ParentingNH April 2020

CORONAVIRUS FAQ • DOES MY CHILD HAVE AUTISM?

COMPLIMENTARY

APRIL 2 02 0

Is this your new normal?

HOW TO RAISE HEALTHY KIDS IN THE 21ST CENTURY

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Healthy eating in the 21st century How to help your kids build a better relationship with food, and be healthier overall

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APRIL 2020 21 It’s time to give plant-based eating a try Your family won’t miss the meat and it’s better for you

26 Does my child have autism?

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4 The short list 34 Dad on board

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from the publisher’s desk LOOKING AHEAD: A MESSAGE TO OUR COMMUNITY Somewhere partway through last week, the already strange-feeling reality we were all living in here in New Hampshire took a hard, fast lurch to the surreal. If your business, work and life have been anything like mine since then, it may feel like three weeks have gone by in the space of three days. It may also feel like your primary daily activity has become reacting and reorienting your plan to the daily, sometimes hourly, changes wrought by our government’s work to clamp down on the transmission of the coronavirus.

But despite the psychic whiplash we may all be feeling, we’re also all getting on with it. We know you are, too. And there have been very good parts to the last few days: moments I’ve witnessed great acts of kindness and compassion in our communities. Bravery and resolution on the part of public servants, laborers in critical industries from health care, to food supply, to sanitation. And a genuine comingtogether (metaphorically if not literally, given the need for social distancing) of families, friends, neighbors and communities to adapt and overcome.

I’ve also been proud to see our team at McLean Communications regroup, without missing a beat, as remote-working professionals, and fire up their webcams, laptops and VPNs to continue the business of providing news, entertainment, information and most of all, connection, to our readers and advertisers. Our entire team, from editors, writers, designers, marketers, advertising staff and operations folks, cares deeply about the publications we produce, including New Hampshire Business Review, New Hampshire Magazine, ParentingNH, New Hampshire Home and more. That devotion to the publications grows out of a love for the communities these publications serve, whose stories we tell, whose lives are so deeply entwined with our own. In the end, these aren’t just places we write about. They are home.

And while our communities are enduring this extreme trial, we want you to know we’ll continue to be here to tell their stories. Not just the urgent, critical stories of today, but the fun, diverting delightful stories of tomorrow as well, because even as we do the hard work of today, we absolutely have to keep our eyes on that hopefully-not-too-distant patch of green grass and blue sky. At the moment we have had to cancel some of the events we host, and postpone others. But we plan, by working remotely, to continue our regular publishing schedules, and even enhance some of what we offer online.

For example, there aren’t many events for us to populate our

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calendars with right now, but instead we looked for ways we could promote our restaurants that are weathering the crisis by offering takeout and delivery instead of in-restaurant dining. We developed dynamic listings that could instantly be populated across all three of our larger sites. And we’re looking at other ways to support our state’s businesses as well.

On a mid-March day, the temperature in Manchester crept up over 50 degrees, so I took the opportunity to get out for a much-needed lunchtime run. As I passed through our neighborhoods, I was struck by how many people were using their social-distancing time to clean up their yards, raking, clearing brush, turning over the soil, generally preparing for a spring they know is coming. I share that optimism. We’re preparing too. There’s no calendar that can predict the exact date, but we’ll all weather this, together, and before too long, true spring will be here. Businesses reopening, parties being thrown, friends gathering on all of the lawns I saw being prepped today, spring. I can’t wait until we’re telling that story.

— ERNESTO BURDEN VICE PRESIDENT/PUBLISHER OF MCLEAN COMMUNICATIONS, A SUBSIDIARY OF YANKEE PUBLISHING, INC., AN EMPLOYEE-OWNED COMPANY

EDITOR’S NOTE: Ernesto Burden joined McLean Communications on Jan. 21. He was previously an executive at Newspapers of New England, serving as vice president of digital for over five years, most recently serving as general manager of the Concord Monitor. Burden has held a variety of editorial and operational positions at news outlets throughout New England, including PennWell, the Nashua Telegraph, the Rutland Herald and Times Argus.

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the short list

Editor’s note: In the span of a week during production of this issue of ParentingNH, everything changed. We went from planning ahead to Easter and spring to schools and businesses closing down and events being canceled. For that reason, we’ve omitted our monthly calendar and eventsrelated content from this month’s issue — which just happens to be focused on keeping your family healthy. Like you, we hope for a return to a sense of normalcy soon, and a return to our regular format. The Short List space is being used to provide some basic information to deal with the crisis. For more, go to www.parentingnh.com where we will continue to update our readers between issues with additional articles, resources and information, and our new “Dad on Bored” column. We will do our best to keep you and your family updated and informed during these fast-changing and uncertain times. We’re all in this together.

— MELANIE HITCHCOCK, EDITOR, PARENTINGNH

CORONAVIRUS FAQ What are the symptoms of coronavirus?

Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus (COVID-19) cases. The following symptoms may appear 2-14 days after exposure: Fever, cough, shortness of breath. (source: www.cdc.gov)

What should I do if I think I or my child may have a COVID-19 infection?

Call your doctor or pediatrician. If you do not have a doctor, contact your local board of health. They can direct you to the best place for evaluation and treatment in your area. It’s best to not seek medical care in an emergency department unless you have symptoms of severe illness. Severe symptoms include high or very low body temperature, shortness of breath, confusion, or feeling you might pass out. Call ahead of time to let the staff know that you are coming so they can be prepared. (source: Harvard Health; www.health.harvard.edu)

How long is the State of Emergency in NH? When can kids go back to school?

Gov. Chris Sununu declared a State of Emergency on Friday, March 13. The 21-day order expires April 3, but it can be extended if needed. Schools are also closed

4 www.parentingnh.com | APRIL 2020

statewide through April 3, but could remain closed if conditions warrant. (source: www.nh.gov/covid19)

What do I do if I lose my job or I can’t work?

Individuals who are unable to work or who have reduced hours due to the COVID-19 pandemic have immediate access to unemployment benefits. Anyone in the following situations will now be eligible for state unemployment: If your employer temporarily closes due to COVID-19; Individuals that need to self-quarantine or are directed to quarantine at the instruction of a health care provider, employer or government official; Individuals that need to care for a family member that has COVID-19 or is under quarantine; Individuals that need to care for a dependent because of school closures, child care facility closures or other similar types of care programs; Self-employed individuals that are temporarily unable to operate their business because of any of the above listed situations will also be eligible. Go to www.nhes.nh.gov or call 271-7700.

(Gov. Chris Sununu, March 17)

Where can I turn for help?

• Granite United Way’s 211 NH initiative is available 24 hours a day and taking calls from New Hampshire residents regarding COVID-19. The Granite United Way has established a relief fund for those affected financially by the crisis. For more, go to www.graniteuw.org.

• Feeling stressed or anxious? You are not alone. If you or someone you know is struggling emotionally, help is available. Contact NAMI New Hampshire’s information and resources line at info@NAMINH.org or 1-800242-6264.

• For up-to-date, official information from the State of New Hampshire and Governor’s office, go to www.nh.gov/covid19.

• The Centers for Disease Control has information related to all aspects of COVID-19, including resources for parents, businesses, schools and community-based organizations, and more about social distancing. Go to www.cdc.gov.

More resources available at www.parentingnh.com and in the May issue of ParentingNH.

HOW TO TALK TO YOUR CHILD ABOUT CORONAVIRUS As public conversations around coronavirus (COVID-19) increase, children may worry about themselves, their family, and friends getting ill with COVID-19. Parents, family members, school staff, and other trusted adults can play an important role in helping children make sense of what they hear in a way that is honest, accurate, and minimizes anxiety or fear. CDC has created guidance to help adults have conversations with children about COVID-19 and ways they can avoid getting and spreading the disease.

Remain calm and reassuring.

Remember that children will react to both what you say and how you say it. They will pick up cues from the conversations you have with them and with others.

Make yourself available to listen and to talk.

Make time to talk. Be sure children know they can come to you when they have questions.

Avoid language that might blame others and lead to stigma.

Remember that viruses can make anyone sick, regardless of a person’s race or ethnicity. Avoid making assumptions about who might have COVID-19.

Pay attention to what children see or hear on television, radio, or online.

Consider reducing the amount of screen time focused on COVID-19.

Too much information on one topic can lead to anxiety.

Provide information that is honest and accurate.

• Give children information that is truthful and appropriate for the age and developmental level of the child.

• Talk to children about how some stories on COVID-19 on the Internet and social media may be based on rumors and inaccurate information.

Teach children everyday actions to reduce the spread of germs.

• Remind children to stay away from people who are coughing or sneezing or sick.

• Remind them to cough or sneeze into a tissue or their elbow, then throw the tissue into the trash.

• Discuss any new actions that may be taken at school to help protect children and school staff. (e.g., increased handwashing, cancellation of events or activities) Get children into a handwashing habit.

• Teach them to wash their hands with soap and water for at least 20 seconds, especially after blowing their nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.

• If soap and water are not available, teach them to use hand sanitizer.

Hand sanitizer should contain at least 60% alcohol. Supervise young children when they use hand sanitizer to prevent swallowing alcohol, especially in schools and childcare facilities.

— Courtesy of the Centers for Disease Control (www.cdc.gov)

www.parentingnh.com

| APRIL 2020 5

Win the food How to help your kids build a better relationship with food, and be healthier overall

BY KRYSTEN GODFREY MADDOCKS

T

he dinner table is a battlefield. You bribe your daughter to eat her vegetables in exchange for more TV time. You heat up chicken nuggets three nights a week because that’s all your kids will eat. You order take-out pizza because it’s certainly better than fighting at another meal. All of this combat makes a parent want to wave the white flag.

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Parents know it’s important to keep their kids healthy.

Childhood obesity is a serious problem in the United States, with 18.5% of children between the ages of 2 and 19 considered obese, according to the CDC. And as children get older, the numbers climb. For example, for ages 12 to 19, the obesity rate spikes to more than 20% of the population.

But the guidelines can be confusing and unclear. Here’s how parents can ensure their children are eating the right foods in the right amount, and call a ceasefire at the table.

fight

The United States Department of Agriculture replaced the familiar Food Pyramid with MyPlate FIND MORE INFORMATION AT WW.CHOOSEMYPLATE.GOV

Fruits

Vegetables

Focus on whole fruits and select 100% fruit juice when choosing juices.

Eat a variety of vegetables and add them to mixed dishes like casseroles, sandwiches, and wraps.

Grains

Dairy

Choose whole-grain versions of common foods such as bread, pasta, and tortillas.

Choose low-fat (1%) or fat-free (skim) dairy.

Get the same amount of calcium and other nutrients as whole milk, but with less saturated fat and calories.

Pr otein

IT STARTS WITH THE PLATE One of the simplest ways to visualize a healthy meal starts with your dinner plate. Karen Mountjoy, M.Ed., RD, LD, CLC, a licensed and registered dietitian and owner of Coastal Family Nutrition in Portsmouth, recommends parents follow the “MyPlate” way of eating. The United States Department of Agriculture replaced the familiar Food Pyramid with MyPlate (www.choosemyplate.gov) more than 10 years ago.

It can help your family build healthy meals and eliminate some of the confusion about what to serve at mealtimes, Mountjoy said.

Eat a variety of protein foods such as beans, soy, seafood, lean meats, poultry, and unsalted nuts and seeds.

MyWins

United States Department of Agriculture

Agricultural Research Service

Create ‘MyWins’ that fit your healthy eating style.

Start with small changes that you can enjoy, like having an extra piece of fruit today.

www.parentingnh.com

| APRIL 2020 7

EARLY HUMAN NUTRITION RESEARCH ►

1890s

The History of Federal Nutrition Education

1920s to 1930s

◄ THE ROLE OF NUTRIENTS

The United States government has published dietary advice for more than one hundred years. In response to popular interest in these documents, the National Agricultural Library has collected and digitized more than 1,200 items into a single online tool, the Historical Dietary Guidance Digital Collection. Find it at https://naldc.nal.usda.gov/

THE FARMER AS PATRIOT ►

1940s

1950s to 1960s

◄ HEALTHY FAMILY MEALS

1970s to 1980s

◄ DIETARY GUIDANCE TAKES SHAPE

FOOD IS MORE THAN JUST SOMETHING TO EAT ►

1990s to Present

United States Department of Agriculture

Agricultural Research Service

The guidelines to MyPlate are simple: Fill half of your plate with fruits and vegetables, one-quarter of the plate with protein, and the last quarter of your plate with a carbohydrate choice. There is also one serving of dairy included.

“There are flaws for sure. For example, MyPlate doesn’t mention healthy fats, like avocado, fish or olive oil. But I use it with parents as an idea of where to start,” she said.

The MyPlate website does provide some suggested calorie guidelines for children by age and activity level, as well. Along with calorie counts, charts on the site provide a suggested activity level and meal plans. A three-year-old boy, for example, should consume anywhere from 1,000 to 1,400 calories a day depending on his level of activity.

As children get older, it can be more difficult to gauge estimated calorie intake, so other nutritional factors become equally or more important, Mountjoy said.

8 www.parentingnh.com | APRIL 2020

“Most five-year-olds, for example, are moving targets, and you can make an educated guess about what you think he or she might be burning at that age. For a 13-year-old girl entering puberty, figuring out an estimated calorie intake for her is more about making sure she’s getting her period regularly and that her calories and nutrients reflect that,” Mountjoy said.

“I strongly recommend that parents never say the word ‘diet.’ Parents dieting is the number one indicator or risk factor for a child’s eating disorder. Restricting equals weight gain — the research supports this again and again. If you label foods bad or good, you are setting your kids up to sneak foods later on and overeat them.”

HOW TO BE IN CONTROL AT MEAL TIMES Jessica O’Connell, registered dietitian and owner of Jessica O’Connell Nutrition, LLC in Epping, started her private practice in 2019 but has

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served families in hospital settings and as a Hannaford dietitian for more than 15 years.

Dinnertime with children who refuse to eat often erupts into arguments, power struggles, and epic fights. O’Connell suggests that parents avoid expending their energy on forcing their children to eat.

“The more we push, prod, and suggest, the more their resistance goes up,” she said.

She works with families to help their children understand what food is being offered and encourages parents to include at least “one familiar food” on the dinner plate.

Conversely, O’Connell recommends that parents avoid falling into the trap of offering alternate meals or snacks to appease finicky children looking to test their limits.

“They think, they got out of it last time, and they are ready to hear other options,” she said.

Parents may not be able to influence exactly what their kids will eat off of their plates, but they can dictate the “where” and “when” of eating.

They can choose an 8 a.m. breakfast time in the kitchen and offer fruit and waffles. It’s the kid’s job to decide whether to eat, Mountjoy said. It also means parents shouldn’t offer their child endless amounts of waffles. If their child is still hungry during breakfast, they can eat the fruit salad.

“As a parent, it’s your responsibility to make sure you are covering the food groups and introducing as many types of food as you can. If you are offering your child wholesome, nutritious food, 90% of the time you can feel comfortable knowing that you are doing your job and your kid’s body is doing his or her job,” she said.

“If you are concerned about your kid’s Body Mass Index (BMI), and you are concerned they are eating too much, my suggestion would be to look at how often you are feeding your child. Make sure they are not grazing between meals. When breakfast is over, the kitchen is closed. If your child is still hungry at 9 a.m. they can eat a snack at 10:30 a.m.”

Involving your children in meal planning and getting them to take an active role in meal preparation may also inspire them to eat what you are serving, Mountjoy said.

Meals don’t have to be “Pinterest-worthy,” but they should follow the MyPlate model. For example, Monday’s dinner could include homemade pizza, fruit salad, and cut-up vegetables; you could even find a place for macaroni and cheese to fit in the dinner rotation.

While 90% of all the food your children eat should fall into nutritious, healthy food category, there is wiggle room for treats, Mountjoy said.

“Every day, 10% of what they eat can be a fun food…. that translates to a small bag of chips or Goldfish, two Oreos or a half-cup of ice cream,” she said.

O’Connell agrees that involving children in family meal planning can reap positive results. Even if your child wants chicken fingers included on the dinner menu most nights, you can still include them

10 MyPlate snack tips for parents SNACKS CAN HELP CHILDREN GET THE NUTRIENTS NEEDED TO GROW AND MAINTAIN A HEALTHY WEIGHT. PREPARE SINGLE-SERVING SNACKS FOR YOUNGER CHILDREN TO HELP THEM GET JUST ENOUGH TO SATISFY THEIR HUNGER. LET OLDER KIDS MAKE THEIR OWN SNACKS BY KEEPING HEALTHY FOODS IN THE KITCHEN.

SAVE TIME BY SLICING VEGGIES Store sliced vegetables in the refrigerator and serve with dips like hummus or low-calorie dressing. Top half a whole-wheat English muffin with spaghetti sauce, chopped vegetables, and low-fat shredded mozzarella and melt in the microwave.

MIX IT UP For older school-age kids, mix dried fruit, unsalted nuts, and popcorn in a snack-size bag for a quick trail mix. Blend plain fat-free or low-fat yogurt with 100% fruit juice and frozen peaches for a tasty smoothie.

GRAB A GLASS OF MILK A cup of low-fat or fat-free milk or milk alternative (soy milk) is an easy way to drink a healthy snack.

GO FOR GREAT WHOLE GRAINS Offer whole-wheat breads, popcorn, and whole-oat cereals that are high in fiber and low in added sugars, saturated fat, and sodium. Limit refined-grain products such as snack bars, cakes, and sweetened cereals.

NIBBLE ON LEAN PROTEIN Choose lean protein foods such as low-sodium deli meats or unsalted nuts. Wrap sliced, low-sodium deli turkey around an apple wedge. Store hard-cooked (boiled) eggs in the refrigerator for kids to enjoy any time.

KEEP AN EYE ON THE SIZE Snacks shouldn’t replace a meal, so look for ways to help your kids understand how much is enough. Store snack-size bags in the cupboard and use them to control serving sizes.

FRUITS ARE QUICK AND EASY Fresh, frozen, dried, or canned fruits can be easy “grab-and-go” options that need little preparation. Offer whole fruit and limit the amount of 100% juice served.

CONSIDER CONVENIENCE A single-serving container of low-fat or fat-free yogurt or individually wrapped string cheese can be just enough for an after-school snack.

SWAP OUT THE SUGAR Keep healthier foods handy so kids avoid cookies, pastries, or candies between meals. Add seltzer water to a ½ cup of 100% fruit juice instead of offering soda.

PREPARE HOMEMADE GOODIES For homemade sweets, add dried fruits like apricots or raisins and reduce the amount of sugar in the recipe. Adjust recipes that include fats like butter or shortening by using unsweetened applesauce or prune puree for half the amount of fat.

Courtesy of www.choosemyplate.gov

12 www.parentingnh.com | APRIL 2020

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For parents who need to feed underweight children, O’Connell works with hem to develop healthy meal options their kids will actually eat to avoid creating other snacks at night. But for those who are truly “picky,” she suggests waiting until breakfast before offering new choices.

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Some children experience eating issues that go beyond picky eating such as having difficulty swallowing, aversions to food textures, or other medical diagnoses. Mountjoy encourages parents of these children to reach out to their medical provider as soon as possible.

The Department of Health and Human Services of New Hampshire offers a Special Medical Services program for children with special medical needs. One of the programs under SMS is Nutrition, Feeding and Swallowing Services. Through NFSS, parents can ask for initial nutrition and feeding and swallowing evaluations to take place at their home or their child’s school.

In collaboration with Early Supports and Services, Head Start, their doctor, and school teams, families can develop safe eating plans and special meal prescription forms for child care and school meal programs.

The sooner you include nutrition as a part of your child’s overall support services, the better your outcomes will be, Montjoy said.

PUT LESS WEIGHT ON THE NUMBERS At annual well-visits, pediatricians often reveal to parents their child’s Body Mass Index number, or BMI, which can sometimes cause undue alarm. BMI is a diagnostic tool that compares a child’s weight in kilograms divided by the square of height in meters.

A high BMI can be an indicator of high body fatness and it can be used to screen for weight categories that may lead to health problems — but it is not diagnostic of the body fatness or health of an individual, according to CDC. Mountjoy cautions parents to remember that BMI numbers are relative to the “lane” your child is following in his or her growth pattern.

For example, when BMI is above the 75th percentile, that number is considered out of the normal range of what is considered healthy for weight in relation to height. However, if your child was born with a BMI in the 92nd percentile and stays in that growth patten over the next several years, you may have less to worry about. It’s important to look at your child’s natural genetic pattern, and instead of focus on measures of overall health — like blood pressure, blood sugar, and cholesterol, while at the same time making sure that your child is active, eating, and sleeping well, Mountjoy said.

“I’m more concerned about kids who leave their (BMI) lane. What I see happening is kids who stay in the 30th to 40th percentile for BMI until age 9 or 10, and then their BMI goes upward,” she said.

14 www.parentingnh.com | APRIL 2020

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TWEENS AND TEENS O’Connell works with teen clients who are often surprised at the amount of food she suggests they eat, because she asks them to switch out high-sugar, empty-calorie choices for whole foods that contain more protein, fiber, or healthy fats.

She also works with teens to better understand how their body fits in with their family genetics and talks with them about the lies that the diet culture preaches to young women. Calorie-restricted diets may work in the short-term, but they carry with them real implications, including a heavier weight over one’s lifetime. Instead of dieting, O’Connell recommends that teens instead seek to feed their

The final ingredient: Exercise While diet is a critical component to good health, exercise can be overlooked especially if it seems like your child is getting plenty of exercise on the school playground, on weekends or through organized sports. Parents can underestimate how much movement their children need to stay healthy.

Children ages 3 through 5 should be physically active throughout the day for growth and development, according to the Centers for Disease Control. They should be encouraged to be physically active for up to three hours a day. Children and adolescents ages 6 through 17 years should spend 60 minutes or more each day doing moderate-to-vigorous intensity physical activity daily. As part of

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this activity, the CDC recommends on at least three days during a given week, children and adolescents engage in vigorous activity, such as running or soccer; activity that strengthens muscles, such as climbing or push-ups; and activity that

A BETTER

KIND OF CARE

strengthens bones, such as gymnastics or jumping rope.

To help families navigate the balance between healthy eating and exercise, the YMCA offers Prescribe the Y, said Kim Adie, director of Healthy Living at the YMCA of Greater Nashua.

Geared toward ages 6 to 13 and parents, Prescribe the Y meets weekly over

We are proud to be the leading independent practice in New Hampshire. But what does that mean for you?

10 weeks and teaches the whole family basic nutrition and exercise guidelines.

Instead of one hospital, we work with them all. You have the freedom to choose any specialist, while we have the freedom to provide the care you need, including same-day primary care appointments and extensive wellness programs.

method— the idea of eating five or more fruits and vegetables a day; viewing

Because that’s what independence means.

health care providers, according to Adie.

The freedom to be better.

es as part of their weekly grocery shopping trips. As part of Prescribe the Y, families

Divided into two groups, younger children ages 6 to 9 learn how to play games as a way of exercising, while kids ages 10 through 13 work use the club’s cardio and Cybex weight equipment. At the same time, families learn about the 5-2-1-0 two hours or less of screen time; getting one or more hours of physical activity; and committing to 0 sugary beverages each day.

The free program, which the Y has run since 2008, continues to gain in popularity, Adie said. The YMCA’s annual campaign, grants and donations help keep the program free-of-charge for members and nonmembers. Families are typically referred to the program by pediatricians, school nurses, psychologists, or other

The YMCA also works closely with Hannaford to help families make healthy choic-

Always welcoming new patients.

visit the store, have questions answered by the store’s nutritionist about shopping and cooking, and often return to take advantage of the store’s free classes held every month.

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Why is childhood obesity considered a health problem?

• Children with obesity can be bullied and teased more than their normal weight peers. They are also more likely to suffer from social isolation, depression and lower self-esteem. The effects of this can last into adulthood.

• Children with obesity are at higher risk for having other chronic health conditions and diseases, such as asthma, sleep apnea, bone and joint problems, and type 2 diabetes.

• Type 2 diabetes is increasingly being reported among children who are overweight. Onset of diabetes in children can lead to heart disease and kidney failure.

• Children with obesity also have more risk factors for heart disease than their normal-weight peers. Risk factors include high blood pressure and high cholesterol. In a sample of 5- to 17-year-olds, almost 60% of children who were overweight had at least one risk factor for cardiovascular disease, and 25% had two or more risk factors.

• Children with obesity are more likely to have obesity as adults.

This can lead to lifelong physical and mental health problems.

Adult obesity is associated with a higher risk of type 2 diabetes, heart disease, and many types of cancers.

Courtesy of the Centers of Disease Control (www.cdc.gov)

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bodies with nutritious foods first.

“I really work with young girls on body positivity and accepting our body for the powerful, beautiful being it is,” she said. “By instituting calorie restriction, we are setting teens up for a lifetime of disordered eating and potential eating disorders.”

And while the low-carb craze might be an option for adults who want to lose weight and reduce their BMI quickly, it’s not a diet for teens. Instead, they should aim to reduce their intake of simple carbs such as cake, cookies, white bread and pasta; but they should not cut out fruit, vegetables, whole-grains or potatoes, O’Connell said.

“Carbs are a primary fuel for the body and brain. If you deprive your body of carbs it can impact hormone levels. In teenage girls, hormones are in a delicate place as it is and they are not something to mess with,” she said.

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• Creating your own personalized MyPlate eating plan: www.choosemyplate.gov.

• Nutrition and diet: Hannaford offers free dietitian demos and nutrition classes in its stores. Registered dietitians cover a variety of class topics including managing special dietary needs like diabetes and heart health, portion control, and many more. www.hannaford.com • Healthy eating and keeping your kids healthy: Centers for Disease Control, www.cdc.gov • Your local Y: www.ymcasofnh.org/find-your-nh-ymca

18 www.parentingnh.com | APRIL 2020

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WHEN PARENTS SHOULD SEEK HELP If you find yourself engaging in food battles with your 6-yearold every night or your teen is experiencing body image concerns, O’Connell suggests reaching out to a dietitian. Depending upon your insurance plan, preventative nutritional counseling might fall under your health benefits and may only require a co-payment.

Children often do not need medical referrals or need to meet specific weight requirements to get seen, she said. But, if you are working with a pediatrician to get your child weighed monthly, and he or she is not gaining any weight, for example, it’s really important to take the next steps to ensure your child is following a healthy path.

All Aboard!

Krysten Godfrey Maddocks is a frequent contributor to ParentingNH.

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CAMP BIRCH HILL With a focus on each individual camper Birch Hill offers over 50 activities to choose from to create a personalized schedule. Let’s have a fun summer!

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Each day will be filled with fun projects and valuable lessons, from crafts to athletic events. Registration is open, and our space is limited. Sign up before March 1st to receive our Early Registration Deal — the $50 registration fee waived!

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20 www.parentingnh.com | APRIL 2020

IT’S TIME TO GIVE

plant-based eating A TRY Your family won’t miss the meat and it’s better for you

BY MICHELLE LAHEY

L

ately, it seems like everyone — from Burger King to celebrity chefs — is touting plant-based foods. And for good reason.

Research has shown that eating less meat is better for our bodies and better for the environment — and better for our wallets, too.

“Plant-based” is the trendy term for vegetarian, i.e., it encompasses foods made with plants versus animals.

Before you start buying everything labeled “plantbased” at the grocery store, though, develop a buyer beware mentality. Any food manufacturer can easily call foods such as potato chips, peanut butter, and sugar-filled cereals “plant-based” because they don’t include any meat products. www.parentingnh.com

| APRIL 2020 21

Lovin’ It Lasagna

If your goal is to cut back on meat for your family’s overall health and wellness, it’s important to read labels Recipe courtesy of Tiffany Calcutt of Harvest Nutrition & Wellness, LLC and to stick with the healthy stuff: fruits, vegetables, (www.harvestnutritionwellness.com). Yields: 8-10 servings legumes, grains, nuts, and the like.

A pound of lasagna noodles (bonus points for whole-wheat variety) “Eating a plant-based diet is beneficial in a myriad of 24 ounces marinara sauce ways, including a lower environmental impact, lower A pound of extra-firm tofu risk of heart disease and some cancers, lower risk of 1 egg children developing Type 2 diabetes, and a higher in1¾ cups shredded cheese (recommended: equal parts Mozzarella take of important vitamins, minerals, antioxidants, and and Parmesan, with ¼ cup set aside for topping) phytonutrients,” said Stacey Hamblett, a professional Crushed red pepper, Italian seasoning, and/or salt and pepper to taste plant-based chef, holistic nutritionist, herbalist, and integrative wellness advocate located on the Seacoast.

Preheat oven to 375°F. Cook ¾ cup cheese, followed by ½ of The beauty of plant-based foods is that they are easy pasta according to package remaining sauce. Repeat with to incorporate in your family’s weekly diets because instructions. Drain and set aside. second layer. Finally, place four of how versatile and easily accessible they are. Even Note: there will be leftover noomore noodles on top and sprinkle replacing two or three meat-based meals a week with dles, which make for a handy with last ¼ cup of cheese. something vegetarian can benefit you, your family, and quick snack or lunchbox addition.

Cover with foil and bake for 25 your budget — no matter the varying palates in your Place tofu in blender with egg minutes. Uncover and bake for household. and optional seasonings. Pulse or 5-10 more minutes or until golden mix until it’s a ricotta-like consison top. Let rest 15 minutes before “A plant-based diet can mean different things to tency. serving. different people,” said Tiffany Calcutt, MBA, RDN, LD, Pour small amount (1/4 cup-ish) Note: Adventurous families can President and Founder of Harvest of sauce into 9x13 baking dish also blend several handfuls of raw Nutrition & Wellness, LLC, based in and spread out. Construct first lababy spinach in with the tofu for a Peterborough. sagna layer as follows: Place four “spring green” lasagna filling.

“I look at this newer terminology as noodles on bottom, top with half a spectrum, ranging from a diet that of tofu/egg mixture, then sprinkle is semi-vegetarian to a vegetarian diet that has no meat or fish but includes The texture and taste of this lasagna is no different than dairy and eggs, all the way to a diet your favorite family recipe, that is vegan.” but the nutritional value is far Plant-based foods have come a long superior thanks to protein-rich tofu that replaces ricotta way over the years, and now it’s easier cheese. Never tried tofu? than ever to trick even the most pasHere’s the perfect way to sionate of carnivores into not missincorporate it into a meal ing the meat. Beans and lentils, for inwhere no one except the chef knows. stance, provide a satiating alternative to animal proteins. Quinoa is chock-full of protein and fiber, and adds plenty of heft to any dish.

“There are several sneaky ‘meat extenders’ — plant-based substitutes that can be added to meals such as tacos, meatballs, lasagna or burgers, without depriving folks of the meaty taste they may love,” Calcutt said. “For example, instead of using two pounds of beef and pork to make a meatloaf, one could substitute in one pound of mushrooms and begin by cutting back on the meat.”

All of these ideas to incorporate more vegetarian foods in our diets sound great for the adults, but we all know who the toughest of critics at the dinner table are

22 www.parentingnh.com | APRIL 2020

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Quick & Easy Cold Soba Noodles Recipe courtesy of Chef Stacey Hamblett (www.chefstaceyjean.com).

Yields: 1 serving 1 bundle of your favorite soba noodle (I love Organic Planet) ¼ cup frozen peas ¼ (or more) cup of fried tofu (I have this on-hand so I can just eat it as is with soy sauce and tamari, or to pop into meals. Always found in fridge at Asian Markets.) ½ cup chopped bok choy 2 tablespoons chopped cashews 1 green onion, chopped Handful of fresh cilantro, chopped 1 tablespoon sesame oil 2 tablespoons soy sauce (I prefer tamari) 1 teaspoon agave ¼ of a lime, juiced Optional: sliced jalapenos or a sprinkle of crushed red chili pepper flakes In a small sauce pot, bring about 3 cups of water to boil.

Add soba noodles and the frozen peas. Cook about 3 to 5 minutes or until noodles are al dente.

Drain and rinse with cool water.

Add sesame oil, soy sauce, lime and agave, and stir to cover noodles thoroughly. The noodles will soak up the dressing, so don’t

worry if it looks a little “soupy.”

Add the rest of the ingredients and season to taste. Place in fridge overnight so you can enjoy how the flavors have come together the next day.

— the kids. How can we get them on board with a diet that includes fewer hot dogs and more beans?

“I have found that kids love learning about (and eating) plant-based foods when you teach them to garden and cook,” Hamblett said. “Let them plant a summer garden filled with herbs, leafy greens, carrots, beets, and more, and get them involved in the kitchen. You will be surprised when they ask to make a salad and even to add parsley to it (I have witnessed it).”

Calcutt agrees that it’s important to empower kids with choices especially given their unique preferences.

Calcutt loves making Buddha Bowls for kids, where one cooks a grain, such as brown rice, and then sets out numerous toppings to mix in. Think tofu, avocado, broccoli, etc.

“Then everyone gathers around the bowls and plops in what he/she wishes. Everyone’s bowl will look different and all tastes can be met,” Calcutt said.

Despite the many positives with incorporating more plant-based foods in your diet, there are also some risks to consider — especially if you decide to go fully meatfree.

For instance, soy, found in tofu and plant-based “meats,” can mimic the activity of estrogen in the body, which could increase your breast cancer risk and cause other health issues in some, so it’s important to read labels and check with your doctor.

You also need to ensure that your family is eating a well-balanced diet and getting the proper nutrients that all of your household’s different bodies need.

“It’s important everyone obtains adequate calcium, vitamin D, B-12, iron, and zinc — nutrients which many animal products such as dairy and red meat deliver readily,” Calcutt said. “These needs can easily be met with proper knowledge of alternate food sources and/or supplementation.”

Adding more plant-based foods and meals to your family’s regular repertoire can be easy, beneficial, and budget-friendly. Just be sure to eat the right plant-based foods so your family is getting the dietary benefit it deserves.

“In my professional opinion, there are no drawbacks to eating a plethora of plant-based foods,” Hamblett said.

Michelle Lahey is a food writer who has been writing about (and eating) food in New Hampshire for over 10 years. Outside of food, you can find her sipping on a good IPA, correcting other people’s grammar, or hiking in the White Mountains.

24 www.parentingnh.com | APRIL 2020

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Does my child have autism?

What parents need to know about getting a diagnosis and finding support

BY KRYSTEN GODFREY MADDOCKS

26 www.parentingnh.com | APRIL 2020

S

tephanie Morin was in disbelief when her twin sons

received autism diagnoses, one at 17 months and the other at 26 months.

When the boys’ pediatrician suggested that she get her sons evaluated by a developmental pediatrician, Morin balked. After all, Morin was a practicing Board Certified Behavior Analyst (BCBA), an expert certified in applied behavior analysis who typically works with children on the autism spectrum.

She had worked previously for a psychiatric hospital’s developmental disabilities unit, where she was first exposed to groups of children and adults diagnosed with autism. It was in this job that Morin changed her educational path from special education to applied behavior analysis, a scientific approach to understanding different behaviors and helping people improve their social and communication skills, as well as adaptive learning skills related to fine motor dexterity.

Looking back, she recalls that some of the early signs were there. When family members walked into the room, her boys didn’t seem to notice. They weren’t hitting typical language milestones, either.

“As an autism expert working in the field… I didn’t notice that my own kids had autism. When the pediatrician told me, I was in such shock and denial that I was completely immobilized,” said Morin, who is a clinical outreach director for The Birchtree Center in Newington, an organization that provides applied behavior analysis (ABA) services both on-site and in school for children with autism.

“The doctor had a frank conversation with me and told me not doing anything is not going to make anything better. At work, I see a lot of that. Sometimes I feel that I should share my story, because I want people to know what I experienced. Looking at my boys now, people are shocked to learn that both boys have autism.”

Here twins are now four years old and thriving thanks to a combination of inschool support and ABA services they receive after their preschool day ends.

“Both of them are now talking up a storm; it’s unbelievable,” she said.

But before parents can address any developmental delays in their children and get early intervention support services or in-school support, they first must get the right diagnosis, Morin said.

GETTING A DIAGNOSIS One in 59 children has been identified with autism spectrum disorder (ASD), according to current estimates from the Centers for Disease Control’s Autism and Developmental Disabilities Monitoring Network. (This number is up from 20 years ago, when the number was about 1 in 150 children, according to the CDC.) ASD is about four times more common in boys than girls.

Getting an autism diagnosis is not as simple as getting a blood test.

To make an accurate diagnosis, doctors must look at a child’s behavior and development, according to the CDC. Although it can be detected as early as 18 months, many children do not receive a final diagnosis until

www.parentingnh.com

| APRIL 2020 27

WHAT DO I DO NOW?

they are much older.

Nina Sand-Loud, assistant professor of psychiatry at the Geisel school of Medicine at Dartmouth Medical School and a developmental pediatrician at Dartmouth-Hitchcock Medical Center, said that most parents complete a developmental screening test at their pediatrician’s office during annual well child visits.

General developmental screenings (like the Ages and Stages Questionnaire) typically take place at 9, 18, and 30 months; specific autism screenings take place at 18 and 24 months. It’s important to note that these screenings only show that a child is having problems reaching developmental milestones; they do not in themselves make a diagnosis, Sand-Loud said.

One of the most common autism spectrum screeners, the Modified Checklist for Autism in Toddlers, or MCHAT, asks parents to assess whether their children do things like point at objects, play pretend games, show interest in other children or move their fingers near their eyes, to name a few. If children score in an “at-risk” range, a pediatrician will ask supplementary questions to try to pull out more information, Sand-Loud said.

“If the child shows that he or she is at risk … we typically do refer them to someone else for further evaluation. It’s very rare for a pediatrician to make a diagnosis based on a screening instrument alone,” she said.

At the same time, Sand-Loud urges parents to advocate for themselves if they think the screening tools aren’t addressing the behaviors they are concerned about. “(At the doctor’s office) some kids are chatty and comfortable, and some hide under the chair. We have to use the glimpse of them we see in the office as a full picture — but mostly, parents know best. Their teachers also know them well because they teach in classrooms of children who are the same age and they might be able to help address potential concerns, too,” she said.

If a child is younger than age 3, their parents would typically contact New Hampshire’s early intervention program, Family-Centered Early Supports and Services.

Each region of New Hampshire has its own location where children can be assessed by specialists who can screen and support toddlers with developmental delays, including autism. In an early intervention screening, occupational therapists, speech therapists, and/or early childhood educators might take part in the screening.

At this age, children often receive services at home. In other cases, therapists may visit the child’s child care center. In all cases, services are free-of-charge to the parent.

Even if you don’t have an autism diagnosis, it’s still important to follow through with any support services at the same time you are seeking an official diagnosis from a developmental pediatrician, Sand-Loud said.

“It can be a long wait before you are able to see a developmental pediatrician. In my practice, we triage cases. We look at whether their age, specific concerns, and the early supports they are already receiving, and decide how quickly they need to be seen,” she said.

Currently, children under age 3 diagnosed with autism can usually be seen within two months; whereas older children might receive an assessment and wait six to eight months before visiting a developmental pediatrician, Sand-Loud said.

Whether a child is ultimately diagnosed with autism, it’s important for them to start working on areas that are challenging for them while they wait for a diagnosis It’s important for parents to understand that they shouldn’t wait to address the concern,” she said.

Once a child reaches age 3, they age out of early intervention and become eligible to receive services through the local school district, because of the Individuals with Disabilities Act (IDEA). However, many of the state’s public preschool programs only run parttime for a few days a week.

To bridge the gap, children can supplement their support through centers like The Birchtree Center, Morin said. Families who have children with an autism diagnosis can get private services reimbursed through their insurance companies or Medicaid. And while it seems like kids might need some “downtime” from school,

To learn more about autism and available services Crotched Mountain’s Ready Set Connect program: www.readysetconnect.org The Birchtree Center: www.birchtreecenter.org New Hampshire Family Voices: www.nhfv.org New Hampshire Council on Developmental Disabilities: www.nhddc.org Centers for Disease Control: www.cdc.gov Children’s Hospital at Dartmouth (CHaD): www.chadkids.org

28 www.parentingnh.com | APRIL 2020

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30 www.parentingnh.com | APRIL 2020

for children with autism, the opposite can be true.

“For really young kids, 40 hours a week of ABA therapy is the gold standard,” she said.

“A lot of the kids I work with don’t know how to fill their downtime appropriately. They need someone facilitating, guiding and structuring things for them. Otherwise, some of those inappropriate behaviors can come into play and they become harder to break.”

Most states have laws that require insurance coverage of autism services, including New Hampshire, although coverage for ABA services can be capped at a certain amount. In New Hampshire, coverage is limited to $36,000 per year for children up to 12 years and $27,000 for children ages 13-21, according to House Bill 569, passed in 2010.

The Birchtree Center staff work closely with a student’s school team to determine what support kids need. Together, they create an environment for a child in the least restrictive learning setting.

“I am a firm believer that anything can happen in a public school if you are pulling in the right resources. I’ve seen kids in public schools where the school said that they were so disruptive and dangerous that they couldn’t continue at that level of support. I’ve said to them, ‘give me a month and I can turn it around,’” Morin said. “In this case, the child has had zero instances of interfering behavior with the right supports in place.”

Crotched Mountain’s Ready Set Connect autism centers also provide ABA therapy to children in New Hampshire. Located in Manchester, Concord, and Tilton, the centers blend individualized teaching with group learning.

BCBAs and ABA therapists measure skills and track data while children participate in group activities and build skills to better navigate relationships with their peers. Ready Set Connect also offers topic-based parent trainings and consultations.

The organization started as a small center in Concord 11 years ago and has expanded as the need for services has spiked, said David Johnson, vice president of marketing and communications for Crotched Mountain.

Once parents have a comprehensive diagnostic evaluation that confirms the diagnosis of autism from a psychiatrist, licensed professional psychologist, pediatric neurologist, or developmental pediatrician, their child can begin to access services.

Like The Birchtree Center, Ready Set Connect’s case workers, BCBAs, and ABA therapists work closely with a child’s family and school team to make adjustments in his or her treatment plan as behaviors change or improve.

“The sooner the child gets services, the better. If a pediatrician says it’s worth looking at, get your child tested. It’s tough to get to that point and acknowledge that, but the research is rock solid, and we can serve kids at younger and younger ages,” Johnson said.

EXTRA SUPPORT FOR FAMILIES Families whose children receive an autism diagnosis, or any other medical diagnosis that requires additional support, often feel alone and unsure of where to turn.

Terry Ohlson-Martin, who founded New Hampshire Family Voices in 1994 with Martha Jean Madison, encourages parents to remember that their child is the same person he or she was before they

received an official diagnosis.

Ohlson-Martin, whose son, Kenny, 40, has cerebral palsy and is nonverbal, said that while there was a good public education system in place for her son when he was younger, there was no direct system to help her navigate the health care side for him.

New Hampshire signed on as one of the first Family Voices National organizations in the nation and began as a grassroots network of families of children and youth with special health care needs for the purpose of sharing information, resources, health programs and policies.

Today, New Hampshire Family Voices participates in program development, implementation and evaluation, and sharing families’ expertise in the formation of policies affecting their children. In addition, the nonprofit organization connects families with one another and provides families and professionals with information to connect children to services.

Parents concerned about following the right protocol to get their kids the right treatment at the right time turn to New Hampshire Family Voices for help navigating the ABCs of autism.

“The first thing you have to do after you get a diagnosis is reframe your thinking. There is not just one road you should go down. Families often ask, ‘what do I do next?’ I tell them to tell me about their child, not the diagnosis and how it presents,” she said.

Each family’s capacity and stamina for pursuing support is different, she said. Depending on the child’s diagnosis and the severity of his or her behavior, families might take a different approach when it comes to next steps.

“I ask them, ‘what do you want to change? What is getting in the way and what is the barrier your child needs to get over?’” Ohlson-Martin said.

New Hampshire Family Voices can talk parents through their concerns, let them know where to call, what to ask when they do call, and what they might want to think about, she said, adding that because each state offers services a little differently, it can be especially difficult for people who’ve recently moved to New Hampshire to navigate the system. An emerging group seeking assistance, grandparents often find themselves overwhelmed after they receive custody of a grandchild with an autism diagnosis.

“We can walk them through it. Sometimes we are the calming factor in the system,” she said.

The organization also hosts a private Facebook group of more than 1,000 members, holds training for families on topics such as health care financing, best practices and family/professional partnerships; supports a lending library and offers parent-to-parent support for families who just need to talk to someone.

Morin agrees that finding the right people to talk to can help make receiving an autism diagnosis a lot less overwhelming.

“I felt so alone that I didn’t even share it with colleagues at first. It was about finding people to open up to and talk to,” she said. “Now I have a great group of friends.”

Krysten Godfrey Maddocks is a former journalist and marketing director who now regularly writes for higher education and technology organizations in New Hampshire and Massachusetts. Krysten won three awards — gold, silver and bronze — from the Parenting Media Association in 2020.

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| APRIL 2020 31

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ASK THE EXPERTS: ORTHODONTICS Dental health starts early,

and orthodontic treatment can correct issues before they become serious. Parenting NH reached out to Agata A. Bartels DMD, MS, Pediatric Orthodontist at Children’s Dental Center Of New Hampshire and Orthodontics Too to learn why an early visit to the orthodontist is important, and how your children will benefit in the long run.

What is the difference between a dentist and an orthodontist?

Bartels: “General Dentists are concerned with overall health of the teeth and gums. Orthodontists are dentists with additional specialized training. Both orthodontists and general dentists have to complete four years of dental school but orthodontists complete an additional 2-3 years of training to become specialized in moving teeth.”

At what age should my child have an orthodontics appointment, and why is it important?

Bartels: “According to the American Association of Orthodontists children should first visit an orthodontist around the age of seven. Orthodontists can identify even the slightest problems with jaw growth and erupting teeth that may not be obvious to the parent. This check up may reveal that your child’s tooth and jaw development is totally normal. Sometimes a developing problem may be recognized and the orthodontist will recommend a periodic evaluation every 6-12 months to monitor the growth

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and development of your child and determine the optimal time to start orthodontic treatment. In some cases, a problem that could benefit from early treatment may be identified.”

How can you tell if your child may need early treatment?

Bartels: “Some problems that may indicate that your child will need early treatment include: • Protruding front teeth • Crowded teeth around age • Teeth that don’t come together in seven or eight a normal manner (an underbite) • Mouth breathing • Early or late loss of baby teeth – • Difficulty chewing or biting your child will typically start • Thumb or finger sucking or any other habits after age five losing their baby teeth at • Shifting of the jaw when your child around age five and should opens or closes his or her mouth have all permanent teeth at (crossbites) about age thirteen”

What can I expect at the initial visit?

Bartels: “The goal of the first visit is to determine if orthodontic treatment is needed and when to start. You should expect to be at the initial visit for about one hour. A staff member will take photos of your child’s mouth and teeth and a panoramic x-ray. The orthodontist will then do a thorough clinical examination, review your child’s medical and dental history, and go over the photos and x-rays taken. After the exam, the orthodontist and staff will discuss various treatment options, treatment time and cost of treatment.”

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Going Places?

Have we got a magazine for you!

dad on board FROM A TRIO TO A BUNCH MY ONLY CHILD IS NOT QUITE PREPARED FOR THE DORM-LIVING EXPERIENCE

BY BILL BURKE

Find it on Newsstands Best Places New Hampshire

This special edition of New Hampshire Magazine will map out the best places in the state to get a new job, buy a home, find the right school or stroll the sweet spots of local culture, nightlife and tax-free shopping.

Interested in advertising?

Contact Kimberly Lencki at (603) 413-5154 or klencki@mcleancommunications.com.

34 www.parentingnh.com | APRIL 2020

“Here’s the story of a lovely lady, who was bringing up one very lovely girl…”

That’s right — one. With a distinct lack of our own Marcia, Greg, et al., the past 18 years haven’t exactly been like living among The Burke Bunch. There are three of us all told, which means that when my only child goes off to college in a couple months, she’s in for a potentially jarring wake-up call.

She’s never had to share a bedroom, the Xbox, food or the bathroom. She’s always been free to roam about untethered by siblings.

To my free-range progeny: Dispose of your sense of personal space, because the throngs are nigh. Picture, if you will, roommate(s) just an arm’s length away, laundry aplenty, one of those tiny refrigerators jammed into a corner, and laptops scattered to and fro — all in a living space roughly the size of a thing that’s really small.

I grew up one of four kids, so sharing space was a normal way of life.

My brother and his wife have eight kids, though I should check in with them — they may have added a few more since I started writing this.

Half of their kids have completed or are in the midst of their college experience. I assume their adjustment was fairly wrinkle-free because they trained for it.

We wanted to prepare her for living among others who aren’t a dog or her mom or me, so we sent her to campus for a “shadow day.” She attended classes, played bass in a couple of ensembles and loved the experience. When she got home, however, one of the unexpected takeaways was “there’s no way that room should’ve been a triple.”

Welcome to inhabited spaces, kid.

This upcoming challenge, though admittedly inconsequential in the big picture, would’ve been slightly easier if she had a bunch of brothers and sisters. The closest we’ve come is by adding our own Cousin Oliver to the mix.

When she was about five, I told her she had an older sister named Sally who had to live in the attic because she wouldn’t take a bath and go to bed when we asked her to. It didn’t have the effect I had hoped. She started signing Sally’s name to greeting cards and referring to her around holidays.

Ultimately, I think she’ll be happy with the change. I don’t remember much about my first college roommate other than his name was Chuck. He’d put on headphones and sing along with the radio at 5 a.m., but other than that I had no complaints. If she doesn’t draw a headphone-singer, I think she’ll be fine.

The barbarians aren’t exactly at the gate, but her daily life is about to get a bit more populated.

Bill Burke lives in southern New Hampshire with his wife and daughter in a house with avocado-colored appliances and a live-in housekeeper who dates the butcher. He is also managing editor of custom publications for McLean Communications.

never a dull moment HEALTHY, WEALTHY AND WISE? BEING A ROLE MODEL IS OVERRATED

BY KATHLEEN PALMER

In my youth, I used to be a big fan of putting bumper stickers on my car.

One of my favorites was, “If you can’t be a role model, be a terrible warning.” But these days, our social media is filled with encouraging statements written over glorious images. My humorous Gen X-era low self-esteem bumper sticker has been replaced by, “If you can’t find a role model, be one.”

Whatever, little Suzie Positive Affirmation; I’ll be over here, watching “The Breakfast Club” for the millionth time.

Now that I’m in the position to actually be a role model to my kid, I’m ruefully realizing that my snarky 20-something bumper sticker may have been painfully prescient.

To be fair to myself, I come from a long line of late bloomers (my mom’s words) and imperfect parenting. I know my grandmother used to tell my mom a similar sentiment: “Do as I say, not as I do.”

We’re all out here doing the best we can to improve on the next generation coming up in the ranks under our (floundering) tutelage. Sometimes we lead by example, and sometimes we show them what they don’t want to emulate.

Since this month’s issue focus is on health, I’ll admit (as I have countless times) that I’m not the perfect role model on nutrition and fitness for my daughter. I do try — every day, over and over — with my own success in those arenas.

I keep reiterating suggestions for her to avoid my own pitfalls by being proactive in her healthy choices now. And she has made incredible strides to not be like her ancestors. She’s a vegetarian who eats tons of fruit. She’s a cross-country runner. She doesn’t drink soda. And I’m ecstatic about these choices.

She also sees me struggling financially as a solo parent with my four jobs, and I know that her disappointment with my available funds is driving her to become a successful adult in a high-paying profession. Her straight-A machine mentality is partly because she wants to get into a high-profile university and do things a lot differently than I did.

I’m glad — well, maybe not glad, as much as I am willing — to accept the digs and jibes from her about my shortcomings, if it means she is striving to do better than I have in her own adult journey. I will be proud of her if she overcomes her family’s historical foibles. I will be proud of her regardless.

So… yay for being a terrible warning. Sincerely yours, The Breakfast Club.

Kathleen Palmer is an award-winning editor and journalist, marketing/ communications content writer and occasional comedic actress. Nothing makes her happier than making people laugh. She is a single mom to a teenager, so naturally she enjoys a glass of wine, or two.

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house calls SAFEGUARD YOUR CHILD’S SIGHT INCREASED SCREEN TIME CONTRIBUTES TO DRY AND TIRED EYES

BY ERIN SALCONE, MD

AGES

Amherst BedforddConcordd DoverdLondonderrydManchesterd NashuadNew LondondPelhamd PortsmouthdSalem Windham

Our children are precious, and so is their eyesight. Basic vision screenings are part of pediatric health care, and primary care physicians perform these screening eye exams. They help catch developmental issues requiring a referral to a pediatric optometrist or ophthalmologist for diagnosis and treatment such as strabismus (misalignment), amblyopia (lazy eye) and anisometropia (asymmetric refractive error), as well as anatomic abnormalities like cataracts.

Primary care practices are increasingly using automated vision screeners.

Children look inside these electronic boxes for a refraction and alignment test, providing data indicating whether they might require eyeglasses, patching or even surgery. This makes exams more efficient and reduces the number of unnecessary referrals.

There is no evidence that all children need full, dilated eye exams, unless there is a strong family history of vision problems or the child has subjective complaints. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) encourages the medical home (primary care practice) as the place to conduct pediatric vision screenings. Children are never too young for vision screenings. Providers can always get information, even in infants.

Screen time strain The popularity of online videos, television shows and gaming geared to children and teens has markedly increased the amount of daily time spent in front of screens. There is no hard data indicating screen time is damaging to the eyes, but there is a decreased blink time versus when you are reading books. People tend to look away from reading material more often than they do with screens.

With much of today’s school work online, children are taking fewer breaks from screens, which is fatiguing to the eyes and contributes to dryness.

Pediatric ophthalmologists have observed an increase in strabismus among teenagers, frequently requiring surgery to correct. There is a lot of accommodation required by the eyes to concentrate on a small target, like a screen, for a prolonged period of time.

In 2019, the World Health Organization (WHO) released the first guidelines on screen time for children under the age 5. WHO recommends zero screen time for children under two years of age, and only 60 minutes (or less) each day for two- to four-year-olds.

Protection is key Unfortunately, pediatric eye trauma is common. According to AAPOS, “Close to 50 percent of [eye] injuries occur in sports and recreational activities — more often in children and teens than any other age group.”

I have seen this first-hand. Projectile eye injuries caused by toys, rocks and debris propelled by lawn equipment and household items like pencils, scissors and cleaning solutions can be superficial to severe. Everything is an eye injury waiting to happen.

Children participating in sports, and all children with poor vision in one eye, should consider wearing eye protection featuring sports frames with shatterproof polycarbonate lenses.

Erin Salcone, MD, is a Pediatric Ophthalmologist at the Children’s Hospital at DartmouthHitchcock (CHaD). For more information, go to www.chadkids.org/ophthalmology.

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