Category: Pediatric Corner

Mindfulness in Adolescents

This is the third part on the topic of Mindfulness after talking about it in infants and in children.  See archived issues in September and October respectively, at

Although apps can be useful to teens when they are trying to learn about mindfulness and the techniques to practice mindfulness (Headspace, Calm, Insight Meditation Timer, Smiling Mind, and Stop, Breathe and Think), teens learn best by practicing mindfulness in the moment and as they are relating to others.  The daily practice involves being in the moment with friends, family, in a relationship, or in sports competition.  At the heart of the activity is the ability to be present in the moment, listen with an open mind, and speak back with kindness, understanding and honesty.

When we begin to practice mindfulness, we become in tune with our bodies: we learn to pair our emotions with how our body feels.  During moments of stress, for example, we learn what parts of our body tend to tense up.  As we learn to recognize what is going on with our body in a particular moment and practice mindfulness, we learn to control our emotions.  From here, we begin to improve our relationships as we learn to listen to others.  Interestingly enough, we release dopamine (the “feel-good neurotransmitter”) when we show compassion and kindness to others.

Part of mindfulness involves being in the moment without passing judgment.   This frees us from any distractions while we try to absorb the outside and feel what we have in the inside.  This allows us to see ourselves as we are, with all our positives and even accepting all our negatives.  As we accept ourselves as we are, we become more confident and begin to develop a more positive self-image.  Studies have shown that teens who practice mindfulness have less problems with anxiety, depression and have more resilience.  In addition, teens that meditate or practice mindfulness concentrate better at school and perform better during the exams.

We can begin this concept of mindfulness at home during dinnertime.  The conversation can go in many directions, including some joyful and laughing moments while at other times there may be some stress and tension.  In either situation, being able to listen with an open heart and mind while making sure we understand and empathize what the other is saying is key to avoiding raising voices and beginning an argument.   We can minimize distractions by putting our phones down and beginning the meal with a moment of silence to be grateful for being together and sharing each other’s company.  For some families, this may take the form of a prayer.

It is important that teens understand why this is important.  I found Sara Raymond’s YouTube video from the Mindful Movement a good introduction to mindfulness:

I also found an easy read for teens the book by pediatrician Dzung X. Vo, MD: The Mindful Teen.

Let’s empower our teens to be free and resilient!

Thanksgiving for Picky Eaters

Thanksgiving can be a fun time for family get-togethers.  However, sometimes life can be challenging when trying to prepare a meal plan for your picky eater.

Here are some tips to improve your chances that your child will have a good meal experience:

Engage your child in meal planning.  Some pointed questions like, “what veggie would you like with your dinner?” “What do you think about a fruit with your meal?” “What do you think about eating turkey for dinner?” can empower them to help us with the menu, especially if we look up together some recipes.  Then, they are more likely to look forward to the event and eat a balanced meal.  Here are some samples of food groups from the American Academy of Pediatrics

Use food bridges or like foods to expand their repertoire of healthy foods. For Example, if he likes mashed potatoes, try sweet potatoes.

Choose at least one food you know your child will like.  In that way, she is guaranteed to eat something nutritious at meal time.

Make it look, smell, and taste delicious. What do you think about becoming an artist for thanksgiving?  Enhance the look and smell of a dish with special ingredients (for example cinnamon on cooked apples or nutmeg on peaches.

Keep the mealtime relaxing and enjoyable.  After all, this is time for family and friends to come together, feel thankful and enjoy each other’s company.

To learn more about fussy eaters, follow this link:


Mindfulness in Children

By 5 years of age, most children are heading into kindergarten having learned to polish learning some life skills: getting dressed, taking baths, washing hands, learning how to write, riding a bike and so on.  As it turns out, it is possible to begin to teach mindfulness in children and some meditation.

It is a good idea to instill this concept as a daily habit rather than using it during times of stress.  Practice is key to becoming more proficient, and can be incorporated into daily routines or activities, such as when playing outside, drawing or painting, and when doing bedtime reading.  Help children feel new feelings and sensations, even if the moment may seem neutral at the time.  It’s amazing how easily pleasantness can pop up after a few minutes.

Children like to copy parents so it’s a clever idea for parents to be role models for them.  Practice mindfulness yourself in front of them and with them.  It’s possible that at the beginning, while you are seated in a relaxed position, maybe even in a yoga pose with your eyes closed, your child may not know what you are doing (there may be even some laughing and giggling) but will be curious and learn from there.

As kids grow older, life becomes more challenging as they begin to experience the loss of control and have set backs.  They may even find adversity in the school playground or classroom.  It is easy to lose grip of the moment to the point that it threatens the sense of self.  It is at this point that kids begin to question their worth and their strength.  A simple exercise to incorporate into the practice of mindfulness is with the mnemonic RAIN (The New York Times, 2017):

  • R (Recognize): Acknowledge the moment in a calm, accepting manner
  • A (Accept): Allow the moment to be what it is without changing it right away
  • I (Investigate): Be in touch with your feelings and see how you feel
  • N (Non-Identification): Realize the sensations and feelings will soon pass and do not define you.

Here are some phone apps that can be helpful to kids (from iPhone Magazine and Psychology Today).   You may need to be involved initially to help them explore the app:

  • Smiling Mind ( Produced by non-profit organization in Australia, a good beginner’s tool to help children develop awareness of how their body feels.
  • Breathe, Think, Do with Sesame ( Good for young kids to learn the concept of calming down through breathing.
  • Headspace ( Uses cartoons to teach how meditation works.  It has a lot of guided meditations in different areas, even incorporating sports and health.  Focuses on calm, kindness and bedtime.  Can be customized to children < 5 years, 6 to 8, 9 to 12, and adult version.
  • Calm ( Helps children relax and restore themselves after a full day of running around.  Has sounds like ocean waves and wind that kids may like to listen to.  It has sleep stories to read to kids to help them relax and sleep better.
  • Three Good Things ( This app is actually a journal that helps children focus on the positive of life by writing 3 good things that went well that day, and therefore practicing gratitude.

As kids grow into their pre-teen and teenage years, it will become important for them to understand that either good or adverse moments, bringing either happiness or sadness/frustration/anger, do not define them.  By practicing mindfulness and meditation, they can go deeper into who they are and what they want in life.   Tune in for the next article on Mindfulness for Teenagers!

Mindfulness and Your Infants

Our lives are frequently challenged with work and other external pressures that often make it hard to parent.  Sometimes we find ourselves trying to parent but are not in the moment, we are stressed or preoccupied.  It is not much different with children and teens, although their stressors may seem trivial to us.  Starting with this post, I’ll try to cover the practice of mindfulness over the next 3 editions (mindfulness in infants, children, and teens) and hopefully you’ll find these tips helpful for you and your children.

The concept of mindfulness is a technique that helps us pay attention to the current moment with an accepting, gentle and non-judgmental attitude.  This practice helps develop compassion, curiosity, focus and empathy, thereby relieving stress, minimizing anxiety and promoting happiness.

Our frontal lobes act as the Executive Office in our decision making and conscious behavior.  The area behind these lobes, the pre-frontal cortex area, oversees focus, paying attention and cognitive control.  This area develops quickly in our infancy and childhood years and is involved ultimately in the development of skills such as self-regulation, focus, judgement, and patience.  As parents, we are instrumental in the development of mindfulness in our children. In fact, the best way to teach them this skill is by modeling it ourselves.

It is possible to begin to instill this concept with our infants, even right after birth.  Newborns and infants can feel our bodies when we are holding them.  Feeling relaxed, we can impart this feeling to them and help them relax as well.  Being in the moment implies putting away our distractions, including electronics, no matter what is happening.  While holding the baby quietly, we can make eye contact in a gentle and loving manner.   Being in the moment, totally dedicated to them during the feedings, can allow the infants to bond with us in a relaxed and mindful way.  They will actually start to copy our behavior.

When your infant becomes upset or cries, try to not let him or her make you agitated and anxious.  You will end up tensing up your body.  Instead, remain calm, maybe take some deep breaths, and remember that you are always in control.  It is important that you feel confident in yourself.  Acknowledge to yourself what is going on and think calmly how you are going to solve the problem.  With time, it will become important for you to acknowledge that you can soothe your infant.

Finally, incorporate thankfulness into the moment.  After all, how special is it that you are here with your infant?  Feeling their breathing, the warmth of their body, and the wiggles of their legs on your chest and belly will help you feel thankful that you have brought this little creature into the world.  It then becomes easy to feel that our lives are better because of our child.

Back to School

It is hard to believe that it is that time of the year already to start thinking about going to school in September.  After such an odd year last year with COVID-19, our sons and daughters can expect to be at school in person this academic year.  With those 12 years of age and older and who have had the COVID vaccine, they may be given the option to not wear a mask in class.  However, for those 11 years of age and younger, they are going to still need to practice safe guidelines, including wearing a mask, social distancing for 6 feet and good handwashing.

Otherwise, we are back to the usual routine of getting ready to start school that first week of September (or last week of August for private schools).  Here are some thoughts and tips to help you get ready:

Your son or daughter is new to the school

Meet your new teacher.  One of the big questions before school starts is, “Will I like my teacher?”  You can help break the ice by taking advantage of the school open house or back-to-school night event.  Usually, these events are very friendly with kids’ activities to help your child feel “at home.”  Around this time, teachers may also make themselves available via phone calls or email in case you need to discuss special circumstances, such as learning disabilities or food allergies, for example.   Also take advantage of the school’s website so you can let your son/daughter see a picture of the new teacher.

Tour the school premises.  The open house also becomes an opportunity to tour the school.  Help your son/daughter familiar themselves with the classroom, hallways, bathrooms and the main office.  You may also get an opportunity to see where your child may sit and what her/his desk looks like.  Sitting at the desk can bring a lot comfort.  Finally, seeing the playground will help him/her visualize what recess is going to look like and feel like.

Connecting with Friends.  Sometimes you get lucky during the open house visit that your son/daughter will get a chance to see a familiar face or friend.  Even just one friend can make all the difference in the world as odds are, they are looking forward to being in school with your son/daughter.  If you happen to know if friend might be attending that school, maybe set up a playdate prior to the open house so they can talk about the school and develop a comfort level with each other.

Recall past positive experiences.  Help them remember that they have had fun with other kids in previous activities, be them sports, another school or other recreational activity.  Highlight for them how they were able to get over their fears or anxieties and enjoyed themselves.  Self-efficacy is part of being able to visualize yourself and see yourself succeed, and memory plays a big part.

Weeks before school starts

Get Your Supplies.  One of my more exciting times before school started was going with my mom to the office supply store to buy my coloring pencils, paper pads or notebooks, ruler and pens.  Check with his/her teacher as to what is being recommended so your son/daughter is ready to go on day one.  Let your child pick out the supplies with your guidance.  Giving them the opportunity to make decisions will empower them to go to school.

Choose a backpack.  Another fun item for them to pick out!  Make sure it is wide enough for school supplies, has padded shoulder straps and a padded back.  Teach them about all the compartments the backpack has and what to place in each one.  Encourage them to keep the backpack light so talk about what goes in it and what does not belong.  A good rule of thumb is that the backpack should not weight more than 10-20% of your child’s weight.  Teach them how to use both straps and make sure the bottom of the backpack is at their waste line.

Getting a new lunch box.  What art design will it be this year? What was the latest Pixair movie or Disney show? This is another opportunity for them to make a choice and let them buy into the excitement of going back to school. Keep the lunchbox simple and easy to use.

Minimize school work before school starts.  It might be possible that you had a curriculum, perhaps a small one and at a more leisurely pace, that you followed during the summer months.  This is always a great idea to maintain some academic performance and him/her ready for when school starts.  However, it would be a good idea to back off and let your son/daughter have unstructured play time at least a couple weeks before school starts.

Get back to the school routine.  As a family, you probably have been enjoying the sun setting down late in the evening to continue to do family and play activities.  Turning the “sleep” clock back gradually over the course of 1-2 weeks is helpful as you get ready for that first day when your child has to be out the door by 730 in the morning.  Go through your routine with your child and what expectations you have so as to be on time, either being on time at the bus stop or you are driving them to school.

Make the First Day a Success!

Be on time.  Better yet, if you can, try to arrive to school early so you can give your son/daughter an opportunity to walk around the hallways, classroom and recall where are the bathrooms.

Make contact with the teacher.  It is a good idea to touch bases with teacher at the end of the 1st day, and maybe even every day during the first week, to see how your son/daughter is integrating into the new learning environment.  Check to see how friendships and cooperation are developing.  Finally, this gives the teacher an opportunity to see that you are engaged and invested in your child’s success.

Traveling To and From School

Riding the school bus.  Here are a few tips to ease their fears and ensure safety:

  • Remind them to always board and exit the bus at locations that provide safe access to the bus or to the school building.
  • They should make themselves visible to the bus driver so teach them how to look at the driver so they can see that the driver is looking at them.
  • Remind your child to wait for the bus to stop before approaching it from the curb.  If he/she has to cross the street to get to the bus, they should look both ways before crossing.  You can work with them 1-2 weeks before school starts to teach them how to cross the street.
  • Remind them that one of the rules in the bus is they should stay in their seat and not move around to chat with friends.
  • Check on the school’s policy regarding food on the bus. Eating on the bus can present a problem for students with allergy and also lead to infestations of insects and vermin on the vehicles.
  • If your son/daughter has food allergy problems or chronic medical conditions, make sure the school and bus driver know about these and they can have a “bus emergency plan.”

Riding in the Car.  This is a good time to review the basics just in case you are taking other children:

  • Children should be in a car seat with a harness for as long as possible, and then ride in a belt-positioning booster seat.  Check specifications for both types of seats but some good rules of thumb for moving to the booster seat include the shoulders are above the top harness slots or their ears have reached the top of the seat.
  • For older children, our State of Michigan law calls for them to be in the back seat until the age of 12 years and they reach a height of 4’ 9”.  If they have outgrown their booster seat, double check that the shoulder belt lies across the chest and shoulder and not the neck or throat; and the lap belt should ride across the pelvic bones and by the thighs, and not over the stomach area.
  • For those in high school, remind them to limit the number of passengers in the car to minimize distractions while driving.  In the State of Michigan, the recommendation is to have no more than one non-family member in the car.  Also remind them about not texting while driving, no cell-phone conversations and no alcohol-drinking.  You can learn more about graduated driver’s license law from the AAP’s Healthy Children website.

Riding a bike.  Follow these guidelines to ensure a safe ride:

  • Practice the bike route to school before the first day of school to make sure your child can manage it.
  • Make it a rule to always wear a helmet no matter how short or long the ride to and from school.
  • Use the sidewalks as much as possible, and if they have to go on the road, to ride on the right side of the street, in the same direction as auto traffic and ride in bike lanes if they are present.
  • Use appropriate hand signals when coming to a corner or turn.
  • Respect traffic lights and stop signs.
  • Wear bright-colored clothing to increase visibility. White or light-colored clothing and reflective gear is especially important after dark.

Walking to and from School.

In general, children are ready developmentally to start walking to and from school around the age ages between 9 and 11 years.  But also check to see how they are doing with their impulse control.  In general, younger children tend to be more impulsive and need an adult to go with them to school.

  • Walking with friends and in a group is always safer than walking alone.
  • Try to stay on the path or side walk where there are trained adult crossing guards, particularly as it related to crossing the streets.
  • Think about dressing your children with bright-colored clothing to make them more visible to drivers.

Water Safety This Summer

How big is the problem?

According to the CDC1, there were 3.536 fatal unintentional drownings (not boat related) per year in the United States for the 10-year period 2005-2014.  About 1 in 5 were pediatric patients age 14 years and younger.  About 50% of these drownings required a hospitalization or transfer to long-term care for physical, occupational and speech therapies.  Many had severe brain damage that resulted in long-term brain damage including memory problems, learning disabilities, or permanent loss of basic life functioning.

When we look at the pediatric population, there are 2 main spikes in incidence in drownings and fatalities:  the 1-4 year old age group and the 15 year olds and older group.  When you look at the 1-4 year old age group, about 1/3 of children who died from unintentional injury were from drowning, and the most common site of drowning was the home swimming pool.

In the 15 year old and older group, most drownings occur in natural water settings (lakes, rivers, oceans).  Drowning fatalities are second to motor vehicle accidents fatalities in this population.  Interesting enough, as a whole, 80% of those who die from drowning are male and commonly tied to high-risk behavior.

Alcohol use among adolescents and adults is responsible for about 70% of deaths associated with water recreation.  Alcohol impairs our ability to maintain balance, coordination and most important of all, our judgement.

Some Advice

So how do we make our environment safer and reduce the risk of drowning in our loved ones?  The best way to do this is to have a layered approach where we have multiple steps in place to reduce the risk.  From learning how to swim to having a fence around the pool, there are multiple steps we can take to make their lives safer.  Here are some tips from American Academy of Pediatrics (AAP) website, healthychildren.org2 and from the AAP patient education handouts3.

Water Safety at Home

  • Have deadbolts on any doors that lead to water, latches that are high enough where only adults can reach.
  • Never leave your child alone in the bathtub, even if it is for just a few seconds.
  • Empty water from containers when you are done with your cleaning projects.
  • Install locks on toilets so they remain closed. Toddlers can get theirs heads stuck in the toilet if they are curious about that water.
  • Children with seizure disorder are at high risk of drowning. The most common cause for an unintentional injury to children with a seizure disorder is drowning, with the bathtub being the most common site.

Water Safety at the Pool

  • Never leave children alone in your backyard where your pool may be. The best way to prevent drowning is to have an adult supervising child.
  • If an adult needs to take a break or take care of something else, practice a verbal hand-off with another adult so there is a direct link with the responsibility
  • Install a fence that is at least 4 feet tall around all 4 sides of the pool and not connected to the house.
  • The gate to the pool should open out from the pool and have a self-close and self-latch that children can’t reach.
  • Children can be tricky and fast, so think about installing window guards on windows facing the pool and reconsider using pet doors that can have access to the pool.
  • Think about having rescue equipment made of fiberglass or other material that does not conduct electricity, including a shepherd’s hook (a long pole with a hook on the end).
  • Have approved life jackets for their age and size, as recommended by US Coast Guard and tested by Underwriters Laboratories (UL). Avoid using “floaties” as these are not a substitute for life jackets and create a false sense of security.
  • It’s a good idea to take swim lessons, and you as the parent can decide when it is best for your child to take those lessons based on their development. But remember, swim programs should not be viewed as “drown proof” for any child.
  • Talk to child about diving at your pool and avoid diving in the shallow ends. As a general rule, teach them to get into unknown waters with their feet first.
  • Keep riding toys away from the pool and talk about not running on the pool deck

Water Safety in the Open Water

  • It’s a good idea to swim with an adult around, and definitely avoid swimming by themselves.
  • Avoid diving into the water unless they know the depth of the water.
  • If you are swimming on lake Michigan and get caught by a riptide, allow the current to take you out until you feel it has dissipated and remain calm. Then swallow parallel to the beach line and eventually turn in towards the beach.
  • Other water hazards found near homes where you may want to keep a close eye on your child include canals, ditches, postholes, wells, fishponds and fountains

Boating Safety

  • Wear an approved personal floatation device (life jacket or vest) when boating, riding a personal watercraft, fishing, water skiing or just plain playing in a river or water stream
  • Avoid swimming around anchored boats, motorboat lanes or where people are waterskiing.
  • Do not swim in electrical storms

In Case of an Emergency

  • It’s a good idea for parents to learn CPR if you live near bodies of water, you never know when you are going to need it.
  • Have pool safety and CPR instructions by the pool side.
  • Always have a phone near a pool and teach your children about 911.
  • Make sure rescue equipment is readily available by the pool side, including a shepherd hook, rope and a safety ring.