November 21, 2016

Saying Grace and Then Demonstrating Grace at Thanksgiving

Don Shifrin MD FAAP 
Bellevue, WA

As parents, we encounter “teachable moments” every day. There is an old saying about children that they have small heads but big ears. It is unlikely and impossible to ignore that they have not seen or heard, media portrayals of both presidential candidates this year that were (OK, perhaps not unjustifiably) significantly negative. And certainly, vitriolic rhetoric from the candidates and media pundits as well. We have seen and heard hateful remarks on all media venues and our children have been watching. We have not seen many role models of civility.
America has concluded a contentious election, and now there is a significant winner/loser mentality among at least half the population, again not unjustifiable based on previous statements by both candidates, especially from our new president-elect. 
Regardless of what we are experiencing we do have a president-elect. And as parents we need to model respect for the office. Yes, we can comment that politicians can be flawed, but accusations of racism, sexism, and classism are going to stay in children’s minds a long time. 
So how should we to speak to children and families about the results, how to help families cope with disturbing rhetoric, and how to explain news reports of increasing numbers of protests? 
It is vitally important that we calmly reassure all children  so they feel safe and protected in their day-to-day lives.
Explain clearly that the way democracy works is that we vote to elect who will oversee our government. This is a good opportunity to invoke what Abraham Lincoln (our 16th president) meant (in his Gettysburg address in Nov. 1863 - 153 years ago) when he said  “government of the people ( coming from the people), by the people, and for the people.” 
Do find out what your children and teens have heard and what they understand. Teens may be very passionate when expressing their opinions about the election. 
Listen!  Try not to quickly interrupt. Allow your child to express what he or she is feeling, including fear, anxiety, or anger.  Do not minimize or dismiss their concerns. As you listen, note any misconceptions, misinformation, or anxieties. 
Every child is different. Their age and individual anxiety level will determine how much and what information you may wish to share. Try to separate fact from fiction. Put provocative statements (i.e. building a wall - deporting all ‘illegals’ - putting Ms. Clinton in jail.) in the  context of our democratic system.  
Because we live in a media saturated world, pay attention to what your children watch on screens. Try, if possible, to watch with them and use those ‘teachable moments’ to help them digest what is being discussed. Be careful not to verbally provide aggressive, dismissive, discriminatory, or inflammatory color commentary about topics being discussed. Children are not politically savvy and are unfamiliar with the checks and balances of the US Government. 
We are all American citizens. You now have a continuing opportunity to be a positive and reassuring role model for your family. When you share your feelings about new information, do so in a respectful manner. The teachable moment emphasizes that respect and kindness are important values for families, even if they have significant disagreements with someone. If we see or hear that some adults do not understand or demonstrate  disrespect by using shouts or threats, we will still value these attributes and proclaim them. Avoid generalizations about gender, race, or culture. And note that a strong democracy is designed to protect all Americans.
How can we act if we disagree? We have legislators we can petition, op-eds we can write. And we can recognize and provide commentary on incendiary and offensive words and actions. Your child is always watching, and you are the door they walk through on their way into the world. Your calm reassurance (we will be OK) and ability to promote wellbeing is  the most empowering part of parenting.
So this Thanksgiving please pay attention when political commentary (if you even agree to discuss politics) becomes inflammatory or overwhelming to children that are present. Focus on what is positive is your lives, that our Republic has survived almost 250 years and will indeed survive this administration. If adults will not cease angry or fiery words, you can gently point out to the children that is not the kind of talk that you endorse. “Our thanksgiving table is a place where we model love and value acceptance, tolerance…. and thanks.”
Finally - Always encourage your child to tell you or a teacher if he/she feels threatened or bullied,  and to speak up when they see or hear something inappropriate. 

J. M Barrie (Peter Pan) “Always be a little kinder than necessary.”
Warren Buffet, (a vocal Clinton advocate) stated, “I support any President of the United states. It’s very important that the American people coalesce behind the President. That does not mean we cannot criticize him or disagree with what he is doing. But we need a country unified. He (the president) deserves our respect.” 



October 30, 2016

New Media Plan Toolkit Available for Parents on HealthyChildren.org


Corinn Cross, MD FAAP
Pacific Palisades, CA
Council on Communications and Media Executive Committee

The AAP’s Council on Communications and Media has two new policy statements, Media and Young Minds and Media Use in School-Aged Children and Adolescents” as well as a corresponding Technical Report, Children and Adolescents and Digital Media,” out in the November issue of PEDIATRICS. These statements outline the changing relationship children and teens have with media. While the policy statements allow for us to discuss what we know and map out what still needs to be researched, the toolkit on HealthyChildren.org gives pediatricians and families the guidance and tools they need to parent, now.

Media has become ubiquitous in our daily lives. For children and adolescents, this includes school time, free time and homework time. Media is used for communication, education and recreation. The policy statements and technical report outline something that many parents have realized -- the 2 hour limit just isn’t enough advice. Screen use is so nuanced and weaved into our day that parents need more guidance. 

As busy pediatricians, we don’t often have the time to delve into media use in our office visits but recommending parents visit the website and create a Family Media Use Plan is something we can find the time to do. Creating a Family Media Use Plan is an important step in helping parents realize that they can, and should, still “parent” their children’s online life and be aware of, and hopefully approve of, their online and media choices.  The toolkit discusses screen free zones and times, device curfews and where devices should charge overnight. It talks about displacement and the need to maintain a healthy balance, which includes an appropriate number of hours of sleep for age as well as 1 hour of physical activity a day. Parents are encouraged to co-play, and co-view media with their children and to research apps and shows through sites like Common Sense Media so that they can be aware of content and age appropriateness. The toolkit introduces the ideas of diversifying media experiences and encourages parents to think about what their family’s values are and to ensure that their child or adolescent’s media experiences are inline with those values. 


Many parents feel overwhelmed when it comes to parenting, device use and media choices. The online resource gives parents concrete tools to navigate this new area of parenting. 

September 29, 2016

Stress and Teens: Does Media Play a Role?

Hansa Bhargava MD FAAP
Staff Physician, Children's Healthcare of Atlanta
Medical Editor, WebMD



Pediatricians are seeing more and more teens suffering from stress. Whether they are complaining of it or having somatic symptoms such as headaches and stomach aches, it seems that stress and anxiety are on the rise. We know that over scheduling, homework, and the pressures of getting into college can contribute to this. But can media also affect it? Is screen time and media a stressor or a remedy for stress?
In a recent WebMD survey published in their Teens and Stress report, 54% of teens were stressed according to parents. Interestingly, 40% of parents turned to the screen  for family stress relief while 58% of teens did. Social media and texting was used as stress relief by almost half the teens. This is on the heels of the Common Sense Media survey reporting that US teens were using media for 9 hours a day. Other recent reports have shown that 94% of teens with mobile devices are online daily with many online constantly.
So it seems that stress is on the rise and media use is on the rise. Although there may not be a direct relationship, some real issues impact stress and anxiety. Consider this: 23 % of teens report cyberbullying, especially girls. There have been reports of “Facebook depression” and loneliness, as kids who aren’t in social media conversations may feel left out. Other negative consequences can also have an impact: many teens are in front of a screen late at night or ‘sleep text’, both of which can contribute to lack of sleep, which in turn can decrease focus and potentially cause irritability and depression. And last but certainly not least, what about the time media consumes? 
Time spent on media is time often not spent communicating with family. Lately, when I’ve gone into a restaurant, I’ve observed that as soon as a family sits down, everyone pulls out a mobile device. No one is really talking. So even the short amount of time not doing homework, playing soccer, or at school is being compromised. Psychologists, community leaders and experts have long reported that family time can contribute to less depression, less anxiety, better academic performance and generally happier kids. But what if that family time is on media?? 
As the AAP reviews our screen time recommendations,  I feel that we, as pediatricians should continue to advise parents about basic principles. 

Parents need to lay down some parameters about when and how media is used. Media is a centerpiece of teens’ lives and is not going away, but just as we don’t give our kids a set of keys to our car and say “just drive”, we need to enforce appropriate media use. And  good modeling is also critical: parents need to put down their mobile devices and simply communicate with their kids. Old fashioned parenting and just talking to your kids can build the foundation to a less stressful childhood and hopefully a happier life. 





August 29, 2016

What’s New and Next? Applying Past and Present Principles of Professionalism for Posting



Terry Kind, MD, MPH
Associate Professor of Pediatrics
The George Washington University / Children’s National

From the latest way to share information, to dire concerns about career-ending posts, to the next new thing, where have we been and where are we going?  Guidelines are essentially meant as a starting point [Kind in AMA J Ethics 2015], to encourage thoughtful posting.  The same principles to guide your professional behavior in real life remain applicable in the online arena as well, but with additional considerations.  Your personal and professional might blend.  The voice you project --and the images you share-- are augmented. And, depending on the context, your post may be ephemeral or everlasting.  Social media has transformed our communication options, and has great potential to improve healthcare, communication, and information sharing. It allows us to innovatively reach out and engage.  And to listen.  

We’ve crafted tips for using social media in clinical care drawing upon ethical and professional principles [Chretien and Kind in Circulation 2013] and tips for use in medical education [Kind, Patel, Lie in Pediatrics 2013 and Kind, Patel, Lie, Chretien in Med Teacher 2014].   When considering new platforms of communication, think about who you are online and offline, who is or may be reading and engaging with what you post, and what are your goals?  Essentially, be a good and thoughtful citizen and share well.  

What does sharing well actually mean?  Just like in pediatrics where we aim to “catch a toddler being good” my colleagues and I sought to explore how medical students are using Twitter in “good” ways, such as for their professional development.  Do they, and if so how?  In this digital ethnographic study, we found that they do use Twitter to supplement their traditional medical school experience. It provides them with access and voice.  Access, to experts and various perspectives, and to communities of support.  Voice, for advocacy, and to craft their own digital identity, and to level the playing field among the various medical hierarchies.   [Chretien, Tuck, Simon, Singh, Kind in JGIM 2015].  

What do you need in order to post well, in addition to Wifi and a charger?  We propose that in the health professions, your posting rests on a platform of public trust [Chretien and Kind in Acad Med 2014]..  Consider security, that is, what online behaviors could jeopardize patient privacy and/or impact your own career security.  Resting on that secure base, then reflect on your own online identity and the relationships you navigate.  This sets you up to discover ways to use social media to improve health, enhance career paths (self and others) and innovate.  Throughout your journey, maintain an awareness of potential challenges and opportunities. 

Ultimately, you should draw upon the same principles of professionalism that you’d employ offline, as online.   I shall leave you with this tweet-sized tip I once shared a few years back.

T is it thoughtful
W is it wise?
E is it educational?
E is if evidence-based?
T is it tweet-worthy?

References/Resources:



July 26, 2016

Fast Food Marketing to Children: What Parents Can Do

Kathleen Lovlie MD FAAP
Gulf Shores AL
Author of "Practical Parenting: An Un-Politically Correct Guide from the Trenches"
 



Lately, children and teens are exposed to fast-food advertising from every angle. Traditional print, TV, and radio ads are ever present.  Marketers carefully place products at child height and colorfully design packaging to attract their attention. Mobile devices and social media accounts are plagued with ads.

Social media sites entice with advergames, contests, points to redeem and free downloads. If your child subscribes to or follows a YouTube channel or Twitter handle, he or she is volunteering to be sent endless “opportunities,” with ads attached. These ads encourage users (your children) to “share” and “invite” friends to participate on the websites – free word of mouth advertising! Facebook, for example, comes with 6 billion fast food ads – 19% of the total ads on the site.

Food stylists make their products look better than they ever do in reality. Advertisements suggest health benefits and a happier, more carefree life. They bait with prices that will feed your children more cheaply than a grocery store, until you switch to higher priced items at the counter. Restaurants default to a less healthy options like French fries and soda, rather than the more costly fruit and milk.

The purveyors of fast food are not on your side. Their success depends on your failure, and they have bigger wallets than you do.



Fast Food Ad Facts

Here are some facts about fast food advertising from the Rudd Center for Food Policy & Obesity



  • In 2012, 4.6 billion dollars was spent on fast food advertising—a hard number for me to get my brain around. 4.6 billion dollars will buy 920 million kid’s meals: 33,000 lifetimes worth of daily happy meals. Imagine the profit that must be generated to make spending that amount of money reasonable. These people are not your friends.
  • Less than 1% of kid’s meals (33 out of 5427) met USDA nutrition standards.
  • Only 3% of kid’s meals met the industry’s own standards.

Fast Food Ads Have Presence in Your Child’s Life


Fast food ads are unavoidable. Your children will see them and will want what they are selling.

There is no evidence that media literacy in any way defends against the effectiveness of advertisements. Knowing that fast food ads are trying to sell you something that is bad for you does not keep you from wanting it. We are grownups, and we fall for the ads.  We cannot expect more of our children than we do of ourselves.
 

In the end, it comes down to committing to do the right thing, and then acting on that commitment:


  • Clean out your cupboards and throw out all the junk.
  • Make a healthy meal plan for the week before you shop.
  • Shop with a list made from that meal plan, and stick to the list.
  • Shop at farmer’s markets and around the outer rim of the grocery store. Avoid the aisles unless there is something on your list that is on that aisle.
  • Prepare meals ahead for busy nights, so that you don’t end up in the drive-through line at the fast food restaurant.
  • Keep healthy snack food available at hand: fruits and veggies, whole grain crackers, cheese, popcorn... Throw out the chips and snack cakes.


Why "Never" is Easier for Kids to Understand than "Sometimes"
 
Remember that “never” is much easier for a child to understand and deal with than “sometimes.” If you never stop at the drive through and never buy junk food, after the first two weeks your kids will rarely ask, even though they saw that yummy advertisement a dozen times and really wanted to try those fruit snacks. Be consistent.

If you sometimes give in, they will ask until your ears bleed. Pestering is powerful when you’re tired and stressed.

Remember, you have the greatest influence on your children’s health. Fast food companies have 4.6 billion dollars on their side, but you have love for your children and the responsibility they handed you with that warm sweet bundle. You win.

June 28, 2016

Diversity in Children's Media

Jacqueline Dougé, MD, MPH, FAAP
Medical Director, Bureau of Child Health
Howard County Health Department
Blog site: DrJacquelineDouge.com


I had an interesting conversation with my older son after watching an interview of Marvel Comic authors and illustrators.  The interviewer asked about the diversity of modern day Avenger characters.  The new Spiderman is African-American and Latino, Ms. Marvel will be Pakistani-American and the new Thor is a woman.  My seventeen year old son was surprised that the characters he grew up watching were going to be of different genders, religions, races and ethnicities.  I asked him what he thought about the increasing diversity of the characters.  His response wasn’t what I expected, “I’m older now and don’t need the characters to be diverse to look up to them.”  Would his response have been different if he had grown up watching diverse superheroes?

But he also made another interesting point; characters shouldn’t be created solely to meet a demand for diversity.  My son’s response surprised me. I expected to hear that he agreed with me that there should be more diverse images and characters for kids.

My son and I have had many conversations about race, especially being African-American.  We’ve had more discussions over the past few years in light of news stories that report on the murder and violence of young black men.  In addition, he’s had to address negative biases based on his race in school.  My suggestion of having more kids of color in media was a possible solution to combat negative stereotypes and normalize the idea that different people live, work and play together.  My son is very aware of the lack of diversity in media, and as a recently graduated senior no longer needs to look up to superheroes.  He realizes that diversity in media is important, but to just have characters of different races and ethnicities isn’t enough and shouldn’t be done solely to meet some demand or current trend.
 
In 2013 blog post on diversity in children’s media, Dr. Kevin Clark wrote, “Diversity is more than demographics. We need to think about diversity holistically. Yes, it’s about gender and race, but we need to add a component to go with those demographic components of diversity—being aware of what children hear, see, and do.”  In his blog, he discusses his work to help young children create video games. He realized that even thought he was the same race of the children, African-American, he was working with, their experiences were different.  Race isn’t the only factor that connects or resonates with kids.  In creating diverse media for children, one must also consider whether the content and experiences are relatable and realistic.

Children’s media has the opportunity to create positive and enriching experiences for children.  What children see, hear and read influences their self-identity.  In the 2015 AAP News article on racial socialization, which refers to the process how kids learn to deal with racial issues, the authors discussed the role that pediatricians can play to help parents navigate the issue of race with their children.  One strategy mentioned was to discuss with parents the role that positive cultural and diverse images can have on children.  These images provide a counter narrative to images of negative stereotypes and violence.

Most pediatricians aren’t in the business of developing media, but there are opportunities to promote positive culturally diverse media such as the books recommended to our families and books and magazines displayed in waiting rooms.  In addition, there are opportunities to create diverse media content, i.e. write a book, create videos.

The term diversity is broad and complex.  It must not only have individuals or images that check a box, such as gender, race, religion or sexual orientation, but include the multifaceted layers of being a person.  Our kids are surrounded by and use media, why not have it also reflect the diversity of its users?


Resources to learn more about diverse media for children:

    •    Help your kids find books with diverse characters

    •    Apps and Games with Diverse Characters

    •    DiversityinApps



References:
Anderson A, Ellison A. Helping families navigate race issues should be an ongoing conversation. AAP News 2015;36;2. Retrieved May 28, 2016, from http://www.aappublications.org/content/aapnews/36/8/11.full.pdf

Clark, K., Ph.D. (2013, July 09). Diversity in Children's Media Is More Than Just Race or Gender - Fred Rogers Center for Early Learning & Children's Media. Retrieved May 28, 2016, from http://www.fredrogerscenter.org/2013/07/09/diversity-in-childrens-media-is-more-than-just-race-or-gender/

May 16, 2016

Screenagers

Nelson Branco, MD FAAP
Tamalpais Pediatrics
Larkspur, California
www.tamalpaispediatrics.com

I recently had the opportunity to watch the documentary Screenagers with some friends, colleagues and two of my children.  This documentary about the pervasive nature of screens in our lives and environment is relevant, informative and well done. The movie centers on a physician parent’s decision to give her middle-school aged daughter a smartphone and explores the ways that screens play a role, both positive and negative, in our lives.

This movie resonated with me as a pediatrician and a parent. I have tried to be thoughtful and balanced about both the rules I set for my family and the anticipatory guidance I give about screen time. Time will tell if my children have learned to manage the different screens in their lives, and whether I have modeled responsible behavior. Nonetheless, there are principles that we can use to guide us when giving advice to families and kids around screen time.

The amount of information at our fingertips and the ability to connect and communicate with virtually anyone in our lives is truly incredible.  It’s not surprising that it is so addictive – these devices are useful, entertaining and engaging. When we deny this we lose credibility with the kids in our lives.

Minecraft is cool.  It really is – spend some time with a Minecraft-savvy tween and you’ll see.  Social media at it’s best is fun and interesting. Texting can be a good way to communicate – more immediate than email but not as intrusive as a phone call. Video games can teach kids to try, fail and try again.  Movies and TV help us relax, share stories and learn.

There are well-documented negatives, of course. Few of us may qualify for the DSM-V diagnosis of Internet addiction, but we all react to the jolt of dopamine that we get from a new email or text.  Minecraft can take over time that could be spent playing outside, reading, doing homework or being creative with another medium besides animated blocks and elements.  Teens can use social media and text messaging to bully, harass or hurt their friends and schoolmates. Violent video games can expose kids to sights and sounds that we would like them to avoid, and can be addictive as well. Movies and TV shows can model unhealthy behavior and unwelcome stereotypes.

 As parents, we work hard to protect our children from harm. In my practice, most families are aware of the need for rules around media and limit their young children’s screen time.  I see it become more difficult in the middle and high school years, once smartphones become ubiquitous. I also see parents who think nothing of pulling out their smartphone while waiting, or while I am talking to or examining their child.


 I’m sure most of us have done the same. We often use the excuse that we are doing “work” when we’re on our screens.  We should remember that teens can use the same excuse.  Their “work” is to connect with their friends and form an identity. Social media, texting, Skype and email are all ways to do that – more efficiently and more pervasively than the phone calls and hanging out that our generation did as teens.

If we are going to teach our kids to use screens and media wisely we need to monitor and track our own use.  Are we reaching for the phone as soon as it dings, even if we’re in the middle of a conversation?  Do we stand around checking email or social media while waiting in line or sitting with our kids in an office? Do we have screen-free times for the whole family?

We can’t expect our kids to learn to eat vegetables if we aren’t serving and eating them ourselves, and we can’t expect kids to use devices and media responsibly if we aren’t doing it as well.

 Screenagers touches on these same points, and uses stories and examples to illustrate these topics. This movie won’t break any new ground for pediatricians – these are topics that we talk and think about every day.

What I liked about this movie is that it gathers interesting information and presents it in a balanced and engaging way. It opens the door for consideration and conversation. I wish more documentaries about parenting, families and kids did this as well.

The movie is being screened in many communities. I highly recommend you see it and engage your colleagues, kids and other parents in the discussion. For information about the movie, visit their website: www.screenagersmovie.com.