Author Archives: Hassenfeld Children’s Hospital at NYU Langone

About Hassenfeld Children’s Hospital at NYU Langone

At Hassenfeld Children’s Hospital at NYU Langone, we understand that caring for infants, children, and teenagers is a special privilege. That’s why we partner with our young patients and their families to offer expert medical and surgical care. Our specialists treat children with conditions ranging from minor illnesses to complex, more serious issues at locations throughout the New York metropolitan area.

How to Prepare Your Child for Sleepaway Camp

campfireFor some children, heading off to an overnight summer camp is natural and easy, and their parents aren’t too concerned. For others, especially those who are younger, more prone to anxiety, or who have special needs, the approaching first day of camp can be daunting.

Whether your child is spending a week or the whole summer away from home, here are a few tips to help you prepare your child (and yourself!) for a smooth transition to camp.

Manage your own anxiety.
Maybe you’re questioning your decision to send your daughter away to camp at her young age. Maybe you’re nervous that both you and your son will spend the first few nights of camp crying. Fears are natural, but don’t let your kids know how worried you are!

Take care of yourself and your needs first. Speak to friends and family about your anxiety, but make sure that you convey an excited, optimistic attitude when talking to your child. Remind yourself why you wanted to send her to camp in the first place. Making new friends, learning new skills, playing in the fresh air, and gaining a sense of independence are all wonderful experiences that will benefit her. You can also look forward to getting a brief respite from parenting duties while she’s away!

Whatever you do, never tell your tell child that you will miss him too much or that you wish he could stay home. If he asks if you’ll miss him, let him know that you love him, but that you want him to be at camp and that you can’t wait to read his letters and hear all about camp when he gets home.

Preview the camp schedule.
For anxious children or those who have difficulty adjusting to new routines, checking out the camp’s daily schedule together can be beneficial. These are often available on the camp’s website. If you can’t locate it, email the camp and ask for the schedule for your child’s age group.

With your child, review when wake up, bedtime, mealtimes, and activity periods will be. If he has been waking up and going to sleep on a drastically different schedule, slowly adjusting to the camp’s schedule can help make it more likely that he’ll fall asleep easily when he arrives. Taking a look at photos on the camp website to preview the new surroundings can also be useful.

Make sure to read the list of activities that are offered at camp. Generate excitement for both of you by talking about which new things your child wants to try at camp!

Let the camp know about your child’s special needs.
If your child has special needs, chances are that you have already discussed them with the camp director. If not, make a phone call or send an email to the camp administration to let them know. They will be glad that you shared information that will make the start of camp easier for both your child and for her counselors.

Full-time camp staff are childcare professionals who have seen and heard it all, so don’t worry about upsetting them with this information. Many children who require unique diets, have psychiatric diagnoses such as ADHD, or who have behavior problems in school have wildly successful summer camp experiences.

Although you might feel anxious and want to call multiple times, restrict yourself to one or two communications with the camp before the first day, unless the camp indicates that more are necessary, as camp directors are extremely busy just before and during the summer season.

Practice spending nights away from home.
If your child has rarely spent the night outside the comfort of her own bedroom, practice for the camp experience by having her sleep at friend’s and family member’s houses a few times before camp begins. Don’t call her to say goodnight; allow her to become accustomed to doing her bedtime routine under the watchful eye of another adult. When she returns home, praise her for her success at staying by herself.

Your child might ask if he can come home if he changes his mind about a sleepover or about camp. Reiterate that you’re confident that he will have a great time without you. Prepare him for the experience by saying, “A lot of kids feel homesick on their first few nights away. It’s okay if you feel that way or if you don’t feel that way. If it happens to you, don’t worry that it means you won’t have a good summer anyway.” Never promise your child that you will pick him up if he feels homesick.

Let go.
Once your child arrives at camp, the staff will take care of her needs. If there’s a problem that you need to know about, they’ll call you. Enjoy your freedom and give yourself time to relax while the children are away. Remember, whatever happens, your child will be home in a few weeks!

hassFrom the Real Experts at Hassenfeld Children’s Hospital at NYU Langone:

Arielle Walzer, MA, PsyM, is a psychology extern at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone, and a doctoral candidate at Rutgers University.

Summer Socializing: How to Help Your Child Make Friends Over Summer Break

summer-friendsAs with times tables, proper spelling, and other academic skills, social skills can decline over summer vacation if children sit at home for months and ignore them. Yet, just as summer school and intensive tutoring in July and August can help kids catch up to their peers academically by September, so too can summertime be used for strengthening kids’ social skills and increasing their circle of friends before the new school year begins.

For children who struggle to make friends during the school year, the summer can be a valuable time to break free from their school-based social circles and form positive relationships with a variety of other peers. Follow these steps to learn how to maximize your child’s chance of success:

Choose the right activity.
Children are most likely to succeed in making friends when they are engaged in an activity that they love. While you might desperately want your video game-loving kid to get some exercise this summer, soccer camp is probably a poor choice if your child can’t stand organized sports. Crying or complaining about the activity is unlikely to attract new friends!

Play to your child’s strengths. What does your son or daughter talk about the most? If your daughter talks non-stop about animals, a nature program is where she’s most likely to find friends who share her passion. There are camps and classes out there for everything – coding, cooking, science, and movie-making camps are all alternatives to traditional sports and swimming summer programs.

Make sure the activity meets often.
Although it might seem like other kids make friends during chance meetings on the playground, these are unlikely to turn into lasting relationships without thoughtful follow-up. Even if your son enjoys splashing around in the pool with a boy he’s just met, it would be hard for him to turn that one-time interaction into a genuine friendship without repeated contact. Friendships tend to form over time when there are repeated opportunities to play together. If your child isn’t attending a daily camp program, try to ensure that the activities she’s enrolled in meet at least once per week to increase the odds that she’ll form a connection.

Identify potential friends.
Kids who struggle to form peer relationships often find it hard to identify potential friends. Even when they do report friendships, parents sometimes can’t help but wonder if the feeling is mutual. When possible, watch your child at the end of a program to see with whom she gets along well. If you can’t watch or if you find it difficult to tell, ask the group leader. Teachers and camp counselors are usually excited about helping facilitate new friendships and are likely to have good insight.

Make the first move.
Once you’ve figured out who might be receptive to an invitation from your child, approach the parents at pick up time or ask the group leader for contact information and call them. Suggest a specific activity and date.

Remember that parents and children often have busy summer vacation schedules, so it might be hard to set a time. Remember, there are many possible reasons that your playdate idea might be rejected! If unsuccessful at first, try again with a different family.

For an older child or teenager, help her brainstorm the activity and encourage her to ask peers herself, as those out of elementary school rarely have adults coordinate their get-togethers. If she’s nervous, role play with her until she feels more comfortable. Remember to rehearse staying calm and shrugging it off if the peer says no.

Keep playdates short and planned.
To help reduce the likelihood that kids will become bored with each other or get into an argument, first playdates should be short and sweet. Aim for two hours or less.

Inviting the child to your home with a vague plan to play can be a great choice once the friendship is established, but it’s not the best move for a first playdate. It might be hard for the kids to choose an activity, and the playdate could quickly become boring or contentious. Instead, choose a specific activity that you know both kids enjoy. Activities such as watching a specific movie or completing a craft project can take place in your home, while visiting a children’s museum or a zoo are good options for outings.

Have realistic expectations.
Summer programs can be a great way for your child to improve his social skills and make friends, but remember that summer vacation lasts only a few months. Celebrate small victories, such as a single successful get-together with a friend or even the exchange of social media usernames. If your child’s summer buddy doesn’t turn into a year-round pal, that’s okay. Even a short friendship is worthwhile if it helps your kid feel less lonely and learn new skills for the next friendship. There’s always next summer!

Does your child have social communication difficulties? The Child Study Center’s Social Learning Program offers a wide array of social skills group therapy services for children as young as 3 through young adults up to age 35. Groups are appropriate for individuals with social communication difficulties related to attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, anxiety, depression, or other challenges. Both children and parents participate in separate weekly groups that run concurrently for 12-16 weeks. Clinical faculty and staff use evidence-based interventions based on research that shows positive long-term outcomes. For more information about our social skills group sessions in Manhattan, please contact our Social Learning Program intake team at 646-754-5284 or email csc.sociallearning@nyumc.org.

hassFrom the Real Experts at Hassenfeld Children’s Hospital at NYU Langone:

Arielle Walzer, MA, PsyM, is a psychology extern in Autism Spectrum Disorder service at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone. Rebecca Shalev, PhD, BCBA, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone.

Tips to Get Your Teen on a Regular—and Healthy—Sleep Schedule

teensleepI hear from many parents that they struggle to get their teens to go to bed at a reasonable hour. Consistent sleep schedules are difficult for teens because there are many environmental factors—including school schedules, homework, extracurricular activities, and jobs—that regularly force teens to adjust their schedule in an unnatural way. The biological clock or circadian rhythm of a teen is actually designed to shift toward a delayed schedule; that is, teens naturally want to go to bed late and wake up late.

We notice this circadian shift starting around puberty, and we think it happens for two main reasons.  First, teens are the strongest, fastest, have the best immune response, tolerate pain and extremes of temperature better than adults, and they are more likely to take risks (like put themselves in harm’s way).  As a result, teens and those in their early twenties (“adolescents” in today’s parlance) are the best suited to protect the cave and clan while others sleep.  So, the adolescents stay up until the wee hours, while the adults sleep.  The oldest among us then awaken early and relieve the young protectors, who can now go to sleep as the dawn is breaking and the threat of predators has considerably lessened.

Second, teens have reached puberty and so are ready, by evolutionary standards, to begin coupling and reproducing.  And so, they need time alone with other teens, without the watchful eyes of parents, to get to know one another, measure up, and decide who belongs with whom; there’s no better time for this than late at night when the parents are asleep.  For these two reasons, teens and young adults typically have a delayed sleep schedule.

While studies show that teens actually benefit from later high school and college start times—and the CDC actually has advised that high schools not start before 8:30AM—fewer than 20% of American schools adhere to this recommendation. If your family is struggling with getting your teenager on a consistent sleep schedule, here are some helpful tips:

Learn about sleep and teach your kids. There are many great books, and the data on getting more sleep is compelling. I teach a college class on sleep at NYU, and I’ve learned that young people really do want to understand their sleep and get better at it. I talk with my own kids about the effects of not getting enough sleep, from the physical to the neuropsychological. Things like immune system functioning, digestion, height, concentration, muscle growth, skin strength, decision-making, memory, anxiety and mood, and so many more factors all improve when you get a good night’s sleep. And on the flip side, illnesses, wrinkles, weight gain, exhaustion, and irritability are all side effects of not getting enough sleep.

Take away screens an hour before bed and limit their use. Screens are distracting and keep us awake. Remember, moms and dads, you own the phone.

Limit sleep-disrupting light exposure. Try eye masks and/or heavy curtains to keep the light out of their eyes while they sleep. Download apps like lux or use ‘nightshift’ on their smartphone so that the blue light that blocks melatonin is removed from their screens. Light is the most influential factor in setting our internal circadian clocks, so we want to control light and make sure that we live in dim light for about 3-4 hours before bed, at the least.

Keep the last few hours before bed calm. Try and do something that’s not stressful before bed, at least for the last 30 minutes. Don’t watch a thriller or action adventure movie before bed—it will jazz your kids up.  Instead, read something relaxing, watch something easy like the food channel, or do something else that eases your mind.

Figure out a schedule that allows for sufficient sleep. As parents, try to help schedule your children’s lives so that they can get sufficient sleep. Make sure homework gets done as early as possible. Make it clear to your kids that while school performance is important, they shouldn’t pressure themselves to stay up all night long to work or study. In fact, we know from lots of data that people remember and learn much better when they’ve slept 8-9 hours than when they sleep less. Students who get more sleep do better in school.

Start going to bed earlier yourself.
Parents are the role models—when we take sleep more seriously, our kids will as well.

hassFrom the Real Experts at Hassenfeld Children’s Hospital at NYU Langone:

Jess Shatkin, MD, MPH, is a professor in the Departments of Child & Adolescent Psychiatry and Pediatrics at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone. He also serves as the Vice Chair for Education in the Department of Child & Adolescent Psychiatry, and the Director of Undergraduate Studies for Child & Adolescent Mental Health Studies (CAMS) at NYU College of Arts & Science. He’s also the author of Born to Be Wild: Why Teens Take Risks, and How We Can Help Keep Them Safe.

Skin Deep: Understanding Body Dysmorphic Disorder

body

Body Dysmorphic Disorder (BDD) is a condition that affects more than 1 in 100 people.  Though it can appear in children as young as five, it often begins in teen years and continues into adulthood if it’s left untreated.  Unfortunately, many people with BDD are too ashamed to speak about it, leaving them without ever receiving support. If you’re a parent with concerns about your own child showing signs of body dysmorphic disorder, here are some important facts about this widely misunderstood yet common condition:

  1. BDD is not a typical concern about weight. Seeking weight loss and supermodel looks is far from unusual in our culture and prevalent in individuals with eating disorders.  However, individuals with BDD are convinced that one or more specific areas or aspects of their body are deformed or extremely flawed, despite looking normal to others.  People with BDD often fixate on the areas around their head, such as their nose, hair, or the skin on their face, but any aspect of the body can become a focus.  In one type of BDD called “muscle dysmorphia,” individuals believe that they look too small and continuously obsess about having a more muscular body.
  2. BDD is related to Obsessive Compulsive Disorder (OCD). Individuals with BDD spend hours each day obsessing about particular areas of their body and then engage in behaviors that are similar to compulsions in response to their concerns.  Their compulsions typically involve either frequently looking at or avoiding looking at an area of the body, repeatedly seeking reassurance from others about how they look, and/or getting multiple cosmetic procedures to try to correct the imagined flaw.  They may go to dermatologists and cosmetic surgeons often as they try to improve their appearance, however no procedure can address their psychological experience.
  3. BDD can affect anyone. Cases of BDD have been reported in children as young as 5 and adults as old as 80.  Although it occurs slightly more often in women, it is almost as common in men as it is in women.  BDD has also been found in people across different cultures and ethnicities.
  4. BDD can interrupt all aspects of a person’s life. Individuals with BDD may be so self-conscious about how they look that they completely avoid social interactions.  This may mean that they remain home and do not go to work or school.  Adults with BDD have a higher rate of unemployment than the general population.  They often have limited contact with friends and family.  When they are with others, they continue to be preoccupied with their perceived flaw.
  5. BDD takes a large emotional toll. Most people with BDD will also experience depression secondary to their body image concerns.  Many also experience thoughts of suicide and are between 6 to 23 times more likely to attempt suicide than the average person.  People will BDD also are more vulnerable to struggle with anxiety and substance use problems.  The high-likelihood of additional psychological concerns with BDD further highlight the need for these individuals to receive treatment.
  6. BDD is treatable.  People of all ages with BDD can benefit from Cognitive Behavioral Therapy (CBT).  However, as there are a number of complicating factors in BDD, such a suicidality, it is important to find a therapist with expertise in this condition.  In addition, serotonin reuptake inhibitors (SRIs) such as Prozac, have been found to be effective in treating BDD.  If your child is showing signs of BDD, you can ask your pediatrician about obtaining an evaluation by a mental health professional with expertise in this condition, who can help determine whether they require treatment.

hassFrom the Real Experts at Hassenfeld Children’s Hospital at NYU Langone:

Michelle Miller, PsyD, is a licensed psychologist and clinical assistant professor in the Department of Child and Adolescent Psychology at NYU Langone Health. She practices at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone, in the NYC and New Jersey locations.  Dr. Miller specializes in the treatment of body dysmorphic disorder, eating disorders, obsessive compulsive disorders, tic disorders, and selective mutism.

Rewarding Kids for Good Behavior: A Bad Idea? (Part 2 of 2)

Close Up Of Girl Eating Iced Donut

Two weeks ago, we began a two-part series that aims to provide information to parents about rewards and how to use them strategically and systematically to teach children skills and modify behaviors. Our first post discussed common parental concerns about rewarding kids for good behavior. This week’s will focus on how to use a reward system effectively.

1. Define the target behavior and set up attainable goals. This involves planning what behavior(s) you want to target over time and then defining the behavior so it is specific, observable, measurable, positively-stated, and attainable:

Specific and Observable:
Avoid using vague terms that cannot be measured such as “Behaving,” “Listening,” or “Being nice.” Instead try “Staying next to parent outside of home,” “Using kind words with brother and sister.” Make sure the target behavior can be observed directly by anyone observing including a parent, nanny, or sitter.

Measurable: The next step is to make sure the goals are measurable. Make sure to focus on behavior and to avoid using thoughts and feelings in the goal because these internal states can’t be quantified by an observer. Also, make sure your goal has parameters like a time of day, number of reminders, or quantifiable amount. For instance, “Completing homework accurately,” could be defined as “Completing homework with at least 75% accuracy.”

Positively-Stated: After goals are specific and observable, they should be reworded if needed to ensure they are positively-stated. Positively-stated goals tell a child what to do instead of what not to do. For example: “Using a big boy voice,” or “Using an appropriate tone of voice,” can be used instead of “Not whining.”

Attainable: 
It’s important to set the target so it’s an improvement over where your child started but not so hard that it’s impossible. You want to find the right balance so you don’t reward things they are already doing and also don’t make it so difficult that they lose interest and your chart starts to collect dust. Adding a set number of reminders or specifying a small timeframe can help make challenging goals more attainable. Then when a child is successful, parents can make the target harder, which shapes the goal closer to the parents’ desired outcome. For instance, a goal of “Keeping hands and feet to self with 2 or fewer reminders in the afternoon,” can be changed to “1 or fewer reminders” after a child is consistently successful with 2 reminders.

2. Select Appropriate Rewards. Once targets are set, parents need to establish rewards based on their child’s preferences. Parents should brainstorm privileges, activities, and tangible items that would be enjoyable for their child. Examples of privileges or activities are extra screen time, extra story time, a board game with a parent, a craft or activity with a parent, a later bedtime, or an outing. Tangible items can include stickers, small prizes in a grab bag or treasure chest, a special treat, or items a child wants such as Pokemon cards, Legos, downloading a song or game, or gift cards. Parents should make sure the reward is something the child does not already get for free, such as offering an additional 20 minutes of screen time when current screen time is unlimited. They will also want to make sure they are comfortable withholding the rewards if the child does not earn them. For instance, a parent who is trying to help a child make more friends may not want to use play-dates as a reward. In general, younger children and children who have trouble waiting respond best to daily rewards and older children can wait for larger rewards.

3. Preparing Your Child: It’s important to prepare your child in advance by discussing briefly during a calm time. In this discussion you would want to let your child know what he or she will be working on and why, review how rewards can be earned and what types of rewards will be provided. You will also want to get input from the child about rewards.

4. Starting the Program, Giving Feedback, and Monitoring Progress: Once you start the system, it’s important to monitor and give feedback consistently after every opportunity to earn. Feedback should be praise when your child meets the goal and neutral feedback when he or she does not. For instance, positive feedback could be, “Great job getting dressed on your own with only one reminder.  You earned something from your reward list.”  Alternatively, on a tougher day, feedback could be, “I had to give you three reminders to get dressed today so you didn’t earn your reward.  We’ll try again tomorrow.”  You could also help problem solve with your child any difficulties depending on their age and ability.  In addition to regular verbal feedback, formally tracking progress is important to assess the effects of the program and determine next steps.  Having a visual such as tokens, a marble jar, or a behavior chart with stars or stickers helps the child understand the system and their progress. Visuals also can be important cues to busy parents that remind them to use the system.  In addition to providing a visual cue, behavior charts are particularly helpful for tracking progress over time to help parents decide when to make the goal easier or harder.

5. Troubleshooting: A number of problems can come up with reward systems. It’s important to consider several causes if your child is not responding or was responding and then stopped. One possible problem is your child’s motivation. Consider whether they are motivated by the reward, if the reward is too far in the future, and if the reward is something they already get for free. Sometimes refreshing the reward menu periodically can significantly help motivation and prevent a child from getting bored of the system. For children who are hard to motivate, pay attention to how they are spending their free time and what they are asking for. Some children are very motivated by parent attention and respond best to individual time with a parent or parent-child activities.  If it’s not a motivation problem, parents should consider whether they are giving regular and clear feedback consistently and should take steps to improve consistency by using reminders on a phone and/or placing the chart in a visible area. For parents with children who argue about their behavior, parents should make sure their feedback is given right when they see a behavior, let their child know that parent decisions are final, and then ignore arguing consistently.

Behavior charts can be very effective in changing behavior over time when used correctly. If you’ve tried these steps without positive results, you may want to consider professional guidance.

hassFrom the Real Experts at Hassenfeld Children’s Hospital at NYU Langone:

Stephanie M. Wagner, PhD, is a licensed clinical psychologist and clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone Health. She serves as the co-director of the Early Childhood Clinical Service at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone.

Rewarding Kids for Good Behavior: A Bad Idea? (Part 1 of 2)

Close Up Of Girl Eating Iced Donut


This is the first post of a two-part series that aims to provide information to parents about rewards and how to use them strategically and systematically to teach children skills and modify behaviors.

Most parents have found themselves uttering something to the extent of, “If you are good, I’ll buy you a piece of candy,” at one point or another.  Although rewarding appropriate behaviors can help modify behavior over time, parent concerns about rewarding and incorrect use of rewards often get in the way.

Frequently, parent concerns center on the principle of rewards. Common concerns along with considerations for these concerns include:

“I don’t want to reward my child for something he/she should be doing.” This concern often arises when there is a mismatch between parent expectations and the reality of child behavior. While this can happen for a number of reasons, parents ultimately have a choice here of accepting the behavior as is or working to change the behavior over time. For instance a parent whose 3 year old tantrums in stores when she is told no could simply accept the tantrums as the reality of shopping with a young child. However, most parents will be compelled to either try things in the moment that may make the behavior worse or avoid stores with the toddler, which does not teach the skill of staying calm and listening in these settings. Rewards used strategically can help turn a behavior that a child is not doing but “should be” into a routine habit.

“My child will become dependent on rewards.” This concern revolves around the idea that a child will need rewards in order to do anything and may even refuse tasks in absence of a reward. Here, it’s important to remember that rewards help facilitate skills and change habits over time. Once habits are formed, rewards are no longer necessary. Many parents have experience with this if they used small prizes for toilet training and can chuckle at the absurdity of giving their teenager M&Ms for using the potty. It is true that some children try to negotiate for rewards once they understand how rewards work. Negotiation can be reduced by having a clear and specific reward plan in place from the beginning.

“Rewards ruin a child’s intrinsic motivation.” This concern comes from research on rewarding and motivation. Findings from this research have fueled a backlash against incentive systems. When considering rewards for your child, it’s important to remember that there are more details to these studies that have been overlooked at times. Specifically, one of the major studies examined motivation for tasks that were enjoyable to participants before they were rewarded. If you are considering rewards for your child, there’s a good chance that your child does not find the task enjoyable and motivating on its own.

“Rewards are unnatural and not the way the world works.” Some parents worry that rewards do not prepare children for adulthood. While there are a number of examples of rewards in everyday life including working for a paycheck, another consideration here is that the use of rewards to form positive habits in childhood helps increase the likelihood of success in adulthood.

“Reward systems don’t work.” Parents will often say that they’ve tried rewards and they don’t work.

Stay tuned for our second post on rewarding kids for good behavior, which will discuss tips to help you use incentives effectively to address problem behaviors.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Stephanie M. Wagner, PhD, is a licensed clinical psychologist and clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone Health. She serves as the co-director of the Early Childhood Clinical Service at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone.

How to Support Your Transgender or Gender Expansive Child

transGender is not as simple as boy or girl and is composed of many parts. A child’s sex assigned at birth is an assignment or classification given to an infant based on physical anatomy. Gender identity is an individual’s sense of being male, female, neither, both, or other genders. For many individuals, their sex assigned at birth and gender identity match (i.e. they are cisgender). For other individuals, sex assigned at birth and gender identity do not match (i.e. they are transgender or gender expansive).

Transgender and gender expansive youth face a number of challenges in the community due to stigma and discrimination. They are at high risk for mental health issues including suicidal thoughts, anxiety, and depression when they are not supported in their identities.

Here are some suggestions to help parents and caregivers best support their transgender and gender expansive youth. Regardless of where your family is on the gender journey, these ideas can help you provide the most supportive environment for your child.

1. Listen, validate, and accept: Parental acceptance is the single largest protective factor for transgender and gender expansive youth. Youth who have support from their families have similar mental health rates and diagnoses when compared to cisgender peers. Provide a space for your child to have open conversations. Ask open ended questions like: “How do you describe your gender?” or “What does gender mean to you?” Follow your child’s lead and provide a supportive stance. Use the name and pronouns that your child prefers.

2. Find support for your child (if needed): Your child might feel like they would like support from the community or from mental health providers, though it is certainly not required. If they do, look for clinicians who provide gender affirmative care. You might want to find a team of gender affirming providers including primary care, psychology, and endocrinology if your child is medically transitioning.

3. Require respect within the family and promote pride in your child’s gender identity: Always promote that family members and friends use preferred name and pronouns for your child. Celebrate your child’s identity and encourage others to do so.

4. Advocate: Transgender and gender expansive youth have a number of different challenges that they face on a day to day basis. For example, these children and teens might not know how to talk to their school about their preferred name and pronouns, what restroom to use, or how to correct someone who is misgendering them. Parents can play a huge role in helping advocate for their child by talking to the school administration or becoming more involved within the transgender community. Learn as much as you can through reading and take part in advocacy groups.

5. Find support for you: It is normal for parents to have their own emotional processes around their child coming out as transgender or gender expansive. It is important for parents to find their own support if they feel as though they are struggling with their own reactions. Parents can join support groups aimed towards parents or confide in friends and family.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Samantha Busa, PsyD, is a licensed psychologist and clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone Health. She sees patients for evaluations, individual therapy, and group therapy as part of the Gender & Sexuality Service  at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone. She also conducts individual and group therapy for anxiety disorders, mood disorders, tics and Tourette disorder, trichotillomania and body-focused repetitive behaviors, and school refusal using cognitive behavioral therapy (CBT), dialectical behavioral therapy, and habit reversal training.

Top Flu Facts to Keep Your Child Healthy This Winter

faverAs a pediatrician in a busy New York City practice, I have been asked lot of questions from concerned parents about how bad this year’s flu season has been. Here are answers to some of the most frequently asked questions I’ve been asked this flu season.

Why should I bother with the vaccine if it’s not effective?
While there have been a lot of headlines about how this year’s vaccine is not that effective, it is still a good idea to get vaccinated—while the vaccine is certainly not 100% effective, we still recommend parents vaccinate their children (and get the vaccine themselves!).  The latest midseason estimates by the CDC show that the vaccine is about 36% effective overall (25% effective against influenza A H3N2 virus strain – which is the most commonly circulating and virulent strain this season so far, 67% effective against influenza A H1N1, and 42% effective against influenza B virus strains). Among children aged 6 months to 8 years, the flu vaccine reduces the risk of seeking medical attention because of the flu by more than half – about 59%! Even if your child contracts the influenza virus after having received the flu vaccine, the severity of your child’s illness will likely be decreased. Additionally, the side effects of the vaccine are very minimal and significant adverse events are exceedingly rare, so the benefits of getting vaccinated far outweigh the risks.

Can I get the flu from the flu vaccine?
No, the flu vaccine cannot cause the flu. The vaccine that is administered this season is the inactivated flu vaccine, which contains virus particles that have been altered such that it is impossible for them to cause infection. Generally, the vaccine may at most cause a low-grade fever, headache, nausea, or soreness at the site of injection. Remember that it is still possible to get the flu even after having received the vaccine, but it would likely be less severe. Also, keep in mind that we tend to administer the flu vaccine in fall or winter months when other viruses are already circulating so it is entirely plausible to fall sick with another virus shortly after receiving the flu vaccine.

Is it too late to get the vaccine now?
The earlier you get the flu vaccine the better, but I would still encourage anyone to get it now, especially as we are seeing such a high incidence of the flu. The flu season is likely to last several more weeks at least. The flu vaccine is one of the only ways to help reduce your risk of contracting influenza and spreading it to others. Keep in mind that it takes about 2 weeks after receiving the vaccine for your body to generate antibodies to help protect yourself from the flu virus.

I see in the news that people are dying of the flu—how worried should I be?
Influenza is a viral illness that can and does cause severe complications and possibly death in some patients every year. However, it is important to remember that most people who contract the flu develop relatively mild illness and recover fully within one to two weeks. There are certain individuals who are at high risk for developing influenza-related complications. These people include children under the age of 5 years (and especially under the age of 2 years), adults aged 65 years and older, pregnant women, immunocompromised individuals, and those with chronic health conditions such as asthma, diabetes, or kidney disease. That being said, there are ways to help protect yourself and your loved ones. Firstly, get the flu vaccine every year and encourage your friends and family to do the same. This is one of the most important steps in protecting yourself and your child from influenza-related complications. Secondly, practice good hand hygiene and avoid contact with anyone who might be sick. Thirdly, if your child does get sick with flu-like symptoms, please be proactive and bring your child in to be evaluated as soon as possible – there are things that we as doctors can do to help. Ask your child’s pediatrician if your child would benefit from antiviral treatment for the flu.

Should I avoid taking my child to the pediatrician, with so many sick kids in the waiting room?
In general, most practices have a way to isolate people who are sick and sanitize waiting areas and exam rooms. For children who have fever and/or cough, we offer medical masks for them to wear if they are able when they check in. If you’re setting up a well appointment for your child, I’d recommend you see if there is a time of day to come when there aren’t as many people in the waiting area, to minimize flu exposure. That’s especially important for small infants or newborns—I’d suggest coming in first thing in the morning or at the end of the day. You shouldn’t skip it altogether though; it’s still a good idea to see your doctor whenever you or your child needs to.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Madhavi Kapoor, MD, is a clinical assistant professor in the Department of Pediatrics at Hassenfeld Children’s Hospital at NYU Langone, and a pediatrician at NYU Langone at Trinity.

Teach Your Kids How to Win (and Lose) Like an Olympian

learn-to-skate-429537_1920Starting next week, viewers around the world will turn their attention to Pyeongchang, South Korea, for the 2018 Olympic Winter Games. If your children are watching the Games, they may aspire to compete themselves one day. If they haven’t already shown interest, your kids may suddenly want to try their hand at bobsledding, skiing, or skating.

There is a lot of conflicting data about competitive activities for children, but for the most part experts agree: it’s not about the competition itself, but about the values placed upon it.

Let your children try a variety of activities. Today’s kids have many specialty and school teams available, but focusing on a single activity too soon can lead to burn out and injuries. Even if they start out loving basketball, have them try baseball or dance or swimming, too. Young bodies shouldn’t repeat the same intense movements over and over; they should move in a variety of ways while they grow.

Don’t protect your kids from failure. The value of losing is a concept many of us struggle with even as adults, so start now helping your kids become comfortable with it. We’ve learned that children afraid of losing will quickly cease trying to challenge themselves. Instead they’ll “stick with what they know,” and only aim for goals they know they can achieve. Growth happens when children aren’t afraid to try something challenging just because they might fail.

Teach your children to value effort, responsibility, kindness, and discipline, rather than “talent” or “skill.” When a player on the other team scores, remind your child to celebrate his effort. When a member of the relay team lags behind, have your child thank her for never giving up.

You might ask, how do I do that? How do I acknowledge my child’s efforts without focusing on the win? What if my kid loses or gets embarrassed? We enroll our kids in activities so they’ll have fun, be active, and socialize, but if we aren’t careful, kids often end up playing to please their parents. Instead of celebrating their own tenacity and drive, kids begin to expect our celebration of them—and to be devastated when they don’t get it.

There are two types of praise that you can give your children. The first is called person-centered praise and includes phrases such as “you’re so smart!” or “you’re a good kid!” This type of praise places emphasis on traits that are assumed to be inherent and concrete—you are either smart, or you are not. You are a good athlete, or you are not. It does not leave room for skill-building, second-place trophies, or a failed exam.

These trait-based compliments become internalized by our kids, especially at a young age. Any result that doesn’t support the internalized narrative—say, a lost race—leaves kids questioning their inherent worthiness. (Am I a terrible athlete because I didn’t win?) This damages their sense of self-worth and creates a heightened sense of vulnerability. In short, kids who receive mostly person-centered praise are terrified of failure because failing might mean they really aren’t [smart/talented/an athlete/an artist]. So stop telling your kids how great they are!

Wait, what? Yep! Science tells us to stop with all of the “person praise” and switch to what we call process praise. It takes some time to develop this skill, but the results are invaluable. To do it:
1. Praise the strategy (e.g., “You found a creative solution to that problem even when you felt frustrated.”)
2. Praise with specificity (e.g., “I noticed you were very careful when you carried your friend’s bag to the car.”)
3. Praise the effort (e.g., “I can tell you’ve been practicing your leaps and turns!”)

With process praise, neither the trait (goodness, talent, intelligence, etc.) nor the outcome (a winning game or the aesthetics of the painting) are mentioned. With process praise kids learn that a terrible game doesn’t mean “I’m a bad athlete,” it means, “I tried really hard but I didn’t practice last week – how can I try differently?”

Remember, most of your children won’t ever compete at the highest level of sport, and even if they do, they won’t be able to do it forever. The values you instill in them now will long outlast their ability to play.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Hayley Adkisson, LCSW, is the senior social worker for the Divisions of Pediatric Gastroenterology, Rheumatology, Nephrology, and Infectious Disease at the Fink Children’s Ambulatory Care Center, part of Hassenfeld Children’s Hospital at NYU Langone. She also serves as a clinical social worker for NYU Langone’s Adolescent Gender Clinic and NYU Langone’s Pediatric Celiac Disease and Gluten-Related Disorders Program. Ms. Adkisson specializes in adolescent medicine, chronic illness, survivorship of sexual trauma, and mood disorders.

Baby Bonding Basics: How New Dads Can Jumpstart Their Baby Bond

baby-dadIt’s not unusual for new fathers to feel nervous that they aren’t bonding with their baby. Moms generally have biology on their side for the process of bonding and feeling attached to their newborns—first, they’ve had nine months of pregnancy to begin that process as they share one body. Then through birth, skin to skin contact, breastfeeding, and the sensitive dance of learning to respond to baby’s cues, mom and baby nurture that bond outside the womb. Dads may also have different messages from society or their own experiences that make their early involvement feel less important or less skilled than new moms, and this frame of mind is kind of self-fulfilling.

If a dad is having a hard time feeling the love for a tiny stranger, there are a couple of things that are likely to help. The first is, don’t beat yourself up about it and remember there isn’t just one way to be a great dad; bonds will form and grow and strain many times over the course of your child’s development. Be patient.

The second is, get to know your baby and put in the time you would to grow any new relationship. Here are some helpful tips on how to do that:

•Spend skin to skin time, what is referred to as “kangaroo care,” with your infant. There are numerous positive benefits to your infant’s health and biological regulation, and the tender moments with that little one on your chest will make sweet memories for you too.
•Start having those heart to hearts with the baby, even when he can’t talk back. Talking to infants stimulates their language development; the more infants hear and connect to the world around them, the better off their vocabulary, social skills, and cognitive development will be. Do this with face to face chats, and narrative play by plays as you go about your day with baby.
•Be proactive in asking your partner how you can divide up baby care responsibilities. There is a lot of attention right now on mothers feeling the weight of “mental load” in the family. New parents can try to avoid some of this uneven burden by working out a system for communicating needs and day to day responsibilities. Give yourself room to make your own approach to feeding or playing instead of feeling (or getting the message) that you have to do it just like mom.
•Do something you enjoy and find a way to incorporate your baby. For many dads, quality time can be taking a walk with baby in the carrier and telling him or her about your favorite spots. Maybe you can introduce baby to your love of cooking, or music. Sharing experiences and finding alone time to bond are helpful even when infants cannot yet respond as interactively.
•If it can be done in your family, take on some of the feedings to give your partner a break and let you in on the close contact as your baby eats. If not, try sitting with your partner during some feedings and provide moral support, a neck rub, or extra set of hands.

Bonding sets the stage for a secure attachment, one that is warm and responsive. For both moms and dads (and caregivers in any arrangement), a secure attachment that is formed in the first year or two of development helps promote a worldview for the infant that people can be trusted, the world is a place to explore and enjoy, gives them more confidence, and a host of benefits for social and cognitive development.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Lauren Knickerbocker, PhD, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone Health. Dr. Knickerbocker specializes in treating selective mutism and anxiety in young children, ADHD and difficulties with organization and time management, disruptive behaviors, and parent management training. She is also the co-director of Early Childhood Service at NYU Langone’s Child Study Center, a part of Hassenfeld Children’s Hospital.