumped?

    • Listen to the whole story. Try not to interrupt, scold, judge, or problem solve. Just listen.

    • Being hurt in a fight can be scary and embarrassing. It's important to pay attention to your teen's feelings.

    Find out if the fight is over:

    • Help resolve the problem. “Are you still afraid? Are you thinking of getting even? Do you think the other person is looking for revenge?”

    • Involve your teen in finding a solution. “What else could you have done besides fight? Is there someone else who can help you and find a solution to this problem?”

    Develop a safety plan for the future:

    • Change routes to avoid known threats. “Is there another way that you can get home? Can you leave home or school at a different time? Try not to travel alone.”

    • Guard against robbery. “Always know what's going on around you, especially if you are wearing new clothes or flashy jewelry. It may be better to just hand it over. Things can be replaced; you can't.”

    • Seek a safe place when being followed. “Walk or run into a store, police or fire station, or any other public building. Tell them it's an emergency and ask to use the phone to call for a ride. Or, go to a friend's home and get inside quickly.”

    When your Teen May Need Help

    Your teen may need help if you notice any of the following warning signs:

    • Not talking, or a change in communication style

    • Feeling down most of the time—losing interest in friends or activities

    • Change in school performance, skipping school, or maybe even dropping out

    • Trouble with the law

    If you or your teenager needs help, please contact your pediatrician.

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    Tantrums - Preparation is critical

    Our daughter used to have tantrums whenever we would get to the checkout counter at the store because she wanted a treat. We learned to prepare her by telling her in the car as we approached the store: "Mommy is going to buy some good food and a treat when we go to the store. If there is no crying at the checkout, we'll eat that treat when we get home."

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    Tattooing and Body Piercing

    Are you thinking about getting a tattoo or body piercing?

    Teens get tattoos or body parts pierced for different reasons.Most teens get a tattoo or body piercing because they like the way it looks or to express themselves. Some get a tattoo or piercing to feel like part of a group. In some states and cities, you need to be 18 or have a parent's permission to get a piercing or tattoo.

    Before you decide, you should know about the possible health risks. And if you do decide to get a tattoo or body piercing, it's important that it's done safely.

    How it's done


    Ink is injected into the skin with a tattoo machine. Attached to the machine is a bar with needles that move up and down inside a tube, vibrating 50 to 3,000 times a minute. Because the skin is punctured, there's usually a lot of bleeding and the machine must be stopped often to wipe away the blood. It can take from 15 minutes to several sessions to get a tattoo depending on the size and detail of the tattoo. Most people say it hurts to get a tattoo.

    Body piercing.

    A hole is made in the skin with a hollow needle. The body jewelry is then inserted into the hole. The jewelry should be made ofsurgical stainless steel, solid 14- or 18-karat gold, niobium, or titanium. It shouldn't contain nickel because it's known to cause allergic reactions. Also, jewelry should be the right fit for the body part pierced. For example, a tongue barbell should be long enough because the tongue will swell. Piercing guns shouldn't be used because they can't be properly sterilized.

    Getting it done safely

    You'll want a professional tattoo or body-piercing artist to do the work. And you'll want an artist who does good work and does it safely, so shop around and ask for references. Never tattoo or pierce yourself or a friend.

    If you're younger than 18, beware of a tattoo or piercing parlor that is willing to bend the rules about age.

    Safety rules should always be followed, including the following:

    • • A tattoo or piercing parlor should be as clean as a dentist's office! The work area should be clean and have good lighting.

    • • Equipment should be sterilized using a heated machine called an autoclave.

    • • The artist should wash and dry his hands and wear a new pair of gloves.

    • • New needles should be used. They should be sterilized needles and disposable. You should be able to watch the artist open the package in front of you.

    • • New ink should be used. Extra ink should never be poured back into the bottle and reused.

    Caring for your tattoo

    You need to take special care of your new tattoo in order for the dye and design to stay in place. Here are ways to care for your tattoo

    • • Keep the bandage on for 12 to 24 hours then wash with soap and warm water. All the blood and soap should be rinsed off.

    • • Apply an antibiotic ointment or fragrance-free lotion 3 times a day for a week.

    • • Don't use petroleum jelly, rubbing alcohol, or peroxide.

    • • Don't allow the tattoo to dry out or expose it to direct sunlight for 2 weeks.

    • • Avoid swimming, hot tubs, and long baths for several weeks.

    Caring for your piercing

    • • Always wash your hands before touching or cleaning the pierced area. Try not to touch the jewelry too often to prevent infection.

    • • You will need to clean your new piercing at least 2 times a day to help it heal. There may be some redness or discharge for a few days. Use an antibacterial soap, especially for areas exposed to sweat. Don't use alcohol or peroxide because they will dry out your skin. Also, using iodine solution can discolor gold jewelry.

    • • Pierced eyebrow—If you wear glasses, keep your glasses clean.

    • • Pierced navel—Wear clean and loose-fitting clothing. Avoid hot tubs until the piercing heals.

    • • Pierced tongue—Rinse with antibacterial mouthwash that doesn't contain alcohol. Check the jewelry 2 times a day to make sure the ends are tight so it doesn't fall out in your mouth.

    Body part How long it may take to heal
    Ear cartilage 2 months–1 year
    Earlobe 4–6 weeks
    Eyebrow 6–8 weeks
    Genital 2–6 months
    Lip and cheek 2–6 months
    Navel 6 months–1 year
    Nipple 2–6 months
    Nostril 2–4 months
    Tongue 4–6 weeks

    What could go wrong?

    The following are risks of tattooing and body piercing:

    • • Scars, including large keloids (hard scars), especially with ears

    • • Bacterial skin infections

    • • Allergic reactions to dyes and metals (The pigments typically used in the dyes aren't regulated by the government.)

    • • Hepatitis B and C, HIV/AIDS, and tetanus (Hepatitis B and tetanus vaccines are available to help reduce your risk.)

    • • Bleeding

    • • Torn skin, like a ripped earlobe (Visible jewelry, including tongue studs, should be removed before you participate in sports to avoid injury.)

    • • Chipping of teeth and speech problems caused by tongue and lip rings

    Also, if you are unhappy with your tattoo once you have gotten it or later regret getting a tattoo, it can be a painful process and cost thousands of dollars to remove it.

    When to call your pediatrician

    If you have any of the following symptoms, let your pediatrician know:

    • • Redness, warmth, tenderness, or swelling that is excessive or that lasts longer than a few days

    • • Yellow or green discharge or pus

    • • Oozing or bleeding that lasts longer than several days

    The persons whose photographs are depicted in this publication are professional models. They have no relation to the issues discussed. Any characters they are portraying are fictional.

    The AAP Section on Dermatology and Committee on Adolescence would like to thank the AAP NY Chapter 2 for their assistance in developing this publication.

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    Teen Dating Violence: Tips for Parents

    Parents Need to Know What's Going on

    • Learn the myths and facts about dating violence.

    • Some teens who are abused don't talk about it.

    • There are warning signs of abuse.

    • Teach your teenager that respect is the most important thing in a dating relationship.

    • Learn how to talk with your child about dating violence.

    Romantic and sexual feelings develop during the teen years. Teenagers are starting to date and experiment with different types of relationships. It is fun and exciting to meet someone new, and sad and difficult to break up.

    As a parent, you can help your teenager make good decisions about dating. With guidance and support, teens can learn about healthy relationships and get the strength and courage needed to leave those that are not.

    There is no place for verbal or physical abuse in a healthy and respectful relationship.

    Myths and Facts

    MYTH : “Teen dating violence is just another way of saying rape.”

    FACT : Abuse comes in many forms. Besides sexual violence, it also includes:

    • Yelling, swearing, put-downs, and threats

    • Being pushed around or hit

    • Controlling, bossy, and bullying behavior

    MYTH: “Oh, it's not that common.”


    • More than 1 in 10 teenagers experience physical violence in a dating relationship.

    • When threats and emotional abuse are included, it's even higher.

    MYTH: “It only happens to kids from bad homes.”


    Dating violence is not limited to families with a history of violence. It happens to teens from families of all cultures, income levels, and educational backgrounds.

    MYTH: “It can't happen to my child.”


    • Boys, as well as girls, can be victims of dating violence.

    • It can happen in any type of relationship—straight, gay, or lesbian.

    • It can occur at any time in a relationship—those just starting or ones that have been going on for a while.

    Why Teens are Silent

    There are many reasons why teens don't tell their parents or friends about the violence they are experiencing. They may:

    • Feel embarrassed, ashamed, or afraid of getting hurt.

    • Be convinced it is their fault and do not know that it is abuse.

    • Feel afraid they will be forced to break up or of losing privileges.

    • Feel certain that being in a relationship is the most important thing in their life.

    • Confuse jealousy with love, and think this is how it should be.

    • Be afraid of losing friends. They may think friends would not believe this is happening, and they may feel alone after having lost touch with friends.

    • Know the abuser will act nice some of the time, and they are happy when this happens.

    • Feel hopeful that things will get better and convinced that they can help or change their partner.

    Warning Signs of Abuse

    Some of the following may be just part of being a teenager. But, when these changes happen suddenly or without explanation, there is cause for concern.


    • Failing grades

    • Dropping out of school or school activities


    • Difficulty making decisions

    • Changes in personality, becoming anxious or depressed

    • Acting out or being secretive

    • Avoiding eye contact

    • Having “crying jags” or getting “hysterical”

    • Constantly thinking about dating partner

    Physical appearance

    • Bruises, scratches, or other injuries

    • Sudden changes in clothes or make-up


    • Avoiding friends or changing peer groups

    • Giving up activities, interests, or family time that previously had been important

    • Changes in eating or sleeping habits

    • Using alcohol, tobacco, or other drugs


    • Some teenagers believe that having a baby will help make things better.

    • Some girls are forced to have sex.

    Abusive Behavior

    It is important for you to recognize signs of an abusive relationship.

    • Wanting to get serious quickly and refusing to take NO for an answer

    • Acting jealous and possessive and wanting to pick partner's friends and activities

    • Being controlling and bossy and making all the decisions, not taking opinions of others seriously, and always checking up on partner

    • Using threats and “put-downs” when alone or with friends

    • Using guilt trips like, “If you really loved me, you would .”

    • Blaming the victim for what is wrong, like saying, “It's because of you that I get so mad.”

    • Apologizing or giving excuses for violent behavior like, “I promise I’ll never do it again,” or “I was drinking and just didn’t know that I .”

    Your child needs help in either case—victim or abuser

    Tips for Parents

    Talk about healthy dating relationships and possible problems.

    It is never too early or too late to teach about respect. Respect for self and others is important in any relationship.

    If you think your teenager already may be involved with an abusive partner:

    • Give your teen a chance to talk. Listen quietly to the whole story.

    • Tell your child that you are there to help, not to judge.

    • If your teen does not want to talk with you, help find another trusted person for your child to talk with.

    • Focus on your child's safety and self-esteem. Point out how unhappy your teenager seems to be while with this person and the possibility of danger or harm. Do not “put down” the abusive partner.

    • Let your child know that abuse always gets worse. What may start as minor verbal or physical abuse is very likely to get worse if not stopped immediately.

    If your teenager tries to break up with an abusive partner:

    • Advise that the breakup be definite and final.

    • Develop a safety plan with your teen ahead of time.

    • Support your teenager's decision and be ready to help.

    • Make sure your teen takes all necessary safety measures.

      • Avoid walking or riding alone, and always travel with another friend.

      • Consider changing class schedules.

      • Get help from the guidance counselor, school principal, or if necessary, the police.

    What you can say

    It is important for your teen to talk about dating violence, either with you or with another trusted adult. Many people who have been victims of dating violence have been able to change their lives after they began talking with others.

    • “I care about what happens to you. I love you and I want to help.”

    • “If you feel afraid, it may be abuse. Sometimes people act in ways that are scary and make you feel threatened, even without using physical violence. Pay attention to what you are feeling.”

    • “No one has the right to hit you. No one has the right to control you or what you do.”

    • “The abuse is not your fault. You are not to blame, no matter how guilty _____ is trying to make you feel. This should not be happening to you.”

    • “It _____ is who has a problem, not you. It is not your responsibility to help _____ change.”

      Ask for teen dating violence prevention and intervention programs at your teenager's school or through religious or other community groups.

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    Teen Suicide and Guns

    Protect your Teenager

    • Many teens attempt suicide on impulse, and there's no second chance with a gun.

    • Counting on a teen's ability to resist strong emotional impulses when there is a gun is not a good idea.

    • Young people need safe environments that protect them from deadly harm.

    Many teens who attempt suicide do so because of a temporary problem, like the end of a romance. When guns are involved, teens can waste their lives and destroy the happiness of their friends and families in an instant. They are thinking of a passing problem, not the outcome!

    Teen Suicide—A Big Problem

    • Suicide is one of the 3 leading causes of death for 13- to 19-year-olds in the United States.

    • An average of 4 American teenagers commit suicide every day.

    Does a gun in the home increase the chance of suicide? YES!

    • In states where there are more guns, more people commit suicide.

    • Studies have shown that the risk of suicide is 4 to 10 times higher in homes with guns than in those without.

    • If the gun is a handgun or is stored loaded or unlocked, the risk of suicide is even higher.

    Does it matter how a person tries to commit suicide? YES!

    • Suicide attempts with a gun are very likely to be deadly.

    • Suicide attempts with drugs or methods other than guns have a greater chance of survival.

    Protect Young People from Killing Themselves

    Teens often see any change as a major life event. Adults and teens need to talk about things, like budding sexuality and taking responsibility for one's own actions, as they occur.

    It is best to not have any guns in homes where children or teenagers live.

    If there is a gun:

    • Keep it unloaded and locked up or with a trigger lock. Store the bullets in a different place that is also locked.

    • Do not let teens have a key to the places where guns and bullets are stored.

    • If a teen becomes depressed or has severe mood swings, store the gun outside the home for the time being.

    Many communities have laws that prevent teenagers from getting their own weapons.

    Find out what the laws are in your community and ask that they be enforced.

    Most young survivors of a serious suicide attempt do not commit suicide later, and most survivors of suicide attempts are glad they were saved.

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    Teen Suicide, Mood Disorder, and Depression: What Parents Need to Know

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    Teeth, Brushing of

    Have your child stand on a step stool in front of the mirror so she can see herself. Give her your toothbrush, while you hold hers. Then, tell her that she gets to brush your teeth, while you brush hers. Stand over her, bending forward with your mouth open, and instruct her to start brushing your teeth. Because she is so busy brushing your teeth, she is pretty much unaware of the thorough job you can do on her teeth. You also get a good view of the backsides of her lower central teeth, where plaque build-up is usually the greatest. Kathleen Traylor, M.D.

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    Teething is the cause of occasional worry by parents, occasional fussiness by infants, and just plain curiosity by both! The general guidelines for incoming teeth are as follows: Central incisors usually come in around 6 months of age, lateral incisors around 8 months of age, first molars around 14 months of age, canines around 19 months of age, and second molars around 24 months of age. By 2 1/2 years of age, children should have 20 teeth. Remember to brush them daily! These 20 teeth remain until school age; then, the baby teeth will start to fall out and be replaced by the permanent teeth. Children should start seeing the dentist regularly around 3 years of age.

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    Temper Tantrums

    It's hard for a young child to hold strong feelings inside. Young children often cry, scream, or stomp up and down when they are upset. As a parent, you may feel angry, helpless, or ashamed.

    Temper tantrums are normal. They are one way a child learns self-control. Almost all children have tantrums between the ages of 1 and 3. By age 4, they usually stop.

    What to Do for a Temper Tantrum

    Try these tips when your child has a temper tantrum:

    • Try to stay calm. If you can't stay calm, leave the room. Wait a minute or two before coming back, or wait until the crying stops.

    • Distract your child. Point out something else to do, like read a book or play with a toy. Say something like, “Look at what the kitty is doing”

    • Let your child cool off or have a “time-out.” Take your child away from the problem. Give your child some time alone to calm down. Try 1 minute of time-out for every year of your child's age. (For example, a 4-year-old would get a 4-minute time-out.) Don't use time-out too much or it won't work.

    • Be ready to take your child home if your child has a “public” tantrum. The best way of stopping “public” tantrums is to take your child home or to the car.

    • Ignore your child's crying, screaming, or kicking if you can. Stand nearby or hold your child without talking until your child calms down. The more attention you give a tantrum, the more likely it is to happen again.

    The following things are not OK. Don't ignore these actions:

    • Hitting or kicking people

    • Throwing things that might hurt someone or break something

    • Yelling for a long time

    If your child does these things, take him or her away from the problem. Hold your child. Say firmly, “No hitting” or “No throwing” to make sure your child knows what behavior is not OK.

    What Not to Do

    Never punish your child for temper tantrums. Your child may start to keep feelings inside, which is worse.

    Don't give in to your child's demands just to stop a tantrum. This teaches that a temper tantrum will help your child get his or her way. Tantrums are more likely to stop if your child doesn't gain anything from them.

    Don't talk too much to your child during the tantrum. It is hard to reason with a screaming child. When your child calms down, talk about better ways to deal with anger and frustration.

    What to Expect

    Your child should have fewer temper tantrums by age 31/2. Between tantrums, he or she should seem normal and healthy. Every child grows and learns at his or her own pace. It may take time to learn how to control his or her temper.

    A Word About Safety

    Sometimes you have to say “no” to protect your child from harm. This is a common cause of a tantrum. So, what can you do?

    • Childproof your home as much as you can.

    • Make dangerous places and things off-limits.

    • Keep an eye on your child at all times. Never leave small children alone, especially if there may be danger.

    • Take away anything dangerous right away. Give your child something safe in its place.

    • Be clear and firm about safety rules.

    Call the Doctor If…

    …your child shows any of these signs:

    • Hurts himself or herself or others during tantrums

    • Holds his or her breath and faints

    • The tantrums get worse after age 4

    • Has lots of other behavior problems

    When tantrums are bad or happen often, they may be a sign of emotional problems. Your child's doctor can help you find out what is behind the tantrums. The doctor can also give you advice on dealing with them.

    How to Help Prevent Temper Tantrums

    You can't prevent all tantrums, but these ideas may help:

    • Make sure you give your child enough attention. Children try to get attention in many ways. If being good doesn't do it, they may try being bad. To children, even “negative” attention (when you are upset) is better than none at all. So notice your child being good and reward the behavior.

    • Set limits that make sense. Give simple reasons for the rules you set, and don't change the rules.

    • Keep a daily routine as much as you can. This helps your child know what to expect.

    • Let your child make choices whenever you can. For example, “Do you want apple juice or orange juice?” Or let's say your child doesn't want to take a bath. Make it clear that he or she will be taking a bath. But offer a real choice he or she can make. Try saying, “It's time for your bath. Would you like to walk or have me carry you?”

    • Try not to say “no” too much. Choose your battles. Children need to have some feeling of control.

    • Give your child a few minutes’ warning before changing activities. This helps children get ready for a change.

    • Ask your child to use words to tell you how he or she is feeling. Suggest words he or she can use to describe those feelings. For example, “I'm really mad.”

    • Be ready with healthy snacks when your child gets hungry.

    • Make sure your child gets enough rest.

    • Set a good example. Try not to argue or yell in front of your child.

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    Temper Tantrums: A Normal Part of Growing Up

    It’s hard for young children to hold strong feelings inside. When they feel frustrated or angry, they often cry, scream, or stomp up and down. This is a temper tantrum.

    Temper tantrums are a normal part of your ­children’s development. They usually begin around 12 to 18 months of age, get worse between 2 and 3 years, and taper off after that, once children are able to use words to communicate their wants and needs.

    Here is information from the American Academy of Pediatrics to help parents understand temper tantrums and how best to deal with them.

    Why do children have temper tantrums?

    During the toddler years, there is a change in how children process information. They suddenly become more aware that their world can change. They realize they won’t always get what they expect or want. Their young minds are easily overwhelmed, and they don’t know how to cope with change or how to deal with not getting their way.

    A lot of things can trigger a tantrum. For example, children may have a temper tantrum because they

    • Do not understand what you are saying or asking

    • Are upset when others cannot understand them

    • Do not know how to tell you how they feel or what they need

    • Do not know how to solve problems on their own

    • Have an illness or other problem that keeps them from expressing how they feel

    • Are hungry

    • Are tired

    • Are anxious or uncomfortable

    • Are reacting to stress or changes at home

    • Are jealous, want what other children have, or want the attention others receive

    • Are not be able to do as much as they think they can, such as walking, running, climbing, drawing, or making toys work

    How to prevent temper tantrums

    Temper tantrums are a normal part of growing up, but you may be able to prevent some from happening.

    What you can do

    • Encourage your children to use words to tell you how they are feeling. Try to suggest words they can use to describe their feelings.

    • Set reasonable limits, and don’t expect your children to be perfect. Give simple reasons for the rules, and don’t change them.

    • Keep to a daily routine as much as possible so your children know what to expect.

    • Distract your children. Try a new game, book, or toy. Sometimes a change in location can prevent a tantrum. For example, if you are indoors, go outside to look for birds in the sky.

    • Avoid situations that frustrate your children, such as playing with toys that are too advanced.

    • Avoid long outings during which your children have to sit still or cannot play. If you have to take a trip, bring along a favorite book or toy.

    • Have healthy snacks ready for when your children get hungry.

    • Make sure your children are well rested.

    • Be choosy about saying no. When you say no to everything, it can frustrate your children. Consider saying yes sometimes. Of course, if your children’s safety is at stake, don’t say yes just to avoid a tantrum. Praise your children when they do something good that otherwise might have led to frustration.

    • Give choices. For example, make it clear that while they have to take a bath, they can make some choices on their own. Try saying, “It’s time for your bath. Would you like to walk upstairs or have me carry you?” Be sure the choices you offer are also acceptable to you.

    • Set a good example. Avoid arguing or yelling in front of your children.

    How to handle tantrums

    What you can do

    • Let the tantrum end itself. Once children begin a tantrum, only they can end it. Allow them the time and space to be left alone (in a safe place) to let the tantrum run its course. All tantrums end, almost always by a child’s path to resolution. Trying to end one early usually delays the child’s resolution.

    • Try to stay calm. If you shout or get angry, it can make things worse. If you can’t stay calm, leave the room. Wait a minute or two, or until the crying stops, before returning.

    • Offer a cooling down time. During a tantrum, it’s helpful for parents to let children not only manage their tantrum but also know there is a safe place and safe time for them to do so. It can be called a cooling-down time and place or a time-out.

    • Ignore minor displays of anger, such as crying, screaming, or kicking. Try touching or holding your children to calm them. Or, try standing nearby without talking until they calm down. If your children have tantrums in a public place, take them home or to the car.

    Some behaviors arenot OK and should not be ignored, such as

    • Hitting or kicking people

    • Throwing things that might hurt someone or break something

    • Screaming or yelling for a long time

    If these things happen, take your children away from the problem. Say firmly, “No hitting,” or “No throwing,” to make sure your children know these behaviors are not OK.

    What not to do

    • Never punish your children for temper tantrums. They may start to keep their anger or frustration inside, which can be unhealthy. Keep in mind that as your children grow, they will learn to deal with their strong emotions.

    • Do not give in to your children just to stop a tantrum. This teaches your children that temper tantrums get them what they want. Also, don’t feel guilty about saying no to your children. Set the rules and stick with them. When parents change the rules, it is harder for children to understand which rules are firm and which ones are not. Discuss with those who care for your children which rules are really needed and how to be firm about them.

    When temper tantrums are serious

    Your children should have fewer temper tantrums by 3½ years of age. Between tantrums, their behavior should seem normal and healthy. If the outbursts are severe or happen too often, they may be an early sign of emotional problems. Talk with your children’s doctor if your children seem to have difficulty expressing themselves with words (compared with other children the same age), cause harm to themselves or others, or hold their breath and faint, or if tantrums get worse after 4 years of age. Your children’s doctor will make sure no physical or emotional problems are causing the tantrums. He or she can also give you advice to help you deal with these outbursts.

    It is important to realize that temper tantrums are a normal part of growing up. While tantrums are not always easy to deal with, a loving and understanding approach will help you and your children get through them.

    Breath-holding spells

    Some children, when upset and crying very hard, hold their breath after taking a big breath. They can even hold their breath to the point of passing out. It is not done on purpose but may happen when children are upset, such as during a temper tantrum. While these episodes can be scary for parents, rest assured that they are usually harmless and your children will grow out of them. If you are concerned about your children’s behavior, talk with your children’s doctor.

    Keeping your children safe

    Many times you will have to tell your children no to protect them from harm or injury. For example, the kitchen and bathroom can be dangerous places for your children. They may not understand why you will not let them play there. This can cause a tantrum. However, it’s more important to keep your children safe.

    Childproof your home, and make dangerous areas or objects off-limits. Keep an eye on your children at all times. Never leave them alone in a situation that could be hazardous. Take away dangerous objects and replace them with something safe. It is up to you to keep your children safe.

    The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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    Thumbs, Fingers, and Pacifiers

    All babies are born with the need to suck. This is important because babies need the sucking reflex to eat and drink. Sucking for some babies also can have a soothing and calming effect. However, when does sucking become a problem? Read on for information from the American Academy of Pediatrics about pacifiers, when pacifier use and thumb and finger sucking could become a problem, and how to help your child stop pacifier use or thumb or finger sucking.

    What do I need to know before offering a pacifier?

    If your baby wants to suck beyond what nursing or bottle-feeding provides, a pacifier may satisfy that need. Before offering a pacifier, keep the following tips in mind:

    • Offer a pacifier at nap time and bedtime. This helps to reduce the risk of sudden infant death syndrome (SIDS). If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes about 3 to 4 weeks.

    • Do not use a pacifier to replace or delay meals. Only offer it when you are sure your baby is not hungry.

    • Do not force your baby to take the pacifier if he doesn't want it.

    • Never tie a pacifier to your child's crib or around your child's neck or hand. This is very dangerous and could cause serious injury or even death.

    • Be prepared for night waking. If your child depends on a pacifier to fall asleep at night, he may wake up when the pacifier falls out. If you child is too young to put it back in his mouth or can't find or reach it if it has fallen out of the crib, you may need to wake up and get it for him.

    What should I keep in mind when shopping for a pacifier?

    • Pacifiers come in different sizes. You will also find a variety of nipple shapes, from squarish "orthodontic" versions to the standard bottle type. Try different kinds until you find the one your baby prefers.

    • Look for a 1-piece model that has a soft nipple (some models can break into 2 pieces).

    • The shield should be at least 11/2 inches across so a baby cannot put the entire paci­fier into her mouth. Also, the shield should be made of firm plastic with airholes.

    • Make sure the pacifier is dishwasher-safe. Follow the instructions on the pacifier and boil it or run it through the dishwasher before your baby uses it. Be sure to squeeze the water out of the nipple with clean hands; otherwise, the hot water inside might burn your baby's mouth. Clean it this way frequently until your baby is 6 months old so that your infant is not exposed to germs. After that you can just wash it with soap and rinse it in clear water.

    • Buy some extras. Pacifiers have a way of getting lost or falling on the floor or street when you need them most.

    • Do not use the nipple from a baby bottle as a pacifier. If the baby sucks hard, the nipple may pop out of the ring and choke her.

    • Pacifiers fall apart over time. Some manufacturers have expiration dates for pacifiers. Do not keep pacifiers past that time. Inspect them every once in a while to see whether the rubber has changed color or has torn. If so, replace them.

    When do pacifier use and thumb and finger sucking become a problem?

    If your child sucks strongly on a pacifier or his thumb or fingers beyond 2 to 4 years of age, this behavior may affect the shape of his mouth or how his teeth are lining up. If your child stops sucking on a pacifier or his thumb or fingers before his permanent front teeth come in, there's a good chance his bite will correct itself. However, if the bite does not correct itself and the upper adult teeth are sticking out, orthodontic treatment may be needed to realign the teeth and help prevent broken front teeth.

    How can I help my child stop her pacifier use or thumb- or finger-sucking habit?

    As a first step in dealing with your child's sucking habits, ignore them! Most often, they will stop on their own. Harsh words, teasing, or punishment may upset your child and is not an effective way to get rid of habits. Instead, try the following:

    • Praise and reward your child when she does not suck her thumb or use the pacifier. Star charts, daily rewards, and gentle reminders, especially during the day, are also very helpful.

    • If your child uses sucking to relieve boredom, keep her hands busy or distract her with things she finds fun.

    • If you see changes in the roof of your child's mouth (palate) or in the way the teeth are lining up, talk with your pediatrician or pediatric dentist. There are devices that can be put in the mouth that make it uncomfortable to suck on a finger or thumb.

    • No matter what method you try, be sure to explain it to your child. If it makes your child afraid or tense, stop it at once.

    The good news is that most children stop their sucking habits before they get very far in school. This is because of peer pressure. While your child might still use sucking as a way of going to sleep or calming down when upset, this is usually done in private and is not harmful. Putting too much pressure on your child to stop may cause more harm than good. Be assured your child will eventually stop the habit on her own.

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    Tips for Parents of Adolescents

    Adolescence is the time between childhood and adulthood when your daughter or son will go through many physical and emotional changes. It begins with puberty which, for girls, usually starts between 8 and 13 years of age, and for boys, between 10 to 14 years of age.

    Though these years can be difficult, it can also be a rewarding time watching your teen make the transition into an independent, caring, and responsible adult.

    The American Academy of Pediatrics offers the following tips to help you and your teen navigate adolescence. Teen will be the term used in this publication when referring to adolescent, teenager, preteen, and tween.

    • Spend family time with your teen. Although many teens may seem more interested in friends, this does not mean they are not interested in family.

    • Spend time alone with your teen. Even if your teen does not want time alone with you, remind him or her often that you are always available to listen or talk. One way to make yourself available is to offer rides; a great opportunity to talk (if the radio isn't too loud).

    • When your teen talks

      • —Pay attention.

      • —Watch, as well as listen.

      • —Try not to interrupt.

      • —Ask for further details if you don't understand.

      • —If you don't have time to listen, set a time that will be good for both of you.

    • Respect your teen. It's OK to disagree with your teen, but disagree respectfully, not insultingly. Don't dismiss his or her feelings or opinions as silly or senseless. You may not always be able to help when your teen is upset about something, but it is important to say, "I want to understand," or "Help me understand."

    • When rules are needed, set and enforce them. Don't be afraid to be unpopular for a day or two. Believe it or not, teens see setting limits as a form of caring.

    • Try not to get upset if your teen makes mistakes. This will help your teen take responsibility for his or her actions. Remem­ber to offer guidance when necessary. Direct the discussion toward solutions. For example, saying, "I get upset when I find clothes all over the floor," is much better than, "You're a slob."

      Be willing to negotiate and compromise. This will teach problem solving in a healthy way. Remember to choose your battles. Let go of the little things that may not be worth a big fight.

    • Criticize a behavior, not an attitude. For example, instead of saying, "You're late. That's so irresponsible. And I don't like your attitude," try saying, "I worry about your safety when you're late. I trust you, but when I don't hear from you and don't know where you are, I wonder whether something bad has happened to you. What can we do together to help you get home on time and make sure I know where you are or when you're going to be late?"

    • Mix criticism with praise. Your teen needs to know how you feel when he or she is not doing what you want him or her to do. Be sure to mix in positive feedback with this criticism. For example, "I'm proud that you are able to hold a job and get your homework done. I would like to see you use some of that energy to help do the dishes after meals."

    • Let your teen be a teen. Give your teen some leeway with regard to clothes, hairstyle, etc. Many teens go through a rebellious period in which they want to express themselves in ways that are different from their parents. However, be aware of the messages and ratings of the music, movies, and video games to which your teen is exposed.

    • Be a parent first, not a friend. Your teen's separation from you as a parent is a normal part of development. Don't take it personally.

    • Don't be afraid to share mistakes you've made as a parent or as a teen.

    • Talk with your teen's pediatrician if you need advice on how to talk with or get along with your teen.

    Common questions

    The following are answers to questions from parents of teens.

    Dieting and body image

    "My daughter is always trying new diets. How can I help her lose weight safely?"

    Many teens resort to extreme diet or exercise programs because they want their bodies to look like the models, singers, actors, or athletes they see in the media.

    Be aware of any diet or exercise program your daughter is following. Be watchful of how much weight she loses and make sure the diet program is healthy. Eating disorders such as anorexia nervosa and bulimia nervosa can be very dangerous. If you suspect your daughter has an eating disorder, talk with her doctor right away. Also, if you have a son, it's important to be aware of his diet or exercise habits too.

    Many diets are unhealthy for teens because they do not have the nutritional value that bodies need during puberty. If your daughter wants to lose weight, urge her to increase physical activity and to take weight off slowly. Let her eat according to her own appetite, but make sure she gets enough fats, carbohydrates, protein, and calcium.

    If your daughter decides to become a vegetarian, make certain she follows a healthy vegetarian diet. She may need to see her doctor or a nutritionist to ensure that she is getting enough fat, calories, protein, and calcium.

    If your teen (like many teens) is unhappy with the way she looks, encourage healthy exercise. Physical activity will help stop hunger pangs, create a positive self-image, and take away the "blahs." If she wants to train with weights, she should check with her doctor, as well as a trainer, coach, or physical education teacher.

    Help create a positive self-image by praising her wonderful qualities and focusing less on her appearance. Set a good example by making exercise and eating right a part of your daily routine also.

    Tips for a healthy diet

    • Limit fast-food meals. Discuss the options available at fast-food restaurants and help your teen find a healthy, balanced diet. Fat should not come from junk food but from healthier foods such as low-fat cheese or low-fat yogurt.

    • Keep the household supply of junk food such as candy, cookies, and potato chips to a minimum.

    • Stock up on low-fat healthy items for snacking such as fruit, raw vegetables, whole-grain crackers, and low-fat yogurt. Encourage eating fruits and vegetables as snacks.

    • Check with your teen's doctor about the proper amounts of calories, fat, protein, and carbohydrates for your teen.

    • As a parent, model good eating habits. Make mealtime family time (5 times per week or more)—eating meals together helps with communication and reduces teen risk-taking.

    Dating and sex education

    "With all the sex on TV, how can I teach my son to wait until he is ready?"

    Teens (females and males) are naturally curious about sex. This is completely normal and healthy. However, teens may be pressured into having sex too soon by their peers or the media. Talk with your son to understand his feelings and views about sex. Start early and provide him with access to information that is accurate and appropriate. Delaying sexual involvement could be the most important decision he makes.

    Talking with your teen about sex

    Before your teen becomes sexually active, make sure you discuss the following topics:

    • Medical and physical risks. Risks include unwanted pregnancy and sexually transmitted infections (STIs) such as gonorrhea, chlamydia, hepatitis B, syphilis, herpes, HIV (the virus that causes AIDS), and HPV (human papillomavirus—the virus that can cause cancers of the mouth and throat, cervix, and genitals in teens and adults).

    • Emotional risks. Teens who have sex before they are emotionally ready may regret the decision when they are older or feel guilty, frightened, or ashamed from the experience. Your teen should ask himself or herself, "Am I ready to have sex?" or "What will happen after I have sex?"

    • Promoting safer sex. Anyone who is sexually active needs to be aware of how to prevent unintended pregnancies, as well as how to protect against STIs. Condoms should always be used along with a second method of contraception to prevent pregnancy and reduce the risk of STIs.

    • Setting limits. Make sure your teen has thought about what his or her sexual limits are before dating begins.

    Most importantly, let your teen know that he or she can talk with you and his or her doctor about dating and relationships. Offer your guidance throughout this important stage in your teen's life.


    "I am afraid some of my daughter's friends have offered her drugs. How can I help her make the right decision?"

    Teens may try or use tobacco and alcohol or other drugs to fit in or as a way to deal with peer pressure. Try to help build self-­confidence or self-esteem in your teen. Ask your daughter about any concerns and problems she is facing and help her learn how to deal with strong emotions and cope with stress in ways that are healthy. For instance, encourage her to participate in leisure and outside activities with teens who don't drink and use drugs.

    Smoking and tobacco

    "My daughter smokes behind my back. How do I convince her to quit?"

    Smoking can turn into a lifelong addiction that can be extremely hard to break. Discuss with your teen some of the more undesirable effects of smoking, including bad breath, stained teeth, wrinkles, a long-term cough, and decreased athletic performance. Long-term use can also lead to serious health problems like emphy­sema and cancer.

    Chew or snuff can also lead to nicotine addic­tion and causes the same health problems as smoking cigarettes. In addition, mouth wounds or sores can form and may not heal easily. Smokeless tobacco can also lead to cancer.

    If you suspect your daughter is smoking or using smokeless tobacco and you need advice, talk with her doctor. Schedule a visit with her doctor when you and your daughter can discuss the risks associated with smoking and the best ways to quit before it becomes a lifelong habit.

    If you smoke…Âquit

    If you or someone else in the household smokes, now is a good time to quit. Watching a parent struggle through the process of quitting can be a powerful message for a teen who is thinking about starting. It also shows that you care about your health, as well as your teen's.


    "I know my son drinks once in a while, but it's just beer. Why should I worry?"

    Alcohol is the most socially accepted drug in our society, and also one of the most abused and destructive. Even small amounts of alcohol can impair judgment, provoke risky and violent behavior, and slow down reaction time. An intoxicated teen (or anyone else) behind the wheel of a car makes it a lethal weapon. Alcohol-related car crashes are the leading cause of death for young adults aged 15 to 24 years.

    Though it's illegal for people younger than 21 years to drink, we all know that most teens are not strangers to alcohol. Many of them are introduced to alcohol during childhood. If you choose to use alcohol in your home, be aware of the example you set for your teen. The following suggestions may help:

    • Having a drink should never be shown as a way to cope with problems.

    • Don't drink in unsafe conditions—for example, driving the car, mowing the lawn, and using the stove.

    • Don't encourage your teen to drink or to join you in having a drink.

    • Do not allow your children to drink alcohol before they reach the legal age and teach them never, ever to drink and drive.

    • Never make jokes about getting drunk; make sure that your children understand that it is neither funny nor acceptable.

    • Show your children that there are many ways to have fun without alcohol. Happy occasions and special events don't have to include drinking.

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    Trampolines: What You Need to Know

    Trampolines are popular among children and teens and even among some adults. Though it may be fun to jump and do somersaults on a trampoline, landing wrong can cause serious, permanent injuries. Injuries can occur even when a trampoline has a net and padding and parents are watching. Read on for more information from the American Academy of Pediatrics (AAP) about common trampoline injuries and how they occur.

    Common injuries

    Thousands of people are injured on trampolines each year. Most of these injuries happen on home trampolines. Children younger than 6 years are at greatest risk of injury. Common injuries include

    • Broken bones (Sometimes surgery is needed.)

    • Concussions and other head injuries

    • Sprains/strains

    • Bruises, scrapes, and cuts

    • Head and neck injuries (which can lead to permanent paralysis or death)

    How injuries occur

    Most trampoline injuries occur when there is more than one person using a trampoline. Children can get hurt when they

    • Land wrong while jumping.

    • Land wrong while flipping and doing somersaults (this should not be allowed because of the risk of head and neck injuries).

    • Try stunts.

    • Strike or are struck by another person.

    • Fall or jump off the trampoline.

    • Land on the springs or frame.

    What you can do to keep your children safe

    Don't buy a trampoline for your home! Trampolines may be popular and a fun way to get exercise, but there are safer ways to encourage your children to be physically active, such as playing catch, riding a bike (don't forget a bike helmet), or playing a team sport. The AAP recommends that mini and full-sized trampolines never be used at home, in routine gym classes, or on playgrounds. They should only be used in supervised training programs for gymnastics, diving, or other competitive sports. Only one person should be allowed on a trampoline at any given time.

    If you choose to have a home trampoline, the AAP recommends the following safety precautions: adult supervision at all times, only one jumper on the trampoline at a time, and no somersaults should be performed. Also, trampolines should have adequate protective padding that is in good condition and appropriately placed. All equipment should be checked often and protective padding, the net enclosure, and any other parts should be repaired or replaced when damaged. Parents should check their homeowner's policy and obtain a rider to cover trampoline-related injuries if not included in the basic policy.

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    Traveling with Young Children

    We discovered that we could go to storynory.com and download some brief audio books/stories with a message. We load them onto our iPod and let our 4 year old listen to them whenever we go on a long trip.

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    Trying New Foods

    Getting children to taste or try new foods is often a trying experience. It is okay to keep offering it, and you may eventually succeed. Surveys have shown that children may need to see something on their plate 10 to 20 times before they will actually try it!

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    What Is ADHD?

    ADHD is short for attention-deficit/hyperactivity disorder (uh-TEN-shun DEF-uh-sit HYE-pur-ak-TIV-uh-tee dis-ORD-ur). ADHD makes it hard to sit still, pay attention, take turns, and finish things. It is one of the most common chronic (long-term) problems of childhood.

    All children have problems behaving sometimes. Children with ADHD have a very hard time behaving a lot of the time. They usually have problems behaving in school and at home.

    The cause of ADHD is not clear. We know the brain works a little differently in a child with ADHD. We also know it runs in families. There is no cure, but we are learning more every day. Children who get treatment can do very well.

    Symptoms of ADHD

    A child with ADHD may have one or more of these problems:

    Inattention (IN-uh-TEN-shin)

    • Has trouble paying attention

    • Daydreams and is easily distracted

    • Can't get organized and forgets things

    Hyperactivity (HYE-pur-ak-TIV-uh-tee)

    • Is moving almost all the time

    • Has trouble sitting still, squirms, and talks too much

    Impulsivity (IM-puhl-SIV-uh-tee)

    • Acts and talks without thinking

    • Has trouble taking turns and interrupts a lot

    Hyperactivity and impulsivity go together. Or maybe the child just has trouble paying attention. Most children with ADHD have all the problems above.

    Finding Out If Your Child Has ADHD

    If your child has ADHD, the symptoms will:

    • Happen in more than one place, like home, school, team sports, and camps.

    • Be worse than in other children the same age.

    • Start before your child is 7 years old.

    • Last more than 6 months.

    • Make it hard for your child to do well at school and in other group activities.

    Call your child's doctor if you think your child may have ADHD. The doctor will talk with you both and check your child.

    You should know:

    • It is hard to diagnose ADHD in children younger than 6 years.

    • The doctor will ask about how your child behaves at home, school, and other places. The doctor may have you or your child's teacher fill out a form to learn about your child's behavior.

    • There are other problems that have the same symptoms as ADHD. And some children have ADHD with other behavior problems, like not obeying, anxiety, learning problems, or depression.

    Are There Medical Tests for ADHD?

    There is no proven medical test for ADHD at this time. Blood tests; computer tests; x-rays, like MRIs or CAT scans; or brain-wave tests don't help diagnose ADHD. Your child's doctor may have other reasons for ordering these tests. Ask the doctor if you have questions.


    There is no cure for ADHD. But there are many good treatments to help your child. As a parent, you are very important in the treatment process.

    Your child's doctor will help you make a long-term plan for managing your child's ADHD. The plan will have:

    • Goals (often called “target outcomes”). Example: better schoolwork

    • Activities to help reach your child's goals. Examples: taking medicine, making changes at school and at home

    • Ways to check your child's progress toward the goals.

    Most ADHD plans include:

    Medicine. For most children, drugs called stimulants (STIM-yuh-lints) are safe and work well. They speed up the signals in your child's brain. This helps your child focus and can help other symptoms too. There may be other medicines that the doctor suggests. The doctor may prescribe these instead of stimulants, or together with stimulants.

    Behavior therapy. This helps parents, teachers, and other caregivers learn better ways to relate to the child with ADHD. You will learn how to set and enforce rules. And your child will learn better ways to control his or her behavior.

    Working with the school. Treatment works best when everyone works as a team. The team should include doctors, parents, teachers, caregivers, and children themselves. Talk with the teacher or principal if you think your child needs more help.

    By law, public schools must:

    • Pay for testing for a child with learning problems.

    • Use teaching methods that meet children's needs.

    • Give extra help when needed.

    It may take time to find the right treatment for your child. And treatment may not get rid of all the ADHD problems. But treatment with both medicine and behavior therapy helps most school-aged children with ADHD.

    What Else Should Parents Know?

    You are not alone. There are parent training and support groups for ADHD. These can be a great help. Being the parent of a child with ADHD can be hard. Seek counseling if you feel overwhelmed or hopeless. Ask your child's doctor where you can find this kind of help.

    Answers to Common Questions

    Will my child outgrow ADHD?

    ADHD usually lasts into adulthood. People with ADHD can live good, productive lives. Having lots of energy can help in some careers.

    Do children get “high” on stimulants?

    Stimulants don’t make children high. They don't make children sleepy or “dopey” either. But it's important for your child to get the right kind and amount of medicine for him or her. That's why regular doctor visits are important.

    Do schools put children on ADHD medicines?

    Sometimes teachers are the first to notice signs of ADHD. But only a doctor can say whether your child has ADHD and order medicine for it.

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    What is ADHD? Questions from Teens

    Attention-deficit/hyperactivity disorder (ADHD) is a condition of the brain that makes it difficult for people to concentrate or pay attention in certain areas where it is easy for others, like school or homework. The following are quick answers to some common questions:

    Q: What causes ADHD?

    A: There isn't just one cause. Research shows that

    • ADHD is a medical condition caused by small changes in how the brain works. It seems to be related to 2 chemicals in your brain called dopamine and norepinephrine. These chemicals help send messages between nerve cells in the brain—especially those areas of the brain that control attention and activity level.

    • ADHD most often runs in families.

    • In a few people with ADHD, being born prematurely or being exposed to alcohol during the pregnancy can contribute to ADHD.

    • Immunizations and eating too much sugar do NOT cause ADHD. And there isn't enough evidence that shows allergies and food additives cause ADHD.

    Q: How can you tell if someone has ADHD?

    A: You can't tell if someone has ADHD just by looks. People with ADHD don't look any different, but how they act may make them stand out from the crowd. Some people with ADHD are very hyperactive (they move around a lot and are not able to sit still) and have behavior problems that are obvious to everyone. Other people with ADHD are quiet and more laid back on the outside, but on the inside struggle with ­attention to schoolwork and other tasks. They are distracted by people and things around them when they try to study; they may have trouble organizing schoolwork or forget to turn in assignments.

    Q: Can ADHD cause someone to act up or get in trouble?

    A: Having ADHD can cause you to struggle in school or have problems controlling your behavior. Some people may say or think that your struggles and problems are because you are bad, lazy, or not smart. But they're wrong. It's important that you get help so your impulses don't get you into serious trouble.

    Q: Don't little kids who have ADHD outgrow it by the time they are teens?

    A: Often kids with the hyperactive kind of ADHD get less hyperactive as they get into their teens, but usually they still have a lot of difficulty paying attention, remembering what they have read, and getting their work done. They may or may not have other behavior problems. Some kids with ADHD have never been hyperactive at all, but usually their attention problems also continue into their teens.

    Q: If I have trouble with homework or tests, do I have ADHD?

    A: There could be many reasons why a student ­struggles with schoolwork and tests. ADHD could be one reason. It may or may not be, but your doctor is the best person to say for sure. Kids with ADHD often say it's hard to concentrate, focus on a task (for example, schoolwork, chores, or a job), manage their time, and finish tasks. This could explain why they may have trouble with schoolwork and tests. Whatever the problem, there are many people willing to help you. You need to find the approach that works best for you.

    Q: Does having ADHD mean a person is not very smart?

    A: Absolutely not! People who have trouble paying attention may have problems in school, but that doesn't mean they're not smart. In fact, some people with ADHD are very smart, but may not be able to reach their potential in school until they get treatment.

    ADHD is a common problem. Teens with ADHD have the potential to do well in school and live a normal life with the right treatment.

    Q: Is ADHD more common in boys?

    A: More boys than girls are diagnosed with ADHD—about 2 or 3 boys to every 1 girl. However, these numbers do not include the number of girls with the inattentive type of ADHD who are not diagnosed. Girls with the inattentive type of ADHD tend to be overlooked entirely or do not attract attention until they are older.

    Q: What do I do if I think I have ADHD?

    A: Don't be afraid to talk with your parents or other adults that you trust. Together you can meet with your doctor and find out if you really have ADHD. If you do, your doctor will help you learn how to live with ADHD and find ways to deal with your condition.

    The persons whose photographs are depicted in this publication are professional models. They have no relation to the issues discussed. Any characters they are portraying are fictional.

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    When Children Won't Eat Vegetables

    Parents often get worried when their child won't eat vegetables. Keep offering different vegetable choices (presented in interesting ways) to your child, but be reassured that many of the necessary vitamins and minerals in vegetables are also in the fruits that your child may eat more willingly. If you are still concerned, give your child a children's chewable multivitamin. Don't forget that you can always count the tomatoes on your child's favorite pizza as their daily vegetable!

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    When to Learn About Rules

    The most difficult time for a child to learn a rule is when it has been broken. Instead, try to establish a rule before there is an opportunity to break it. For example, telling a child to stop running by a swimming pool immediately sets up a conflict. An explanation of the rule upon arrival at the pool allows communication of it before the conflict arises. This is not to say that there won't be a discussion of adhering to the rules later!

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