Pregnancy Book

If you are expecting, you might have a lot of questions about what to expect during your pregnancy.  I would like to suggest a book for you: You & Your Baby: Pregnancy by Dr. Laura Riley, OB/GYN.

Dr. Riley is an author, the medical director of labor and delivery at Massachusetts General Hospital in Boston, and a mom to two daughters.  In her book, she talks about how a mom's-to-be body changes week-by-week and what symptoms expecting moms can experience.  She also offers advise on how to deal with the morning sickness, mood swings, and lower back pain. 

You & Your Baby: Pregnancy gives moms-to-be a good overview of the amazing journey that pregnancy is.  She suggests exercise programs, healthy diet, addresses safety issues in preparing women to progress through the pregnancy as healthy as possible, and helps them to conquer childbirth fears.

It is a great read full of very good information.

Understand Your Septic System

Many people live in rural areas that are not supplied with municipal water or sewer, and they face a new form of sewage disposal: a septic system. Whether you're a new homeowner or not, understanding your septic system is a must. Here's what you should know:

The septic system consists of three main parts: the septic tank, the septic field, and the soil beneath the septic field. 



The septic tank is a watertight concrete box that temporarily holds household wastes. The tank is connected to the septic field by a buried pipe. The purpose of the septic field is to deliver wastewater to the soil. The soil purifies the wastewater by removing the germs and chemicals before they reach the groundwater or any adjacent surface waters such as rivers, lakes, and estuaries.

Appropriate septic system maintenance is necessary to prevent damage and costly replacement that may run anywhere between $5,000 and $25,000, depending on the system that you have.

These suggestions might help you to prolong your septic tank’s life:

Do not put too much water into the septic system; typical water use is about 50 gallons per day for each person in the family.

Spread your laundry over the week to avoid dumping a lot of water into the tank at once.

Dispose only toilet water and water from bathing, showering, dishwashing, and laundry into the septic system.

Use biodegradable cleaners and soaps, as harsh chemicals will kill the bacteria that aids in breaking down the sludge in your septic system.

Don’t drive or build on the septic field. The majority of water in the field evaporates. Soil compaction prevents oxygen from getting into the soil.

For more information, check out this guide: Septic System Maintenance

6 Keys for Coping with Divorce and Separation

Bette J. Freedson

If you are a separated or divorced parent, you have experienced overwhelming stress and know the value of effective coping strategies. When my own marriage ended, a savvy friend reminded me that I was the one in charge of my choices and reactions. I could decide how to manage my kids, deal with my ex, and cope with my stress.

Over time I discovered six keys that make single parenting easier and more effective. Give these strategies a try. They can reduce conflict, create greater stability and increase your peace of mind.

Key #1. Use a No Drama approach to communication.

~ Tell children about divorce/separation with parents and siblings together if possible. Allow the kids to ask questions and express feelings appropriately. Avoid drama about parental problems. Tell children that adults will work out adult business. Try saying, “You did not cause our problems and you are not responsible for fixing them.” Messages like these build comfort and security.

~ Reassure children that both parents will continue to love them, care for them, and (when true) be involved with them. This applies to the first telling and ongoing informing. Refrain from making one child your “confidant.” Being kept out of parental conflict creates more stability for the children.

~ State the facts, not your feelings, about changes in life’s events. You need not have all the answers. Reassure the kids that you will tell them what they need to know when they need to know it. Keep your personal grievances out of the discussion. Factual information reduces stress -- emotional unloading will raise it.

~ Have a no blame/no shame policy. Never blame children for marital stress, or put down the other parent to the kids. Hearing parental anger confuses and burdens children.

~ Keep as much consistency and predictability in children’s routines as possible to create a sense of security.

Key #2. Manage your stress.

~ What’s your coping method?  Do you vent? Shut down? Do you eat, drink or party? Do you think your coping style affects your children? The single parent who uses children as sounding boards for anger creates confusion in the kids. The parent who withdraws may find the kids acting out to get attention. Spend some time examining your stress strategies, and...

~ Develop your coping toolkit. Learn relaxation techniques such as breathing and meditation. Vent to appropriate adults. Train your thinking toward solving, not obsessing.

~ Remember “Bette’s Motto:” children’s stress levels relate directly to the parent’s coping quality! Your children will use you as a model. The “Do-as-I-say-not-as-I-do” motto is a myth. The kids will “Do as you Do!!”

~ Build your Self-esteem. You have a right to value and respect yourself. Tell yourself: “I am a worthy human being by virtue of being Me.” Add this: “I am doing the best I can, and my best is good enough.”

~ Depersonalize the ex’s actions. It is easy to feel like a victim, but doing so can put you at risk to act out your anger or resentment, and cause you to make less effective coping choices.

Key #3. Keep communication open.

~ Consider the other parent a “business” partner. When exes co-parent, children fare better. When possible, discuss and make decisions together for the sake of the kids.

~ Refrain from making children reporters between you and the other parent. Children will feel pressured by being in the middle.

~ Let children express love for the other parent even when it is hard to hear. Children identify with both parents, and do better when allowed to love both without guilt. Life will be calmer when children carry fewer emotional burdens.

Key #4. Keep your outlook balanced.

~ Avoid negative mind-sets like blaming, personalizing, catastrophizing and victim thinking. Talk to yourself in ways that affirm your efforts and accomplishments.

~ Accept painful feelings, but steer clear of resentment. Clearing your mind of toxic thinking will lower your stress and increase ability to solve problems. Stay hopeful without denying difficult realities. Balanced thinking promotes clarity.

~ Learn to access inner wisdom. Use both analytical thinking and intuition to make effective coping choices. In other words, get the facts and trust your gut.

Key #5. Bring in supports.

~ Seek friends and family members who can give you a hand, lend you an ear, or sit with the kids.

~ Believe that it is okay to ask for help. You need and deserve people to rely on.

~ Develop social networks. Find support groups in the community to learn from others in similar situations. Social connection reduces stress.

~ Use appropriate adult supports for venting and advising.

These may include friends, pastoral counselors and mental health or legal professionals.

Key #6. Have fun with the kids—and without.

~ You need fun for emotional, physical, and mental health. Enjoyment can boost your spirits and your immune system too. Fun gives respite from pressures.

~ Play a little. You don’ t have to pay a lot. Take a walk in the woods -- go to a public garden -- make family play dates -- go on a picnic -- go to the beach -- make a snowman -- play with a ball, a frisbee, a jump rope -- go to a public concert -- tell stories -- do an art project -- watch a good TV show — play a board game.

~ Take alone-time for yourself. Carve out time with other adults.

This type of break recharges the coping batteries.

A word of caution and a word of hope:

The suggestions in these six keys assume that it is safe to deal with “the other” parent. If safety concerns exist, these ideas may need to be modified, and you may wish to seek legal, and possibly, mental health counseling.

With practice and patience you can utilize these strategies to reduce your stress, provide greater stability and security for your kids, increase your self worth, strengthen your resilience, and reward yourself with greater serenity.

BETTE J. FREEDSON Bette J. Freedson, LICSW, LCSW, CGP is a clinical social worker and a certified group psychotherapist who is dedicated to helping clients tackle life using simple, sound and effective strategies. As a Stress Expert, author and speaker, Bette makes overcoming life’s challenges easy with simple and accessible tools. Throughout her career Bette has worked with hundreds of children, parents, adults, couples, and groups to help them relieve the stress that interferes with success in life. By using her ideas and solutions, Bette's patients and pupils are able to quickly develop the skills to become directors of their own destinies.

Enhanced Chicken?

I rarely buy frozen chicken, but when I read an article in Consumer Reports about how some companies enhance the flavor of poultry and alter its weight by injecting it with broth and salt, I vowed to start reading labels more carefully.

Supposedly, the practice of injecting broth into poultry renders the meat tastier, juicier, and more tender...but at the cost of high sodium levels. So, those of you with elevated blood pressure, beware! 

According to Consumer Reports, by buying enhanced chicken, customers may pay up to an extra $1.70 for the added broth! I don't know about you, but I don’t feel like paying extra for chicken that has been pumped with a broth and sodium concoction behind my back. I would rather go an extra mile to get fresh, organic chicken from a local farm and know that I am getting the real thing. 

To find a local farm near you, go to: local harvest.org.

Relieving Childhood Stress

Bette J. Freedson

"Aaaah, sweet childhood!" Do you become wistful reflecting on your past? With the pressures of parenting and earning a living, it is easy to forget that growing up is not stress-free.

Children have stress, but typically do not have the awareness or skill for understanding and expressing problems. However, with three simple steps, parents can become "plugged in" to sweet relief for childhood stress.

Step 1. Know sources of stress.

Step 2. Recognize stress signals.

Step 3. Use stress-reducing strategies

SourcesStress arises from personal, social, domestic, and/or psychological sources. The intensity and amount of childhood stress depends on age, development, temperament, and environment. While baby’s stress comes from needing comfort, stimulation, food, or diaper change, teenage stress comes from school, home and peer pressures. Plugging into your child’s world helps identify sources of stress.

Signs
Because kids typically act out stress, signs often show up in behaviors. Notice your child’s actions. Is the child pushing limits more than is normal for his age? Is behavior chronically oppositional or overly compliant? Is he physically aggressive with other kids or adults? Are there ongoing changes in sleeping, eating, playing, or relating patterns? Does she appear overly tense? Listening to play themes will offer clues to stress, and insight into possible distress. Keep your ears perked and your eyes peeled. Evaluate duration and intensity of events and your child’s response to them.

But worry minimally. Some stress is normal, and can be relieved when handled effectively.

Strategies

Discuss
Kids might not initiate, but you can. Try a discussion opener:
“Sometimes children feel___________(sad, mad, bad, etc) about_____(fill in the circumstance)_______. I wonder if you might be feeling that way?”
If the child engages, you can probe a little. If he resists sharing, don’t push. Try again later.

Show interest 
Ask about her day, school, teachers, friends, activities, feelings etc. Try questions like this:
“Can you tell me something that made you glad (mad or sad) today?”

Give attention
Naughty behavior will get attention but creates stress for all. Try planned ignoring for negative behaviors (if safe), and offer attention for behaviors you want to establish. Positive attention for positive behavior helps reduce children’s stress.

Be consistent
Kids need stability. Even if your own life has stress, try to keep your parenting as predictable and consistent as possible.

Use a no-blame/no-shame policy
Guilt and shame creates stress for kids. Deal with problems without blaming children. Gently help kids to see their part in a problem. When you take realistic responsibility for your own actions, your child’s stress will be relieved, and their self-esteem will grow.

Teach replacement behaviors
When a situation is stressful, discuss how your child might handle this now, or a similar problem in the future. Offer suggestions, and use a no shame approach.

Help your child understand life
Kids can misunderstand what adults take for granted. Explain how things work with a no blame approach.

Use stillness and meditation
Children’s stress can be alleviated by stillness. This does not mean forcing them to be quiet. Try music, reading, and a gentle relaxation exercise like this:
“Imagine you are surrounded by beautiful butterflies. Picture the butterflies flying your troubles out of your mind. Then imagine the butterflies come back with happy thoughts.”
Use variations, and let your child tell you about what flew away.

Model effective coping
Stress is contagious. What you do when you are stressed will model your coping techniques. Deal with your own stress. Try relaxation, meditation, exercise, good nutrition, or professional help. The healthier parents are, the more sweet the stress relief for the kids.

BETTE J. FREEDSON Bette J. Freedson, LICSW, LCSW, CGP is a clinical social worker and a certified group psychotherapist who is dedicated to helping clients tackle life using simple, sound and effective strategies. As a Stress Expert, author and speaker, Bette makes overcoming life’s challenges easy with simple and accessible tools. Throughout her career Bette has worked with hundreds of children, parents, adults, couples, and groups to help them relieve the stress that interferes with success in life. By using her ideas and solutions, Bette's patients and pupils are able to quickly develop the skills to become directors of their own destinies.

Understanding Your Septic System

Many people live in rural areas that are not supplied with municipal water or sewer, and they face a new form of sewage disposal: a septic system. Whether you're a new homeowner or not, understanding your septic system is a must. Here's what you should know:

The septic system consists of three main parts: the septic tank, the septic field, and the soil beneath the septic field. 





















The septic tank is a watertight concrete box that temporarily holds household wastes. The tank is connected to the septic field by a buried pipe. The purpose of the septic field is to deliver wastewater to the soil. The soil purifies the wastewater by removing the germs and chemicals before they reach the groundwater or any adjacent surface waters such as rivers, lakes, and estuaries.

Appropriate septic system maintenance is necessary to prevent damage and costly replacement that may run anywhere between $5,000 and $25,000, depending on the system that you have.

These suggestions might help you to prolong your septic tank’s life:

Do not put too much water into the septic system; typical water use is about 50 gallons per day for each person in the family.

Spread your laundry over the week to avoid dumping a lot of water into the tank at once.

Dispose only toilet water and water from bathing, showering, dishwashing, and laundry into the septic system.

Use biodegradable cleaners and soaps, as harsh chemicals will kill the bacteria that aids in breaking down the sludge in your septic system.

Don’t drive or build on the septic field. The majority of water in the field evaporates. Soil compaction prevents oxygen from getting into the soil.

Budget Meal Planning

Ed Jackson

Amber S. is a stay-at-home mother of three. With only her husband's income to count on, budget meal planning has become an art form, as well as a necessity.

Amber was happy to share one of her weekly menus with us, which we've reproduced below. The first meal listed for each day is what she served her family for breakfast, the second is lunch, and the third is dinner.


Sunday 
Pancakes from a box mix
Grilled cheese sandwiches and tomato soup
A roast with potatoes and a canned vegetable

Amber makes a full box of pancake mix every Sunday. She freezes the extra pancakes in bags of 3. This way her children can choose pancakes or cereal every day of the week. It costs Amber less than a dollar a day for each breakfast, whether it's leftover pancakes or cereal.


Monday
Leftover pancakes from the freezer, or cereal
Mac & Cheese (3 boxes) and hot dogs with fruit
Cheesy Ham and Potatoes

For Cheesy Ham and Potatoes, Amber cooks 2 family size boxes of scalloped potatoes, according to the package directions, and then adds 1 can of canned ham, diced up. The recipe is super easy and only costs about $5.00.


Tuesday
Pancakes or cereal
Leftover Cheesy ham and potatoes
Spaghetti with garlic toast

Spaghetti is just a can of Hunts pasta sauce (because it's usually only $1 a can), a can of diced tomatoes, 1 pound of cooked ground beef, and 1 pound of spaghetti noodles. This meal cost Amber about $3.56.


Wednesday
Pancakes or cereal
Leftover spaghetti
Chicken and Rice

Click here for Amber's Chicken and Rice recipe. 


Thursday
Pancakes or cereal
Leftover Chicken and rice
Beef Stroganoff

Click here for Amber's Beef Stroganoff recipe.


Friday
Pancakes or cereal
Canned soup and grilled cheese sandwiches
Three Bean Chili

Click here for Amber's Three Bean Chili recipe.


Saturday
French Toast
Leftovers (clean out the fridge day)
Spanish Rice

For Spanish Rice, Amber combines 6 cups cooked rice, diced tomatoes, canned corn, and 1 pound cooked ground beef.


Amber also shared her grocery list and prices with us.

1 box Pancake mix -- $1.27
2 loaves bread -- $2.50
1 (5 lb) roast -- $4.97
3 boxes of Mac & Cheese -- $1.79
1 package of hot dogs -- $0.99
2 family boxes of scalloped potatoes -- $2.50
1 can of canned ham -- $2.49
2 lb. box spaghetti noodles -- $1.39
1 can Hunts spaghetti sauce -- $1.00
4 cans diced tomatoes -- $0.86 ea
1 pound ground chicken -- $1.00
2 family cans cream of mushroom soup -- $1.92
1 family can cream of chicken soup -- $.96
5 pounds ground beef -- $4.95
1 bag of egg noodles -- $1.06
1 family can baked beans -- $.96
1 family can chilli beans -- $1.05
1 family can kidney beans -- $1.05
1 box of instant rice -- $1.74
10 cans of various vegetables -- $3.00
2 gallons milk -- $5.00
2 bags cereal -- $4.50

for a total of $49.53


Prices may vary depending on your location's cost of living and the types of stores available to you. But here are Amber's tips for always getting a bargain:

 Don't do your shopping all at the same store.
Amber shops at three different stores to get the best bargains: Cub Foods (which is a wholesale store like Costco or Sam's Club) for meats and canned goods (canned vegetables are on sale twice a month at Cub Foods -- 10 for $3.00!), Super Walmart for pasta, potatoes, pancake mix, cereal, family size cream of mushroom and chicken soups, and a budget store like Rainbow, Roundy's, Aldi, etc. for the rest of her necessities like bread and eggs.

 Do your research.
Amber says she always talks to the butcher in the meat section to find out when meats are going to be marked down. At Cub Foods, they knock the price of ground beef down from $1.97/lb to just $.99/lb. on Sunday mornings. Amber keeps out a pound or two of beef that she will use right away, then freezes the rest in 1.5 pound bags.

 Don't be afraid of store brands.
"There are some store brand foods that my family just won't eat," says Amber, "like Mac N Cheese--it has to be Kraft. They don't like the flavor of the other brands. But cereal and pasta, beans, canned or frozen veggies--they're all made by the same few manufacturing companies so the flavor is the same."

 Stick to your list.
Amber checks out the ads, and sets her menu based on the items that are on sale that week. She makes a list according to that menu and does not deviate from it. Adding extra impulse items will put you over your budget within seconds.

 Plan your trips.
"We do shop at three different stores," says Amber, "but we try to combine the trips so we aren't wasting a bunch of time and gas. We hit Cub Foods and Walmart on Sundays after church, because all three are within a couple miles of each other. We hit Rainbow on Monday because it's on the way to our son's preschool. Some weeks we get lucky and one store will have all the items we need for what we are willing to pay. Thats always a bonus."

 Always make enough for leftovers.
Each of Amber's recipes yield 12-14 servings. By making larger quantities, you'll have enough to feed your family at least two times, maybe three. This saves on the budget, as well as multiple trips to the store.

ED JACKSON Ed has a business degree and years of experience in management and marketing in both the mortgage and automotive industry. He is currently a marketing and financial consultant, and shares his financial advice with parents via PluggedInParents.com. He is a seasoned world traveler and loves good food.

Winter Safety

Monika Pis, PhD, CPNP

Winter is here, so is the snow, ice and frigid temperatures, and while winter activities may seem mundane, they can be dangerous. Winter wonderland offers plenty opportunities for various outdoor activities than can be fun, but may present all of us with safety challenges. 

Accidents are the most obvious safety issue of winter outdoor activities. However, let’s not forget frostbite, hypothermia, and heart attack. I always tell my patients that prevention is the best medicine. In agreement with this principle, I have outlined important safety measures below that you should take this winter to keep yourself and your family safe.

Before You Head Outside
- Dress in light layers, paying special attention to your nose, ears, hands, and feet.
- Wear a hat, as the most heat escapes our bodies through the head!
- Wear gloves and thick/warm socks.
- Cover lips/cheeks with a thin layer of Vaseline or Eucerin to prevent excessive skip drying and chapping.
- Check out these safety tips for sledding: Winter Sledding Safety Tips
- Check out these safety tips on ice safety: Danger Thin Ice

Getting Ready To Shovel
- Snow shoveling increases heart rate and blood pressure, so if you have a heart condition or are out of shape, do not shovel unless your health care provider says that you can.

- If you are over 40 years old, or physically inactive, check with your health care provider before trying to shovel your driveway.

- Snow shoveling is aerobic activity, so warm up before you grab the shovel.

- Pace yourself! Take frequent breaks and drink fluid to prevent dehydration.

- If you experience chest pain, shortness of breath, or other symptoms of heart attack, stop shoveling and immediately seek emergency care!

- Pushing snow in front of you is easier on your back than lifting and throwing it.

- If you have to lift, use proper body mechanics: squat, bend knees, and lift with your back straight. Scoop some snow, and walk to where you want to dispose of it. Throwing snow with a shovel, especially if you twist your body, puts too much stress on your back.

- Before you operate a snow blower, read the instructions. The most important thing to remember: Never stick you fingers in the snow blower to remove impacted snow! Use a stick instead.

When On The Road 
Have these emergency items in the car with you at all times in winter:
- Cell phone
- Flashlight
- Jumper cables
- Snow scraper/brush
- Small shovel
- Blankets
- Flare
- Sand or cat litter for traction

For long car trips, pack water, energy bars, food, extra blankets, and necessary medications.

When you stay outside on cold winter days, come inside every half hour to warm up. Every couple of hours drink a cup of hot cocoa or broth. Do not drink caffeine. Warming up will prevent hypothermia.

What is hypothermia?
Hypothermia is a term to describe low body temperature that results from extended exposure to cold temperatures. Each year over 700 people die from hypothermia, so it’s important to be aware of it and know how to prevent it. About half of deaths due to hypothermia occur among people younger than 65 years of age. However, anybody is at risk in wintertime, so take steps to prevent it!

How to prevent hypothermia?
- Dress in light layers.
- Wear gloves, hat, thick/warm socks, and water proof shoes.
- Go indoors every half hour to warm up.
- Every couple of hours, have hot cocoa or broth.
- If you are cold, stay indoors, and do not venture out again until you warm up adequately.

What is frostbite?
Frostbite results from exposure to freezing temperatures. It most often affects the nose, ears, cheeks, chin, fingers, and toes. Frostbite causes a loss of feeling and color in the affected area, and it may settle in as little as 20 minutes! Frostbite can lead to permanent damage of the affected area, and if severe, may lead to amputation. 

Signs and symptoms of frostbite: numbness, waxy white or grayish-yellow skin. If you see these signs, seek medical care right away. If you cannot see a health care provider immediately and have no signs of hypothermia, get into a warm room right away, do not walk on frostbitten toes as it may increase damage, immerse the affected area in warm water, do not rub it, do not use a heating pad. If hypothermia settles in, seek immediate medical attention!

How To Talk To Your Teen About Relationships

Heather Mikkelsen

As contemporary parents of teens, we are pretty progressive. We have used anatomically correct terms for body parts since our children can remember. We’ve banished “The Sex Talk” from our collective vocabulary, understanding that it is a conversation that is ongoing. But there is one area we may overlook in our zest to pass on our understanding of hard science. We need to talk to our teens about relationships.

When we talk to our teens about abstinence and delaying sex, we make marriage the end goal. However, we know that marriage does not necessarily create a healthy relationship, but a successful marriage cannot exist without one. So, what does a good relationship look like?

You may feel as if you are teetering on the brink of “do as I say and not as I do” when the conversation about relationships begins with your teenager. Don’t be afraid to admit your own struggles. Demonstrate kindness with yourself as it will heal you and model this behavior for your children. Keep talking even if it seems they aren’t listening. By doing that, you are creating a space for future conversations and letting them know that this is not an area you are afraid to explore with them.

Below, find excerpts from my book Be Smart that I hope will give you some ideas for ways to begin a dialogue with your teens about relationships.

When your teen comes to you to talk about a friend, a break-up, or any struggle, comfort her as you would a friend, listening and reassuring, being present while she finds her own answers. I tell myself to listen with heart. To me, this means listening with compassion, but respecting the other person’s need to experience this. The widening of one’s frame of reference can be painful. Just be there for your child.

Teach your teen that the most important relationship he or she will ever have is that with oneself. Joseph Campbell said, “The privilege of a lifetime is being who you are." It takes practice to do this, because it is much more common and acceptable to be self-critical than respectful and loving. Teach your teen to treat the self lovingly and with respect, and they will never settle for anything less in future relationships.

Every relationship is a tapestry of experiences, history, and feelings. Some of the most important ingredients of a quality relationship are mutual trust, respect, dialogue, desires, honesty, and faithfulness. Without these the relationship will run out of steam. Teach your teen to be observant of the self and the other person, learn, and then use this new knowledge to improve every relationship.



What readers are saying about Heather's book, Be Smart (Your Nurse Practitioner's Guide to Sexual Health and Well-being):

"This book is perfect! I'm a college freshman and I plan on taking it with me for a reference for my friends and I for any questions that we encounter! Finally someone knows what they are talking about and put it in a non-embarrassing manner! Thanks Heather! You're the best!" ~ Elizabeth Harkey

"Be Smart is a well written and informative book for all young adults. It is the book you wish every teenager could read before becoming sexually active. Heather Mikkelsen has provided parents with the perfect handbook to give to our children which fills the gaps in the information they are receiving from both home and school. Cheers!" ~ Patricia A. Cook

"As a nurse, I have worked to educate adolescents and adults about sexual health and well-being, often struggling to explain health practices and processes in a way my patients can understand. I believe this book has a great deal to offer readers from puberty and onward; clearly answering the sexual health questions many of us either don't know how to discuss or don't give needed attention. This book gives understandable, to-the-point info in a non-judgmental way which I believe is absolutely necessary in reaching teenagers (and many adults). Highly recommend!" ~ Pazoo Xiong

HEATHER MIKKELSEN Heather Mikkelsen has been a Family Nurse Practitioner for ten years. She received her undergraduate degree from the University of North Carolina-Chapel Hill and her graduate degrees from San Diego State University and University of California San Diego. She currently works in a setting where she sees primarily adolescent patients. It was their honesty and questions that lead to the writing of her book Be Smart (Your Nurse Practitioner’s Guide to Sexual Health and Well-being).

Probiotic Use in Children

Monika Pis, PhD, CPNP

In today’s medically savvy society, parents often seek "natural" remedies for health ailments, or to help their children feel better. They also reach for supplements in an attempt to improve health and seek "super foods" to promote wellness.

"Super foods," known as functional foods, describe foods or nutrients that promote health beyond providing nutrition. Probiotics are considered to be a functional food, and in the recent years they have received increased attention from the scientific and general communities.

The World Health Organization defines probiotics as live organisms, usually bacteria, that are used to change or re-establish the intestinal or gut flora and improve our health. In the early 20th century, a Russian scientist and Nobel laureate Eli Metchnikoff, PhD proposed that ingestion of certain bacteria, like those that come from fermented milk, had a beneficial impact on health. Today we have scientific evidence that certain bacteria, probiotics, play a beneficial role in certain diseases in adults and children. For example, there is compelling evidence that probiotics are effective in the treatment of viral and antibiotic induced diarrhea.

VIRAL DIARRHEA
Every year thousands of children become ill with gastroenteritis, or "the stomach flu." They experience a rapid onset of watery diarrhea with vomiting, nausea, abdominal pain, and fever. Research indicates that in the United States diarrhea is associated with 150,000 to 170,000 hospitalizations annually. According to the American Academy of Pediatrics, scientists estimate that 1 out of 23-27 children will be hospitalized with diarrhea by age 5.

Recent scientific findings indicate that probiotics are extremely effective in preventing acute diarrhea in children. They are also effective when administered during the early stages of viral diarrhea.

DIARRHEA DUE TO ANTIBIOTIC TREATMENT
Antibiotic treatments often lead to the disruption of intestinal flora and cause diarrhea. Studies show that the administration of probiotics to children taking antibiotics reduces the risk of diarrhea.

So far, the research on probiotic use in the treatment of irritable bowel disease (IBD), irritable bowel syndrome (IBS), or eczema shows no benefit of probiotic use to prevent or alleviate symptoms.

SAFETY
Most probiotics have been used in foods like yogurt and kefir and have a long-standing history of safety. Therefore, they are considered safe for use by healthy people. Individuals with compromised immune systems, such as those with chronic diseases or undergoing chemotherapy, should not take probiotics, as there have been reports of probiotic-associated sepsis and endocarditis.

One thing to remember is that probiotics are not regulated by the FDA, thus over-the-counter products may vary widely in quality. Infant formula containing B. lactis is the only exception. The FDA considers it safe to use in infants.

The bottom line is that probiotics may be beneficial for certain diseases, but may prove harmful for certain individuals. Therefore, before considering a probiotic supplement, talk to your health care provider.

When To Keep Your Child Home From School

Monika Pis, PhD, CPNP

Has your child ever been sent home from school because of "pink eye?" Did you know that conjunctivitis DOES NOT warrant immediate exclusion from school?

Recently, the American Academy of Pediatrics (AAP) updated its guidelines for school exclusion due to infectious diseases. Here is what you need to know about the recommendations on when your child should stay home when sick. Bear in mind that these are just recommendations and your school’s policy might differ.

FEVER
According to the AAP, children with fever should not be excluded from school unless they exhibit behavioral changes, or other signs and symptoms of illness. The exception is infants younger than 4 months of age with unexplained fever.

COLD
Most respiratory illnesses do not require exclusion. However, if there is a persistent cough or difficulties breathing, your child should be evaluated by her health care provider as soon as possible.

EAR PAIN WITHOUT FEVER
If your child is in pain, he/she should stay at home.

VOMITING
If your child is vomiting, you should keep her at home until she stops and has not vomited for 24 hours.

DIARRHEA
The AAP recommends that children in diapers who have diarrhea may remain in daycare if the diarrhea is contained in the diaper and the child has no more than two abnormal stools above what she normally has.

DRAINING SKIN INFECTIONS
This guideline includes ALL skin infections, including those caused by MRSA. Your child should be excluded from school only if the infection is accompanied by a fever or behavior change.

FIFTH DISEASE
Once the rash of fifth’s disease appears, your child is not contagious. Therefore, she should not be excluded from school.

HAND-FOOT-MOUTH DISEASE
According to the AAP, children should be excluded only if they have sores in the mouth and are drooling, or if they have a rash and a fever.

Holiday Salads

Cheryl Tallman  

Including a salad on your Holiday dinner menu offers guests a pleasant balance to some of the more traditionally heavy side dishes.  Ensure your salad pairs nicely with the rest of the feast by including traditional holiday ingredients such as dried fruits, nuts, apples, and beets.

Salads and dressings can be made ahead and refrigerated until you are ready to serve. For maximum freshness, toss the dressing into the salad just before serving (unless the recipe specifically states otherwise). 

Waldorf Salad
In the 1890's, the famed Waldorf Salad was invented by the maître d'hôtel of the Waldorf Astoria in New York City. Our version includes carrots, apples and grapes making it kid-friendly. 

Salad Ingredients:

1-1/2 cups julienne or shredded carrots 

1 apple peeled, cored and diced 

2 tsp lemon juice 

10-12 seedless grapes, cut in half 

¼ cup chopped dates 

¼ cup walnuts, chopped (optional)

Directions: Toss apple and lemon juice in a medium sized salad bowl.  Add remaining ingredients and gently toss. Refrigerate until ready to serve.
     
Waldorf Dressing

1/3 cup mayonnaise 

2 tsp. sugar 

1 Tbsp lime juice 

1 Tbsp olive oil

Whisk all ingredients together in a small bowl. Refrigerate until ready to serve.
Before Serving: Drizzle dressing over salad ingredients and toss gently. 

  

Broccoli Slaw

This recipe uses store-bought broccoli slaw mix and ramen noodles. It's simple and full of great flavor.

Salad Ingredients:
Directions: Crush ramen noodles.  In a skillet, heat butter, walnuts and ramen noodles over medium heat.  Stir constantly until golden brown, about 10 minutes.  Drain on paper towel and cool. Set aside at room temperature until just before serving.

Salad Ingredients:

¼ cup butter 

1 cup chopped walnuts 

1 3-oz package of ramen noodles, chicken flavored 

1 16 oz. package shredded broccoli slaw mix 

¼ cup thin sliced sweet onion 

Dressing:

2 Tbsp olive oil 

2 Tbsp sugar 

2 Tbsp balsamic vinegar 

2 Tbsp soy sauce 

Chicken flavored seasoning packet from Ramen noodles
 

In saucepan, combine all ingredients over medium heat.  Stir constantly until sugar dissolves about 2 minutes.  Set aside at room temperature until just before serving.

Before Serving: Toss broccoli slaw mix and onions together in salad bowl. Toss nut mixture into salad mixture. Whisk the dressing and drizzle it over the salad ingredients and toss gently. 

Spinach & Beet Salad
This colorful salad is a more traditional tossed green salad with a holiday lift. 

Salad:
9-12 oz baby spinach, washed and dried 
½ cup canned beets, drained, sliced or julienned 
½ cup mandarin oranges, drained 
¼ cup feta or blue cheese, crumbled 
¼ cup sunflower seeds 
Dressing: 

¼ cup balsamic vinegar 

¾ cup extra virgin olive oil 

1 Tbsp sugar 

1 Tbsp minced garlic 

2 Tbsp cilantro, chopped 

Salt and Pepper, to taste

Combine all ingredients in an airtight container, cover and shake. Refrigerate until ready to use. (Dressing can be made a day ahead). 

Before serving: Whisk salad dressing and toss with spinach leaves.  Spread spinach on a large platter or flat bowl.  Add beets and oranges on top of spinach. Sprinkle cheese and sunflower seeds.  Serve.

About the Author: Cheryl Tallman is the co-founder of Fresh Baby, creators of the award-winning So Easy Baby Food Kit, and author of the So Easy Baby Food and the new book So Easy Toddler Food: Survival Tips and Simple Recipes for the Toddler Years. Visit Cheryl online at HYPERLINKwww.FreshBaby.com for more delicious tips.

Parenting on the Fly: The Joys of Holiday Air Travel

Erik Fisher, PhD

Ahhh, the joys of holiday air travel. So much to do before you leave, and add the stress of rushing around to the airport and through security. Then add potential stress of family conflict when you get there. Finally add your kids to this holiday cocktail and it can become an experiment in hair loss.

So, just what can you do to keep your sanity and your hair line intact?

Many parents know and are prepared for the fact that many air travelers feel a sense of dread when they see infants and young children board a plane. Because of this, parents can be prepared for the worst instead of expecting the best. So just how can you make the most of this situation and make your holiday travel pleasurable for you, your children, and the passengers around you?

Here are my Top Ten Tips and Tricks to help you parents out there on your flight.

1. Prepare your kids for the flight. Start to talk about air travel with your kids and what they should expect days in advance.  Don't think your child is too young to understand what you are talking about.  Try to point out pictures of planes in books, on television or movies, and let them know where their destination is and what they will be doing there. Children often need to be prepared for new events and/or change, and when they know what to expect, they often adapt to it quicker than if they were not prepared. Add the excitement of the holidays to this, and kids can be off the hook.

2. Bring your own snacks/drinks on your trip. And plenty of them. You never know when you may be delayed or stuck on the tarmac or at the gate and food / drink is not available. When your kids feel hungry, there is often no stopping their discomfort, and patience is not a virtue that many of your kids understand.

However, on my recent trip I was able to discuss the concept of patience with my 2 year-old daughter. She wanted get on the plane (unrelated to the food issue), but it was not time to board. She saw other people boarding and began to cry and plead to get on the plane. I talked about patience and waiting. I said that patience is when someone waits for something and they choose not to feel upset. She stopped crying and started saying “patience… wait…”.  The biggest disservice I feel we do with our children is to not believe that they can understand concepts. The second disservice is getting upset when we set our expectations too high.

3. Realize that you are taking your child out of their normal routine. Keep in mind how they respond to change in other situations involving change, and don't expect them to behave any differently. Be aware of your child's temperament (easy, slow to warm up, or difficult or any mix of the three), and know that even if they normally do behave well, they may react out of character when under stress.

4. Note that when you are under stress, your children are under stress. You cannot avoid this. Travel is rough enough, but visiting family can add to the undercurrent of your stress. Your children are often a mirror for you, whether you recognize it or not.  In my work with children and families, I can confidently say that most of the time that children are having challenges, it is because the parents are also having challenges in some way.  Check your own attitude and your feelings about traveling with your children before you leave, and check in with yourself or spouse many times throughout your flight, if necessary.  If you are having a tough time with your stress, calmly let your kids know and be honest about it.  If you know that you may feel stress before you take a flight, prepare yourself and prepare with different strategies to keep your kids and yourself cool.

5. Don't blame your kids for your stress. This is your stress, and even if they are doing things to contribute to how you're feeling, be careful not to take it out on them. When parents are in public situations, they're less likely to outwardly lose their temper, however sometimes they may say things or do things to try to quiet their children. Don’t make threats or promises that you will not or cannot follow through on.  Realize that you are affecting their trust in you and are likely using fear or manipulation to gain control.  While this may get you what you want in the short run, it can have long-term consequences on your relationship.

6. Don’t expect the friendly passenger to baby-sit your child the entire flight. There are many passengers who enjoy kids and will talk with them and play peek-a-boo for a few minutes, but they don’t want to spend their flight with your kids. The hard part is finding the balance. Some parents are almost militant about not letting their kids talk to or play with passengers, because some don’t trust others or feel afraid of upsetting fellow passengers.  So ask the passenger if they mind your child interacting with them for a few minutes. You can usually glean their feelings from their response or body language. Put a cap on your child’s play time with other passengers so as to not over extend their welcome. It also helps your kids learn limits and boundaries. If they want to play later with the passenger, just ask the passenger again. We once had a passenger ask if our daughter could sit on their lap after a few balanced interactions. We were fine with this, because we had spent the past hour talking with them and we were right there.

7. Make sure you have activities to keep your kids occupied. Even if your kids are not interested in what you may have brought or planned. Instead of feeling upset, get creative. The plane is a great place to teach about colors, letters, numbers and also to play “I Spy”. One of my favorite games is to play who can be quiet the longest. Make up games, and see if your children can make up games too. The more that your children feel invested in what you are doing, the better response you will get.

8. Use technology in moderation. There are a number of parents who bring DVD players or game systems for their kids, and from the moment that they get on the plane until the moment they land, their kids are glued in front of the DVD player or game system. I am not a proponent of these to the degree that they are often used. You are developing habits that your kids are going to have possibly for a lifetime. Be careful not to develop a tendency for your child to bury themselves. The plane flight is a great time to interact with your kids. You have a captive audience. Make sure you pay attention to all of your kids. While kids who are younger may need attention for their needs, older kids also require attention and communication. Take the time to talk to your kids about school, friends, dreams, and hopes.

9. Create an area where your child can move. You don’t have to keep them tethered to their seat, and you don’t want to let them wander the plane. Let them know their boundary and have them stick to it. Some kids cannot sit in their seat for an entire flight, and if you expect them to, you are setting all of you up for failure. Give your kids a little space to be kids, but put limits around it. If they want to stand or move a little, show them their area to move around in when the seatbelt light is off. If it is time to sit when the seat belt light is on and they do not want to, have a consequence in place.  If your kids get upset and cry or scream, you have to be willing to weather this storm so that they understand the limits of their behavior. Keep in mind that you are setting the standard not only for this flight, but for all future flights.

10. Remember that your kids are only young once. See the wisdom in creating positive memories, especially on these special events and seasons. Find the joys in your children and bring that energy into your experience, not just on your flight but every day.

About the Author: Erik Fisher, PhD, aka Dr. E…, is a licensed psychologist and author of two books whose work has been featured NBC, CBS, FOX and CNN. Visit him at www.DrEPresents.com.