Children/Teens & Alcohol

As much as moms & dads may not like to think about it, the truth is that many children and teenagers try alcohol during their high school and college years, long before it's legal for them to drink it. Research has shown that nearly 80% of high school children have tried alcohol.

Although experimentation with alcohol may be common among children, it's not safe or legal. So it's important to start discussing alcohol use and abuse with your children at an early age and keep talking about it as they grow up.

Alcohol interferes with a person's perception of reality and ability to make good decisions. This can be particularly hazardous for children and teenagers who have less problem-solving and decision-making experience.

Short-term effects of drinking include:

·altered perceptions and emotions
·bad breath
·distorted vision, hearing, and coordination
·hangovers
·impaired judgment, which can lead to accidents, drowning, and other risky behaviors like unsafe sex and drug use

Long-term effects include:

· an increased risk of impotence
· cirrhosis and cancer of the liver
· heart and central nervous system damage
· high risk for overdosing
· loss of appetite
· memory loss
· serious vitamin deficiencies
· stomach ailments

Long before your children are presented with a chance to drink alcohol, you can increase the chances that they'll just say "no."

Childhood is a time of learning and discovery, so it's important to encourage children to ask questions, even ones that might be hard to answer. Open, honest, age- appropriate communication now sets the stage for your children to come to you later with other difficult topics or problems.

Preschoolers—

Although 3- and 4-year-olds aren't ready to learn the facts about alcohol or other drugs, they start to develop the decision-making and problem-solving skills they will need later on. You can help them develop those skills in some simple ways.

For instance, let toddlers choose their own clothing and don't worry if the choices don't match. This lets them know you think they're capable of making good decisions. Assign simple tasks and let children know what a big help they are.

And set a good example of the behavior that you want your children to demonstrate. This is especially true in the preschool years when children tend to imitate adults' actions as a way of learning. So, by being active, eating healthy, and drinking responsibly, moms & dads teach their children important lessons early on.

Ages 4 to 7—

Children this age still think and learn mostly by experience and don't have a good understanding of things that will happen in the future. So keep discussions about alcohol in the present tense and relate them to things that children know and understand. For example, watching TV with your child can provide a chance to talk about advertising messages. Ask about the ads you see and encourage children to ask questions too.

Children are interested in how their bodies work, so this is a good time to talk about maintaining good health and avoiding substances that might harm the body. Talk about how alcohol hurts a person's ability to see, hear, and walk without tripping; it alters the way people feel; and it makes it hard to judge things like whether the water is too deep or if there's a car coming too close. And it gives people bad breath and a headache!

Ages 8 to 11—

The later elementary school years are a crucial time in which you can influence your child's decisions about alcohol use. Children at this age tend to love to learn facts, especially strange ones, and are eager to learn how things work and what sources of information are available to them.

So it's a good time to openly discuss facts about alcohol: its long- and short-term effects and consequences, its physical effects, and why it's especially dangerous for growing bodies.

Children also can be heavily influenced by friends now. Their interests may be determined by what their peers think. So teach your child to say "no" to peer pressure, and discuss the importance of thinking and acting as an individual.

Casual discussions about alcohol and friends can take place at the dinner table as part of your normal conversation: "I've been reading about young children using alcohol. Do you ever hear about children using alcohol or other drugs in your school?"

Ages 12 to 17—

By the teen years, your children should know the facts about alcohol and your attitudes and beliefs about substance abuse. So use this time to reinforce what you've already taught them and focus on keeping the lines of communication open.

Teenagers are more likely to engage in risky behaviors, and their increasing need for independence may make them want to defy their moms & dads' wishes or instructions. But if you make your teen feel accepted and respected as an individual, you increase the chances that your child will try to be open with you.

Children want to be liked and accepted by their peers, and they need a certain degree of privacy and trust. Avoid excessive preaching and threats, and instead, emphasize your love and concern. Even when they're annoyed by parental interest and questions, teenagers still recognize that it comes with the territory.

Teaching Children to Say "No"—

Teach children a variety of approaches to deal with offers of alcohol:

·Encourage them to ask questions. If a drink of any kind is offered, they should ask, "What is it?" and "Where did you get it?"
·Remind them to leave any uncomfortable situation. Make sure they have money for transportation or a phone number where you or another responsible adult can be reached.
·Teach children never to accept a ride from someone who has been drinking. Some moms & dads find that offering to pick up their children from an uncomfortable situation — no questions asked — helps encourage children to be honest and call when they need help.
·Teach them to say "no, thanks" when the drink offered is an alcoholic one.

Risk Factors—

Times of transition, such as the onset of puberty or a moms & dads' divorce, can lead children to alcohol use. So teach your children that even when life is upsetting or stressful, drinking alcohol as an escape can make a bad situation much worse.

Children who have problems with self-control or low self-esteem are more likely to abuse alcohol. They may not believe that they can handle their problems and frustrations without using something to make them feel better.

Children without a sense of connectedness with their families or who feel different in some way (appearance, economic circumstances, etc.) may also be at risk. Those who find it hard to believe in themselves desperately need the love and support of moms & dads or other family members.

In fact, not wanting to harm the relationships between themselves and the adults who care about them is the most common reason that young people give for not using alcohol and other drugs.

Fortunately, moms & dads can do much to protect their children from using and abusing alcohol:

·Try to be conscious of how you can help build your child's self-esteem. For example, children are more likely to feel good about themselves if you emphasize their strengths and positively reinforce healthy behaviors.
·Teach children to manage stress in healthy ways, such as by seeking help from a trusted adult or engaging in a favorite activity.
·Educate yourself about alcohol so you can be a better teacher. Read and collect information that you can share with children and other moms & dads.
·Be a good role model. Consider how your use of alcohol or medications may influence your children. Consider offering only nonalcoholic beverages at parties and other social events to show your children that you don't need to drink to have fun.

Despite your efforts, your child may still use — and abuse — alcohol. How can you tell? Here are some common warning signs:

·alcohol disappearing from your home
·association with a new group of friends and reluctance to introduce them to you
·change in attendance or performance at school
·depression and developmental difficulties
·discipline problems at school
·loss of interest in school, sports, or other activities
·secrecy
·sudden change in mood or attitude
·the odor of alcohol
·withdrawal from family and friends

It's important not to jump to conclusions based on only one or two signs. Adolescence is a time of change — physically, socially, emotionally, and intellectually. This can lead to erratic behavior and mood swings as children try to cope with all of these changes.

If your child is using alcohol, there will usually be a cluster of these signs, like changes in friends, behavior, dress, attitude, mood, and grades. If you see a number of changes, look for all explanations by talking to your children, but don't overlook substance abuse as a possibility.

Other tips to try:

·Always make sure you have a phone number where you can reach your child.
·Have children check in regularly when they're away from home.
·Keep tabs on where your children go.
·Know the moms & dads of your child's friends.
·When spending an extended length of time away from you, your child should check in periodically with a phone call, e-mail, or visit home.

For teenagers, especially those old enough to drive, consider negotiating and signing a behavioral contract. This contract should spell out the way you expect your child to behave and state the consequences if your teen drives under the influence. Follow through and take the keys away, if necessary.

Make part of the deal with your teen that you and the rest of your family also agree never to drink and drive. Also encourage responsible behaviors, such as planning for a designated driver or calling an adult for help rather than driving under the influence.

It's important to keep communication open and expectations reasonable. Tying responsible actions to freedoms such as a later curfew or a driver's license can be a powerful motivator. Teach your children that freedom only comes with responsibility — a lesson that should last a lifetime.

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Kids & Watching TV

American kids watch an average of three to fours hours of television daily. Television can be a powerful influence in developing value systems and shaping behavior.

Unfortunately, much of today's television programming is violent. Hundreds of studies of the effects of TV violence on kids and teenagers have found that kids may:

· become "immune" or numb to the horror of violence
· gradually accept violence as a way to solve problems
· identify with certain characters, victims and/or victimizers
· imitate the violence they observe on television

Extensive viewing of television violence by kids causes greater aggressiveness. Sometimes, watching a single violent program can increase aggressiveness. Kids who view shows in which violence is very realistic, frequently repeated or unpunished, are more likely to imitate what they see. Kids with emotional, behavioral, learning or impulse control problems may be more easily influenced by TV violence. The impact of TV violence may be immediately evident in the youngster's behavior or may surface years later. Young people can even be affected when the family atmosphere shows no tendency toward violence.

While TV violence is not the only cause of aggressive or violent behavior, it is clearly a significant factor. Moms & dads can protect kids from excessive TV violence in the following ways:

· to offset peer pressure among friends and classmates, contact other moms & dads and agree to enforce similar rules about the length of time and type of program the kids may watch

· set limits on the amount of time they spend with the television; consider removing the TV set from the youngster's bedroom

· refuse to let the kids see shows known to be violent, and change the channel or turn off the TV set when offensive material comes on, with an explanation of what is wrong with the program

· point out that although the actor has not actually been hurt or killed, such violence in real life results in pain or death

· pay attention to the programs their kids are watching and watch some with them

· disapprove of the violent episodes in front of the kids, stressing the belief that such behavior is not the best way to resolve a problem

Moms & dads can also use these measures to prevent harmful effects from television in other areas such as racial or sexual stereotyping. The amount of time kids watch TV, regardless of content, should be moderated because it decreases time spent on more beneficial activities such as reading, playing with friends, and developing hobbies.

Time spent watching television takes away from important activities such as reading, school work, playing, exercise, family interaction, and social development. Kids also learn information from television that may be inappropriate or incorrect. They often can not tell the difference between the fantasy presented on television versus reality. They are influenced by the thousands of commercials seen each year, many of which are for alcohol, junk food, fast foods, and toys.

Kids who watch a lot of television are likely to:

· Be overweight
· Exercise less
· Have lower grades in school
· Read fewer books

Violence, sexuality, race and gender stereotypes, drug and alcohol abuse are common themes of television programs. Young kids are impressionable and may assume that what they see on television is typical, safe, and acceptable. As a result, television also exposes kids to behaviors and attitudes that may be overwhelming and difficult to understand.

Active parenting can ensure that kids have a positive experience with television. Moms & dads can help by:

· Placing limits on the amount of television viewing (per day and per week)
· Selecting developmentally appropriate shows
· Turning off shows you don't feel are appropriate for your youngster
· Turning off the TV during family meals and study time
· Viewing programs with your kids

In addition, moms & dads can help by doing the following: don't allow kids to watch long blocks of TV, but help them select individual programs. Choose shows that meet the developmental needs of your youngster. Kid's shows on public TV are appropriate, but soap operas, adult sitcoms, and adult talk shows are not. Set certain periods when the television will be off. Study times are for learning, not for sitting in front of the TV doing homework. Meal times are a good time for family members to talk with each other, not for watching television.

Encourage discussions with your kids about what they are seeing as you watch shows with them. Point out positive behavior, such as cooperation, friendship, and concern for others. While watching, make connections to history, books, places of interest, and personal events. Talk about your personal and family values as they relate to the show. Ask kids to compare what they are watching with real events. Talk about the realistic consequences of violence. Discuss the role of advertising and its influence on buying. Encourage your youngster to be involved in hobbies, sports, and peers. With proper guidance, your youngster can learn to use television in a healthy and positive way.

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Kids & Smoking

The health risks of tobacco are well known, yet the rates of smoking and the use of chewing tobacco continue to grow. Many people pick up these habits when they're young — in fact, 90% of all adult smokers started when they were children. And each day, more than 4,400 children become regular smokers.

So it's important to make sure children understand the dangers that go along with tobacco use. Smoking is the leading cause of preventable deaths in the United States. It can cause cancer, heart disease, and lung disease. Chewing tobacco (smokeless or spit tobacco) can lead to nicotine addiction, oral cancer, gum disease, and an increased risk of cardiovascular disease, including heart attacks.

Giving children information about the risks of smoking and chewing tobacco, and establishing clear rules and your reasons for them, can help protect them from these unhealthy habits.

You should also know the warning signs of tobacco use and constructive ways to help someone kick the habit.

The Facts About Tobacco—

One of the major problems with smoking and chewing tobacco has to do with the chemical nicotine. A person can get addicted to nicotine within days of a first encounter with it. In fact, the nicotine in tobacco can be as addictive as cocaine or heroine. Nicotine affects mood as well as the heart, lungs, stomach, and nervous system.

And there are other health risks. Short-term effects of smoking include coughing and throat irritation. Over time, more serious conditions may develop, including increases in heart rate and blood pressure, bronchitis, and emphysema.

Finally, numerous studies indicate that young smokers are more likely to experiment with marijuana, cocaine, heroin, or other illicit drugs.

More facts—

· Approximately 3,000 teenagers start smoking every day and one-third of them will die prematurely of a smoking related disease (American Cancer Society).
· Cigarette smoking and tobacco use are associated with many forms of cancer.
· High school students who smoke cigarettes are more likely to take risks such as ignoring seat belts, getting into physical fights, carrying weapons, and having sex at an earlier age.
· Most adult smokers started smoking before the age of 18.
· Nearly 3 million U.S. teenagers smoke.
· Smoking is the main cause of lung and heart disease.
· Smoking worsens existing medical problems, such as asthma, high blood pressure and diabetes.
· The earlier a person starts smoking, the greater the risk to his or her health and the harder it is to quit.
· Tobacco is considered to be a gateway drug@ which may lead to alcohol, marijuana, and other illegal drug use.
· Tobacco use continues to be the most common cause of preventable disease and death in the United States.

Kids at MOST risk for Tobacco use:

· are very influenced by advertisements that relate cigarette smoking to being thin and/or suffer from eating disorders
· deny the harmful effects of tobacco
· exhibit characteristics such as toughness and acting grown up
· have fewer coping skills and smoke to alleviate stress
· have moms and dads, siblings, or friends who smoke
· have poor academic performance, especially girls
· have poor self esteem and depression

What Moms and dads can do to prevent Tobacco use:

· Ask about tobacco use by friends; compliment kids who do not smoke.
· Ask whether tobacco is discussed in school.
· Discuss with your kids the false and misleading images used in advertising and movies, which portray smoking as glamorous, healthy, sexy, and mature.
· Do not allow smoking in your home and strictly enforce your No Smoking rule.
· Do not allow your kids to handle smoking materials.
· Do not allow your kids to play with candy cigarettes. They are symbols of real cigarettes, and young kids who use them may be more likely to smoke.
· Emphasize that nicotine is addictive.
· Emphasize the short-term negative effects such as bad breath, yellowed fingers, smelly clothes, shortness of breath, and decreased performance in sports.
· Help kids to say "No" to tobacco by role-playing situations in which tobacco is offered by peers.
· Make tobacco less readily available to kids and teens
· Support higher taxes on tobacco, licensing of vendors, and bans on unattended vending machines.
· Moms and dads are role models. If you smoke, quit. If you have not quit, do not smoke in front of your kids and tell them you regret that you started.
· Support school and community anti-smoking efforts and tell school officials you expect them to enforce no smoking policies.

If your child or teen has already begun to use tobacco, the following steps can help him or her to stop:

· Provide educational materials.
· If you smoke, agree to quit with your child and negotiate a quit date.
· If the child is abusing other drugs and/or alcohol or there are problems with mood or other disorders, evaluation by a child and adolescent psychiatrist or other mental health professional may be indicated.
· Help your youngster identify personally relevant reasons to quit.
· Enlist the child's pediatrician or family physician to help the child stop smoking.
· Assist his/her efforts to quit and express your desire to help.
· Advise him/her to stop. Be non-confrontational, supportive, and respectful.

Preventing Children From Picking Up the Habit—

Children might be drawn to smoking and chewing tobacco for any number of reasons — to look cool, act older, lose weight, win cool merchandise, seem tough, or feel independent. But moms and dads can combat those draws and keep children from trying — and getting addicted to — tobacco.

Establish a good foundation of communication with your children early on to make it easier to work through tricky issues like tobacco use. Some guidelines to keep in mind:

· Ask what children find appealing — or unappealing — about smoking. Be a patient listener.
· Discuss sensitive topics in a way that doesn't make children fear punishment or judgment.
· Discuss ways to respond to peer pressure to smoke. Your child may feel confident simply saying "no." But also offer alternative responses such as "It will make my clothes and breath smell bad" or "I hate the way it makes me look."
· Emphasize what children do right rather than wrong. Self-confidence is a child's best protection against peer pressure.
· Encourage children to get involved in activities that prohibit smoking, such as sports.
· Encourage children to walk away from friends who don't respect their reasons for not smoking.
· Establish firm rules that exclude smoking and chewing tobacco from your house and explain why: Smokers smell bad, look bad, and feel bad, and it's bad for everyone's health.
· Explain how much smoking governs the daily life of children who start doing it. How do they afford the cigarettes? How do they have money to pay for other things they want? How does it affect their friendships?
· It's important to keep talking to children about the dangers of tobacco use over the years. Even the youngest child can understand that smoking is bad for the body.
· Read, watch TV, and go to the movies with your children. Compare media images with what happens in reality.
· Show that you value your children' opinions and ideas.

If Your Child Smokes—

If you smell smoke on your child's clothing, try not to overreact. Ask about it first — maybe your child has been hanging around with friends who smoke or just tried one cigarette. Many children do try a cigarette at one time or another but don't go on to become regular smokers.

Additional signs of tobacco use include:

· bad breath
· coughing
· decreased athletic performance
· greater susceptibility to colds
· hoarseness
· shortness of breath
· stained teeth and clothing (also signs of chewing tobacco use)
· throat irritation

Sometimes even the best foundation isn't enough to stop children from experimenting with tobacco. It may be tempting to get angry, but it's more productive to focus on communicating with your child.

Here are some tips that may help:

· Encourage a meeting with your child's doctor, who can be supportive emotionally and may have treatment plans.
· Help your child develop a quitting plan and offer information and resources, and reinforce the decision to quit with praise.
· If you hear, "I can quit any time I want," ask your child to show you by quitting cold turkey for a week.
· Many times, children aren't able to appreciate how their current behaviors can affect their future health. So talk about the immediate downsides to smoking: less money to spend on other pursuits, shortness of breath, bad breath, yellow teeth, and smelly clothes.
· Resist lecturing or turning your advice into a sermon.
· Stick to the smoking rules you've set up. And don't let a child smoke at home to keep the peace.
· Stress the natural rewards that come with quitting: freedom from addiction, improved fitness, better athletic performance, and improved appearance.
· Try not to nag. Ultimately, quitting is your child's decision.
· Uncover what appeals to your child about smoking and talk about it honestly.

If You Smoke—

Children are quick to observe any contradiction between what their moms and dads say and what they do. Despite what you might think, most children say that the adult whom they most want to be like when they grow up is a parent.

If you're a smoker:

· First, admit to that you made a mistake by starting to smoke and that if you had it to do over again, you'd never start.
· Second, quit. It's not simple and it may take a few attempts and the extra help of a program or support group. But your children will be encouraged as they see you overcome your addiction to tobacco.



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Children & Sleep Problems

Many kids have sleep problems. Examples include:

• Bedwetting
• Difficulty falling asleep
• Feeling sleepy during the day
• Frequent awakening during the night
• Having nightmares; or
• Talking during sleep
• Teeth grinding and clenching
• Waking early
• Waking up crying

Many childhood sleep problems are related to poor sleep habits or to anxiety about going to bed and falling asleep. Persistent sleep problems may also be symptoms of emotional difficulties. "Separation anxiety" is a developmental landmark for young kids. For all young kids, bedtime is a time of separation. Some kids will do all they can to prevent separation at bedtime. However, to help minimize common sleep problems, a parent should develop consistent bedtime and regular bedtime and sleep routines for kids. Moms and dads often find that feeding and rocking help an infant to get to sleep. However, as the youngster leaves infancy, moms and dads should encourage the youngster to sleep without feeding and rocking. Otherwise, the youngster will have a hard time going to sleep alone.

Nightmares are relatively common during childhood. The youngster often remembers nightmares, which usually involve major threats to the youngster's well-being. Nightmares, which begin at a variety of ages, affect girls more often than boys. For some kids nightmares are serious, frequent, and interfere with restful sleep.

Sleep terrors (night terrors), sleepwalking, and sleep talking constitute a relatively rare group of sleep disorders, called "parasomnias." Sleep terrors are different from nightmares. The youngster with sleep terrors will scream uncontrollably and appear to be awake, but is confused and can't communicate. Sleep terrors usually begin between ages 4 and 12. Kids who sleepwalk may appear to be awake as they move around, but are actually asleep and in danger of hurting themselves. Sleepwalking usually begins between ages 6 and 12. Both sleep terrors and sleepwalking run in families and affect boys more often than girls. Most often, kids with these sleep disorders have single or occasional episodes of the disorder. However, when episodes occur several times a night, or nightly for weeks at a time, or interfere with the youngster's daytime behavior, treatment by a youngster and adolescent psychiatrist may be necessary. A range of treatments is available for sleep disorders.

Sleep wake reversal may occur in some teens and may cause problems with daily life. Sleep can also be disturbed by mood disorders, PTSD, substance abuse, ADHD, and anxiety.

Fortunately, as they mature, kids usually get over common sleep problems as well as the more serious sleep disorders (parasomnias). However, moms and dads with ongoing concerns should contact their pediatrician or directly seek consultation with a youngster and adolescent psychiatrist.

Pointers for Parents —

1. Educate yourself about adolescent development, including physical and behavioral changes you can expect, including those that relate to their sleep needs and patterns. 2. Look for signs of sleep deprivation (insufficient sleep) and sleepiness in your child -- keep in mind that they are not always obvious. Signs include difficulty waking in the morning, irritability late in the day, falling asleep spontaneously during quiet times of the day, and sleeping for extra long periods on the weekends. In addition, sleepiness can also look similar to attention deficit hyperactivity disorder. Above all, don't allow any family member to drive when sleep deprived or drowsy. 3. Enforce regular sleep schedules for all kids and maintain appropriate schedules as they grow older. To help induce sleepiness in adolescents, establish a quiet time in the evening when the lights are dimmed and loud music is not permitted. 4. Talk with your kids about their individual sleep/wake schedules and level of sleepiness. Assess the time spent in extracurricular and employment activities with regard to their sleep patterns and needs, and make adjustments if necessary. 5. Encourage your kids to complete a sleep diary for 7 to 14 consecutive (and typical) days. The diary can provide immediate information on poor sleep hygiene, and it can be used to measure the effectiveness of efforts to change. Be sure to share the sleep logs or diaries with any sleep experts or other health professional who later assesses your child's sleep or sleepiness. (Why not keep your own sleep diary as well?) 6. If your child's sleep schedule during vacation is not in sync with the upcoming school schedule, help him or her adjust it for a smooth transition. This process can take from several days to several weeks, so plan ahead! 7. If conservative measures to shift your child's circadian rhythm are ineffective, or if your child practices good sleep hygiene and still has difficulty staying awake at times throughout the day: (a) Consult a sleep expert. Excessive daytime sleepiness can be a sign of narcolepsy, apnea, periodic limb movement disorder and other serious but treatable sleep disorders; (b) Discuss with teachers and school officials ways to accommodate your child's needs, if necessary. Excessive daytime sleepiness due to sleep disorders or other medical conditions are covered under the Americans with Disabilities Act and the Disabilities Education Act of 1997. 8. Be a good role model: Make sleep a high priority for yourself and your family and practice good sleep hygiene. Listen to your body. If you are often sleepy, get more sleep at night, take naps, or sleep longer when possible. Consult a sleep expert if needed. 9. Actively seek positive changes in your community by increasing public awareness about sleep and the harmful effects of sleep deprivation, and by supporting sleep-smart policies. Request sleep education in school curricula at all levels and encourage your school district to provide optimal environments for learning, including adopting healthy and appropriate school start times for all students.

Here are some "Do’s and Don’ts":

DO:

• Keep to a regular daily routine—the same waking time, meal times, nap time and play times will help your baby to feel secure and comfortable, and help with a smooth bedtime. Babies and kids like to know what to expect.
• Make bedtime a special time. It should be a time for you to interact with your kid in a way that is secure and loving, yet firm. At bedtime, spend some special time with your kid. Be firm and go through a certain bedtime routine that your kid is used to. At the end of that routine the lights go off and it is time to fall asleep.
• Make sure the sleep routines you use can be used anywhere, so you can help your baby get to sleep wherever you may be.
• Make sure your kids have interesting and varied activities during the day, including physical activity and fresh air.
• Put some thought into finding your kid’s ideal bedtime. In the evening, look for the time when your kid really is starting to slow down and getting physically tired. That's the time that they should be going to sleep, so get their bedtime routine done and get them into bed before that time. If you wait beyond that time, then your kid tends to get a second wind. At that point they will become more difficult to handle, and will have a harder time falling asleep.
• Some babies are soothed by the sound of a vaporizer or fan running. This "white noise" not only blocks out the distraction of other sounds, it also simulates the sounds babies hear in the womb. Small, portable white noise machines with a variety of different sounds are now available.
• Use a simple, regular bedtime routine. It should not last too long and should take place primarily in the room where the kid will sleep. It may include a few simple, quiet activities, such as a light snack, bath, cuddling, saying goodnight, and a story or lullaby. The kinds of activities in the routine will depend on the kid’s age.
• Use light to your advantage. Keep lights dim in the evening as bedtime approaches. In the morning, get your kid into bright light, and, if possible, take them outside. Light helps signal the brain into the right sleep-wake cycle.

DON’T:

• Don’t fill up your kid’s bed with toys. It’s probably best to keep your kid’s bed a place to sleep, rather than a place to play. Too many toys in the bed can be distracting. One or two transitional objects--like a favorite doll, a security blanket, or a special book--are okay, and can help with separation issues. Babies under 4-6 months should have an empty crib to prevent suffocation.
• Don’t give your kid foods and drinks with caffeine in them, like hot chocolate, tea, cola, chocolate, etc. Even caffeine earlier in the day could disrupt your kid’s sleep cycle.
• Don’t start giving solids before about 6 months of age. Starting solid food sooner will not help your baby sleep though the night. In fact, if you give your baby solids before their system can digest them, they may sleep worse because they have a tummy ache! The American Academy of Pediatrics says that breast milk or formula is all a baby needs to eat until six months of age. Contrary to popular belief, a heavier baby or a baby with a stuffed-full tummy is not more likely to sleep through the night.
• Don't let your kid watch more than one to two hours of TV during the day, and don't let them watch TV at bedtime at all. TV viewing at bedtime has been linked to poor sleep.
• If your kid has a TV set in their bedroom, remove it. Research shows watching TV is linked to sleep problems, especially if the TV set is in the kid’s bedroom. The presence of other media, such as a computer, video games or Internet in a kid’s bedroom is also associated with worse sleep.
• Never soothe your kid to sleep by putting them to bed with a bottle of juice, milk or formula. Water is okay. Anything other than water in the bottle can cause baby bottle tooth decay. Feed or nurse your baby, and then put them down to sleep.
• Never use sending your kid to bed as a threat. Bedtime needs to be a secure, loving time, not a punishment. Your goal is to teach your kids that bedtime is enjoyable, just as it is for us adults. If the feeling around bedtime is a good feeling, your kid will fall asleep easier.

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Obesity in Kids & Teenagers—

Do you know when to be concerned about your child's weight? Of course, all kids gain weight as they grow older. But extra pounds — more than what's needed to support their growth and development — can lead to childhood obesity.

The problem of childhood obesity in the United States has grown considerably in recent years. Between 16 and 33 percent of kids and teenagers are obese. Obesity is among the easiest medical conditions to recognize but most difficult to treat. Unhealthy weight gain due to poor diet and lack of exercise is responsible for over 300,000 deaths each year. The annual cost to society for obesity is estimated at nearly $100 billion. Overweight kids are much more likely to become overweight adults unless they adopt and maintain healthier patterns of eating and exercise.

A few extra pounds do not suggest obesity. However they may indicate a tendency to gain weight easily and a need for changes in diet and/or exercise. Generally, a child is not considered obese until the weight is at least 10 percent higher than what is recommended for the height and body type. Obesity most commonly begins in childhood between the ages of 5 and 6, and during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.

Although there are some genetic and hormonal causes of childhood obesity, most excess weight is caused by kids eating too much and exercising too little. Kids, unlike adults, need extra nutrients and calories to fuel their growth and development. So if they consume the calories needed for daily activities, growth and metabolism, they add pounds in proportion to their growth. But kids who eat more calories than needed gain weight beyond what's required to support their growing bodies.

The causes of obesity are complex and include genetic, biological, behavioral and cultural factors. Basically, obesity occurs when a person eats more calories than the body burns up. If one parent is obese, there is a 50 percent chance that the kids will also be obese. However, when both moms & dads are obese, the kids have an 80 percent chance of being obese. Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems. Obesity in childhood and adolescence can be related to:

• depression or other emotional problems
• family and peer problems
• family history of obesity
• lack of exercise (i.e., couch potato kids)
• low self-esteem
• medical illnesses (endocrine, neurological problems)
• medications (steroids, some psychiatric medications)
• overeating or binging
• poor eating habits
• stressful life events or changes (separations, divorce, moves, deaths, abuse)

Far less common than lifestyle issues are genetic diseases and hormonal disorders that can predispose a child to obesity. These diseases, such as Prader-Willi syndrome and Cushing's syndrome, affect a very small proportion of kids. In the general population, eating and exercise habits play a much larger role.

There are many risks and complications with obesity. Physical consequences include:

• breathing problems
• diabetes
• high blood pressure
• increased risk of heart disease
• trouble sleeping

Many factors — usually working in combination — increase your child's risk of becoming overweight:

• Diet. Regular consumption of high-calorie foods, such as fast foods, baked goods and vending machine snacks, contribute to weight gain. High-fat foods are dense in calories. Loading up on soft drinks, candy and desserts also can cause weight gain. Foods and beverages like these are high in sugar and calories.

• Family factors. Most kids don't shop for the family's groceries. Indeed, moms & dads are responsible for putting healthy foods in the kitchen at home and leaving unhealthy foods in the store. You can't blame your kids for being attracted to sweet, salty and fatty foods; after all they taste good. But you can control much of their access to these foods, especially at home.

• Genetics. If your child comes from a family of overweight people, he or she may be genetically predisposed to put on excess weight, especially in an environment where high-calorie food is always available and physical activity isn't encouraged.

• Inactivity. Sedentary kids are more likely to gain weight because they don't burn calories through physical activity. Inactive leisure activities, such as watching television or playing video games, contribute to the problem.

• Psychological factors. Some kids overeat to cope with problems or to deal with emotions, such as stress or boredom. Their moms & dads may have similar tendencies.

• Socioeconomic factors. Kids from low-income backgrounds are at greater risk of becoming obese. Poverty and obesity often go hand in hand because low-income moms & dads may lack the time and resources to make healthy eating and exercise a family priority.

Child and adolescent obesity is also associated with increased risk of emotional problems. Teenagers with weight problems tend to have much lower self-esteem and be less popular with their peers. Depression, anxiety, and obsessive-compulsive disorder can also occur.

Whether your child is at risk of becoming overweight or currently at a healthy weight, you can take proactive measures to get or keep things on the right track.

• Avoid food-related power struggles with your child. You might unintentionally lay the groundwork for such battles by providing or withholding certain foods — sweets, for instance — as rewards or punishments. As a general rule, foods aren't recommended for behavior modification in kids.

• Be patient. Many overweight kids grow into their extra pounds as they get taller. Realize, too, that an intense focus on your child's eating habits and weight can easily backfire, leading a child to overeat even more, or possibly making him or her more prone to developing an eating disorder.

• Emphasize the positive. Encourage a healthy lifestyle by highlighting the positive — the fun of playing outside or the variety of fresh fruit you can get year-round, for example. Emphasize the benefits of exercise apart from helping to manage their weight, for example, it makes their heart, lungs and other muscles stronger. If you foster your child's natural inclination to run around, explore and eat only when hungry — not out of boredom — a healthy weight should take care of itself.

• Schedule yearly well-child visits. Take your child to the doctor for well-child checkups at least once a year. During this visit, the doctor measures your child's height and weight and calculates his or her BMI. Increases in your child's BMI or in his or her percentile rank over one year, especially if your child is older than 4, is a possible sign that your child is at risk of becoming overweight.

• Set a good example. Make sure you eat healthy foods and exercise regularly to maintain your weight. Then, invite your child to join you.

Obese kids need a thorough medical evaluation by a pediatrician or family physician to consider the possibility of a physical cause. In the absence of a physical disorder, the only way to lose weight is to reduce the number of calories being eaten and to increase the child's or adolescent's level of physical activity. Lasting weight loss can only occur when there is self-motivation. Since obesity often affects more than one family member, making healthy eating and regular exercise a family activity can improve the chances of successful weight control for the child or adolescent.

Ways to manage obesity in kids and teenagers include:

• attend a support group (e.g., Overeaters Anonymous)
• change eating habits (eat slowly, develop a routine)
• control portions and consume less calories
• do not use food as a reward
• eat meals as a family instead of while watching television or at the computer
• increase physical activity (especially walking) and have a more active lifestyle
• know what your child eats at school
• limit snacking
• plan meals and make better food selections (eat less fatty foods, avoid junk and fast foods)
• start a weight-management program

Moms & dads play a crucial role in helping kids who are obese feel loved and in control of their weight. Take advantage of every opportunity to build your child's self-esteem. Overweight kids are at increased risk of low self-esteem because of the social emphasis on appearance and being slim. Don't be afraid to bring up the topic of health and fitness, but do be sensitive that a child may view your concern as an insult. Talk to your kids directly, openly and without being critical or judgmental.

In addition, consider the following advice:

• Find reasons to praise your child's efforts. Celebrate small, incremental changes, but don't reward with food. Choose other ways to mark your child's accomplishments, such as going to the bowling alley or a local park.
• Help your child focus on positive goals. For example, point out that he or she can now bike for more than 20 minutes without getting tired or can run the required number of laps in physical education class.
• Talk to your child about his or her feelings. Help your child find ways to deal with his or her emotions that don't involve eating.

Obesity frequently becomes a lifelong issue. The reason most obese teenagers gain back their lost pounds is that after they have reached their goal, they go back to their old habits of eating and exercising. An obese adolescent must therefore learn to eat and enjoy healthy foods in moderate amounts and to exercise regularly to maintain the desired weight. Moms & dads of an obese child can improve their child's self esteem by emphasizing the child's strengths and positive qualities rather than just focusing on their weight problem.



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