Recently, I was walking back from the tennis courts on a crisp winter day when I had a flashback to my youth. Suddenly, in that moment, I recalled the wonderful sensation of my childhood, being outdoors, free of immediate demands and responsibilities. I was just enjoying the air, the green, and the sky all around me. I could feel my mental state improve and my body and mind relax. You see, during my childhood, the only entertainment we had after school was to go outside and find things to do. My memory of childhood was outdoors, walking, experiencing whatever the weather was serving that day along with whomever I could find to play with. My walk from the courts reminded me of the joyous feeling that my experiences of youth had created. On that walk home, I began to wonder, what the children growing up today will remember as their happy place? Where will that place be that brings out the relaxation reflex in your children, twenty years from now? An interesting question and one that every parent should ponder because you have a lot to do with the kind of childhood your children have. So stay tuned, for the next edition of Portable Practical Pediatrics where we will ponder the question of where your children will recall the joy in their childhood? Continue reading
I’ve got a very interesting subject to talk to you about today that I discovered while listening to a podcast! Yes, not only do I make podcasts but I am an avid listener of them as well. In this particular podcast, I heard Dr. Cal Newport, a computer scientist, interviewed about the negative effects of interruptions on learning, memory, and creativity. I thought that what he was saying had so much relevance for your children that I couldn’t wait to introduce my listeners to his research and ideas. Please take a few minutes to listen to this post that I call Distraction Free Thinking Vital for Kids. The message is so vital for all parents to hear that I don’t want you to miss it. Continue reading
Thank you for joining me today…I am your host, Dr Paul Smolen
I a general pediatrician by day and a blogger at night.
I create these short practical and hopefully informative podcasts to make information about parenting more accessible to parents. As I like to say, from the bassinette to the boardroom, from the crib to the country club, from the delivery room to the doctorate…. DocSmo is there.
Important topic today for parents with especially school age children
In order for your child to “run” well, they have to get good quality sleep
In order to get good quality sleep, they need to have an adequate airway while asleep and lying in order to have comfortable breathing.
Snoring is often a sign that a child has a poor airway at night and MAY not be breathing well in their sleep.
So lets talk about this aspect of sleep in today’s podcast and explore more on the subject of sleep in children. Before we get started, my lawyer…my wife, wants me to remind my listeners that this podcast is not intended to give parents specific information about their child but rather is intended to provide general information only, not specific medical advice for your child.
Long time listeners know I love to talk science when it relates to the topic of the day so I think it is time to take a little ride down “Science lane” so we can get some more understanding about sleep and breathing as it relates to today’s topic.
In order to have restorative sleep, our brains need to get a certain amount of slow brainwave sleep, quiet restful sleep.
Comfortable unlabored breathing is essential to getting this restorative sleep.
Comfortable breathing needs an adequate airway to provide air to our lungs and here is where children often have problems.
Small noses often clogged with mucous from colds or allergy, small throats because they are kids, and large tonsils and adenoids (tonsils that sit behind the nose) because they put so many germs in their mouths that these structures are stimulated to be big… and big they can get. Sometimes there is an almost complete occlusion of the nose and throat.
If a child has a poor airway during sleep it is likely that they will snore, be restless most of the night, sleep in unusual hyper extended positions, get up in the morning as if they still need sleep, and maybe have behavior and learning problems at school.
They might even have sleep apnea where they stop breathing for 10-20 seconds followed by very heavy gasps when breathing restarts.
I once had a dad bring his child to the office with a video of their child doing this and he refused to leave until I made arrangements for it to be fixed!
To illustrate this point let me tell you a story.
I was in the office recently and a parent did what they often do during their child’s routine visit… I got the “Oh by the way” question.
Their toddler was in the office for a well visit but they wanted to talk about their 6 year old who was having problems in school
The 6 year olds teacher had some concerns about his emotional state. He seemed overwhelmed, anxious, and frankly, was not performing well compared to his classmates.
Little Johnny, let’s call him, had an anxious disposition:…the parents admit that… but his teacher wanted to make sure there was nothing wrong physically with him. They had noted that by the afternoon, he seemed overwhelmed, crying, having outbursts and tantrums. He seemed smart but was not learning as well as he should be.
So here was my quick thought process…remember, this was a “Oh by the way question”. Was this child reacting to stress at home, or were we beginning to see a child who has trouble with a mood problem like depression or anxiety, or was this a child with developmental delays who could not cope and tantrum to get out of situations, or was this a child who felt physically ill manifesting as fatigue and truly couldn’t cope?
Fortunately, I stumbled right into what is probably the right answer.
I asked if he slept well, and specifically did he snore?
They said he did snore and was a restless sleeper.
Now the big question: Is he rested when he gets up in the morning or does he have a difficult time getting going in the morning? Yes he is irritable and slow in the morning they said…DING,DING,DING…now we are getting somewhere.
This is a perfect example to highlight the importance of sleep to a child’s well being.
Turns out that Johnny’s large tonsils and adenoids were causing serious sleep problems for him.
He was tired and frazzled all the time.
He just couldn’t cope with the demands of school and melted down when he was overwhelmed by fatigue.
An alert teacher and parents knew something was wrong and they took action… good for them.
A tonsillectomy cured this child’s behavior problem at school by giving him a large enough airway in sleep to allow him to get restorative sleep.
Surgeons curing behavior problems and improving school performance…what won’t they figure out next?
So here are the take home points I want you to remember from today’s cast.
Snoring during sleep is usually not a health problem except when a child, or an adult for that matter, doesn’t get enough quality sleep to feel restored.
School age children are very prone to obstructive sleep because they have small noses and throats, large tonsils and adenoids due to so many nose and throat infections, are frequently congested, and have a higher need for sleep.
If a child is sleep deprived, the consequences are very large for them including learning problems, behavior difficulties, impulsiveness with all it’s consequences, and more frequent illnesses.
If you think your child may have trouble with sleep, talk to your pediatrician… they may be able to help.
If they can’t help, most big cities now have sleep specialists who are expert in these matters… be your child’s advocate…you will be glad you did.
Again, thank you for joining me today.
I am truly flattered by the following we are starting to get for the blog.
I had no idea I would become a media personality in my next career.
Comments on Itunes, face book or twitter are welcome.
I will post insightful comments on my blog so keep those coming.
Please spread the DocSmo word to your friends.
I try and bring you high quality, peer reviewed and referenced information in a very approachable form.
I have started posting transcripts of each pedcast for those who might prefer to read the content rather than listening… I hope you will find that useful.
This is Dr. Paul Smolen, your host, broadcasting from studio 1E in Charlotte, NC hoping your children won’t make a peep during their restorative sleep.
Until next time.
In November of 2011, the Academy of Pediatrics experts revised their guidelines for pediatricians when it comes to the management of children with ADD. In this edition of DocSmo.com, Dr Smolen introduces parents to the new changes when it comes to helping children with ADD along with some of his own insights and opinions. Informed parents will certainly want to listen.
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My partners are really smart people with a lot of experience under their collective belts. I pay a lot of attention when they speak, because I always learn from their wise insights. Such was the case the other day in the lunchroom, when the subject of practical ADD management tips came up. One of our doctors has a child with ADD, so she is speaking from more than doctoring experience, which gave the conversation a whole new perspective. Here are the highlights:
Things are not always what they appear: Dr. Kimberly Riley recalled stories of children whose main problem was not attention span but learning disabilities. She has noticed that after their learning problem had been identified and helped, the impulsiveness and inattention faded away. They didn’t have ADD, simply a learning disability that had not been recognized. Dr. Riley also pointed out that if a child has severe learning difficulties, genetic testing may aid in looking for recognized genetic problems that impair learning. Conversely, Dr. Downing has noticed that in her experience, many of the children that present mood problems like anxiety, depression, or oppositional behavior really have ADD as a core feature dominating these children’s personality. Both the mood problem and the ADD issue need to be addressed for the child to get maximum benefit.
Sleep problems usually seem to accompany the ADD personality: all of the doctors agreed that many children who are diagnosed with ADD have innate sleep difficulties. Certainly, the medications that are used to treat ADD can cause sleep problems on their own, but this is not the root cause. Dr. Plonk has noticed that initiation of sleep can be very difficult for these children, going all the way back to infancy. He believes that this problem has a neurological basis. Drs. Plonk, Riley, Moorman, and Downing all recommend 1-3 mgs. of Melatonin about 30 minutes before bedtime to help children get to sleep; they feel that this OTC hormone is both safe and effective. They also have found that a homeopathic product called Calms Forte can be effective in children with ADD. Both of these products have unfortunately not been tested by the FDA for safety or effectiveness since they are non prescription products. Keep in mind, however, that both parents and doctors are fans of melatonin so I think you can be confident giving it a try.
Beware of the easy fixes: My colleagues believe that ADD is a neurologically based “chronic” disorder. Chronic means just that, chronic. They have noticed that as children mature, they almost always improve in their ability to concentrate and to avoid distractions but often don’t catch up with their age-matched peers until adolescence or beyond. For those who need help, the combination of behavioral therapy, attention to learning problems and associated mood problems, and possibly medication seems to get the best results. The doctors were pretty unanimous declaring that dietary supplements (except fish oil), strict dietary restriction of sugar, gluten and preservatives along with other assorted therapies seem to have limited effectiveness. As you will hear in the Pedcast featuring Dr. Kilbane, other physicians strongly disagree with that contention.
Let’s not forget there is a kid with feelings behind that diagnosis of ADD: Drs. Plonk, Riley, Downing, and Moorman became very animated and forceful when the subject of a child’s self image and self esteem came up. They all strongly feel there is a need to speak directly and honestly to children who have this diagnosis, reminding them that they are not “bad kids” and that to a large degree, they can’t help this impulsive behavior and lack of attentiveness. Dr Downing even noted that one of her patients declared to his mother just after this conversation, “You owe me, Mom” (an apology I presume). Understanding that the ADD behavior pattern is not anyone’s fault can be a huge relief to many families. As Dr. Downing points out, guilt is a strong emotion, and doctors can be very useful in mitigating some of this emotional baggage.
Conclusions of the doctors: My partners feel that the best approach to helping a child with an ADD diagnosis includes: having their learning problem and mood difficulties addressed, managing sleep problems if they exist, making sure that the school they attend provides appropriate accommodations to help the child with behavior and learning, initiating good behavioral management strategies at school and home, and most of all treating the child and his/her family with the respect and patience they deserve. That is the Lunchroom Lowdown for this week.
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