The PediaMag Winter 2021

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Welcome to The PediaMag.............. 2 WINTER FUN Sledding Safety............................... 4 BEST PEDIATRIC OFFICE AHN Pediatrics AHN Health and Wellness Pavilion West.............. 6 FEATURED OFFICE AHN Pediatrics Featured Office: St. Clair.................. 6

HOLIDAY MEALS Healthy for the Holidays Holiday Favorites Lighten Up........... 8 KID STRESS COVID Is Stressing Kids Out Helping Kids Cope With Stress......... 10 CLIMATE CHANGE Climate Change Is Scaring Kids....... 12 TEMPERAMENT Temperament: Parenting, Pediatrics and Person Potential....... 14

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Welcome to The PediaMag Welcome to the Winter issue of The PediaMag. We are only weeks away from the Christmas holiday and we want you to have a safe and healthy holiday continuing on throughout the rest of the winter. We will be talking about healthy holiday eating, sledding safety, how to help your children manage stress, and how to understand their temperament. This Holiday Season, it is still important that you and your family keep yourselves and others safe from the spread of COVID-19. Everyone aged 5 years and up has a COVID vaccine available to them. Contact your AHN Pediatrics to make sure your children have the happiest and healthiest holiday possible.

About Us: Pediatric Alliance was formed in 1996 when eight individual practices joined together to provide quality health care throughout Southwestern Pennsylvania. Over the years, Pediatric Alliance grew to be the largest physician-owned group pediatric practice in the area. In 2019, Pediatric Alliance joined with Allegheny Health Network to allow expansion of resources in order to stay abreast of the latest technology and advances in health care. Our board-certified pediatricians offer primary care to children and adolescents in 18 offices in the Pittsburgh and Erie areas including 14 primary care offices and 4 specialty offices - Allergy, Endocrinology, Developmental Pediatrics, and Dermatology. We are proud to offer personalized, patient-centered care to patients from birth to 21 years of age. We strive to meet your family’s pediatric needs, provide convenient access to care, and build strong relationships with families to maximize your child’s health. To learn more about AHN PediatricsPediatric Alliance, visit our website at

AHN Pediatrics-Pediatric Alliance 1100 Washington Ave., Suite 219 Carnegie, PA 15106


The PediaMag is published quarterly, copyright 2020. All rights reserved. Publisher AHN PediatricsPediatric Alliance

AHN Pediatrics • Winter 2021 •

Editor Rebecca Scalise

Art Director Brent Cashman

New & Expectant Parent Classes Increase your knowledge and confidence as you prepare for the birth of your baby. Receive helpful tips to calm a baby, ease fussiness, and much more! Advanced registration is required for these complimentary classes. Make sure to register early to reserve your space.

All classes are free and conducted online via Zoom. Login information is provided up on confirmation of registration. Visit for class schedules and registration.



Expectant parents can meet with a physician and receive basic information about the care of their newborn and what to expect while they are in the hospital.

Expectant moms and their partners can meet with a BoardCertified Lactation Consultant and gain knowledge on how to successfully initiate breastfeeding from day one.



Starting solids can be scary! There is so much information about what to feed baby, when to feed baby, and how to feed baby, that it can be overwhelming. This fun and informative discussion will help you understand the role of complimentary foods in your baby’s first year of life and navigate the best feeding choices for your baby and family.

Learn all about the how-to’s and benefits of breastfeeding, both short-term and long-term, for Mom, Dad, and baby. Be aware of some challenges you may experience breastfeeding to be prepared for your journey and make decisions about your baby’s feeding.

AHN Pediatrics • Winter 2021 •


Winter Fun

Sledding Safety by Edwin King, MD and Felicia Finnegan, PA-C Originally published at

True story: Walking through the woods with sleds in tow to a popular sledding hill in Frick Park, I was pelted with questions from my 5-year-old and 10-year-old. “Why do we have to wear helmets, nobody else wears helmets?!” The pediatrician’s logical explanation followed. Hearing this, the children, unimpressed, remained helmetless and disgruntled. As we approached the busy, massive, steep sledding hill, there was an ambulance at the top. The children, now quite silent, looked up to the ambulance, then looked back at me – repeatedly. I remained silent as we watched the stretcher being loaded into the ambulance. We asked a passerby what had happened. “Some sort of head injury, maybe concussion, maybe worse, they do not know.” The children quickly looked at me and then the ambulance a few more times, jaws agape. They scurried to put their helmets on as soon as they could, and have not questioned wearing helmets while sledding since that day.


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Unfortunately, most parents do not have the luxury of an immediate, poignant example to impress their children to follow safety recommendations. Nonetheless, it is our responsibility as parents to keep them safe. Since the American Academy of Pediatrics has recommended helmets for sledding, let’s review some important safety precautions for winter. Remember as a child the excitement you had of tearing apart the winter bins in the attic looking for matching gloves and snow pants and boots (that hopefully still fit) in angst to celebrate the first snowfall. Winter is here and in Western Pennsylvania there will be no shortage of snowfall. Children of all ages will be participating in sledding and it is our responsibility as adults, parents, and providers to assure their safety. In 2014, according to the U.S. Consumer Product Safety Commission, more than 52,000 injuries related to sledding, snow tubing, and

tobogganing were treated at emergency rooms and doctors’ offices. Injuries associated with sledding ranged from bumps and bruises to broken bones, head and neck injuries, hypothermia, frost bite, and death. Another study showed that 64% of pediatric hospitalizations from sledding injuries were from hitting trees. In addition, researchers found: > 37% of pediatric hospitalizations involved head injuries, with more than two-thirds (70%) requiring ICU admission, and 10% resulting in permanent disability. > 33% of injured children had fractures, half of which were severe enough to require surgery. > 19% had internal organ damage.

General Sledding Safetyand Gear GEAR: > We agree with the American Academy of Pediatrics and strongly recommend that your child wear a helmet when sledding. Remember some basic physics when sledding: the faster and steeper the hill, the more force is generated upon collision. Young heads should be protected with helmets! > Wear hats, mittens, boots, and layers of clothing. Generally speaking, young children should have on one more layer of clothing than an adult would wear. Remember that babies and young children’s heads are proportionally larger than the rest of their body. A hat properly fitted under the helmet should be worn at all times. Proper attire prevents traumatic injury and cold injury, which includes hypothermia and frost bite. Instruct your child to come inside if clothing is wet. > Only use sleds that are in good condition and are approved for such activity. Plastic sheets, garbage bags, etc., can tear during activity and should not be used. > If sledding in the evening, assure the area is adequately lighted.

> Sleds with steering mechanisms, such

as runners, are safer that discs, tubes, and flat sheets. >

GENERAL SAFETY TIPS FOR SLEDDING: > Always have an adult present when sledding. Adults’ responsibility is to supervise the number of sledders in one area, control traffic at the bottom of the hill, prevent potential injuries, and monitor for actual injuries. > If your child is 11 or older, be sure he/ she has had a baseline IMPACT concussion test before hitting the slopes. > Reiterate the importance of stranger danger to your child often when he/ she goes outside. > Sun rays are still damaging in the winter, especially with reflection off the snow. Sunscreen on exposed areas of skin and sunglasses will help protect against snow glare. > Feet first and sitting upright is safer than lying down or going head first. > Take turns! One person should be on a path at any given time. > Designate a side of the hill for sledding and a side for climbing back up the trail. > Sled only in areas designated for


> >

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sledding. Avoid sledding in areas of trees, fences, streets, cars, curbs, light posts, rocks, snow banks, etc. Number of sled passengers should never exceed that recommended by the sled’s manufacturer. One passenger per sled is the safest. Assure that the area at the bottom of the hill is clear – no drop offs, water sources such as ponds, streets, trees, other sledders, etc. Make sure your child knows to move off the path when the run is complete. Teach your child to roll off the sled if it won’t stop and assure them the sled will be retrieved later. Never ride a sled being towed by a street vehicle, ATV, snowmobile, etc. Do not build your own jumps or obstacles. Never be under the influence of any substance when supervising your child’s sledding. Never stand or hang out in the traffic areas of a sledding hill and always keep your eye on speeding sledders heading your way. The AAP has more winter safety tips here. Have fun and enjoy a safe winter season.

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Best Pediatric Office

Best Pediatric Office: AHN Pediatrics AHN Health and Wellness Pavilion West Congratulations to our providers and staff at AHN Pediatrics Erie Health and Wellness Pavilion Westside for winning the 2021 Erie’s Choice Award for Best Pediatric Office! The Erie’s Choice program polls the local community to select the best businesses and organizations in the area. Through nominations and voting, they choose in more than 150 categories in Beauty & Health, Clothing, Dining, Entertainment & Leisure, Home, Home Services & Finance, Kids & Education, Media, People & Places, Services, Shopping, Spirits, Sports, Top Employer and Vehicles Dealers & Services.

Featured Office

AHN Pediatrics Featured Office: St. Clair Where is your office located? We are located in Upper St. Clair, next to the Post Office, in the Pine Bridge Commons building. 1580 McLaughlin Run Road, Suite 207. When did your office open? We opened in the 80s. This was before we were Pediatric Alliance. How many providers and staff does your office have? We have our office manager, 5 Physicians and 1 Physician Assistant, one certified Lactation Consultant/Nutritionist, and one inhouse Behavioral Health Specialist. Currently there are 4 medical assistants, 5 nurses, and 4 front desk staff, and one scribe.


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Does your office offer any special services? Jennifer Yoon is our Nutritionist and Lactation Consultant. Mike Scarff is our in-house Behavioral Health Specialist. It is great having these services on-site. They are valuable resources to have. Tell us something unique about your office, something that you do together or celebrate. Our office is like a family, and though we don’t spend a lot of time together outside of the office, everyone is supportive of whatever you and your family are going through. Everyone in the office will check on you, congratulate, or offer their advice and support. We also celebrate EVERYONE’S birthday! No one is left out. And lastly, we are ALL dog lovers. We wish we could have a Bring Your Dog To Work Day! Fun Facts About Staff Members and Providers: Julie Cowden, our PA, moved onto 16 acres of land, and her husband fulfilled one of her greatest wishes by getting FOUR GOATS! Their names are Oreo, Bubbles, Felix, and Beans. Dr. Ashley Loboda has an interest in international medicine and spent a few months working at a clinic in the Amazon rainforest that was only accessible by canoe. She is also fluent in Spanish.

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Holiday Meals

Healthy for the Holidays Holiday Favorites Lighten Up by Jennifer Yoon RDN, LDN, IBCLC Holiday meals are central to our traditions and gatherings. Unfortunately these meals are traditionally heavy on simple starches and high in fat. These lightened up options for traditional holiday fare will quickly become your new staple dishes.

Broccoli and Cauliflower Au Gratin Enjoy the flavor of au gratin potatoes while cutting back on the carbs and calories with this recipe that uses broccoli and cauliflower in place of potatoes. Depending on your family’s preferences, you may choose to use either broccoli or cauliflower rather than both.

Oven Roasted Vegetables Oven Roasted Vegetables are a great substitute for starchy sides. Roasting brings out the natural sweetness of vegetables and retains some firmness. Whether you choose a single vegetable to roast, or use a combination, the dish is a healthy side, satisfying and low in fat, and easy to prepare ahead and reheat.

Lightened Sweet Potato Casserole

Lightened Up Apple Crisp This delicious apple crisp combines classic apple and cinnamon with whole grain oats for all the flavor of an apple pie, but with less than half the calories, fat, carbohydrates, and sugar. Lightened-Up Apple Crisp Recipe | SparkRecipes (


AHN Pediatrics • Winter 2021 •

This recipe reduces the use of butter and sugar, but is big on flavor pairing the natural sweetness of the sweet potato with a little maple syrup and almond milk. The topping incorporates whole grains and healthy fats which are sure to satisfy. The recipe includes vegan and gluten free modifications. lightened-sweet-potatocasserole-pecan-oat-streusel

Green Bean Casserole Slimmed Green Bean casserole has always been a staple side at my holiday meals. The cream soup and can of fried onions provide creamy, crunchy goodness…and a lot of fat. This slimmed down version from the Food Network combines fresh green beans, mushrooms, and bread crumbs for all the flavor and crunch of the original, while cutting the calories by up to 60% and the fat by 80%.

Veggies and dip Rather than starting the party with chips and dip, consider serving veggies and a low fat dip. This recipe from Simple Joy combines pureed cottage cheese, Italian seasoning, and lemon juice for a delicious creamy treat that is low in fat and calories and high in protein.

Lighten up your holiday table by switching out one or two foods for healthier options, or overhaul the entire menu! See this list from Harvard Health for additional ways to be Healthy for the Holidays. 1. Budget wisely. Don’t eat everything at feasts and parties. Be 7. Put on your dancing (or walking) shoes. Dancing is a great choosy and spend calories judiciously on the foods you love. way to work off some holiday calories. If you are at a family 2. Take 10 before taking seconds. It takes a few minutes for your gathering, suggest a walk before the feast or even between stomach’s “I’m getting full” signal to get to your brain. After findinner and dessert. ishing your first helping, take a 10-minute break. Make conver8. Make room for veggies. At meals and parties, don’t ignore sation. Drink some water. Then recheck your appetite. You might fruits and vegetables. They make great snacks and even better realize you are full or want only a small portion of seconds. side or main dishes — unless they’re slathered with creamy 3. Distance helps the heart stay healthy. At a party, don’t stand sauces or butter. next to the food table. That makes it harder to mindlessly reach 9. Be buffet savvy. At a buffet, wander ’round the food table before for food as you talk. If you know you are prone to recreational putting anything on your plate. By checking out all of your options, eating, pop a mint or a stick of gum so you won’t keep reaching you might be less inclined to pile on items one after another. for the chips. 10. Don’t shop hungry. Eat before you go shopping so the scent of 4. Don’t go out with an empty tank. Before setting out for a Cinnabons or caramel corn doesn’t tempt you to gobble treats party, eat something so you don’t arrive famished. Excellent you don’t need. pre-party snacks combine complex carbohydrates with protein 11. Cook from (and for) the heart. To show family and friends and unsaturated fat, like apple slices with peanut butter or a that you really care about them, be creative with recipes that slice of turkey and cheese on whole-wheat pita bread. use less butter, cream, lard, vegetable shortening, and other 5. Drink to your health. A glass of eggnog can set you back 500 ingredients rich in saturated fats. Prepare turkey or fish instead calories; wine, beer, and mixed drinks range from 150 to 225 of red meat. calories. If you drink alcohol, have a glass of water or juice-fla12. Pay attention to what really matters. Although food is an vored seltzer in between drinks. integral part of the holidays, put the focus on family and friends, 6. Avoid alcohol on an empty stomach. Alcohol increases your laughter and cheer. If balance and moderation are your usual appetite and diminishes your ability to control what you eat. guides, it’s okay to indulge or overeat once in a while.

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Kids Stress

COVID Is Stressing Kids Out Helping Kids Cope With Stress by Ned Ketyer, MD Originally Published on

COVID Is Stressing Kids Out Generalized Anxiety is the most common mental health condition diagnosed by pediatric providers, affecting approximately 12% of children worldwide. Depression is second. In normal times, returning to school after a fun and relaxing summer can be expected to exacerbate anxiety and depression in children. The pandemic has only added fuel to the fire, helping to produce a “global crisis” of mental health problems in children and teenagers, according to a new study in JAMA Pediatrics.

The study’s authors think they know why so many kids are stressed. (Hint: it’s not because they are being asked to wear face masks in school): The COVID-19 pandemic, and its associated restrictions and consequences appear to have taken a considerable toll on youth and their psychological well-being. Loss of peer interactions, social isolation, and reduced contact with buffering supports (eg, teachers, coaches) may have precipitated these increases. In addition, schools are often a primary location for receiving psychological services, with 80% of children relying on schoolbased services to address their mental health needs. For many children, these services were rendered unavailable owing to school closures. Ken Downey Jr. discovered additional factors leading to the spoke in mental health symptoms over the last year-and-a-half: According to the AAP, more than 40,000 children in the United States have lost a parent to COVID-19, the trauma of which is often compounded by the loss of material stability and economic hardship and has been associated with poor educational and mental health. That’s not all: Families living in poverty and in under-resourced communities may be at an additional risk, the AAP noted. Children who are refugees and seeking asylum, children with special health care needs and children on welfare and in the juvenile justice system are also at a higher risk.

Tami D. Benton, MD and colleagues assess the sobering data contained in the study: Prior to COVID-19, global estimates for depression and anxiety, 2 of the most common mental health conditions of childhood, were estimated to be 8.5% for depression and 11.6% for anxiety. The meta-analysis by Racine and colleagues suggests significantly higher rates for clinically significant depression (23.8%) and anxiety (19%) for children and adolescents, a more than 2-fold increase in prevalence rates compared with those reported prior to the pandemic.


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Many families have had a difficult time coping with COVID-19: “We were already experiencing a mental health crisis in our children and teens before the pandemic,” AAP President Lee Savio Beers, MD, FAAP, said in a statement. “Families have been under considerably more stress over the past year and a half, only making this crisis worse.” The stress has been enormous for adults with pre-existing mental health conditions: The AAP said parents may also be suffering from mental health challenges. It recommends that during every office

visit, clinicians ask parents and guardians about the impact of the pandemic on the well-being of the child. Integrating these questions into routine visits can help make sure all concerns are addressed, the AAP said. “ The emotional well-being of children is tied closely to their parents’ well-being,” Beers said. “That is why children are said to be the emotional barometers of the family. We recommend that families let their pediatrician know about anything going on in a child’s life that might be stressful. The pediatrician is a safe and supportive source for the whole family.” Read about the signs and symptoms children and teenagers exhibit when they are not coping well with stressors (an unprecedented global pandemic is a fair example) here.

Helping Kids Cope With Stress The last two years have been tremendously stressful for everyone everywhere…The American Academy of Pediatrics explains why pandemic-related stressors and trauma are having lasting effects on the developing minds of young people: An estimated 40,000 children in the United States have lost a parent to COVID-19, for example. Many families have also lost financial stability during the pandemic. At the same time, children have had vital supports including school, health care services, and other community supports interrupted by the pandemic. And many have experienced or witnessed increased racism and xenophobia during the pandemic, particularly toward families of Asian descent. Parents may find it difficult to recognize when their children and teenagers are struggling with their emotions. Toddlers and young children who have a hard time expressing in words what they are feeling inside may start to backtrack on their developmental milestones and budding social skills, and exhibit behavioral changes such as: > Fussiness and irritability, startling and crying more easily, and be more difficult to console. > Falling asleep and waking up more during the night. > Feeding issues such as frantic nippling, more reflux, constipation or loose stools, or new complaints for stomach pain. > Separation anxiety, seeming more clingy, socially withdrawn, hesitant to explore, and seeming to fear going outside. > Hitting, frustration, biting, and more frequent or intense tantrums. > Bedwetting after they’re potty trained. > Urgently expressed needs while seemingly unable to feel satisfied. > Conflict and aggression or themes like illness or death during play.

The AAP warns parents that teenagers “may try to hide their struggles because of fear, shame, or a sense of responsibility to avoid burdening others.” Having trouble coping with feelings of stress, anxiety, and depression, can lead to a number of worrisome signs and symptoms as they go through adolescence and enter adulthood, including: > Changes in mood that are not usual for your child, such as ongoing irritability, feelings of hopelessness and rage, and frequent conflicts with friends and family. > Changes in behavior, such as stepping back from personal relationships. If your ordinarily outgoing teen shows little interest in spending time with, texting or video chatting with their friends, for example, this might be cause for concern. > A loss of interest in activities previously enjoyed. Did your music-loving child suddenly stop wanting to practice guitar, for example? Did your aspiring chef lose all interest in cooking and baking? > A hard time falling or staying asleep, or starting to sleep all the time. > Changes in appetite, weight or eating patterns, such as never being hungry or eating all the time. > Problems with memory, thinking, or concentration. > Less interest in schoolwork and drop in academic effort. > Changes in appearance, such as lack of basic personal hygiene […] > An increase in risky or reckless behaviors, such as using drugs or alcohol. > Thoughts about death or suicide, or talking about it. Living through this dreadful pandemic has been stressful for everyone, not just our kids. Sometimes parents forget that the stress we experience can be contagious: Parents set the tone in the household. Expressing extreme doom or fear can affect your children. It can be challenging to stay positive, especially if you’re struggling with your own stress. But try to stay positive and relay constant messages that a brighter future lies ahead. It helps to set aside time to take care of yourself when possible, and seek the support you may need for your own mental health. Read more about “Mental Health During COVID-19: Signs Your Child May Need More Support” from the AAP here. If you think your child is struggling with his or her mental or physical health, pick up the phone and give the pediatrician’s office a call. We can screen for mental health issues and provide guidance to help your child cope with what’s on their mind.

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Climate Change

Climate Change Is Scaring Kids by Ned Ketyer, MD Originally published on October 13, 2021 at

You may be surprised to learn that climate denial isn’t really a thing in the United States anymore. Sure, there are a few people living out there on the fringe of reality who still insist, without displaying any credible, peer-reviewed, scientific evidence whatsoever, that climate change is a hoax propagated by a cabal of pointy-headed “coastal elites” or some such conspiracy theory. According to the Yale Program on Climate Change Communication, 72% of American adults who were surveyed in 2020 agreed that global warming is happening, and most of them know that human activities – greatest among them, extracting and burning fossil fuels – are to blame. Nearly three-quarters of those surveyed said they were worried future generations will suffer harm as a result of climate change. The concern for their kids and grandkids goes so deep that 78% of American adults say that schools should teach children about global warming, according to the poll. Adults who are still on the fence about accepting the reality of climate change should just ask their kids. They know all about global warming and the climate crisis that isn’t waiting for them to grow up. They are learning about changes in the environment occurring right now – in

school when they study science, at home when they turn on the TV to watch extreme weather happening in real time, and when they simply have time and curiosity to explore and ponder the great outdoors. And what they are learning, seeing, hearing, and experience is really scaring them. In a study pre-printed last month in The Lancet, researchers from the University of Bath in England describe the eco-anxiety young people around the world are feeling as global warming accelerates without eliciting the responsible, bold, and, yes, adult response that is needed to stop it: Climate change has significant implications for the health and futures of children and young people, yet they have little power to limit its harm, making them vulnerable to increased climate anxiety. Qualitative studies show climate anxiety is associated with perceptions of inadequate action by adults and governments, feelings of betrayal, abandonment and moral injury. American youth in particular “expressed the lowest levels of trust in government, and American young adults overwhelmingly said that their climate concerns are not being taken seriously enough,” says Karin Kirk, who reviewed the methodology: The researchers surveyed 10,000 young people, aged 16 to 25 years, in 10 countries. They gauged how people feel about the future, how well humanity has cared for the Earth, and if governments’ responses have been honest, sufficient, and aligned with climate science. One of the study’s lead authors calls the results of the survey “devastating;” another says their study “paints a horrific picture of widespread climate anxiety in our children and young people.” > 59% of children and young people surveyed were very or extremely worried about climate change [84% said they were at least moderately worried]; > More than half of respondents said they had felt afraid, sad, anxious, angry, powerless, helpless, and/or guilty; > 55% of respondents felt they would have fewer opportunities than their parents; > 65% felt governments were failing young people, while 61% said the way governments deal with climate change was not “protecting me, the planet and/or future generations”; > Almost half (48%) of those who said they talked with others about climate change felt ignored or dismissed.


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> Young people surveyed from the Global South expressed more

worry and a greater impact on functioning; while young people surveyed in Portugal (which has seen dramatic increases in wildfires since 2017) showed the highest level of worry amongst those from the Global North. Children’s fear about climate change are well founded and shouldn’t be dismissed by the adults in their lives. Another study published last month in Science revealed the extent of the “Intergenerational inequality” of climate change. Sarah Kaplan says the study shows that children living today “will be exposed to an average of five times more disasters than if they lived 150 years ago.” If the planet continues to warm on its current trajectory, the average six-year-old will live through roughly three times as many climate disasters as their grandparents, the study finds. They will see twice as many wildfires, 1.7 times as many tropical cyclones, 3.4 times more river floods, 2.5 times more

crop failures and 2.3 times as many droughts as someone born in 1960. How can parents alleviate the eco-anxiety their children may be feeling? Andrew Gregory spoke to two public health experts who worry that the climate crisis is “taking a growing toll on the mental health of children and young people.” “The best chance of increasing optimism and hope in the ecoanxious young and old is to ensure they have access to the best and most reliable information on climate mitigation and adaptation,” they said. “Especially important is information on how they could connect more strongly with nature, contribute to greener choices at an individual level, and join forces with like-minded communities and groups.” Finally seeing some positive actions on fixing the climate crisis by adults in responsible positions wouldn’t hurt young people either. That’s precisely what health professionals in the U.S. and around the world are calling for.

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Temperament: Parenting, Pediatrics and Person Potential Temperament can be described as an individual’s underlying behavioral style and how an individual habitually responds to the events of daily living. In this article, let’s discuss background research in the field of temperament and how a knowledge of temperament can benefit parents, pediatricians and any individual. In full disclosure, I do acknowledge there is some controversy regarding the science behind infant and child temperament. I am not a specialist in developmental or behavioral pediatrics. Rather, I am currently a newborn pediatric hospitalist at West Penn Hospital with subspecialty boards in pediatric emergency medicine and clinical interests in child abuse and critical care. I first delved into the topic of infant temperament during my 4th year Chief Residency at the Children’s Hospital of Philadelphia. Much to my surprise, one of the leading investigators on this topic was Dr. William D. Carey, one of my continuity clinic attendings, and during the three years we worked together he never referred to his pivotal role in advancing the field of behavioral pediatrics


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Dr. Carey believed: 1. Temperament is a reality, not just a "maternal perception.” 2. The child's temperament affects the parents and the care they provide. 3. Temperament predisposes to some physical problems. 4. Temperament predisposes to behavioral problems in childhood. 5. Temperament's impact on school performance is unappreciated. 6. Temperament affects responses to environmental stressors. The traits of infant temperament were first characterized 1956. Researchers Thomas and Chess considered these traits 50% genetically determined and stable. My own view is that these traits are genetically hardwired and are lifelong unless altered by circumstances that disrupt neurodevelopment such as fetal alcohol/drug exposure, adverse childhood experiences, and/or traumatic brain injury. While temperament traits are hardwired, the expression of these traits can be modified. An individual’s ability to change outward expressions of

temperament requires a conscious effort to suppress temperament tendencies that would likely be a poor fit for a situation. The following is a list of the 9 traits of temperament and a brief explanation of each: > Activity: the amount of physical motion during daily activities. > Rhythmicity: the regularity of physiologic functions such as wakefulness, sleep, and hunger. > Approach/withdrawal: the type of initial response when presented with a stimulus. > Adaptability: regardless of the initial response, the ease or difficulty of adjusting in a desirable manner. > Intensity: the energy level of responses regardless of quality or direction (think of a light bulb; a light bulb can be on all the time at 10 watts or 100 watts). > Mood: the amount of pleasant and friendly or unpleasant and unfriendly behavior in various situations on a day to day basis, the amount of time in positive versus negative thinking and behaviors. > Persistence/attention span: the length of time activities are pursued with or without obstacles. > Distractibility: the degree to which any type of stimulus may interfere with ongoing behaviors. > Sensory threshold: the amount of stimulation, whether internally or externally generated, necessary to create a response. One of the keys to parenting and understanding child behavior is an awareness of the child’s temperament style and the child’s progression from concrete to abstract reasoning. A parent who appreciates a child’s temperament can customize parenting techniques to better fit the child’s temperament style. A child with a negative response to a new request along with the temperament traits of high intensity and persistence, will reflexively and emphatically say no. In this situation, the parent needs to identify the behaviors as a knee jerk, temperament driven responses rather than this is a “bad” child. With parental consistency and positive support, the initial negative response will fade away and the child is likely to follow the parent’s request. Concrete thinking predominates until about 7 years of age. Beginning around 12 years of age and continuing to adulthood, most individuals are capable of abstract thinking. Prior to age 7 years, it is unproductive for a parent to respond to the child repetitive “why” questions with much detail. A child’s repeat questioning is unlikely to improve the child’s appreciation of the situation and instead is a child’s way to manipulate the parent. After age 7, the child begins to develop reasoning skills that progress to abstract thinking. During this stage, the parent should

switch gears and explain to the child how temperament and behavior can positively or negatively influence outcomes. Once the typical young adolescent achieves abstract thinking, they then can use cognitive strategies to suppress temperament traits that would lead to negative results. Also, by understanding one’s own temperament, a person is better able to make life decisions. For instance, someone with a short attention span will be ill suited for a career in neurosurgery and an individual who is easily distracted is a poor fit for a career in air traffic control.

An appreciation of temperament gives a window for the pediatrician to appreciate conditions like attention deficit disorder not from a psychiatric perspective but rather a constellation of temperament traits (short attention span, distractibility). Anticipatory guidance can then be customized to advise reducing distractions and allowing the child to shift between tasks. Temperament also influences a child’s response to injury or illness. For example, a child with a low sensory threshold - negative response to stimulation and low adaptability - is more likely to appear ill with a minor illness while a child with a high sensory threshold may lead to a delayed diagnosis of a more serious illness or injury. It would be an interesting activity for the reader to write down the 9 domains of temperament and see where you fit. Then do the same for family members and maybe friends and co-workers. It’s likely that through a better grasp of temperament you will gain personal insight and be better equipped to manage the events of daily living and appreciate the behaviors of others.

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Now that Pediatric Alliance is part of Allegheny Health Network, we’re moving from Patient Portal to MyChart. MyChart is a secure online platform that gives you a quick and easy way to connect with our office: • Book appointments • View test results • Communicate with our care team • Request prescription refills • Review your child’s health history • Pay bills and view statements


Follow these steps to register for MyChart now: 1. Visit and click “Sign Up Now.” 2. O n the next screen, under “No activation code?” click “Sign Up Online” and follow the onscreen prompts. 3. Once you’re logged in, click “Profile” in the top right and then “My Family Access.” 4. Based on your child’s age, follow the instructions to get proxy access.

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