“Back to schoolitis”…All our kids experience this – it is really a form of stress. Kids handle transitions differently from each other and many do just fine but the start of a new school year is a transition and you should expect the other shoe to drop as expectations and work increase. Each Fall, Pediatricians and school Guidance Counselors see an increase in kids of all ages having vague symptoms including:

• Fatigue
• Sleep issues
• Stomach complaints: aches, constipation, diarrhea
• Nervousness to frank anxiety
• Headaches
• Anger
• Feeling overwhelmed
• Depression

What should you do? First, reassure your child that he or she is doing just fine and feeling the same way as every other kid at school this time of year. If your child is in elementary school, talk to your child’s teacher. Find out how your child seems at school. It is very normal for a child to get through the day at school and “let their hair down” at home showing you their true feelings. If all is fine at school, I would worry less. If your child is in middle school or high school where many teachers are involved, the school guidance office is the place to start. School typically assign a student to a guidance counselor who can talk to your child and see if there is anything going on beyond expected school transition issues.

If your child’s symptoms begin to interfere with home, social or school functioning that’s the time to call your child’s pediatrician to intervene. Medication may help with the physical symptoms. If stress is the issue, counseling may help. If school is causing issues, the school should get involved and help form an action plan based on the root cause.

Education is complicated and issues in school from academic to social do manifest with physical issues at times. So, keep an eye out and let your pediatrician know if you are concerned.

(updated September, 2011)

One of the situations I found most challenging working in emergency rooms and urgent care settings was when a teen came in for “medical clearance”. This phrase is code for “a teen in an emotional crisis who may need be having a major psychiatric issue…or not.” My job was look into any possible medical issues of the mood changes and then to call the on-call psychiatric crisis team in for the remainder of the evaluation, if needed…which was the majority of the time.

I recall one 17 year old teenager who had threatened to commit suicide earlier that day.  I remember being struck by two observations: how sad she appeared and how “normal” her family was by all standards. They were basically like any of our neighbors.

Talking to this particular teenager, I learned she had great success in school, sports and music and appeared to have a very loving and supportive family. Yet, she never felt happy…ever. Her parents described her to me as a “serious” teenager and very busy, burning the candle at both ends and feeling enormous pressure about the college application process.

That particular day, she decided the world would be better off without her and it frightened her so much she told one of her high school teachers.  After the initial shock of the moment, her parents and teachers were able to look back and notice small clues that were missed by this teens outward success that lead to that day. Thankfully, they knew to bring her in for a crisis evaluation and the team on-call agreed she was clinically depressed and needed in-patient care. Finding that care was a different story with the usual bed crunch we have in the child psychiatry world but at least in this case we had a family on board with care and a teen wanting help. These situations don’t always occur this way.

What makes teen depression so challenging is teens are moody and can have off days. So, how do we decide if our teen is “clinically” depressed or just going through a short term rough patch, perhaps due to t a friendship issue or issue with a boyfriend or girl friend, or simply having a bad day?

Keep in mind that most teens, despite their reputation as a group, do listen to adults and follow the rules. Remember, a busy teen is a happy teen most of the time. What we have to look for is a flip-flopping of emotions where the teen’s mood shifts from being mostly cooperative and happy to mostly not so cooperative and unhappy. In other words, instead of the teen melodrama being the exception and fleeting, it becomes more persistent and prevailing and lasts at least 2 weeks, if not more. That’s the point we have to pause and get our teen evaluated.

www.aboutourkids.org has a list of screening questions that can help you decide whether you may need to seek professional help for your child. Keep in mind that a “screening” test picks up kids who MIGHT have a problem – kids you want to have someone else look at – but it may not mean that there is a HUGE problem.

1. Does your child feel sad, blue, or tearful?
2. Is your child often angry or picks fights at school or at home?
3. Does your child no longer care about favorite activities?
4. Has your child lost or gained a lot of weight?
5. Does your child have trouble sleeping or sleeps too much?
6. Does your child have trouble sitting still or appears very slowed down?
7. Does your child always look tired or is “too tired to play”?
8. Does your child feel hopeless or tell you, “I’m no good?”
9. Does your child have trouble concentrating or making small decisions?
10. Does your child talk about how life is not worth living, death, or suicide?
11. Have you noticed these symptoms have been present for almost every day for a 2 week period?
12. Do these problems get in the way of activities at home, in school, or with friends?

If your teen is clinically depressed, you will have a large peak to climb – but don’t let that deter you. There will be peaks and valleys as you help your teen battle this beast but keep the ultimate peak, the gold ring in mind to keep you focused: the smile on your child’s face that you’ve likely not seen in all too long a time.

Does your teen or tween every travel alone? “Of course not,” you say. What about school trips in middle school or high school?  What about overnight camp and day trips or overnights they may take?

Any time your kids do something without you, they are travelling alone. Once kids are old enough to have these opportunities, they are old enough to not only understand important safety rules about travelling without you, but understand how to care for themselves and their health a bit. In fact, if they can’t accomplish either of those tasks, perhaps they are not quite ready to be on their own.

Top Ten Travel Alone Issues To Talk To Your Teens and Tweens About:

• Health issues
• Travel safety
• Calling Mom and Dad
• Technology On the Go
• Hotel safety
• 911 moments
• Basic first aid
• Restaurant etiquette
• Public Do’s and Don’ts
• The Dating Game

Health Issues
Does your teen or tween  know his health history? How about when her last tetanus shot was? Even if a trip is supervised, adults won’t be around all the time and with so many kids to keep track of, won’t be able to rattle off every piece of information about every child. Your teens’ best health historian is himself. Simply review the highlights and write them down. Create a wallet card or small computer print out for your teen to have on hand and all health information bases will be covered. Essentials to focus on include:

• Important illnesses and surgeries
• Medications and medication allergies
• Last tetanus shot dates
• Health insurance card copy and number

Travel Safety

Does your tween or teen understand how to travel safely? Whether by air, car, boat, bus or train, it is important that your teen have a sense of safety issues for those modes of transportation. Review what to do in case your teen gets separated from the group. Explain safety procedures if there will be any, and the importance of taking those seriously. And, explain that with other passengers around, hoarsing around and being loud is not acceptable.

Calling Mom and Dad

With cell phones so prevalent, many kids in the tween and teen age group don’t know their parents cell phone numbers. Make sure your teen knows yours. Review it with her. Write it down and put it in her wallet if you have to but don’t just rely on her speed dial!

Technology On The Go

Teens and tweens often think that being away from home is carte blanche for extra cell phone use or IM use. It is crucial that teens understand that they are not safe with earphones in. If running, have a partner. Never talk and walk. And, never IM anyone he doesn’t know.

Hotel Safety

Hotels are great fun and teens become very excited being in a hotel room without their family. Review etiquette with your teen as well as common law concepts and the fact that the walls are thinner than they appear. Review locking the door. Review not letting strangers into their room.

911 Moments

I try and keep this simple with kids  away from home. If  they are scared or uncomfortable and feel at all unsafe, that is a 911 moment. Better to call authorities than get into trouble. Feeling unsafe is not the time to consult a friend; it is the time to call for real help.

Basic First Aid

Most local fire departments and health centers have basic first aid classes for teens and this is a fantastic idea. These courses review everything from wound care to  CPR and will come in handy when you are not around. I’d strongly recommend this before your teen ventures on any trip without you.

Money Safety

Even savvy older kids don’t understand how pick pockets and criminals think. So, be very clear and specific with your teen and tween about safe ATM use and how to pull money out of a wallet. Review concepts like not putting a wallet on a counter or table and, for girls, not leaving a purse on the back of a chair.

Public Do’s and Don’ts

This is a tough one for teens! They have to understand they represent themselves, their family and their organization. Other people are around and they have to remember to be polite and responsible. Sometimes under the influence of peers they forget this.

The Dating Game

It is when teens are on trips like this that first dating experiences often happen: first kisses, for example!  Many organized trips have policies about fraternization and it would be a good idea to review these policies with your teen as well as reviewing safe sex practices.  They key is to try and get information across without coming across too strongly. Talking about more old fashioned dating concepts like holding hands may come in useful if your teen finds himself in a dating situation and wants to create some intimacy without going too far.

Final Thoughts

If  you can impart these words of wisdom, your teen and tween will be safer and more prepared than others.  And,  should your teen accuse you of not trusting her while reviewing these ideas, simply tell her that it will make you feel better to know she understands these things – that you’re having trouble with her venturing out into the world!  And, remind him that it isn’t him that you don’t trust but the rest of the world. Tweens and teens usually do well with explanations like this.

Safe travels!

(Originally posted July 2008; Updated December 2009)

Attending conferences and events, I’m always amazed by the new parenting devices and  gadgets that appear on the market. What’s timeless, however, are the questions parents have about the health of their young families.

Here’s a sampling of those common parents of new babies or of young children typically ask:

Can you really over bundle a baby?

Believe it or not, you can. Babies don’t have the best temperature control when very young so can get overheated very easily by being over swaddled or over-dressed. The best rule of thumb is to dress your baby as you dress yourself. Overheated babies can become fussy and clammy and may even run a low-grade temperature. If this occurs, try unbundling your baby a bit and if that doesn’t help calm your baby, call your pediatrician advice.

Should daycare centers and schools be nut free?

Nut allergies are very common and can be life threatening even from a simple touch or sip of water from someone who had recently eating peanut butter.  Schools vary in how they handle this but the only way to ensure the safety of the kids affected is to keep public places as nut free as possible.

How can I tell if my preschooler’s speech is normal?

The trouble with preschool speech is while there are guidelines for milestones there is a wide range for when kids are allowed to reach those milestones and still be “normal”. Here are the commonly accepted guidelines by the American Speech and Hearing Association (www.asha.org). If your child falls outside these guidelines, call your pediatrician or public school speech department to arrange for an evaluation.

3-4 Years:

Talks about their day at school or at a friend’s house

Understandable by people outside the family

Uses 4 or more words in a sentence

Usually talks easily

4-5 Years:

Sounds like other kids

Uses a lot of detail in sentences

Can stick to a topic when talking

Talks easily with kids and adults

Can say most sounds well except: l, s, r, v, z, ch, sh, th.

Uses the same grammar as other family members

Can I pamper myself while I’m pregnant? Get my hair colored or nails done?

The short answer: absolutely! You go girl! A pampered mom is a happy mom!

The longer explanation:

The cosmetic industry has come a long way in ensuring the safety of its products, and most OB/GYN doctors and salon stylists agree that the products on the market can be used during pregnancy without hesitation. The smells may bother you early on but a well ventilated room usually alleviates any nausea that may result.

Keep in mind, though, that hair does change during pregnancy and many women find they don’t need as much artificial color. Your stylist can guide you to what makes sense for your hair as your pregnancy progresses but many advocate waiting until second trimester to start any coloring during pregnancy to give the hair time to adjust.

Similarly, manicures and pedicures pose no risk at all during pregnancy. Nail color can’t penetrate the nails at all. The fumes are the only potential annoyance but, again, a well ventilated room can help with that.

Finally, while considering other spa services, massages are a wonderful way to pamper yourself and are very safe for you and your growing baby. However, avoid any activity in the spa that could cause you to overheat such as hot tubs and saunas. Increased body temperature is a risk factor for birth defects.

Closing Thoughts

Our own experience is our best asset as a parent and one of the best gifts we can give each other is the benefit of that experience. At the Baby Faire last year, a mother of two, ages 4 years and 9 weeks, shared with me this snapshot of her family:

Me: How is your older daughter adjusting to having a new baby at home?

Mom: Great! I give her jobs which helps us all out.

Me: Jobs? How does that work?

Mom: Well, I figured by making her part of the baby stuff she’d feel more included. Her job is to get the diaper for every diaper change and help get the car seat ready. She loves this and it really helps us out! Besides, a child is never too young to learn to have responsibilities.

What a brilliant idea! I wish I had thought of it when my kids were young. Older siblings are often at a loss to figure out their place in the new family and giving them simple jobs around the baby helps them become more used to this new family entity. Of course, we all know the other show will drop at some point but no reason we can’t all enjoy some sibling harmony while it lasts.

(Originally posted March 2008; Updated December 2009)

Having “the talk” with our kids is never easy. Just getting through saying the various anatomic names can be daunting for even the most savvy or parents.  It used to be that we would talk about the basics, reproduction, and add sexuality, birth control and life issues like babies later on as our kids got older. The news of 17 pregnant teens in Gloucester, MA in 2008 rocked our beliefs to their core and there was a great deal of talk about how we can improve on reaching teens more effectively.

Given how many celebrity teen moms we now have and shows glamorizing teen pregnancy it’s clear we haven’t learned our lesson and are still not willing to see that teens need a different approach…one that takes into account the reality of what today’s teens are truly doing sexually and that goes beyond the basics to include:

• Accurate and honest information
• A discussion of consequences
• Problem solving ways to keep themselves safe – that is, an honest talk of birth control
• The knowledge they can turn to their parents if something goes wrong

Accurate and Honest Information

Accurate information is easy for parents, especially with the help of websites, books and basic reproductive health taught in 5th grade. Where parents have trouble is going the step further and being honest with their tweens and teens about the facts. The facts that need to be discussed are the basic facts of reproduction, the fact that sex leads to a baby, and the fact that something called birth control exists. To leave out any of those facts is not being honest with our kids about the full picture of reproduction and sexuality. In today’s society, kids need all this information, even in a basic form, our of the birds and bee talk gate.

A Discussion Of Consequences

Teens don’t problem solve well about sexual behavior so you have to do it for them and keep it simple.  My talk with teens about consequences of sex is simple: “If you have sex as a teen, you’ll either become a teenage parent, get a disease, or both.” Teens are very impulsive. They think sex is fun and babies are cute. If you start spelling out the reality of having a baby or getting a disease, most teens will begin to wake up and want to take steps to be more responsible.

Enlist your pediatrician’s help in talking to your teen about sexually transmitted diseases. Most teens become quite stunned when they learn the details of many of those STDs. To give your teen a reality check about life with a baby, don’t just tell them stories of your teen or other kids as cute babies – tell the tough stuff: hours of colic, sleepless nights, trips to the pediatrician, sick stuff, diapers, feeding, no social life, no money for anything but baby stuff. Don’t paint a pretty or overly glorious picture.

Problem Solving and Ways to Keep Them Safe

While many parents hope their kids will not have sex, clearly that is a pipe dream.  To truly keep your teens out of trouble if they have sex, birth control and the HPV shot for girls are the best methods at the moment. It is a huge myth that talking about birth control and the HPV shot will entice your kids into sexual activity.  Teens who have decided to have sex will do so with or without their parents “consent”. Think of it like this. You don’t have to approve or like your teen’s decision to have sex and you can let your teen know that. But, as a parent, you have a responsibility to help your teen not do something too stupid, either. Teens are impulsive and sometimes need rope to run with a gently tug back.

BTW, abstinence only programs don’t work. But, what does work is giving teens information and having parents who support them. What also works is keeping teens busy in other activities and helping keep their self-esteem high. Teens with high self-esteem who have lots of activities in their lives tend to not look for the “other” form of gratification too young.

The Knowledge They Can Turn To Their Parents

For problem solving to really work, our teens need to know they can talk to us. I know too many teens way too fearful of talking to their parents about issues of sex and sexuality for fear of being disowned. That’s very sad to me.  Our teens need to know we won’t always be happy with their choices but they also need to know we will unconditionally love and support them regardless of the outcome. If you haven’t seen the movie June, see it. The way those parents handled the news of Juno’s pregnancy is a model to us all.

Final Thoughts

The biggest pill to swallow here is that teens are having sex, in all walks of life.  If we all become more honest about that perhaps we can cultivate a more open atmosphere in our own homes so our own teens make better choices than the Gloucester teens did (or Bristol Palin or Jamie Lynn Spears) – and one less baby born to a teen.

(Originally posted September 2008; Updated December 2009)

What is it? The inability for Seniors (typically) to focus due to a feeling that “they are done”. However, this can occur in all kids at various stages.

Symptoms:

Not applying as much effort in school work

Loosing interest in activities

Grades slipping

Lackadaisical attitude

What you should do as a parent:

• Talk to your child
• Talk to the school

The goal is to uncover from your child what is driving your child’s thinking and motivation. Your job is to be helpful and to be a good listener. The school is your best ally in helping you talk to your child and explaining the big picture.

The Cure

GRADUATION! And, staying busy and involved well before then.

However, your Senior needs to understand that some colleges and universities are not as forgiving if grades slip too much. Scholarships and awards have been revoked so it is important to keep GPAs respectable. Many schools have helped by keeping kids busy with projects and fun class activities.

See Resources for more information and tips.

Resources For Parents

What to do about Senioritis (College Board Association)

Does this tale ring a bell with you and your family moments?

A while back,  I walked by the registration desk at work and noticed a mom very focused with the registration process while a couple small children sat by her feet. Another child, presumably hers given the interaction with the other kids, sat a few feet away near a large and very beautiful floor plant–one of those plants with endless leaves and branches that seem to reach out to you. The child seemed intrigued by the plant. Here mom looked over a few times and hurriedly commented “be sure not to touch that plant.”  Well, before you could blink an eye, the child touched one of the outer leaves with her index finger. Her mother looked noticeably agitated and pulled her over to sit with the other kids. “I told you to leave that alone.” “Why?” The child quietly asked. “Because I said so.” I’m not sure who was more uncomfortable – those of us witnessing this exchange, or the small child who was the recipient of her mother’s wrath.

We’ve all been in this mother’s shoes – so focused on the task at hand that we were a bit unduly short with our kids. And plants can be dangerous – although one could assume a plant in a doctor’s office has already passed that test. Sometimes kids do have to listen first and talk about what happened later. What can be difficult during a hectic day is to remember to make sure the talking part does happen and to make sure we don’t abuse the “because I’m the parent” card out of frustration or exhaustion.

To play devil’s advocate a moment, I wonder how the child would have responded had her mother instead said “Look, Mama’s busy now and plants can make you sick,” or “Plants are alive just like us. We don’t want to hurt them.” Mom could have also regrouped after snapping by making a joke at her own expense: “Mom just needs more coffee. I have a short fuse today.” Any of these retorts would have reinforced to the child her mom’s priority in keeping her safe but being willing to compromise and be part of the child’s interests. And it would have shown the child that mom is human and sometimes makes mistakes.

Power struggles happen at times, and, as frustrating as they can be, they are also an opportunity to learn something about your child. Perhaps there is a need or interest not being met. For example, in the plant situation, that mom could have asked the child later “Why did you like that plant so much?” Perhaps the child is developing a green thumb or found something interesting about the plant.

Perhaps the power struggle occurred because you misgauged what your kids needed to stay occupied while you conducted your business. Some things, like insurance and registration matters, take more time than our children have the attention span for.

Having snacks and activities on hand can be a sanity saver for all in a pinch.

The impact of power struggles can be lessened if we foster an aura of openness and communication. That can be hard in today’s world with everyone coming and going, even at very young ages. If you are finding yourself butting heads with your kids more than you’d like, you may want to consider that the pace of your life could be catching up with you. This is one of the driving forces behind the push for more family dinners. You can’t get much more downtime than the summer – so use it to your advantage. Use the lack of carpools and chaos to find small ways to build in family time that you can carry over once the fall hits. Family dinner is less about eating and more about regrouping – catching up over the day’s goings on. If dinner doesn’t work for you, have a regular family breakfast, lunch or weekend barbeque. Be spontaneous and go out for ice cream.

Today’s power struggle over a plant may be tomorrow’s differences over puberty issues, clothing choices, friendship choices, dating issues, and school problems. For our kids to know they can come to us when they are in a pickle, we need to cultivate an aura of fairness and openness. Sure, some broken rules will have consequences – particularly if a dangerous or destructive situation is afoot. But most times old-fashioned compromise will do the trick. Start it young and it will be second nature to all of you when the stakes are higher.

So next time you snap or your child defies you, perhaps what you all need is to find your inner latte or ice cream flavor. While doing so, you can calmly explore what really happened and hope to avoid it in the future.

(Originally posted June 2006; Updated December 2009)

Puberty – the final frontier.

These are the voyages of our tweens and teens*.

Their 5-ish year mission: to become independent while their body is changing inside and out,

to boldly go where every tween and teen in history has gone before!

Just like Captains Picard and Kirk on Star Trek, we encounter aliens daily as our kids evolve through puberty. Those aliens are none other than our teens and tweens, or Ts for short. I have to admit I was a nonbeliever that the alien force could start so young until my girls both entered the terrible Ts at the early age of 9. But, that is when it begins – tweendom and puberty.

When parenting Ts, we’d be wise to follow Star Fleet Academy’s Prime Directive.  The Prime Directive allows for healthy interaction without interference in a way that would alter the natural history of that alien culture, and prohibits introducing technology and information they have not advanced to.  Sounds like parenting maturing children to me. But, unlike in Star Trek, the lines of where to not intervene are not so clear cut. Our kids are still kids even as they enter and evolve through puberty.

Puberty, the process, changes everything about our Ts inside and out, similar to a purge and rebuild of a computer hard drive. Sometimes the transition is smooth and other times bumpy but in the end all systems return to normal.  Puberty occurs over 5-7 years in 5 stages starting with our prepubertal child in stage 1 and ending with an adult-like older teen in stage 5.  All Ts go through the same 5 stages but the timing can be very different from T to T.  Inside and out, the focal point of puberty is a maturing reproductive system and ability to reproduce. So, needless to say, our Ts sexual lives start to develop during this process. Whether they act on those feelings or not, the feelings are their and can be confusing.

Boys and girls experience puberty very differently.  Maria Olio, a mom of three teen boys and one tween girl and local columnist, found that all her Ts were similarly moody but her boys seemed to have an easier time accepting the physical changes. This makes sense since girls’ physical changes are quite obvious whereas a  boys’ are more subtle.

What can we do as parents during this chaotic time? Simple. Follow the Prime Directive of Parenting Ts:

1. Develop a good poker face. There will be some Tums moments, but the less you react, the quicker the emotional chaos will subside.
2. Expect RHMs for all kids, boys and girls: Random Hormonal Moments. There will be times your child appears possessed. To handle a RHM, listen – breathe – listen…exhale…then talk. When in doubt, say nothing. Once the RHM subsides, it will be easier to figure out if any real issue is at play.
3. Space is your friend. Ts need some alone time but they also very much struggle to stay connected to their family. True give and take work better then edicts.
4. Be open for conversation and accepting if they have emotional or sexual views different from your own. Work in tidbits and find teachable moments from the news or town and school events. Kids this age do better if the information isn’t too personal at first.  “Don’t wait for them to ask you”, notes Maria. “You ask them”.

As our Ts go through puberty and become young adults,  we have to change our parenting styles. We have to become less hands-on and more observers while keeping a foot in the door to intervene and advise when needed. We have to help them find boundaries, learn from their mistakes and discover who they are as individuals. And, we have to be accepting if they develop different views from our own.

The key to success is being mindful of the stage they are at and not reading too much into everything. I was reminded of that recently with my own 9 year old daughter in this conversation:

Tween: “Mom, did I tell you that Loralei and Christopher are back together on the Gilmore girls. They’re sleeping together, too”

Mom:   “Oh? What exactly is ‘sleeping together’?” (very calm, I might add – practiced points 1 and 2 above!)

Tween: “You know, dating…and sleeping in the same bed. I don’t think they’ve had sex yet.”

Mom: “Sex?”

Tween: “Yea, You know, when you get naked and kiss a lot.”

She’s only 9 so I would not expect more detail, but it is coming and before I’ll be ready, or 5th grade, which ever comes first!  But, the clock is ticking!  I just hope I remember to follow the Prime Directive when the conversations get more in tense.

[*Teen: a child in the later stages of puberty, 13-18

Tween: a kid no longer a child but not yet a teen, early to mid puberty, ages 9-12]

(Originally posted January 2007; Updated December 2009)

Disney movies have a wonderful way of providing something for everyone but are sometimes criticized for content that may be too overwhelming for children – parents dying, natural disasters, and sickness in a friend or loved one. I was particularly sensitive to these very issues when my children were younger and would simply fast-forward through “questionable” scenes. Eventually my kids started insisting on watching movies without interruptions regardless of content. What’s interesting is my kids did fine with the movies we felt were “too intense” but had a tough time with movies we assumed would be more low-keyed. For example, in Bambi, my oldest daughter figured out at age 5 that Bambi’s mother was now gone but told us that Bambi would be ok because his daddy and Flower were around to help. In contrast, when my youngest daughter was 3 she cried uncontrollably in Elmo in Grouchland because Elmo’s favorite blanket was lost. She had a much loved blanket at the time called “kiki” which she still has. The parallel to her life was just too intense for her whereas my older daughter was more able to process a tough topic because her life was not at all like Bambi’s – her mom and dad were right there watching the movie with her.

We could not have predicted these reactions if we tried – they were completely opposite of what we anticipated. And, according to child psychiatry experts, my daughter’s reactions were not only predictable but essential for their development. According to Paula Rauch, MD, Director of Massachusetts General Hospital’s Parenting At a Challenging Time (PACT) Program, (www.mgh.harvard.edu/cancer/cancer_ptsupportedu_pact.htm ) “rather than “protecting” children from loss related content, think of them as opportunities. It is not protective to exclude children from the reality that people get sick, and people and animals die. When parents do “protect” their child, they ensure that a child’s first experience with loss will be more overwhelming. Having a pet die, hearing about a friend’s parent dying, going to a family member’s funeral are sad experiences but they are also opportunities to talk about feelings and observations and hear a child’s questions. When the experiences are less overwhelming than a close family member’s death, the parents are likely to be most emotionally available to hear a child’s full experience and a child to feel safe enough to really talk about the loss and the ceremonies associated with it or the treatment that was involved.”

Additionally, Dr. Rauch encouraged families to consider the PACT’s “lessons learned” to help guide them through challenging conversations with children on illness and death. While originally designed for use by cancer patient’s and families, these tips are applicable to most other situations that put stress on a family and on children such as divorce, natural disasters, terrorism and war.
Euphemisms lead to confusion.
Name the illness, e.g. “Breast Cancer,” not “lump” or “boo-boo”. Facilitate honest communication.

The worst way to hear news is to overhear it.
Describe what is happening and what to expect.

Welcome all questions.
Learn the settings that work best for each child, e.g. in the car, at the kitchen table while a parent is cooking, at bedtime etc.

Figure out what the real question is.
“What got you wondering about …?” The real question is often easier to answer than the imagined one.

Questions do not always require immediate answers.
“That is such a good question. I’ll need to think about it, or discuss with my (doctor, nurse, social worker) and get back to you.”

Children shouldn’t worry alone.
“Bring what you hear back home to us for accuracy”. Sometimes people say unhelpful things with the kindest intentions.

Review your child’s support system.
Assign tasks, or appoint a person for each child.
Keep the channels of communication open with key caregivers.

Maintain the child’s usual schedule.
Try to preserve some time for kids to be kids.

Keep a pulse on each child’s experience.
Find reflective times to check in about hearing too much/too little. “What is it like having …”

Respect a child’s wish not to talk.
Non-talkers need “News Bulletins”. There is information that the child needs to hear, but may not want to discuss.

Bring support people for hospital visits.
Adjust visit lengths to the comfort of the child.

Learning to handle bitter life moments is essential for savoring and appreciating the sweet. Disney’s use of humor and grace to portray the more fragile and difficult aspects of life provides us with a blueprint for managing difficult aspects of our own lives. So, next time you feel the urge to fast forward through a “tough” scene in a show, sit on the remote, hand out tissue, and allow your family to experience the moment together. As often as art imitates life, life will eventually imitate art – someday that experience will help all of you enormously.

Our summer has had some interesting moments. Summer camp had barely begun before our 9 year old daughter threw us a curve ball. “Mom, J is going to sleep away camp this year. You HAVE to let me go next year – otherwise I’ll be the only 5th grader in the entire world not going.” I have to say, while she’s been somewhat of a pneumatic drill on the topic this summer, watching her try to convince us has been quite amusing. She’s tried everything from emailing us to leaving notes around the house to borrowing the overnight camp promotional DVD from here friend. In her mind, She is completely convinced life will stop if she does not go next summer – the first of many such situations we’re sure to face as her preteen years creep in. Somehow, we went from the cat’s meow to yesterday’s news in the blink of an eye. Just goes to show you that just when you think you have your child figured out, they change again….

Have you ever stopped to consider just how important peers our for our kids and at very young ages and with even ordinary events? We recently had a funny experience at a local restaurant with friends when we discovered that the 9 year olds and 7 year olds were conferencing about what to order and unwilling to order something the others did not like, want, or agree to. So, my friend’s 9 year old ended up eating prime rib because my daughter “had to have it”, and my 6 year old actually ate food she’s never eaten before because her 7 year old buddy was eating it! If only all peer experiences could be so positive – and so innocent….

Peers are good – we need them to develop and thrive. We influence them and they us. It’s really in all our wiring to want to be accepted by our peers and to want to seek out their opinions. Just watching kids in action for even simple, daily interactions you’ll be amazed at how pervasive kids sense the need to be like each other. Our kids get easily energized by what excites their friends – from books to sports to movies to food. And, just as easily, kids can be swayed to the “dark side” and try things that are not acceptable – shoplifting, drinking, drugs, skipping school, bullying, to name a few. The goal is to empower our children so much when they are young in feeling positive and good about their choices that when the stakes are higher they’ll know what to do. The little stuff in early childhood is practice for the big stuff in the teen years and beyond. And, in many ways, how we handle our kids’ mistakes and decisions when they are young will color whether they turn to us when the stakes are really high.

So, take a deep breath and consider these simple ideas to help you help your kids with their peer negotiations while keeping you in the wings the entire time:

1. Help your kids learn the language to get out of a situation or say “no” to something they are not comfortable with. Role play to give your kids scripts for what to say in different situations. Take turns being different types of people.
2. Many kids think they need to solve their own problems instead of turning to an adult. Help your kids understand this by explaining to them that even adults turn to others for advice when in a tough situation.
3. Kids who feel good about themselves and good about what they do are less likely to get into trouble or mix with the “wrong kids”. Praising our kids often and watching the tone of criticism will help our kids think about themselves positively.
4. If you are worried about the type of kids your child is hanging out with, redirect your kids towards kids and activities that are more positive. At the same time, explain to your child what made you worried or uncomfortable about a particular situation or person.
5. Try to find consistent time to talk with your kids each day – even if while driving to the next activity, just asking “how was your day? Anything you want to talk about?” will give your kids the message you are available.

You can never start too young or with too mundane an event to start reinforcing “good” vs. “bad” peer issues with your kids. In my mind, it’s the simple decisions when our kids are young that will arm them with solid self-esteems and well rehearsed strategies when they are older. For example, if your daughter wants to play the trombone and every other girl she knows is playing the flute, she may feel left out and the other kids may look at her odd for playing a “boy” instrument. Use humor – have her picture what that band would be like with 100 flutes!! Find some role models in the “real” world where girls play instruments that are not thought of as a “girl” choice.

So, find something wonderful that your kids have done today and tell them that you noticed. Find a decision they made that was good, and tell them how proud you are of that. And, if you get a strange look, just smile knowing you hit the nerve that will keep them coming home when it counts.

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