What’s Working For Me: A Game To Help Stressed Kids Feel Better

Children often have feelings and thoughts of which they are not mindfully aware. Those thoughts and feelings about life experiences or specific situations can cause feelings of unease that increases anxiety.

At the heart of it, the cognitive side of anxiety (because there can be quite a strong biological side as well) is about the perception that one does not possess the necessary skills to cope with or manage specific task demands in daily life. As an example, a child might be stressed about a vocabulary test if the words are difficult for the child to read, remember and retrieve.  A child might be anxious about going to lunch when he feels he might not have the skills to seek out a table mate and feel less alone while eating lunch.

So we have an activity in our book of 70 Play Activities called What’s Working For Me that helps children think about what might be working and what might not be working about a specific life circumstance. The children are then empowered to find new thoughts, words and actions to cope in a new way with the situation. You can use it for a variety of circumstances, let your creativity guide the way.

Let’s look at the lunch example.  We would say this….quietly, one on one with the child.

“Joey, I see that you are hesitant to go to lunch each day. I’d like to know more about what that is like for you. Are you open to playing a thinking game with me about lunchtime?”

“Let’s write down a few things that are working for you when you go to lunch. Then we can fill out our What’s Working for Me planning sheet and develop a plan to make lunch time better for you.”

What’s Working For Me

T: Let’s think about what you like about lunch.

J: “Well, I’m usually hungry, so it’s good to eat.”

J: “I like the days when they serve grilled cheese.”

J: “When Sam is at school, I usually sit with him.”

T: “Great! let’s write that in the green box, What’s Working For Me.”

T: Now, what don’t you like about lunchtime?

J: “I hate sitting alone.”

J: “Sam is sick a lot so then I have to sit alone.”

J: “No one asks me to sit with them.”

J: “It’s embarrassing.”

T: “Thanks for sharing that with me, I can see how it could feel sad to eat lunch alone.”

T: “We have a third box on our What’s Working For Me planning sheet. Let’s brainstorm how lunch could look differently so you can feel better about going to lunch.”

T: “If lunch were better for you, what would that look like?”

J: “Well, I’d have a friend to sit with all the time.”

T: “Who else besides Sam, might you like to sit with?”

J: “Jessica but she sits with her friends.”

T: What if you asked Jessica, “Hey Jessica when Sam’s not here, may I sit with you guys at lunch?”

J: “She’d probably say, ‘No.’

T: “What might be a good time to ask her? Would the best time be right before lunch, or might you ask her in class one day to plan ahead for the situation?”

J: “I could try to ask her in the morning before school.”

T: Okay let’s write that down and maybe even practice the words you will use.

T: “Then we can even write a few more ideas, about other things you can do to make lunchtime a happier time for you.”

As teachers, clinicians and parents, you know that conversations with children might be really straight-forward or you might need to help them along in the conversation. Be patient, ask reflective questions or ask the child to tell you a bit more, “Help me understand that better.”

Just letting stressed children know that they can solve a difficult situation by looking at what is working and what they’d like to see be different is empowering and can lead to better daily experiences.


70-play-hi-res-150x197Written for teachers, educators, and clinicians whose work involves playing, talking or teaching children who would benefit from better executive function and social-emotional learning skills, 70 Play Activities incorporates over 100 research studies into printable worksheets, handouts, and guided scripts with step-by-step directions, to empower children to learn and behave better. “With 70 Play Activities we aim to improve the trajectory of children’s learning by integrating the newest neuroscience with activities children love!” With over 70 activities designed to improve thinking, self-regulation, learning and behavior, your tool-kit will be full and your creative brain will be inspired to craft your own meaningful exercises. 70 Play Activities is available at amazon.com


Video: Is Your Child’s Rash Fifth Disease and Should You Worry?

In this video Dr. Rob Hicks, a general practitioner (GP) or family physician, briefly describes Fifth Disease or “Slapped Cheek Syndrome,” and how you can tell this rash apart from other more concerning illnesses.

Editor’s Note: Video Highlights

  • child-fifth diseaseFifth Disease – or “slapped cheek syndrome” is a viral infection, caused by the virus, parvovirus B19
  • It is spread in the air when we cough or laugh, when we sneeze, or in saliva and air droplets when we’re in close contact
  • It is most commonly children who get it – usually between the age of four and 12 – and can spread very rapidly throughout a classroom or school
  • The symptoms to look out for are generally those of a common cold,so sneezing, runny nose, sore throat, headache, fever.
  • But the characteristic of this infection is the rash – the blotchy red rash on one or both cheeks that gives the slapped cheek appearance
  • The rash can remain on the face, but could spread to the rest of the body,including the palms of the hands and the soles of the feet
  • Generally, it’s not painful but it might be irritating for some
  • Unlike the worrying rash of meningitis, if you press this rash it will fade
  • Symptoms are often mild and parents should follow the usual management of any viral infection,
    • Plenty of rest and plenty of fluids
    • For sore throats or a high temperature children’s paracetamol (acetaminophen) or ibuprofen is perfectly reasonable
  • If you’re not sure have a word with a pharmacist or with your doctor
  • The people who need to be concerned are pregnant women – if you get the infection in early pregnancy and you’ve not had it before it can increase the risk of miscarriage

Child Health & Safety News 4/17: Dangers of ‘Sharenting’

twitter thumbIn this week’s Child Safety News: Fire safety: One child dies every two weeks from fire-related injuries http://bit.ly/2oQrDPZ

Welcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use social media to communicate relevant and timely health and safety information to the parents, medical professionals and caregivers who follow us. Occasionally we miss something, but overall we think we’re doing a pretty good job of keeping you informed. But for friends and colleagues not on Twitter or FB (or who are but may have missed something), we offer you a recap of this past week’s top 15 events & stories.

PedSafe Child Health & Safety News Headline of the Week:
‘Sharenting’ – parents sharing their kid’s information online – could get their kids in trouble (identity theft, predators, etc.) http://kng5.tv/2oG5P7V

Service Dogs in Schools? What Do You Need to Know?

There are many questions and concerns involving the use of Service Dogs by children in schools, but it is becoming a recurring theme in the news of late. So I decided to write a post about it to better educate parents in case this becomes an issue in your school. What are the pros and cons? Do the pros outweigh the cons? Are there risks to your child both physically and educationally by having a dog in the classroom? These are all topics I would like to discuss with you, because I think they are important.

So I think the first step needs to be precisely defining what a Service Dog is, and what their role is for a person with disabilities. And I think it is important to explain that not all disabilities that require a Service Dog are visible.

That being said, in layman’s terms, a Service Dog (or SD) is a dog that has been specifically trained to perform certain TASKS that allow the owner with disabilities the ability to live a full and independent life. What do I mean by ‘tasks”? Let’s break it down into obvious and not-so obvious disabilities (visible –vs- invisible) that allow a person to function and perform what we call ‘daily living skills.’

Obvious Disabilities:

  • Someone in a wheelchair may have a dog that pulls the wheelchair for them.
  • Someone who has difficulty walking due to certain medical conditions (such as Multiple Sclerosis or Cerebral Palsy) may use their dog to lean on to get them from one place to another. (Also known as a Mobility Support Animal)
  • Someone who is blind may have a guide dog.

Not-So-Obvious Disabilities:

  • Someone who suffers from seizures may have a seizure alert dog. Under ‘typical’ circumstances, they look just like everyone else and you would never know they have a debilitating disability. But this dog can save their life. The dog cannot stop the seizure from actually happening, but by ‘alerting’ their person (often with a touch or a whine or bark) that a seizure is imminent…. it allows the person time to get themselves into a safe position (ie: lying down or out of the shower or tub) so when the seizure hits, they do not fall from a standing position, causing a possible head injury, or drown in a shower or tub.
  • Someone who suffers from diabetes may have a diabetic alert dog. The dog is trained to ‘alert’ their person if their glucose levels becomes very low, or too high. Unlike the seizure alert dog, where the dog cannot physically stop the seizure from happening, by alerting their person that their sugar levels have changed, it enables the person time they would not have had before to check their sugar levels and correct the situation before it can become dangerous.

Put yourself in the shoes of the parent of the children who suffer these disabilities (and many others….. there are just too many to list) and ask yourselves this: if you had a child with some of these issues, how much comfort would it give you to know that they have a constant ‘early detection device’ with them at all times?

I have touched on some of the life-saving ‘pro’s’ of the child having their Service Dog with them. But here are a few other benefits:

  • Integration into everyday life: A child with disabilities can easily feel ostracized or different from other people. This may make them shy, insecure, fearful, and at times unable to talk to or connect with their peers that they see as ‘normal’. They are more open to taunting and bullying. I mentioned in a previous post how I was once so painfully insecure, I did not know how to approach or talk to people. What I did not mention was that had it not been for my Golden Retriever Radar, I doubt I would have made it to or through my first Narcotics Anonymous meeting! In my mind, it was just one more group of people that would reject me! But amazingly, walking in with my dog broke the ice. People approached ME and asked me questions, which opened up that line of communication I so desperately needed!
  • Independence: If you are anything like me, asking for help is never an easy thing. I like to be self-reliant. So imagine having to constantly ask for help with things, and what a toll that might take on your self-esteem and confidence daily? Now imagine having something that suddenly allows you to do for yourself what you previously always had to ask others to do for you? Can you imagine the sense of freedom that would give you?

I want to share with you here a wonderful short video that can show you first-hand (From the perspective of both a parent and a child) how a service dog can drastically change the life of a child.

So what we have focused on until now are the positives for the parent and child WITH disabilities. So if you are a parent who has a child with disabilities, this post may open new doors for you!! After reading this, you may have never thought of getting a Service Dog for your child, and this may have shed some light on some of the wonderful advantages your child may enjoy by obtaining a Service Dog! If you are interested in learning more about obtaining a service dog for your child, there are numerous organizations that specialize in training Service Dogs specifically for children such as Canines For Kids and 4 Paws for Ability.

But what if you do not have a child that suffers from disabilities, how can having a SD in a classroom affect your child?

First off, it is important to understand that the training that goes into a Service Dog is quite different from the training you would get for an everyday pet. It begins the same way, with basic housebreaking and commands, but after that, it becomes very different.  Depending on the type of Service Dog required, some Service Dog training companies such as CCI (Canine Companions for Independence) or the Guide Dog Foundation begin training at eight weeks old or younger. The pups are raised by people or families known as ‘puppy raisers’ where they learn things like the basic commands, leash manners, and are brought into numerous different situations to acclimate them to things like sudden loud noises, (such as cheering at a ball game) flickering lights (such as in a movie theater) constant action (like in a mall or store) or even sudden applause (like at a show.) Then at 18 months, they are brought back to the facility where they came from for extensive training, where they learn specific tasks, like pulling a wheelchair, turning lights on and off, picking things up when they fall on the floor, etc. I will add here that an any given time, the facility may determine that a dog is NOT suitable for this type of work, (they may be a bit too energetic, or may be easily distracted…. all traits that could be very dangerous for the person depending on them!) and their SD training ends there.  After about a year of this extensive training, they are finally matched with their eventual owner/handler and for the next six to eight months, the dog/handler team work together at the facility on the challenges the specific owner has that requires the Service Dog’s assistance.

Photo Credit: de:Benutzer:Rmarte; CC BY-SA 3.0

Some Service Dogs, again, depending on the situations the dog is needed for, may be owner taught, or the owner may have hired a professional trainer to make their current dog a Service Dog, but regardless of where they have received their specialized training, all Service Dogs must pass a Service Dog Public Access Test to be recognized as a SD. If you are interested in learning more about what this test requires, and it would make you feel more comfortable about a Service Dog being in your child’s school, you can watch this video on the requirements to pass the test.

So safety-wise, your child should not be at risk having a Service Dog that’s passed the Service Dog Public Access Test in their school, because the training requirements are quite high!

However, there are some potential risks to your child health-wise. For example, if your child has severe allergies to dogs, this may make it very difficult for your child to be in an enclosed environment (such as a classroom) with one.

And educationally… it may cause some issues for your child as well. Let’s face it….having a dog in a classroom (even an extremely well behaved dog, doing nothing but lying quietly next to the child’s desk) can be a major distraction for the first few weeks or months…. especially for a child who is easily distractible to begin with. (Think about the words to Mary Had A Little Lamb…. “It made the children laugh and play to see a lamb at school.’)

And lastly, we don’t want to forget about the child who is deathly afraid of dogs! Especially since most dogs trained to work with children tend to be on the larger size for stability reasons.

So how can we make this a win-win situation where everyone is happy? By following some simple guidelines right from the start:

If it is your child’s dog:

  • Make sure the school is aware that your child will have a Service Dog with them before the term begins.
  • The school has quite enough to do ensuring the safety and well-being of every child in their care. It is not their responsibility to walk, clean up after, or take care of the dog. So you must make sure that either your child can fully tend to their own dog (taking them to potty and cleaning up after them, giving them water, etc.) or make sure to arrange for yourself or someone outside of the school staff to take care of them periodically throughout the day.
  • Prepare your child for different scenarios that may come up and coach your child on how to handle them. For example, kids will be curious, and do not know how to ‘sensor’ questions the way adults learn to, so your child may be asked, “What’s wrong with you that you need a dog?” Explain that the child may not necessarily be trying to be cruel, but probably just curious. You can also prepare your child on what to do if someone comes up to pet the dog, or asks to pet the dog. (It might help to have a “Working: Do Not Pet” patch on the dog’s vest.)
  • Be aware of your child’s rights to have their dog with them in case you come across any difficulty and you need to advocate for your child. Be willing to be flexible and accommodating if another parent has a kid with severe allergies but is stead-fast on their child staying in a specific classroom for whatever reason. Remember, it is not about who is right and who is wrong here; it is about working together for the best outcome for all children involved.

Suggestions for the school:

  • Send out notices to the parents regarding the presence of the dog several months prior to the start of the term. You can even ask the parent of the disabled child if they would like to create the first draft: it will save you hours of worry about wording it correctly and help them to protect their child’s privacy…at a minimum they’ll appreciate your making the effort. Also, sending notices early will give you time to identify any potential conflicts (i.e. if a child with severe allergies or a fear of dogs is scheduled to be in the same class).  This will give you ample time to move one of the children into a different classroom prior to school beginning, or to allow parents the opportunity to ask any questions they may have.

Note: keep in mind the ADA (Americans with Disabilities Act) states: “Allergies and fear of dogs are not valid reasons for denying access or refusing service to people using service animals. When a person who is allergic to dog dander and a person who uses a service animal must spend time in the same room or facility, for example, in a school classroom or at a homeless shelter, they both should be accommodated by assigning them, if possible, to different locations within the room or different rooms in the facility.” 

  • Hold an assembly or at least a classroom meeting at the start of the year to explain to the children a few important guidelines and boundaries regarding the Service Dog. For example, the fact that the dog is not a pet, but that it is working, and the importance of them not petting or distracting the dog from its job. I find it helpful to explain to children that in this case, the dog is really no different than a wheelchair or crutches would be for a child. I have also found that many children are very excited and proud of their dogs, and the things their dog can do for them… so ask the child if they would like to participate and help talk to the children about their dog. This may also avoid a situation like I mentioned above…. Questions being asked out of curiosity that may hurt a child’s feelings.

If you have a non-disabled child that will be in a class with a SD:

  • Talk to your child in advance about there being a Service Dog in the classroom to help a child who needs assistance. Ask for their input if they feel this would make it too distracting for them, and really listen to their answers. Remember, the parent of the disabled child is looking out for the best interest of their child by having the dog; you have to look out for the best interest of yours! It is not a matter of not caring about the other child, but remember, you are always your child’s best advocate! And your child has rights too.
  • Encourage them to ask you if they have any questions, and if you are not sure of the answer, spend time with them researching the answer online.

In conclusion, I will wrap this up by saying that it is important to remember that every single child matters! Each child has their own set of strengths and weaknesses that make them special and unique. If we all work together, we can create a safe, loving, caring, and happy environment and future for each and every one of them!

How Can a Sock Monkey Make Commuting with Your Kid Safer?

Rarely do you find yourself getting excited while driving your kid to school. But, much to my teen’s chagrin, that’s just what happened one morning last week.

It’s all because my son was awake and observant that morning. As I was navigating a busy round-about near our neighborhood – he cried out, “What the heck?? Some crazy person has a life-size sock monkey in their front passenger seat!”

Now this intrigued me, but I didn’t manage to see the car since I was trying to keep us safe in traffic. So I asked him for more details, like who was driving. “It was a woman,” he said…..and then the all important clue: “And she had a little kid in a car seat in the back….what a weirdo!”

Now I am both a newly minted public health professional (MPH received last year!) and a child health and safety geek (seven years as Senior Editor at Pediatric Safety will do that to you!), so I immediately had a flash of insight. “Oh,” I said, “I know what she’s doing!!” “Oh that’s so cool!” I was practically bouncing up and down in my seat. Thankfully I had already merged into traffic on the local parkway.

“She’s taking her kid to daycare on her way to work, and the sock monkey is next to her to remind her that the child is in the back seat. When they aren’t using the car seat, the sock monkey sits in it – and when they put the little girl in the car seat, they move the sock monkey doll up front as a visual cue.”

The reason I was SO excited is this was an example of child safety in action. Forgetting a baby or young child in the back seat can happen to any parent when we are on autopilot, trying to get all the morning tasks done and get to work. And even a short time alone in a hot car can be fatal, since children’s bodies heat up faster than those of adults. More details on heatstroke and kids can be found at the links below:

Given the risks of heatstroke, government experts and child advocates recommend memory helpers, like keeping a stuffed animal in the car seat and moving it up front when the child is strapped in (see the links above). Experts also advise parents to keep something critical for their day in the back near their child – like a purse, briefcase or mobile phone.

Now you might think that you don’t need to take measures like this….but research shows that the easiest way to adopt a new habit or remember something is to set up your environment to help you – like ridding your house of fattening foods, keeping your gym clothes handy and visible….or putting a life-sized stuffed animal next to you in the car when your child is in back.

I don’t know who the woman was on the road that morning, but I commend her effort to ensure her child’s safety – and she really made a child safety geek’s day! Oh, and if you’d like to buy a life-size sock monkey, they have them on Amazon.


How to Boost Your Child’s Bones for Lifelong Health

Children’s bones keep growing throughout childhood. They grow fastest of all very early in life and when children go through puberty.

The bones keep getting denser until they reach what’s known as “peak bone mass”. This usually happens between the ages of 18 and 25.

boost-your-childs-bone-healthThe denser your child’s bones are at the time of peak bone mass, the greater their reserves of bone to protect against the fragile bone disease osteoporosis later in life.

“The reserve of bone you establish during childhood and the teenage years is with you through early adulthood,” explains Dr Paul Arundel, a consultant in paediatric metabolic bone disease at Sheffield Children’s Hospital. “We all start to lose bone mass later in life. If you are starting from a low baseline you are more likely to develop osteoporosis sooner.”

The good news is that you can protect your child’s bone health with some simple lifestyle measures.

Your Child’s Bone-friendly Diet

Building strong bones in childhood requires a range of vitamins and minerals. A healthy, balanced diet will provide this. That means a diet that includes:

  • fruit and vegetables – at least five portions every day (but no more than one 150ml – *about 5 oz – glass of fruit juice)
  • carbohydrates – such as potatoes, pasta, rice and bread (preferably wholegrain)
  • protein – such as meat, fish, eggs, beans, nuts and seeds
  • dairy products – such as milk, cheese and yoghurts

There are a couple of nutrients that are particularly important for building strong healthy bones.

Calcium for Healthy Bones

Our bodies contain about 1kg (*about 2.2 lbs) of calcium. About 99% of this is found in our bones and teeth – it’s what makes them strong and hard. Most of this calcium is laid down during childhood and the teenage years.

Calcium is particularly vital during puberty when the bones grow quicker than at any other time. Puberty takes place over a number of years, typically sometime between 11 to 15 for girls and 12 to 16 for boys.

The recommended calcium intake for children and young people aged from 11 to 18 is 800-1,000mg compared with 700mg for adults. But research shows that, on average, children and young people in this age group don’t get enough.

“Teens need more calcium because they’re growing,” says Dr Arundel. “People don’t think about bone health in teenagers as much as they do with toddlers, but teenagers are growing a lot more.”

Foods that contain lots of calcium include dairy foods such as milk, cheese and yoghurt, but also tinned sardines (with the bones in), green, leafy vegetables (but not spinach), peas, dried figs, nuts, seeds and anything that’s fortified with calcium, including some soya milks.

Vitamin D for Kids’ Bone Health

Vitamin D is important for bones because it helps our bodies to absorb calcium.

Our main source of vitamin D is sunlight. Vitamin D is made by our skin when it’s exposed to sunlight during the summer months (late March/April to the end of September).

There are only a few foods that are a good source of vitamin D. These include oily fish, eggs and foods that have been fortified with vitamin D, such as fat spreads and some breakfast cereals. Read Food for strong bones.

To ensure they get enough vitamin D, the following groups should take daily vitamin D supplements, to make sure they get enough (*US recommendations are similar – click here):

  • All babies from birth to one year of age (including breastfed babies and formula fed babies who have less than 500ml a day of infant formula)
  • All children aged one to four years old

Everyone over the age of five years is advised to consider taking a daily supplement containing 10 micrograms (mcg) of vitamin D.

But most people aged five years and above will probably get enough vitamin D from sunlight in the summer (late March/early April to the end of September), so you might choose not to take a vitamin D supplement during these months.

It’s important never to let your child’s skin go red or start to burn. Babies under six months should never go in direct sunlight. Find out how to get vitamin D from sunlight safely.

Find out more about who should take vitamin D supplements and how much to take.

If you receive benefits, you may be eligible for free Healthy Start vitamins, which contain vitamin D. Your health visitor can tell you more, or you can visit the Healthy Start website.

Bone-strengthening Exercises for Children

Daily physical activity is important for children’s health and development, including their bone health.

Try not to let your child be sedentary for long periods. You can do this by reducing the amount of time they spend sitting down, for example, watching TV or playing video games.

Children under five who aren’t yet walking should be encouraged to play actively on the floor. Children who can walk on their own should be physically active daily for at least 180 minutes (three hours) spread throughout the day. This should include some bone-strengthening activities, such as climbing and jumping.

Children aged five to 18 need at least 60 minutes (one hour) of physical activity every day, which should include moderate-intensity activity, such as cycling and playground games.

To strengthen muscles and bones, vigorous-intensity activities should be included at least three times a week. This could be swinging on playground equipment, sports such as gymnastics or tennis, or hopping and skipping.

See 10 ways to get active with your kids.

Eating Disorders and Bone Health

Eating disorders affect people of all ages, both male and female. But girls and women are more likely to be affected and anorexia most commonly develops in the teenage years.

The bones are still growing and strengthening at this time and eating disorders like anorexia can affect their development. Low body weight can lower oestrogen levels, which may reduce bone density. Poor nutrition and reduced muscle strength caused by eating disorders can also lower bone density.

If your teenage child has anorexia or another eating disorder, it’s important to seek medical advice about their bone health.

Editor’s Note: *clarification provided for our US readers.