Tag Archives: mood

Stomachaches: Worried about the Wrong Organ? (Pedcast)

Topic Introduction

Pediatricians see a lot of children with stomachaches. It is estimated that about 10% of the childhood population have a stomachaches as often as 3X/3months, the definition of a syndrome pediatricians call recurrent abdominal pain. These children not only suffer great pain, but they miss a lot of school and other activities of childhood. Children with recurrent abdominal pain need to have some tests to make sure that they don’t have a serious disorder but fortunately, most of the time there is nothing seriously wrong with them. That is not to say that there is nothing wrong, just nothing seriously wrong with their intestines. The lack of a major disease of the gut is great news for these families but leaves everyone with a real dilemma, what is wrong with these children how do you help the child? That’s the topic that we are going to explore today so sit back and get ready for another edition of Portable Practical PediatricsContinue reading

The Tired Teen (Pedcast)

Doc Smo here, you know Dr. Paul Smolen, your pedcast host.  Today we are going to discuss a topic that is most relevant for parents with teens in the house.   You folks with younger children, you listen up as well:  your time is coming before you know it. We all know that teenagers tend to be moody but what should a parent do when their child has persistent fatigue and changes in mood. Well, that’s the topic we are going to take on today.   It’s not too uncommon for parents to bring their teenagers to the pediatrician with physical complaints of fatigue, irritability,  dizziness, and sleep problems.  More times than not, these physical complaints turn out to due to difficulties with mood, either excessive sadness, worry, or even anger.  As a pediatrician, I always have my radar up for physical symptoms that might indicate a serious disease process but most of the time fatigue is an emotional symptom.  So once we are sure that our tired teen does not have fatigue from a something like diabetes or thyroid disease, what’s next?  How can we help them feel better?  I thought it would be useful to take a few moments and share with you my practical suggestions that I have found can be very helpful to children and families in who find themselves in this situation… having physical symptoms from emotional fatigue and stress.     I think step one is to visit a pediatrician who has cared for your child and knows them well.  I think a large part of the healing process comes from a child feeling that those around them care and take their complaints seriously.  Reassuring them that they don’t have some dreaded disease by taking their complaints seriously is also an important aspect of the doctor visit.  I feel this is best done by someone who they already know and trust. Don’t underestimate the power of a health professional listening, touching, reassuring, and demonstrating understanding.   Next I suggest that all my tired teens work on a few things that have been shown to improve mood in anyone, child or adult:   -I make sure that they are getting enough physical exercise.  I think they should exercise a minimum of an hour a day.  Walking is fine, riding a bike, throwing a Frisby, whatever but they need to get out and do it!  Movement and enjoyment is the key! And I mean out, that’s outside where there are green trees and lots of light.  Light sets our clocks for sleep and can help your child get enough sleep and the light also improves their mood…for real. Actually researchers have found that physical exercise is as effective at improving mood as most anti-depressants and a whole lot cheaper and safer! -Next, we go over their sleep habits and possibly make improvements there. Experts think that children older than 12 years old need 8-9 hours of sleep nightly. Regular bedtimes, turning off electronics, quieter activities in the evening are an important part of a healthy sleep formula.  I encourage the child to establish a regular bedtime ROUTINE. Many parents tell me that evening, near bedtime, is a good time to talk about your child’s feeling.  Bedside conversations like these can be very powerful and I think you should try and initiate these talks.  Enforce no cell phones or other electronics in your teens room.   -Nutrition is also an important aspect of mood and energy.  I explain to the tired teen that certain fats found in fish and other foods can really be helpful.   Fish consumption or an omega 3 supplement is a must as is vitamin D supplementation  in case the child’s level should be low.  In this situation, I actually recommend a multivitamin, especially if the teen’s diet is poor.  It also goes without saying that reducing soda, caffeine, and processed food will help anyone feel better.   -Finally, I think that having friends, helping others, and being praised for even the smallest of achievements can all be very uplifting activities. I encourage families who have a tired teen to try all these things. Parents can facilitate their child’s friendships by making an extra effort to provide transportation and activities their teens might like as well as encourage their teen to help around the house, neighborhood, or community… and of course they can praise and recognize any helpfulness, success, or healthy attitude their teen exhibits.     And finally, I think a follow-up visit to assess how your teen is doing is really important at which time we determine if things are getting better or a mental health referral is indicated.  Let me reiterate that what we have talked about is for mildly depressed or anxious teens and not for children with severe disturbances in mood or behavior.  If these measures doesn’t improve things for your child or you think they may be having serious thoughts of harming themselves or others, please…. get some professional psychological help.  You’ll be glad you did.   For more portable, practical parenting information, take a few minutes and explore the literally hundreds of pedcasts and articles posted at my blog, www.docsmo.com.  Your comments and stories are always welcome and of course we love when you share these posts with friends and family.  This is Doc Smo, hoping you can find a simple step to increase your teen’s pep. Until next time.

Lunchroom Lowdown- Attention Deficit Disorder (Article)

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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