How parents can deal with COVID-19 stress

With schools and many businesses closed amid the COVID-19 pandemic, parents have been tasked with more than ever and many are dealing with COVID-19 stress. Their homes are now distance learning facilities, daycares, activity centers, remote offices and more.

The American Academy of Pediatrics (AAP) urges parents during this uncertain and difficult time to practice self-care, ask others for help, and use healthy discipline techniques when necessary.

How parents can practice self-care

“It’s more important than ever for parents to take care of themselves first,” says Dr. Katherine Williamson, a CHOC Children’s pediatrician and president of the Orange County chapter of AAP. “Unless parents are themselves well nourished, well-rested and maintaining healthy relationships, they won’t be able to provide the care or environment their kids need right now.”

There are several ways for parents to practice self-care while juggling their added responsibilities:

  • Eat a balanced diet
  • Exercise
  • Get enough sleep
  • Maintain social connections with friends and family via phone or video chat. These relationships are an important source of support during trying times. Discussion forums and online communities of other parents can be especially helpful.
  • Use your helpers. If you have a new baby at home, older siblings can help in developmentally appropriate ways.
  • Speak with your healthcare provider about your mental health. Many doctors and mental health providers are offering telehealth visits.

Healthy discipline techniques

Children have also had their lives disrupted by COVID-19. Schools are closed, and they can’t have play dates with friends. When children are bored or frustrated, they are more likely to act out.

“When children misbehave, effective discipline teaches them to regulate their emotions and helps them gain a better understanding of rules and expectations,” Williamson says.

The AAP recommends the following techniques when children feel stressed:

  • Engage kids in constructive activities. Here’s a roundup of activities for kids during COVID-19.
  • Help kids sort through their fears. Kids old enough to understand the news may be scared someone they love will die. Acknowledge their fear and share all the things your family is doing to stay safe, like washing your hands and staying home. Here’s a pediatric psychologist’s advice on helping kids cope with COVID-19 anxiety.
  • Call a time-out. Warn children they will get a time-out if their current behavior continues. Remind them what they did wrong in as few words with as little emotion as possible. Remove them from the environment for a pre-set amount of time. One minute per year of age is a good guide.
  • Know when not to respond. If your child isn’t doing something dangerous and gets plenty of attention for good behavior, an effective way to stop bad behavior can be just ignoring it.
  • Catch them being good. Point out good behavior, and praise children for their good tries and success. This is especially important in the disruption of children’s normal routines and friends.
  • Give them your attention. The most powerful tool for effective discipline is attention—to reinforce good behaviors and discourage others. Remember, all children want their parent’s attention. When parents are trying to work at home, this can be particularly challenging. Clear communication and setting expectations can help, particularly with older children.

“Corporal punishment – like spanking or hitting – can harm children and hinder brain development long-term. It is also not effective in teaching kids self-control,” Williamson says.

The AAP also cautions caregivers never to shake or throw a child. Tips for calming a fussy baby:

  • Check to see if your baby’s diaper needs changing.
  • Swaddle your baby in a large, thin blanket. Your child’s pediatrician can show you how to do it correctly to help her feel secure.
  • Feed your baby slowly, stopping to burp often.
  • Offer your baby a pacifier.
  • Hold your baby against bare skin, like on your chest, or cheek-to-cheek.
  • Rock your baby using slow, rhythmic movements.
  • Sing to your baby or play soft, soothing music.
  • Take your baby for a walk in a stroller.
  • Go for a ride with your baby in the car (remember to always use a car seat).

Most babies get tired after crying for a long period of time and then fall asleep. If your child continues to cry, call your pediatrician to discuss your concerns and stress. There may be an underlying medical reason for your child’s tears.

This article was last updated on April 14, 2020.

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Body mass index or BMI: What parents should know

By Dr. Angela Dangvu, a CHOC Children’s pediatrician

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Dr. Angela Dangvu, a CHOC Children’s pediatrician

 As a pediatrician, I spend much of my day doing well child visits for my patients. A big part of those appointments is looking at a child’s growth. Parents are usually interested in knowing their child’s weight and height percentiles, but they rarely ask directly about body mass index or BMI.

What is body mass index?

BMI is a measure of a person’s weight in relation to their height. It varies based on the age and gender of the person and is used to estimate the amount of body fat.

BMI is calculated starting at 2 years of age.  At this age it tends to be higher and will generally get lower until a child is 5 or 6 years old. Then, it will increase with age as they grow into early adulthood. Often, parents of children ages 3 to 4 ask me if their child is too skinny. They’ve begun to notice that their once chubby-looking toddler has thinned out. This is completely normal but can cause parents to overfeed their child because they think they are underweight.

Kids come in many different shapes, so they shouldn’t all have the same BMI. There is a wide range of BMIs that are considered normal. On the lower end, the normal range for BMI starts at the 5th percentile — meaning that 5% of children of the same age and gender will have a BMI lower than them. On the higher end of normal is a BMI in the 85th percentile, which means that 85% of kids of the same age and gender will have a lower BMI.

A BMI lower than the 5th percentile is considered underweight, while a BMI between the 85th and 95th percentile is in the overweight category. A BMI of more than the 95th percentile is considered obese.

When a child’s BMI indicates that they are underweight, it can be a sign of a medical condition that is preventing them from gaining weight. When a child’s BMI puts them in the overweight or obese range, we as pediatricians worry that they could be gaining too much weight, putting them at risk for diseases like diabetes or high blood pressure when they are older.

What body mass index is not

BMI is not a perfect measurement of a child’s body fat, but rather it is just one tool that we use in evaluating a patient’s overall growth and nutrition.

For example, a child being underweight doesn’t always mean they have a medical condition or are not getting enough calories. The child could be underweight because of genetic factors; perhaps both parents were thin as kids, and their child is taking after them.

How your pediatrician can help you improve your child’s BMI

As physicians we look at multiple sources of information to determine why a patient is underweight. We look at the growth chart, medical history and family history. We might order lab tests and refer our patients to a specialist depending on the findings. If the child appears to simply need to consume more calories, I usually encourage the family to incorporate some more calorie-dense foods into the child’s diet, rather than getting into a power struggle with their child about the amount of food they are eating.

If your child’s BMI is in the overweight or obese category, your physician should work with your family to determine possible causes, and solutions as well. Many parents already know that their child’s weight is a concern, but others may not notice that it has become an issue.  With my patients, I try to identify factors in their diet and activity levels to find potential areas for change. One thing to remember with children is that they will continue to grow into their teens, meaning that the goal doesn’t usually need to be weight loss. If they can slow their weight gain or even go for a period of time without gaining weight as they grow in height, their BMI will improve.

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Eczema Treatment for Kids

By Dr. Eric Ball, a CHOC Children’s pediatrician

What is eczema? Atopic dermatitis, more commonly known as eczema, is a common skin condition that can plague everyone from babies to grown-ups. It can be as mild as a nuisance, or more serve with skin so dry it cracks, bleeds or gets infected. Most kids will get an itchy skin rash at some point in childhood, but about one out of every 10 kids will develop eczema.

Eczema causes are unknown, but it’s believed to be a combination between genetics and a trigger, which could be certain foods, seasonal or environmental allergies, stress, hormones and weather. Diagnosing eczema can be tricky because each child has a unique combination of symptoms that can vary in severity, and there is no test to diagnose it definitively. If you suspect your child has eczema, consult your pediatrician. They will conduct a physical examination, and help you identify things in your child’s environment that may be contributing to skin irritation.

Eczema is not contagious, so there is no need to keep a child with eczema home from daycare or school.

Eczema symptoms

Eczema symptoms typically appear within the first few months of life, and almost always before a child turns 5. More than half of all children who suffer from eczema will outgrow it by the time they’re teenagers.

Between 2 and 6 months of age, kids with eczema will have itchy, dry, red skin and small bumps. These eczema symptoms can appear on their cheeks, forehead or scalp. It may spread to the arms, legs and trunk; in the bends of the elbows; behind the knees; or on the backs of the wrists and ankles.

Eczema symptoms tend to worsen and improve over time. For many kids, it begins to improve by the age of 5 or 6; others may have flare-ups into adolescence and early adulthood. In many cases, eczema goes into remission and symptoms may disappear altogether for months or even years.

How to treat eczema

There is no known eczema cure. However, your child’s pediatrician may prescribe a topical corticosteroid, also known as cortisone or steroid creams or ointments, which are commonly used to treat eczema. These “eczema creams” are usually applied directly to the affected area twice a day. Continue using these corticosteroids for as long as your doctor suggests.

These creams and ointments vary in strength, so do not apply a topical corticosteroid intended for someone else.

Your doctor may suggest nonsteroidal medications instead of a topical steroid. These may also prescribe antihistamines to help control itching, or an oral or topical antibiotic to prevent or treat secondary infections common in kids with eczema.

How to help your child with eczema

  1. Avoid frequent hot baths or showers, which dry out the skin. Use warm waters and mild soaps during bath time. Gently pat their skin dry, instead of scrubbing or toweling.
  2. Avoid fabrics that may irritate their skin including wool or coarsely woven materials. Favor materials that “breathe” such as cotton.
  3. Apply moisturizing ointments like petroleum jelly, lotions or creams to their skin two to three times per day. Always apply within a few minutes of bathing after a gently pat dry, before the skin has fully dried. Do this in addition to using a cream prescribed by their pediatrician.
  4. Apply a cool compress to the skin to ease itching.
  5. Eliminate known allergens from your home, including certain foods, dust or pet dander.
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How to Deal With a Toddler Who is a Picky Eater

By Dr. Eric Ball, a CHOC Children’s pediatrician

Most babies are great eaters. The average twelve-month-old will eat most of what he is offered. At my son’s first birthday party, I remember that he happily ate broccoli and strawberries, and only nibbling on his birthday cake. Three months later, my wife and I were begging him to just try or lick a piece of broccoli. What happened?

Some studies suggest that over 90 percent of toddlers and preschoolers are described by their parents as picky. I have a few theories about what happens to these formerly stellar eaters:

  • Children’s growth velocity slows down dramatically after their first birthday. The average child gains 15 pounds in the first year of life and only 5 pounds in the second year. Most of the food your baby ate went to growth, whereas most of a toddler’s food will go to running around and playing. Therefore, a toddler’s hunger will be variable. There will be days when they are hungrier than other days. It is normal for toddlers to have meals― or even days― when they eat little. There are also days when a toddler might eat more during a meal than their parents.
  • The last thing a toddler wants to do is sit in a highchair for thirty minutes and eat a meal. They want to play and explore. The average toddler or preschooler will eat just enough to get the energy to play more. When their tank is refilled, off they go!
  • Kids get smarter as they get older. Eventually my son realized that chicken nuggets taste better than broccoli. Since toddlers have no knowledge of nutrition, they want to eat what they like the most. At this stage, the biggest pitfall parents can make is to start allowing their toddlers to decide what food will be served. They will obviously choose the junk food that tastes best to them.

So, what do you do with your newly picky eater? I was raised in a strict household where my brothers and I were forced into eating our food. My brothers and I all struggled with obesity as children and were all very picky eaters. My wife’s family had one rule for the table, “Eat what you want, leave the rest.” There was no arguing or bargaining around the dinner table in their home. My wife and her brother were always a healthy weight and ate a good variety of foods. Here are some tips that I learned from my wife’s family that I try to pass onto my patients and my own children:

As parents, we are in control of the quality of the food offered to our children, and they are almost 100 percent in control of the quantity that they eat.

Toddlers have a fierce independent streak and the more they are pushed, the more they push back. Do not bribe, coerce, or force your children to eat. Sit your toddler down for three well rounded meals per day and at least one healthy snack per day. Make sure that he is offered a variety of healthy foods at each meal. If he eats what is served, that is fantastic. If he does not eat what is served, that is okay, too, but do not offer him anything else. We parents are not short order cooks. If the family is eating chicken, rice and broccoli, then that is what the toddler should be served. If he is offered macaroni and cheese after he whines that he does not like chicken, then you have essentially taught him that in order to get macaroni and cheese, simply whine and refuse your food. This is the first step in the making of a picky eater. It is better to excuse him from the table if he does not want what he is served rather than give him something else. Children do not starve themselves to death. Place the dinner plate in the refrigerator, and he can have a second chance at eating his dinner later that evening if he decides he’s hungry.

Maximize your opportunities for successful meals by not filling up on liquid calories and snacks.

I do not serve milk or juice with meals, only water. When my son was a toddler, if he had milk with his dinner, he would chug the milk until he was almost completely full, and then eat little or no food A ten-ounce cup of whole milk has more calories than an equivalent sized soda. I would save milk or juice for snack time and limit my children to no more than 16 ounces of milk per day. In fact, I filled a 16-ounce measuring cup with milk each morning so that my children could see exactly how much milk would be allotted for the day. When the cup was empty, the milk for the day was over.

Give your toddler mutually acceptable choices for snack foods.

I will offer my children an apple or a pear for a snack. If they respond that they want Goldfish crackers, I will remind them again that their choices are between an apple and a pear.

Eat as a family whenever possible.

Children are much more likely to eat their food if they see others eating the same food. It is hard to expect a toddler to eat peas if he is the only one eating them. Even if work schedules make a true family meal impossible, try to have one parent sit with the children and eat small portions of what the children are served.

Allow children to participate in food preparation.

Most people are more willing to eat something of which they have ownership. Even something as simple as having your toddler stir the peas and corn may increase the odds that he will eat them.

If there are foods that you do not want your children to eat, do not buy those foods.

Good nutrition starts at the grocery store. If a child’s only options for snacks are fruits or vegetables, it is likely that he will eat them. Most toddlers and preschoolers eventually are smart enough and agile enough to find that stash of Oreos in the cabinet.

In medical school, I was repeatedly taught that parents should not make mealtime a battle. That lesson didn’t fully sink in until I had my own children and I realized how quickly a lovely family meal could degenerate into a stress-filled ordeal. By applying the simple family rule of “Eat what you want, leave the rest,” mealtime at our home is once again a pleasant experience.

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Stomach Flu vs. Influenza

Many people talk about the “stomach flu” when they’re feeling sick to their stomachs. It isn’t the same as influenza or the flu. Stomach flu is an illness called gastroenteritis, which is usually caused by a virus. The seasonal flu, or influenza, is a virus in the upper respiratory system. Each year from October to May, millions of people all across the U.S. come down with the flu.

Stomach flu (gastroenteritis)

Someone with the stomach flu may have the following symptoms:

  • Stomach cramps
  • Diarrhea
  • Fever
  • Nausea
  • Vomiting

He or she will usually feel sick for a day or two and then feel better. Unfortunately, there is no vaccine or cure for the stomach flu or gastroenteritis. Here’s how you can make the stomach flu go away:

  • Get lots of rest
  • If you’re throwing up, avoid solid food. When you feel up for reintroducing food, start with bland items like bananas, rice, applesauce or toast.
  • Sip fluids, such as water, or try a popsicle.
  • To avoid dehydration, sip small amounts of beverages that contain electrolytes.

Seasonal flu (influenza)

When people have influenza, they usually feel worse than they do with a cold. Most people start to feel sick about two days after they come in contact with the flu virus. They might have:

  • Fever
  • Chills
  • Headache
  • Muscle aches
  • Dizziness
  • Loss of appetite
  • Tiredness
  • Cough
  • Sore throat
  • Runny nose
  • Nausea or vomiting
  • Weakness
  • Ear pain
  • Diarrhea

Sometimes, influenza can turn into pneumonia. This is especially dangerous for babies, or kids and adults with pre-existing health conditions. If you think your child has influenza, see a doctor.

How to treat the flu

Most kids with influenza will get better at home. Make sure your child:

  • Drinks plenty of fluids
  • Gets plenty of sleep
  • Takes acetaminophen or ibuprofen to relieve fever and aches.
  • Wears layers that are easy to remove. Children might feel cold one minute and hot the next.

Fever and most other flu symptoms often go away in about five days, but kids may experience a lingering cough or feel weak. Children should be kept home from school or daycare until they have been fever-free for 24 hours.

Tips for keeping your kids safe from the seasonal flu:

There are several things you can do to help your family avoid the seasonal flu.

  1. Get a flu shot. It’s better to get vaccinated later in the season than not at all. The Centers for Disease Control recommends annual influenza vaccinations for everyone 6 months and older.
  2. Practice proper hand washing. Besides getting a flu shot, proper hand-washing is the best way to prevent the spread of illness, including the seasonal flu.
  3. Stay away from people who have a fever. Ask friends, family and caregivers who have had a fever or chills within the past 24 hours to stay away from your child. Likewise, keep your little ones home from school or daycare for 24 hours after they’ve had the same symptoms.
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