Our Childrens' Health

n

Preventive health

our

Walking to School Safely > PAGE 19

children’s health Texas Children’s Hospital & Defender Media Group | Volume 1| 2014-2015

NUTRITION

EASY, TASTY HEALTHY MEALS > PAGE 5

SPORTS

BACK TO SCHOOL SPECIAL

AVOID BODY OVERHEATING > PAGE 11

MENTAL HEALTH

UNDERSTANDING ADHD & MEDS > PAGE 12

Texas Children’s Health Plan covers children from newborns to teenagers. We even cover adults and pregnant moms through STAR Medicaid. Families with children who qualify for CHIP pay $50 or less a year. Those who qualify for Medicaid pay nothing. CHIP and STAR Medicaid offer a wide range of benefits including checkups and shots, dental services, medications, and more.

With Texas Children’s Health Plan you also get: ■

Over 2,100 doctors.

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A 24-hour nurse hotline.

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Free transportation to doctor visits.

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Pregnancy support program and classes.

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Help losing weight through the Keep Fit Program.

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Learn how to play soccer from the Houston Dynamo coaches.

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Fun, free member events!

For more information, to receive an application, or to find an event in your

MK-1208-007

area, visit us online or call today.

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Our children deserve the best

A

60 years providing health to children

s parents we want to provide our children with the best life has to offer. From their amazing birth to the amusing teen years, we strive to help them develop into strong, responsible individuals. Granted, we might be limited by our pocketbook or lack of knowledge, but we try to do our best.

As we mold their development, we often forget about a fundamental responsibility – our children’s health. We must teach them what to eat, what not to eat, how to exercise, how to take care of their bodies, how to be safe and so Sonny Messiah much more.

JilesPublisher and CEO In an effort to provide parents with greater resources, The Defender is blessed to join forces with world-renowned experts at Texas Children’s Hospital to offer you this back-to-school publication. We also thank the Texas Children’s family for their dedication to improving the quality of life of our children.

F

or more than 60 years, Texas Children’s Hospital has been providing health and hope to children and their families.

Today, we are not only Houston’s largest and most comprehensive pediatric hospital, but also one of the most preeminent centers for children’s health care in the nation. We are committed to medical excellence and quality outcomes with a single purpose – to ensure the health of the youngest and most vulnerable members of our community, whether they reside in nearby Dr. Mark W. Kline neighborhoods or on the other Physician-in-Chief side of the world.

Health needs are not simply about providing cures and care for physical maladies.

We are committed to bringing services, support and education right to families in their own neighborhoods and working collaboratively with other institutions and groups who bring additional expertise in these areas.

table of contents

Preventive hea

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children’s health Texas Child

ren’s Hosp

Healthy eating habits 4 Strategies to fight child obesity 5 Homework tips for parents and students 8 Parenting in the digital age 10

Avoid body overheating 11 Understanding ADHD & meds 12 Helpful websites & resources 14 Stop bullying & hazing 15 Talking to teens 18

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ital & Defe

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NUTRITIO N

EASY, TASTY HEALTHY MEAL > PAGE 5

BACK TO SCHO SPECIAL OL

SPORTS

AVOID BO DY OVERHEAT ING > PAGE 11

MENTAL HE

UNDERSTA ALTH NDING ADHD & MEDS > PAGE 12

Our Children’s Health | 2014-2015 | 3

nutrition

Healthy

eating habits

H

ealthy eating habits can help your child maintain a healthy weight. It is important for children to eat balanced meals to ensure good nutrition and to prevent extra weight gain as they grow. Here are some suggestions to help you get started.

• Eat a variety of foods. Eat fruits, vegetables, low-fat and fat-free dairy products, lean meats, fish and chicken, bread, cereal, rice, pasta and corn tortillas. Eat only a small amount of fats like margarine, butter, oil, mayonnaise and salad dressing. Do not eat a lot of fried foods.

• Eat proper portion sizes. Avoid large portions of foods. Large portions are common when you eat out, so split meals or take half home.

4 | 2014-2015 | Texas Children’s Hospital & Defender Media Group

Changing to a healthier diet and increasing exercise is good for every person in the family.

• Do not skip meals. Try to eat at the same time every day. Regular meal and snack times will give you more control over what you eat. If you skip meals, you might over eat at the next meal.

• Eat slowly. Put your fork down between bites.

• Drink plenty of water. Drink about eight glasses of water a day. Regular sodas, fruit juice, fruit punches and sports drinks should be avoided or limited to one per day.

Sugar-free drinks are okay in moderation.

nutrition A physically active lifestyle helps prevent weight gain and obesity.

Fitness encourages a feeling of self confidence and control that will help children be happy and healthy.

• Eat healthy snacks. Regular snacking on chips, cookies, candy and ice cream can cause weight gain.

See the snack list for ideas on healthier, lower calorie snacks.

• Do not eat in front of the television. It is easy to overeat when you are paying attention to the television instead of your food.

• Increase your activities. Walk the dog, ride your bike, skate, play basketball, play sports at school or after school, swim or do any activity you enjoy.

If you use a wheelchair, talk to your doctor about activities and exercises you can do.

Changing your habits is easier to do if the whole family is helping. Changing to a healthier diet and increasing exercise is good for every person in the family.

Healthy snacks for kids and grown-ups

Remember: Plan your snack time and eat snacks in moderation.

• Fresh fruits, frozen grapes, fruit kabobs (cut up favorite fruits and let children put on wooden skewers – with adult supervision since the sticks are sharp) • Bagels • Hot or cold cereals with low-fat (1/2 percent or 1 percent) or skim milk. Choose low sugar cereal with 10 grams of sugar or less per serving • Low-fat snack crackers, pretzels, baked chips, low-fat microwave popcorn • Vanilla wafers, Teddy Grahams®, animal crackers, graham crackers (limit amount to a small serving) • Flavored rice cakes • Frozen fruit bars, sorbet, fat-free frozen yogurt or ice milk • Pudding made with low-fat or skim milk (instant pudding is quick and less expensive than the ready-made pudding; put in individual cups for easy serving) • Sugar-free gelatin made with fresh or canned unsweetened fruit • Canned fruit packed in its own juice • Fruit snacks or fruit roll ups • Blanched (slightly cooked) plain fresh vegetables or with low-fat or fat-free salad dressing

• Low-fat cheese or turkey sticks • Frozen banana sticks (Put a Popsicle stick into half a banana, roll in yogurt and freeze on wax paper. When frozen, roll in more yogurt and then roll in graham cracker crumbs. Let thaw slightly before eating.)

• Frozen fruit juice Popsicles (Partially freeze your favorite fruit juice in a paper cup, put a Popsicle stick in it and then thoroughly freeze.)

Get up and get moving

Children who are physically active have more energy and can develop better strength, coordination, balance and flexibility than those who are not active.

A physically active lifestyle helps prevent weight gain and obesity. Fitness encourages a feeling of self confidence and control that will help children be happy and healthy.

Physical activity: Any movement will do. A total of 60 minutes of active play and physical activity every day is recommended.

This goal can be reached in a few minutes of time throughout the day.

• Walk to and from the bus stop • Jump rope or play tag at recess • Ride a bike after school • Walk the dog • Take stairs instead of the elevator • Play frisbee or basketball after supper • Mow the grass or rake leaves • Play soccer in the yard with friends • Help vacuum and sweep the house • Limit television, video game and computer time to no more than an hour a day Parents: Be a role model to your children by exercising regularly and remaining active.

The better choice for healthy eating

Breakfast

Instead of Sausage biscuit Hash browns Bacon and eggs Whole milk

Lunch

Instead of Cheeseburger Peanut butter sandwich Pepperoni pizza French fries Potato chips Soft drink

Try Waffle with fruit Oatmeal or grits Raisin bran Low-fat milk

Try Small, lean burger Turkey sandwich Cheese pizza Carrot sticks Pretzels Water, skim milk or sugar-free drink

Dinner

Instead of Try Fried, breaded pork chops Baked pork chops Fried fish Broiled fish Fried chicken Grilled chicken Mashed potatoes with gravy Baked potato with

low-fat sour cream Green beans with salt pork Steamed green

beans with a little margarine White rice with gravy Brown rice with a little margarine Refried beans Fat-free or low-fat refried beans Flour tortilla Corn tortilla

Our Children’s Health | 2014-2015 | 5

nutrition By e a t i ng particip right and a physica ting in l it will d activities e m o n st r positiv e beha ate v iors.

In fact, tr i n st i t u t y in activiti g family es will hel ; this p impro ve everyon e’s hea lt while a lso ens h u q u a l i ty ri family ng time.

Making

healthy meals It’s that time of year again, when American families are increasingly strapped for time. While juggling work and shuttling children toand-from school, as well as other activities, finding time to make nutritious meals can be difficult.

This is one of the many reasons why obesity, especially among children, is becoming a more omnipresent issue.

The good news is there are simple things parents can do to help the family start this school year off right. Below are some healthy lunch and snack ideas, as well as some tips to ensure children are successful in making healthy choices at lunch time.

Breakfast

Cereal: Add 1 cup of skim or 1 percent milk to 1 cup of low sugar cereal (options include Cheerios, Multigrain Cheerios, Fiber One Honey Clusters, any flavor Chex, Honey Bunches of Oats or All Bran) and add ½ cup of berries or one small banana.

Egg and cheese breakfast tacos: Heat two small (six inch) corn or whole wheat tortillas. Fill tortillas with ½ cup Egg Beaters or two egg whites – scrambled using no calorie cooking spray, 2 tablespoons reduced fat cheese and salsa.

Honey walnut yogurt: Mix 1 cup of low-fat plain yogurt with 1 tablespoon of honey and top it off with 2 tablespoons of chopped walnuts.

Lunches

Sandwiches: Two quick things to remember are to transition the child to wheat bread and use turkey or chicken as an option over ham. For peanut butter and jelly versions, look for jelly with reduced sugar.

Make the child’s own Lunchable: It is

well known children love Lunchables and they are very easy to grab and go, but they aren’t the healthiest choice. Instead, make a Lunchable with whole grain crackers, turkey, fat-free cheese and add a sugar free yogurt as the dessert. If yogurt doesn’t fly with the child, consider a sugar-free chocolate pudding.

Whole wheat English muffin pizza: Top one whole wheat English muffin with 2 tablespoons red sauce, 2 tablespoons cooked vegetables and 2 tablespoons of reduced fat cheese.

Quesadilla: Fill one whole wheat tortilla with ¼ cup grated reduced fat cheese and heat until the cheese is melted. Optional: add in 2 ounces of grilled chicken.

Snacks

Fruit and cheese: Have one medium fruit (apple, banana, orange or grapefruit) with one stick of reduced fat string cheese or 1 tablespoon of peanut butter.

Peanut butter grahams: Top two graham crackers with 1 tablespoon of peanut butter.

Crackers and cheese: Serve five whole wheat crackers with one wedge of Laughing Cow cheese.

Pudding: Pair one low fat pudding snack pack with 10 Teddy Grahams.

Experts at Texas Children’s Hospital say parents should be mindful to only serve snacks between meals and only if the child is hungry. Also, snacks should be limited to

6 | 2014-2015 | Texas Children’s Hospital & Defender Media Group

no more than two daily and each should contain between 100 and 200 calories.

Although getting any child on board with these changes can be a challenge, below are tips to help children transition quickly and easily: Give the children healthy choices. By offering children healthy choices it fosters their sense of independence (they get to choose) while ensuring they are eating nutritious meals and snacks (all choices are healthy). It also is important to balance meals and snacks. By providing options, it guarantees the child is getting the right proteins, carbohydrates and healthy fats.

Be a positive role model. Children watch and mimic more than any parent realizes. By eating right and participating in physical activities it will demonstrate positive behaviors. In fact, try instituting family activities; this will help improve everyone’s health while also ensuring quality family time.

Put structure into the children’s lives.

Arrange for them to have the same schedule during the week and plan three meals and one or two snacks served at the same time every day. Getting into a routine can help mitigate the last minute fast food runs or reaching for a sugary, unhealthy snack.

Although the school year can be a hectic time for any family, good quality nutrition should always be a top priority.

The road to a healthier lifestyle for the entire family can start with these tips which can easily be added to any family routine.

nutrition

Strategies to fight

child obesity

C

hildhood obesity is a real issue that many families face. A majority of the discussion has placed an emphasis on encouraging physical activity for children as a way to keep them healthy. While this is vital to any healthy living plan, an equally important facet is helping children maintain a balanced nutritional diet. This task isn’t always easy for busy families, but there are simple tips that everyone can use to make healthy eating fun for the entire family.

A common struggle when it comes to healthy eating among most families is portion sizes.

As families may know, the U.S. Department of Agriculture replaced the food pyramid with the “MyPlate” concept. “MyPlate” gives a more visual demonstration of how much of each food group families should have during main meals. Though the basics still apply, this concept visually reminds everyone of the importance of controlling serving sizes and portion control. For instance, some bags of chips or containers of frozen yogurt are multiple serving sizes even though people may think it is just one. Utilizing “MyPlate” also ensures families are eating from a variety of food groups. For more information about “MyPlate” visit: http://www.choosemyplate.gov/.

Parents also commonly struggle with getting their children to eat healthy foods as some inherently assume healthy foods taste bad.

“Children thrive in an environment where they have some control. If parents truly want their children to be successful, they need to allow them the opportunity to become active members in their nutrition,” says Dawn Bunting, manager of clinical

nutrition services at Texas Children’s Hospital West Campus.

Some ways parents can easily do this include: allowing children to create the grocery list – with their parent’s helpful suggestions of course, asking the child to help plan a meal a week and play a part of the meal preparation, let the child select a color for each day and use that as inspiration for a new fruit or vegetable the family tries.

Even if parents are successful at getting their children to try healthy foods, a major struggle can be ensuring children enjoy those foods. This is one of the most difficult, yet common, roadblocks parents run into. When this happens to families,

re nts a ng e r a if p etti Even sful at g try o es succ hildren t c a their y foods, an be c h healt struggle n enjoy r e majo ng childr ri ensu foods. e thos

the best advice given to parents is to continue to retry different types of foods. Just because the child did not like something the first time does not mean they will not the second or third time. Also, try preparing food items in a variety of ways as acquiring tastes for different foods can take time.

Another issue families have is trying to differentiate between a picky eater and an underlying medical problem. If a parent is ever concerned that their child’s selective eating habits are more than just that of a picky eater, they can always have their pediatrician make a referral to the Clinical Nutrition Services to see a registered dietitian at Texas Children’s where the team really takes the time to understand every parent’s concern, because nutrition and healthy eating affects the entire family.

When trying to move towards healthier eating habits, it does not mean that the family must forsake all things sweet. There are plenty of ways families can take something nutritious, like a fruit or vegetable, and add something sweet to create a healthy snack or dessert. Some options include: • Homemade fruit pops – take a banana, dip it in yogurt & freeze it • The old favorite – “ants on a log” – celery, peanut butter and raisins - Or try celery and cream cheese • Ice cream sundae using frozen yogurt and graham crackers • Homemade baked fries or try homemade baked sweet potato fries for a special treat A well-balanced diet is extremely important for the entire family. Starting young children on a healthy lifestyle can help prevent childhood obesity and control unhealthy habits that can be continued throughout their entire lives.

Our Children’s Health | 2014-2015 | 7

fyi

HOMEWORK TIPS

1

for parents and students

Designate a specific area in the house where your child’s homework is to be completed daily. This area should be a low-traffic area that is as distractionfree as possible with no television or radio playing.

Your child should have all of the supplies she needs in order to complete homework: • All books and homework assignments • Agenda book/planner • Extra pencils and pens with pencil sharpener • Extra paper • Calculator if appropriate • Dictionary and thesaurus • Appropriate lighting • Comfortable chair Review your child’s agenda book in order to know what assignments need to be completed. Allow a specific amount of time for your child to complete each homework assignment. Use a kitchen timer to set time limits for each assignment and give short breaks (5 minutes) between assignments. Set a specific goal of the amount of the assignment to be completed in the allotted time (e.g., 10 addition problems in 15 minutes): • Do easiest assignment first. Allow

2

3

10 to 15 minutes for child to complete easier, less time-consuming assignments.

Reset timer for a 5-minute break between each assignment to redirect attention and release energy.

• Allow more time for more complicated tasks (e.g., 20 to 30 minutes). Remember to give your child breaks after each task or assignment is complete.

• Ensure your child respects the timer.

If he or she is wasting time instead of completing an assignment, reset the timer.

Encourage your child to use a dictionary to look up unfamiliar words or a thesaurus to learn synonyms. This will help him understand the assignment better and help build your child’s vocabulary at the same time. The

4

R ev i e w yo agen u d a b r c h i l d ’s o o rd e r to k o k i n no what assig w need n to b e m e n t s co m p l e te d .

8 | 2014-2015 | Texas Children’s Hospital & Defender Media Group

dictionary and thesaurus should be kept within the homework area. Your child should keep a small dictionary in his or her backpack to be used for school or at home. Consider the websites www. dictionary.com and www.thesaurus.com Encourage your child to check over her homework assignments.

This is an important method of teaching your child to self-monitor.

Children should be in the habit of checking over their own work and to monitor for mistakes that they need to correct.

Encourage independence, but make yourself available to help your child with his assignments.

Help your child think through more complicated concepts without giving him or her the correct answer. In this way, you are showing your child support without doing his homework for him.

If you are unable to help your child with his homework, ask another family member or neighbor who is competent in the subject to help your child with certain assignments. You also may consider hiring a qualified tutor to be the designated homework helper.

For more homework strategies, consult the Great Schools website at www.greatschools.org

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6

technology

eel f in h t You cipation ing k i p a r t l n e t wo r c y a s o c i a d e s l i te r e d i p r ov t o s u c c e r a r y o to o l s o n te m p c in a . d wo r l

Parenting in the digital age

T

echnology has changed and advanced at a supersonic pace and this remarkable shift has presented a new landscape for socializing, working, parenting and relating.

Where does this ever-changing landscape leave parents who are guiding youth online?

Some may feel good about the move to a more digital world. However, it may leave others feeling confused, overwhelmed or detached.

These feelings of insecurity may cause some dissonance as parents assist their children to make choices that ensure internet safety, consider consequences of behavior online and help children think critically about media and digital decisions.

Even though technology can bring feelings of insecurity, the bright side is children can utilize and mine the internet and online tools for valuable information, for connecting with friends and for developing communication skills in a modern world. When talking to teens, it may be important to remember that in a large study (approximately 800 youth), the participants describe a generation gap in which they feel adults see online behavior as distracting and dangerous, whereas they see this time as useful. Youth feel participation in social networking provides literacy tools to succeed in a contemporary world (MacArthur Foundation Study).

Technology has advantages in learning settings as well. Although it is not always the

appropriate tool, (an artist would best grasp the nuance of a color pallet by mixing actual paint); digital communication is being utilized in classrooms and new media allows for autonomy and exploration not found in the traditional classroom setting (e.g. Skyping a class from across the globe). The shift continues to progress with new technologies, it might be important to remember when talking to the child, the value they may place on digital communication.

Although, there are some risks online that are important to discuss with the child, or better yet, the child may have some good ideas about how he or she navigates around these risks to maintain a positive reputation online.

Some of the risks include, cyber bullying which is any harassment online of a peer. This may start as a “joke” and become hurtful and harassing in ways adolescents have trouble managing and navigating. The publicity and potential permanence of these comments online can leave wounds that are not easy to erase. The child may choose to view inappropriate content or create inappropriate content. The child may also over-share personal life events without realizing the publicity of the audience. Over-sharing may be linked to adolescents seeking validation online from others about private topics in a public forum.

Talking to children about their internet use might not be an easy conversation. In order to

help with the process here are a few discussion topics: • Media literacy: How does the child interpret information online? Advertisements?

Statements? Even photographs? This material has context online that may be different than in person. Having the understanding of the context of material shared online can be helpful to developing critical thinking skills online.

• Level of oversight: Consider the child’s age, maturity level and decision making skills when determining the level of oversight the parent can have over the child online.

Communicate the “house rules” with the child.

• Understanding privacy, permanence and publicity online • Discussing internet safety • Talking about the utility and value of new technologies A few more helpful tips include limiting screen time. When do members of the family “unplug” for downtime? This is an opportunity for parents to model good behavior about limiting time on-screen.

Reputation management: What is the child’s “brand” online and how can he/she “self-edit” in such a way that his/her identity online is positive?

Finally, having ongoing conversations about digital reputation management, critical thinking and internet safety may decrease the parental worry and offer guidance to the child as he or she navigates this brave new world.

Our Children’s Health | 2014-2015 | 9

sports

Building

stronger bodies W

e all know good nutrition is important, but it goes beyond the way we look and feel.

For young athletes, maintaining a balanced diet is critical to the health, growth and development, safety and success of their sport.

Eating the right kinds of foods at the right time can help provide the sustained energy during activities and promote the recovery muscles need after strenuous exercise.

A common concern is if a child is getting enough of the right kinds of protein. Protein is necessary to build and repair muscles and it boosts the immune system too.

The need for protein in an athlete is increased, but many athletes over consume protein and under consume calories. Children can make healthy protein choices by choosing lean meats (turkey, fish, sirloin, beans, tofu), using egg whites instead of whole eggs, choosing low fat dairy products (skim milk, 1 percent milk, low fat yogurt), and avoiding fried meats.

Depending on the child’s age, parents can calculate the young athlete’s protein needs: 0. 5 to 0.

8 grams of protein per pound of body weight.

Also, two to four hours prior to a workout, a moderate amount of protein can be eaten with carbohydrates. Examples might be a turkey sandwich with lettuce and tomato or a yogurt parfait made with Greek yogurt, chopped fruit and dry cereal. This can be repeated within 30 minutes after a workout to help re-load the depleted muscles with the fuel they need.

Carbohydrates are the fuel of exercising muscle; however quality always counts. Carbohydrates consist of both sugars and starches. Sugars appear in cookies, candies, cake, pies and many snacks that children love. The sugars in these foods often contain large amounts of fat making them unsuitable for athletic performance. Sugars are fast acting carbohydrates and the closer it is to competition the more these fast-acting carbohydrates take center stage. Think of these sugars as topping off a well-fueled tank. But the staple of the well-fueled 10 | 2014-2015 | Texas Children’s Hospital & Defender Media Group

Abo u child t half o f b e f ’s p l a te a r s ve g u i t s a n d h o u l d etab l a re 90 p es, whi ch and e c a n rc e n t w deh yd ra h e l p p re a t e r tion ve n t .

athlete are the starches such as bread, rice, beans, some fruits and vegetables. The correct carbohydrate choice to use depends on the time remaining before the event. If it is 15 minutes before a soccer match it would be best to use a sports drink or a carbohydrate gel or honey. If there is more time, an hour or so, foods like whole grain cereal and milk or graham crackers with some peanut butter and honey would be a good choice. A low fat meal like chicken spaghetti or a sandwich and fruit can also be considered part of a performance plate.

Experts at Texas Children’s Hospital say protein alone does not fuel muscles for activity. When foods are chosen by a few basic principles the plate becomes an ally in the prevention of chronic illness and a strategy to improve performance. The principles are simple, choose a plate rich in colorful produce, quality whole grain carbohydrates and lean protein.

About half of a child’s plate should be fruits and vegetables, which are 90 percent water and can help prevent dehydration. Next, whole grain carbohydrates, such as whole grain pasta, brown rice, oatmeal and 100 percent whole wheat bread, should take up onefourth of the plate. These high fiber foods contribute to a sense of fullness and may aid in weight reduction. If a child doesn’t like these whole grain foods, consider foods that have some whole wheat in them. There are pastas, for example, that combine white and whole wheat flours to make a less chewy product. Lastly, lean protein should be approximately one-fourth of the plate and protein should be consumed at each meal. Some protein suggestions for breakfast include flavored Greek yogurt, egg whites or Canadian bacon added to the first meal of the day.

For young athletes, maintaining a balanced diet is critical to the health, growth and development, safety and success of their sport. By following these tips, parents can help their young athletes have a healthier diet and help prevent potential illnesses related to poor nutrition.

sports

Avoid body overheating

S

ports practice and workouts are tough on school athletes and coaches during the brutal heat of August and September. A rise in body heat of just 2 to 3 percent is likely to weaken a player’s performance, and not much more is needed to endanger health. Heat-related illnesses, often called heat exhaustion or heat stroke, are dangerous and can even be deadly for young athletes.

In professional leagues, highly trained certified athletic trainers and sports dietitians constantly monitor their players’ performance and health.

High school and junior high coaches are trained, as well, to watch for signs of trouble. But elementary school and volunteer coaches or parents may be less aware of warning signs.

Children are at much higher risk for heat illness than adults and can easily get sick going back to sports practices this fall. Doctors at Texas Children’s Hospital believe it is important for children to be acclimated to the heat before practices begin to best prepare their bodies to fight against heat illness.

Children’s bodies produce more heat, but they sweat less. That puts them at special risk for heat-related injuries. The challenge however is not only confined to the extreme workouts of older teens.

Young kids feel the heat, too, and their bodies are less adept at regulating internal temperatures.

“We need to do a better job of educating parents, coaches and especially players, themselves, about dealing with summer heat,” says Roberta Anding, director of sports nutrition and dietitian with the Adolescent Medicine clinic of Texas Children’s.

“Dehydration is cumulative.

You can go out on the field on day one, then go home and drink. But if you don’t take in enough fluid to truly rehydrate, day two will feel worse.”

An athlete’s intake of fluids should never be restricted. Coaches of long ago tried to “toughen” players by withholding breaks and water. Many coaches are

Heat illness tips

• Monitoring the child’s weight is critical. Most experts agree that about 80 percent of weight lost in a workout should be replaced by fluid intake. Parents can help by weighing their child every day of pre-season practice or other hard workouts. If his or her weight is down each day, the child is almost certainly dehydrated. How much weight is too much to lose during workouts? More than 2 percent, which is two pounds per 100 pounds of weight.

• Checking urine color is important, too. Young kids might giggle at the lesson, but coaches should teach athletes to check their urine during practice breaks. To help explain to a young class, experts suggest coaches use two simple visual aids, glasses of apple juice and pale lemonade. As long as urine looks about the color of the lemonade, the urine test is fine. If their urine is closer to apple juice it is time to take in more fluid.

still unaware of potential dangers of wearing helmets. The very same gear that improves safety on the field can increase risks on the sidelines. “Helmets protect the head, but they also prevent sweat from evaporating,” Anding says.

Because helmets hold in body heat, coaches need to urge players to remove helmets between plays.

A common question among parents and coaches is what should active children drink? Water is almost always best, but after working hard outside for an hour or more, a sports drink is a good option as it will replace electrolytes lost in sweat and add carbohydrates to fuel exercising muscles. “The purpose of a sports drink is to replace what a body has lost. Other than that, plain water is just fine,” Anding explains.

Another common question is how much should the child drink? Unfortunately, the thirst response is not a good measure. Humans do not rehydrate if they stop drinking fluids as soon as they are no longer thirsty. The body needs more.

Experts debate exact proportions, but here are general guidelines when it comes to fluid intake: • If the child is age 10 and under: drink about four ounces one to two hours before an activity, four more ounces just before an activity, and another four ounces after every quarter hour of activity.

• If the child is from age 10 to about 13: follow the young children’s schedule, but increase the intake for each step to about eight ounces.

• If the child is an adolescent or older: follow guidelines for adults, which call for drinking about 16 ounces of fluid an hour or two before an activity, eight to 16 ounces about 15 minutes before an activity, and enough fluid during an activity to replace what’s lost.

It is important for everyone to stay educated on heat-related illnesses and how to prevent them for occurring.

Applying these tips to an athlete’s routine can help them stay hydrated and help prevent a heat-related accident from occurring.

Our Children’s Health | 2014-2015 | 11

mental

Ensure back-to-school success for childr

By DAVID F. CURTIS, PhD and SARA R. ELKINS, PhD Baylor College of Medicine / Texas Children’s Hospital Pediatrics – Psychology Section

P

arents of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and those with other special learning and behavioral needs are often challenged (more than others) by their children’s transition back to school. One of the best things that parents can do to set their children up for school success is to be more proactive before each new school year begins.

Three specific ways to prepare children for going back to school are to: 1. Set good routines and daily schedules.

2. Establish a regular dose of medication (if the child is taking an ADHD medication).

3. Make a plan with the child’s teacher and other educators at the child’s school.

Begin good school habits early

One of the biggest challenges for children when returning to school is adjusting to a new routine. To help make this easier, begin a sleep-wake schedule for your child two weeks before the start of the school year. If your child has been keeping late hours over the summer break, you may have to do this gradually, setting earlier bedtimes every other night.

A week before school starts, your child should be going to bed each night and waking up each morning at the same times that he or she will during the school year. This will allow you to work out all the kinks related to the potential fatigue, irritability, alertness, and general level of energy that are affected when children return to school. In addition to the sleep-wake schedule, prepare healthy meals, provide outdoor activities, limit screen time, and set a daily reading routine that is similar to your child’s afterschool homework schedule.

Although it’s tempting to squeeze in one last vacation right before school starts, try to avoid going on an end-of-summer trip or even a long weekend to the beach. Instead, schedule your last summer vacation before the last three weeks of summer. That way, your family can enjoy one last end-of-summer “fling” while also showing your children the importance of the whole family gearing up for the new school year.

During the weeks leading up to the first day of school, you may also want to re-set clear expectations for other daily routines.

For example, you might set a bedtime routine for your child with a checklist of things to finish the day and to prepare for the next, such as: • Taking a shower.

• Putting clothes in the laundry basket.

• Brushing teeth and hair.

• Selecting clothes for the next day.

Set specific start and end times for these routines and motivate children to complete their routines on time. For example, if all bedtime routine activities are completed by 8 p.m., you might allow your child to watch 30 minutes of television before bed. Also, consider being more involved in the bedtime routine during the two weeks before the start of school and to provide positive feedback by “noticing out loud” all the things your child is doing right to stick to the routine.

Use daily report card to keep focused on goals A daily report card gives parents and teachers a document of the child’s progress on daily goals to use positive behavior in the classroom.

The child should be expected to work on only one behavioral goal at a time, for about a week at a time. Goals should be written down and easily understood by the teacher, child and parent. The child should then take the daily report card home for the parent to review each day, so the parent can determine the appropriate positive or negative consequences.

Using a daily report card

• First, speak to the teacher about your child’s behavior at school.

• Based on the teacher’s feedback, decide on 2-3 school behaviors that need improvement (i.e., staying seated, following instructions, paying attention).

• Set the first goal that the child will work on.

• Make sure the teacher understands: - Clear and simple behavioral definitions should be used.

- The child will focus only on one goal at a time.

Finally, consider the power of an effective tuck-in. Just before saying good night, take some time to look back on the events of the day with your child and talk to him or her about plans for the next day. This is helpful for children with ADHD who tend to struggle with organizing their thoughts (“quieting” their minds) and settling their bodies at the end of a fast-paced day. This also helps continue a positive, parent-child connection while showing your child how to practice reflection and planning.

Plan now for restarting medication

Children with ADHD may have very high intelligence, but they still struggle with consistent behavioral and academic performance because of their problems with inattention and controlling their behavior without help. Many of these children take “medication holidays” during summer months, but their medication is an important part of their ongoing treatment and academic success.

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- The child should only be evaluated for the goal he currently working on, not all behaviors.

- The focus is on the DOs, not the DON’Ts. - He / she should use simple ratings like: 0 = didn’t p behavior, 1 = met the behavior goal with teacher assista performed the behavior mostly independently, etc.

- He / she should support your child’s goal progress giving the child morning reminders and prompts about current goal.

• Let the teacher know that ratings are linked to a list o the child can earn for his or her classroom efforts and w for carrying out consequences at home.

• Have your child take the daily report card back and fo the teacher each day.

Discuss your plan as an easy way to promote pos at school by working on one goal at a time. Use the dai as a way to reward the positive behavior at school and be more successful in the classroom throughout the sch

To ensure that children are getting the mos the fewest side effects from their medication, sch your child’s pediatrician three to four weeks befo begins. Pediatric clinics get very busy toward the well-child exams, vaccinations and pre-athletic p pediatrician may not have an appointment availa schedule your visit before the end of summer.

During this visit with your child’s doctor, dis the medication at the lowest possible dose to allo observe your child and for his or her body to phy medicine before they have to handle the daily de Restarting medication before school begins allow with problems related to the medication without that with the newness of academic demands, so afterschool activities.

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Parent-teacher collaboration is essential for a good back-toschool transition for children with ADHD and other types of behavioral and learning needs. Children spend more time at school than they do at home during the academic year, so establishing a good relationship with the teacher and a plan for effective school-home communication should be an important priority for parents.

Children with ADHD have a strong desire for “newness,” which typically helps them have a very positive start to the new school year. But instead of waiting for the end of the “honeymoon period,” or waiting for problems to start, reach out to your child’s teachers and take charge of your child’s success early. Once the novelty and excitement of a new situation wears off, children with ADHD often become less attentive to their work, because school becomes more routine and may begin to feel a bit boring.

To help prevent this, request a brief parent-teacher conference during the first four to six weeks of the school year to establish a “foot in the door” with the teacher. Consider your child’s teacher the “classroom expert,” and let him or her know you are interested in supporting their lead role in your child’s academic success.

To support the teacher’s classroom goals, ask about the teacher’s preferred method of communication and how often he or she likes to communicate (e.g. weekly emails, bi-weekly phone calls, etc.). Express your interest in being an “active and supportive part” of your child’s education, but explain that you do not want to “get in the teacher’s way or become over-involved.” This will show that you are being supportive and that you respect the teacher’s time and other responsibilities.

The first meeting with the teacher is really to set a good working partnership with him or her and to discuss your child’s strengths and areas for growth. The next parent-teacher communications can then focus on helping the child stay on the right track. In these discussions, you should discuss what has worked in the past to help your children do well in class.

Share any past documents related to classroom accommodations and support, examples of behavior plans previously used for your child and any other materials that may keep the teacher from “reinventing the wheel” to help your child. You can also ask about the teacher’s past successes with children with ADHD to learn more about what the teacher may suggest to support classroom goals.

When working with the teacher to establish behavioral goals for your child, consider a few key points. Set goals that promote good behavior rather than reduce problem behavior. Also, start small: instead of making a list of several behaviors for your child to work on all at once, let him or her focus on just one. Children with ADHD can benefit more from an intensive focus on one new behavior at a time. Make sure all target behaviors and goals are clearly explained in a way both the teacher and the child understand.

Get help to get started

Preparing early, making a clear plan and giving your child positive encouragement will get them off to a good start in the new school year – and help is available. If setting routines and scheduling activities to handle daily tasks feels overwhelming, get the help of a child psychologist, social worker, family counselor or an ADHD coach. These specialists can assist the family in finding better ways to cope with ADHD-related challenges, determine what support is available at your child’s school, and ultimately, help improve the family’s communication and relationships.

Autism Minority parents beware Some children with autism appear to be developing normally when they are very young. They babble or even talk, make eye contact with their parents and crawl and walk on schedule. Then suddenly, these skills seem to vanish.

Described as developmental regression, this loss of language, motor or social skills occurs more often in black and Hispanic children compared to white children, according to a study led by Dr. Adiaha Spinks-Franklin, associate director of the Meyer Center for Developmental Pediatrics at Texas Children’s Hospital.

“Lost skills are very difficult to recover and unfortunately, there is no way to prevent developmental regression,” said Spinks-Franklin. “What we know is important in helping children with autism learn to communicate better, develop improved social skills, engage in more functioning behaviors, participate in an appropriate school curriculum that addresses their unique needs and learn to function as independently as each child can.”

Spinks-Franklin and her team analyzed data on 1,353 preschool children with autism enrolled in the Autism Speaks Autism Treatment Network database between March 2008 and December 2011. The database includes demographic and medical information on each child enrolled at one of 17 locations across the United States and Canada. Information collected included whether parents reported that their child had lost skills.

Results showed that 27 percent of children experienced developmental regression according to their parents. Black children were twice as likely to have parent-reported regression compared to white children. Hispanic children were about 1.5 times more likely than white children to lose early skills according to their parents. This difference was apparent even when researchers controlled for primary caretaker’s education Dr. Spinks-Franklin and the child’s insurance status.

“Each child with autism is a unique individual with their own strengths and challenges,” said Spinks-Franklin. “It is very important that all parents in all communities become aware of the early signs of autism – poor communication skills, impaired social skills and unusual behaviors and interests.”

According to Spinks-Franklin, the rates of autism are the same among AfricanAmerican, Hispanic and white children. However, African-American and Hispanic children are generally diagnosed with autism at later ages than white children and have less access to much-needed educational, therapeutic and medical resources that are designed to help address the needs of children with Autism.

The study, which is an insightful exploration of racial disparities among children with autism, is Spinks-Franklin’s latest step towards understanding how culture impacts child development. Her previous research experience includes studying the development of children in Senegal, West Africa, and studying the mental health impact of the aftermath of Hurricane Katrina on school-aged African-American children in Houston, as well as exploring the racial identity development of school-aged African-American and Latino children in the Houston area who participated in a reading intervention program.

“The earlier a child is diagnosed with autism, the better chance they have to receive the help and interventions the child needs to function to the best of their ability,” said Spinks-Franklin. “One of my goals is to increase awareness of autism in underserved communities in the Houston area in order for all children to have a better chance of obtaining the help they may need.”

If a parent reports that a child has lost a developmental skill, health care providers should address the parent’s concerns with appropriate screening and referrals. Texas Children’s staff should be aware that there are many community-based and school-based services available to support and help children who have Autism and their families.

Spinks-Franklin presented the study, titled Racial Differences in Developmental Regression in Children with Autism Spectrum Disorders earlier this year at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

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fyi Attention Deficit Hyperactivity Disorder

Helpful websites & resources

Attention Deficit Disorder Assoc (ADDA) www.adda-sr.org Children & Adults with ADHD (CHADD) www.chadd.org National Resource Center on ADHD www.help4adhd.org School Behavior www.schoolbehavior.com/ Spark Top www.sparktop.com

Autism

Autism Consortiam www.autismconsortium.org Do 2 Learn www.do2learn.com The Gray Center for Social Learning and Understanding www.thegraycenter.org Hanen Center www.hanen.org Model Me Kids www.modelmekids.org

Behavior reward charts Behavior Contracts www.freebehaviorcontracts.com Free Behavior Charts www.freeprintablebehaviorcharts.com www.freebahaviorcharts.com www.latitudes.org/behavioral_charts Intervention Central www.interventioncentral.org

Bullying Bullying www.bullying.org Kids Against Bullying www.pacerkidsagainstbullying.org Stop Bullying! www.stopbullying.gov STRYVE www.safeyouth.gov Teens Against Bullying www.pacerteensagainstbullying.org

Fun/educational websites for children and families General Education.com www.education.com Education Place www.eduplace.com

Fun Brain www.funbrain.com First Gov for Kids www.kids.gov/ Homework Hub www.scholastic.com/kids/homework Kids Health www.kidshealth.org National Center for Educational Statistics, Kids’ Zone http://nces.ed.gov/nceskids PBS Kids www.pbskids.org PBS It’s My Life www.pbskids.org/itsmylife PBS Kids Go! www.pbskids.org/go Pearson School www.pearsonschool.com Scholastic www.scholastic.com Math AAA Math www.aaamath.com/ Cool Math www.coolmath.com Figure This! www.figurethis.org Math.com www.math.com Math Playground www.mathplayground.com Reading Dositey www.dositey.com Get Ready to Read www.getreadytoread.org Leading to Reading www.rif.org/leadingtoreading PBS Between the Lions www.pbskids.org/lions Reading Planet www.rif.org/readingplanet Starfall www.starfall.com Writing Spelling It Right www.spelling.hemscott.net Vocabulary & Spelling City www.spelling.city.com

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General educational websites The Arc of Greater Houston www.thearcofgreaterhouston.com Do 2 Learn www.do2learn.com Learning Disabilities On-Line www.ldonline.com National Dissemination Center for Children with Disabilities (NICHCY) www.nichcy.org PBS Parents www.pbs.org/parents Region 10 Dyslexia handbook www.region10.org/dyslexia Study Guides & Strategies www.studygs.net Texas Education Agency TAKS information www.tea.state.tx.us U.S. Department of Education www.ed.gov Wright’s Law www.wrightslaw.com

Math worksheet websites A Plus Math www.aplusmath.com Kidzone Math www.kidzone.ws/math The Math Worksheet Site www.themathworksheetsite.com Reading websites ED Helper www.edhelper.com Florida Center for Reading Research www.fcrr.org International Dyslexia Association www.interdys.org Reading is Fundamental www.rif.org Reading Rockets www.readingrockets.org

Writing websites

BBC Dance Mat Typing www.bbc.co.uk/schools/typing Handwriting Without Tears www.hwtears.com Handwriting for Kids www.handwritingforkids.com Magnetic Poetry www.magneticpoetry.com

preventive health

Keeping your As parents stock up on supplies for the upcoming school year, ensuring their child’s health should be at the top of the backto-school to-do list. For many parents, the weeks preceding the first day of school is the perfect time to schedule an annual wellchild appointment.

According to experts at Texas Children’s Pediatrics, every child needs a yearly physical. Many parents believe once a child has received all of their vaccinations an annual well-child visit is not necessary,

child well

but this simply is not the case. This exam provides parents with an opportunity to discuss any issues related to their child’s health and development, as well as any learning or attention problems that occurred in the previous school year.

The back-to-school visit may also uncover visual or hearing impairments that, if untreated, may lead to issues for a child during the school year. Even though children may have their hearing and vision tested at school, these quick evaluations

may not always catch all issues. Depending upon what a pediatrician finds during the vision screening of an annual physical, they may refer a child to an optometrist or an ophthalmologist for further treatment.

Finally, parents need to be sure to understand all of the health requirements when attending a new school district and remember to bring that information back to the pediatrician for review. It is never safe to assume that a former school and a new school will have the same health requirements.

sports

Stop bullying, hazing

T

hose who perpetrate hazing often The handbook also states that defend the action as a necessary preventing hazing is a shared way for a newcomer to “prove that responsibility among administrators, they deserve to be on the team.” coaches and players. At youth levels, this Shouldn’t the newcomer’s performance would include parents. on the playing field and how well “As with other behaviors they support their we want to avoid having our taken teammates prove that children and teens engage The following is ndbook: ha e they have a right to be in this act,” says Dr. Jorge th m fro ly direct on the team?

Gomez, sports medicine Hazing vs.

After a highly specialist at Texas Children’s publicized incident with Hospital West Campus. “It is Team building: two professional football important for parents and • Hazing degrades players surfaced, coaches to send a strong, Humiliates and viduals Tears down indi both professional and anti-hazing message to Creates division college coaches voiced their child that spells ares Lifelong nightm their opinions about out the consequences ecy Shame and secr hazing in sports, calling for the people doing Is a power trip it counterproductive, the hazing.” g in • Team build distracting and harmful.

Children should not t and dignity Promotes respec wers po The National College have to undergo hazing em d an ts or Supp work am te Athletic Association rituals just so that they al re s te ea Cr ies (NCAA) has an official can feel accepted on a Lifelong memor ity handbook devoted entirely team sport. They do not Pride and integr ive experience sit po ed ar to the issue of hazing. have to be “forced” to do Is a sh

something for it to be hazing; sometimes peer pressure alone, or wanting to be accepted, will lead a youngster to do something they really don’t want to do.

Gomez goes on to say that a team member should never have to prove they have the right to be treated with dignity and respect at all times. Mutual respect and caring for every member of the team, no matter what their level of talent, should be a goal for every team. Coaches, parents and team captains have to talk about this, and set the examples for our children.

Our Children’s Health | 2014-2015 | 15

preventive health

Heavy backpacks M

warnings

any children carry backpacks that are far too heavy thus increasing their vulnerability for injuries.

Experts at Texas Children’s Hospital say a loaded backpack should be light enough for a child to walk or stand up straight without leaning forward or to the side.

Also, backpacks should be no heavier than 10 to 15 percent of a child’s body weight. That means if your child weighs 80 pounds, the backpack should weigh no more than 8 to 12 pounds.

When carried correctly, a backpack is easier on the back and shoulders than carrying a briefcase or purse.

That’s because the strongest muscles in the body, the back and the abdominal muscles, support the weight of the load. Backpacks worn using both the shoulder and hip straps are less likely to cause neck and shoulder pain because it helps distribute weight more evenly across the body.

In order to help parents ensure their child avoids neck and back strain caused by heavy backpacks, here a few helpful tips: • Buy a backpack with padded shoulder straps and a hip strap.

• Pack heavy items in the pack closest to the body.

• Teach your child to lift heavy objects by bending at the knees and lifting with both legs.

• Use both backpack shoulder straps over both shoulders; slinging it over one shoulder increases the risk of back and shoulder pain.

• Adjust straps to fit snugly around your child’s shoulders and hips with weight carried no lower than two to four inches below the waist.

• Carry a smaller load, if possible.

• Encourage your child to participate in a regular exercise routine to gain overall strength and stamina.

tips for back safety

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fyi

Emergency center vs. urgent care clinic O

ftentimes, families turn to an emergency center after hours, on weekends or perhaps even during the day, when a significant event occurs with their child.

Though the emergency center is the right place for some incidents or ailments, the majority of the time, minor illnesses can and should be treated at a pediatric urgent care facility.

One of the most common concerns for parents is when their child has a fever.

For children younger than 8 weeks who have a fever of 100.4 degrees Fahrenheit or higher, parents should immediately take the child to a pediatric emergency center.

If the child is older than 8 weeks with a fever of 100.4 degrees Fahrenheit or higher, parents should contact their pediatrician or seek care at a pediatric urgent care clinic.

Any conditions which threaten a child’s life or limb should be treated at a pediatric emergency center which can also provide initial stabilization for severely injured pediatric patients.

Other conditions that should be treated at a pediatric emergency center include: • Bleeding that won’t stop • Extensive or complicated cuts or lacerations • Fainting or head injury with loss of consciousness or disorientation • Loss or change of vision

• Major fracture that breaks the skin or is at a severe angle • Seizures without a previous diagnosis or epilepsy • Serious burns • Snake bites • Spinal injuries • Sudden change in mental state • Sudden shortness of breath or difficulty breathing • Vomiting or coughing up blood

For those conditions that require immediate care but are not life threatening, families should seek care for their child at a pediatric urgent care clinic. Texas Children’s Urgent Care recently opened two locations offering high-quality, efficient and affordable patient care during evenings and weekends, in convenient, community locations.

Fo r c h i t h a n 8 l d r e n yo u n g e h a ve a w e e k s w h o r d e g r e f e ve r o f 1 0 0 e . o r h i g s Fa h r e n h e i 4 h e r, p t a re n t s should i m m e t a ke t h e c h i d i a te l y ld pedia t r i c e m to a ce n te r e rg e n cy .

Texas Children’s Urgent Care is equipped to treat the following conditions: • Mild abdominal pain • Allergic reactions • Mild asthma • Cough • Croup • Ear pain • Fever • Flu • Minor burns • Minor injuries from falls or sports • Pink eye • Rashes • Simple lacerations • Sinus infections • Skin infections • Sore throat • Sprains and strains • Urinary tract infections • Vomiting and diarrhea These tips should help guide parents as they determine which setting is best suited to treat their child’s ailments and injuries. However, if there is ever any doubt, families can always contact their pediatrician for additional decision-making support.

Our Children’s Health | 2014-2015 | 17

fyi

Talking teens t o

A

s a parent of an adolescent, you may be having some difficulty talking with your teen.

Because of the dramatic changes in your teen’s life, he or she may seem more like a stranger.

Communicating openly will help both of you adjust to these changes.

LISTENING is the most important aspect of clear communication. Some things you can do to help you in listening to your teen include: • Respect your teen’s privacy. Be available to listen to your teen when he or she wants to talk.

• Get comfortable and use eye contact when listening to your teen.

• Make sure you understand the words your teen uses. Ask to make sure you are following his or her intended meaning.

• Be open and allow your teen to express all feelings, including anger and sadness. Avoid being judgmental.

In RESPONDING to your teen, the following suggestions may help you: • Be yourself—a parent—not a peer.

• Avoid using teen slang words.

• Be honest about your feelings, beliefs, and values.

• Use a reassuring pat on the shoulder or a hug.

• Use “I” statements, such as “I feel…,” “I thought…,” “I am happy,” “I am upset,” rather than statements which tend to imply blame.

• Ask open-ended questions.

Explore the hows, whats, and whys of

Make unde sure you r word stand the s uses. your tee n sure Ask to m ake you a follow re i n g inten h ded is or her mean ing.

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a situation. This type of questioning allows you the chance to learn more information without placing your teen on the defensive. For example, say, “What did you think about the movie?” or “What type of party is planned?”

• Make your statements direct and clear.

• Do things that are the same as what you say.

• If you don’t know something, say so and work with your teen to find the answer.

• If you are uncomfortable talking about a subject, tell your teen and help him or her find an alternative.

For example, use a book or a trusted friend.

Overall, be a good listener and respond in a way that leads your teen in open discussions. This is a time when your teen is evaluating all aspects of his or her life. The trust and confidence you give your teen will help him or her make better decisions and build self-esteem.

preventive health

Walking to school

W

safely

hether children are walking to school, the park or a friend’s house, allowing them to go alone can be very unsettling.

Before your child steps out the door for the first time to walk alone, talk with them about how to be safe while walking.

It is always best to remind children to walk on sidewalks or paths, and cross at street corners using traffic signals and crosswalks.

Most injuries happen midblock or someplace other than intersections. If there are no sidewalks, children and families should walk facing traffic and as far away from vehicles as possible.

Teach children from an early age to put down their devices and look left, right and left again when crossing the street. Unintentional pedestrian injuries are the fifth leading cause of injury related deaths in the United States for children ages 5 to 19. Teenagers are now at greatest risk. Teens have a death rate twice that of younger children and account for half of all child pedestrian deaths, most commonly attributed to the distraction of devices.

Remind children to make eye contact with drivers before crossing the street and to watch out for cars that are turning or backing up. Make sure they also know not to run or dart out into the street or cross between parked cars.

“Any child under the age of 10 should still cross the street with an adult,” says Kristen

Beckworth, manager of Texas Children’s Center for Childhood Injury Prevention.

“Though every child is different, developmentally it can be hard for kids to judge speed and distances of cars until age 10.”

When teaching children how to walk safely, remind them to look up and pay extra attention when using headphones,

o re n t d l i h tact ind c R e m e ye c o n e f o r e e m a k d r i ve r s b t r e e t w i t h i n g t h e s o u t fo r s c ro s o w a t c h u r n i n g t t a n d h a t a re . t cars cking up a or b cell phones or electronic devices such as tablets or games. Make it a rule to put these devices down when crossing the street. It is particularly important to reinforce the message with teenagers.

Remind children to also be aware of others who may be distracted, and to speak up when they see someone who is in danger. If a child needs to use a cell phone, teach them to stop walking and find a safe area to talk. For headphones, pull them down or turn off the volume before crossing the street.

It is always important for other family members to emulate good behaviors as well.

One way to set a good example is by putting devices down while driving or walking around cars. If parents put devices down, children are more likely to do the same.

When driving, parents should be especially alert in residential neighborhoods and school zones. Be on the lookout for bikers, walkers or runners who may be distracted or may step into the street unexpectedly. Give pedestrians the right of way and look both ways when making a turn to help spot anyone who may not be immediately visible. When behind the wheel it is also important to put cell phones and other distractions in the back seat or out of sight.

Allowing children to walk alone can be an exciting experience for them and allow a sense of independence, but it is always important to remind them to use safety precautions and stay alert.

Our Children’s Health | 2014-2015 | 19

preventive health

T

Bike safety

here are many great reasons for families to allow their child to ride a bike. It offers fun, freedom and exercise. Some parents even allow their children to ride bikes alone or use them as a means of transportation to and from school. Although riding a bike can be an enjoyable experience, there are precautions every parent needs to take to ensure their child’s safety.

The most important is to make sure children always wear a helmet. A simple saying to remember is, “use your head, wear a helmet.” It is the single most effective safety device available to reduce head injury and death from bicycle crashes.

Experts from Texas Children’s Hospital note that more children ages 5 to 14 are seen in emergency rooms for injuries related to biking than any other sport. Helmets can reduce the risk of severe brain injuries by 88 percent, yet only 45 percent of children 14 and under usually wear a bike helmet.

Although wearing a helmet is the key to safety, it is also extremely important to make sure the child has the right size helmet. It should meet the U.S. Consumer Product Safety Commission’s standards. Experts also suggest that when it is time to purchase a new helmet, let the child pick out their own, as they will be more likely to wear it for every ride.

When purchasing a helmet, make sure it fits and the child knows how to put it on correctly.

A helmet should sit on top of the head in a level position, and should not rock forward, backward or side-to-side. The helmet straps must always be buckled, but not too tightly. Safe Kids Greater Houston recommends children take the Helmet Fit Test: • EYES check: Position the helmet on your child’s head. When they look up, they should see the bottom rim of the helmet. The rim should be one to two finger-widths above their eyebrows.

• EARS check: Make sure the straps of the helmet form a “V” under your child’s ears when buckled. The strap should be snug but comfortable.

• MOUTH check: Ask your child to open their mouth as wide as they can. Ask them if they feel

the helmet hug their head. If not, tighten those straps and make sure the buckle is flat against their skin.

Although children might try to convince their parent they only need a helmet when riding a bike, that is not the case. Children should always wear a helmet for all wheeled sports activities. A properlyfitted bike helmet is just as effective when riding a scooter, roller skating or in-line skating. No matter the activity, always ensure your child is wearing the correct helmet for that activity.

When shopping for a bike, bring the child along to ensure a proper bike fit as well. Select one that is the right size for the child, not one he or she will grow into. When children are sitting on the seat of the bicycle, their feet should be able to touch the ground.

Before children ride a bike make sure the reflectors are secure, brakes work properly, gears shift smoothly, and tires are tightly secured and properly inflated. Also, long or loose clothing can get caught in bike chains or wheel spokes. Dress young children appropriately to ensure a safe ride.

When children are riding bikes, be sure to

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actively supervise them until they are responsible enough to ride on their own. Every child is different, but developmentally, it can be hard for kids to judge speed and distance of cars until age 10, so limit riding to sidewalks (although be careful for vehicles in driveways), parks or bike paths until age 10. No matter where the child rides, teach them to stay alert and watch for cars and trucks. Children should be able to demonstrate riding competence and knowledge of the rules of the road before cycling with traffic.

When teaching your child to ride a bike, model and teach good behavior.

It is surprising how much children learn from watching their parents, so it is especially important for parents to model proper behavior. Always wear a helmet, even if you may have chosen not to do so as a child.

Make sure to teach your child to make eye contact with drivers. Bikers should make sure drivers are paying attention and are going to stop before they cross the street.

Tell the children to ride on the right side of the road, with traffic, not against it. Stay as far to the right as possible. Use appropriate hand signals and respect traffic signals, stopping at all stop signs and stoplights.

Stop and look left, right and left again before entering a street or crossing an intersection. Look back and yield to traffic coming from behind before turning left.

When riding at dusk, dawn or in the evening, ensure your child is dressed in bright colors, they use lights and make sure the bike has reflectors as well. It’s also smart to wear clothes and accessories that have retro-reflective materials to improve biker visibility to motorists.

Most states require a front light, but allow the use of a rear reflector. Headlights aren’t so much for bicyclists to see where they are going, but for others to see them. Riding without a headlight means drivers won’t see bicyclists, and surprising motorists is never a good idea.

preventive health

Stresses on teens A

s a parent of an adolescent, you may have noticed your teen has been acting stressed. And it’s no wonder. Teens are going through rapid physical and emotional changes as well as evaluating many aspects of their life. Quite a hefty load for one person to carry! During this time teens are finding and testing their strengths, following and trying out different role models and learning to set self-limits. These behaviors are normal, but they can be stressful for your teen.

Some of the factors which your teen may be learning to cope with include: • His or her changing role in the family.

Teens generally begin to assume more responsible roles in the family. This may occur more often within families whose structures are changing. For example, many teens are adjusting to divorce, single-parent families, and step-families.

These changes may make the teen’s adjust ment more difficult.

• Increasing school pressures. Your teen may

be trying to relate school work to his or her own future. As school expectations increase, your teen may feel more stress.

• Greater use of teens in the media. Teens are often shown in the media as being very adult. If teens try to imitate those roles, they may become confused and frustrated because they aren’t ready for adulthood yet.

• Increased influence of peers. Peer groups

Durin teen g this tim s and t are find e i stren esting th ng e a n d t g t h s , fo l l i r o diffe rying out wing r mod ent role els a n to se t self d learnin -limi ts. g

may apply pressures which make your teen uncomfortable.

Some things you can do which might help your teen cope with stress are: • Be a sounding board for your teen. Listen to teens as they test new ideas and talk about their concerns.

• Spend time with your teen and his or her friends.

• Help your teen with school matters.

• Help your teen sort through his or her values. Realize it is normal for teens to test their parents’ value system.

• Help your teen set self-limits. Allow your teen to have choices, but be clear about what is acceptable to you.

• Compliment your teen often.

Remember, you are still a very important person in your teen’s life. Your opinions and advice still matter very much. By understanding the stresses your teen is going through, you will be able to adjust more easily and keep open communication with him or her.

Our Children’s Health | 2014-2015 | 21

calendar Who: Texas Children’s Health Plan Back to School Date: Saturday, August 2 Time: 10 a.m. to 2 p.m.

Location: 9700 Bissonnet Houston, TX 77081 Who: Mi Tenda Date: Saturday, August 2 Time: 8 a.m. to noon Location: 1630 Spencer Highway Houston, TX 77587 Who: Access Health Community Operation Back-to-School Health Fairs Date: Saturday, August 2 Time: 9 a.m. to noon Location: Richmond Center 400 Austin Street Richmond, TX 77469 Who: Back to School Community Health and Resource Fair/ABC Dental Family Dentistry Date: Saturday, August 2 Time: 11 a.m. to 3 p.m.

Location: 210 Peach Avenue Cleveland, TX 77327 Who: Christian Temple Church Date: Saturday, August 2 Time: 10 a.m. to 2 p.m.

Location: 9701 Almeda Genoa Road Houston, TX 77075 Who: Boat People SOS Date: Saturday, August 2 Time: 10 a.m. to 1 p.m.

Location: 8235 Park Place Houston, TX 77017 Who: NCI Cleveland Ripley Date: Tuesday, August 5 Time: 9 a.m. to noon Location: 720 Fairmont Parkway Pasadena, TX 77504 Who: NCI Baker Ripley/ABC Dental Back to School Date: Wednesday, August 6 Time: 8 a.m. to 11 a.m.

Location: 6565 Rookin St. Houston, TX 77074 Who: NCI Hiram Clarke/ABC Dental Back to School Date: Thursday, August 7 Time: 8 a.m. to 11 a.m.

Location: 3018 West Fuqua Houston, TX 77045 Who: NCI Sharpview/ABC Dental Back to School Date: Friday, August 8 Time: 8 a.m. to 11 a.m.

Location: 12280 Sharpview Houston, TX 77072 Who: Council Member Dwight Boykins Back to School Bash Date: Saturday, August 9

Time: 9 a.m. to noon Location: 3502 Bellfort St. Houston, TX 77051 Who: Brazoria County Dream Center Back-toSchool Bash Date: Saturday, August 9 Time: 10 a.m. to 6 p.m.

Location: Brazoria County Dream Center 796 Brazosport Blvd S Clute, TX 77531 Who: Orange County Back to School Fair Date: Saturday, August 9 Time: 9 a.m. to 2 p.m.

Location: Lamar State College-Orange Student Center 410 W Front St. Orange, TX 77630 Who: Rivers for Health Fair Date: Saturday, August 9 Time: 10 a.m. to 4 p.m.

Location: 7500 Bellaire Blvd Houston, TX 77036 Who: Access Health Community Operation Back-to-School Health Fairs Date: Saturday, August 9 Time: 9 a.m. to noon Location: Missouri City Center 307 Texas Parkway, Ste. 100 Missouri City, TX 77489 Who: Greater Vision Church Community Back to School Health Fair Date: Sunday, August 10 Time: noon to 4 p.m.

Location: 615 Westshire Drive Houston, TX 77013 Who: Emancipation Community Center and Council Member Dwight Boykins Back to School Bash Date: Saturday, August 16 Time: 9 a.m. to noon Location: 3018 Dowling Houston, TX 77004 Who: CT Church Date: Saturday, August 16 Time: 9 a.m. to 2 p.m.

Location: 7805 Kimble St. Houston, TX 77017 Who: YMCA W Orem Date: Saturday, August 16 Time: 10 a.m. to 1 p.m.

Location: YMCA W. Omen 5801 W Orem Houston, TX 77085 Who: PACE Date: Saturday, August 16 Time: 10 a.m. to noon Location: William P Hobby Elementary School Who: 4th Annual Back-to-School Jamboree Date: Saturday, August 16

22 | 2014-2015 | Texas Children’s Hospital & Defender Media Group

Time: 11 a.m. to 1 p.m.

Location: Inside M.O. Campbell Educational Center 1865 Aldine Bender Rd. Houston, TX 77032 Who: Mayor’s Back to School Date: Saturday, August 16 Time: 8 a.m. to 5 p.m.

Location: University of Houston 4800 Calhoun Rd Houston, TX 77004 Date: Saturday, August 16 Time: 9 a.m. to 2 p.m.

Location: St. Mark the Evangelist Catholic Church 5430 West Ridge Dr. Houston, TX 77053 Who: Texas Children’s Health Plan Huntsville Back-to-School Fair Date: Wednesday, August 20 Time: 11 a.m. to 2 p.m.

Location: Huntsville Public Library Community Room 1219 13th Street Huntsville, TX 77340 Who: Alvin Family Community Center 3rd Annual Back to School Health Fair Date: Friday, August 22 Time: 9 a.m. to 1 p.m.

Location: 1031 W. Sealy Alvin, TX 77511 Who: Texas Children’s Health Plan Back-to-School Bash Date: Friday, August 22 Time: 1 p.m. to 4 p.m.

Location: Beaumont Housing Authority 2850 Gulf Street Beaumont, TX 77703 Who: Spring Branch Back to School Fair Date: Saturday, August 23 Time: 8 a.m. to noon Location: 8575 Pitner Road Houston, TX 77080 Who: The R.O.C.K. Reflections of Christ’s Kingdom World Outreach International Date: Saturday, August 23 Time: 10 a.m. to 3 p.m.

Location: 9321 Edgebrook Drive Houston, TX 77075 Who: ABC Dental Date: Saturday, September 6 Time: 10 a.m. to 1 p.m.

Location: 1500 East Southmore Avenue Pasadena, TX 77504 Who: ABC Dental Back to School Date: Saturday, September 13 Time: 10 a.m. to 1 p.m.

Location: 5505 W Orem Dr. Houston, TX 77085

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