Books For Tweens & Teens

Parenting a tweenager (around 9-12 years old), when puberty begins can be a stressful time for the whole household, with hormones running rampant, bodies sprouting hair, new smells, and kids trying to figure out what is normal. Below is a list of books (with information about them below each one) for you and /or your child to read during this time, to help everyone out.

Some more tips before having “the talk” with your child (or any talk, really):

  • Try to be calm and open about the topic (pay attention to your body language and tone of voice).
  • Avoid shame.
  • Accept & support their feelings.
  • Set rational and consistent limits.
  • Encourage your child to ask you questions, and to learn that coming to you with their thoughts is never bad.

THE BOOKS

  • “Everything You NEVER Wanted Your Kids To Know About Sex (but were afraid they’d ask)” by Richardson & Schuster

This is really the best book for parents to read on the subject. It tackles every stage of development, as well as other topics, such as homosexuality. I recommend starting to read this book when your child is young, although it’s never too late to learn.

  •  “The Care & Keeping of YOU 1: The Body Book for Younger Girls” by Natterson, from AmericanGirl

This is the most popular puberty book in the market. My tween patients report that they love this book. It goes over what to expect in puberty, and how to take care of girls’ changing bodies. It is full of illustrations. Rated age 8-10, this book is best before puberty really starts. Once puberty is in full swing, the 2nd version of this book is better (see below).

  •  “The Care & Keeping of YOU 2: The Body Book for Older Girls” by Natterson, from AmericanGirl

Rated age 10-12, this book is the second in the series, not a newer version of the first. It is for girls with some understanding of puberty, who need more details. It goes over the physical and emotional changes of puberty, but also practicalities, such as how to insert a tampon. It still has a simple writing style and lots of illustrations, so it is not recommended for older teenagers.

  •  “Guy Stuff: the Body Book for Boys” by Natterson

This is the boy’s equivalent book to the popular girl version “The Care and Keeping of YOU 1” mentioned above. It is rated age 9-12, but having read it, I think it is more for 8-10 year olds. Every page is full of illustrations, and it covers just the basics of puberty: changing body, changing voice, mood, bullying, shaving, eating well, exercising, but not sex. Unfortunately, there is no part 2 for older boys.

  • “Boy’s Guide to Becoming a Teen” by Middelman & Pfeifer, from The American Medical Association

This is the book I like to use for older tween and teen boys. It has simple, but thorough, medically accurate information about growing, puberty, and sex. There is a chapter on masturbation. There are still some cartoonish pictures and it does not go into a lot of detail, so it is probably best for ages 10-13.

  • “Let’s Talk About S-E-X” by Gitchell & Foster, from Planned Parenthood

Rated for ages 9-12, this book is meant to be read by tweens and their parents, to help with understanding and open discussion. The end of many sections have questions to open discussion and learn. The end of the book has a section to help parents talk to their kids about sex. It also lists websites for tweens, teens, and parents, to further the discussion, with good, age-appropriate information. Despite the name of the book, it does not go into depth about sex, but does provide basic, medically accurate information, without shame. I highly recommend this book for all families with kids starting puberty.

  • “A Smart Girl’s Guide: Knowing What to Say: Finding the Words to Fit Any Situation” by Criswell, from AmericanGirl

Tips, techniques, and actual suggested conversations for how to handle more than 200 situations common for tweens. Rated age 8-12. Helps kids handle real life. Part of the Smart Girls series, but good for all genders.

  • “A Smart Girl’s Guide: Drama, Rumors & Secrets: Staying True to Yourself” by Holyoke, from AmericanGirl

Reviews indicate younger kids and those starting middle school tend to get the most out of this, but a lot of the book talks about social media or phone etiquette, which may not be useful to younger girls. Rated age 8-12. Best read by both tweens and their parents, to help open up discussion, as well as help kids with the drama they may face at school. My only critique is that this is written for girls, when it could be written regardless of gender.

  •  “It’s Perfectly Normal: Changing Bodies, Growing Up, Sex, and Sexual Health” by Harris & Emberley

This book is rated for age 10 and up, and is the best selling book in “children’s sexuality” on Amazon, but it is not my favorite. It has a lot of information, including topics such as birth control and abortion, but still uses cartoons, which may make it unappealing to older kids. It is good for younger tweens, if you do not mind them reading about all topics on sexuality, and want to discuss it with them afterwards.

For books recommendations for younger children, please see my previous blog post on the topic: Private Parts.

For information on protecting your child from sexual abuse, as well as talking about sex, I recommend The Mama Bear Effect

For families of trans youth, I recommend starting with The TransYouth Family Allies, as well as the resources from one of  the large trans youth centers at most major children’s hospitals. Here in Los Angeles, both CHLA and UCLA have centers to help trans children. 

Note: cover photo borrowed from https://www.commonsensemedia.org/blog/how-to-talk-to-kids-about-difficult-subjects

A Spoon-full of Sugar Helps the Medicine Go Down

Lots of parents have trouble getting their children to take medicine, so here are some tips to help:

Some techniques to help medicine go down easier:

Marry Poppins was right- a spoon-full of sugar helps the medicine go down! More accurately, a spoon-full of chocolate syrup will cover up the taste of most yucky medications. Apple sauce and yogurt are other common foods used to mask bad tastes. Many medications can be made to taste like your child’s favorite flavor by the pharmacist before you even pick it up, so ask about this when you submit your prescription. Some medications come in “orally dissolving tablets” which kids (age 3 and older) can put in their mouth and they will dissolve without having to chew or swallow.

Liquid meds are often easiest to give to babies with a syringe (a tube that looks like shot, but does NOT have a needle on it), which you can get at any pharmacy, baby store, or from your physician. Squirt small amounts of medication into your baby’s cheek and they’ll usually swallow it. Don’t squirt it directly onto their tongue or into the back of their throat, as this can lead to gagging. Follow-up with breast milk or formula (whatever they normally drink), before giving the next part of the dose. Alternatively, you can put the liquid medication in a bottle nipple along with a little breast milk/formula, and have them suck directly from the nipple, without the bottle attached. I do not recommend mixing the medication in a whole bottle, unless you know the baby will take the whole thing regardless of taste.

Most baby stores also sell special devices to help kids swallow medications,such as something that looks like a bottle, but keeps the medication separate, so you know exactly how much the child takes. I do not recommend giving children medications with droppers, because it’s difficult to measure the amount you’re giving, difficult to get all of the medication out of the dropper, and difficult to clean and dry the dropper fully between each use.

Learning how to swallow pills:

Once your child is ready to swallow pills (often by age 5!), it’s a great help to teach them how, since many medications are easier to take in pill form, the older they get, the bigger the dose, and some medications are not available in liquid/ chewable form. Starting young can also be beneficial in preventing anxiety associated with swallowing pills. Adolescents and adults often have trouble swallowing pills because they fear that the pill will get stuck in their throats. Relaxation techniques and deep breathing can help. Looking in a mirror, sticking your tongue out, and saying “aaah” out loud (this lifts the palate so you can see your throat), can help people see that their throat is much bigger then the pill, and ease some of the anxiety.

The first step in learning how to swallow a pill is to practice with something that is NOT medication. I recommend starting with small, smooth, round candies (such as mini m&m’s), and progressing to slightly larger candies (such as regular m&m’s). People with anxiety may want to start with tiny candies, such as sprinkles. Other people prefer to start with tiny bread balls (made from mashing a tiny piece of bread between your fingers), and go progressively bigger, since the bread dissolves easily in the throat. You will also need a big glass of water, juice, or carbonated beverage (such as plain soda water, which the pill can float on).

Younger kids can be told to just try swallowing the candy without chewing, because they are often successful without thinking about it. Older children, or those without a natural tendency to swallowing whole pieces, can start by visualizing the item floating down their throat on water, like a little boat. They should start by making sure the mouth is moist, by salivating or taking a sip of their drink. Nest place the candy as far back on the tongue as possible, using the teeth to scrape the candy to the back of the tongue (a mirror helps some people see how far back it is). Then take a big gulp of the liquid, which should float the candy and allow it to be swallowed, just as you would usually swallow any regular drink. Some children will swallow the candy (and later pills) more easily by drinking the liquid through a straw.

When it comes to taking real medicine, some people hide their pills in mini-marshmallows, which are slippery when wet, and therefore easier to swallow. I recommend trying this without medication first, since these are bigger then most pills. You can also try covering the pills in chocolate syrup, applesauce, yogurt, or jam (but see the warnings below before trying that).

I suggest experimenting with these techniques in a relaxed environment until you find something that works for you.

Warnings:

These techniques are for generally healthy children, with normal anatomy and mentation! They should not be used for children with any anatomical abnormalities, dysphagia (trouble swallowing regular foods or drinks), or any medical conditions that effect swallowing, the head/face, the GI system, or the neurological system.

All children should be supervised when practicing swallowing candies, and when taking ANY medication. NEVER tell your child that the medication is candy, as this can cause them to sneak some more when you’re not looking (many medications these days actually do taste like candy). Always keep medications (over the counter and prescription) and vitamins/ supplements out of reach AND in a LOCKED container. Kids are good at climbing and getting into high cabinets, purses, closets, and other hiding places.

Please speak to your pharmacist (who is usually in the back of the store, who has spent at least 5 years in post-graduate university studies, getting a doctorate degree in pharmacy), about what you can take your medication with, and whether you can cut, crush, chew, or open the medication. Many medications should NOT be taken with grapefruit juice. Some medications should NOT be taken with anything dairy. Some pills can be crushed and mixed with foods, where as others can not. Your pharmacist and/ or physician are the best people to speak to before taking your medication with anything but water.

Car Safety

Motor vehicle injuries are the leading cause of preventable death and disability in children in the USA. Using the right car seat the right away can prevent your child from getting hurt!

Vehicle Safety Information & CarSeat Review Sites:

The CDC 

The CarSeat Lady (PICU mommy doctor who specializes in car safety)

CarSeats For the Littles

The CarSeat Blog

Safe Kids Worldwide

Bureau of Highway Safety

NTHSA Car Safety

Tips for traveling with children in general

The Biggest Mistakes Parents Make:

1) Not installing the carseat properly

Most parents think they have installed the car seat correctly themselves, but 71% of car seats are not installed or used correctly!

The best thing to do is have your car seat installed and checked by a certified professional. You can find car seat inspection locations here and here.

You can get advice on how to install all types of car seats here.

2) Putting the baby/child in with straps too loose, too high or low, and the chest clip not at the chest

Many parents place their child in the seat, but leave the chest clip too low and/or the straps too loose. The Car Seat Lady has a nice video explaining how to get your new infant in the seat just right. Remember, the chest clip should always be at armpit level. See above graphics (borrowed from the internet) for more information.

3) Turning a toddler forward facing too soon

Children should be at least 2 years old and have reached the maximum weight or height for rear-facing in their chair, before being turned around. Regardless of age or size, it is 5 times safer to be rear-facing!!

This video demonstrates why kids under 2 years old are in greater danger when facing forward in a crash.

This blog post by Dr. Stuppy is my favorite explanation on why kids should be rear-facing and stay in car seats as long as possible.

This website goes over common car seat direction myths.

This infographic goes over how car seats work, including forward vs rear-facing.

4) Putting a child in a booster, instead of a car seat, too soon

Parents often want to move their kids to booster seats as soon as possible, for the convenience of having a lighter, more portable, cheaper seat, but it’s NOT convenient if your child is hurt in a minor accident because you moved them too soon (and it will cost you a lot more money than a new car seat, too).

Children will always be safer in a 5 point restraint (aka harness system), than using a regular seat belt. I often remind my patients that race car drivers use a harness system, and don’t rely on simple seat belts to keep them safe.

More information on how to decide when your child can move to a booster can be found on CSFTL and TheCarSeatLady.

5) Letting the child use a regular seatbelt too soon

This is also a matter a cost and convenience, as well as peer pressure, but don’t let what other people do put your child at risk. Most children need to ride in a booster seat until at least age 10, since they need to be at least 57″ (4 foot 9) to fit with a regular seatbelt. TheCarSeatLady has another good explanation on how and why booster seats work. Aside from height, they also need to be mature enough to sit straight and still i  the car, since if they are leaning over in a crash, the seatbelt will not be in the proper place, and may not protect them as well as it can.

6) Letting a child/tween sit in the front seat

Children that are not fully skeletally mature (e.g. have not gone through puberty yet), and are younger than 13 years, should not sit in the front seat. Dr. Burgert does the best job explaining why on her blog. Regardless of age, size, or type of seat, everyone is safer in the back seat.

7) Using an old carseat

Carseats from online sites, such as Craig’s List, may have microfractures in them from unreported accidents or being too old. For your first baby, use a new carseat, or one you can guarantee has never been in a car that had an accident and has not expired. For more information on car seat expirations check out BabyLic’s post.

No one wants to think about getting into a car accident, especially when you’re transporting your most precious cargo. But with tens of thousands of deaths from motor vehicle collisions every year, no parent can afford to take chances. The odds are reasonably high that you will be involved in some kind of car accident before your littlest one turns 18. If your children are with you, you want to have done everything in your power to reduce the risk that they will suffer serious injury, and you will demonstrate to them the importance of car safety for when they have families of their own.

Traveling With Children

Fortunately for us modern moms and dads, anywhere we want to go is just a plane, train, or automobile ride away. Despite the conveniences of modern transit, traveling with children can be a difficult endeavor if you’re not prepared. So here are a few tips to make your journey smoother:

1) Know your rights.

This sounds funny, but a lot has recently changed in U.S.A. airport security rules. For example children under 12 do not need to remove their shoes during screening. According to the TSA’s website, you may carry as much juice and milk for toddlers as you “need until you reach your destination”. The precise definition of how much you need varies by who is screening you at security.  During one trip with my then 1 year old, the security agent at LAX insisted that 3 small juice boxes was too much for a 5 hour flight, and threw all of our drinks away. I did not know enough to argue and instead I spent $$$ buying some non-dilute juice for my child at the airport 🙁 This also brings up the point to remember to be flexible, and give yourself extra time for the unexpected.

For the latest information, check out the TSA website. For information on car seat travel rights, see this post by TheCarSeatLady.

2) Know your company.

Certain airlines and hotel chains are better at hosting children than others. Conversely, some airlines have recently banned children from first class on their flights, so don’t expect an upgrade (or even friendly service) on those airlines. In general, European and Asian companies are considered friendlier to children on flights than North American airlines, often providing coloring books, special snacks, small toys, and other treats for families.

Some airlines offer pre-boarding for families with infants and toddlers, while others have none. This may be more annoying than you think. When traveling with our then 2 year old, we had to wait until first class, business class, and everyone with a silver/gold card from the airline boarded (more than half of the passengers) before we were allowed to get on with a toddler, car seat, and hand luggage. Trying to get past the tiny aisle with people everywhere and a large car seat was not fun, and I think it disturbed the other passengers as well. Allowing us to board early, install the carseat and settle in would have prevented a lot of hassle for everyone. However, when we got to our destination we stayed at a hotel that provided us with squeaky bath toys and other amenities in the room that made us feel like family.

Check out this article on the most family friendly airlines.

 

3) More tips just for flying with children:

– Try and book a flight with as few stops as possible, as take-off, landing, and boarding are the toughest times.

– Make sure you have assigned seats together in advance. Many companies have been separating families on flights, and then you rely on your fellow passengers to switch seats so you can sit together, or charge extra money to seat families together (but a July 2016 ruling by Congress outlawed this for kids under 13 years old). This LA Times article gives tips on how to stay together.

– I take our car seat when flying with my son, to make sure he is strapped in securely during our flight (even turbulence can be dangerous to a lap child). This also ensures that he has a safe seat for automobile travel when we arrive at our destination. It is also easier for him to fall asleep during the flight in his car seat, and more difficult for him to annoy other passengers by kicking them or climbing on the chairs. We use a GoGo Kidz Travelmate to turn the car seat into a stroller at the airport. Booster seats are not necessary (or allowed) on flights, since there are no chest straps.

excited by the stuff he sees through the window
My son sitting in his carseat happily staring out the plane window

– To avoid pain from the changes in pressure in the ear during flights, teenagers and adults can chew gum or drink water to encourage swallowing, and thereby open up the eustachian tubes in their ears to relieve the pressure. For babies the best way to do this is breast or formula feeding. Breast or formula feeding has the added bonus of being a natural pain reliever. For toddlers, diluted juice in a straw cup works well. Older children can suck on lollipops to get them swallowing (and happy and distracted by candy). Nasal sprays can also help relieve congestion and prevent pain during the flight, but speak to your pediatrician about this (salt water sprays can help babies with stuffy noses, while kids with ear infections or sinus problems may need a prescription nasal spray). If all this ear tube talk is confusing, check out the ear anatomy pics on my pinterest page.

– I recommend waiting as long as possible before flying with infants. The younger an infant is, the less developed their immune system, and the more likely they are to get sick. The air on airplanes is re-circulated so it is very easy to pick up germs from other travelers, even ones who are seated far away from you. Infants younger than 2 months old who catch an illness with fever may have to undergo extensive testing, including blood, urine, and spinal fluid exams if they get sick. I know this is not possible for many families, but waiting until your infant is 9 months or older can save you a lot of hassle.

I advise checking the CDC travel web page, and making an appointment with your pediatrician at least 2 months before any foreign travel, so you can get any needed vaccinations or medications for your trip. You can also check out travel clinics in Los Angeles.

4) Have your bags packed with items that will keep your child calm, quiet and comfortable. 

I prefer small, light items. If you are used to distracting your child with your phone or other electronic items, keep in mind that you will not be able to use them on take-off or landing, and they might run out of batteries on long car trips, so make sure to pack low-tech items as well. I recommend packing a carry-on or car bag with:

  • baby wipes (good for cleaning up messes for kids of all ages, cleaning up yourself, and cleaning up icky surfaces)
  • snacks
  • your own sippy cups or bottles
  • more diapers than you think you need
  • several different sizes of ziplock bags (for messes, soiled clothes, soiled diapers, and they are just generally handy to have)
  • a medical bag (children’s acetaminophen, children’s ibuprofen, children’s benadryl, disinfectant, bandaids)
  • sunscreen (the sun through a car’s windows can burn a child, and then sun through a plane’s window has more radiation than down on the ground, so slather yourself and your child with sunscreen to avoid sunburns and -much later- skin cancer)
  • lollipops for older kids
  • extra clothes (even for older children, as it’s easy to get spilled-on during a flight or car trip, and you never know if, when or where you’ll get stuck)
  • books
  • re-usable stickers
  • dry-erase crayons/markers and board
  • a soft blanket
  • your child’s lovey (favorite blankey, stuffed animal, or other comfort item).

I’ve linked to a few of these items, as well as book suggestions, on pinterest.

Eat Pack Go has many more great travel tips, and the link is for a funny story illustrating why you shouldn’t feel bad about that huge carry on with extra supplies.

Traveling with children can be more stressful than traveling alone, but with patience, planning, and a large bag it can be a fabulous adventure.

Tips for Sensitive Skin & Eczematous Kids

Part of the information is from UpToDate.com, but has been extensively revised by Dr. Shaham.
What is eczema? — Eczema is a skin condition that makes your skin itchy and flaky. Doctors do not know what causes it. Eczema often happens in people who have allergies. Another term for eczema is “atopic dermatitis.”

What are the symptoms of eczema? — The symptoms of eczema can include: intense itching (even before the rash starts), redness, rough patches of skin, small bumps, skin that flakes or skin that forms scales.

What can I do to reduce my symptoms? — Use unscented thick moisturizing creams (ointments preferred) to keep the skin from getting too dry. Also, try to avoid things that can make eczema worse, such as: being too hot or sweating too much, very dry air, stress, sudden temperature changes, harsh soaps or cleaning products, perfumes, wool or synthetic fabrics (like polyester), things that you may be allergic to (often foods for infants or pets for older kids).

Bathing Tips— Use warm water for bathing and washing hands. Use a mild, non-drying cleanser that is fragrance-free, dye-free, and allergy tested. Avoid body sponges and washcloths (friction can make the skin worse).  Gently pat skin dry with a towel, do not rub the skin. Kids with frequent eczema flares or infections can benefit from bleach baths, but ask your pediatrician first if this treatment should be used for your child.

Moisturizing Tips— Apply any special skin medications prescribed for you and then liberally apply a moisturizer. Use a moisturizer within 3 minutes of getting out of the bath, to lock in the moisture. Re-apply moisturizer throughout the day, whenever your skin feels dry or itchy. Regular petroleum jelly works very well for this. A recent study showed applying petroleum jelly 3 times a day to infants who had a family history of eczema helped prevent eczema in those babies.

More Tips— Use dye-free and fragrance-free detergents. Use an extra rinse cycle on laundry to get rid of any soap remnants. Keep fingernails short to avoid scratching. Consider weekly bleach baths if the eczema gets infected often. Check out www.eczemacenter.org  and the national eczema association for more information and videos.

How is eczema treated? — There are treatments that can relieve the symptoms of eczema. But the condition cannot be cured. Even so, about half of children with eczema grow out of it by the time they become adults. The treatments for eczema include:

  • Moisturizing creams or ointments – These products help keep your skin moist. An ointment (such as aquaphor or vaseline) can be soothing, lock-in the moisture and act as a barrier to environmental allergens. Other lotions (such as Cetaphil) help repair your skin’s barrier. These need to be applied at least 3 times per day!
  • Steroid creams and ointments – These medicines are different than the steroids athletes take to build muscle. They go on the skin, and they relieve itching, redness, and inflammation. (In severe cases, you may need to take steroids by mouth, but only under physician supervision).
  • Antihistamine pills – Antihistamines are the medicines people take for allergies and also relieve itching. Many people find that itching is worst at night, which can make it hard to sleep. If you have this problem, talk with your doctor or nurse about it. He or she might recommend an antihistamine that can also help with sleep, such as Children’s Benadryl (aka diphenhydramine HCl).

Private Parts: Talking to Your Child About Their Bodies, Behavior, and Babies

It is important to start speaking with your children about their bodies and behavior at an early age. If you create an open dialogue, without shame, your children will feel free to bring you their questions throughout their lives. This is often an uncomfortable topic for parents, so I have created a list of books and resources to help you get through it (scroll down). I also encourage you to discuss any questions you have on the topic with your child’s pediatrician (we are always here to help!).

Some tips:

  • Watch out for everyday opportunities to teach your child about privacy and hygiene.
  • Encourage your child to ask you questions, to learn that they can feel comfortable coming to you with their thoughts.
  • Try to be calm and open about the topic (pay attention to your body language and tone of voice).
  • Give simple and short answers.
  • Make sure your answers are age appropriate.
  • Young children take everything you say literally, so avoid metaphors.
  • Use anatomically correct terms for their body parts (i.e. penis and vulva, not “weewee”)
  • Avoid shame and ridicule.
  • Become closer to your child by showing them that you accept & support their feelings.
  • Set rational and consistent limits.

Here is a great blogpost by Dr. Claire McCarthy on getting started with the conversation: “6 Tips For Talking To Your Kids About Sex.”

I also recommend looking at the website “Empowering Our Children,” which is designed to teach parents how to protect their children from sexual abuse.

The “ScaryMommy” website has a good post on what these conversations with toddlers may look like.

My Book Recommendations:

For parents to read overall:

This is the best book for parents to read on the subject. It tackles every sexual stage of development from infancy (yup, some babies masturbate) through adolescence, as well as age-less topics, such as homosexuality. I recommend starting to read this book when your child is young, although it’s never too late to learn.

Books to read with your children (or for them to read by themselves), by age group:

Toddlers & Pre-Schoolers:

My favorite overall book for toddlers. Teaches basic anatomy, privacy, and even how babies are born.

A very simple book on pregnancy and birth to read to young children. No lies (e.g the stork), but no anatomy or private parts mentioned either.

This book is great for families that conceived via IVF, adoption, surrogacy, or traditional means. It talks about sperm, egg, uterus, and birth, but each as its own thing, and at the end it asks, “Who was waiting for you to be born?” Technically accurate, but simple, with cartoonish illustrations.

This is the classic “how babies are made” children’s book, but take a look through this book before buying it, as it is may be too explicit for some families (see the anecdote at the end of this blog post).

This book discusses inappropriate touching/abuse. It does not discuss development or how babies are made.

School Age Children:

Covers all of the basics, including proper anatomy, mostly with diagrams, and a little cartoon guidebird.

Tweens:

Very similar to the school-age version by Harris (above), but with more words, less illustrations, and more details.

My tween patients report that they love this book. It goes over what to expect in puberty and how to take care of girls’ changing bodies. This book includes discussions on hygiene and how to use menstrual products. There is a version for boys. There is also a version with the number 2 at the end for teenagers.

Dr. Stuppy and the Mighty Girl website also have good posts on discussing puberty.

A Funny Story About Me:

When I was 3 years old, my mother (who is a pediatrician as well) read me the book “Where Did I Come From?” I went to my religious nursery school and proceeded to tell everyone, “I was the fastest sperm!” Some of the other parents were not happy when their own children went home and repeated the same thing to them. My mom got a stern ‘talking to’ by the school. We still laugh about it, to this day. The moral of the story? Teach your children about their bodies and development before anyone else does, or you may not be happy with what they learn 😉

For newer blog posts on the subject, as they come out, you can also follow my pinterest boards on Teenagers, Parenting, and Kids’ Health.

Getting Ready for Camp

Camp is a great way for kids to improve their social skills, exercise, and explore new things.

If you are considering sleep away camp, but aren’t sure if it’s the right thing to do, click here for a psychologist’s perspective on camps away from home.

Whether you decide on day camp or sleep away fun, here are some tips to get ready:

Day to Day


Sunscreen

Lather up your child with a full shot-glass worth of sunscreen every morning. Then send them to camp with a sunscreen stick, so they can reapply it as needed throughout the day (especially before and after water activities, and at lunch time). Get new tubes of sunscreen every year, and pay attention to expiration dates. Sunscreen should be thrown out 1 year after it is opened. Any sunscreen you use should be SPF 30 to 50. For more information on sunscreen choices, click here. A hat and clothing are also good ways to protect your child from harmful rays.

Insect Repellent

If your child will be in an area with mosquitos or ticks, don’t forget the insect repellant. These only need to be applied once a day. If there are deer ticks in the area, please do a tick-check daily to make sure none are taking a ride, especially in the hairline. Ticks usually have to be attached to the skin and feeding for 24-48 hours before they transmit diseases like Lyme Disease, so a daily tick check can really prevent your child from getting sick. If you do find a tick, pull it out completely with tweezers, or follow the tips at HealthyChildren. Do not apply vaseline and do not burn the tick, as this can cause the tick to vomit into the host and transmit disease. For more information on insect repellants in kids, click here (Tara Haelle talks about the latest science and studies on types of repellents) and here (Dr. Iannelli discusses what to buy).

Food

If your child is going to a day camp, don’t forget ice water and healthy snacks and lunch, for maximum energy and hydration. At sleep-away camp, food in the cabins can attract bugs, so it’s better to leave it at home.

Safety

Teach your child to swim before they go to a camp with a pool or lake. Empower them to be protective of their body, and not to allow unwanted touches. For more help with that, see here and here. Finally, remind them to wear helmets for certain sports (rock climbing, skateboarding, bicycling, and horseback riding are popular camp activities).


Help From Your Pediatrician


Forms

Most camps require health forms to be completed by your primary care physician before you can attend camp. If you have had an annual physical office visit less than a year from the form due date, most offices will complete your forms without a visit. Some camps require the forms to be completed with a doctor’s visit after April, in which case you should make an appointment as soon as possible. Either way, you will need to contact your PMD office well in advance of when you need the forms completed. Some camps are now also requiring immunization records. If you have an up to date yellow immunization card you can give the camp a copy. If you don’t have one, get a copy from your pediatrician (it’s a good idea to have these at all times anyways).

Medications

If your child will need to take any medications at camp, even over the counter ones, get the medication forms from camp and send them to your prescribing physician at least a couple of weeks before they need to be submitted. You should also speak to your doctor about prescribing extras for camp, especially inhalers and spacers. If your child has asthma, or wheezes, send a copy of their Asthma Action Plan to the camp.

Allergies & Special Diets

If your child has real allergies or medical diets (like with celiac disease), inform the camp ahead of time, and call to make sure they can accommodate your child safely. Allergy warning bracelets can help avoid accidental ingestion at camp, by reminding staff before they share food or special camp treats. If your child has a possibly anaphylactic (life threatening) allergy to insects, food, or anything, be sure to send an Epi-Pen or Epi-Pen Jr set (2 pens in case of anaphylaxis, not just 1) to the camp. You should also have an allergy plan, so the camp (and you) knows when to use the pen. You may need extra forms to be filled out, to be able to have these used at camp, and an extra prescription, so call your primary care or allergy doctors’ office at least a month before camp starts to have this done. Teaching your child the symptoms to look for, and how to use the epinephrine is also important.

You can read more about creating a healthy camp experience at the AAP’s parent site, but most importantly, have a fun summer!

Interviewing A Pediatrician

Originally posted on my old blog in 2012.

Recently, one of my friends asked me what questions she should ask when interviewing a prospective pediatrician, so I thought I’d share my answer with everyone.

My son is too young to be your pediatrician right now, but he’s trying.

1) What insurance do you take?

Of course, this is only important if you’re using insurance. The BEST way to make sure you are covered by your insurance is to go to your insurance and ask them directly, as some plans, even with a large network and PPO, exclude some doctors directly.

I know several families now that have health insurance for emergencies, but pay for regular doctor visits out of their own pockets, due to very large deductibles. This reduces their overall medical expenses (because they have a cheap insurance plan, only for emergencies), and allows them to see whatever doctor they like, but only as long as nobody gets sick. These families usually use free clinics for vaccinations, or pay out of pocket. If you choose this option, ask about “cash” visit prices instead.

2) What hours is the office open for well visits? For sick visits? When is your chosen primary pediatrician actually in the office during the week? Who is there to see you when they are not in (a doctor or NP)?

Keep in mind that the smaller the office, the less hours they are usually open, but the better service and more personalization you usually get. So if you want to do well visits at night or on weekends, you will probably have to go with a very large practice, but usually see a different doctor (or nurse practitioner or physician assistant) each time.

3) Who covers for your physician when they are not in the office, not on call at night, or they are on vacation?

For night call, is the person on the phone your physician, a physician from your practice, a physician from another practice, or a physician extender (NP or PA) or a phone triage nurse (someone who has a book of triage protocols that they read from)?

4) Do you use electronic medical records?

These can allow the physician on call (if they are a doctor from the same practice) to access your chart at night and on weekends, if needed.

5) Can I get a same day sick visit appointment?

These should be reserved for urgent matters, not chronic medical problems.

6) Who answers regular questions by phone during the day?

Does your pediatrician call you back even for non urgent questions? Does a nurse handle most questions about illnesses on the phone? Does another physician answer the phone when your physician is not available?

7) Are there any physician extenders (nurse practitioners or physician assistants)?

Are they the ones to see you for same-day sick visits or phone calls, or will your physician or their partner see you?

8) Are there separate sick and well waiting rooms? How long is the typical wait in the waiting room?

Recent studies have shown that this does not actually matter, as most kids do not get sick from the waiting room, although the elevator and pharmacy near the office may be bigger germ pools. However, I have included it because people like it. An alternative question to ask, is how long someone typically spends in the waiting room. Some small practices get everyone into exam rooms very quickly, whereas other places have you waiting there for an hour.

9) What is your vaccine policy?

If the physician allows un-vaccinated children in their practice, consider that your baby (who is too young to be vaccinated for certain diseases) may be exposed to somebody in the waiting room with measles, chicken pox, etc…

10) How often do you see the baby or child for regular check-ups?

This can actually vary quite a bit between pediatricians for the first 3 years of a child’s life. After that, your child is seen for an annual well check every year.

11) Do you have a website? Do you use email to communicate with patients?

12) What hospitals do you cover?

Will your chosen primary physician be the one to see your baby everyday in the hospital (when they are born and if they are admitted later) or will one of the covering physicians see them?

13) Where is the best place to park or closest public transportation stop?

I have found (at least in big cities, such as LA and NY), that the best place to park for my doctor appointments is often somewhere other than the valet parking in the medical building. The administrative assistants at your pediatrician office should be able to tell you the best place to park, as well as help you get there by public transportation, if that’s your preferred mode of transport.

Vaccine Science Made Simple

This is a guest post by Kimberly Mulligan, PhD from the department of biological sciences at California State University Sacramento

Hi parents! Scientist here. I decided to write a long post about vaccines to help shed some light on how vaccines work and, hopefully, bring some clarity to topics of debate. The amount of misinformation about vaccines feels a little out of control to me. And no matter what you think about vaccines, it’s tough to wade through this information without a scientific background. FYI, my science background: PhD in developmental biology from Stanford University, postdoctoral research at UCSF on the molecular basis of brain development with an emphasis on a group of genes implicated in autism and other neuropsychiatric disorders, and I just joined the faculty at CSUS this January where I teach molecular cell biology and will have a research program focused on the molecular basis of neurodevelopment and neuropsychiatric illness. Ok, on to the fun stuff.  (It’s long because I wanted to be comprehensive and address all of the questions I usually get about vaccines.)

First, I ask that you read this with an open mind.  Having an open mind is an integral quality of good scientists – it is the only way to objectively analyze data. (Open minds are wise minds!) I also want to add that this debate gets nasty, but in the end we all love our kids and want what’s best for them (as a mama of two, I get that).  I am not judging, I do not feel that is my place as a scientist – my place as a scientist is to arm you with information and help you better understand that information.

Important vocabulary: pathogen = disease-causing bacteria or virus

Q: Ok, so what are vaccines? (I feel like this very basic question is often not clearly answered.) 

A: Usually they are viruses or bacteria that have been modified so they cannot hurt you, but still look like pathogens to your immune system. That part is key. When a weakened pathogen (or “acelluar” pieces of a pathogen) enters your body your immune system responds by making antibodies that will bind specifically to that pathogen, and target it for destruction. Here’s the really cool part – our immune system makes cells called memory B cells that will stay in our body for a really long time (depending on how strong the vaccine is). These memory B cells are primed to make antibodies specific for that pathogen if you were to get infected again. This is important because our immune response can take a long time – long enough for pathogens to have debilitating and sometimes lethal consequences. If you have those B cells ready to go, your body makes specific antibodies that will get rid of the pathogen before it hurts you.

Q: What about the other scary sounding stuff in vaccines?

A: They are all there to make sure the vaccine stays safe and effective. And while they sound awful, they are all actually totally safe in the amounts present. For example, formaldehyde sounds scary, but did you know that it is a normal metabolic byproduct that your body produces in small amounts constantly? You produce more formaldehyde over a matter of minutes than you get from a vaccine. Another fun fact: there is 4-15 times more formaldehyde in a single apple than any one vaccine. And your body simply processes it and gets rid of it (again, it knows how since you are always producing it). Aluminum?  Present in things ranging from organic pears to natural breast milk. One of the first things biochemistry students learn is that dose matters. Yes, large amounts of aluminum and formaldehyde are bad…but large amounts of water can be lethal. Oh, and mercury-containing thimerosol is no longer in early childhood vaccines because it was removed due to public outcry. However, there is still zero scientific data to suggest that thimerosol has any detrimental effects. In fact, the type of mercury in thimerosol is ethyl mercury, which is readily flushed from the body. The bad mercury that our body has a harder time getting rid of is methyl mercury (found in tuna).

Q: Why should you trust a big pharma who profits from vaccines? 

A: My first answer is that you don’t have to. There are a lot of scientists who have published research on the safety of vaccines that are not affiliated with big pharma and do not profit from the results of their findings. They are people like me – who became scientists because they wanted to help learn more about biology in order to diminish human suffering. We work for academic institutions, not big pharma. We ask questions without a vested interest in the answers. These are the scientists that can provide you with unbiased information. You can do a search for yourself on the largest database of scientific journals here: http://www.ncbi.nlm.nih.gov/pubmed

You will find that when you search for studies on autism and vaccines, of the hundreds of studies conducted, there is still no scientific data to suggest a link between the two. For example, every epidemiological study conducted on populations of children living in the same community has shown autism occurs at the same rate in vaccinated and unvaccinated children.

  1. What is currently thought to be the cause of autism?

A: It is currently thought that autism is a neurodevelopmental disorder that often begins in utero. A number of the autism risk genes identified affect how the brain develops during gestation. There were actually a couple of papers very recently published indicating specific mutations in a large number of candidate risk genes for autism1, 2. There has also been research showing the influence of environmental factors like maternal antibodies that are present in the womb, which were identified by scientists at the UC Davis MIND Institute3. Autism is a very complicated disorder, and we certainly don’t have all of the answers! But, again, there has been an overwhelming amount of time and money dedicated to investigating a potential link between autism and vaccines, and every study has come back with the same results: there is no data to suggest a link between autism and vaccines.

Q: Back to the big-pharma-makes-a-lot-of-money-argument.

A: Yes, they do. They make money on every drug they produce. I have opinions on big pharma’s business practices that I won’t go into now because it actually has nothing to do with the argument about vaccine effectiveness or safety. For better or for worse, our entire medical system is profit based (our entire economy is, actually). The people at the forefront of the anti-vaccination movement also make a lot of money. That is not why I don’t believe them, though. I don’t believe anti-vaccination proponents because of the absence of scientific data to support their claims. As a scientist, I only believe what the scientific data supports. I read research, not opinions. (That is not meant as a slight to anyone!  I am simply stating my practices. I know that reading primary research papers can be like reading a different language if you do not have a science background, so I would not really expect any non-scientist to have this practice. It’s the same reason I don’t read economics papers. Bleh!)

Q: What about vaccine-related injury?

A: The overall risk is something like 0.003%. And the VAST majority of those 0.003% have minor allergic reactions. Severe allergic reactions can occur, though they are extremely rare. There have been a few cases of autoimmune disorders being triggered by a vaccine. It is not entirely clear whether the vaccine was actually the trigger because it could have been triggered by any pathogen. Importantly, people who are immunocompromised, meaning they have a weakened immune system (chemotherapy patients, HIV patients, genetic immune deficiencies, etc.), cannot be immunized because their immune systems are so weak that even the weakened virus might hurt them. All of these people fall into the class of people who should not get vaccinated and for whom herd immunity is so important!

Q: What is herd immunity?

A: It’s kind of basic math. Viruses cannot replicate on their own. They need to infect a host cell in order to replicate. If they don’t make it into a host cell, they will eventually die. Here’s an easy example: a person infected with a virus walks into a room where there are 20 vaccinated people separating him from a single unvaccinated person. That virus cannot move from the infected person and replicate in any of the vaccinated people because once it gets into their bodies, those memory B cells start pumping out antibodies that kill it before it can replicate and spread. Therefore, those 20 vaccinated people make it harder for the virus to make it to the single unvaccinated person. If half of the people were unvaccinated, that virus would get to have a replication party in all of their cells and would have a much easier time surviving, multiplying, and spreading. Herd immunity is just a basic principle about how infectious pathogens spread. If someone tells you it doesn’t exist, you should be wary of any other scientific information they give you because it means that they have never taken or studied immunology or microbiology and are not qualified to have an educated discussion about those topics.

The tricky thing about vaccines and herd immunity is that herd immunity really only works when a high percentage of the population are vaccinated. If not, then viruses have an easier time spreading around our communities, putting at risk our neighbors who cannot be vaccinated (newborns, cancer patients, etc.), and who are also much more likely to die as a result of infection. That is why the scientific community is so scared.  We feel that even a single death from a vaccine-preventable disease is a tragedy.

Q: Isn’t natural immunity better than vaccine-induced immunity?

A: Well, the immune response is stronger because the pathogens are not weakened, so if you make it through the illness you will, in theory, have a great supply of those memory B cells. The problem is that a lot of these vaccine-preventable pathogens can cause blindness, deafness, brain damage, paralysis, or death. I know of a mama who has a sister who contracted rubella while she was pregnant. Her baby was born blind and deaf because of the infection. So, yes, she now has great immunity to rubella. But she would give anything to have had vaccine-induced immunity prior to her pregnancy.

Q: Why do some vaccines not give lasting immunity? 

A: Each vaccine has a varying degree of effectiveness. By effectiveness I specifically mean the quantity and quality of memory cells that will stick around in the immune system post-vaccine. For example, the smallpox vaccine gave immunity for 65 years whereas the pertussis vaccine only lasts for about 10 years. This is the purpose of boosters. Boosters essentially tell your immune system that it is still important to mount a defense against the pathogen, and replenishes your stock of memory cells.

Q: I heard a lot of adults are to blame for the current measles outbreak. Should adults get vaccinated, too?

  1. Absolutely! If you are unsure of your immunity, you can talk to your medical provider about checking your titer (a measure of your immunity), or you can just get a booster. Even if you’ve had a booster, but can’t exactly remember when and your provider doesn’t do the titer test, getting another booster cannot hurt you.

Q: Why do babies often get fevers after being vaccinated?

A: Part of the natural immune response is the release of molecules called chemokines, which cause fever. As a mama, I know how scary it can be when your little one has a fever, but a post-vaccine fever is indicative of a robust immune response and means they are making great memory B cells. That does not mean you shouldn’t treat your baby’s fever!  (Please consult your pediatrician on when you should treat your baby’s fever.)

Q: What’s up with vaccine shedding?

A: Vaccine shedding is something only possible with a live attenuated virus. This is different from the pertussis vaccine, for example, which is an acellular vaccine, meaning it contains various pieces of the pertussis bacterial molecules and is not infectious at all, cannot cause illness ever, and cannot shed. Again, a live attenuated virus is a weakened virus that reproduces so slowly that a normal immune system will take care of it before it causes any harm. If a person is immunocompromised, live attenuated vaccines cannot be used because their immune system might not be able to handle even a weakened virus. The nasal spray flu vaccine does have a risk of vaccine shedding because the vaccine is administered directly to the mucus membranes of the nose. Therefore, if that recently immunized person were to sneeze onto an immunocompromised person, there is a theoretical possibility that the attenuated virus could give that immunocompromised individual the flu. This is why it is recommended to stay away from immunocompromised individuals for a week after getting the nasal spray flu vaccine.  Other live attenuated viruses are injected into muscle. Some of the weakened virus will get into the lymphatic system, which is where all that good immunity will happen (production of specific antibodies, effector cells, and memory cells that will stay around for a long time). From there, some of the vaccine can enter saliva and mucus, although it is going to be a much lower amount. I think this is why the CDC only has the recommendation to steer clear of immunocompromised individuals in the case of the nasal spray flu vaccine. BUT, and this is critical, the virus that would potentially be shed post-vaccine is the attenuated (weakened) virus that does not cause illness in a person with a normal immune system. This is why vaccine shedding does not cause disease EVER in a person with a normal immune system. It would essentially be like getting an ultra-tiny dose of a vaccine (not enough to even cause an appreciable immune response that would lead to acquired immunity). This is anecdotal, but when my daughter was newborn, my husband did not realize this about the nasal spray flu vaccine when he took our 2 year-old to the doctor…and he got him the nasal spray form of the flu vaccine. I’m happy to report that my newborn daughter did not get the flu. I actually wasn’t really worried; it’s a very minimal risk….but when a person is severely immunocompromised it is important to worry about any potential risk.

Q: If I have a baby that is too young for MMR, could a booster given to a breastfeeding mama give the baby passive immunity through antibodies present in the breast milk?

A: Passive immunity is the transfer of active antibodies from one person to another. This happens during pregnancy when antibodies present in mama cross the placenta to the developing fetus. I recently spoke to an immunologist friend about passive immunity through breast milk. I myself was considering getting the MMR booster to help my 7 month-old baby girl, but he said (sadly) it probably would not boost her passive immunity an appreciable amount (for a virus as strong as measles, anyway). There are five classes of antibodies (IgA, IgG, IgD, IgE, and IgM). The type that is most effective in preventing infection from something like the measles is IgG. These antibodies cross the placenta during pregnancy and give passive immunity to the baby when it is newborn. The primary type of antibody that gets into breast milk is IgA. It provides some protection, but it’s just not as great as IgG.

Q: If newborns get passive immunity from mama during pregnancy, why are they susceptible to illness? 

A: Passive immunity only lasts for a short time. That’s because antibodies tend to not survive very long (a few weeks to a few months, on average). Unfortunately, the effector cells and memory cells that are responsible for making the antibodies in mama do not cross the placenta. The memory cells are the cell types that stick around for years to provide lasting immunity. I read a study that indicated 88 percent of babies of vaccinated mothers have passive immunity to measles at 4 months, and that number dropped to 15 percent by 8 months of age4. Although, and this is important, the amount of antibodies acquired through passive immunity may not be sufficient to protect the baby from a strong pathogen.

Q: What about the alternative vaccine schedule versus the CDC recommended vaccine schedule?

A: I’ve never found evidence to support the alternative vaccine schedule. It is my understanding that it is something to make parents feel more comfortable. There are a lot of factors taken into account for the CDC schedule, which have to do with considerations like when the acquired immunity will be best. For example, MMR is not given until 12 months because they want to make sure that all passive immunity acquired from mama during pregnancy is gone by the time the vaccine is administered because those circulating antibodies would decrease the immune response to the vaccine. So MMR can be given at 6 months, but is better at 12 months…and I recently read a study indicating even a little tiny bit better at 15 months5; but, you could possibly do the initial shot earlier than 12 months and then get the booster early if you are concerned about measles in your community (of course, talk to your doc about these decisions).

I hope this was helpful! Again, I have no financial interest in this debate. As the mama of a 7 month-old baby girl who is not old enough to have MMR, a 2 year-old little boy who only now has partial immunity, and as the stepdaughter to a wonderful man who spent his final 9 months severely immunocompromised due to chemotherapy, I am certainly emotionally invested in the debate. But as a scientist who has read thousands of pages of scientific research, I only want to help spread knowledge and quell fear.

For links to more information about vaccines please check out the blog post just prior to this one.

References

1 Iossifov I, et al., The contributions of de novo coding mutations to autism spectrum disorder. Nature. (2014) 515(7526)

2 De Rubeis S, et al., Synaptic, transcriptional and chromatin genes in autism. Nature. (2014) 515(7526)

3 Bauman MD, et al., Maternal antibodies from mothers of children with autism alter brain growth and social behavior development in the rhesus monkey. Transl Psychiatry. (2013) 9;3

4 De Serres, et al., Passive immunity against measles during the first 8 months of life of infants born to vaccinated mother or to mothers who sustained measles. Vaccine. (1997) 15(6-7):620-3.

5 Hinman A., et al., Comparison of Vaccination with Measles-Mumps-Rubella Vaccine at 9, 12, and 15 Months of Age. J Infect Dis. (2004) 189