Category Archives: From the Real Experts at NYU

Vascular Birthmarks in Babies: What Parents Need to Know Part 2 of 2

Vascular birthmark

From the real experts at Hassenfield Children’s Hospital at NYU Langone:

Last time, we learned about the most common type of vascular birthmark in babies, the infantile hemangioma. Read on to learn more about the other most common vascular birthmark in babies, capillary malformations.

Capillary Malformations

Capillary malformations are another very common vascular birthmark. More commonly called “port wine stains,” “angel’s kiss,” or “salmon spots,” they are the result of dilated capillary connections close to the surface of the skin. Unlike infantile hemangiomas, these vascular birthmarks are almost always clearly visible at birth. They start off pink, red, or salmon-colored, flat and flush with the skin, and usually stay flat for years. They are painless and do not bleed, and they do not follow their own growth cycle like infantile hemangiomas do. Depending on the type, they either fade early on, or grow with the patient and remain present for life.

When capillary malformations are located along the middle of a baby’s body, they are called medial capillary malformations. On the face, they appear in the middle of the forehead, and point downwards in a V shape that ends with the point of the V around the tip of the nose. The sides of the V can cross the skin of the eyelids. On the back of the neck, they spread from the bottom of the hairline to the upper neck. They can also be located at the base of the spine. While common, medial capillary malformations usually fade on their own by two to three years of age, and generally do not require treatment.

Capillary malformations that are closer to the sides of the body are less likely to disappear without treatment. If these more lateral birthmarks are left alone, they can continue to darken and begin to grow thicker. They tend to turn a rich purple color, and will go from flat and smooth, to raised, with areas that feel like nodules under the skin. When they get to this point, they become much more difficult to treat.

Which Capillary Malformations Need Treatment?

In general, if a capillary malformation appears to be growing or darkening, it should be evaluated by a specialist. This is not only because there can be cosmetic consequences to leaving it alone, but also because, similar to infantile hemangiomas, capillary malformations can be external signs of internal issues. If this is the case, your doctor may order an MRI to check your baby’s internal organs. In particular, the brain and eyes may need to be examined if there are extensive capillary malformations over the face.

In very rare cases, a capillary malformation birthmark can also be an early sign of more serious health issues that are not obvious until late childhood. Because of this, babies with capillary malformations that are not in the middle of the body and/or do not fade after birth should be followed by a vascular anomalies specialist.

Laser therapy is the mainstay of treatment for capillary malformations. If laser therapy is chosen for your baby, the treatments will be spaced out to allow time for healing in between sessions. Your doctor might also prescribe a cream that helps to shrink the blood vessels close to the skin’s surface, which helps to make the effects of laser treatment longer lasting. This cream is also available without laser therapy, but is more effective when combined.

Take Home Message for Parents

All in all, most vascular birthmarks are completely benign, and will not lead to any complications or necessitate any treatment. If any of your baby’s marks resemble what has been described here, and you have more questions, speak with your pediatrician about seeing a vascular anomalies specialist. And congratulations on your new baby!

hassenfield
Megan M. Gaffey, MD, is a pediatric otolaryngologist at Hassenfeld Children’s Hospital at NYU Langone. She specializes in the medical and surgical treatment of children with complex ENT issues. She has focused training in vascular malformation management.

Vascular Birthmarks in Babies: What Parents Need to Know Part 1 of 2

 

Vascular birthmark

From the real experts at Hassenfield Children’s Hospital at NYU Langone:

More babies than not are born with some sort of birthmark, and while many fade, some are here to stay. Birthmarks come in all shapes, colors, and sizes. Most of them are fine to leave alone, but there are a few kinds that can become problematic. For parents, it’s important to know which birthmarks are abnormal and should be seen by a physician.

What Are Vascular Birthmarks?

Vascular birthmarks fall under the category of vascular anomalies, which are the result of abnormal blood or lymphatic vessels. They can present anywhere on the body, including the skin, the scalp, on the inside of the mouth, or on the genitalia. They can also be present in internal organs. Depending on the vessel type, vascular birthmarks can vary in color from pink or red, to blue, purple, or gray. Some vascular birthmarks are close enough to the surface of the skin to be seen and/or felt immediately after birth, but others don’t appear until later in infancy or childhood.

What Are the Most Common Vascular Birthmarks?

Infantile hemangiomas and capillary malformations are the most common vascular birthmarks. Both are on the skin’s surface, or typically close enough to the surface to be noticed before a baby is one month old, and tend to be pink, red, or purple.

Infantile Hemangiomas

Infantile hemangiomas are the most common vascular birthmarks. They are commonly called “strawberry angiomas,” because they often look attached to the skin’s surface, and protrude in small, clustered red bumps. Parents tend to say that the marks started as a single, small, red spot right at birth.

Hemangiomas can also be on the flatter side, or located deep to the skin. When deep, they might look like a tinted, smooth protrusion of skin. Shortly after birth, they begin to grow rapidly; during this period, they usually darken and turn from red to purplish.

Infantile hemangiomas grow at their fastest rate when babies are around seven months old. By one year, they begin to shrink. One of the first signs of shrinkage is lightening of the involved skin to gray, which usually begins in the center of the hemangioma. The gray skin is a sign that the blood vessels are being replaced by fatty tissue, which may or may not be noticeable, depending on how big or how deep the infantile hemangioma was.

By age two, infantile hemangiomas usually go away on their own, leaving only a faint mark, if anything. This is why most infantile hemangiomas can be observed as your baby grows, and don’t require any medicine or surgery.

Which Infantile Hemangiomas Need Treatment?

If infantile hemangiomas grow too quickly or get too large, complications can arise. Rapid growth can lead to ulceration, forming cracks in the skin and bleeding. This can lead to infection and scarring.

The size of infantile hemangiomas can also become problematic when they compress or cover surrounding structures. For example, an infantile hemangioma blocking a nostril, or one causing an eyelid to droop and block vision, requires action from your doctor.

Very large infantile hemangiomas can also become aesthetically unappealing, especially if they are located on the face. Even though the birthmark most often goes away on its own, large infantile hemangiomas can leave behind some fatty tissue and distended skin when they fade. This left-behind skin has a pale, saggy appearance. Typically, the larger infantile hemangiomas are allowed to grow, the more saggy tissue they will leave behind.

The birthmark location is also important because it may signify a disorder in the underlying tissues or organs. For example, infantile hemangiomas under or around the chin might indicate that there are infantile hemangiomas in the mucosa of the upper airway, which can lead to breathing problems. If your pediatrician suspects internal organ involvement, your baby may need an airway evaluation by an airway specialist, or an MRI, which is a special imaging study that helps evaluate deep effects of vascular anomalies.

Besides size and location, the number of infantile hemangiomas can also be concerning. In particular, if a patient has more than five separate hemangiomas, that could indicate vascular anomalies of the liver. Make sure to tell your doctor if your baby has multiple infantile hemangiomas, so that imaging tests to check the liver and other internal organs can be ordered, if necessary.

If your baby’s hemangioma is changing and showing some concerning signs, you should see a vascular anomalies specialist—a pediatrician, dermatologist, or surgeon who has spent time dedicated to learning about the spectrum of vascular anomalies, and how to treat them. This specialist will take into account the factors discussed above, and help guide you towards further observation of the infantile hemangioma, or towards a treatment plan. He or she may want you to see a subspecialist, like an otolaryngologist, ophthalmologist, orthopedist, etc, for an opinion about the area potentially affected by the hemangioma.

After evaluating your baby’s infantile hemangioma, your doctor may encourage you to intervene to halt its growth. Treatment options for infantile hemangiomas can be divided into three main groups:

  1. Medical Therapy – Several medications exist that have been shown to help slow or halt hemangioma growth, and in some cases, speed up the regression process.
  2. Laser Therapy – There are advanced medical lasers that can be used to shrink the blood vessels specific to infantile hemangiomas.
  3. Surgical Therapy – Occasionally, removing the hemangioma is the best option. This is usually a decision that is made when it is evident that the hemangioma will cause functional, developmental, or aesthetic problems if left alone

Choosing if and when to perform surgery is a decision that should be made with the help of a vascular anomalies surgeon. It is important to remember that surgery will always leave a scar, no matter when it is performed, so surgery is only chosen if the scar is more favorable than the predicted “scar” left behind by the infantile hemangioma.

hassenfieldMegan M. Gaffey, MD, is a pediatric otolaryngologist at Hassenfeld Children’s Hospital at NYU Langone. She specializes in the medical and surgical treatment of children with complex ENT issues. She has focused training in vascular malformation management.

NYU Langone’s Virtual Urgent Care for Kids Age 12+

Sick Over the Holidays? Get Help Without Leaving Your Couch with NYU Langone’s Virtual Urgent Care

Virtual Urgent CareWhen you’re not feeling well and it isn’t easy to make it to the doctor, what do you do? NYU Langone Health’s Virtual Urgent Care service now offers patients in New York, New Jersey, Connecticut, and Pennsylvania a real-time video visit with a world-class doctor in the palm of the hand.

Saving you a trip to the doctor or even leaving your couch, adults, as well as kids 12 and older can see an NYU Langone board-certified emergency medicine physician for minor medical concerns—right from the comfort of home, on any mobile device.

The service is ideal for non-emergency issues such as cold and flu, sore throat, pink eye, earache, rashes, and urinary tract infection, for both adults and children. Physicians are available for appointments Monday through Friday from 7 am to 11 pm, and on Saturdays and Sundays from 8 am to 8 pm.

These video visits are just like an office appointment. The doctor will review your child’s medical history and symptoms, develop a treatment plan, prescribe any needed medications and, if necessary, provide a referral to a pediatric specialist at Hassenfeld Children’s Hospital at NYU Langone.

For children, parents must schedule the appointment and be present with their child during the visit. They will also need to have proxy access to their child’s NYU Langone Health MyChart account, which can be set up by calling 929-455-6409, or in person, at your child’s doctor’s office. You must be in New York, New Jersey, Connecticut, or Pennsylvania to use the Virtual Urgent Care service.

So the next time your child has flu symptoms and doesn’t want to get out of bed to go to the doctor, they don’t have to—NYU Langone Health’s Virtual Urgent Care is here for you when you need it.

Learn More about NYU Langone Health’s Virtual Urgent Care service on Youtube

How to Support Your Child, and Cope with Anxiety During the Holidays

Holidanxiety? 

ANXIETY

The holiday season is often accompanied by stress, which can be particularly difficult for children and adolescents with elevated anxiety. Here are some tips about how parents can help.

  1. Maintain Structure. Late nights, holiday treats, and unscheduled days are what many children love most about the holiday season. At the same time, sufficient sleep, staying active, and a healthy diet set the foundation for adaptive coping. We are all more at-risk of feeling overwhelmed when tired, hungry, or sick! Encourage your child to enjoy the freedoms of their holiday break in moderation. Maintaining a (mostly) consistent bed-time and wake-time (ideally within 1-2 hours of when they need to go to sleep and wake up for school) will ease your child’s transition back to school, and ensure they are well rested during the break. Encouraging your child to eat complete meals, in addition to holiday sweets, provides them with the energy to take full advantage of their free time. Additionally, having a daily routine can help your child know what to expect, and lessen overall anxiety.
  2. Cope ahead. If your child experiences elevated anxiety that causes significant distress, they may benefit from working with a cognitive-behavioral therapist to learn how to identify and effectively cope with anxiety. If your child is already working with a therapist, collaborate with them on ways you can best support your child in generalizing skills learned in therapy to anxiety-provoking situations that arise during the holidays. This may involve developing a cope ahead plan, which includes identifying situations that induce anxiety (e.g., family gatherings, parties, sleepovers, etc.) and selecting coping skills to help your child approach rather than avoid these difficult situations.
  3. The same strategies that apply to supporting your anxious child during the school year also apply during holiday breaks.

    Below are tips on how to CARE for a child with anxiety (Swan, Kagan, Frank, Crawford & Kendall, 2016).

    1. Coping model: Children learn from parents, which means you play a key role in modeling for your child how to manage anxiety effectively. Notice your own reactions to holiday stress, and put the proverbial airplane oxygen mask on yourself first. Being a coping model is not about being ever calm and anxiety-free (good luck!); rather, it is about noticing your own anxiety, and modeling how to skillfully manage. Everyone experiences anxiety, we just don’t want anxiety to keep us from doing what we want or need to do.
    2. Accommodate less. Accommodating anxiety (helping your child avoid situations that cause distress) alleviates anxiety short-term, but maintains anxiety over time. In collaboration with your child’s therapist, work to gradually reduce current accommodations. Try not to anticipate that your child will be anxious and give them an out. Instead, support them in coping with (rather than avoiding) anxiety during the holidays, so that they become more comfortable with practice.
    3. Reinforce brave behavior. Exposures are a key component of cognitive-behavioral therapy for anxiety, and involve children gradually engaging in situations that cause anxiety in the context of a supportive, therapeutic environment. If your child is working with a therapist, collaborate on how they can practice being brave over the break, and provide reinforcement. Without the competing demands of school, the holidays present a golden opportunity for at-home exposure practice! Reinforcement can be social (praise), tangible (stickers, rewards), or activity-driven (extra screen time, picking the family movie). In general, notice and reinforce when your child bravely engages in situations that make them nervous.
    4. Empathize and validate. While we recommend against parents accommodating their child’s anxiety, we also do not want parents to become frustrated or punitive when their child expresses feeling scared, frightened, or nervous. It is completely natural to want to avoid situations that cause anxiety. Telling your child “just do it” or “don’t be nervous” is unlikely to help. Instead, express to your child that you understand how they are feeling, empathize with them, and encourage them to do it anyway. If “it” seems too hard, work together to find one small step your child can take to practice.

The holidays can be stressful for parents and children. Supporting your child by maintaining structure, coping ahead, and reinforcing brave behavior can help!

Anna J. Swan, PhD, 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 cognitive-behavioral therapy, and group therapy as part of the Anxiety and Mood Disorders Service at the Manhattan and New Jersey locations of the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone.

A Developmental Pediatricians’ Tips for the Best Holiday Gifts for Children of Any Age

Best Holiday GiftsNow that the last of the Thanksgiving leftovers have been consumed, the holiday season is officially upon us and for many families this is a time when we begin to shop for holiday gifts for the children in our lives. Here are a few suggestions of some developmentally appropriate toys for the holidays.


0-12 months: Babies are attracted to bright colors and objects with high-contrast patterns. Their play involves watching and exploring their own bodies. Look for multisensory toys with a variety of textures and toys that are soft, lightweight, easily grasped, washable, and safe to go in the mouth. Good toys in this category include activity mats and gyms, mobiles, and plush toys. Mirrors help develop self-awareness and identity. In the later end of this age children become interested in cause and effect and container play so consider pop-up toys, stacking and sorting toys such as nesting cups and boxes, and squeeze and squeak toys.

1-2 years: Children in this age-group are increasingly interested in cause and effect activities such as dumping and filling, building and knocking down, and pushing and pulling. Building play starts to emerge towards the later portion of this age range so lightweight blocks or building materials are good options. Blocks are also a great example of open-ended play items that can encourage creativity and language development. Other suggestions include shape sorters, cars with handles or short cords, or simple trains. A riding horse can also be introduced at this age provided the child’s feet touch the floor or base of the horse when they are seated. Musical instruments such as xylophones and small tambourines are also fun.

2-3 years: Pretend play is now emerging and building play becomes more sophisticated as a child’s fine motor skills become more developed. Realistic props help enhance pretend play. Additional building blocks and materials and push-pull toys that resemble real life objects such as strollers, shopping carts, and vacuum cleaners are very popular at this age. Straddle ride-on toys and slow-moving three-wheeled scooters with wide standing platforms are fun and encourage physical development and self-esteem. Additional suggestions include easels and non-toxic finger paints. Play with simple insert puzzles may enhance attention span and visual discrimination.

3-4 years: Pretend play is at its peak in the preschool years and there are a variety of toys to encourage this sort of creative play such as action figures and dolls, playhouses, doll houses and thematic play scenes, dress up materials, and tools and props that resemble real items such as medical kits, cash registers, and cooking/kitchen sets.

4-6 years: Game play emerges more in elementary school as attention span increases and turn-taking behavior emerges. Many children begin to enjoy traditional board and card games at this age such as ‘Go Fish,’ and ‘Uno’ as well as matching or memory games. Train and car sets with multiple cars that detach and tracks are popular at this age along with more simple sewing and craft kits, water colors, and stamps with ink pads. Two-wheeled scooters and bicycles with training wheels (with the appropriate protective gear such as helmets) are popular gift ideas.

6-9 years: Children now have the ability to work on multi-step sequences and have the fine motor dexterity to begin complex model kits and more complex craft kits such as beading, jewelry kits, and yarn looms. Other ideas include jigsaw puzzles with 100-500 pieces and strategy games such as checkers. Skateboards, two-wheeled bicycles without training wheels and equipment based on your child’s interests such as cameras, roller skates and sports equipment are additional options.

9-12 years: Children in this age range are developing their skills from the sports and activities of their earlier years. Tailor your gifts based on your child’s interests and abilities. Examples include more advanced jigsaw puzzles, trivia games, and sports or recreational equipment such as camping gear.


Manage expectations

Children do not require a large amount of gifts or toys to have a magical holiday experience. In fact, too many toys and gifts can overwhelm young children and there is evidence to show that fewer toys may help young children focus better and play more creatively with the toys they have. Set your own limits ahead of time on the right number of gifts that makes sense for your family and consider including extended family members in the conversation.

Safety

Of utmost importance is ensuring whichever toy you select is safe for the age of your child. The American Academy of Pediatrics (AAP) offers a variety of tips to aid in safe toy selection.

Catherine Workman, MD, is a clinical assistant professor in the Department of Pediatrics and a developmental pediatrician at Hassenfeld Children’s Hospital at NYU Langone.

Giving Thanks at Thanksgiving: Practicing Gratitude with Your Kids

thank-youThanksgiving and the holiday season that follows are a wonderful opportunity to instill a sense of gratitude in your children and teens. We often think about gratitude as a way to show others we appreciate them or that we are thankful for the things we have when others are less fortunate. But, did you know that practicing gratitude can also help the giver?

Positive psychology finds that gratitude benefits our mental health, our friendships and connections to others, and our daily mood. What is important is feeling positive and noticing what we have and appreciate, so do not roll your eyes if your teen is grateful for his video games! Here are some ways you can practice gratitude with your child:

•Try sharing 3 things you are grateful for from your day, or have everyone say something they love about another family member at the dinner table.

•Make a Gratitude Jar or Box. Decorate the outside however you’d like with paper, paint, or stickers. Every day, write down at least three things you are grateful for on little slips of paper and add them to the jar. The jar will fill up, and you or your child can revisit the slips of paper when you need a mood lift.

•Help your child write a letter to a person they are thankful for and have them personally deliver it. They will get a boost seeing how happy that gift of gratitude makes the recipient.

•If you want to make gratefulness more of an activity at the Thanksgiving table, combine it with a fun craft. Make colorful leaves or turkey feathers out of construction paper with a prompt for everyone to write (or draw) something they are thankful for, then share answers around the table and put the leaves/feathers in the centerpiece or on a central picture of a tree or turkey. You can hang up the final project and create a nice memento of the shared meal.

While Thanksgiving is a great time to talk with your family about gratitude, it’s a practice that would benefit the family to continue year-round.

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.

I Ain’t Afraid of No Ghosts: How to Handle Your Child’s Supernatural Sightings

Ghosts and Kids

It’s Halloween time again—neighborhoods are filled with decorations featuring witches, ghosts, gravestones, and more. Children are excited about the prospect of trick-or-treating and are planning their costumes. With this increased focus on Halloween, this time of year may also come with an increase in children talking about the supernatural or worrying more about ghosts, monsters, or more.

If a child expresses that they think they have seen something scary or supernatural, there can be several explanations. Most commonly, these statements are related to the fact that young children have difficulty separating fantasy from reality. Children are hard-wired to learn through imaginative and pretend play and therefore they can slip between reality and fantasy much more easily than adults. Also, children’s visual perception skills develop most quickly in infancy and toddlerhood, but these skills are still developing throughout early childhood so they are also more likely than adults to misperceive a visual stimulus. Therefore, while an adult might dismiss something they see quickly out of the corner of their eye as “nothing” or have a reality-based explanation, children might insist they saw a ghost or a fairy or some other creature.  Additionally, this perception feels real to them and they might get upset if an adult tries to convince them otherwise.

We also have to look to what the response to this declaration is. Attention is the currency of childhood – if a young child who states he or she has seen a supernatural gets a great deal of attention for that statement, he or she is much more likely to make such a statement again in the future. It goes back to basic principles of rewards: behavior that gets rewarded continues and attention is a great reward for most children. We must also look at the function of the behavior. Does declaring that there is a monster under the bed delay the separation from parents at bedtime that can be challenging for many children? In this case, the reward is the parent staying in the room longer.

Of course, more than one of these issues can be at play at any given time. A young child may genuinely misperceive a sight or sound as being a monster, their difficulty distinguishing fantasy from reality leads them to fully believe that monsters are real, and then they are rewarded with time, attention, possibly some soothing from parents, and with the delay of the separation at bedtime.

So what’s a parent to do?

Start with validating the child’s concern or fear, while helping them distinguish reality from fantasy. Sometimes offering an explanation can help allay fears, for example, letting them know that at this time of year witches and ghosts and the like are on our minds more. If attention seems to be motivating the behavior, decrease the amount of attention you provide for these statements and increase the amount of attention you give to other things they say. For example, a statement about seeing a ghost gets a brief “Uh-huh” while a statement about what they are doing or the dog they see outside gets an enthusiastic “Wow! That’s great! What color was the dog?” A quick “monster check” at bedtime is typically fine for a young child, but as children get older parents should help with differentiating fantasy from reality and reminding them that monsters are not real.

Aleta G. Angelosante, PhD, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone Health. She is a child psychologist and the Clinical Director of the Anita Saltz Institute for Anxiety and Mood Disorders at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone.

Keeping Kids Safe from Eye Injuries

eye injuries

Eye injuries are one of the leading causes of vision loss in children and teenagers. Injuries are most likely to happen at home or in familiar spots, to happen by accident, and are nearly always preventable! Most of us think that eye injuries happen during sports or rough play—and they certainly do—but keeping your child’s eyes safe should always be on your mind.

What can be injured and how?

Any of the tissues around the eye can be damaged by injuries. This includes fractures of the bones of the orbit, scratches (abrasions) and cuts (lacerations) to the eyelids or eyeball, burns from heat or chemicals, blunt trauma causing internal swelling, bleeding or inflammation, or penetrating trauma into the eyeball itself.

Prevention. Prevention. Prevention.

Your child’s eyes will be safest if you avoid dangerous activities. I know many people get squeamish when thinking about eyes and eye injuries so I won’t go into much detail, but you can use your imagination that care should be taken with sharp objects, projectiles like sports balls, or explosives like fireworks. Unfortunately, there has been a steady rise in serious eye injuries from paintball guns, airguns, BB guns, and other firearms, even with recommended safety goggles. From an eye safety perspective these activities should simply be avoided.

What about sports?

We all know eye injuries happen during sports, especially ball sports. Many leagues have taken great measures to make eye safety equipment standard. If that is an option for your children, insist that they wear it. Often injuries will happen during informal games like pick-up basketball, soccer, or badminton. So get your child a pair of sports goggles. These are usually cheap, durable, and provide excellent protection. Most sporting goods stores will sell models with good fits and styles. The same thing goes for using safety goggles for woodworking or grinding metals where small pieces can fly into the air.

What if my child already has glasses?

With the right pair of glasses your child will be seeing well and will be better protected. Just make sure they have the right:

  • Fit- The lenses should fully cover the eyes, the nosepiece should rest comfortably on the bridge of the nose, and the ear pieces snuggly around the ear. Try using a strap around the head to keep them on while doing activities.
  • Lenses- All kids should get impact resistant lenses made out of a material like polycarbonate plastic. Remind your eye doctor to write that on the glasses prescription.
  • Style- If your child does not like the glasses he or she will never wear them!

Prescriptions can also be placed into sports and safety goggles for extra protection.

Accidents happen…

If you suspect an eye injury, try the following:

  • First, if you think the injury opened the eyeball or if you see something sticking into the eye, do not touch it or try to remove any objects. If you can find something that can be used as a protective shield (a paper cup works well) tape it over the eye. Go immediately to an emergency department.
  • If you think an object or chemical got stuck around the eye or under the eyelids, try to irrigate or wash it out with clean water for 10-15 seconds and then seek medical help.
  • If after an injury your child is complaining about eye pain, a change in vision, light sensitivity, or is unable to open the eye, take him or her to an emergency department or local ophthalmologist for a complete eye exam.

Your sight is one of your most valuable senses, protect it! NYU Langone Health has ophthalmologists trained in eye trauma at our offices and every emergency department to help when you need it.

Zachary Elkin, MD, is a pediatric ophthalmologist and assistant professor in the Department of Ophthalmology at NYU Langone Health. He sees patients at the NYU Langone Eye Center in Manhattan.

Depression in Children: Signs and How to Help

Depression in Kids

Is My Child Depressed? What Parents Should Look For, and How to Help

Approximately 5-10% of children struggle with depressive symptoms. Indeed, children as young as 3 can demonstrate signs of clinical depression, and rates of depression increase sharply during adolescence, particularly for girls. Feelings of intense sadness, emptiness, and/or loss of interest in previously enjoyed activities are the cardinal features of depression in adults; however, depression sometimes presents differently in youth. Indeed, irritable mood can be the first sign of child depression, and persistent irritability that causes significant problems in your child’s life at school, with friends, or with family indicates concerns beyond typical adolescent behavior.

Signs your child may be struggling with Depression:

  • Withdrawing from extracurricular activities, or continuing to participate in them without enjoyment.
  • Spending more time alone, and isolating from family or friends.
  • Constantly feeling bored, like nothing is interesting or worthwhile.
  • A significant drop in school grades, homework completion, and/or overall motivation for school.
  • Urges to avoid school.
  • Significant change in behavior: being more oppositional or argumentative, using drugs or alcohol, or caring less about consequences that used to matter.
  • A change in appetite: eating much more or much less.
  • A change in sleep: difficulty sleeping, or sleeping much more than is typical.
  • Feeling tired, without energy.
  • Increased difficulty concentrating in school or in conversations.
  • Thoughts of death or dying.
  • Engaging in self-injurious behaviors (cutting).

How can I support my child?

  • Talk to your child. Ask how they are feeling and what might be bothering them. Actively listen, without judgment, and reflect back what your child says to show that you understand.
  • Tell your child’s pediatrician. Schedule an appointment with a mental healthcare provider to discuss your concerns and to learn more about treatment options. There are evidence-based therapies and medication that can help.

Therapy:

  • Cognitive-behavioral therapy helps children to identify the connection between depressive thoughts, feelings, and behaviors, to observe patterns in their mood, and to learn coping skills to improve mood. Behavioral activation is often a key component of CBT for depression, and focuses on helping youth boost mood by changing behavior.
  • Dialectic behavior therapy is a more intensive treatment for youth who struggle with chronic emotion dysregulation and problem behaviors, such as chronic suicidal thoughts or actions, self-injurious behavior, and other risky behaviors.
  • Other evidence-based therapies include interpersonal therapy and attachment-based family therapy.
  • Medication:  Selective Serotonin Reuptake Inhibitors (SSRIs) are considered the first line medication for depression. For more information about antidepressant medication, consult with your child’s pediatrician or psychiatrist.
  • Promote safety. Encourage your child to share their feelings, including thoughts about death or dying. Normalize that this is a common symptom of depression, and develop a plan that includes people to reach out to for help and mood-boosting activities to engage in when they have those thoughts. Ensure that your home is safe by locking up guns, knives, medicines, and alcohol.
  • Stick to the treatment plan. If your child is in treatment, ensure that they attend therapy consistently and/or take medication as prescribed. Your child may feel frustrated or defeated if they do not feel better quickly. Treatment works, but it takes time. Model hope, and communicate concerns with your treatment provider.
  • Provide praise and acknowledgement for small steps. Depression can feel like a weighted jacket, and activities (schoolwork, chores) that used to be easy to carry can feel impossible to lift. Rather than focus on what your child might not be doing, model attending to the positive by acknowledging and praising what your child is doing well.
  • Educate others and externalize the depression. People in your child’s life may misperceive depression as your child being lazy or purposefully grouchy, which can make it difficult for your child to receive the care and support they need. Remind yourself and others that depression is driving these symptoms, not your child.
  • Enhance social supports. Help your child to connect with peers and family. Look for opportunities to bolster the relationship you already have with your child by taking a brief “vacation” from daily chores and responsibilities to engage in enjoyable activities together. Facilitate social engagement by helping your child to schedule after-school hangouts with friends, providing transportation, and offering other means of support.
  • Monitor for risk factors for suicide, which includes your child having more intense or frequent thoughts about death or dying, talking about suicide online or in person, and using substances. The National Suicide Prevention Lifeline can be reached at 1 800-273-8255 or online at www.suicidepreventionlifeline.org.

Anna J. Swan, PhD 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 cognitive-behavioral therapy, and group therapy as part of the Anxiety and Mood Disorders Service at the Child Study Center’s Manhattan and Hackensack locations, part of Hassenfeld Children’s Hospital at NYU Langone.

Back to School with Diabetes Management

diabetes managementAdapting Your Child’s Diabetes Management for a New School Year

With a new school year just around the corner, many parents are strategizing for their children to receive the medical care they need in their new classroom environments. The goal for families of children with diabetes is for their kids to have access to appropriate diabetes management while having the same school experience as children without diabetes. Here are some aspects of care at school that parents of children with diabetes should consider in order to meet that goal:

  • Is there a nurse at school? If not, who can take responsibility for helping to assist with the day-to-day management of diabetes? There should be a medical plan in place and parents should discuss that with the school administration.
  • If your child is involved with after-school activities or field trips, will there be care available at those places?
  • What supplies does your child need at school? Think about the amount of supplies they will need, whether they will be centrally located for the child, or whether they will be carrying their own testing equipment to treat hypoglycemia.
  • If your child is involved with after school sports, make sure the school administration is aware of their condition. Parents should also talk to the child’s coaches so they can assist if needed.
  • Make sure your child always has something on them to fix a low—and coaches, teachers, and other staff should be aware so they can help if necessary.
  • Some school systems, like New York City public schools, have carb count menus for school meals up online. If your child is buying their lunch at school, check the menu ahead of time and review it with your child. Kids dose insulin according to carb counts, so it’s very important to plan for that. If your school doesn’t have a menu with a carb count, work with the school cafeteria and school administration to come up with carb counts for the menu.
  • Your child’s schedule will change when they go back to school, sometimes going from a schedule where they are more active during the day to being more sedentary during the day and active in the evening. If you notice your child’s blood sugar levels are out of range, be in touch with your diabetes care team so they can adjust insulin doses to the new school schedule.

You should go to your child’s diabetes care team with any questions. Other great resources for Safe at School information can be found at the American Diabetes Association, JDRF, and Children with Diabetes websites.

 

Christine Lally, RN, CDE, is a registered nurse and certified diabetes educator at the Robert I. Grossman, MD, and Elisabeth J. Cohen, MD, Pediatric Diabetes Center at Hassenfeld Children’s Hospital of New York at NYU Langone. She provides education and support to patients, families, and caregivers, and helps them fit diabetes management into their lives in a healthful way.