Tag Archives: behavior

Can TV be a positive influence on your children? (Article)

For parents, it can often seem like their children are being lost to the tempting clutches of a technological world. Instead of playing outside in the fresh air or creating adventures in tree houses, many children now invest their imaginations in the flashing of television screens and video games. A large percentage of children in the U.S. spend over three hours every day watching the TV–an alarming statistic with potentially severe consequences if we fail to check this trend.

Research has confirmed that TV messages are not always benign and have the potential to alter a child’s maturation, foster aggression, or even impair attention spans. Parents know they need to limit the amount and type of TV their children watch,  but placing limits is always easier said than done. Cutting television consumption down to less than an hour a day, as recommended by the American Academy of Pediatrics, is hard. Parents have increasingly packed schedules and often little time to monitor their children’s television viewing habits. TV provides endless entertainment, and I have found that many parents have so much anxiety about allowing their children to have unstructured time outside that they prefer to let their children watch TV in the safety of their living room.

An article in the November issue of the journal Pediatrics posed the following question about TV viewing and children: would replacing the programming that includes violence with educational and positive message programming alter reduce TV’s effect on children? In their study, researchers informed families about the dangers of violent television shows and introduced them to programs that promoted positive societal ideals. The focus was no longer on how long TV was watched, but on what was being watched. The study found that when parents sat down with their children to explain and moderate educational television content, the children who watched these pro-social programs became less aggressive and interacted with peers in a more appropriate manner. So, instead of battling with your child about switching the television off, just flip the channel to a healthy, educational show and watch it together. Unsupervised, unstructured viewing is what parents want to avoid. Both you and your child will be satisfied, and such a little change may increase your child’s curiosity about the world. Watching quality TV will not be a substitute for the great outdoors, unstructured play, physical activity, and your attention, but it’s a step in the right direction.

Smo Notes:



Written collaboratively by Keri Register and Dr. Paul Smolen

When Snoring is a Problem for Children (Pedcast)


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.

From the desk of Doc Smo: Pediatric Practice, the New Frontier (article)

I get a lot of reading material each week, way more than I can possibly digest with a full time job and a cutting edge blog to run. On Sunday, I received a newsletter from the Center for Disease Control with recent information that they have collected and published. I also get various pediatric new journals, including the journal Pediatrics, as part of my membership to the Academy of Pediatrics. While diving into these publications this week, I was struck by the number of articles that revolve around mental health issues. I went into the practice of pediatrics because I really enjoyed the practice of infectious disease. Pediatrics was an infectious disease specialty when I signed up for duty. Not any more; it seems to be evolving into a mental health specialty. Let me give you a flavor of some of the information that is coming at pediatricians these days:

Pediatrics, November 2011
“Media, Profanity, and Aggression”
“‘Action signs’ for Child Behavioral Health Problems”
“Shyness vs. social phobia”
“School Nurse Treatment of Adolescent Smoking”
“Correlates of Sedentary Behavior in Preschool Children”
“ADHD: Clinical Practice Guideline”
“Media Use by Children Younger than Two Years of Age”

The Mortality and Morbidity Newsletter from the CDC, January 2012
“Quick Stats- Depression in the population divided by age”

Pediatric News, December 2011
“Don’t Let Comorbidities Keep Obese Child on the Couch”
“15 Minute Interview for Serious Mental Disorders”
“Teen Behavior Involving Sexting Varies Widely”

The shift in pediatric practice from infectious disease to a mental health is undeniable. Fortunately, I feel that I am much better equipped to advise families with regards to behavioral issues now that I have 30 years of pediatric experience under my belt. Those families that I tried to help 30 years ago didn’t get as much bang for their buck. We were simply not trained or prepared to help families with behavioral problems, let alone families encountering true mental illness. If things keep going in the direction that I am seeing, the next generation of pediatricians better get ready for an ever-increasing amount of childhood anxiety, depression, behavioral problems, developmental disorders, and autism. Hopefully they will up to the challenge.

“Sit Down and Listen”: ADD News 2011 (Pedcast)

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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