Houston Defender: Our Children's Health Magazine August, 2015

CENTERFOLD

Emergency Care vs. Urgent Care: What, When, Where > PAGE 12

Texas Children’s Hospital & Houston Defender Media Group Alliance | 2015-16

PREVENTIVE HEALTH

ASTHMA > PAGE 8 SPORTS

BACK TO SCHOOL SPECIAL

CONCUSSIONS > PAGE 9

ADOLESCENSE

PUBERTY > PAGE 17

Quality health care for $50 or less a year.

What a relief.

Texas Children’s Health Plan covers children from newborns to teenagers. We even cover adults and pregnant moms through STAR Medicaid.

Families with children who qualify for CHIP pay $50 or less a year. Those who qualify for Medicaid pay nothing. CHIP and STAR Medicaid offer a wide range of benefits including checkups and shots, dental services, medications, and more.

With Texas Children’s Health Plan you also get: ■ Over 2,100 doctors.

■ A 24-hour nurse hotline.

■ Transportation to doctor visits at no cost.

■ Pregnancy support program and classes.

■ Help losing weight through the Keep Fit Program.

■ Learn how to play soccer from the Houston Dynamo coaches.

■ Fun member events!

For more information, to receive an application, or to find an event in your area, visit us online or call today.

MK-1208-007

1-800-990-8247 | TexasChildrensHealthPlan.org

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Improving kids’ quality of life

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ur children are our future, and we must ensure that they have the best and brightest tomorrow possible. That includes leading a healthy lifestyle – physically, mentally and emotionally.

The Defender is pleased to once again join forces with Texas Children’s Hospital – one of the nation’s leading children’s hospitals – to bring you this back-toschool special edition dedicated to improving the quality of life of our children.

We offer news that you can use in such areas as preventive health, adolescence, behavior, nutrition and sports.

Sonny Messiah Jiles What should you know about Publisher and CEO asthma? How can you get little ones to eat more veggies? Why are concussions a silent epidemic? The answers to these questions and more are found in this edition.

Parenting can be challenging, but having the right tools and resources can help. It is our goal to help you and your family lead happier, healthier lives.

A healthier future for children

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s you prepare to send your kids back to school, education is no doubt at the top of your minds.

To give each child the best chance to succeed in school, your child’s health is our top priority.

At Texas Children’s Hospital, we are committed to providing the best care for every child in our global community. More than 8,700 children are cared for at a Texas Children’s facility in Houston and the surrounding community every single day. Hundreds more receive access to the right care in their own neighborhoods across the world through Texas Children’s various programs. We are committed Dr. Mark W. Kline to providing the right care, in the right place, at the right time. It’s this Physician-in-Chief commitment that brings Texas Children’s into the community for immunization events as children in our underserved communities go back to school.

We are not just a hospital for sick kids, we offer pediatric care for check ups and ensure a continuum of care throughout childhood for your children.

Texas Children’s is committed to creating a healthier future for all children through our collaborations with our community partners across the globe.

CENTERFOL

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table of contents > Safer schools & food allergies 4 > Eat more vegetables 5 > E-cigarettes 6 > Asthma 8

Texas Children’s

> Concussions 9 > Emergency care vs. Urgent care 12 > Bullying 15 > Bedwetting 16 > Puberty 18

Emergency

Hospital & Hous

Care vs. Urg ent

ton Defender

Media Group

Care: What, Wh

en, Where >

Alliance | 2015

PAGE 12

-16

PREVENTIV

E HEALTH

ASTHMA

> PAGE 8

BACK TO SCHOOL SPECIAL

SPORTS

CONCUSSI

ONS

> PAGE 9

ADOLESCEN

SE

PUBERTY

> PAGE 17

Texas Children’s Hospital & Houston Defender Media Group | 2015-2016 | 3

nutrition

Making schools safer for children with

food allergies

By DR. CARLA DAVIS, allergy and immunology specialist at Texas Children’s Hospital

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arents of children with food allergies know how frightening it is the first time a child experiences a severe allergic reaction. It often happens quickly, severely and without any previous incident or warning. And for some children, this first incident may happen at school.

Every six minutes a severe food allergy reaction, or anaphylactic shock, sends someone to an emergency room and for the one in every 13 American children who have a food allergy, 40 percent are considered high risk for such an occurrence. For children, 25 percent of first-time anaphylactic shocks happen at school and data shows that fatal episodes are often due to delayed administration of an injectable epinephrine or EpiPen.

These facts drove the team at the Texas Children’s Food Allergy Clinic to partner with the Houston Independent School District on a pilot program that included a one-time seminar on food allergy preparedness and education for school nurses.

Together, we developed a campaign that significantly impacted school preparedness – a simple precaution that can save a child’s life.

For example, the timing of epinephrine treatment after a reaction, the expiration date of the dose and the proper storage

These facts drove the team at the Texas Children’s Food Allergy Clinic to partner with the Houston Independent School District on a pilot program that included a one-time seminar on food allergy.

of the injectable are all vital to a child’s outcome. All of which can be quickly taught to school nurses, empowering them to move quickly and confidently if a child is experiencing a severe allergic reaction.

It is crucial for parents to communicate any known food allergies with their children’s school, but it is equally important for schools to be prepared, with proper training and a surplus inventory of EpiPens in case an accidental exposure occurs. We have found with both an on-site supply of injectables and quality training, school personnel will be able to administer a dose quickly and effectively.

The initial response of our one-day, educational seminar was very promising, with schools that participated already seeing an increase in preparedness. With the proper communication, training and supplies, we can significantly decrease the number of allergic reactions at schools and possibly save a life in the case of a severe occurrence.

By creating a targeted way to not only increase access of injectables but also provide education to school nurses, we can ensure that life-saving treatment is ready for food allergic children at school. Our plan is to reach beyond HISD and replicate this program on a global level to enhance the care and safety for food allergic children worldwide.

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

Eating more

nutrition

vegetables By: MEGAN TRIPPIE, clinical dietitian at Texas Children’s Hospital

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any times registered dietitians at Texas Children’s Hospital are questioned by patient families on how to get their child to consume more vegetables. I have also been told more times than I would like to admit that “my child is too much of a picky eater to ever eat vegetables.” While it can be a challenge, there are different techniques that can introduce vegetables and help ensure children get the 1 to 2½ cups of vegetable needed each day. (Serving size varies depending on age, gender and physical activity level.)

Before discussing how to incorporate more vegetables into your child’s diet, it is important to discuss the importance of vegetables and why they are a vital part of our diet. Vegetables are loaded with vitamins and minerals such as potassium, vitamin A and vitamin C, as well as fiber – all are major components in keeping us healthy and strong.

• Potassium can help keep blood pressure regular and help maintain a strong heart.

• Vitamin A acts to protect vision and skin, and can help fight off infections.

• Vitamin C helps to keep gums and teeth healthy. It also acts as a building block used in building and repairing skin after cuts and scrapes.

• Fiber acts as a sweeper in our bodies by cleaning out arteries and intestines to keep hearts healthy and tummies feeling happy.

In addition to vitamins and minerals, vegetables are also loaded with antioxidants that act as small superheroes to fight the enemy know as free radicals which are known to cause damage to tissues and organs. Of course, this only begins to scratch the surface of the benefits vegetables provide.

Incorporating more vegetables into the diet can range from simple to a bit more elaborate.

For some children it is the taste of vegetables they have trouble getting past. In this case, adding low fat cheese, low fat yogurt or even a bit of ranch dressing can help enhance the flavor.

Sometimes these additions can have added health benefits of their own, such as calcium for bone health. For other children it may be a lack of exposure to different vegetables that can lead to hesitations about trying something new. Children tend to respond better when involved in the planning and cooking of meals and snacks. Bring your child to the grocery store and encourage them to pick out a vegetable that looks fun or appealing to them. Then sit down together and find a recipe involving that particular vegetable and cook it together! Big Oven is a great app

that can be helpful in finding recipes when you have one or two ingredients but are unsure of how to use them. Furthermore, there are products that can help to cut vegetables in different ways in order to incorporate them into foods we may not typically think of.

One of my favorite products I use quite regularly is the Veggetti. The Veggetti will cut vegetables such as cucumber, zucchini and squash into long strips or noodle shapes. The thought behind this product it to make the vegetable into spaghetti and use this in pasta dishes as opposed to the typical spaghetti noodle. It is then up to you to decide if you would like to replace all of the spaghetti or some of it to increase your vegetable intake. The Veggetti also comes with a few recipes to help incorporate vegetables into different foods and dishes. (This product is sharp and will cut fingers easily, please be careful and never let a child operate without supervision.)

Additionally, as a way to help you get started with your family, a recipe from Texas Children’s chef Achim is included below. Making small changes can have a lasting impact and this is only the beginning. Happy eating!

Fettuccini Vegetable Pasta with Marinara Sauce, Mozzarella and Basil Servings: 4 Ingredients: 1 yellow squash 1 green Zucchini 1 carrot 8 oz. spinach egg fettuccini pasta 1 teaspoon Salt for Life Ingredients for sauce: 1½ cup canned tomatoes (Harvest value brand tomato, whole in juice peeled canned) 1 tablespoons extra virgin olive oil 1 teaspoon dried oregano 1 garlic cloves 1 Tablespoon of chopped white onion 1 teaspoon smoked paprika 10-15 basil leaves 4 ounces of shredded mozzarella cheese (Roseli brand) Sprinkle ground pepper ¼ teaspoon Salt for Life Dry thyme for taste as needed.

Instructions: Use a julienne peeler or spiraliser (i.e. Veggetti) to turn the squash, zucchini and carrots into noodle-like strips.

Put all the vegetable noodles in a bowl and sprinkle with 1 tablespoon salt. Use your hands and stir it well, mixing the salt evenly. Allow the noodles to sit for about half an hour so that water can be drained.

(OPTIONAL, 1 Tablespoon of salt has not been added to the ingredient list) Once you see water leave the vegetable noodles, drain out as much water as possible. If the noodles are too salty, you may want to rinse it.

To make the fettuccini: Heat a large pot of salted water for making the pasta. While the water is heating, prep the ingredients.

Once water is boiling, add the pasta and cook until al dente (cooked through, but still a little firm to the bite).

Once the pasta is done, drain it and place it in a bowl.

To make the sauce: Heat the olive oil in a stock pot over medium heat;

add minced onion and ends of carrots and sauté for 15 minutes, then add the garlic and sauté until fragrant, about 2 minutes Working in batches, add the canned tomatoes to the bowl of a food processor fitted with the steel blade and pulse the tomatoes until chunky. You can add the sautéed ends of the carrots and blend it with the tomatoes.

Add sauce into the pot with the onions and garlic.

Add the salt, pepper, paprika, oregano and dry thyme; stir everything together and bring the sauce to the boil.

Once the sauce is ready, combine vegetable noodles and fettuccini pasta. Cover with marinara sauce and sprinkle with chopped basil leaves and fat free mozzarella cheese.

Nutrition facts per serving: Serving per Recipe: 4 Per serving: 387 kcals, 13.7 g total fat (5.6 g sat. fat), 55.7 mg cholesterol., 529.8 mg sodium, 50.3 g carb.

(5.4 g fiber, 9.3 g sugars), 17.3 g pro.

Texas Children’s Hospital & Houston Defender Media Group | 2015-2016 | 5

preventive health

E-cigarettes

Why caution is warranted By: DR. HAROLD FARBER, pediatric pulmonologist at Texas Children’s Hospital

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ith sales and promotions, unregulated e-cigarettes are becoming the newest fad among youth.

From 2011 to 2012, e-cigarette use doubled among middle and high school students. With bright colors, appealing flavors and celebrities modeling their use, e-cigarettes are being heavily marketed to children.

An e-cigarette usually contains a solvent (usually propylene glycol), nicotine and flavoring agents. There is no regulation or even disclosure about what else may be added. The manufacturers of these products sued the Food and Drug Administration to keep from having to show they are safe or effective, or even follow good manufacturing processes.

Nicotine harms fetuses. It hurts lung development, lowers birth weight and increases risk for miscarriage, prematurity and crib death.

We are now finding that nicotine in the womb increases a child’s risk for obesity and attention

deficit disorder. Not wanting to neglect a potential market, e-cigarettes are being promoted to women of childbearing age.

Carcinogenic and toxic substances have been found in the vapor of e-cigarettes.

Researchers have found lung function decreases after use of an e-cigarette. What else does it do? We don’t know yet. A large, uncontrolled and unregulated experiment is being conducted by the tobacco industry by inflicting this product on our children.

What about inhaling the emissions from someone else’s e-cigarette? There is plenty of reason to believe it can be harmful also. At a minimum it contains nicotine, a highly addictive substance that changes brain structure and chemistry. One study found toxic, irritating and carcinogenic substances in the second hand

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

“vapor.” They found chemicals such as formaldehyde, acrolien and polyaromatic hydrocarbons and heavy metals such as lead and cadmium. It is not just water. I certainly would not want to be exposed to it.

If you want to stop smoking there are medications that are safe and effective. The nicotine patch, nicotine gum and nicotine lozenge are available over the counter. By prescription there is a nicotine nasal spray and nicotine inhaler, as well as bupropion (Wellbutrin, Zyban) and varenicline (Chantix). Those with moderate or severe tobacco dependence usually need to use a combination of these products to feel normal when not smoking. Talk to your doctor or your child’s doctor about help with tobacco dependence treatment. Free help is also available from the national smoker’s helpline at 1-800-QUIT-NOW.

“From 2011 to 2012, e-cigarette use doubled among middle and high school students.”

preventive health

If you smoke,

your baby smokes too

By DR. HAROLD FARBER, pediatric pulmonologist at Texas Children’s Hospital

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ne of the most important things you can do for the health of your baby is to not smoke and not let yourself or your baby be around smoke. Nicotine, even from e-cigarettes, and tobacco smoke are very harmful for a baby’s developing brain and lungs. Babies exposed to tobacco smoke before birth have an increased risk of crib death (SIDS, sudden infant death syndrome), wheezing, poorly controlled asthma, attention deficit disorder and learning problems.

Tobacco dependence can be a very severe addiction and while some people can get through the withdrawal without medicine, most people cannot.

When the withdrawal is well controlled it can be easy for an individual to not smoke. When the withdrawal is not well controlled the nicotine takes over your brain and makes you smoke. So, what does that mean exactly? When nicotine withdrawal is not well controlled you can feel irritable, anxious, depressed and have a hard time concentrating. When the withdrawal is controlled you can feel normal and less-anxious when not smoking.

When you are pregnant, the best thing you can do for you and your baby is to stop smoking – or better yet, stop smoking before you get pregnant. If you are pregnant, continued tobacco use is the worst thing you can do for your baby. There are good treatments for tobacco dependence that are a lot better for you and your baby than continued smoking. The first line treatment for a pregnant woman would be a medication called bupropion (brand names of Wellbutrin and Zyban). This medication is available as a prescription from your doctor. If this medication is not enough to feel comfortable when not smoking (or if it is not tolerated), nicotine replacement therapy can be added.

Nicotine replacement includes the nicotine patch, gum and lozenge – which are available over the counter. The nicotine nasal spray and inhaler are both available by prescription.

When you are pregnant, the best thing you can do for you and your baby is to stop smoking – or better yet, stop smoking before you get pregnant. If you are pregnant, continued tobacco use is the worst thing you can do for your baby.

Although nicotine can be harmful to the baby, tobacco is the most toxic and harmful way to deliver nicotine.

If you cannot stop smoking without it, use of nicotine replacement can substantially reduce the harm to your baby.

I do not recommend the e-cigarette as they are completely unregulated and have never been shown to be safe or effective for tobacco dependence treatment. Carcinogenic and toxic chemicals have been found in most of the e-cigarettes studied.

Many women who stopped smoking during pregnancy, have a hard time staying a non-smoker after the birth of their baby – even if they were able to stop during pregnancy without medicine. If you need it, don’t hesitate to ask your doctor for tobacco dependence treatment medicines after your baby is born. Staying tobacco free is one of the best things you can do for your health and for the health of your beautiful new baby. You also can talk to your doctor about tobacco dependence treatment. For free help and counseling call 1-800-QUIT-NOW.

Texas Children’s Hospital & Houston Defender Media Group | 2015-2016 | 7

preventive health

Asthma By: DR. HAROLD FARBER, pediatric pulmonologist at Texas Children’s Hospital

Children with asthma should be able to run and play. There are just a few simple things to remember to keep asthma in good control:

Be careful about what you breathe.

Smoke of all kinds hurts the lungs. We all know tobacco smoke is bad to breathe and other smoke can be just as bad. Often, fireplace smoke and barbecue smoke can set off asthma problems.

It is hard to be a tobacco smoker and not expose children.

Keeping your home and car smoke free helps, but this usually is not enough to completely protect children if someone they are close to is a smoker. Free help for tobacco dependence is available at 1-800-QUITNOW.

Know your child’s asthma medicines.

There are two types of asthma medicines – a quick reliever and a long-term controller. With quick relief medicine, you use it and you feel better right away, but it only lasts for a few hours. Quick relief medicines are great for quick relief, but they don’t fix the asthma problem. The more quick relief medicine your child needs, the worse their asthma is. As a rule of thumb, if your child needs a quick relief medicine to relieve asthma symptoms more

than twice a week during the day, or if your child wakes up needing his or her inhaler more than twice a month at night, asthma is not in good control. If your child’s asthma is not in good control, see your child’s doctor.

With long-term control medicine, you may not feel it working. This medicine tells the breathing tubes in the lungs “don’t be so sensitive, act like you don’t have asthma.” When your child uses it every day, after two to four weeks you will find your child feels better and has fewer asthma symptoms.

When you feel better, you are tempted to stop using the medicine, but don’t. The medicine can be the reason your child is so much better.

Be sure to ask your doctor, nurse and/or pharmacist which of your child’s asthma medicines are quick relief and which are long-term control medicines. Also ask them to check that your child is using his or her inhalers correctly.

“There are two types of asthma medicines – a quick reliever and a long-term controller.”

8 | 2015-2016 | Texas Children’s Hospital & Houston Defender Media Group

Have a plan.

Good asthma doctors will give you a written asthma action plan. This plan goes over what to do when your child is well, when asthma problems are just starting and what to do if asthma problems are starting to get bad. We usually call this green (for good), yellow (for warning) and red (for trouble) zones. Be sure to ask your child’s doctor for an asthma action plan!

sports New concussion testing helps athletes By: DR. JORGE GOMEZ, sports medicine specialist at Texas Children’s Hospital West Campus

Concussions: A silent epidemic among our children

By DR. SANDI LAM, pediatric neurosurgeon at Texas Children’s Hospital

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concussion is a trauma, blow or jolt to the head that can cause the brain to not work properly. This is considered a mild traumatic brain injury.

Each year, thousands of children are diagnosed with concussions. While we hear about a lot of sports-related injuries, only half of all concussions are from sports. Many are from car accidents, falls, fights and other accidents.

The Center for Disease Control and Prevention estimates well over 1.5 million concussions per year in the U.S. The function of the brain is affected in concussions on a cellular level, so the brain structures we can see on CT or MRI scan generally appear normal. Concussions can happen even if the child does not get “knocked out” at the time of the injury. In fact, only 10 to 20 percent of children with concussions have any loss of consciousness.

Although helmets can help prevent skull fractures and certain types of brain injuries, they are actually not shown to prevent concussions.

It’s not uncommon for parents to worry about their child as they play sports. Because young athletes are more susceptible to concussion, it’s important to know what options are available for your child if they are injured. Texas Children’s Hospital wants to ensure each patient we see has the best care possible, which is why we’ve started using computerized neuropsychological (NP) testing to evaluate an athlete’s brain function after a concussion.

NP testing evaluates an individual’s brain function – how well they concentrate, remember, organize information and how quickly they can solve problems. While not as thorough as traditional NP testing which is done with pencil and paper and conducted by a specialist called a neuropsychologist, computerized NP testing allows similar evaluation of brain function that can be done quickly and does not require a neuropsychologist to interpret the results.

It’s important to note that computerized NP testing does not make the diagnosis of concussion. There can be other reasons besides concussion for an athlete to perform poorly on such a test. Concussion is still a clinical diagnosis, meaning a health care provider makes the diagnosis based on information on how the injury occurred, the patient’s symptoms immediately after the injury and any abnormalities the provider finds upon examining the patient. Computerized NP testing has given us an additional tool for determining when an athlete’s brain has returned to normal, and therefore when they may safely return to sport.

Many health care providers are promoting baseline NP testing for athletes in contact and collision sports; that is, testing before they suffer a concussion, in order to have something to compare to if and when they do get a concussion. While it seems logical to get baseline testing for comparison, recent research indicates that checking a concussed athlete’s NP test results against standard scores for their age gives a more reliable indication of whether the athlete’s brain function is normal than comparing their results to baseline scores. Other recent research has shown baseline testing of team sport athletes in groups results in many of the tests being invalid.

Every child and every injury is unique. Some symptoms of concussion can happen right after the injury, while other symptoms may not show up for days. The symptoms may last days, weeks or months. Symptoms may also get worse when the brain is not given time to rest. For instance, if the brain is stressed with schoolwork and sports instead of being allowed time and energy to recover, the symptoms may get worse, and it can take longer to eventually get better.

Symptoms may show up as headaches, nausea, balance problems, slowed reaction time, dizziness, light or sound sensitivity, blurry vision, sleep disturbance, difficulty concentrating or thinking, and/or mood changes. Everyone is different. A child may appear normal on the outside but have symptoms that impair everyday life. So it’s important for kids, parents, teachers, coaches and all caregivers to have open communication about what is going on.

The road to recovery is guided by your concussion team. At Texas Children’s Hospital, the

Head Injury Clinic has members of the neurosurgery and physical medicine and rehabilitation teams who help kids get back to their potential.

A number of specialists, including doctors, neuropsychologists, and therapists for speech, occupational function and physical function have vitals roles.

For instance, professional sports teams have rules on returning to sports after a concussion.

While not all kids with concussions are athletes, all are students. We have special guidelines for returning to sports play and for returning to learning at school. We are attuned to the needs of growing children, and are here to advocate for kids and help get them back on track safely!

Texas Children’s Hospital & Houston Defender Media Group | 2015-2016 | 9

Building

sports

stronger bodies

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

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

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

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

The need for protein in an athlete is increased, but many athletes over consume protein and under consume calories.

Children can make healthy protein choices by choosing lean meats (turkey, fish, sirloin, beans, tofu), using egg whites instead of whole eggs, choosing low fat dairy products (skim milk, 1 percent milk, low fat yogurt), and avoiding fried meats.

Depending on the child’s age, parents can calculate the young athlete’s protein needs: 0. 5 to 0.8 grams of protein per pound of body weight.

Also, two to four hours prior to a workout, a moderate amount of protein can be eaten with carbohydrates.

Examples might be a turkey sandwich with lettuce and tomato or a yogurt parfait made with Greek yogurt, chopped fruit and dry cereal. This can be repeated within 30 minutes after a workout to help re-load the depleted muscles with the fuel they need.

Carbohydrates are the fuel of exercising muscle; however quality always counts. Carbohydrates consist of both sugars and starches. Sugars appear in cookies, candies, cake, pies and many snacks that children love.

The sugars in these foods often contain large amounts of fat making them unsuitable for athletic performance.

Sugars are fast acting carbohydrates and the closer it is to competition the more these fast-acting carbohydrates take center stage.

Think of these sugars as topping off a well-fueled tank.

But the staple of the well-fueled athlete are the starches such as bread, rice, beans, some fruits and vegetables. The correct carbohydrate choice to use depends on the time re-

“Experts at Texas Children’s Hospital say protein alone does not fuel muscles for activity.”

maining before the event. If it is 15 minutes before a soccer match it would be best to use a sports drink or a carbohydrate gel or honey.

If there is more time, an hour or so, foods like whole grain cereal and milk or graham crackers with some peanut butter and honey would be a good choice. A low fat meal like chicken spaghetti or a sandwich and fruit can also be considered part of a performance plate.

Experts at Texas Children’s Hospital say protein alone does not fuel muscles for activity. When foods are chosen by a few basic principles the plate becomes an ally in the prevention of chronic illness and a strategy to improve performance.

The principles are simple; choose a plate rich in colorful produce, quality whole grain carbohydrates and lean protein. About half of a child’s plate should be fruits and vegetables, which are 90 percent water and can help prevent dehydration.

Next, whole grain carbohydrates, such as whole grain pasta, brown rice, oatmeal and 100 percent whole wheat bread, should take up one fourth of the plate. These high fiber foods contribute to a sense of fullness and may aid in weight reduction.

If a child doesn’t like these whole grain foods, consider foods that have some whole wheat in them. There are pastas, for example, that combine white and whole wheat flours to make a less chewy product.

Lastly, lean protein should be approximately one-fourth of the plate and protein should be consumed at each meal. Some protein suggestions for breakfast include flavored Greek yogurt, egg whites or Canadian bacon added to the first meal of the day.

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

By following these tips, parents can help their young athletes have a healthier diet and help prevent potential illnesses related to poor nutrition.

10 | 2015-2016 | Texas Children’s Hospital & Houston Defender Media Group

sports

S

Avoid body overheating

ports practice and workouts are tough on school athletes and coaches during the brutal heat of August and September. A rise in body heat of just 2 to 3 percent is likely to weaken a player’s performance, and not much more is needed to endanger health.

Heat-related illnesses, often called heat exhaustion or heat stroke, are dangerous and can even be deadly for young athletes.

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

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

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

Children’s bodies produce more heat, but they sweat less. That puts them at special risk for heat-related injuries. The challenge however is not only confined to the extreme workouts of older teens. Young kids feel the heat, too, and their bodies are less adept at regulating internal temperatures.

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

“Dehydration is cumulative. You can go out on the field on day one, then go home and drink.

But if you don’t take in enough fluid to truly rehydrate, day two will feel worse.”

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

Heat illness tips • Monitoring the child’s weight is critical.

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

• Checking urine color is important, too.

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

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

A common question among parents and coaches is what should active children drink?

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

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

Experts debate exact proportions, but here are

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

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

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

• If the child is an adolescent or older: follow guidelines for adults, which call for drinking about 16 ounces of fluid an hour or two before an activity, eight to 16 ounces about 15 minutes before an activity, and enough fluid during an activity to replace what’s lost. It is important for everyone to stay educated on heat-related illnesses and how to prevent them for occurring.

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

Texas Children’s Hospital & Houston Defender Media Group | 2015-2016 | 11

Access

EC vs UC (Emergency Care vs. Urgent Care) By: DR. STAN SPINNER, Texas Children’s Pediatrics and Texas Children’s Urgent Care Chief Medical Officer

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ften times, families turn to an emergency center after hours, on weekends or perhaps even during the day, when a significant event occurs with their child. Though the emergency center is the right place for some incidents or ailments, the majority of the time, minor illnesses can and should be treated at a pediatric urgent care facility when your physician’s office is closed and you are not comfortable waiting until the office opens.

One of the most common concerns for parents is when their child has a fever. For children 4 weeks of age or younger who have a fever of 100.4 degrees Fahrenheit or higher, parents should immediately take the child to a pediatric emergency center. If the child is older than 8 weeks with a fever of 100.4 degrees Fahrenheit or higher, parents should contact their pediatrician or seek care at a pediatric urgent care clinic. Infants between 4 and 8 weeks of age with fever should be taken to a pediatric emergency center if the infant is acting sick, otherwise contact your pediatrician’s office for instructions.

Any conditions which threaten a child’s life or limb should be treated at a pediatric emergency center which can also provide initial stabilization for severely injured pediatric patients. Other conditions that should be treated at a pediatric emergency center include: n Bleeding that won’t stop n Extensive or complicated cuts or lacerations n Fainting or head injury with loss of consciousness or disorientation n Loss or change of vision n Major fracture that breaks the skin or is at a severe angle n Seizures without a previous diagnosis or epilepsy

EC Serious burns Snake bites Spinal injuries Sudden change in mental state Sudden shortness of breath or difficulty breathing n Vomiting or coughing up blood For those conditions that require immediate care but are not life threatening, families should seek care for their child at a pediatric urgent care clinic. Texas Children’s Urgent Care offers high-quality, efficient and affordable patient care during evenings and weekends, in convenient, community locations.

Texas Children’s Urgent Care is equipped to treat the following conditions: n Abdominal pain n Allergic reactions n Asthma n Cough n Croup n n n n n

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UC n n n n n n n n n n n n n n

Ear pain Fever Flu Minor burns Minor injuries from falls or sports Pink eye Rashes Simple lacerations Sinus infections Skin infections Sore throat Sprains and strains Urinary tract infections Vomiting and diarrhea

s to care

EC UC EC These tips should help guide parents as they determine which setting is best suited to treat their child’s ailments and injuries.

However, if there is ever any doubt, families can always contact their pediatrician for additional decision-making support.

In addition, these decisions just got easier for patient families. The recently introduced Texas Children’s Pediatrics Parent Advice Center app is designed to help families better understand and make decisions about their children’s health.

Available for download on iTunes and

Google Play, Texas Children’s ParentAdvice Center helps provide parents the support and information they need to make timely decisions about what type of care their child needs in a medical situation – whether that means providing care for minor illnesses at home or finding a Texas Children’s Pediatrics practice or urgent care facility.

With this new app, families can look up a child’s symptoms by body area, keyword or alphabetical list. Each symptom will provide the cause, advice to care for the symptoms, when to call 911, go to the emergency

center or to call a pediatrician. The app also provides answers to behavior, eating and wellness questions along with an area to save your child’s medications, allergies and dosage tables.

Through the app, families also have the option to locate a Texas Children’s Pediatrics practice by clicking on the “Seek Help” section at the bottom. This will allow the user to select and call their specific practice, locate a practice, login to MyChart, find the closest ER or Urgent Care, call poison control or call 911.

Texas Children’s Hospital & Houston Defender Media Group | 2015-2016 | 13

behavior

Children with ADHD Ensure back-to-school success

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By DAVID F. CURTIS, PH.D. and SARA R. ELKINS, PH.D. Baylor College of Medicine/ Texas Children’s Hospital

arents of children with attention-deficit/ hyperactivity disorder (ADHD) and those with other special learning and behavioral needs are often challenged by their children’s transition back to school.

One of the best things parents can do to set their child up for success is to be more proactive before each new school year begins. Here are three ways to prepare children for going back to school.

Begin good school habits early.

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

A week before school starts, your child should be going to bed each night and waking up each morning at the same times that he or she will during the school year.

In addition to the sleep-wake schedule, prepare regular healthy meals, provide outdoor activities, limit screen time, and set a daily reading routine that is similar to your child’s after-school homework schedule. Plan your last vacation before the last three weeks of summer.

You also may want to re-set clear expectations for other daily routines, such as taking a shower, brushing teeth and hair and selecting clothes for the next day.

Just before saying good night, look back on the events of the day with your child and talk to him or her about plans for the next day. This is helpful for children with ADHD who tend to struggle with organizing their thoughts and settling their bodies at the end of a fast-paced day.

Plan now for restarting medication.

Children with ADHD may have very high intelligence, but struggle with consistent behavioral and academic performance because of their problems with inattention and controlling their behavior without help.

Many of these children take “medication holidays” during summer months, but their

1

2

medication is an important part of their ongoing treatment and academic success.

To ensure that children are getting the most benefits with the fewest side effects from their medication, schedule a visit with your child’s pediatrician three to four weeks before the school year begins.

During this visit, discuss a plan to restart the medication at the lowest possible dose to allow time for you to observe your child and for his or her body to physically readjust to the medicine before they have to handle the daily demands of school life.

Restarting medication before school begins allows your child to deal with problems related to the medication without having to balance that with the newness of academic demands, social experiences and after-school activities.

Make the teacher your partner.

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

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Children with ADHD have a strong desire for “newness,” which typically helps them have a very positive start to the new school year. Once the novelty and excitement of a new situation wears off, children with ADHD often become less attentive to their work, because school becomes more routine and may begin to feel a bit boring.

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

When working with the teacher to establish behavioral goals for your child, set goals that promote good behavior rather than reduce problem behavior. Also, start small: instead of making a list of several behaviors for your child to work on all at once, let him or her focus on just one.

Preparing early, making a clear plan and giving your child positive encouragement will get them off to a good start in the new school year. If setting routines and scheduling activities to handle daily tasks feels overwhelming, get the help of a child psychologist, social worker, family counselor or an ADHD coach.

behavior

Bullying

By DIANE MURRELL, clinical social worker at Texas Children’s Hospital

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Signs your child is being bullied include any type of emotional shut down: sadness, depression, socially isolating themselves, avoiding school, the emotional pain may lead to self-abuse.

very so often national headlines shed light upon a persistently ugly issue: bullying. In a recent incident, a Florida teen tragically took her own life in response to a barrage of bullying, most of which occurred online. In fact, two teens were arrested in connection with the bullying.

While I don’t believe this will stop bullying, it does send three very strong messages: • That our youth are more vulnerable to verbal cruelty than we have been willing to acknowledge.

• Those who bully will not always get away with it.

• Discussion of charging the perpetrators will be a wakeup call. Parents, schools and communities need to be aware of the vulnerability of adolescents and realize the adults’ role of responsibility.

Some of the questions about this immensely painful story are: Who was aware of what was going on and what response took place?

Did anyone intervene, other than the parents?

What was the safety plan?

Any good safety plan has to include more than parents. Community members are involved whether they wish to be or not. This is a community story, not, the story of a family who lived in isolation.

We don’t all perceive bullying in the same way, but if we reframe the issue, the question becomes, What does a child’s safety mean to you?

The adolescent brain is not developmentally

mature to always regulate what they say and do. They don’t look ahead and predict what may happen, so parents and other adults must monitor cyber activities just as we monitor a 3-year old learning to climb on a jungle gym, a 5-year old crossing the street, drinking and driving, etc.

Cyber safety needs to become another parenting norm.

At Texas Children’s Hospital we use a simple two step plan when coaching schools and parents about bullying, I call it Safety and Engagement. While geared towards physical and verbal bullying, it also works for cyberbullying.

SAFETY refers to physically removing the child from the danger or removing the danger from the child. We talk to appropriate authorities about putting a safety plan in place. We enlist others to keep the child safe when the situation requires that.

With cyberbullying we want to remove the access of the perpetrator to the victim’s life and stop the perpetrator posting.

ENGAGEMENT refers to connecting. We strategize how to build psychosocial and emotional safety. Remember bullying is often about isolating the victim and destroying their connection from a peer group. Conversely, we help the child engage with others. Positive social and emotional engagement creates protective factors: emotional protection when you know you are accepted by others, protection by the physical presence of those with you and emotional resiliency from being in a socially accepting group.

During adolescence our peers act as a mirror reflecting back to us who we are, so make sure

your child has some positive experiences reflecting back on their successes. Help them find positive peers, adults and teachers who reflect back positive messages, “I accept you,” “I like you,” “You’re smart,” “You’re kind,” “You’re helpful,” “You’re funny,” etc.

There is not a magical answer, but these strategies can be tailored to individual needs and have helped many of our patients once the community they are in is made aware of the situation and involves itself.

Signs your child is being bullied include any type of emotional shut down: sadness, depression, socially isolating themselves, avoiding school, the emotional pain may lead to self-abuse. There is a long list, but the bottom line is do you notice your child behaving differently? Try to provide a safe environment for your child to share and not feel embarrassed to report something negative.

Advice for kids who are being bullied: Keep yourself safe; tell as many people as possible. The more people you tell, the less the bully can control the situation. Tell your parents, tell the school, tell your church, tell the police if you feel no one is listening, talk to other friends and adults. Ask for help.

Remember, by asking for help you are getting help for other people too, not just yourself.

Teenagers, take back control. Block your social media, and if needed shut down Twitter, Facebook, etc. Cut off the portals that allow someone to reach you. That person does not get to write your life story. You take charge, you draw boundaries, you enlist others and you write your story because the bully wants to cut you out from your peers. Do the opposite and build a support network around yourself. It will likely take the help of adults and other students to do this so you must report what is happening and ask for the help. Asking for help will not only protect you, it will protect others down the road as well.

Texas Children’s Hospital & Houston Defender Media Group | 2015-2016 | 15

Bedwetting

By DR. PATRICIO GARGOLLO, pediatric urologist at Texas Children’s Hospital

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octurnal enuresis, also known as bedwetting, is a common condition that occurs when a sleeping child is unable to hold and control their bladder at night. Every child is different, but nighttime incontinence becomes most concerning for parents of children who are at an age where they should be able to have control of their bladders, which is usually by age 6 or 7.

According to the American Academy of Pediatrics, bedwetting affects nearly 20 percent of all 5 year olds, 10 percent of 6 year olds and 3 percent of 12 year olds.

Bedwetting is an issue that affects both genders, but boys tend to suffer from the problem more than girls. It almost always occurs among children who are very heavy sleepers. Additionally, the condition often occurs in children whose parents or other relatives have also suffered from bedwetting when they were young.

At Texas Children’s Hospital, we see hundreds of kids ranging in ages between 6 and 18 years of age who suffer from issues

behavior

related to bedwetting. Parents don’t need to worry about this issue as most of the time it’s considered a non-dangerous issue that children typically outgrow.

Coping with bedwetting

Bedwetting usually goes away on its own, but until it does it can be a humiliating time for your child. It’s important parents not get upset with their child after an accident occurs because that’s exactly what it is – an accident. The child isn’t being lazy or rebellious by wetting the bed.

A more medical explanation is that the child’s brain is not getting the signal from their bladder to wake up. In time, once their nervous system matures, the issue will typically resolve itself. But until then, parents should reassure their children that they are not alone and thousands of kids go through similar experiences – it’s all part of growing up.

When to call a doctor

Parents need to be concerned at the point that the condition hinders the child from excelling socially. When it keeps your child from experiencing normal childhood

activities such as sleepovers and overnight camps then it’s time to address the issue and seek medical help. Parents should also be concerned if their child was once completely continent and then suddenly begins wetting the bed or having daytime accidents as well. Lastly, a parent may consider medical advice if their child remains incontinent once he or she has reached 6 or 7 years old.

If you have a growing concern about your child’s battle with enuresis, talk to your child’s pediatrician or book an appointment with a pediatric urologist.

Specific treatment for enuresis will be determined by your child’s pediatrician based on their age, overall health and medical history.

Sleep schedules improve classroom performance

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ith summer vacation coming to an end it means it’s time to dust off the alarm clock and for parents to hear “five more minutes!”

During summer children tend to stay up late, sleep in and take naps during the day.

Experts at Texas Children’s Pediatrics warn these erratic summertime sleep patterns can lead to a rough adjustment period when trying to get children back on track and get the right amount of rest their bodies demand during the school year.

Dr. Tyeshia Babineaux from Texas Children’s Pediatrics Corinthian Pointe offers a few suggestions to help parents get their children back on a proper sleep schedule.

Good sleep means less behavior problems. If children continue their relaxed sleep patterns from the summer parents could potentially see physical, behavioral and emotional effects during the school year. Parents, be sure you start early and promote proper sleep health. Children aged 5 to 12 years

old need approximately 10 hours of sleep per night while older, high school aged children need about 9 hours.

Get ready for the temper tantrums. Younger kids tend to have the hardest time reacquainting with the bedtime ritual and schedule when transitioning back to school. They may become oppositional during this period, which may temporarily lead to difficult-to-cope-with behavior. To address this, parents should start getting their child back

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on to a proper sleep schedule now. Try and get your child’s schedule back on track while there is still plenty of time. It takes about two weeks to get back into a healthy sleep routine.

Sleep schedule affects health and the classroom. Without the proper sleep regimen, older kids and teens may show signs including fatigue, headaches, altered metabolic rates (leading to summer weight gain), moodiness and decreased ability to focus and pay attention. Be sure children of all ages start getting back into a healthy sleep schedule early on.

To help parents during this difficult transition time, Texas Children’s pediatricians recommend allowing for some flexibility, especially during times of vacationing, movie nights, sleepovers, etc. Be sure not to take all of the “fun” out of summertime due to very strict sleep schedules. However, these periods should be intermittent and infrequent. Parents should clearly explain these times are temporary.

They may even choose to use this sleep time flexibility as a “summertime reward.”

behavior

Is my child

too shy?

By: DR. KARIN PRICE, psychologist at Texas Children’s Hospital

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any children are described as shy and during some stages of development the tendency to be quiet or cautious around unfamiliar people is 100 percent appropriate. Shy children may be seen as quiet, selective about peers or “slow to warm up” in new situations. We describe shy adults as introverted, reserved or even thoughtful. It is estimated that between 20 and 48 percent of people have shy personalities, and some studies have shown nearly half of teenagers describe themselves as shy.

For many children, teenagers and even adults, shyness is simply a personality trait.

Can you simply let your child be shy, or do you need to “bring her out of her shell?”

You can do both. Shy children may not become social butterflies, but parents can still help them learn how to be more comfortable in social situations and build friendships.

Before entering a situation the child feels nervous about, parents can talk about likely experiences and practice how to respond.

For example: “I know you sometimes feel shy at birthday parties. I think today at Megan’s party there will be a swing set, pony rides and a birthday cake. They might even have a craft to do. Let’s practice sing-

ing ‘Happy Birthday’ so you can participate when Megan blows out her candles. If you do not want to ride the pony, how can you let Megan’s mom know?” Building confidence by discussing past successes in similar situations also can help.

For some children, shyness becomes a major cause for distress and begins to interfere with their ability to do well in school, with peers or in other social settings (like sports teams, dance classes, birthday parties or summer camps). These children are thought to have social anxiety. The main feature of social anxiety is a strong and persistent fear of social or performance situations. These children and adolescents fear they will act in a way that would be humiliating or embarrassing and being exposed to feared social situations almost always causes anxiety. These situations are either avoided or endured with a great deal of distress (e.g., crying, freezing, temper tantrums).

Some children with social anxiety find it difficult or impossible to speak in social situations. This is called selective mutism. Children

with selective mutism appear comfortable and talkative with close family members.

However, whenever people other than the closest family members are present, the child is quiet and shy. Some children with selective mutism avoid eye contact and do not communicate in any form with others.

Social anxiety and selective mutism require treatment from a behavioral health specialist.

Cognitive behavioral therapy (CBT) is a research-based treatment for anxiety in children, adolescents and adults.

CBT provides education to children and their families about anxiety, and uses a collaborative relationship to design plans for being brave in situations where extreme shyness or inhibition are present. For example, a socially anxious child may progress through a series of practices involving things like making a phone call to a shop or restaurant, asking a question of a store clerk, ordering her own meal at a restaurant, reading aloud to his teacher or reading in front of the class.

Some children with social anxiety find it difficult or impossible to speak in social situations. This is called selective mutism.

Texas Children’s Hospital & Houston Defender Media Group | 2015-2016 | 17

adolescence

PUBERTY

By: DR. SHARONDA TAYLOR, director of Teens Working on Wellness Adolescent Weight Management Clinic

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uberty starts long before it becomes obvious and so should the conversations you have about it with your daughter.

Typically, people associate girls going through puberty with getting their first period or shopping for that first bra. But there are so many other changes that take place – physically, mentally and emotionally – and many of them start several years before these outward signs of adolescence. Keep in mind most girls have their first period around age 12½, but for some it can be as early as 8 or 9.

As parents, it’s important to start thinking – and talking – about all the changes coming well before they get here. For example, changes in body hair, which parents may not even be aware of because the girls are bathing themselves.

While breast development is typically the first sign of puberty in girls, for some it may be pubic hair. Another sign that things are changing: body odor. As a parent, you may just think your child is getting sweatier and not bathing well. In reality, it’s a sign her puberty hormones are kicking in.

When should you have the puberty conversation? You should have it repeatedly, and in small doses, not one long, sit-down lecture.

Have regular conversations, for example, about personal hygiene, and how to bathe themselves.

Help them prepare for when their body starts developing odors. Make the conversations gradual, natural lessons, so they’re less likely to be embarrassed or avoid talking about the subjects – although most often it’s the parents who avoid

these conversations. Also, these discussions emotion part of her brain. As her brain develops don’t always have to come from mom. Dads can, and she gains more executive function, logical, and should, be a part of the conversation, too. rational thinking will override that impulse coming from the emotional center. Unfortunately, it

The conversation about puberty should isn’t always a smooth process so you may find start early to prepare them not only for the some days she seems to have it all together; physical changes that are coming, but how to then other days you’re pulling your hair out handle them emotionally. One of the first changes moms might notice is vaginal because she doesn’t seem to discharge in panties when doing be using her brain at all. laundry, a sign of increased esFinally, puberty is notoritrogen in the vagina. Talk about ous for being a time of conWhen should it with your daughter, ask her if stantly changing emotions you have she’s noticed and let her know for girls. The reality is they it’s completely normal. Kids see are becoming aware of more the puberty these things happening and emotions and better able to conversation? they can worry. When differentiate them. So when You should have their breasts start to they storm out of a room develop, they need to be mad, then end up crying, it repeatedly, and prepared to look different from they may realize they’re in small doses, not not angry after all, they’re their classmates, whether they are an early bloomer – which can one long, sit-down actually disappointed or sad. be isolating for girls – or a late It can also be a time when lecture. bloomer, which can be rough as issues they experienced well. They need to be prepared when they were younger for unwanted attention they may reemerge, such as the loss get from both boys and girls. of a parent or loved one, Puberty is also a critical time to teach girls especially as they approach milestones like about accepting their body and how they are their sweet sixteen or quinceañera. They are developing. As their bodies change, we see an experiencing emotions in a way they weren’t increase in eating disorders. able to before.

During adolescence a lot of changes are

There are plenty of resources available also happening in their brain development. to help with puberty conversations. Talk with New pathways are being laid and remodeled your pediatrician and check out information that change thought processes. In early adolesavailable through the American Congress of Obstetricians and Gynecologists, as well as the cence, many of your daughter’s decisions are American Academy of Pediatrics. emotion-based because they are made in the

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adolescence

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dolescence is divided into three stages: early (12 to 14 years), middle (15 to 17 years) and late adolescence (18 to 20 years). While certain attitudes, behaviors and physical milestones tend to occur at certain ages, a wide spectrum of growth and behavior for each age is normal.

Consequently, these guidelines are offered as a way of showing a general progression through the developmental stages rather than as fixed requirements. It is perfectly natural for a teen to attain some milestones earlier and other milestones later than the general trend.

Physical development

Emotional development

Social development

Early Adolescence (12 to 14 years)

Growth spurt (girls usually develop two years earlier than boys) n Girls: changes in fat distribution, pubic hair, breast development, start of menstrual period n Boys: testicular growth, voice changes, pubic hair, “wet dreams� n May try to experiment with body

Moody behavior Struggles with sense of identity n Sensitive and has a need for privacy n Anxious due to increased social and academic stresses n Starts to look for loving relationships outside of family n May become opinionated and challenge family rules and values n May try to show-off

n Becomes increasingly self-sufficient n Usually seeks out friends with beliefs and values similar to those of his or her family n May be preoccupied by appearance n Influenced by peers about clothes and interests n May be influenced by peers to try risky behaviors

n Mostly bases judgements on concrete rules of right and wrong, good or bad n Thinks in terms of the present rather than the future n May start to think abstractly about complex issues

Middle Adolescence (15 to 17 years)

n Most girls have completed the physical changes related to puberty by age 15 Boys are still maturing and gaining strength, muscle mass and height, and are completing the development of sexual traits

n May have anxiety over school and test scores n Is self-involved (may have high expectations and low self-concept) Seeks privacy and time alone n Is concerned about physical and sexual attractiveness n May complain that parents prevent him or her from doing things independently n Starts to integrate both physical and emotional intimacy into relationships

n Is increasingly aware of social behaviors of friends n Seeks friends who share similar beliefs, values, and interests n Friends become more important n Starts to have more intellectual interests n May be influenced by peers to try risky behaviors

n Becomes better able to set goals and think in terms of the future n Has a better understanding of complex interrelationships of problems and issues n Starts to develop moral ideals and to select role models

n

n n

Mental development

Texas Children’s Hospital & Houston Defender Media Group | 2015-2016 | 19

adolescence

Physical development Late Adolescence (18 to 20 years)

Emotional development n Has a better sense of self becomes gradually more emotionally stable n Has a greater concern for others n Has thoughts about his or her purpose in life n Has pride in his or her own work

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Social development n Has become self-reliant and able to make own decisions n Becomes more comfortable around parents n Becomes interested and concerned in serious relationships n Can integrate both emotional and physical intimacy in a relationship n Has developed a clear sexual identity

Mental development n Has ability to think ideas through and set goals n Has ability to express ideas n Has developed a deeper perspective of life and may become involved in community issues

fyifyi Attention Deficit Hyperactivity Disorder

Helpful websites & resources

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

Autism

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

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

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

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

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

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

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

Writing websites

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

Texas Children’s Hospital & Houston Defender Media Group | 2015-2016 | 21 14 | 2014-2015 | Texas Children’s Hospital & Defender Media Group

calendar Who: Aldine ISD Parent Expo Date: Saturday, August 1 Time: 8 a.m. to 1 p.m.

Location: M. O Campbell 1865 Aldine Bender Houston TX 77032 Who: Denver Harbor Family Clinic Date: Saturday, August 1 Time: 9 a.m. to noon Location: 424 Hahlo Street Houston, TX 77020 Who: Spring ISD Back to School Bash Date: Saturday, August 1 Time: 8 a.m. to 2 p.m.

Location: Dekaney High School 22351 Imperial Valley Dr. Houston, TX 77073 Who: Community Operation 2015 Back to School Health Fair Date: Saturday, August 1 Time: 9 a.m. to noon Location: Access Health 400 Austin Street Richmond, TX 77469 Who: CT Church – Back to School Date: Saturday, August 1 Time: 10 a.m. to 2 p.m.

Location: 9701 Almeda Genoa Rd. Houston, TX 77075 Who: Change Happens Back to School Almeda Mall Date: Saturday, August 1 Time: 10 a.m. to 2 p.m.

Location: 12200 Gulf Freeway Houston, TX 77075 Who: Northside Back to School Health and Resource Fair Date: Friday, August 7 Time: 8 a.m. to 11 a.m.

Location: Moody Park Community Center /Hosted by Jessica Farr Who: Texas Children’s Health Plan 11th Annual Back to School Fair Date: Saturday, August 8 Time: 10 a.m. to 2 p.m.

Location: Almeda Mall 12200 Gulf Freeway Houston, TX 77075 Who: Brazoria County Dream Center Back to School Health Fair Date: Saturday, August 8 Time: 10 a.m. to 6 p.m.

Location: Brazoria County Dream Center 796 South Highway 288 – B Clute, TX 77531

Who: Community Operation 2015 Back to School Health Fair Date: Saturday, August 8 Time: 9 a.m. to noon Location: Access Health 307 Texas Parkway Missouri City, TX 77469 Who: Sunnyside and Dwight Boykins Back to School Date: Saturday, August 8 Time: 9 a.m. to 1 p.m.

Location: 3502 Belfort St. Houston, TX 77051 Who: Emancipation Park and Dwight Boykins Back to School Date: Saturday, August 15 Time: 9 a.m. to 1 p.m.

Location: Third Ward Multi Service Center 3611 Ennis Houston, TX 77004 Who: CT Church Gulfgate – Back to School Date: Saturday, August 15 Time: 10 a.m. to 2 p.m.

Location: 7805 Kimble Street Houston, TX 77017 Who: AAMA – Congressman Gene Green’s 20th Annual Immunization Day Date: Saturday, August 15 Time: 10 a.m. to 2 p.m.

Location: 6001 Gulf Freeway Houston, TX 77023 Building E Who: Citywide Youth Explosion, A Healthy Start to School Date: Saturday, August 15 Time: 9 a.m. to noon Location: Memorial High School Stadium 2200 Jefferson Drive Port Arthur, TX 77642 Who: Orange County Back to School Fair Date: Saturday, August 15 Time: 9 a.m. to noon Location: Lamar University Student Center 407 Green Avenue Orange, TX 77630 Who: Gene Green Back to School Date: Saturday, August 15 Time: 9 a.m. to 1 p.m.

Location: M. O Campbell 1865 Aldine Bender Houston TX 77032

22 | 2015-2016 | Texas Children’s Hospital & Houston Defender Media Group

Who: North Pasadena Community Outreach Center – Back to School Date: Tuesday, August 18 Time: 9 a.m. to 1 p.m.

Location: 705 ½ Williams Street. Pasadena, TX 77505 Who: Star of Hope Homeless Shelter – Back to School Date: Wednesday, August 19 Time: 9 a.m. to 11 a.m.

Location: 419 Dowling Houston, TX 77003 Who: Texas Children’s Health Plan Back to School Fair at Huntsville Date: Wednesday, August 19 Time: 10 a.m. to 1 p.m.

Location: Huntsville Public Library 1219 13th Street Huntsville, TX 77340 Who: Texas Children’s Health Plan Back to School Fair at Livingston Date: Thursday, August 20 Time: 10 a.m. to 1 p.m.

Location: Livingston Municipal Library 707 N. Tyler Avenue Livingston, TX 77351 Who: Alvin Community Center Back to School Date: Friday, August 21 Time: 9 a.m. to 1:30 p.m.

Location: 1031 W Sealy St. Alvin, TX 77511 Who: Texas Children’s Health Plan Back to School at Beaumont Date: Friday, August 21 Time: 1 p.m. to 4 p.m.

Location: Gloria Ramirez Neighborhood Resource Center 2850 Gulf Street Beaumont, TX 77703 Who: Spring Branch Family Development Center Back to School Fair Date: Saturday, August 22 Time: 8 a.m. to noon Location: 8575 Pitner Rd. Houston, TX 77080 Who: Congressman Gene Green’s 20th Annual Immunization Day Date: Saturday, August 22 Time: 9 a.m. to noon Location: Galena Park High School Who: Gulf Coast Health Centers Back to School Fair Date: Saturday, August 22 Time: 9 a.m. to 1 p.m.

Location: Robert “Bob” Bowers Civic Center 3401 Cultural Drive Port Arthur, TX 77642