Tech time/ How much is too much?

Tech Time/ How much is too much?

"Enjoy media, not too much, mostly together" - Anya Kamenetz (author of The Art of Screen Time) Tech Time/ How much is too much? In this ever changing world, the topic of how much screen time we should allow our children is one that affects most of us. I am not alone in thinking that most kids have too much screen time and tend to be overscheduled in general. They need time to just be kids and have some free play. When a child is in front of a screen, they are not talking, running around, or playing. These activities are essential for cultivating some basic skills. While I understand that a bit of the peace and quiet we might get from the ‘electronic babysitter’ (for the purpose of this post I am referring to screen time as anything computer, tv or video related) is so tempting, I want kids outside when possible, not inside glued to a screen. I want my patients to know what it feels like to turn the pages of a real book, not just to swipe their fingers across an iPad. I want them to know how to get messy with finger paints, not just how to create virtual art. I want them to interact with friends in person, not with avatars online. However, as much as we may be tempted to wrap the Luddite cloak around our households, is that really fair to our kids? Those who try to ignore all the technology may be at a disadvantage. While they live under your roof, you are in charge of how much screen time your child gets. I think that there is absolute value in getting some. It is a wonderful thing to be able to facetime with long distance friends and relatives. The instant gratification and ease of real time virtual visits is a game changer in the relationships that grandparents can now establish even when they are not local. It certainly beats our old method of sending VHS tapes in the mail. (I just rescued a box of those from my mom’s house. It is time to get those digitized!) Technology also offers a vast array of education and entertainment. We can learn so much from computers. The games are fun. Television has some nice programs; Daniel Tiger is my favorite. Getting time while you get something else done and your child is happily engaged is essential for some busy parents. How many of you have been in the position when you want to strangle your partner because they voiced the "no computer or videos for you ALL week!" as a consequence for some errant behavior. Some of you need that down time more than the kids! The key is figuring out how much is too much. You might be surprised that some high tech names limit the amount that their kids were allowed. Several years ago when I ran a post about this topic, I opened with an article about Steve Jobs that ran in the NY Times: Steve Jobs was a low tech parent! He was onto something. There are more and more studies coming out that are a bit alarming. Some of these studies indicate that there are actual changes in the brain of young kids who are spending too much screen time: Screen Time Inhibits Toddler Development Other studies are worrying about potential eye damage from too much time in front of a screen. Researchers are finding the exposure to the blue light prior to bedtime might impact sleep. We probably won’t really have firm data for many years, but common sense would come into play here. Unlimited time in front of a screen is not a good thing. Dabney Ingram, who used to be a NVP mom but has since moved out of SF, let me know about this worthy organization that she is involved with:https://www.screensense.org ScreenSense is a great resource for any family grappling with this issue. While we can all agree that too much is a problem, having a no tv/no computer environment is not something that I recommend either. When your child emerges from that protective bubble of a screen free existence, they may feel a bit like Alice in Wonderland. Back in the "olden days" when my kids were young, our screen was simply the TV. They had friends come for play dates who were not allowed any television at home. If I allowed it, the only thing those kids wanted to do was watch tv because it was such a treat for them. I give the same advise with candy. If it is forbidden completely, there are some kids that will seek it out as a treasure. So both tech time and dessert have some commonalities..They are enjoyable but too much is not healthy and we can’t forget about the main course. My goal is for your child to have a healthy relationship with technology. Learning how to use it at a young age will keep them on the level playing field with others. Not all tech time is equal. There is a lot of research going on that describes the different pathways in the brain when you are producing something or learning while using tech versus simply playing or gaming. Andrea Dunn, a teacher up in Marin, sent me a list of some cool free activities that would fall under the "productive use" label. Duolingo - learn a language Koma Koma - make fun stop-action animations Snapseed - take a photo and use lots of neat photo editing tools to jazz it up. Adobe suite of productivity/creativity tools (Adobe Spark Video, Adobe Spark Post) iMovie - make fun short creative movies Pic Collage - make a collage with lots of backgrounds and design options (free but has annoying pop-up ads) Blogger - create your own blog around any topic, invite readers and authors or keep it private just for you, as a virtual diary. Each family should discuss what their tech usage plan will be. Some families will allow more than others. Your own family should be the only one to make rules that make sense to you, but please, set some sensible limits. Dabney makes a good point. A family movie, with everyone snuggled together on the couch does not need to count towards the screen quota. Don't sabotage each other. If you have a partner, figure out the rules that you both feel comfortable with. Be consistent. If your kids figure out that the rules are meaningless, you have significantly weakened your credibility. At my solid foods class when I discuss "safe eating" I tell parents that they need to set a good example. If you shovel food in your mouth and talk with your mouth full, why would your child learn to eat any other way? Put in a small piece of food, chew and swallow. Set the standard. When it comes to being a role model, technology is no different. I am no hero here, I have reached an embarrassingly high level on the time suck of a game Candy Crush. If you are always looking at a screen, if your forms of relaxation are all technology related, consider making some small changes. Extra screen time (still with limits) can be a commodity that can be earned for good behavior. But because I don't want it elevated to the most important thing in their lives, I would rather make the rewards that they work towards be special non-tech activities with you. Let kids enjoy their allotment of tech time, but focus on opportunities where they can have just as much fun reading a book, or doing other things that don't have a screen involved. There are so many options: https://nursejudynvp.blogspot.com/2017/12/the-best-present-is-your-presence.html Board games are a wonderful way for a family to spend memorable hours together. I rescued a tattered box of the game RACKO back from my house-cleaning escapade last month in Pittsburgh, and brought it home. I have such warm memories of playing that with my dad and sisters. Marie Kondo would approve. It gives me joy. If you are going to a restaurant, create a restaurant activity kit to take with you so that you are not all sitting on your phones. Or have some restaurant games at the ready. I spy with my little eye...what do you see? Find different letters on the menu. Being at a restaurant is also the perfect place to play some math games. You could start with basic counting (how many peas are on the plate) and then up the skill level for your older kids and have them help you figure out the tip. Check out this very cool book that addresses getting your child comfortable with numbers and math: www.talkaboutmath.orgHaving kids have a basic understanding of numbers so that they don’t go through life depending on a calculator is a worthy goal. Our family's all time favorite game was the “act out the emotion” game. The girls would hold the napkin over their face. We would call out "sad" or "scared" or "surprised", or "in love" and they would lower the napkin making the assigned face. Make sure you put some child control limits on your device. There are lots of apps out there, with more being developed all the time. Some can help you make sure that all the sites that your child can access are safe and appropriate, others can help you limit the time allowed. https://www.consumersadvocate.org/parental-control-apps/best-parental-control-apps As your child gets older, it becomes much trickier. It is reasonable for rules to be renegotiated with each age. When to get your child a cell phone is another layer to this discussion. A limited phone plan has tremendous benefit to you, but I emphasize the word limited. Starting younger kids with a basic phone that is not a smartphone is an option for those afraid of going down the slippery slope while still being able to reach each other throughout the day. Have your child be part of the discussion and verbalize understanding of the family rules. Until they are a certain age, many experts agree that all computing should be done in a common room. Be clear from the start (if it isn’t too late) that while you are providing them with the digital tool and data plan, you have the right to go on to all accounts and check their texts if you have concerns that make that warranted. Changes in mood or behavior, as well as sudden ‘tanking’ grades would be reasons for checking. It is not breaking trust if you make it clear from the beginning that it is not just your option, but your job as the parent. This is also a time to remind them of another important lesson, that nothing that they put online is actually private. As Dabney suggested, “If they want privacy, they can write in an old fashion journal."

Talking to your kids about sex

Talking to your kids about the birds and the bees

While the majority of the calls we deal with are about little acute illnesses, we also field queries about all aspects of growth and development. Recently I have had several folks ask me my two cents about answering the "Where do babies come from" question. So here goes. Comes the time in every family when it is time to have the talk about sex, but how and when? It varies with every child. There is a story about a young boy visiting his grandparents’ house one summer. He came rushing in from outside where he had been playing with some new friends from the neighborhood. “Grandma, what’s it called when two people are in bed, but one is on top of the other one?” Grandma was taken aback for a moment but sat him down and gave him a matter of fact talk about the birds and the bees, so to speak. The little boy listened carefully with his eyes open wide and then ran back out to join his friends. It wasn’t long before he ran back into the house saying, “Grandma, it’s called BUNK BEDS and Mrs. Wilson wants to talk to you!" The all important moral of this story is to make sure that when your child presents you with a question, that you understand what they are actually asking before you launch into any complex explanations. You could start with a statement such as “ I am so glad that you asked me. I am always happy to help you find answers to things. Tell me more about what you are wondering about." My sister Amy has her own tale. She and her husband are National Park rangers and they moved to Utah when her oldest son was in 4th grade. Even when reading the Harry Potter series, my nephew Asher covered his ears when they were reading any scenes that involved kissing, but now that they were living in a new place, he had a question. “Mom, where to babies come from”? Amy paused and then followed up appropriately. “Is there something specific that you are wondering about?” “I heard that babies happen when a mommy and daddy love each other very much and their souls connect.” My sister's family was now living in the heart of Mormon country where most families were quite a bit larger than he was used to seeing. He knew that his mom and dad seemed to love each other a lot, but they just had 2 kids, Asher and his brother Ben. The math wasn’t adding up. Amy went on to let him know that there was a little more to it than that, but it involved some more mechanics including some of that “Kissing stuff”. Nope...no need to talk about it any more. Get yourself as comfortable as you can with the discussion. What do you call body parts? Does your family use a nickname (perfectly fine) or is your child able to rattle of the anatomical names for all of their “parts"? Of course having discussions about bodies usually comes long before discussions about sex. Many parents are a little shocked and uncomfortable when infant boys have erections or they notice young boys and girls masturbating. This is incredibly common (the human race is quite fortunate that masturbation doesn’t actually cause blindness.) While it is usually quite normal, if you notice that your child is constantly touching themselves to excess, I want to make sure there is no irritation or external cause. Maybe their underwear is too tight. It could even be something like pin worms! If there is no obvious underlying issue, consider having a discussion about that fact that, yes it feels good, but our bodies are delicate and it is important not to touch so much that things can get sore. Some families have a talk about family rules and theirs might be that gentle touching is a private activity. Beware, a true story - one of my families who made a point of having accurate vocabulary was caught off guard one night when their 4 year old son made an announcement at a fairly formal dinner party with mom’s boss. “ I am going to go into my room now so that I can touch my penis in private.” This is also an important time to have a discussion about body ownership. No one should be able to touch any part of your child’s body without permission. Exceptions are parents and doctors (with parent present) and that should never be a secret! Empowering your child about their body early is important. And then they get a little bit older…. I remember driving a van loaded with carpool kids to school many many years ago. I caught a piece of the conversation that was going on in the back seat and my ears perked up a bit as I tuned in. “Yours have done it at least twice." “Yours have done it at least once” "Ours have done it at least twice...Oooh/Yuck” As soon as you feel that your child is curious and is possibly going to be picking up odd or skewed information from their friends or classmates, it is important that you make an opportunity to have a chat. It is essential that your child sees you as the trusted source of correct information and is comfortable asking you questions. Unfortunately in this high tech world, it is becoming increasingly easy to kids to be exposed to all sorts of things with very adult content at a very young age. You may want the help of a book. Amazon and libraries have an enormous amount of books that you can use as a resource. There are so many good ones out there. I would suggest that you read several until you find one that feels like it is the right comfort level for you. You may want to do this research a little ahead of time. Liesel Harris-Boundy from the West Portal Branch of the San Francisco Public Library was kind enough to come up with a list of good books on the subject that she is familiar with. Liesel shared that an ObGyn friend recounted that her 7-year old son asked her, "Mom, what's a vagina?" and though she talks about vaginas all day, she was unprepared to tell her son and excused herself from answering! That reserved part of her upbringing came through in spite of all her medical training! The following books should all available through the library. Perhaps go in and leaf through a few until you pick one that you like. Talk to Me First: Everything You Need to Know to Become Your Kids' "Go-To" Person about Sex by Deborah Roffman Talking to Your Kids About Sex: turning "the talk" into a conversation for life by Laura Berman Asking About Sex & Growing Up: A Question-and-Answer Book for Kids by Joanna Cole Everything You Never Wanted Your Kids to Know about Sex, (but Were Afraid They'd Ask): The Secrets to Surviving Your Child's Sexual Development from Birth to the Teens by Justin Richardson and Mark A. Schuster Talking to Your Kids About Sex: From Toddlers to Preteens by Lauri Berkenkamp, Steven C. Atkins, Charlie Woglom Sex Is a Funny Word: A Book about Bodies, Relationships, and YOU by Cory Silverberg It's Perfectly Normal: Changing Bodies, Growing Up, Sex, and Sexual Health (20th Anniv. Edition) by Robie H. Harris You want to make sure that the books are geared to the correct age. Some are guides for the parents and some are meant as a resource for the child. ****************************************************************** In our practice we are fortunate to have many different kinds of families, it isn’t always mommy plus daddy equals baby. I was happy to find out about the book below. http://corysilverberg.com/what-makes-a-baby/ What Makes a Baby is a children’s picture book about where babies come from that is written and illustrated to include all kinds of kids, adults, and families. Geared to readers from preschool to about 8 years old, it teaches curious kids about conception, gestation, and birth in a way that works regardless of whether or not the child in question was adopted, conceived using reproductive technologies at home or in a clinic, through surrogacy, or the old fashioned way; and regardless of how many people were involved, their orientation, gender and other identity, or family composition. Just as important, the story doesn’t gender identify people or body parts, so most parents and families will find that it leaves room for them to educate their child without having to erase their own experience. Once you do pick your book that you feel comfortable using as a resource,go ahead and buy a copy so that there isn’t a time limit. If your child is embarking on puberty and you are looking for something more interactive than a book, check out the Heart to Heart seminars hosted by Stanford. They hold these in multiple locations. The San Francisco class is held at CPMC on California street. https://www.stanfordchildrens.org/en/classes/community/pre-teen-teen-parent A list of other classes they offer are here:https://www.stanfordchildrens.org/en/classes One mom in our practice who went to the session thought it was very worthwhile, but she wished she had taken it earlier. She thought ten or eleven would have been perfect. Bottom line, honesty and communication are essential. As awkward as this conversation may feel to some of you, you really don’t want your kids to be getting their sex education from the neighborhood kids (or even worse, the internet!) Don't force too much information on a younger child who isn't interested. Letting them know that you are always open and willing to talk about "grown up" stuff with them is a great start.

Hepatitis A: Are you protected?

Hepatitis A: Are you protected? Please see updated post June 2022

Scroll to the bottom for a new vaccination recommendation Parents, have you gotten your Hepatitis A vaccine? Hepatitis A is an inflammatory disease of the liver that is caused by a virus. Some people consider the Hep A shot a travel vaccine because it is the most common vaccine-preventable illness that folks get infected with when traveling. We think that everyone over a year old should get it even if you aren't going anywhere. Hepatitis A is certainly more common in countries with lower standards of sanitation, but this virus doesn’t care about borders. There are plenty of cases right here in this country. Transmission occurs through direct person-to-person contact (fecal-oral transmission), contaminated water, ice, or shellfish harvested from sewage-contaminated water. You can also get it from contaminated raw, inadequately cooked, frozen fruits, vegetables, or other foods. Hepatitis A is quite hardy and can live outside the body for quite a while. It can survive being frozen. This is a nasty virus. Hand washing is important and can stop you from spreading it, but won't protect you from catching it. It makes no sense not to get the vaccine if eligible. Poor hand washing and then handling food is a common mode of transmission, but so is changing a diaper. Thus diaper age children, infected with the virus, are a large reservoir for spreading it. People are most infectious 1–2 weeks before the onset of clinical signs and symptoms, and can shed the virus in the stool for months and months. Dr. Schwanke had read somewhere that in some cases poop can remain contagious for up to a year! The incubation period averages 28 days (range 15–50 days). Infection can be asymptomatic or range in severity from a mild illness lasting 1–2 weeks to a severely disabling disease lasting several months. Most common symptoms include the abrupt onset of fever, malaise, poor appetite, nausea, and abdominal discomfort, followed within a few days by jaundice. Urine may be very dark colored and stool is often clay colored or freakishly light. The likelihood of having symptoms with a Hep-A infection is related to the age of the infected person. Fortunately, although it is rarely fatal, adults with this can become quite SICK! Here is one of the most important facts worth emphasizing: In children aged <6 years, most (70%) infections are asymptomatic. In the young children who are actually acting ill, jaundice is not a common symptom, so it might be awhile until someone figures out that they are dealing with a form of Hepatitis. Most of the time,young children don’t usually exhibit many symptoms at all, or appear too ill, but they pass the virus along to their caregivers who get walloped. We have seen it sweep through a daycare, with many of the caregivers and parents catching it. The vaccine first became available in Europe back in 1993 and started getting phased in to our vaccine schedule in 1996. It has been a routine childhood vaccine in the United States since 2005. It is nearly 100% effective. Interestingly, although it is recommended, it is not one of the vaccines that are required for school entry. It can be given as soon as a child reaches their first birthday and should be followed by a booster six to twelve months later. Protection against hepatitis A begins approximately two to four weeks after the initial vaccination. Because the protection isn’t instant, the recommendation for travelers is to get it at least 2 weeks before your trip, so plan accordingly. The vaccine comes only in preservative free form (no thimerosal concerns). I rarely see any side effects at all. Once in awhile a baby post vaccine might be extra fussy, but that is rare and not necessarily shot related. This one requires little thought. You should make sure that Hepatitis A vaccine is included in your child’s immunization schedule. Parents, also please check your own health records and make sure that you are protected. Adults are often quite clueless about their own vaccination status! This is new! Recommendations for Preexposure Protection Against Hep A Infection for Travelers Infants aged 6–11 months: Hep A vaccine should be administered to infants aged 6–11 months traveling outside the United States when protection against Hepatitis A Virus is recommended. This travel related dose for infants aged 6–11 months should not be counted toward the routine 2-dose series! Therefore, the routine 2 - dose Hep A vaccination series should be initiated between age 12-15 months according to the routine, age-appropriate vaccination schedule. High risk travel zones include all parts of the world except Canada, western Europe and Scandinavia, Japan, New Zealand, and Australia.