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Should Kids “Motor Mouth”? (do they need an electric toothbrush?)

Has your dentist recommended an electric toothbrush for your child?

Why spend the money? You didn’t have one and turned out just fine, right? Well you may not have had a car seat as a child either but does that mean it was right?

Clinical research shows that electric toothbrushes are far superior to manual brushing when it comes to removing plaque and preventing gum disease. Children who lack the understanding of proper brushing or the motor skills necessary to do so are given a much more effective way to maintain good dental health. It is important to instill the behavior of good oral hygiene habits early to promote a life long understanding. Your child may begin with an electric toothbrush as soon as he/she is able to hold it steady and firmly.

Starting your child with a basic, colorful electric toothbrush is recommended.

There is an assortment of toothbrushes with your child’s favorite characters or princesses available that will help encourage use. If your child already uses a manual toothbrush, they may not be interested in the switch. Any brushing is better than none so if the transition doesn’t go well, you can always try again later.

Of the many electric toothbrushes, there are also many features offered and the cost can vary from $15-$200. It is important to choose a brush that is age appropriate in size and speed. Electric toothbrushes with a timer and include a melody and/or light up make for a more fun brushing experience. Of the higher end models, such as Sonicare and Rotadent, you are actually able to provide a much more cost-effective way to provide electric tooth brushing to your entire family. With these systems, your family can share the handle and just replace the head (or brush) with their own when it’s time to brush. These systems have different speeds, different types and sizes of brush heads ensuring that everyone in the family can brush correctly and safely. These higher end electric toothbrushes also come with warranties and can be repaired or replaced in the event of malfunction.

The best benefit to electric toothbrushes, as a parent, is the peace of mind that our children are creating and maintaining good dental habits.

Since an electric toothbrush does a better job of cleaning your child’s teeth, this eliminates the need for you to step in and finish the job. I don’t know about you but I’m all for improved dental health, preventing gum disease and whiter, healthier teeth with less work!

Is it Safe to Wiggle a Loose Baby Tooth?

My daughter Katie’s first baby tooth came out in a spoonful of Nutella. And she lost the second one backstage at a play when she bumped a chair against her mouth by accident. She had gauze in her mouth until seconds before she had to perform.

By the time the third tooth got loose, she was pretty brazen about it. She wiggled it. She let kids at school wiggle it. And I worried whether all that twisting and turning would make the tooth come out before it was ready, so I asked her to leave it alone and let nature take its course. The tooth fairy did visit, and she has visited a couple of more times since then.

But since Katie has 12 more of her 20 baby teeth to lose, I knew this issue would come up again. So I called Rhea Haugseth, dentist and president of the American Academy of Pediatric Dentistry, for some advice.

“My daughter is obsessed with wiggling a loose tooth. Is that helpful or harmful?” I asked.

“Most kids can’t resist,” said Haugseth, assuring me that Katie’s behavior is normal. “It’s fine to go after it. It’s actually even good.”

Haugseth explained that even wiggling a baby tooth wouldn’t make it come out before it’s ready. “By the time a child feels that a tooth is loose, the roots of the baby tooth have dissolved and only the gum tissue is holding it in its place,” she said. “In fact, if it’s left in there too long – because some children may be scared to wiggle it – the surrounding gums can get inflamed and irritated. That’s when parents call me.”

“So what do you recommend if a child is scared to wiggle her tooth?”

“I tell moms to accidentally bump into it when they’re helping their child brush their teeth,” she says. “And if that doesn’t work, a conversation about what the tooth fairy might bring works wonders.”

BUZZY – Because We ALL Need Shots That Don’t Hurt!

As a pediatrician, I strongly support vaccination. I never thought shots were a big deal; parents and staff even chuckle sometimes when a kid is freaking out about shots. You know, ‘deal with it’. I have taken care of children who died from vaccine-preventable diseases, and I used to think that any delay in shots endangers all society. Then I had my own kids, and witnessed firsthand that while vaccines don’t hurt children, shots do. Like most of the 22% of adults who fear needles, my son Max developed a phobia after a horrible shot experience at age 4. This fear affected him every time he had to go to the doctor. I gradually realized that if I didn’t act he could go through adulthood avoiding medical care.

It makes sense that being held down and subjected to more than five shots at a time could have a lifelong impact on complying with health care. When I tried to use numbing creams, one nurse said “that stuff doesn’t work, they need to get used to it”, and gave the shot outside the numb zone! I got mad at the system and myself. If I couldn’t protect my child and I’m part of the system, what parent could? I wanted to come up with something that worked instantly that parents and patients with established needle phobia could bring and use even if the healthcare system wasn’t interested.

I knew that the body could stop pain naturally using something called “gate theory”. If you bang your knee and rub it the pain stops, if you smash your finger and shake it, it helps the pain, or if you burn your finger and stick it under cold running water it quits hurting. I thought of cuffs of cold water, all sorts of messy stuff. Driving home from the hospital one day it occurred to me that vibration would block pain, but it wasn’t until my husband suggested frozen peas UNDER the vibration that it really made my kids’ hands numb to sharp pokes. And Buzzy was conceived.

Buzzy® uses natural pain relief by confusing your body’s own nerves and distracting attention away from the poke, thereby dulling or eliminating sharp pain. Over the past 5 years my children helped test, build, and prototype Buzzy until we had a device that worked. They smashed cell phones, helped me use electric tape and elastic bands, and have served as my first and best advisors. We started with a hand held massager and frozen peas, and finally got to a cute bee with frozen wings.

From a scientific standpoint, I didn’t want to put it out there unless I knew it worked for other people as well as my kids. The Mayday Fund, a nonprofit dedicated to the reduction of pain and suffering, sponsored Georgia State to do a research study in adult volunteers getting IVs inserted. Buzzy significantly decreased pain, and was more effective the more anxiety people already had. A trial in children needing IV starts in the emergency department also showed significantly decreased pain by child and parent report, and even increased IV success threefold. On the basis of this, we got a $1M grant from the National Institutes of Health to study whether Buzzy reduces the pain of immunizations, and hopefully can avoid the development of needle phobia.

How important is this?? Although needle pain from a shot may not seem like a big deal, needle sticks are the most common and most feared cause of medical pain in the world. Blood donation, preventative health care, and diagnosing serious illnesses like cancer are all impacted by fearing doctors and needles. Conversely, awareness and use of available pain control methods for children can result in years of improved health. Buzzy® is now being used for dentistry, travel immunizations, fertility shots, and finger pricks, splinter removal, and flu injections! We’ve heard from parents who had considered stopping more effective injected or IV treatments due to needle fear who are now able to give their kids the best treatment due to Buzzy. We’ve even heard from kids… stories and letters that remind us that Needle Pain Matters…and because of that, so does Buzzy.

HEALTHFUL HINTS:

Before a shot:

My area of research is pain control, so I hear a lot of stories about drama at the doctor’s. For young children, pain is punishment and scary, so addressing fear is an important first step to making shots less of a big deal. Children are less fearful when they know what’s happening and feel in control. Sadly, there are no global answers, but there are some general tricks of the trade you can try.

  • When asked “am I going to get a shot?” focus on the benefit. “Yes, they have medicine that keeps you healthy.”
  • NEVER promise they won’t get a shot unless you intend to follow through and come back another time if they’re due for one
  • NEVER threaten with a shot if children don’t behave (establishing a needle as punishment or you as untrustworthy will guarantee a bad experience).
  • If the child’s question is, “Is it going to hurt?”, avoid using the words pain or hurt. Instead, use the word “bother”, and answer this way: “Actually, a lot of kids aren’t that bothered by shots. Before you get them, I’ll show you how we will make getting them not a big deal.”
  • If they’ve had a bad experience in the past, say “I found out about some new cool things we can do to make them much more comfortable.”

And now – the shot:

  • First, relieving kids’ distress begins with you. The best combination is warm but firm. No apologizing, empathizing, or letting them “just go to the bathroom real quick.” Instead, use praise, “I know you can do this”, and direct them to pay attention to non-shot related things before they get anxious. “Oh, look, SpongeBob.”
  • Second, the person giving the shots. These are research-proven things that make shots hurt less:
    • Give the least painful shot first
    • Give the shots sitting up in the arm after age 18 months
    • Use a slower push
    • Use a longer needle
    • Use “position of comfort”: facing you on your lap, or with your arm around the child if they are older and receiving shots sitting up. Being held flat is the most vulnerable positing you can be in; much better if 4-6 year olds can straddle your lap facing you and get shots while you hug them.
  • Third, to help overcome established needle-phobia:
    • There are creams (over the counter LMX-4, Ferndale Labs) which can be applied 20 minutes in advance, or prescription EMLA (Astra-Zeneca) which needs at least an hour. Be sure they’re placed correctly, and know that they only numb the surface. Never promise complete pain relief. Instead, try “these will help a LOT!”
    • Studies show that appropriate distraction decreases distress. While the nurse is getting the injections, let a child choose from multiple visual games or tasks to focus elsewhere during the shot. “Do you want me to read to you, or give you things to find?” Be prepared to pick if they’re indecisive. “You know what I think would be good? Let’s do this…” Bee-Stractors Emergency Entertainment cards can be kept in a purse or glove compartment for situations when you forget to plan ahead.
    • Tasks that include a sensation also help focus attention away from the poke: for example, tell your child to count zigzags as you scratch the edge of a fingernail on their arm. Tell the child to yell “now!” when a fingernail gets to the elbow or wrist. For multiple shots or a seriously anxious child, bring an ice pack or vibrating toy to touch other body parts and have the child name the body part touched by ice. “Knee! Leg! Nose!” Even better, touch them with an ice pop and 5 right answers wins the pop!
    • And speaking of ice packs, studies have shown that putting an ice cube on the site before a shot can decrease the pain. Adding an element of vibration during the poke can help as well, like when a dentist wiggles your lip during Novocaine. This is the breakthrough of Buzzy, but you can achieve the same results with any vibration/solid ice pack combination. For best results, let the child feel the sensations beforehand by scratching the arm under the ice pack/vibration source. “See how cold this is, and see how now you can’t feel so much any more?” Seeing for themselves and agreeing with you helps the child feel in control.

Whatever happens, praise how they did!

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Editor’s Note: With the increased transmissibility of the Delta variant, COVID-19 cases are on the rise around the United States as well as the rest of the world. And though there is currently no approved vaccine for kids under 12, there is still a tremendous role that Buzzy can play! Over half of adults unvaccinated for COVID-19 fear needles. To no-one’s surprise, this same fear affects how willing teens and adults are to get vaccinated. The good news is you don’t have to be a child for Buzzy to help. Although we first ran this post in 2011, what Dr. Baxter has to say is as true today as it was then. Shots hurt…and they shouldn’t…and with Buzzy, they don’t have to.

Please – if you haven’t already – for your sake and the sake of your family
Get vaccinated for COVID!

Our Super-Successful Kids Are Struggling! How to Help Them Thrive

Worried child in front of graffitiWhat if I told you that 1 out of every 3 kids age 6 to 11 is afraid that the Earth won’t exist when they grow up???

WHO are these children??? What if I told you that little kid you just kissed goodnight,,, who got an A on his test…who practiced her cello for hours… what if I told you they were the ones who said it. What if instead I told you they believed it and told NO ONE??? How is it possible this is happening??

Parents, meet the “Running on Empty” Generation – smart and dearly loved, inclusive and open-minded, well-educated with high aspirations for college and their future. From the outside everything you want and more for your child. But take a second look. These kids are less happy, more stressed, lonely, depressed, and suicidal than ANY other generation… and that was BEFORE COVID!

“We are college and career ready, but sure aren’t ‘human’ ready.” Erin, 16 years old

We are raising a generation of “strivers” – kids that are wonderful at reaching for the brass ring, but never feel good enough. We haven’t given them basic survival tools so when the real challenges hit, they often quit because they don’t have the inner reserve that helps them get through it…

“My parents do everything for me. My biggest worry when I leave home is that I’m going to flunk life.” 17-year-old straight-A student, headed for Yale

Surprisingly, despite today’s kids living through the most stressed time in known history – terrorism, lockdown drills, daily pandemic death counts, insurrections, food insecurity, failing power grids, climate crises and racial violence – some kids are not only surviving, but they’re also thriving.

They are bouncing back despite adversity. WHY?

In her new book THRIVERS, Dr. Michele Borba, Ed. D. shares with us the answer.

In the end, these kids – the Thrivers –manage adversity, develop healthy relationships, and embrace change. They are ready and deal proactively with whatever the world throws at them – even in uncertain times, not because of genes, GPA, IQ or a special skill or talent, but through reliance on a few character strengths they learned along the way that helped them steer their lives in a positive direction – helped them PICK THEMSELVES UP whenever their worlds came crashing down.

It is these seven essential Character Strengths that set Thrivers apart and set them up for happiness and greater accomplishment later in life. Self-confidence, empathy, self-control, integrity, curiosity, perseverance, and optimism – each of these helps safeguard our kids against the depression and anxiety that threatens to derail them. And best of all, these strengths are not something we are born with: from toddler to teen, these can be taught!

But where should you start?? THRIVERS is organized into three parts allowing parent to focus on strengths by category. It’s helpful to understand your child’s “superpowers” – what they’re already good at and can nurture – as well as areas that could use further development.

Consider how you would rate your child on the following: 5 = always, 4 = frequently, 3 = sometimes, 2 = rarely, 1 = never

My Child:

  1. Speaks mostly positively about herself, rarely negatively.
  2. Displays concern and wants to help when someone is treated unfairly or unkindly.
  3. Can be trusted to do the right thing and keep his word even when no one is looking.
  4. Able to manage her own impulses and urges without adult help.
  5. Intrigued or easy to motivate about trying something new, different, or surprising.
  6. Does not become upset when something is difficult; rarely quits but keeps trying.
  7. Can find the silver lining in a hardship or challenge.

As I’m sure you guessed each of these questions represents one of the 7 Character Strengths and is part of a longer assessment that will help you evaluate where your child is right now so you can determine which traits are their natural strengths and which traits need to be encouraged.

Know that these traits are cumulative: each character strength improves a child’s thriving potential as well as academic performance but is always more powerful when combined with another because they create a Multiplier Effect.

Self-Confidence + Curiosity increases self-knowledge and builds self-assuredness and creativity.

Self-Control + Perseverance boosts the chance of reaching a goal and achieving success.

Empathy + Curiosity helps find common ground and strengthens relationships.

At this point some of you may be thinking…yes this all sounds good, but bottom line, I’ve got to give my child every advantage so they can get into the right school because everything depends on that.

But does it? According to Dr. Borba these amazing, brilliant, talented kids are checking out – the urgency in writing this book came from an email from a distraught mom looking for help from her community:

“We have forty dead kids in two-and-a-half years to suicide within a twenty-mile radius. Most are white, affluent, high achieving males who did not use drugs but hung themselves. Most look like your kids and mine. The last seven have been females – two with guns.”

“It’s like we’re being produced to be test takers. We’re missing the pieces on how to be people.” Aaron, 12 years old

The epidemic of unhappy Strivers is real, but it’s not inevitable. We can do something about it. As Dr. Borba says “all our energy has gone into stretching kids’ cognitive abilities and neglecting their human side – the source of energy, joy, inspiration and meaning. The good news: focusing on character can flip that equation and teach your kids how to find happiness, calm and wonder in the world.

But we NEED to pay attention… We SHOULD be worried… WE NEED to listen!!

“There’s an amazing amount of depression and anxiety. Seventy percent of my friends are in therapy; forty percent are on medication. We’re hurting but nobody does anything until another kid is suicidal.” Ava, 15 years old.

One last thought that I’d like to finish with. It is terrifying that our children – even the young ones – go to sleep worried about global warming, pandemics, racial violence, school shootings… the list goes on and on. It is even more terrifying that many of them don’t believe their generation will live to see the future. But there is something Dr. Borba’s book reminded me of that I’d like to share with you, and maybe you can share it with your kids.

Years ago a man named Fred Rogers brought optimism, love and hope to families across the country – and in these dark times we could all use a little of his outlook. With each new terror – each bombing, virus, terrorist attack, natural disaster, hate crime or mass shooting we wonder, “what shall we tell our children?” Fred Rogers had the perfect answer:

“When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’ To this day, especially in times of disaster, I remember my mother’s words, and I am always comforted by realizing that there are still so many helpers, so many caring people in this world”.

My belief, and the reason I share this with all of you, is that this current generation of kids is in pain and they are struggling. Dr. Michele Borba (and THRIVERS) is one of the helpers.

Editors Note: all quotes included in this article, including those attributed to individual children and Fred Rogers can be found in THRIVERS: The Surprising Reasons Why Some Kids Struggle and Others Shine

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Thrivers Book CoverAcross the nation, student mental health is plummeting, major depression rates among teens and young adults are rising faster than among the overall population, and younger children are being impacted. As a teacher, educational consultant, and parent for 40 years, Dr. Michele Borba has never been more worried than she is about this current generation of kids. In THRIVERS, Dr. Borba explains why the old markers of accomplishment (grades, test scores) are no longer reliable predictors of success in the 21st century – and offers 7 teachable traits that will safeguard our kids for the future. She offers practical, actionable ways to develop these Character Strengths (confidence, empathy, self-control, integrity, curiosity, perseverance, and optimism) in children from preschool through high school, showing how to teach kids how to cope today so they can thrive tomorrow. THRIVERS is now available at amazon.com.

Finally – A Step Towards Safe Transport for Kids in Ambulances!

In 2008 the National Highway Traffic Safety Administration (NHTSA) convened a working group of representatives from the American Academy of Pediatrics, Emergency Medical Services for Children, the American Ambulance Association, and other key organizations and started a project called “Solutions to Safely Transport Children in Emergency Vehicles”. Finally a long-standing problem was being recognized and addressed: “there are no Federal standards or standard protocols among EMS and child safety professionals in the U.S. for how best to transport children safely in ground ambulances from the scene of a traffic crash or a medical emergency to a hospital or other facility. The absence of consistent national standards and protocols … complicates the work of EMS professionals and may result in the improper and unsafe restraint of highly vulnerable child passengers.”(1)

In fact a 1998 study regarding the use of child restraints in ambulances revealed that 35 States did not require patients of ANY AGE to be restrained in a ground ambulance. Of those States that did require some sort of child restraint system, requirements for an “acceptable restraint” varied significantly.(2)

It is illegal in the US to travel with an unrestrained child in an automobile. However, when a child is already sick or injured, we have been willing to transport them in a vehicle where the passenger compartment is exempt from most safety requirements, they cannot be properly restrained and they have a higher probability of an accident than an automobile. We might not if we knew the following:

  • It is estimated that up to 1,000 ambulance crashes involve pediatric patients each year.(3)
  • In a collision at 35mph, an unrestrained 15kg child is exposed to the same forces as in falling from a 4th story window.(4)

Wednesday September 19, 2012, after an intense 2 year research effort, a public meeting in August 2010 to review the findings and gather input (see Pediatric Safety Post by Sandy Schnee “A Public Meeting on Safe Transport for Kids on Ambulances“), and 2 additional years refining the results, NHTSA has released the official:

BEST PRACTICE RECOMMENDATIONS FOR THE SAFE TRANSPORT OF CHILDREN IN EMERGENCY GROUND AMBULANCES Thank you NHTSA!!

The working group outlined 5 potential child transport “Situations” (see chart below) and for each described their “Ideal” solution – the best practice recommendation for safe a safe transport for each situation. They also presented an “If the Ideal is not Practical or Achievable” alternative – basically an “acceptable” backup plan.

They also came up with guidelines to assist EMS providers in selecting a child restraint system – particularly important because due to the lack of regulation and testing requirements specific to ground ambulances, many of the available child restraint devices were not designed for use in ambulances, some were tested to automotive standards and others were not tested at all.

In the end, the ultimate goal of ALL the recommendations: Prevent forward motion/ejection, secure the torso, and protect the head, neck, and spine of all children transported in emergency ground ambulances.

In short – transport these children safely.

We know that since the adoption of “mandatory use laws” in the U.S. for child safety restraints in automobiles, that thousands of children’s lives have been saved. Yet for years we have continued to allow children to be transported unrestrained on ambulances. With this report, we have finally taken a step in the right direction

It is hoped that the recommendations provided in this report will address the lack of consistent standards or protocols among EMS and child passenger safety professionals in the United States regarding how to most safely transport children in ground ambulances from the scene of a traffic crash or medical emergency to a hospital or other facility. It should be noted that the expectation is that States, localities, associations, and EMS providers will implement these recommendations to improve the safe transportation of children in emergency ground ambulances when responding to calls encountered in the course of day-to-day operations of EMS providers. In addition, it is hoped that EMS providers will be better prepared to safely transport children in emergency ground ambulances when faced with disaster and mass casualty situations”.

…. Amen to that !!

 

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Editorial Update: Quite a bit has happened since the original publication of this article. Suffice it to say that while this was a terrific step in the right direction – it was not enough to cause the system-wide level of change hoped for. According to ems.gov… unanswered questions remain, primarily due to the lack of ambulance crash testing research specific to children.To address this, in 2017 the National Association of State EMS Officials (NASEMSO) established the Safe Transport of Children Ad Hoc Committee, with the goal of improving the safety of children transported by ambulance through the creation of evidence-based standards. Pediatric Safety will continue to follow their efforts in future articles as they work to improve the national standard of care and establish consistent guidelines for the safe transport of all our children on ambulances. Every ride, every time.

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References:

1. Notice published by NHTSA of Public Meeting on August 5th, 2010 to discuss draft version Recommendations for Safe Transport of Children on Ground Ambulance Vehicles: Federal Register, July 19, 2010,

2 & 3. Working Group Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances: NHTSA / USDOT, September 2012

4. “EMS to Your Rescue?” Int’l Forum on Traffic Records & Hwy Safety Info. Systems – Levick N, July, 2008

To Breastfeed for 6 Months or Not To Breastfeed for 6 Months…

…that is the question…

This week a small group of pediatric health experts from the UK published a report in the British Medical Journal questioning the 2001 World Health Organization’s recommendation to provide 6 months of exclusive breast feeding. The WHO and UNICEF recommend:

  • Initiation of breastfeeding within the first hour of life
  • Exclusive breastfeeding – that is the infant only receives breastmilk without any additional food or drink, not even water
  • Breastfeeding on demand – that is as often as the child wants, day and night
  • No use of bottles, teats or pacifiers

This is based on significant evidence that breast milk reduces the rate of pneumonia, ear infections, gastroenteritis and other infections.

Given however the much lower incidence rate of these illnesses in “developed countries” some medical professionals have voiced their concern about applying the 6 month restriction universally. They argue that while “exclusive breastfeeding for 6 months is readily defendable in resource-poor countries with high morbidity and mortality from infections, in developed countries, other concerns can take precedence”.

This aligns with the new report which suggests that babies who are breastfed exclusively for six months are at a higher risk for iron deficiency and food allergies including celiac disease, and may also lead to a delay in developing a taste for food products which could have a long term impact on diet. Among the questions asked – “will babies who aren’t introduced to bitter-tasting foods in the first 6 months continue to have an aversion to them for the rest of their lives??” If this does in fact occur, will it make it even more difficult to win the battle against obesity?

All of that being said, the current debate is not one which attempts to answer the question of whether or not a mother should breastfeed. That is a separate conversation with its own proponents for and against. But even for those moms who make the decision to breastfeed, many still struggle to continue for the recommended 6 months – especially if they return to work. (According to the CDC , although 75% of new moms in the U.S. start breastfeeding, only 13% are still breastfeeding exclusively at 6 months).

So what is the right answer? Can solid foods be introduced as early as 4 months? The WHO and UNICEF are continuing to support a 6 month guideline while a number of experts are now recommending the alternative. One area they both seem to agree is that each child is different, and watching for baby’s cues will be the best guideline of all.

So what about you?? How did you know when your little one was ready for solids?

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References: