Author Archives: NYU Langone Medical Center

About NYU Langone Medical Center

At the Hassenfeld Children’s Hospital of New York 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 comprehensive inpatient and outpatient services and expertise. Our experts provide the best care possible for children with conditions ranging from minor illnesses to complex, more serious illnesses.

Helping Your Children Make Resolutions That Stick

resolutions

We all know the story: make a New Year’s resolution in January, and by mid-March you’ll be asking yourself, “What happened to that diet?” Now that it’s December, children in classrooms around the country are hearing about New Year’s resolutions. Your child might be thinking about what she wants hers to be for 2017. Unfortunately for students excited to make resolutions, research bears out the common wisdom that setting a large goal is unlikely to result in any meaningful change. That’s because our desire to change only accounts for a percentage of our ability to follow through with it. So if research shows that grand, sweeping goals do not make effective resolutions, then why set our kids up for failure? Rather than give up on resolutions altogether, follow these four steps to help your children devise plans that create real results!

1. First, find out what your child thinks a good resolution would be. If he’s like most people, he’ll probably pick something that sounds wonderful and is hard to quantify, like, “Be a better friend.” Allow your child to imagine how he’ll feel if he pursues this resolution. This step is all about your child identifying the goal and feeling motivated to achieve it.

2. Next, ask her what that resolution would look like. In other words, if she told a story or drew a picture about her resolution, what would it be? A resolution to help out more around the house might be a picture of a child putting her dinner plate in the dishwasher. This step is all about identifying the behavior behind the resolution.

3. After that, brainstorm with your child to find out when that behavior should happen. Being nicer to a younger sibling might happen during homework time or on a Saturday morning before parents are awake. The key here is for your child to identify a specific situation when the behavior should occur. It is clear and concrete; not “someday” or “all the time.”

4. Finally, have your child create an “If-Then” statement for using the new behavior. “If-Then” statements combine the situation with the desired behavioral response. Psychologists call this an “implementation intention.” A teenager who wants to procrastinate less might create the statement, “If I feel like procrastinating during homework time, then I will set the timer on my phone to at least work for two minutes before taking a break.”

And that’s it! Follow these steps for effective goal setting and behavior change, and give your kids the chance to make their resolutions a reality.

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

Christina Di Bartolo, LMSW, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry and the program supervisor for the Institute for Attention Deficit Hyperactivity and Behavior Disorder Centers at the Child Study Center at NYU Langone Medical Center

Holiday Hothead? Tips for Preventing and Managing Your Child’s Holiday Behavior Problems

holiday-upset

It can be the most wonderful time of the year! It can also be a stressful time for parents who worry about how their child will behave at events with family and friends. The hustle and bustle of the season, changes to daily routines, parties, and gifts can contribute to parent-child conflict and meltdowns. The following tips will help you prevent problems and keep the season festive for all.

Anticipate potential problems
Different aspects of the season will be challenging for different children. Take a few minutes to think what parts may be hard for your child. For instance, will your child have trouble playing nicely with the children of relatives and family friends? Do you worry that your child may have tantrums or show disrespect if disappointed about a gift, or test the limits and try to get away with more than what is allowed at home? Problems during holiday travel are also common.

Set up for success
—Playing nicely with others: If your child tends to have trouble playing with others during less structured times, consider planning activities for an event you are hosting, such as cookie decorating, holiday coloring projects, holiday movies, and other games. Try to limit less-structured times if possible. If you are visiting instead of hosting, see if you can bring some activities for all of the children or ones your child can do independently such as stories, paper snowflakes, and coloring books.
—Avoiding meltdowns over gifts: Talk to your child in advance about the reason behind gift giving and the need to be polite to everyone who gives them a gift. Let them know it’s okay to be disappointed, but they still need to show respect. Get them involved in the giving process by picking out gifts for family and friends or donating toys for children less fortunate. Role play situations that may come up, like getting a hand knit sweater instead of that new video game they’ve been wanting.
—Travel tips: If your plans include a lot of travel, consider scheduling it during your child’s nap or at night so they can sleep. You can also bring snacks and toys, sing holiday songs, play games like 20 Questions, and consider using electronics, especially if you have a long flight or drive.
—Testing limits: Decide if it’s realistic and appropriate to use any punishment strategies. Knowing in advance if you will take away privileges or use a timeout will help you avoid making threats that only serve to frustrate you and your child when you cannot follow through.
—Scheduling: For any child who struggles to manage their behavior and emotions, longer days and events will test their resources to keep it together. Consider shortening visits and even saying no to some invites if the day is going to be too action-packed. It’s better to have shorter, more pleasant get-togethers than one that ends in an epic meltdown. If shortening a visit is not an option, see if there is a quieter place in the home for your child to take a couple breaks.
—Have a “worst case scenario” plan: This could be pulling your child aside for a break, having them stay with you if they are having trouble getting along with other children, or even leaving early if you are visiting. Make sure that you are comfortable following through with anything on the plan. Knowing the specific plan will help you feel most prepared.

Review expectations ahead of time
Based on the anticipated problems, let your child know exactly what you expect during holiday visits. Avoid vague expectations such as “Behave” and instead state clearly what behavior you want to see, like “Listen to me,” or “Share toys with other children.” Try to use positive language. Tell your child, “Say thank you for gifts even if it’s not what you were hoping for,” instead of “Don’t be rude.” Choose your battles carefully to focus on the most important goals–which can mean letting go of some limits you normally place. For example, it may not be critical to limit your child to one treat, especially if other children will likely have more and it will be hard for you to fully monitor while spending time with relatives.

During get-togethers
Instead of waiting for the end of a party, try giving frequent spontaneous feedback when you see your child following set expectations to build positive momentum. Make statements such as, “I’m so proud of you for playing nicely,” or “You did a great job being polite to thank grandma for the mittens and hat.” If you start noticing problems, stay as calm as possible (which will help your child stay calm) and use your “worst case scenario” plan. You may feel like other friends and relatives are judging your parenting. Try to remember that every parent has dealt with outbursts and problematic behavior at one point or another; some may just have trouble remembering or feel like they have to share their behavior management tip at an inopportune time.

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

Stephanie Wagner, Ph.D., is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone Medical Center. She specializes in behavioral treatments for sleep as well as providing psychosocial interventions, including parent training, Parent-Child Interaction Therapy (PCIT), and school consultation to parents and teachers of children with ADHD and disruptive behavior disorders. She is also the co-director of Early Childhood Service at NYU Langone’s Child Study Center.

Starting Holiday Traditions with your Little Ones

 

cookies

It’s that time of year again! Young children are already full of holiday cheer and excitement at the prospect of presents, treats, and more family time. Making new holiday traditions with your toddler (or bringing them into your existing traditions) is a wonderful opportunity to strengthen family bonds and promote their healthy development. Here are few toddler-centered milestones to consider when making your own family traditions for this holiday season.

Independence: To foster the independence that toddlers crave, try giving them a job that makes them feel central to the ritual and they can continue to do every year as they grow. For example, letting them light the candles (with supervision!) on a menorah, advent wreath, angel chimes, or centerpiece before a family meal can make them feel proud to be trusted with such a grown up responsibility. Toddlers just want to feel included and to be able imitate what they see you doing. Another fun tradition could be to bake special cookies together and make your toddler the “Chief Decorator” or “Sprinkles Fairy” to give them their special role. For families considering the long term goals of independence, gifting each child a new ornament every year to eventually move with them to their own homes as adults is a thoughtful and heartfelt tradition.

Empathy building: Toddlers are also the perfect age to learn more about empathy and civic mindedness. They will learn and embody these characteristics best by watching you model these values, and participating in the experience of giving back. Take them to buy a present and bring it to a local charity or event for children who do not have resources. Sing Christmas carols or spend time with the elderly at a local nursing home. Make meals for the homeless. Any volunteer opportunities that are family friendly will benefit the cause you are helping as well as your child’s sense of belonging to a community that values each other.

Family Bonding: Match your family vibe to a tradition that creates warm family connections. Are you a favorite movie with a big blanket and snacks family? A creative family that can make up songs or decorate ornaments together? A family who embodies “the more the merrier” mantra who can host a festive holiday get together? I know many families who create traditions that incorporate games and reading aloud during the lead-up to holidays. One family unwraps a new board game each Christmas Eve and they play all together in their pajamas while they snack on sweets. Another family asks each member to write a letter to the other members to express their love and gratitude for that person or something that happened that year (the two year old dictates hers). The letters end up in their stockings to be read aloud Christmas morning. What a wonderful lesson that would be for little ones learning about gratitude and love for others!

Making Good Memories: Whatever you decide to do to mark the holidays in your home, think about making a family tradition that will feel special and exciting to your little ones. It could be as simple as breaking routine at bedtime to stay up for a special treat or a family sleepover. You want a tradition to stand the test of time as your child grows up and ideally is something everyone looks forward to when the holidays roll around. (This may be a tall order for some adolescents who eye roll their way through family time). Make your traditions and rituals a multi-sensory experience that will make good memories filled with warmth, scents, sounds, tastes, and vibrancy. Fond memories of family holidays are treasured far longer than most gifts we receive. After all, it’s not just about getting matching family pajamas; it’s what you do together while you’re wearing them.

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

Lauren Knickerbocker, Ph.D., is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone Medical Center. 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.

American Girl’s Diabetes Care Kit Helps Kids with Diabetes Play, Learn, and Teach Others

diabetesThis year, American Girl made headlines with the introduction of a diabetes care kit for dolls. As a pediatric endocrinologist specializing in the care of diabetes in children, I love this idea. The kit has a glucose meter, glucose tablets, a medic alert bracelet (a pretty one), and an insulin pump, as well as other equipment that my patients have to carry with them at all times. It is a wonderful tool for medical play and for helping to prepare children for the use of an insulin pump.

As a mother, I love the idea even more. American Girl has offered to customize dolls to look like their owners for a long time. This was very exciting news in my house when my daughter was younger. The fact that this is a popular idea tells us something about the psychology of play and the relationship a child can have with a doll. Having American Girl offer accessories that can help dolls look even more like their owners is a wonderful gift to give a child. It allows them to have their doll experience the things that they themselves experience.

Technology is improving the management of diabetes, but it often makes diabetes more visible: an insulin pump clipped to your pants, a continuous glucose monitor on your arm. Many of these things may make children feel different or alone. Being able to customize your doll to share in your experiences is therapeutic.

It may also help children to explain diabetes to their friends. Many people have misconceptions about type 1 diabetes (which is the most common type of diabetes in children). One is that people who get diabetes get it because they ate poorly or did not exercise enough. This is not true. Type 1 diabetes is caused by a number of factors; approximately half of the risk is genetic and the other half is environmental. It isn’t clear what environmental triggers are responsible for the increase in the incidence of type 1 diabetes.

Another misconception is that people with type 1 diabetes can never eat treats like cake or ice cream. This simply isn’t true. We encourage people with diabetes to have a healthy balanced diet but most insulin regimens allow them to adjust their insulin doses depending on what they are eating. Children with diabetes can have treats occasionally, just like children without diabetes.

The Robert I. Grossman, MD, and Elisabeth J. Cohen, MD, Pediatric Diabetes Center at Hassenfeld Children’s Hospital of New York at NYU Langone recognizes the special needs of children with diabetes and we offer a multi-disciplinary approach to help families manage this complex condition. We have not only pediatric endocrinologists who specialize in diabetes care but also certified diabetes educators, nurses, dieticians, a clinical social worker, and a child life specialist. Soon we will also have American Girl Diabetes Kits.

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

Mary Pat Gallagher, MD, is an assistant professor in the Department of Pediatrics and the Director of the Robert I. Grossman, MD, and Elisabeth J. Cohen, MD, Pediatric Diabetes Center at Hassenfeld Children’s Hospital of New York at NYU Langone.

Keep Calm and Play On: How to Help Your Anxious Child Have Successful Play Dates

 

playdatePlay dates are important for both kids and their parents. They help kids build essential social skills (e.g., sharing, problem solving, and conversational skills), facilitate friendships, and improve self-esteem. Play dates can also deepen friendships among parents. However, not every kid will be a natural at play dates. You may notice that when your child is home, they seem comfortable, chatting up a storm, giggling and freely moving about. But during a play date, they may cry, cling to you, and appear generally frozen or tense.

Here are some tips to make play dates more enjoyable and successful for your child. Consider who, what, where, why and how.

Who? Let your child choose who they would like to have a play date with. Giving them choices increases their investment and perception of control in the situation. If they have difficulty selecting a peer, try to give them an option between 2 or 3 children (“Do you want to play with X or Y?”) to narrow down the choices. You can consult with your child’s teacher about classmates who they seem to gravitate towards or play with during recess. I recommend starting with one child, and once they have successful play dates with one child then you can slowly expand to having group play dates.

What? You and your child should pre-select the activities. By doing this, you are giving them some control, familiarity, and predictability with what is going to happen. Children (and adults) have increased anxiety when things are unknown and unstructured. Consider games that your child knows how to play, or activities that are of particular interest for them. Some suggestions include Uno, Guess Who, making bead bracelets, drawing, decorating cupcakes, and gardening. Discuss with them what is going to happen (e.g., your friend will come over, we will start by playing X, and then we will play Y, and then her mommy will come pick her up). You can also make a visual schedule of the activities and the children can cross them off when completed.

Where? Start at your home or another “safe” or comfortable place for your child, such as a local playground. By starting somewhere your child is comfortable, you’ll decrease the time needed for them to warm up. I recommend keeping play dates to an hour. You want it to be long enough for your child to warm up, but short enough to keep your child wanting more.

Why? Although it can be stressful and seem like you need to put in a lot of energy to prepare an hour long play date, it will be worthwhile when your child becomes more comfortable with their peers in a social setting. The more practice your child gets with having play dates, the easier it will be for them, and the less preparation it will take on your part.

How? Initially, parents should provide supervision to help structure the activities and promote comfort. Once you notice that your child has become more comfortable, you should gradually fade away from the interaction and check in as needed. Prior to the play date, you should enthusiastically discuss it with your child. After the play date, focus on the positive aspects. Prepare something fun following the play date (e.g., watching a television show, going for ice cream, or having special one on one time with parent). Most importantly, remain calm, patient, and positive!

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

Brittany D. Roslin, Ph.D., is a clinical assistant professor in the Department of Child and Adolescent Psychiatry  at the Child Study Center at NYU Langone Medical Center. 

Tricks and Treats to Keep Your Family Healthy This Halloween

halloween

With Halloween fast approaching, many households find themselves filled with mini bags of M&Ms and fun-sized candy bars scattered throughout the cupboards. Part of being a kid is trick-or-treating and trading candy for the best loot. Kids should always be kids and enjoy dressing up and collecting bags filled with chocolate, lollipops, and other sugary treats. This does not mean that they need to gorge themselves on candy, which will only lead to stomach aches and sugar crashes—a situation more frightening than a haunted house! Try these tips for keeping meals healthy and kids happy.

1. Keep a balanced perspective. To support healthy habits, set rules before Halloween treats flood your house about how much candy can be eaten on any given day. Try one fun-sized candy bar in lunch boxes balanced with their usual healthy sandwich and fruit. Decide ahead of time (with your kids) that 1 regular candy bar is equivalent to 2-3 fun sized bars and share after dinner. By keeping the usual healthy foods in your kids’ diet, the occasional shared indulgence can be part of that overall healthy lifestyle.

2. Freeze the leftovers. Have kids help organize candy by type and preference. After setting aside 15 fun-sized pieces to be eaten over the next week or two, put the rest away in the freezer to be pulled out for later occasions. It will take some of the temptation and immediacy away.

3. Mix it into healthy snacks. Consider taking extra M&M packs or other mini pieces and mix them in with dried fruit and nuts to pack as an after-school trail mix snack.

4. Give it to others. Encourage kids to make care packages for grandparents or other relatives, “trick or treat” it back to the doorman, or bring it to school for a favorite teacher. Nursing homes, children’s hospitals, and other charities also accept candy donations after Halloween. Giving candy back will help to encourage sharing, while keeping excess candy out of the house.

Remember, many kids have various food allergies that may affect their trick-or-treating experience. The Food Allergy Research and Education (FARE) organization has been working to promote the Teal Pumpkin Project, which encourages people to raise awareness of food allergies and support all kids participating in Halloween, while avoiding risk of allergic reaction. FARE asks participants to provide non-food treats for trick-or-treaters, place a teal pumpkin in front of your home or apartment door to indicate that you have non-food treats available, and consider displaying signs or posters from FARE to explain the meaning of the teal pumpkin and encourage others to consider joining in! For more information about the project, visit http://www.foodallergy.org/teal-pumpkin-project/faqs.

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

Bridget Murphy, MS, RDN, CDN is a registered dietitian and clinical nutritionist at the Child Study Center at NYU Langone Medical Center. 

Helping Young Athletes Prevent a Devastating Knee Injury

soccer-injury

A “popping” sound or sensation, sharp pain, buckling, and swelling in the knee—these are the classic symptoms of a tear in the anterior cruciate ligament (ACL), a major stabilizer of the knee. Many young athletes know these signs all too well. ACL tears have become a problem of epidemic proportions in youth sports, especially female sports like girls’ soccer and basketball.

How do ACL tears happen?
ACL tears are rarely a contact injury. They usually occur upon landing from a jump, particularly with straight knees, which female athletes tend to do more than their male counterparts.

How does a torn ACL affect young athletes?
A torn ACL makes the knee very unstable. Following an injury that damages the ACL, athletes can’t perform at their normal level, particularly in sports like basketball, soccer, lacrosse, and tennis that involve jumping, pivoting, and cutting (a sudden change in direction when running).

A devastating injury to a young athlete, an ACL tear not only has short-term consequences, but long-term consequences as well. In many cases after an ACL injury, patients will be at an increased risk for developing arthritis at a young age.

What does treatment involve?
Complete tears of the ACL do not heal, and the only way to fix them is surgical reconstruction. Treatment for an ACL tear involves arthroscopic (minimally invasive) same-day surgery, but a long recovery follows. Physical therapy begins the first week after surgery and continues for at least a few months. It generally takes about nine months before patients are able to fully return to sports.

Can ACL tears be prevented?
The good news is that young athletes can reduce their risk of this serious, potentially life-changing injury by taking steps to prevent it. Orthopedic studies have found that with the right ACL injury prevention program, 60 to 80 percent of injuries could be avoided, with some studies even finding a 90-percent reduction in ACL tears. More than just preventing ACL injury, participating in such a program could improve performance on the field.

What is an ACL injury prevention program?
An ACL injury prevention program usually involves spending 15 to 20 minutes, two or three days per week, performing plyometric exercises. Typically directed by a coach, this type of program focuses on jumping and landing techniques, as well as building proper muscle strength and balance. The goal is to teach athletes to land properly while helping them improve coordination and proprioception, the brain’s awareness of the body’s position and movement.

What can I do to ensure my child receives proper prevention training?
ACL injury prevention is one of the most important issues in youth sports. All student athletes should have access to a program to prevent ACL injury. Unfortunately, even though very good prevention programs exist, only a small minority of schools and teams offer them. For those that don’t, I encourage parents to speak to their schools and directly to coaches about putting such a program in place.

Every parent whose young child or adolescent engages in school sports should make sure their kids are involved in an ACL injury prevention program, especially for sports involving cutting, pivoting, and jumping. Doing so could mean the difference between getting sidelined for a season with risk of arthritis at a young age—and enjoying all the physical, social, and psychological benefits that participating in sports can bring.

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

Dennis A. Cardone, DO, is Director of Primary Care Sports Medicine in the Department of Orthopedic Surgery and Co-Director of the Concussion Center at NYU Langone Medical Center, and Chief Medical Officer for the New York City Public Schools Athletic League.

Helping Your Child Make and Keep Friends

friends

Friendship is protective—having just one or two friends can make all the difference to a child’s development. Friends increase self-esteem, confidence, and independence. Having friends can also protect children and teens from bullying and victimization, and help buffer the impact of stressful life events.

But for some children and teens, making and keeping friends isn’t easy. Whether due to anxiety, ADHD, autism, or developmental disabilities, some lack the confidence and social skills needed to make a phone call, join a conversation, or play team sports. They may not pick up on verbal and nonverbal cues or empathize with others’ perspectives. And the consequences can be considerable: loneliness, depression, anxiety and isolation. This inevitably spills over into life transitions, including college, dating, and finding and keeping a job.

Fortunately, these skills can be taught. One place to start is building conversation skills including trading information with the goal of finding common interests, sharing conversations, and building awareness of nonverbal communication skills such as making eye contact and having good body boundaries. Another starting place is helping children and teens to choose appropriate friends by identifying a peer group and identifying extracurricular activities to find sources of friends who share common interests as a basis for building friendships.

The Child Study Center at NYU Langone Medical Center conducts social skills classes for children as young as three through young adults up to age 30 to help teach these skills. Our clinical faculty and staff use evidence-based interventions, the Children’s Friendship Program for elementary school children, and the PEERS® program for teenagers and young adults. The children, teens and young adults learn skills through in-class rehearsal and homework. It is a class; it is not a place to make friends, but a strategy on how to make friends in their real, outside lives.

The classes are developmentally appropriate for each age group. The youngest children learn how to play in groups. Elementary school children practice face-to-face conversations, make phone calls, and learn how to handle rejection. Older teens learn dating skills—how to ask someone out, how to behave, and what behavior is acceptable. All groups have homework, which involves practicing their new skills. This homework helps children gain confidence and solidify their new skills.

Parent participation is integral to the program’s success. In separate, concurrent classes, parents learn the language and skills being taught to their children—a requirement that not only enables them to help their children with homework, but also gives them the tools to be social coaches long after the program is over.

Each group meets weekly, for 60, 75 or 90 minutes, depending on age.
•Preschoolers attend 60-minute sessions for 15 weeks.
•Elementary school children between the ages of 5 and 8 attend 75-minute sessions for 12 weeks.
•Elementary school children between the ages of 9 and 10 attend 75-minute sessions for 14 weeks.
•Teens from 11 to 17 attend 90- minute PEERS® program classes for 14 weeks.
•Young adults with autism from 18 to 30 attend 90-minute PEERS® program classes for 16 weeks.

We perform an initial screening of all applicants and then meet with each child and parent to see if the child is appropriate for the group. Minimum requirements include approximately average cognitive and verbal functioning; a parent willing to participate; English language knowledge; and the child’s expressed interest in making and keeping friends.

Manhattan groups are conducted at One Park Avenue, 7th floor, New York, New York 10016. For more information, please call 646-754-5284 or email csc.sociallearning@nyumc.org.

For group offerings at our Long Island campus in Lake Success, please call 516-358-1808 or email Bonnie.Schwartz@nyumc.org.

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

Sarah Kuriakose, PhD, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry and the clinical director of the Autism Spectrum Disorder Clinical and Research Program at the Child Study Center at NYU Langone Medical Center.

Sarah Kern, LCSW, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at the Child Study Center at NYU Langone Medical Center.

Celiac Disease, Wheat Allergy or Gluten Sensitivity: Negotiating a Gluten-Free World with Your Child

As the gluten free diet becomes increasingly popular, I often have parents expressing confusion regarding when their children should eat gluten free products. A common question is, “My child tested negative for celiac disease, but has symptoms when eating gluten. What does that mean?”

To answer this, it’s important to note that there is a difference between celiac disease, wheat allergy, and gluten sensitivity.

Celiac disease is a lifelong diagnosis that is caused by a combination of genetic and environmental factors. When gluten is eaten it damages the intestines, which can cause a variety of symptoms both inside and outside the gastrointestinal system. Thankfully, celiac disease has a very successful treatment: a lifelong gluten free diet. This diet limits wheat, rye, barley, and in some cases, oats. Children should remain on this diet exclusively to ensure that they are healthy through their childhood, adolescence, and adult years.

• A wheat allergy is caused by intolerance to wheat only. Children with a wheat allergy can usually eat rye, barley, and oats without a problem. This allows for a less restricted diet than the gluten free diet. In contrast to celiac disease, when wheat is eaten it triggers a different allergic pathway and children often present with “allergic symptoms.” These include runny nose or eyes, itchy throat, rashes, or even difficulty breathing. Your child will likely be diagnosed with a wheat allergy early in life and may outgrow it later on. Unlike celiac disease, depending on their symptoms your child may need to carry certain medications such as an EpiPen with them.

Gluten sensitivity is how we characterize children who do not have a wheat allergy or celiac disease, but their gastrointestinal symptoms—such as abdominal pain and bloating—improve when they stop eating gluten. Compared to celiac disease, these symptoms do not put children at risk for other nutritional deficits, permanent gastrointestinal damage, or other medical problems.

What does this mean?
If your child has symptoms when eating gluten, before just grabbing the yummy looking gluten free food in the supermarket aisles, bring them to a medical provider who can help differentiate the cause of their symptoms. Remember that you are not alone—if you feel confused navigating the gluten free world, reach out to your medical providers and support staff for assistance.

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

Leora Hauptman, MS, RN, CPNP is a nurse practitioner in the Pediatric Celiac Disease & Gluten-Related Disorders Program at NYU Langone Medical Center. Mrs. Hauptman has many years of experience working with children with gastrointestinal disorders and developmental disabilities.

A Picture’s Worth a Thousand Words: Creating the Perfect Visual Schedule for Your Child with Autism Spectrum Disorder (ASD)

asd

Establishing a predictable and structured daily schedule for your child with Autism Spectrum Disorder (ASD) can make a huge difference in her ability to meet behavioral expectations throughout the day. Unexpected changes in schedule may be upsetting and trigger challenging behavior that impacts the whole family. Follow these simple steps to create a thoughtful daily schedule:

1. Review your child’s daily activities: Begin by writing out your child’s activities on a typical day. Make note of the activities that are associated with challenging behaviors and focus on those activities first.

2. Choose prevention strategies that make sense for you and your child: Consider whether any of the following strategies could be used to prevent problem behavior from occurring.
• Reorder activities: Sometimes children engage in their most naughty behavior when they are asked to stop a favorite activity and transition to a nonpreferred activity. For example, a child might scream and protest when his father asks him to turn off the TV and begin homework. To prevent challenging behaviors that arise during these difficult transitions, simply reorder the activities (i.e., ask him to complete his homework and then offer TV time as a reward).
• Provide warnings: To reduce challenging behaviors associated with transitions, use visual and auditory cues to remind the child about the upcoming change in activities. Setting a timer that signals the end of activity at the 10-, 5-, and 2-minute mark—or simply stating the remaining number of minutes left in the activity—will prepare them for the end of the activity.
• Change the timing of activities: Children may engage in challenging behavior when they are asked to do a difficult task in a short amount of time. If your child engages in disruptive behavior when he is asked to quickly pick out his clothes in the morning, have him complete this activity at the end of the day, when he has more time and there is less pressure to get out the door and catch the school bus.
• Modify the environment: Children sometimes become more distractible when tasked with activities that require sustained mental effort, such as homework or practicing an instrument. Help minimize distractions for your child by creating a distraction-free zone for activities that require continued attention (e.g., provide a quiet work space away from siblings, give your child special headphones, remove technology from the room).
• Build in breaks: If your child engages in problem behavior or is very active when asked to sit down and complete schoolwork, schedule short breaks for her in advance. For example, after completing 10 math problems or engaging in 15 minutes of homework, provide your child with a 2 minute break. During breaks, encourage your child to do something relaxing, like look at a book, or release energy through short exercises or games, such as jumping jacks or a quick round of Simon Says.
• Establish routines: Creating daily routines for activities that are associated with challenging behaviors may help increase compliance and independence with daily living skills. For example, many children demonstrate behavioral difficulties surrounding bedtime; establishing a bedtime routine that incorporates 4-6 steps, which may be completed in the same sequence each night (starting with the more demanding and ending with the more enjoyable), will help your child learn the expected and appropriate behaviors.

3. Set up a visual schedule: After you have developed the schedule of activities for your child, you can create a visual schedule with basic art supplies (e.g., foam board, markers, and Velcro) or on the computer that may be shared with him. Visual schedules promote predictability and increase comfort and independence with daily activities. You can draw pictures of the activities, take photos, or find images online—incorporating simple pictures into the schedule may increase your child’s understanding of the behavioral expectations and the appropriate sequence of activities. Print the pictures, laminate them, and apply Velcro to the backs so they can be placed on the board.

4. Introduce the schedule to your child: Decorating the schedule with your child can be a fun way to introduce the idea. Gather some art supplies that she enjoys and encourage her to make the schedule her own.

5. Post your schedule in a high traffic area: To maximize the impact of the schedule, find it a good home! Posting the schedule in a place where you and your child spend time regularly, such as the kitchen or his bedroom, will facilitate greater exposure. Be sure that the schedule is at his eye level so he can reference it with ease throughout the day.

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

Rebecca Shalev, PhD, BCBA, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at the Child Study Center at NYU Langone Medical Center.