Anxiety in children

 

While summer offers preschool and elementary school children a welcome break and chances to navigate new friendships and activities, it can trigger anxiety in children upset by unstructured time, changes in routine and friend groups, and transitions involving new faces and places. Separation anxiety, social anxiety, and specific phobias are instantly recognizable: a sobbing child clings to a parent, refusing to set foot inside day care; a socially anxious child worries about attending a birthday party because “nobody will play with me;” or a child is so terrified by insects that simple summer fun like a nature stroll, digging in the dirt, or a picnic in the park is impossible.

Common symptoms of anxiety in children

Thumping heart, rapid breathing, sweating, tense muscles, nausea, and dread are familiar symptoms of anxiety that accompany a “fight, flight, or freeze” reaction triggered by real or imagined threats, like a snarling dog or new social experience. Anxious children may be clingy, startle easily, cry or have tantrums, sleep poorly, and have headaches or stomachaches.

But anxiety is not all bad. “It can motivate us, or help us avoid danger,” says Dr. Mona Potter, medical director of McLean Anxiety Mastery Program and McLean Child and Adolescent Outpatient Services. “The problem is when anxiety gets out of hand and makes decisions for us that are no longer helpful — maybe even paralyzing.” By that point, normal anxiety may have become an anxiety disorder.

What types of anxiety are common in children?

  • Separation anxiety: Very anxious and upset when parted from parents and caregivers; refusal to attend camp, sleepovers, or play dates; worry that bad things will happen to self or loved ones while separated.
  • Social anxiety: Strong fear of social situations; very anxious and self-conscious around others; worry about being judged or humiliated.
  • Specific phobia: Severe, irrational fear set off by a situation or thing, such as thunderstorms, worry about vomiting, or insects.

What makes some children more vulnerable to anxiety?

Anxiety may set deep roots due to a blend of

  • biological factors, such as genes and brain wiring
  • psychological factors, such as temperament and coping strategies
  • environmental factors, such as anxious parenting or troubling early childhood experiences and environment.

Sometimes, anxiety is a side effect of medicine. Ask your doctor about this possibility.

Treating anxiety in children

Occasional anxiety is normal. But talk to your pediatrician if anxiety causes your child to limit activities, worry often, or avoid camp or day care. A severe anxiety disorder can delay or derail child development.

Depending on developmental stage and level and type of anxiety, treatment may involve changes you and your child work toward yourselves. Or you might work with child mental health professionals, such as a psychiatrist, psychologist, or social worker. These experts can help parents and children learn to apply cognitive behavioral therapy (CBT), a highly effective treatment that addresses anxious thoughts and behaviors. “For example, we might encourage children to practice ‘detective-thinking’ to catch, check, and change anxious thoughts,” says Dr. Potter. “We also encourage them to approach, rather than avoid, anxiety-provoking triggers.”

Mindfulness techniques and antianxiety or antidepressant medicines also may be discussed. Often a combination of approaches works best.

Ways parents can help children learn to manage anxiety

  • Personalize and externalize: Ask your child to give anxiety a name. Your child can draw pictures of anxiety, too. Then, help your child acknowledge anxiety when it rears up: ‘Is that spiky-toothed, purple Bobo telling you no one wants to play with you?’ Labeling and distancing anxiety can help your child learn to be the boss of it.
  • Preview anxiety-provoking situations. Consider meeting camp counselors or touring new places ahead of time.
  • Model confidence: Children are emotional Geiger counters. They register anxiety radiating from parents. Try to be mindful of what you model through words and body language. Work on tempering overanxious reactions when appropriate.
  • Narrate their world: “Children are coding the world. Particularly through early childhood their brains are just sponges, taking everything in,” says Dr. Potter. “We can help them with the narrative they’re constructing: ‘Is the world a safe place or a dangerous place where I have to be on guard all the time?’”
  • Allow distress: Avoiding distressing situations invites anxiety to ease temporarily, only to pop up elsewhere. Rational explanations won’t work, either. The whirring emotional center of the brain known as the limbic system requires time and tools to calm down enough to let the thinking (cognitive) center of the brain come back online. Instead, try distress tolerance tools: one child might splash her face with cold water, another might charge up and down stairs to blow off anxious energy, or tense and relax her muscles, or distract herself by looking around to find every color in the rainbow.
  • Practice exposure: Gradual exposure helps rewire an anxious brain and shows a child he can survive anxious moments. Let’s say your child is anxious about talking in public, ducking his head and squirming if addressed. Pick a pleasant, slow-paced restaurant for a fun weekly date. Then coach your child to take charge of ordering foods he likes in small steps. At first, he might whisper the order to you and you’ll relay it to the waitress. Next, he might order just his drink or dessert, and finally a full meal as distress tolerance and confidence grows.

A few helpful resources

Anxiety and Depression Association of America

CDC Key Findings: Children’s Mental Health Report (2018)

Key Findings: U.S. Children Diagnosed with Anxiety and Depression (2018)

You and Your Anxious Child, Anne Marie Albano, PhD, with Leslie Pepper (Avery: 2013)

Home cooking: Good for your health

 

Can you imagine if you went to your primary care doctor’s office for cooking classes? What if your visit included time spent planning meals, discussing grocery lists and the benefits of home cooking, and learning culinary techniques?

If that sounds odd to you, it shouldn’t.

We already know that the more people cook at home, the healthier their diet, the fewer calories they consume, and the less likely they are to be obese or develop type 2 diabetes. A growing body of scientific evidence supports teaching patients how to cook meals at home as an effective medical intervention for improving diet quality, weight loss, and diabetes prevention.

In fact, research is turning to studying the value of nutrition programs that include cooking instruction. These programs have been shown to help people adhere to a healthier diet, eat smaller portions, and lose weight — improvements that lasted as long as a year after the study ended. These programs can even help patients with type 2 diabetes to eat healthier, lower blood pressures and blood sugars, and lose weight. Hard to believe it, but time in the kitchen can be as valuable as medication for some people with diabetes.

I recently met with a lovely patient of mine,* She has type 2 diabetes, and has trouble eating a healthy diet. Most of her meals are frozen dinners or takeout, which is all highly processed food with little nutritional value. I asked her if she would like to consult with a nutritionist.

“I have, many times,” she laughed. “They’re all very nice and everything, and it’s all good information, but I can’t cook. I get to the produce section of the grocery store, and I don’t know where to start.” Aha. No surprise, then, that multiple studies have shown that home cooking instruction significantly increase a person’s confidence in his or her food preparation skills, which translates into eating a healthier diet.

Diet and lifestyle interventions have already been shown to be quite effective for weight loss and prevention of type 2 diabetes, and adding a home cooking instruction component could be even more powerful.

Let’s get cooking!

*True story, details changed to protect the patient’s identity.

Grilled Zucchini with Red, Green, and Yellow Pepper Sauce

Zucchini

  • 6
    firm medium zucchini, sliced diagonally into thin rounds
  • 1/4
    tsp
    Atlantic sea salt
  • 1/4
    tsp
    Ground black pepper
  • 2
    Tbsp
    Unrefined canola oil

Sauce

  • 2
    Tbsp
    Extra-virgin olive oil
  • 2
    Tbsp
    Fresh lemon juice
  • 1/4
    cup
    Unsweetened white rice vinegar
  • Pinch
    Atlantic sea salt
  • Pinch
    Ground black pepper
  • 1
    Tbsp
    Unsweetened date honey
  • 1
    Small clove of garlic, crushed
  • 1
    Medium onion, finely chopped
  • 2
    Tbsp
    Chopped fresh parsley
  • 1/2
    Medium yellow bell pepper, seeded and cut into 1/4-inch cubes
  • 1/2
    Medium red bell pepper, seeded and cut into 1/4-inch cubes
  • 1/2
    Medium green bell pepper, seeded and cut into 1/4-inch cubes

Prepare zucchini

  1. Place zucchini rounds in a medium bowl, mix with salt and pepper, and toss with oil to coat.

  2. Heat a grill pan over medium-high heat. Working in batches, roast zucchini rounds for about 1 to 2 minutes on each side, until dark lines appear. Transfer to a large bowl.

Prepare sauce

  1. In a small bowl, mix together olive oil, lemon juice, and vinegar until combined.

  2. Add salt, pepper, and date honey, and mix until combined.

  3. Add garlic, onion, and parsley, and mix well.

  4. Add peppers and mix again.

Finish dish

  1. Pour pepper mixture over zucchinis, and let sit for about 30 minutes, to allow flavors to blend.

  2. Serve at room temperature.

Additional information and selected sources

Additional free and simple recipes from Dr. Rani Polak

Free cooking at home cooking videos from the American Collage of Preventative Medicine (ACPM)

Dr. Rani Polak’s Harvard Medical School Talk@12: “What to Eat: The Emerging Field of Culinary Medicine”

Is cooking at home associated with better diet quality or weight-loss intention? Public Health Nutrition, June 2015.

Consumption of Meals Prepared at Home and Risk of Type 2 Diabetes: An Analysis of Two Prospective Cohort Studies. PLOS Medicine, July 2016.

Impact of cooking and home food preparation interventions among adults: outcomes and implications for future programs. Journal of Nutrition Education and Behavior, July-August 2014.

Impact of cooking and home food preparation interventions among adults: A systematic review (2011-2016). Journal of Nutrition Education and Behavior, February 2018

Teens and drugs: 5 tips for talking with your kids

 

Parents of adolescents face a tough dilemma about substance use: we may want our children to be abstinent, but what do we do if they are not? The risks are high, as we’ve discussed in our blog about adolescent substance use and the developing brain. While parents can and should communicate clearly that non-use is the best decision for health, we simply can’t control every aspect of young people’s lives. There is no one-size-fits-all approach to successful dialogue with teens about substance use, but these principles may be helpful.

1.   Make your values and your rules clear

Parents sometimes use phrases like “be smart” or “make good decisions,” though these terms may have very different meanings to different people. For example, a parent who says, “Be smart!” may think he is asking his child not to drink, while the child may interpret the instructions as, “Don’t drink enough to black out.” So, be specific. If you mean, “You can go out with your friends as long as you can assure me you will not use marijuana,” then say it that way.

2.   Ask and listen, but resist the urge to lecture

As adults we very much want to impart as much wisdom as we can to help young people avoid the same mistakes that we made. But, it is probably more useful to draw out their innate curiosity and encourage them to seek out answers on their own. Consider beginning by asking a question like, “Tell me, what do you know about marijuana?” Teens who feel like their point of view is valued may be more willing to engage in a conversation. In response to what your child says, use nonjudgmental reflective statements to make sure she feels listened to, then follow up with a question. For example: “So you’ve heard that marijuana is pretty safe because it is natural. Do you think that is correct?” You don’t need to agree with everything your teen says; you just need to make it clear you are listening. For more guidance on active listening skills, see this resource from The Center for Parenting Education.

3.   If your child has used substances, try to explore the reasons

Teens may use substances to help manage anxiety, relieve stress, distract from unpleasant emotions, or connect socially with peers. Being curious about those reasons can help him feel less judged. It may also give you a window into your teen’s underlying struggles, help him develop insight into his own behavior, and point to problems that may need professional support. On the other hand, these conversations may be challenging for a parent to have with a child, and some young people have limited understanding as to why they use substances. For adolescents who are using substances regularly, we recommend an assessment by a professional who can support them in behavior change.

4.   Know when (and how) to intervene

Engaging with adolescents on the topic of substance use can be a delicate dance. We want to encourage openness and honesty, and we also want them to get clear messages that help to keep them safe. Teens who use substances recurrently and/or who have had a problem associated with substance use may be on a trajectory for developing a substance use disorder. It is a good idea for them to have a professional assessment. You can find a detailed list of signs and symptoms, as well as information about specific substances, on the website for the Adolescent Substance Use and Addiction Program at Boston Children’s Hospital. If an assessment is warranted, you can start with your pediatrician, who can help refer you to a specialist as necessary.

5.   Be mindful of any family history of substance use disorders

Much of the underlying vulnerability to developing substance use disorders is passed down genetically. Exposure to substance use in the home is also a major risk factor. Both may affect children with a first- or second-degree relative (like a parent, grandparent, aunt, or uncle) with a substance use disorder. While we know from studies that the genetic heritability of addiction is strong, it is also complex, passed on through a series of genes and generally not limited to a single substance. In other words, children who have a relative with an opioid use disorder may themselves develop a cannabis or sedative use disorder. Honest conversations about unhealthy substance use, addiction, and the family risk of substance use disorders can help provide teens a good, solid reason for making the smart decision not to start using in the first place.

Heat related illness: How to keep your cool

 

The summer season is waning but we’re not done with the heat. Hot and humid weather can bring a host of heat-related problems: heat cramps, heat rash, heat exhaustion, heat stroke…. It’s helpful to be aware of these issues, especially as we experience changes in the climate with humidity or rising temperatures. There have been several studies which have documented an uptick in emergency department visits and hospital admissions for conditions like dehydration, electrolyte imbalances, and other types of heat related illness during times of high heat. Persons who are particularly at risk are the very young and old, those who do prolonged exertional work outdoors, and intense athletes.

Getting overheated: The cause of heat related illness

Our bodies are not well-equipped to withstand large increases in our core body temperature, which is usually around 98.6 ˚ F (37˚ C). With heat stroke, core body temperatures may rise dangerously to around 103˚ to 104˚ F (39.4˚ to 40˚ C). If you have a concern about overheating, be sure to check a rectal temperature, as other methods like oral, axillary, or tympanic measurements can be inaccurate in these situations.

Our bodies have a number of mechanisms to help us cool down. One of the most important is evaporation through sweat, but this mechanism becomes less efficient in high humidity. Also, when we are dehydrated or when we are not accustomed to exertion in the heat, cooling off through evaporation becomes more challenging.

Furthermore, there are a number of medications that impair our bodies’ mechanisms for cooling off, like antihistamines, anticholinergics, decongestants, diuretics, stimulants, and some blood pressure pills, to name a few.

Signs and symptoms of heat-related illness vary. Dehydration may cause feelings of thirst, dizziness, and fatigue. Heat stroke, which needs urgent medical attention, may include hot or flushed skin, a fast heart rate, headache, nausea, dizziness, confusion, or loss of consciousness.

3 key questions about hydration

1.   How much should you hydrate? If you know you are going to be exerting yourself in the heat, start your hydration beforehand, so you start with a “full tank.”

2.  Is it possible to “overhydrate”? Yes. Best to speak with your doctor if you have a medical condition that requires you to be on diuretics or a fluid restriction. Also, though not common, drinking too much water can cause hyponatremia, or a low sodium concentration in the blood. This can be quite serious when it does happen, leading to symptoms like nausea, vomiting, headache, muscle cramps, confusion, and seizures. Hyponatremia is more likely to happen with athletes who sweat a lot, losing salt and water, but then replace the sweat by drinking only water, causing a diluting effect. Sport electrolyte drinks (which can be high in sugar and calories) are an option, but usually not necessary if you hydrate with water while having regular meals or salt-containing snacks.

3.  How do you know if you are getting enough fluids? Well, if you feel thirsty, you may already be dehydrated. Another telltale sign of dehydration is making less and darker urine, as opposed to normal amounts of light yellow urine.

10 tips for avoiding heat related illness

  • Plan to take it easy, especially if you are not used to exerting yourself in the heat and humidity.
  • Seek shade or cool areas and avoid prolonged exposure to the heat.
  • Protect yourself from sunburns.
  • Wear light, loose, reflective clothing.
  • Stay hydrated and avoid alcohol and caffeinated drinks.
  • Cool down with a cold bath or shower.
  • Dampen your clothes or apply wet towels while cooling off with an electric fan.
  • Use ice packs, especially on the neck, underarms, or groin near the main blood vessels.
  • If you feel ill and your symptoms are severe, seek prompt medical attention.
  • And remember, check in on anyone you think is at risk and might be more vulnerable!

Small study suggests benefits of computer-guided CBT for substance abuse

 

There is no way to meet the need for substance abuse treatment through the current healthcare system. The number of people who need treatment for drug and alcohol abuse is far greater than the number of clinicians available to treat them. In more rural areas, patients might have to spend a lot of time traveling great distances to appointments, which can be difficult to do while working or taking care of a family. And, the cost and stigma of treatment can get in the way of getting help. Moreover, even if people do get to substance abuse treatment, they often do not receive the most effective ones. As illicit drug use increases in the United States, new ways to deliver treatment are urgently needed.

Computer-guided treatments are one way to overcome the hurdles of access to evidence-based treatments, including travel and scheduling, cost, and stigma. Additionally, using computers to treat one’s own substance abuse can be empowering, giving a sense of “I did it on my own.”

How well do computer-guided treatments work compared to live counseling?

Researchers from Yale University recently developed and studied the “Computer-based Training for Cognitive-behavioral Therapy” (or “CBT4CBT”) web-based substance abuse treatment as a fully standalone intervention. CBT4CBT provides cognitive behavioral therapy (CBT) — an evidence-based treatment for substance abuse. The treatment is completely computer-guided, and does not involve interacting with a counselor or other healthcare professional. It combines online games and video vignettes with actors to teach how to manage one’s own substance use. Specifically, CBT4CBT covers: how to understand and change patterns of substance use; dealing with cravings; refusing offers of alcohol and drugs; problem-solving; noticing thoughts about drugs and alcohol and how to change them; and strengthening decision-making abilities.

Earlier research has shown that CBT4CBT can be an excellent complement to make live treatment with a counselor more effective and efficient. Recently, the research team conducted the first comparison of any standalone web-based treatment for substance abuse to “treatment as usual” — and data suggest that it may be better.

The study on CBT4CBT

The Yale team recruited 137 people seeking substance use treatment from the Connecticut Mental Health Center in New Haven; 49% African American, 34% Caucasian, and 8% Latino or Latina. Substances used were marijuana, cocaine, alcohol, opioids, and PCP. It was a real-world sample in that most participants used more than one illicit drug and most also used alcohol.

One-third of the participants were randomized to use CBT4CBT, with 10-minute in-person weekly checkups to evaluate their overall functioning, their safety, and their use of the online program. One-third of participants were enrolled in “treatment as usual,” which was either group or individual therapy, and covered topics including motivational interviewing, life skills, relapse prevention, harm reduction, mindfulness, and others. The other third were assigned to in-person CBT with a therapist who delivered the same type of content as the CBT4CBT online program.

The researchers found that drug use (measured by urine tests — which corresponded closely with self-reported use) in the CBT4CBT group was significantly less than treatment as usual, and remained lower over six months of follow-up. Persons who received live CBT had the same level of drug use as the treatment as usual group after six months. They also found that participants in the online treatment learned the CBT concepts the best, and had the highest level of satisfaction and lowest dropout rate of any of the three study conditions. Overall, after treatment the percentage of days abstinent from any drug use was 75% for the CBT4CBT group, vs. 67% of days abstinent for the treatment as usual group and 61% for the live CBT group. The study did not enroll a large enough number of participants to conduct a head-to-head comparison of CBT4CBT and live CBT. That may come later, and the results could inform how to conduct live CBT more effectively.

Getting access to computer-guided CBT

Computer-guided CBT for substance abuse should be studied further should be studied further, with different populations and in different settings, the next real challenge is to disseminate it widely across the US and beyond. According to its website, the CBT4CBT program is not yet available to the public, outside of clinical trials.

Building computer-guided treatment programs is often easier than building companies to deliver them. Barriers include acceptance by institutions, payment by insurance companies, liability, FDA approval, and resistance from healthcare providers — as well as coming up with viable business models. But if these obstacles can be overcome, the world could benefit from a highly effective and accessible treatment for drug and alcohol abuse.

References

Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up OutcomesAmerican Journal of Psychiatry, May 2018.

Home cooking: Healthy family meals

 

Family meals are beneficial for so many reasons. People who prepare meals at home tend to consume significantly more fruits and vegetables, and less sugar and fat. People who enjoy meals at home with others, sitting together and conversing, also have reduced stress and higher life satisfaction. The more frequently families with children have meals together, the more likely the children are to eat a high-quality diet, and the less likely to be overweight or obese. There are also other benefits: these children tend to have higher self-esteem and better academic performance, as well as lower risk of engaging in risky behaviors (like drug use) or developing an eating disorder.

Family meals without distraction

All those benefits go out the window if dinner is eaten in front of the television or other devices. This makes sense if we think about why the family meal has such powerful positive effects: it’s about closeness and connection. Sitting down to eat together is often the only time families can reconnect and communicate. Given our busy, technology-driven lives, the family meal is a rare (and critical) opportunity to unplug and check in. What’s even better is getting the kids involved in making dinner, which is also significantly associated with their eating a higher-quality diet.

One of my favorite family meals: Make-your-own soft tacos

The kids can get involved in preparing this simple and healthy meal, which is incredibly rich in protein and fiber, as well as calcium, iron, and potassium. Beans provide plenty of heart-healthy fiber, protein, and are associated with a lower risk of diabetes. Corn and masa (the tortilla flour made from corn) are considered whole grains and are loaded with vitamins and minerals. Avocados and olives provide heart-healthy fats, and the veggies are risk in fiber, vitamins, and antioxidants. All these easy-to-find ingredients, plus healthy veggies, the option of dairy, and protein from the pumpkin seeds, make this nutritious and fun to prepare with the family — and everyone will love that they can build their own taco!

Make-Your-Own Soft Tacos

This recipe will serve six people if some of those people are young children. For hungry teens and adults, expect it to feed three or four.

  • 1
    15-ounce can of unsalted black beans
  • 1
    can corn niblets, unsalted
  • 2
    avocados
  • 1
    red bell pepper sliced thin
  • 1
    tablespoons lemon juice
  • 1
    cup of salsa (fresh or jarred)
  • 1
    cup shredded cheddar or Monterey jack cheese
  • 1/2
    cup of plain Greek yogurt
  • 1/2
    cup pepitas (pumpkin seeds), unsalted (optional)
  • 1/2
    cup green olives (optional)
  • 8-12
    corn tortillas (made without lard)
  1. Dice the avocado and gently mix with the lemon juice.

  2. Heat the beans in the microwave or the stovetop; stir.

  3. Heat the tortillas (I wrap them in a clean towel and zap them in the microwave on high for 30 seconds).

  4. Set out all ingredients on the counter (or table) and let everyone put together their own healthy tacos.

Selected sources

Is cooking at home associated with better diet quality or weight-loss intention? Public Health Nutrition, June 2015.

Health and social determinants and outcomes of home cooking: A systematic review of observational studies. Appetite, April 1, 2017.

The relation between family meals and health of infants and toddlers: A review. Appetite, August 1, 2018.

Systematic review of the effects of family meal frequency on psychosocial outcomes in youth. Canadian Family Physician, February 2015.

A Review of Associations Between Family or Shared Meal Frequency and Dietary and Weight Status Outcomes Across the Lifespan. Journal of Nutrition Education and Behavior, January 2014.

Involvement in Meal Preparation at Home Is Associated With Better Diet Quality Among Canadian Children. Journal of Nutrition Education and Behavior, July-August 2014.

Safe driving protects your brain

 

When it comes to protecting brain health, you may think about exercise, diet, or engaging in activities that challenge you. Yet most of us hop into the car to travel to work, do errands, go on vacations, or drive the kids’ carpool as a matter of habit. But driving is a huge responsibility. One miscalculation on your part or the part of another driver and the results could be disastrous. Staying safe in the car not only protects your body, but also your brain. Follow these common-sense tips and recommendations, understand the law, and never take chances.

Safe driving means never drive if you are feeling woozy, overtired, or can’t see properly

Perhaps your young child has kept you awake for most of the night, and you can tell as you prepare your morning cup of coffee that you are shaky and slow. This is a good day to use public transportation (maybe you can catch a brief nap if you can grab a seat), call a friend for a ride, or use Lyft. Think about backup options for travel, and remember that being green means cutting down on your carbon footprint. If you have a long commute each day, maybe you can arrange a carpool with coworkers.

Always wear your seatbelt — and think about car “ergonomics”

A favorite story is that of a former surgeon general who tapped a taxi driver on the shoulder, and said “Sir, if you don’t buckle your seatbelt, I cannot proceed with this ride.” This should motivate us all to make sure that when we are passengers, the driver is wearing a seatbelt too. Modern cars have features to bolster safety, but they only work if you use them. Sit in your car while it’s in the driveway. Make sure the headrest as at the right height. Make sure you are close enough to reach the pedals and the wheel, but not right on top of it.

Think “defensively.” If the car stopped suddenly to avoid a crash, would your knees smash into the console? And most importantly, would your head be protected? A rapid forward-and-back head movement can bruise your brain, even without direct impact. In the case of a rear-impact collision, the brain accelerates forward and then bounces back against the skull. Even a minor accident can trigger headache and neck pain that need time and rest to recover from. So, make sure you’re positioned properly in your car, and if you share with a family member, be sure to readjust for each driver.

Kids must be buckled in the right car seat

It goes without saying that children should be carefully strapped into the proper size car seats, in the back seat of the car, and once they’re not babies, taught to behave calmly in the car. On long rides, car games and songs can make the time pass safely and are distracting and entertaining. Animals should be safely strapped in as well. Remember that in the event of a crash, an unrestrained pet is a projectile that can propel forward, hitting another passenger or the driver and potentially worsening a bad situation. Teach car safety starting with the youngest children and never put your foot on the gas unless everyone is safely strapped in.

What about a loss of consciousness or a seizure?

Here is where it gets tricky. Every state has different rules for when people who have experienced these situations are allowed to drive again. (Massachusetts says six months without another loss of consciousness event, such as a faint or seizure.) Your doctor must tell you this and must document that he or she has done so, but then you are responsible for reporting this to the Registry of Motor Vehicles. If your doctor is worried that you represent an ongoing danger, then he or she must follow up. Most people understand the risk of driving if there is a chance of a serious medical event, but because we all rely on our cars, it can be life-changing to be told that you are not able to drive for a certain amount of time. Think creatively about alternatives, such as carpools and public transportation. Again, if you have a seizure and lose consciousness while driving, you’re endangering not just yourself and your passengers, but every other car on the road.

Have a plan in case of an accident

Here are a few things to remember in the event of a fender-bender:

  • Take photos with your phone of your car, and anyone else’s car involved.
  • Take a photo of the other driver’s car insurance and license if you are able to as well.
  • Make notes of exactly what happened and contact the police to file a report immediately if you are not injured.
  • If you have any injury, please seek medical evaluation immediately. Sometimes, neck pain and headache will not start until the day after an accident. Check in with your PCP, who may recommend ice, medication such as ibuprofen, or further evaluation based on your symptoms.

The bottom line on safe driving

Remember, a car is a large and dangerous machine. It’s only as safe as the person driving. Speeding and tailgating have no place on the road. One moment of miscalculation can have lifelong consequences. Protect your brain — and everyone else’s brain on the road — by driving with your seatbelt buckled, and safety and good judgement — not speed — propelling your drive.

Back to school anxiety

 

Heading back to school sparks an upswing in anxiety for many children. The average child’s school day is packed with potential stressors: separating from parents, meeting academic expectations, managing peer groups, and navigating loud, crowded school hallways and cafeteria, to name just a few of many challenges. That’s why it’s typical for children to experience some anticipatory anxiety leading up to the new school year — and for parents to notice a rise in worries. For example, your child might ask questions about what her new classroom or teacher will be like, worry about having all of his school supplies ready, or have mild trouble falling asleep in the days leading up to the start of school.

Signs of back to school anxiety

But for some children — and particularly for children who already struggle with anxiety or have anxiety disorders — the return to school can be very stressful. Their behavior can reflect this. Examples of behaviors that suggest your child is experiencing above-average anxiety around the return to school include:

  • Continually seeking reassurance or asking repeated, worried questions despite already receiving an answer. “What if my friends are not in my class? When will I see them? What if I don’t have anyone to sit with at lunch because I have no friends? Will I be okay?”
  • Increased physical complaints, such as headaches, stomachaches, and fatigue in the absence of an actual illness.
  • A significant change in sleep pattern, such as taking an hour to fall asleep when a child normally goes to sleep quickly, or waking you up with worries during the night when a child typically sleeps well.
  • Avoiding school-related activities, such as school tours, teacher meet-and-greets, or avoiding school itself once the year starts (a topic that will be covered in an upcoming post).

Here is how parents can help with back to school anxiety

  • Approach anxiety instead of avoiding it. It’s natural to want to allow your child to avoid situations that make her anxious, or reassure her that her worries won’t come true. However, this can actually contribute to a vicious cycle that reinforces anxiety in the long term. Instead, acknowledge your child’s emotion and then help her think through small steps she might take to approach, rather than avoid, her worries. For example, you might say, “It sounds like you’re feeling anxious about riding the school bus by yourself. Would you be up for checking out the bus stop with me this afternoon?” Give lots of attention and praise to any “brave” behaviors rather than to her anxiety. “I love how willing you were to take the bus this morning! Great job pushing back on the worry bully!”
  • Practice school routines. For example, before the start of the year, you and your child might do a school day walk-through of the morning routine: waking up, eating breakfast, packing his school bag, and traveling to school. School tours or meet-and-greet days can be great opportunities to practice navigating the school environment and tolerating any anxiety in a low-stakes situation. After practice runs, debrief with your child on successes and challenges. Support your child in problem-solving around difficult points. For example, if he worries that he will have trouble finding his new classrooms, help him think through who he could ask for assistance if that occurs.
  • Model behavior you’d like to see. When an anxious child refuses to get onto the school bus or has a tantrum about attending school, it’s natural to feel frustrated, harried, and anxious yourself. However, try to model the calm behavior you would like to see in your child. Take deep breaths from your belly. Remind yourself that your child’s behavior is being driven by anxiety. If necessary, step away from the situation to take a few minutes to breathe and engage in a mindfulness strategy, such as counting all of the objects of a certain color or shape in the room around you.
  • Ensure enough sleep. The shift from a summer wake-up schedule to the school year wake-up time can be very challenging for many children, particularly preteens. Fatigue and crankiness from not getting enough sleep can make children much more vulnerable to anxiety. To combat this, consider moving your child’s wake-up time earlier and earlier in short increments in the weeks leading up to the start of school. Additionally, leave screens (TV, phone, computer) outside the bedroom at night.

When to seek additional help

If a child’s worries about the return to school start to interfere with his or her ability and willingness to attend school or participate in other normal activities, such as camp, beloved sports, or playdates, consider consulting with a licensed mental health professional who specializes in child anxiety. Your pediatrician, school guidance counselor, or health care plan may be able to recommend experts in your area. The Association for Behavioral and Cognitive Therapies and the American Psychological Association also offer online search tools for mental health professionals who can help.

Cannabidiol (CBD) — what we know and what we don’t

 

Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?

How is cannabidiol different from marijuana?

CBD stands for cannabidiol. It is the second most prevalent of the active ingredients of cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, which is a cousin of the marijuana plant. While CBD is a component of marijuana (one of hundreds), by itself it does not cause a “high.” According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD.”

Is cannabidiol legal?

CBD is readily obtainable in most parts of the United States, though its exact legal status is in flux. All 50 states have laws legalizing CBD with varying degrees of restriction, and while the federal government still considers CBD in the same class as marijuana, it doesn’t habitually enforce against it. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. Currently, many people obtain CBD online without a medical cannabis license. The government’s position on CBD is confusing, and depends in part on whether the CBD comes from hemp or marijuana. The legality of CBD is expected to change, as there is currently bipartisan consensus in Congress to make the hemp crop legal which would, for all intents and purposes, make CBD difficult to prohibit.

The evidence for cannabidiol health benefits

CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and in some cases it was able to stop them altogether. Videos of the effects of CBD on these children and their seizures are readily available on the Internet for viewing, and they are quite striking. Recently the FDA approved the first ever cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.

CBD is commonly used to address anxiety, and for patients who suffer through the misery of insomnia, studies suggest that CBD may help with both falling asleep and staying asleep.

CBD may offer an option for treating different types of chronic pain. A study from the European Journal of Pain showed, using an animal model, CBD applied on the skin could help lower pain and inflammation due to arthritis. Another study demonstrated the mechanism by which CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control.

Is cannabidiol safe?

Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level in your blood of the blood thinner coumadin, and it can raise levels of certain other medications in your blood by the exact same mechanism that grapefruit juice does. A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. So you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other (unknown) elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.

The bottom line on cannabidiol

Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer, which it is not. We need more research but CBD may be prove to be an option for managing anxiety, insomnia, and chronic pain. Without sufficient high-quality evidence in human studies we can’t pinpoint effective doses, and because CBD is currently is mostly available as an unregulated supplement, it’s difficult to know exactly what you are getting. If you decide to try CBD, talk with your doctor — if for no other reason than to make sure it won’t affect other medications you are taking.