BIG NEWS!!
Big Sky Pediatrics is moving to a new office. My new address is 1811 N Hwy 281, Bldg A, Suite 8, Marble Falls, TX 78654. It's located between the Panda Express and the funeral home!!
The phone number remains the same- 512-553-1740 and my email is doctormom457@yahoo.com.
I can schedule patients on Monday-Friday, by appointment. Call or email me for an appointment.
Praise for Parenting and “Adulting”
Parenting is hard. It takes time and energy. Being the adult and getting things done takes work. Most people don't really feel that they get recognized for any of it.
A Facebook group I've found has been addressing this very thing. People post what they have done for the day, or maybe the week, and their friends respond with stickers or GIFs sending high-fives, "Good Job", and other encouraging reactions. It's great for helping each other feel more recognition for their hard work.
We try to give our children positive reinforcement for their behavior. It can really help for friends or colleagues to start developing a system of positive reinforcement for "Adulting".
STAYING HEALTHY
Under current guidelines, COVID-19 precautions have been reduced. Most people don't have to wear masks or keep 6 feet of distance all the time. There are exceptions, of course, for people who have decreased immune systems or serious illnesses which put them at greater risk. But that doesn't mean you should give up all methods to keep yourselves and your children healthy!
Here are some of the best ways to help your child stay healthy:
1) Good hand washing- even if the risk of COVID is lessened, children are constantly exposed to germs- viruses and bacteria- all the time. Whenever kids go back to school, they are surrounded by new germ groups! It's common for children to have more colds and other viruses right after school starts, especially when they start a new school. Remind them to wash their hands at school and wash up as soon as they get home (to avoid bringing school germs into the house!)
2) Vaccinations- Childhood vaccines have made dramatic changes in the frequency of diseases which have been common and deadly in the past. By continuing to vaccinate children on the regular schedule, we can best protect them from those diseases returning. It is not recommended
to follow alternative schedules or space them out over longer times. These have been clearly shown to not be effective and result in your child not having complete protection against many serious infections. If you have questions regarding the vaccines, please talk with your child's doctor for accurate, up-to-date information.
3) Healthy nutrition- Children need nutritious food to grow and develop well. We used to use the Food Pyramid to remember what to eat. Now, there's My Plate. The specific guidelines can be found at https://www.myplate.gov/eat-healthy/what-is-myplate. The Five-A-Day Rule means to eat at least 5 servings of fruits and vegetables each day. This easy-to-remember rule should be used to plan your family's meals and snacks. Each meal should contain one or more servings of fruits or vegetables (remember the size of a serving varies by your child's age). Make sure your child drinks plenty of water.
4) Exercise- Kids can get exercise in many different ways. They can play an organized sport or they can just play outside. Encourage your child to be active by doing activities with them- go for a walk, have a family bike ride, throw a ball around. Many kids enjoy video games. That's not all bad, but you may need to motivate them to go outdoors more. Monitor how much screen time your children have and give them positive feedback for doing other activities
5) Keep kids home if they are sick- If your child has a fever over 101 or vomiting, they may be contagious and should stay home from school. You can usually treat their symptoms at home with Tylenol, clear fluids, and rest, but if they are sick for more than a few days, or seem to be getting worse, they need to see a doctor. Many illness are caused by viruses and don't require antibiotics. In fact, the antibiotics won't help at all, and we try to avoid over-using them to prevent resistance. Your child should stay home from school until they don't have a fever over 101 for at least one day, and any vomiting has stopped. If you have any questions, call your child's doctor.
6) Sleep- Make sure your child gets enough sleep. Most teenagers need 9-10 hours of sleep and young children need 9-13 hours. Start healthy sleep habits early. Have a regular routine to get your child ready for bed. Have calming down time with bath, brushing teeth, turning off the TV or other screens, and getting them settled. Spend time reading to your child every day and, then, encourage them to read when they are old enough.
7) As much as possible, keep your child safe! Always buckle them in their car seats from the first trip home from the hospital until they are old enough to start putting on their own seat belts! Make sure your child wears a helmet with bicycling and skateboarding. Keep medications and poisons locked up out of reach. If you have a firearm in your home, be sure to keep it locked away separate from the ammunition. Make sure your child knows not to touch any firearm they might find, and to immediately tell you.
FRUSTRATIONS
Do you ever get frustrated? Do you get bothered when you are trying to do something and it doesn't work? Does it upset you when nothing is going according to plan? Of course!! Everyone does at some time or another.
Frustrations can arise due to miscommunication, unmet expectations, and dealing with situations beyond our control. Our instincts may be to get angry, rage against the whole world, or even, get mad at ourselves. The big problem is that those types of reactions just make the situations worse!
If you are struggling with a problem, one of the first steps can be to just take a break. Stop trying to solve it, and do something else for a while. Hitting your head against the wall isn't very productive! If you notice that you haven't eaten, had enough fluids, or are over-tired, take care of those physical needs first. Physical activity can give you a different direction for your energy – go for a walk, do some exercise, practice some yoga. Using creative activities can also help- do art, music, dance, make something, build something, cook, whatever you enjoy doing. They can take your mind off of the problem, and allow you time to regroup by using your brain in another way.
Ask for help, either to solve the problem, or just to listen and give you some moral support. One of the best tricks is to always tell the other person whether you want problem solving or listening. You can say “I have a problem, and I need to talk about about it, but I don't need you to fix it” or “I have a problem and I'd really like your ideas about it”. That allows the other person to prepare to give you the type of help you really want, if possible.
Calm yourself with meditation or deep breathing. A good method is 4-7-8 breathing: breathe in for four seconds, hold for seven, breathe out for eight. Deep breaths can lower your blood pressure, calm your heart rate and breathing, decrease the tension in you muscles, and clear your mind. Once you have calmed down, you can think more clearly and may be able to problem solve more effectively.
Sometimes frustrations come from trying to do everything. If one thing doesn't go well, it can cause you to spiral and the next thing doesn't go right either, and so on! Stop. You can't do everything! No one can! When you've cleared your mind, decide what you need to do right now. One thing! What is the most important thing to do at this moment? It may be writing an outline or making notes for your project. It may be getting something to eat. Whatever it is, do that first. Don't worry about the next things or what would happen if they aren't accomplished perfectly. Just do the one thing. When you finish that one, then stop and think about what the next most important thing to do is at that moment. It requires some focus to do one thing at a time, but it can be far less frustrating.
This week, the Hill Country Family Therapy website was down for several days. We tried calling/emailing with Google Domains, and frustration just kept building. It affected everything else as well- causing sleep problems, interfering with getting other things done, causing irritability all around. Eventually, we took a break, and stopped obsessing over it. When we stopped stressing, we found the right solution and the website was back.
Learning how to deal with frustrations takes practice. But, it can be very useful!
SOMETHING DIFFERENT
Are you tired of waiting on hold for your child's doctor's office? Do you have trouble getting an appointment for your child's well check or get an evaluation for a mental health issue? Do you leave messages and wait for hours or days, for someone to call you back? Do you get irritated by asking for help and telling the same story to the front desk staff, then the medical assistant, then the doctor? Do you have trouble getting refills of your child's medication without jumping through several hoops? Are you tired of calling doctor's offices and finding out they don't take new patients.
Big Sky Pediatrics is different in multiple ways.
1) If you call Big Sky Pediatrics, you talk with me, Dr. Cheryl Coldwater! I'm “it”, I am Big Sky Pediatrics. There are no staff people to go through.
2) I try to be accessible when you need me. You can call my office number, 512-553-1740, and I will answer.
3) If you have to leave a message, I call you back.
4) If you would rather, you can email me or text me, and I will respond.
5) If you need an appointment, I will set that up for you. I have my office in Marble Falls on Monday which is best for Well Checks.
6) I know your time is valuable, so virtual visits are available when you need them.
7) If we need to do a face-to-face visit on a non-Monday, we can meet at the park in Marble Falls or Burnet for a visit.
If you want to schedule your own appointment, you can easily do so on SimplePractice at https://big-sky-pediatrics.clientsecure.me
9) All of the new patient paperwork is available on the secure patient portal and goes directly into your child's medical record.
10) I accept Superior Medicaid, Blue Cross Blue Shield, United Health Care, and cash pay by PayPal or Venmo.
11) I love seeing my patients and I love meeting new ones.
If you want a different experience for a pediatric practice, Big Sky Pediatrics is here for you!
BACK TO SCHOOL- HOW TO HELP YOUR CHILD SUCCEED IN SCHOOL
With the beginning of the school year, many parents wonder how best to help their child. If you do too much, you may end up doing most of the work for them. If you do too little, your child may get frustrated or overwhelmed. Here are some ideas to help.
1. Have Positive Expectations - Work together to create goals. Do they need to participate more in class? Do some role playing at home. Do they need to get their homework done on time? Break it down into steps so they can start remembering to do each step in order (I'll give an example later). Don't focus too heavily on the grades, especially in elementary school. Your child will be far happier receiving an honest positive statement from you, than all the numbers and letters on the report card! “I really like how you did this drawing. The yellow color makes me feel happy” is better than an “A”. Young children don't really understand grading systems very well, anyway.
2. Have a Homework Routine – If your child has homework assignments, having a consistent routine may help. There is controversy about the benefits of homework in elementary school. If your child is really struggling to do the work, or it seems excessive, talk with your child's teacher or counselor. For older children, I like to break the routine into four parts-
A. Write down the assignment. You may think you will remember, but you might not.
B. Before leaving school, make sure you have all the things you need to do your homework. Check that you have the book, or the worksheet, etc.
C. Do the homework, sooner rather than later. If you put it off, you will be more tired and cranky, and it will take longer.
D. Put the homework back in your binder or backpack where you can find it easily. Otherwise, you get back to school and realize it's still on the table at home.
E. Go back and turn in the homework to your teacher.
Every step is critical. If you don't do each step, your homework doesn't get turned in on time. If you are having trouble getting it done, sit down and figure out which step is the problem and then work on that one specifically.
3. Connect with the teachers. If your child is having trouble, contact the teacher and see what's going on. Some kids have a lot of trouble asking for help, so no one knows they are really struggling until the grades start dropping. Every child is unique with individual educational needs. Work with the teacher to find the best approach for your child.
4. Help your child have healthy sleep habits. One of the most important steps is to limit screen time at least 30 minutes before bedtime. Have a consistent bedtime routine- turn off the electronics, take a bath or shower, brush teeth, use the bathroom, then get in bed and read a book to unwind and get ready for sleep. Make sure your child gets enough sleep (for most kids and teens 9-10 hours is appropriate).
5. Help your child in appropriate ways. You may need to help more with young kids- reviewing the instructions or working with them. Read to your child and encourage them to read independently- it's one of the most important things to do for their education! Avoid doing homework for your child. If it's too difficult or your child doesn't understand it, help them talk with their teacher. There are even times when it's okay to allow your child to fail! If your child is able to do the work, and is making poor choices, not doing assignments, not studying for tests, etc., sometimes, the best thing the parent can do is allow them to fail the test and have the natural consequences. If they have to retake a test, or do extra work to bring up their grade, they will understand that they actually have to do their own work to succeed.
6. Focus on solutions. If there is a problem, sit down and problem solve together. This also helps your student learn problem solving skills! Describe the concern and each of you come up with ideas. Then, discuss the benefits and risks of each idea. When you decide on a good approach, make a plan to activate it. If your child needs help, teach them how to ask for help appropriately. I like the expression “This is an experiment”. Everything is an experiment and we try things to see what works. If it doesn't work, try something else. It takes away the idea of “failure” when someone makes a mistake or their choices don't work out well. An experiment that doesn't turn out as expected isn't a failure; it's the beginning of the next experiment!
Remember, our goal as parents is to help our children succeed in school. We want them to be excited about learning, to enjoy reading, to work on a problem and overcome it, to get along with others, to seek help when needed, to develop self-discipline and understanding of new ideas. Those are the true gifts we give them in their education.
BACK TO SCHOOL- MORNING ROUTINES
It's nearly time for school to start back. One of the most difficult times for kids and parents is the morning routine. Trying to get your children dressed, fed, and ready to go to school can have you pulling your hair out and yelling every morning! It's not a great way for either of you to start the day.
Some basic ideas may help keep things a little smoother, so that everyone gets off to a good beginning.
1) Try to allow enough time that you don't have to rush so much. Make sure your child gets enough sleep so they can get up early enough. Give your child some positive attention for getting ready. Ten or fifteen minutes can make a huge difference in not having to feel so rushed.
2) Complete chores the night before when possible. Make lunches and have them ready to go. Lay out items for breakfast, or for kids who really dawdle, make a sack breakfast to go. You can pack dry cereal, a yogurt and plastic spoon, a peanut butter sandwich, a protein bar, or some fruit. Have your child shower or bathe and lay out their clothes for the next day. Pack the backpacks with the homework, signed forms, and everything your child will need for the day. Encourage your children to help with chores that are appropriate for them.
3) Offer encouragement. When your young child is making an effort, acknowledge that they are doing a good job. If they are moving too slowly, a gentle reminder can help move them along. “We are going to leave for school in 15 minutes. It looks like you still need your shoes and socks on. Can you do that, or do you need some help?”.
4) Have reasonable expectations. Do expect your child to help with appropriate activities, but be aware that a younger child may not be able to do everything and frustration can develop. Give your child one task at a time. If they are focused on getting shoes on, don't bombard them with several other directions at the same time. They may forget the initial job they were working on.
5) Avoid discussing problems during the morning routine. If there are issues with getting ready, or school concerns, or questions about behavior, these are best addressed at another time, when everyone can sit down and talk about them calmly. Then you can problem solve together and come up with ideas to help make the morning run smoothly. During the morning routine, keep things as structured as possible so that everyone knows their part in the schedule.
6) Get out the door. If your child is really having trouble or being uncooperative, use the extra few minutes you built into the schedule to just get them ready with a minimum of fuss. Don't scold them or chat; just do what is needed to leave. “I see you are having trouble getting ready. I'm going to help you right now so we can get going and you can get to school on time”.
7) Breathe!! There will days that things don't go well. Don't dwell on them or get angry. My favourite book for my kids was “Alexander and the Terrible, Horrible, No Good, Very Bad Day”. When everything has gone wrong for Alexander, and he keeps threatening to move to Australia, his mom tells him that “Some days are like that. Even in Australia”! This became our shorthand for explaining that everybody has a bad day once in a while. We move on and, generally, another day will be better!
SUMMER SAFETY
Summer is about half-way over, but it's never too late to remember about safety! Here are a few quick tips.
1) SUNSCREEN! Apply a 30 SPF or higher sunscreen everyday you are outdoors. Reapply in an hour or so, and keep reapplying when you are outside. Even if it is a cloudy day, you can still get a serious sunburn. Babies should not be in the direct sun at all- they can get severely burned in a few minutes, and be miserable for days! Even for quick outings, keep them in light clothes and sunhats, under an umbrella or protected by a cover in the stroller.
2) WATER SAFETY! If you have a pool or hot tub at home, make sure it is enclosed with a fence with a self-closing, self-locking gate. There should ALWAYS be an adult Water Watcher when children or in or around the water. They should actually be within arm's length of young children or beginner swimmers. When supervising them, you really have to keep an eye on them- not on your phone, not drinking, not socializing. Children can have drowning accidents when adults are nearby but not directly watching them! Teach your kids to follow all the safety rules at the pool, on the boat, or at the lake. Set a good example for your children by following the rules yourself, particularly avoiding use of alcohol or drugs in and around the water.
3) HEAT AND DEHYDRATION! Our very hot temperatures can cause serious illness when people get dehydrated. Children typically do not drink as much water as needed, and waiting until they feel thirsty is not a good indicator. If your child feels nauseous, dizzy, has muscle cramps, headache or irritability, they may be suffering from heat cramps or, even, heat exhaustion! Bring them inside, to a cool area, give them water or Gatorade, cool them off with a wet cloth or put them in a tepid bath. If they are vomiting and unable to keep down fluids, they may need to go to Urgent Care or the ER.
You can prevent most heat illness by giving your child frequent fluids, making sure they take breaks from vigorous exercise in the heat, and try to limit strenuous activity to cooler parts of the day.
4) CAR SAFETY! NEVER leave your child alone in a vehicle, even for a few minutes, especially during warm weather. The temperature can climb very quickly and become life-threatening. The same holds true for your pets. Animals are extremely sensitive to the high temperatures in a vehicle, even with the windows partially open. If the outside temperature is 95 degrees, the temp in the car can reach 115 degrees in less than 10 minutes! With Texas temperatures reaching over 100 degrees during much of our summer, NO period of time is safe for a child or pet in a vehicle.
NEW INFORMATION ABOUT THE NATIONAL SUICIDE PREVENTION LIFELINE!
**THE LIFELINE AND 988**
988 has been designated as the new three-digit dialing code that will route callers to the National Suicide Prevention Lifeline. While some areas may be currently able to connect to the Lifeline by dialing 988, this dialing code will be available to everyone across the United States starting on July 16, 2022.
When people call, text, or chat 988, they will be connected to trained counselors that are part of the existing National Suicide Prevention Lifeline network. These trained counselors will listen, understand how their problems are affecting them, provide support, and connect them to resources if necessary.
The current Lifeline phone number (1-800-273-8255) will always remain available to people in emotional distress or suicidal crisis, even after 988 is launched nationally.
The Lifeline’s network of over 200 crisis centers has been in operation since 2005, and has been proven to be effective. It’s the counselors at these local crisis centers who answer the contacts the Lifeline receives every day. Numerous studies have shown that callers feel less suicidal, less depressed, less overwhelmed and more hopeful after speaking with a Lifeline counselor.
GUN SAFETY
I know this is a subject that many people worry about and many people don't want to talk about. But the fact is that there are firearms everywhere. Some people have a hand gun, or rifle, or shotgun, or all of the above in their homes. Some people have none of those.
In a 2020 report, FIREARMS became the leading cause of death in children and teenagers. Previously (for the last 60 years), car accidents were the leading cause of death, but the risk of firearm death has increased drastically. Between 2019 and 2020, firearm deaths for people aged 1-19 increased by 30% (which is a massive jump!). For children, 65% of firearm deaths are homicides and 35% are categorized as suicide. Mass shootings, such as the event in Uvalde recently, contribute to those numbers, but the majority are firearm deaths at home, and in one's own neighborhood. These are daily occurrences!
Over all, there were a record 45,222 firearm-related deaths in the U.S. in 2020! Between 2015 and 2020, there were at least 2,070 unintentional shootings by children that resulted in 765 deaths and 1,366 nonfatal gun injuries. In 2020 alone, at least 125 toddlers and children age 5 and under shot themselves or someone else.
Firearm deaths, especially those affecting children and teens, are preventable. Straight-forward, common sense safety procedures can prevent a majority of the death and injuries. This starts at home.
THE SAFEST HOME FOR A CHILD IS ONE WITHOUT GUNS AT ALL.
If you do keep guns in your home, these are some of the basic safety rules-
*All guns in your home should be locked and unloaded, with ammunition locked separately.
*Use a gun safe and make sure children and teens can't access the keys or combinations to lock boxes or gun safes.
*Don't keep loaded, unlocked guns in the car, or anywhere else on your property.
*When using a gun for hunting or target practice, keep the safety catch in place until you are ready to fire it
*Before setting the gun down, always unload it.
*Teach your child never to touch a firearm if they find one, and to always assume that it is loaded and dangerous.
*No matter how much instruction you may give about how to safely shoot a gun, children are not capable or responsible enough to handle a potentially lethal weapon.
The other major risks to your child are guns kept in other people's homes. Your child probably visits friends, neighbors, and relatives, and you may have no idea whether or not they have firearms in their home.
To keep your kids safe in other homes-
*Ask the question! “Is there an unlocked gun in your house”. You may ask about other safety issues such as allergy issues or who will be supervising the children. Just include this in your usual questions before your child goes to another person's home.
*Remind your children that if they ever come across a gun, they should not touch it at all and tell you immediately.
It is important for all of us to protect our children. Keeping children safe is the highest priority!!
Are You Where You Thought You’d Be?
03/18/2022
In two weeks, I will be 65 years old, officially on Medicare, and officially in AARP! Those are some significant milestones for many people. But there are a ton of other important milestones in our lives. Finishing school (at whatever level), starting or leaving jobs, getting married or divorced, mourning the deaths of people in our lives, and celebrating the births of others. They all can have an effect on a person, in one way or another.
So, are you where you thought you'd be? Did you plan to start your career and earn a good income to be able to afford what you want? Did you plan to marry your best friend and stay together forever? Did you have an unexpected change in your life? Did you wish for one outcome, and find yourself in a completely different situation?
I can honestly say that many of these things have occurred to me. I have had meaningful work as a pediatrician, where I thought my efforts were appreciated, and then found that they weren't always. I've fallen down and had to start over again, more than once. I had a marriage for a long time. We both grew in different directions and got divorced. That led me to finding my current husband, the love of my life! My husband has lost his first wife, suffered a serious injury, changed careers, remarried (me!) and had major surgery. Everyone I know has been through one or more of these life changes, whether they turned out the way they planned, or not.
I don't think any of us planned for a global pandemic and the effects it would have on all of us. People have lost loved ones, lost job situations, had to move, or had to change their school or work environment. It's been an enormous stress for nearly everyone, even if they had some beneficial results in the process (ie. some people found that working at home was a much better fit for them and want to continue to do that). We may have all been in the same “boat”, but we didn't all have the same experience.
It is common for people to think about what they thought would happen in their lives, and compare to where they really are now. That can lead to feelings of disappointment, frustration, anger, sadness. Depression and other mental or emotional problems can be a result of unfulfilled ambitions. When people have expectations about how other people will react or behave, there is the possibility that the other person's expectations may be very different.
How can we handle these feelings in a healthy way? Believe it or not, it actually can help to identify the disappointment. Acknowledging to yourself that you really hoped that your efforts would lead in a certain direction and they didn't can help you cope. Remember that it's okay to have those feelings. Trying to make the feelings “just go away” can make you feel worse! Accepting that you have an emotion, such as disappointment, allows it to gradually fade with time. Asking for help is a great skill to learn. Sharing your thoughts and feelings can help you find more balance. Another person may be able to help you focus your energy to help others.
If you find yourself creating rigid expectations, you may be setting up for more disappointment. Instead of thinking that everything must go exactly one way for it to be a success, you may want to have some flexibility. You can show yourself, and others, that being able to adapt to changes in plans or dealing with new obstacles can be healthier. “Getting lost on a road trip” can turn into “We're taking the scenic route”. If someone frequently disappoints you (they are always “late” on your schedule), you may not be able to change them, but you can manage your own expectations. Give them an earlier time to arrive, so when they are “late”, they will be there when you need them. Change your own behavior- if you always wait on dinner for them, and they can't make it on time, go ahead and eat with the other people and just save some food for the late-comer. I've had patients tell me they were “supposed to be in 4th grade, but I'm just in 3rd”. I explain that if they are in 3rd grade, that is where they are supposed to be! I've always found that the first rule of parenthood is “Be Flexible”; now, I realize it's really the first rule of life!
So, maybe you aren't exactly where you thought you'd be, but you are where you are right now! Be present. Accept your current status. That doesn't mean you won't continue to try new things, improve your situation. But, if this is where you are, that is okay.
TRANSGENDER AND NON-BINARY CHILDREN
Children are taught at a very young age that they are a “boy” or a “girl”, mainly based on their physical appearance. Many children may go through times where they announce that they are the other gender, or wish to play with “boy” or “girl” toys, or dress in different ways. These behaviors change from time to time, but the child is rarely consistent about being different.
A transgender child realizes (also at a fairly young age in some situations) that they don't feel like the gender they have been told is theirs. It is not a passing phase and the children continue to say that they are really a different gender for several months or even years. Non-Binary children may not be able to explain themselves as simply, but they realize that they don't necessarily feel like either gender all the time.
It's important to understand that “gender” does not mean “sex”. Gender is your identity as a male or female, or both or neither. Sexual orientation involves your attraction to other people for intimate relationships. While some people argue that children can't know if they are transgender, we do know that they have a clear understanding of what gender they are, far before they understand their sexual orientation. Do you remember when you were young and someone asked you if you were a boy or a girl? If you said you were a boy, and someone kept saying you were a girl, did you argue with them that they were wrong?? You knew who you really were, as young as 2 or 3 years old. Now, if you really felt like a girl and people kept telling you that you were a boy, you would feel strange and may be likely to be upset about it.
This is what happens to transgender children. They feel very strongly that they are a different gender than the one that people say they are. They may not always be able to express it clearly until later, but they frequently feel this way from a young age. Many children and teens experience “gender dysphoria” which is an emotional condition caused by the disconnect between who they feel they are and how others see them. It can cause severe anxiety or depression, result in bullying and other forms of abuse, and may cause a significantly higher risk of suicide. A study of transgender teens found that more than 50 percent of transgender males and almost 30 percent of transgender females reported attempting suicide!
The most important factor in helping prevent these serious problems is family support! Children who are supported and unconditionally loved will have improved mental health and well-being. Accepting your child can involve using the gender pronoun they want (for example, if they are a transgender female and they want to be referred to as “she”, then you use that term), using the name they want (which may not be the name you gave them at birth), and supporting their choices for their appearance and activities. Parents who take the time to educate themselves about transgender children can make a huge difference! That also extends to being a strong advocate for your child- talk with their school and make sure they are being supported, correct others who refer to your child with their old name or gender, stand up against transphobia (and other forms of discrimination), and teach your child to stand up for themselves when it is safe to do so.
If you think your child is transgender or non-binary, talk with your child's doctor. A gender-affirming provider can help you navigate the resources available. Many of those resources will depend on the age of your child. A young child will appreciate being called by their name and gender, and allowed to dress as they feel comfortable. Children who show anxiety or depression problems should be evaluated for possible medication and/or psychotherapy. Older children may have questions about hormone treatments, preventing menstrual periods, or blocking puberty. As a teen nears adulthood, they may want to talk about changing their body, questions about what their sexual orientation means to them, and how to safely explore relationships as an adult.
Dr Cheryl Coldwater is a Board-Certified Pediatrician with a background in Pediatric Mental Health. She has experience working with LGBTQ+ children and teens. You can schedule an appointment on SimplePractice.com for an office visit, virtual appointment, or a meeting in the park where we can safely distance as needed.
BEHAVIOR PROBLEMS IN TEENS AND PRETEENS
BEHAVIOR PROBLEMS IN TEENS AND PRETEENS
Your preteen or adolescent is going through enormous changes in a few short years. They are physically changing – height, weight, sexual development, skin changes, and a vast number of neurological changes. These can be related to emotional and psychological changes as well.
An important part of their development into happy, healthy adults is to want more independence, spending more time with peers than their family. The parents' job is to set appropriate limits, teach resilience, and help them learn how to have positive relationships.
Some common behaviors that some families find to be challenging are being argumentative, disrespectful in words or actions, moodiness and extremes of emotions, and aggressive or violent behavior. Challenging behavior and changes in mood are a normal part of adolescence, but if it is extreme it may be concerning. Most behaviors or emotional periods should not last more than a few days. If your teen is showing on-going sadness, frustration, isolation from all social activities or violent behavior, you should talk with your teenager's primary care provider.
Their brains are still developing (until the mid twenties), and they may have very intense emotions without the coping tools to deal with them. This results in them being very sensitive, self-conscious, and sometimes, overwhelmed by their feelings. These can be accentuated by poor sleep or dietary habits.
The best way that you, as a parent, can help is to set good examples by having healthy habits yourself, listening to your teenager in a compassionate way, showing interest in their activities (without prying), asking them if they want you to help them with an issue before giving your opinions, and demonstrating effective problem solving skills yourself, without anger.
Some simple guidelines can help when you are having arguments with your adolescent. First, avoid arguments when you can. Ignore little things like eye rolling or muttering if your child is otherwise behaving appropriately. Avoid nagging- they tend to tune out and it will increase your frustration. Defuse arguments (with you or other family members) by listening to each person's opinion and working together to find a solution. Try to stay calm, even if your child reacts with attitude. Pay attention to what the real problems may be. If things get too heated, take a break from each other to calm down and then have a more reasonable discussion.
Your teen may test the boundaries as they exert their independence. Have clear boundaries which have been discussed with your teen. Explain the consequences of breaking rules and make sure they are understood. Natural consequences are most effective. If your teenager stays out past a curfew time without calling, they may lose the privilege of going out in the evening for a set period of time. Failure to do their expected household chores may result in restriction from doing an enjoyable activity until the chores are completed. If they damage property, they may have to repair or replace it, earning money with extra work. Avoid yelling at your teen, shaming or humiliating them, or any physical punishment for behaviors. They tend to cause more behavior problems and don't help them learn effective ways to handle their frustration or anger.
Persistent or severe behavior problems should be discussed with a Pediatrician. There may be other physical or mental health problems that need to be evaluated. Dr. Cheryl Coldwater is a pediatrician with experience evaluating and treating children and adolescents with pediatric mental health issues. You can schedule an appointment on SimplePractice.com for an office visit, virtual appointment, or a meeting in the park where we can safely distance as needed.
CHILDHOOD BEHAVIOR PROBLEMS
Are your children driving you bonkers?? Do you wonder if they lay awake at night thinking of ways to frustrate you? Do you think they wait until you have your hands full and you are busy to interrupt with a strange question? Well, I have often said that “Their job is to test; and they practice all the time!”
But when is it normal childhood behavior, and when is it a sign that your child is having emotional problems? Certainly, children do think differently, and may have ideas and behaviors unique to them. When you are trying to get them ready for daycare or school, their minds may be on something else entirely. They can be extremely creative and come up with all sorts of stories. They see the trip to the grocery store as a great adventure and want to wander all over to explore it. They may try out words they've heard without knowing what they mean and enjoy getting a reaction from you. Children are less likely to lie than many parents think. Their idea of a “truth” just may not be the same as yours.
But most of the time, children can learn to behave appropriately with positive reinforcement. It helps to divide actions into the “Big Stuff” and the “Little Stuff”. Big Stuff is like hitting, biting, throwing things, or jumping off things- behaviors that can hurt your child or someone else. Time out may be needed. Removing your child from the activity for a moment or two (one minute per year of age) helps them understand that they can't keep doing it. Little Stuff is behavior you would rather your child didn't do, but isn't dangerous. The best approach is to distract them to something else. If your child is playing with the TV remote, you can give them a different toy and remind them that “this is your toy; the remote is for mommy and daddy”. That helps you avoid saying “No” all day long! If you say “No” all the time, you will hear “No” back all the time! Neither spanking nor shaming your child is an effective way to control your child's behavior. Natural consequences are far preferable to help children learn how to act.
On the other hand, if your child seems to be terribly unhappy or fearful, there may be a more serious problem. If your child cries frequently and can't be consoled by you, they may be having anxiety or depression problems. Children don't always come and tell you how they feel, and emotional problems can show up as behavior problems- acting out, speaking rudely, breaking things, and other worrisome behaviors. If you have concerns about your child's behavior, you may need to talk with your pediatrician. Dr. Cheryl Coldwater is a pediatrician with experience evaluating and treating children with pediatric mental health issues. You can schedule an appointment on SimplePractice.com for an office visit, virtual appointment, or a meeting in the park where we can safely distance as needed.
My next post will discuss pre-teens and adolescents, who have their own issues!
Adjustment Disorders
What is an adjustment disorder? In the DSM-V (the manual that contains criteria for all sorts of psychiatric problems), it is defined as an emotional or behavior reaction to a stressful event or changes. When the reaction occurs within 3 months after the event, is out of proportion for what would be expected in that situation, and is causing symptoms which can significantly interfere with your child's functioning (at home, school, socially, etc), it is a good idea to have your child evaluated by a pediatric mental health provider.
Changes happen in our children's or adolescents' lives all the time. They may be fairly minor such as a new teacher or they may be fairly major such as parental divorce, family move, new baby in the house, or a serious illness (in the child or a family member). How your child responds may be related to several factors- their age, their usual temperament (how easily do they adjust to most changes), past experiences (have they had other trauma or loss), their support systems (family, friends, teachers, etc), and their overall coping skills. Even the same experience (such as a family move to a new house) can cause different reactions in different children.
Although adults also can have Adjustment Disorders, the symptoms in children may look different. When a child is having trouble adjusting to a change, it can show up with more frequent crying, fear of separation (beyond the usual age for developmental separation anxiety), nervousness, sleep problems, appetite changes, anger and aggressive behavior, and school problems (difficulty with focus, difficulty with controlling behavior, difficulty with peers).
There are different types of Adjustment Disorders based on the main types of symptoms your child or teen may be having.
1) Adjustment Disorder with Depression
2) Adjustment Disorder with Anxiety
3) Adjustment Disorder with Anxiety and Depression
4) Adjustment Disorder with Disturbance of Conduct
5) Adjustment Disorder with Mixed Disturbance of Emotions and Conduct
6) Adjustment Disorder Unspecified (which can be social withdrawal or problems with normally expected activities, like school or other activities)
Sometimes, it can be difficult to tell if your child's behavior is due to an Adjustment Disorder or some other problem. Children with ADHD may have trouble with focus and attention, but a child with an Adjustment Disorder may also not be able to focus well or finish their work. Some children with conduct disorders may be thought to have an Oppositional Defiant Disorder, because they are acting out or breaking rules, but the underlying problem may be very different. Substance abuse problems can cause teens to isolate themselves or appear depressed.
If your child or teen is showing signs of an Adjustment Disorder, a good Psychotherapist may be helpful. They can help your child develop better coping skills to adapt to change, as well as helping reduce the stress. A Family Therapist can help your family handle the change as well, improving communication skills and support among family members. Seeing your child's Pediatrician can help identify whether the symptoms are due to an Adjustment Disorder or some other problem. Most adjustment disorders improve within 6 months after the stressor is removed or reduced. Problems that continue may be attributed to Post-Traumatic Stress Disorder or an Anxiety Disorder or other diagnoses.
Dr. Cheryl Coldwater is a pediatrician with experience evaluating and treating children and adolescents with pediatric mental health issues. You can schedule an appointment on SimplePractice.com for an office visit, virtual appointment, or a meeting in the park where we can safely distance as needed.
Things In The Nose
What do you do if your child puts a bead up their nose? Or some other small object? This question came up today in another group.
First, make sure your child is breathing okay and not choking. Don't try to fish out the object- you are more likely to just push it back further.
Have your child lie down and you tell them you are going to blow in their mouth. Most children will accept this idea, as silly as it sounds! Close the other nostril with your finger, and cover the child's mouth with yours. Blow sharply into their mouth. Frequently, the first try is not hard enough, so try again with a bigger breath.
The pressure of the air will push the bead out of the nostril, probably bumping off of your own cheek, usually with a good amount of slime! (That's why I have the parent do it rather than doing it myself!).
If you have tried this a few times and can't get it to come out, you may need to see a doctor.
NEW YEAR’S WISHES
What do you wish for the New Year? Some people make New Year's resolutions, many of which barely make it through January. Some people specifically refuse to make New Year's resolutions because they find them unhelpful or counterproductive. But, what would you wish for?? That's a different question.
Maybe you wish for yourself or your family to be healthier. Maybe you wish for your relationship with your spouse to be better. Maybe you wish for your children to be better behaved or do better in school. Maybe you wish for a better job (by whatever measurement you choose). Maybe you wish to improve your education.
Whatever it might be, it can start as a wish. Obviously, wishing doesn't make things happen. Wishing doesn't solve a problem or change situations. But it can be a way of putting our ideas into perspective.
There is a great trick that can be used with children when they want something that we can't give them. Perhaps you are driving with them and they are crying because they want something to eat or drink, right now. You can't provide that at this minute. If you just argue with them and say “We'll be home in a little while and you can eat or drink then”, you may not make them feel any better. But, if you give them in wishes what you can't provide in reality, you encourage them to think differently about the situation. Humour and absurdity can help also. You may tell them “Do you wish you had a whole bucketful of water? Do you wish the whole car was full of water? Do you wish you had a whole mountain of food?” and it is likely you will have them giggling rather than whining.
First, you wish, then you can think about what you might do. It's easiest to start small. It doesn't take much to be kind to someone, whether a friend or a stranger. Try something new- make something, go somewhere you've never been, read a new book, learn how to cook something, dance or sing or do something you always wanted to do but were afraid you wouldn't be able to do perfectly. Stop worrying about perfect! Do the thing for yourself, and don't pay any attention to what someone else might think. Do a little exercise- go for a walk, do some yoga, find an activity you enjoy. Call a friend. Listen to your significant other or your child without interruption (just let them tell you how they feel). Don't necessarily focus on a long term goal or a large project. Do one thing at a time and then, give your own self positive feedback. “Yay for me! I did it!!”
My favourite New Year's messages are from Neil Gaiman who has written them on several occasions. One of them, written in 2004, was “I hope you will have a wonderful year, that you'll dream dangerously and outrageously, that you'll make something that didn't exist before you made it, that you will be loved and that you will be liked, and that you will have people to love and to like in return. And, most importantly (because I think there should be more kindness and more wisdom in the world right now), that you will, when you need to be, be wise, and that you will always be kind.”
What do you wish?
Holiday Feelings
HOLIDAY FEELINGS
How do you prepare for the holidays? Do you decorate your home? Do you buy gifts for family and friends? Do you cook special foods? Do you have specific religious rituals? Do you travel to see others or do others visit you?
People have many different ways to celebrate their holidays, as individual as our cultural experiences, our religions (or absence thereof), our family traditions, and our own personal situations. How you choose to prepare can result in feelings of joy, anxiety, excitement, depression, uncertainty, happiness, and exhaustion! Maybe you are a person who tries to do everything and you want it all to be just right. Maybe you're facing a holiday without your family due to COVID restrictions. Maybe you have experienced a loss (it could be recent, or even many years ago) and your grief is much worse during the holiday season because you are without your loved one. Maybe you are in a new situation and don't really know how you want to celebrate the holiday now.
It is common to have some painful or difficult feelings occur during holiday times. There can be a sense around us of “forced merriment” as we are expected to be joyful all the time. It isn't always possible, especially if you already have emotional problems or you are dealing with a family crisis. You may just want to stay home and not acknowledge the holiday at all. You may want to avoid certain family members and have a gathering of a couple of your “chosen family members” to prevent added stress. You may feel isolated and unable to reach out to others at all. You may have a history of past trauma that gets stirred up when you hear a certain Christmas carol or see a certain holiday movie. Other triggers can be completely unpredictable.
Taking care of yourself is extremely important to your own mental health. If you are trying to do the decorating and shopping and cooking all at once, take breaks! Delegate what you can. Use short cuts – buy some prepared foods to go with the homemade ones, use gift bags rather than wrapping everything, use simple tricks to make things as easy as you can. Get children or other family members involved in doing things. Take time for self-care: get some exercise, take a relaxing bath, go for a walk with a friend, listen to some calming music, whatever helps to reduce your stress.
If you just can't do it all, scale it down. Talk with your family and decide what is really the most important part of the holiday for each of you. You may find that the thing you were going to spend a lot of time on isn't even important to your family members and you can skip it, do less of it than you planned, or put it off until after the major holiday days are over!
If the holidays are especially hard for you, you may need a good psychotherapist to help you. For more information about how therapy can help with these problems, contact Martin Noel, LMFT-Associate at Hill Country Family Therapy. If you feel lost or alone, call for help. The Emergency Psychiatric Hotline, 1-800-273-8255, is available for you to talk with a mental health professional at any time. You are not alone!
Worrying
WORRYING
Do you worry about everything?? Do you get nervous about going to a new place or meeting new people? Do you worry about what might happen tomorrow, or next week, or next year? Do you get anxious speaking in public, or talking to a stranger? Do you worry about not fitting in with a group at school? Do relatively minor disruptions cause you to feel the entire day was ruined?
Most people worry some of the time. It's natural to think about “what ifs” and try to control situations to make things go more smoothly. It's common to have certain fears, such as fear of flying in a plane, fear of heights, fear of being ridiculed, etc. We try to plan for problems and avoid troublesome situations. Some of it is simple safety. We try not to walk down dark alleys in unfamiliar places. We put on our seat belts and look both ways before crossing the street.
But sometimes, worrying can become more extreme. Some people will worry so much that it is very difficult for them to leave their home or to go anywhere new. Some people will develop anxieties that lead to OCD (Obsessive Compulsive Disorders) where they constantly feel the need to have objects in the same place, or feel the need to wash their hands or do other rituals to feel any relief of their anxiety. Sometimes, people can worry so much that it seriously affects their ability to go to school or to work.
It may help to think of worries in two categories. There are worries about something you can do something about. If you have a test coming up, worrying may help you have the motivation to study for the exam so you will do your best. If you have an interview or meeting, worrying may help you prepare and rehearse what you want to say. Worrying about things you can change or prepare for can be beneficial.
The other types of worries are those in which you can do nothing. You can't control what other people do or say. You can't control all of the possible events of the day. You can't control “world peace” (as I tell my patients)- not by yourself! These worries don't benefit you at all. They can cause more distress and further anxieties to develop.
At times, we may be able to dismiss the people and situations beyond our control and just accept that worrying over them will not help. At other times, we may feel overwhelmed by them and be unable to get past that point. We can get stuck worrying about what someone said or might say or do. We can become hyper-focused on what might go wrong, even though we can rationally understand that we can't control it.
If you feel your worries are causing a negative impact on your life, or preventing you from being able to enjoy things as you would like, you may need some help. Dr. Cheryl Coldwater is an experienced Pediatric Mental Health provider who can help children and teenagers with these problems. You can schedule an appointment on SimplePractice.com for an office visit, virtual appointment, or a meeting in the park where we can safely distance as needed.
Stressed Out Kids
I wrote this piece several years ago for a local newspaper. In the middle of our COVID pandemic, it is more true than ever.
STRESSED OUT KIDS
Stress is much more common in children and adolescents than most people imagine. Everyone experiences stress at some time, but some kids have a lot more trouble dealing with it. It can also be a cumulative effect- one thing after another until it is overwhelming. The “final straw” can be a simple thing, but it can be combined with other stresses until it is no longer manageable.
For many kids and teens, school can be a stressful environment. There is more pressure to succeed at an earlier age. Kindergartners are expected to have skills previously expected in first and second graders. Students can become very anxious about STAAR testing and may present with stress-related symptoms, including headaches, stomach aches, sleep and appetite changes, school avoidance behavior, and other psychological concerns. Pressure from teachers or parents regarding grades, sports activities and other extracurricular activities may leave some students with little chance to relax. Bullying at school has become a serious source of stress in children and they frequently hesitate to talk with anyone about it.
Children and teens may also have stress due to family situations, such as recent moves, change of school, new siblings or divorce. Kids may notice more than you think when there are household changes due to financial difficulties or illnesses, and feel stress when they don't understand what is happening. Children with a family history for mental illness may be more prone to having severe depression or anxiety issues which may require mental health treatment.
Everybody has stress; it's what you do with it that's important. Children may handle stress differently than adults. Frequently, children hold anxieties inside, and actually become sick from it. It can affect their sleep, appetite, enjoyment of other activities, school performance, as well as cause frequent headaches and stomach problems. Children may act out when they are stressed- hitting, yelling, crying frequently, calling names, or testing their school or home rules with inappropriate behavior. Adolescents may develop self-destructive behaviors such as drinking alcohol, smoking, experimenting with drugs, unsafe sex practices, or self- harm (such as cutting or even attempted suicide).
Helping your child learn to deal with stress starts early.
*Teach your child to deal with frustrations by taking deep breaths, and then trying something a different way or asking for assistance.
*Help them understand that no one is perfect, and you don't expect them to be.
*Remind them that you love them, no matter what.
*Acknowledge their mistakes and help them learn from them rather than feeling that they have failed.
*Demonstrate a positive attitude- show your child that being optimistic can change their outlook. Point out the good in a situation rather than focus on the negative aspects.
*Teach your child to have healthy habits- eat nutritious food, drink plenty of water, get a good night's sleep, avoid alcohol, smoking, and drugs, and exercise regularly.
*Help your child or teen find activities which they enjoy for stress relief.
*Physical exercise is a great way to burn off stress- a walk, riding a bicycle, going to a gym, take a yoga class, playing a sport for fun, or just playing outdoors.
*Help your child or adolescent explore their creativity- art, music, dance, writing, building, cooking, yarn-work- anything that allows your child to express their individuality can be great for the self-esteem.
*When you praise their work, show your child that you notice their efforts and the specific details which are unique to them, such as “I love how you use purple in this painting. It really makes me happy to look at it”. Overpraising a child by telling them they are the “best artist in the world” can backfire and cause the child to be afraid of not being able to live up to your expectation.
*Don't over-schedule your child. Allow some down-time for your child to play, relax, and spend time alone or with friends.
Lastly, teach your child or teen that it is good to ask for help when they are over-stressed, having physical concerns, or feeling overwhelmed. Help your child understand that requesting help from you, a teacher, a doctor, or other trusted adult is a healthy choice, not a sign that they have failed in any way. If you are worried about your child's stress, Dr Cheryl Coldwater may be able to help. She may be able to recommend a therapist, discuss ways to reduce stressful triggers and handle everyday stresses in a more healthy manner, prescribe medication if necessary, or refer you to a specialist. If you'd like to schedule an appointment, go to https://big-sky-pediatrics.clientsecure.me/ or contact Dr. Coldwater at doctormom457@yahoo.com