Tag Archives: parenting advice

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.

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.”

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 ‘Slow Parenting’ Can Help Your Family

slowAs a parent, I have lost count of the number of times I’ve heard, “Cherish these moments, children grow up way too quickly.” It’s true. I feel like it was just yesterday that my soon-to-be two-year-old was barely crawling. Yesterday he climbed a full set of stairs alone. I’m sure many of you reading this post can relate.

Today, many families are on a schedule from morning until bedtime, trying to get our children out the door, scrambling to meet job demands, ferrying our kids from one extracurricular activity to the next, grabbing dinner on the run, and squeezing in extra study or practice time. We thoughtfully program many aspects of our children’s lives in hope of giving them every opportunity we think can give them a leg up.

It’s no wonder many of us feel the end of the day comes way too soon and like life is just rushing by. Sound familiar? If so, it may be time to try a “slow parenting” approach to family life. Slow parenting embraces the idea of consciously pausing this constant motion and taking time to relish the special moments that might otherwise pass us by when we overschedule ourselves and our kids.

For example, I recently realized that I was trying to get my curious four-and-a-half-year-old from one activity to the next too fast. As we were heading out for ballet class one day, she said, “Mom, look at this bug on the floor! It’s so interesting. It’s crawling and falling over!” Normally, I would have rushed her out the door, but, with slow parenting in mind, I decided to stop and see what she was talking about, even if it made us late. We sat on the ground for 10 minutes examining this bug together. My daughter had a lot to say about it as she imagined different scenarios. This time together created a memory more special than watching her through a little glass window while she practiced ballet. We still talk about it, and a scrapbook now holds a picture I took of her with the bug.

Slowing down creates space for relaxation and quiet time, something children’s developing brains need to make sense of the world and integrate new information they learn every day. It also gives parents a chance to be mindful of and appreciate some of our kids’ more subtle developmental milestones like problem-solving and conversational skills. And, it gives us new snapshots of time that would have otherwise been ignored and swallowed up by more pressing demands.

Here are some ideas to help you get started with slow parenting:

1. Limit your children’s recreational activities like ballet or soccer to one activity per season, rather than two or three.
2. Make an effort to have sit-down dinners or even cook together on certain days of the week.
3. Prepare for the next day together the night before. This will allow some practice around choices in the evening (e.g., “Which outfit would you like [choice A or choice B]?” or “What would you like as a snack in your lunchbox?”) and more “together time” in the morning, when you can read to your kids, sing a song together on the ride or walk to school, or talk about the day ahead.
4. Rather than cramming weekends with birthday parties and other scheduled activities, spend a plan-free weekend at home and see what happens. We sometimes forget that there is so much to do together in our own living rooms: play family games, read books, or just chat.
5. Instead of rushing from one activity to the next, pause and say, “We are going to skip karate today and take some time to go for a walk,” or, “We’re just going to sit together and play a game.”
6. In the evening, talk with your kids about how their day went. If a book was introduced at school, read it together at home. If a special event occurred in the news, bring it up and see what their thoughts are.
7. Sit outside at night and talk about the different sounds you hear. Quieting down can give rise to important topics that would not naturally come up during an over-scheduled day.
8. Talk to your kids about your own childhood when the pace of life was slower. Share challenges you faced, fun experiences you had, and how you spent your time. Then suggest some simple, “old-fashioned” outdoor playtime: jump rope, toss a ball, play hopscotch.
9. Dial down the technology: turn off the TV, put phones away during dinner, simply be together and talk. Today’s kids are often whizzes at digital devices, but may be uncomfortable socially because they have little practice with back-and-forth conversation.
10. Pause and pay attention while your children are engaged in a project. For instance, if they are drawing, see how they are making sense of that activity and just appreciate who they are at the present moment.
11. Take time to give a hug and receive one. Just breathe your children in.

Slow parenting allows time to connect with our kids in a different, more positive way, and gives us a chance to quiet ourselves and feel less stressed. Today is a great day to start making the most of your time by doing less—together.

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

Daniela Montalto, PhD, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone’s Child Study Center, a part of Hassenfeld Children’s Hospital. She is the Clinical Director of the Child Study Center’s Institute for Learning and Academic Achievement.

Head of the Class Mom: Shira Lahav

Meet our latest Head of the Class Mom, Shira Lahav—co-founder of Embodied Minds, a public speaking company that helps kids with presentation and self-esteem—and an amazing mom!shira

Why did you start Embodied Minds Public Speaking Consultants?
I am co-founder and consultant at Embodied Minds. I am also a Licensed Creative Arts Therapist, Registered Drama Therapist and a Psychoanalyst in training. During my time working in hospitals, I was leading communication and storytelling groups through drama. I recognized the power of expression and was helping my clients tell their stories in captivating ways, helping them connect with others. During these groups, I found myself guiding my clients therapeutically but also helping them deliver their stories in ways that engage and transmit the meaning to their audience in the most effective way. I enjoyed the process of directing and teaching my clients public speaking techniques. My business partner Leticia and I wanted to take this type of work beyond the hospital walls and so we did.

What is your secret to balancing work and family? Is there a balance?
My secret to balancing work and family life is to constantly remind myself the importance of both and how one feeds the other. If I dedicate enough time to my family, I feel more satisfied during the week, which helps me be more focused and fulfilled at work and vice versa.

I play various roles in my life: public speaking consultant, therapist, mother, wife, sister, daughter, etc. The key is to nurture each and every role and create equilibrium. This includes leaving room for self-care. It is necessary to take care of your own needs while taking care of others. In addition, I find that good time management helps, as well as scheduling quality time with my family between busy workdays. On a more practical note, twice per week I make time to take my daughter to her activities and on the weekends, we always find a fun activity to do together as a family. Additionally, my husband and I go out at least twice per week, whether with friends or on a date. Although babysitting is expensive, date nights are extremely important and we have to keep the romance going between stressful life responsibilities.

Share a funny story that helped you become a better parent and/or better at your job.
Not only am I a mommy to my 2-year-old daughter Lianne, but I am also a mommy to a 5-year-old Shih Tzu named Gizmo. When I first became a mom, I would walk out of the house with my brand new Uppa Baby Vista stroller and would keep getting smiles from strangers. Naïvely and faltered, I thought they were smiling at my baby, but in fact they were smiling at the fact that Gizmo was in the stroller too! Sitting below my baby, with his cute face sticking out of the basket curiously observing everyone around him, my little Shih Tzu found himself the perfect solution so he wouldn’t exert himself or his little paws.

As a result, I’ve learned the importance of multi-tasking and multi-use! Whether using the stroller for my baby and dog, or using the car seat as a spot for my daughter to sit and watch her favorite cartoons, I am always trying to find unique uses for expensive baby gear to make the most of every dollar spent. After all, we must find ways to save up for those “inexpensive” preschools! We also donate a lot, if not money then clothing or baby stuff that we are no longer using. It feels good to be able to help other families.

What has been your biggest challenge and/or greatest reward in the struggle for work-life balance?
Even though I love my job and try to maintain a healthy balance between work and family life I still at times feel guilty that I don’t spend enough time with my daughter. This is probably a result of the pressure of others and my missing my daughter during workdays. At the same time, I know how important it is to teach her that a woman can do both, be a mother and have a career.

What is one thing you wish you knew before you had kids?
That parenting is all about logistics and time management.

If you could give other moms one piece of advice what would it be?
Take other people’s advice with a grain of salt.


What is your favorite children’s book? “Alice in Wonderland”

What has been your favorite kids’ class?  Ballet Class at City Moves Dance Studio. [Now Midtown Movement and Dance – Ed.]

What is your favorite thing to do with your family on weekends? Go to Central Park and spend time on the lawn and children’s playground.

What is your favorite rainy day escape? The Children’s Museum of Manhattan on the Upper West Side

Learn more about Embodied Minds on Kidz Central Station and reserve your child’s spot now for their Public Speaking and Communications Skills Group, starting in the fall.

Head of the Class Mom: Leticia Warner

Meet our latest Head of the Class Mom, Leticia Warner—co-founder of Embodied Minds, a public speaking company that helps kids with presentation and self-esteem—and an amazing mom!leticia

Why did you start Embodied Minds Public Speaking Consultants?
I am co-founder of Embodied Minds as well as a consultant, Licensed Creative Arts Therapist, and Registered Drama Therapist. My co-founder Shira and I started Embodied Minds because we knew there was a lack of public speaking companies that focus on the reasons behind the fear of public speaking. A lot of companies emphasize the surface solutions but aren’t able to delve deeper. We, on the other hand, look at both the internal and external processes. When it comes to our Kids program, we focus on helping children and young adults increase self-esteem, improve their thought organization, interpersonal skills, build confidence, reduce their use of filler words, and more.

What is your secret to balancing work and family? Is there a balance?
I don’t know if I yet have a secret to balancing work and family. It’s something that I’m still figuring out! My son is 5 months old so I’m still getting used to balancing the demands of my business as well as his needs. My husband and I are lucky to have a reliable nanny so when I need to focus on my business, I know my son is in good hands. However, what I have learned so far is that it’s extremely important to spend quality time with my family as often as I possibly can. Time will not stand still and our children are only getting older. Therefore, if I have a break between clients or I can avoid working through lunch, I will take a quick trip to see my son wherever he is and that sustains me for the rest of the day.

Share a funny story that helped you become a better parent and/or better at your job.
I’m not sure if this made me a better parent or better at my job, but it was certainly when I first experienced the two needs clashing for the first time… we had a really important workshop taking place the week I gave birth to my son. Though I couldn’t physically be there, my co-founder Shira and I were literally working on the workshop while I was in labor (!) and once I had given birth. On top of that, I was answering work e-mails while in labor and took an emergency call from one of my private clients less than 24 hours after my son was born. Obviously, the boundaries were out of control to say the least, but this story to me is the epitome of the “working mom” story. In some ways, it helped me become a better working mom because I learned to create boundaries after experiencing it!

What has been your biggest challenge and/or greatest reward in the struggle for work-life balance?
I adore what I do and I’m so lucky to own a business, as it provides me with flexibility and freedom. But, I would be lying if I said I don’t feel guilty that I don’t spend enough time with my son. I have to keep reminding myself that I am doing this for him, to model proper work ethic and make a living doing what I love.

What is one thing you wish you knew before you had kids?
That there’s no way to plan for the overwhelming feeling of being a parent; the awe-inspiring love mixed with the chaos. I also wish I knew how quickly kids grow out of clothes! I had an idea, but could never have anticipated the speed at which it happens.

If you could give other moms one piece of advice what would it be?
Don’t be afraid to ask for help. Sometimes we try really hard to be the “perfect mom” and do it all on our own, but there’s no such thing as a perfect mom and there’s no shame in asking for help and support. If in the end it will keep you sane and allow you to spend more quality time with your child, why not?


What is your favorite children’s book? “The Little Boy Who Lost His Name” (Personalized Book).

What has been your favorite kids’ class?  “Rockin’ Railroad” at Kidville, but I’m moving to Long Island City and bet I’ll have a ton of new favorites!

What is your favorite thing to do with your family on weekends? My son is currently 5 months old so if at home, my husband and I like to pull out the playmat and play with him. If we’re going out, we love to take walks and go to the park with him.

What is your favorite rainy day escape? Any New York Public Library or bookstore that’s nearby.

Learn more about Embodied Minds on Kidz Central Station and reserve your child’s spot now for their Public Speaking and Communications Skills Group, starting in the fall.

Alternative Treatments for ADHD: Do They Work?

Mother and daughter visiting doctor
If your child is one of the 6.4 million American kids diagnosed with attention deficit hyperactivity disorder (ADHD), he or she is probably being treated with medication or behavior modification therapy—or both. Studied extensively, these first-line ADHD treatments have been found to reduce the symptoms or negative effects of ADHD on a child’s daily functioning.

You may have also heard about alternative treatments for ADHD, such as biofeedback or special diets. But what do we really know about these treatments? Do they improve symptoms and functioning? What evidence do we have? The following brief review will help answer these questions for several different treatments.

Addressing organization, time management, and planning (OTMP) skills: In school settings, teaching OTMP skills in groups has been found to be effective for middle and high school students. In clinical settings, the only program that has been tested and found effective was created at NYU Langone Medical Center’s Child Study Center. Clinical intervention improved children’s OTMP skills and academic productivity and performance, and decreased homework problems and family conflict.

Neurofeedback: Also called biofeedback, neurofeedback is a self-regulation technique in which an individual is taught to alter his or her brain’s electrical activity in an attempt to stay focused and attentive. The American Academy of Pediatrics (AAP) does not recommend neurofeedback in its recently revised clinical guidelines for diagnosis and management of ADHD. On top of concerns about its efficacy, neurofeedback is extremely expensive and time-intensive, and may not be covered by insurance.

Cogmed: A commercially available, proprietary neurocognitive training program, Cogmed is marketed as a computer-based solution for attention problems caused by poor working memory. A 2011 study concluded that Cogmed does lead to memory improvement, but does not improve function in the area of the brain associated with ADHD symptoms.

Feingold diet: Restricted in sugar and free of additives and salicylate, this diet shows no significant benefit for ADHD except for those children with related food sensitivities.

Elimination/oligoantigenic diet: An oligoantigenic diet eliminates most known sensitizing food antigens or allergens, such as cow’s milk, eggs, wheat cereals, nuts, and more. Although the AAP does not recognize dietary interventions as effective ADHD treatments, a 2012 meta-analysis of 14 studies suggests that an elimination diet can benefit some children with ADHD.

Ketogenic diet: A diet high in fat and low in carbohydrates does not help with ADHD; however, it may offer some benefit to reducing hyperactivity in epileptic patients.

Poly-unsaturated fatty acid supplements: Some children may be helped by doses of 300 to 600 mg/day of omega-3 and 30 to 60 mg/day of omega-6 fatty acid supplements. These supplements can be continued for two or three months, or longer if indicated, as a complement to medication and behavior treatment.

Other diet considerations: Sugar does not usually affect the behavior or cognitive performance of children, but a small effect on subsets of children cannot be ruled out or proven. Iron deficiency is not linked to ADHD. Any effects of food dyes or artificial food coloring on hyperactivity are inconsistent and moderate. Herbal supplements, such as ginko biloba and kava kava, have shown no positive effects on ADHD.

Exercise: A 2011 review found exercise to have positive effects on the behaviors of children with ADHD, but not necessarily on ADHD symptoms. Exercise can be used as a supplemental—but not stand-alone—treatment.

Occupational therapy techniques: There is not enough evidence to support either the wearing of a weighted vest or the use of an interactive metronome to increase on-task behavior.

If you are considering alternative ADHD treatments for your child, be sure to talk with your doctor about evidence of their efficacy, potential costs and benefits (including side effects), what concerns the treatment will address, and how to measure those concerns.

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

Richard Gallagher, PhD, is a clinical psychologist and neuropsychologist who directs the Selective Mutism Program and Organizational Skills Training Program at NYU Langone Medical Center’s Child Study Center. He also is an associate professor of clinical psychiatry, as well as child and adolescent psychiatry, at the NYU School of Medicine. With a PhD from Temple University, Dr. Gallagher focuses on selective mutism, disruptive behavior disorders, attention deficit disorders in children and adults, organizational skills, and parenting.

How to Prevent or Treat Infant Flat Head Syndrome

Happy laughing funny baby boy wearing a colorful shirt learning to crawl playing on his tummy, on white background
Many parents are understandably worried when their baby is referred to a doctor for an evaluation for plagiocephaly, also known as flat head syndrome—but there is no cause for alarm.

As an infant’s growing brain pushes the skull’s thin, moldable bones apart, new bone forms at expansion joints, or sutures. When pediatricians see an irregularly shaped skull, they often refer patients to a neurosurgeon or other specialist to rule out craniosynostosis, a rare condition in which a baby is born with a premature closure of one or more of these sutures.

Much more common is an easily treatable condition called positional molding or deformational plagiocephaly. This occurs when babies get into the habit of lying on one side of the head, resulting in repeated pressure that flattens that side and back of the skull.

Deformational plagiocephaly is not a brain problem, does not cause neurologic or developmental issues, and does not require surgery. It is usually a minor cosmetic issue noticeable primarily from behind. For the very small percentage of children who have a significant asymmetric frontal appearance, unaddressed plagiocephaly could affect how people treat them later in life, potentially leading to psychosocial issues.

The key to plagiocephaly is prevention. You can prevent it the same way it is corrected: by encouraging tummy time and changing your baby’s sleeping position.

Tummy Time
Unfortunately, many parents confuse the recommendation of placing babies on their backs for safe sleeping with avoiding time on their bellies altogether. Engaging in tummy time while awake is both good for babies developmentally and the best way to prevent plagiocephaly. For babies with signs of the condition, tummy time will keep them off of the flattened portions of their heads as much as possible.

When babies are awake and under supervision, position them on their bellies for as long as they can tolerate. Infants who are used to lying on their backs most of the time may fuss when put on their bellies, so it’s best to start early—within the first month or two from birth.

Early Repositioning
Early repositioning is important if your baby’s head is starting to flatten on one side or you notice that your baby sleeps with his/her head always turned to the same side—a condition called behavioral torticollis. You can change the sleeping position by propping your baby up to prevent putting pressure on the side he or she prefers.

A variety of commercial devices are promoted to counteract torticollis, but the simplest way to lift a child off the flattened or preferred side is to simply prop up that half of the body about 30 to 45 degrees. The cheapest method involves rolling a dishtowel into a cylinder, wrapping it with some tape to make sure it stays firm, and placing it vertically under your baby from the shoulder to the buttock.

Mildly abnormal face-on skull deformities can almost always be corrected with repositioning, as long as they are caught by age four or five months.

A Word About Helmets
Treating plagiocephaly with a helmet works by applying pressure to the skull in the reverse direction of the pressure that caused the initial molding. Helmets work; however, for the vast majority of children, they are not any more effective than simple repositioning and are much more expensive. That’s why it’s best if helmets are considered only for the small group of kids whose skulls are still severely misshapen at four or five months old.

At the end of the day, plagiocephaly is an aesthetic issue, particularly if it is only noticeable at the back of the head. If you are concerned about it, talk to your pediatrician—but the key thing to remember is the importance of tummy time and repositioning.

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

Jeffrey H. Wisoff, M.D. is the director of the Division of Pediatric Neurosurgery at NYU Langone Medical Center and professor of neurosurgery and pediatrics. Over the past 30 years, he has made innovative contributions to the surgical treatment of neurological disorders in children—particularly brain tumors, Chiari malformations, hydrocephalus, and craniosynostosis. A renowned expert in the treatment of craniopharyngioma and other brain tumors, Dr. Wisoff has published more than 160 scientific articles and book chapters, and has been an invited speaker and visiting professor at numerous international sites. Dr. Wisoff received his medical degree from George Washington University School of Medicine, and completed a neurosurgical residency and a fellowship in pediatric neurosurgery at NYU.


Why Kids Can’t Resist Unhealthy Foods at the Grocery Store

Adorable girl sit with set of good in shopping cart in supermarketParents who take their kids to the grocery store are probably used to fending off incessant requests for chips, fruit snacks, sugary cereals, soda, and other unhealthy, nutrient-poor food. This perennial battle is taken for granted today—it’s as much a part of raising children as is changing diapers or reading bedtime stories. But there’s reason to think kids wouldn’t want junk food so much if marketers didn’t target them so heavily.

Take the grocery store. A study by Dr. Brian Wansink and colleagues at Cornell University’s Food and Brand Lab looked at 65 cereals, finding those marketed at kids are placed half as high on grocery store shelves as cereals marketed to adults. They even found that the eyes of characters on cereal boxes, like Cap’n’Crunch and Scooby Doo, are pointed downward to make eye contact with kids, as Dr. Wansink shows in a video. “It looks more trustworthy and increases your likelihood of purchasing things,” he says.

Marketing food to kids is a $2.1 billion industry, the vast majority of it for fast food products, carbonated beverages, cereal, and candy, according to a 2012 Federal Trade Commission report. (Interestingly the foods marketed to kids are a lot less healthy on the whole than those marketed at adults).

Substantial research has found that marketing heavily influences what people choose to purchase and eat. One study found children consumed 45 percent more snack food after watching food advertising compared to those who didn’t view these kinds of ads. This is highly concerning given that one-third of children in America are overweight or obese, according to the U.S. Centers for Disease Control and Prevention, putting them at risk for chronic illnesses later in life, like cardiovascular disease, diabetes, and sleep apnea.

Children are bombarded with all kinds of advertising—TV commercials, giveaways, digital media communication through cell phone, emails, and websites. As the Public Health Law Center puts it, “The means by which these products are marketed are limited only by the creativity of food marketers.”

Marketing junk food with popular children’s characters and celebrities are common tactics by purveyors. Ironically, the celebrities we think of as at the pinnacle of health are some of the worst offenders. Of the ads they have made for food, professional athletes like Peyton Manning, LeBron James, and Serena Williams primarily endorse foods that are energy-dense and nutrient-poor, and the only other products they market more than food are sporting goods, according to a 2013 study by Dr. Bragg and colleagues.

In a future blog entry, we’ll tell you what you can do about all of the ads targeted at your kids.

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

Marie Bragg, Ph.D., assistant professor in the Department of Population Health at NYU School of Medicine and NYU Langone Medical Center and at the NYU Global Institute of Public Health

 Elaine Meyer, M.S., senior communications specialist in the Department of Population Health at NYU School of Medicine and NYU Langone Medical Center

A Guide To Your Baby’s Developmental Milestones

Infant child baby toddler crawlingA new baby can bring parents much joy, but also plenty of worries—especially around meeting developmental milestones like walking and talking. Some parents receive online baby newsletters and milestone alerts and worry that their baby hasn’t developed a particular skill “on time.” The important thing to remember is that pediatricians aren’t concerned so much with exactly when your baby starts crawling or saying “mama,” but that he or she is progressing from stage to stage, and continued growth and change.

Eye Contact
It’s true that a lack of eye contact can be an early sign of a neurological development deficit, such as autism, but not all babies meet their parents’ gaze at the eight week mark. It’s normal for some infants to not make noticeable eye contact until they’re three months old. Also, parents don’t always notice when a baby has made eye contact because it can be subtle and quick. What you should look to see is some brief acknowledgment of your presence when you face your baby. It’s acceptable if he or she looks at you even if just for a little while.

While many babies start to crawl around six months, some may not reach this milestone until nine months or so, which is within normal range. Every baby is different—there is no “one size fits all.” In addition, instead of crawling on hands and knees, some babies move along by scooting on their rear ends, propelling themselves with their upper body in an “army crawl,” or rolling. And, some babies skip to walking without ever crawling at all.

Don’t worry too much if your baby hasn’t started talking by his or her first birthday. The timing of early language development varies from child to child, and researchers have found that most “late talkers” up to age two are able to catch up to their peers by the time they enter school. It’s a good sign when babies babble and understand what you’re saying, even if they don’t have the vocabulary to answer you back yet—such as when they look for their father when asked, “Where’s Daddy?”

Growth and Development
Keep in mind that every baby develops at his or her own pace rather than according to a milestone chart. However, you know your baby better than anyone, so if you think something is wrong, talk to your pediatrician. When there is a problem, the earlier a doctor can intervene, the better he or she can help children reach their full potentials.

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

Julie G. Capiola, MD, is a clinical instructor in the Department of Pediatrics at NYU Langone Medical Center. A board-certified pediatrician, she received her medical degree from Thomas Jefferson University and completed a residency in pediatrics at Yale New Haven Hospital.