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Elise Herman , MD

Pediatric Influenza and Vaccination

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As school starts up again, it is inevitable that kids will pass around lots of viruses, including influenza. Influenza (often called “the flu”) is a very contagious respiratory virus which causes fever up to 103-105 degrees, muscle aches, runny nose, and sore throat. A dry cough which can become severe is common, and fatigue is often extreme.  Nausea, vomiting, and diarrhea may also occur.

Influenza is passed from one person to another by sneezing, coughing, touching objects that are contaminated like countertops, and sharing cups or silverware.  The time between being exposed and getting sick with influenza is 1-4 days, so it moves quickly through a community. Influenza symptoms usually last 7-10 days in kids, though the cough and tiredness can take longer to resolve. Influenza activity peaks between December and February but may start earlier in the fall.

Though influenza may feel just like a severe cold, for many it can be very dangerous, especially older adults and young children. Over 40,000 adults died last year from influenza and its complications. There were 266 reported deaths due to influenza in children this past flu season, a new record high.

Children under age 5 are most at risk of complications, including severe pneumonia caused by bacteria. Kids can also develop bronchiolitis (swelling and inflammation of the small airways) and croup due to influenza. 

Decreased appetite and fluid intake along with vomiting and diarrhea can cause dehydration, signs of which include decreased urination, dry mouth, and sunken appearing eyes. Neurologic complications may include brain inflammation and seizures. A rare complication called Guillain-Barre Syndrome causes progressive and severe weakness, resulting in respiratory distress that can be life-threatening.

Annual influenza vaccination (of you, other family members, and your child) is your best bet to protect your kiddo. All children over age 6 months (with rare exceptions) should get vaccinated ideally before Halloween. The vaccine effect lasts about 6 months and protects up to 60% of those vaccinated from becoming infected. Although not totally protective against getting influenza, the vaccine is very effective at decreasing the severity of infection, with lower rates of hospitalization and complications including pneumonia. Flu vaccine can be given with other childhood vaccinations.

You cannot get influenza from flu vaccine, but mild side effects like a runny nose and low-grade fever can occur; these are due to the appropriate response of your immune system to the vaccine. Influenza vaccines have been well studied and are extremely safe.  In the past some have been concerned about thimerosal, a vaccine preservative, because it contains ethyl mercury. Ethyl mercury is entirely different from methylmercury, which can be harmful in high levels. Ethyl mercury poses no risk, but to minimize concern, thimerosal was removed from most childhood vaccines in 2001. It is present now only in multi-dose flu vaccine vials, which are not commonly used.

Along with influenza vaccination, don’t forget other simple ways to avoid illness during flu season such as good handwashing and avoiding sharing water bottles, drinks, or food. Influenza home care includes encouraging adequate fluids and fluid-containing foods like soup, Jello, or popsicles. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can help with fever and discomfort; be sure to follow age and weight guidelines.

Call your provider if your child has influenza symptoms and has difficulty breathing, appears dehydrated, or has fever for more than 3 days. You should also reach out to your provider if your child has extreme fatigue or irritability, or is under 3 months old with a fever of 100.4 or higher. 

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Help Build Your Child’s Self-Esteem

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Self-esteem is the way we feel about ourselves and is central to how we move through the world. If someone has high self-esteem, they feel confident and capable, and are more able to rise to a challenge and persevere. They can handle making mistakes, and do better overall in terms of school, work, and social interactions.

Those with low self-esteem feel negatively about themselves and their abilities. They may seem withdrawn, avoid challenges, and berate themselves if they feel they have fallen short. They do not stand up for themselves and may have more difficulty maintaining friendships and interacting with others.

Kids with low self-esteem may be moody or irritable. They may be hesitant to try something new, often predicting failure. If they make a mistake, they can be very self-critical, even calling themselves “stupid” or a “loser”. Self-harm (i.e. cutting of the skin) may occur as a way to deal with the negative feelings.

You can help build high self-esteem in your child by being loving, positive, and encouraging them to take on challenges. Don’t have them aim for perfection, an impossible goal, but instead celebrate when they try something hard or make progress towards a goal. Don’t give false high praise- -kids can often see through this which will make them feel less confident in their abilities.

Speak out about what makes them special and unique; avoid comparing them to others. As the parent, model good self-esteem, voicing self-confidence and your ability to tackle something challenging. Let your child hear that you are kind to yourself when you make a mistake and see that you still have self-respect.

Low self-esteem can be improved by getting out in nature (and off of phones and social media). Exercise, time with friends, and playing games can help your child feel more positively about themselves too. A volunteer activity (which you may do together depending upon their age) helps put the focus on others and how we can help instead of feeling negatively about ourselves. Your child may benefit from clubs or classes such as dance or karate that bring them together with peers they can relate to.

If your child is displaying signs of low self-esteem, talk with them about what you are noticing, and empathize with their feelings. Try to understand how the world seems to them even if what is concerning them may seem minor. If things do not improve over time, consider having your child speak with the school counselor or a therapist comfortable treating children.

By showing your child unconditional love, acknowledging their progress towards a goal, and encouraging them to challenge themselves, you can help boost your child’s self-esteem. Your child will be more confident and better able to handle what comes their way as a result.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Bee and Wasp Stings in Children

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Being outside in spring and summer is terrific, but it does come with the risk of bee and wasp stings. It is important to know how to treat stings, what to watch for, and even better, steps you can take to decrease your child’s risk of being stung.

Most bees and wasps can sting multiple times since they do not lose their stinger. Honeybees have a barbed stinger, which remains embedded in the skin so they can only sting once. The honeybee stinger looks like a small black dot in the area of the sting.

The immediate symptoms of a sting are pain and burning; itching may follow. The area becomes red and swollen and this may increase over the next 3 days. A sting on the face can cause severe swelling including around the eye.

If there is bee allergy, anaphylaxis may occur within 15-60 minutes. Anaphylaxis is a severe allergic reaction which may be life threatening and needs emergency treatment with epinephrine, available only by prescription. Signs and symptoms include wheezing, hives, respiratory distress, throat tightness, nausea and vomiting, and swelling of the lips and/or tongue. There may be paleness and fainting. An allergic reaction typically happens after one has had previous stings though can happen with the first sting. Bee allergy occurs in less than 1% of children.

Home care of bee/wasp stings:

  • If you see a stinger, try to remove it by scraping gently with a credit card or fingernail. Do not squeeze or pinch as this can release more venom. Wash with soap and water.
  • Apply a paste of meat tenderizer or baking soda for 20 minutes. Aluminum-based deodorant on the area is another option.
  •  Tylenol (acetaminophen) or Advil (ibuprofen) helps discomfort. Topical or oral Benadryl (do not use these together as it can cause oversedation) helps with itching. 1% hydrocortisone also decreases itching, is available without a prescription, and may be used 2-3 times a day.
  • Cool cloths or an ice pack can help relieve the pain.
  • Use an epinephrine product (injection or nasal spray) as directed if your child has a history of bee allergy

When to call your child’s provider:

  • If there is increasing redness and swelling after 3 days
  • If your child was stung in the mouth or eye
  • If the area of swelling is more than 4 inches across

When to go to the ER/ call 911:

  • If your child has known bee allergy and was stung, even if you treat with an epinephrine product (only available with a prescription)
  • If there are more than 5 stings per 10 pounds of body weight (or more than 50 stings in a teen)
  • If your child appears severely ill

How to help prevent bee/wasp stings:

  • Avoid scented lotions and perfumes
  • Avoid clothes with a floral print or floral colors
  • Have your child always wear shoes since some bees live in the ground
  • Keep food and drink covered; make sure there are no bees in open drink cans or on a straw

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

When is it OK for Kids to Have a Smartphone?

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Seemingly everyone has a smartphone, and kids are drawn to these at a very early age. Parents do their best to supervise and set appropriate boundaries for their kids around phones, but may wonder when it is OK for their child to have their own phone. Making this decision can seem daunting, especially as younger and younger kids seem to have a phone in their pocket. According to Common Sense Media/Research, 43% of kids age 8 to 12 and 88% to 95% of teens up to age 18 have their own smartphone. If you are the parent of a 10-year-old, the begging may have already started. The general recommendation has been “Wait Until 8th (the end of 8th grade)”, but many kids get phones earlier.

Parents often see the benefit of staying in touch as a reason to give their child a phone. Other positives include use in an emergency and socializing. As kids get older, phones can help them stay connected to their friends and communicate about school work, sports, and other activities.

There is no perfect age for a child to have a phone. It may depend on the child’s maturity and sense of responsibility as well as family values. Is the child impulsive? Do they generally respect rules and limits? Are they generally honest? Are they good about following the rules regarding other tech, such as a Chrome book use at school? ATT and the American Academy of Pediatrics have partnered on an online ‘quiz’ to assess a child’s readiness (see resources, below).

The potential negatives of cell phones include less time spent with family, less physical activity, and sleep disturbance. Phones offer access to social media which can increase the risk of depression and anxiety. There is the possibility of kids oversharing, experiencing cyberbullying, and being victimized. Phone addiction is a concern for users of all ages.

On-line pornography poses significant risk to kids and teens. The average child is exposed to pornography by age 12 years. Pornography often portrays physical and verbal aggression and sexual violence, usually directed towards women, including women being choked, slapped and spit upon during sexual activity. It is horrific to note that free porn sites carry videos of child rape and assault. Early exposure to pornography is related to anxiety, depression, and difficulty forming healthy intimate relationships later on.

So how to navigate this complicated situation? Communication is key. Have open discussions with your child regarding the pros and cons of a smartphone. Take the “phone readiness quiz” and review the results with your child. Parental controls restricting the amount of usage as well as access to social media and inappropriate sites are vital. Discuss where and when the phone can be used (not at meals, not during family social time, not after bedtime, etc.) Your child should understand your concerns and the importance of respecting these limits when using other devices, for example, the phone of a friend who may not have the same restrictions.

As the parent, you should have your child’s password, be able to track their usage, and maintain the right to take the phone away if rules are not being followed. Having your child contribute to the purchase of the phone or service plan financially or by doing extra chores teaches responsibility.
As a trial, many families opt for a flip phone (calls and texts only) for a year to assess their child’s readiness. If connection to your child is most important, a smart watch, iPad, or tablet is a good way to start without the complications and potential risks of a smartphone.

Resources

Wait unitl 8th: https://www.waituntil8th.org Parents can join together, pledging to avoid phones for kids in elementary and middle school.

Phone Ready Quiz: https://www.healthychildren.org/English/Pages/PhoneReadyQuiz.aspx

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Dog Safety for Children

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Most kids have a natural attraction to dogs, but we need to teach our children to be safe around them. Of the roughly 4.5 million dog bites annually in the US, the most common victims are kids, and their injuries tend to be more severe. In general, people are most likely to be bitten by a dog they know as opposed to a stray. Talk to your child about dog safety (starting when they are very young) and be a good role model when interacting with dogs. Basic dog safety includes:

  • Always be gentle. This applies to all animals and is a valuable lesson for our kids. Keep voices calm and reassuring as raised voices or screaming are understandably upsetting to dogs and may cause unpredictable actions. Praise your child when you see calm, kind behavior towards any animal. Practicing gentleness at home with a stuffed animal makes kids more confident when interacting with the real thing!
  • Never disturb a dog when sleeping, eating, or caring for puppies. No grabbing at dogs, touching eyes, pulling on ears or tail- even the most patient dog has limits. Stay away from the food bowl, treats, or special toys as any dog can become protective.
  • Never leave a young child (under age 5 years or so) alone with a dog.
  • When out and about, greet a dog’s owner first, and ask about the dog’s temperament and tolerance for children. You or your child can then ask for permission to pet the dog and after greeting the dog by name, can offer the top of a closed hand for a sniff. Stand to the side of the dog and pet gently on the back or side. Keep interactions brief. Commend your child for behaving kindly and gently.
  • If your child is fearful, do not force an interaction. From a comfortable distance, you and your child can chat about the dog, its size, cuteness, etc., to encourage positive feelings.
  • Any treats should be offered with a flat hand. Never tease a dog by offering a treat and then whisking it away.
  • Notice body language: A tucked tail, laid back ears, and a stiff stance may indicate fear. If a dog is trying to hide behind its owner, it is not ready to be social. A wagging tail often indicates friendliness but, in some dogs, may signal being on alert.  If you have concerns, you can say, “It looks like this doggy isn’t ready to meet new friends. Let’s give him some space.”
  • Stay away from strays. If approached by a stray, turn away, avoiding eye contact with arms crossed. Sometimes saying, “Go home!” emphatically will work. Do not scream or run away.

It is important to teach our kids to be kind to animals, and dog safety is particularly vital given the fact that about 65 million US households include at least one dog. So even if you are dogless, your child will undoubtedly have lots of opportunities to interact with them—and you can help those interactions to be positive and safe.

Resources:

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Measles in Children

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The rise in measles cases recently has many people, parents included, very concerned, and with good reason. Measles is a viral illness that can be very dangerous especially for infants, children under age 5 years, pregnant women, and those with immune system problems. As of 2/26/25, there have been 165 cases in 10 states, including Washington, and sadly one child has died. Although the number of infected people does not sound very high, measles is one of the most infectious viruses known, so numbers are likely to grow. Measles infects 90% of those exposed if they are not vaccinated.

Measles starts with a fever (as high as 104), runny nose, cough, and red watery eyes. These symptoms usually start 7-14 days after exposure though it can take as long as 21 days to show signs. Two- three days later, small white spots inside the cheeks (Koplik spots) may show up. The typical measles rash starts on the face at the hairline about 3-5 days after symptoms begin. This rash consists of red, usually flat, spots that spread head to toe and may join together. Fever may spike to 104 when the rash appears. Diarrhea can also occur.

Complications are common with measles, especially in infants, children under age 5 years, pregnant women, adults over age 20 and those who have immune system deficits. Ear infections occur in 1 out of 10 kids with measles and pneumonia happens in 5% of all people infected. Brain inflammation (encephalitis) afflicts 1 out of 1,000 infected children and can cause brain damage, deafness, seizures, and death.  Nearly 3 in 1,000 kids with measles die, most commonly due to pneumonia or encephalitis. Pregnant women are at increased risk of delivering early and having a low-birth-weight baby.

There is a very rare complication that can occur 7-10 years after measles infection called Subacute Sclerosing Panencephalitis (SSPE). It is a brain disorder related to the earlier measles for which there is no treatment and results in death within 3 years of diagnosis without exception.

The good news is that the measles vaccine (either as MMR [measles, mumps, and rubella vaccines] or MMRV (as above plus varicella [chickenpox] vaccine) is safe and effective. For kids it is a 2-dose series, given at ages 12-15 months and 4-6 years; adults who are unvaccinated may only need one dose. One dose of a measles vaccine is 93% effective at preventing infection, and 2 doses gives 97% protection. Common side effects include muscle soreness at the injection site, low grade fever, and a mild rash. Rarely there can be a brief harmless seizure due to fever, occurring in less than 8 kids per 10,000 vaccinated.

The Health and Human Services Secretary Robert F. Kennedy, Jr, issued a statement on March 3, 2025, with the subheading “MMR vaccine is crucial to avoiding potentially deadly disease” and then noted “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”

Earlier concerns about MMR vaccine and autism have been strongly disproved in multiple studies. The doctor who made those claims was found to have fabricated his ‘results’ and lost his medical license. Autism is often diagnosed at around the same age as when kids receive MMR vaccine, but the vaccine does not cause autism.

During a local measles outbreak, students who are unvaccinated are excluded from school for 21 days from the last measles rash identified in the community. If they are given the first dose of the MMR or MMRV series, they may return to school. If an unvaccinated child is exposed to measles, they should be immunized as soon as possible to decrease the risk of infection.

If you have questions about measles vaccination, contact your child’s health care provider. Measles is a very dangerous virus that is unfortunately also extremely contagious. Our best way of protecting our kids and our community is vaccination.

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Dr. Elise Herman

Blog Posts
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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Bad Breath in Children

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As a parent, you may occasionally wonder how your sweet child can have such bad breath, but bad breath in kids happens!

As opposed to just ‘morning breath’, chronic bad breath (“halitosis”) can have a variety of causes and occasionally can indicate a true medical problem. The most common reasons for halitosis in children include:

  • Poor dental habits: Without routine brushing and flossing, bacteria on the teeth increase, which can cause a filmy layer called plaque. Plaque can lead to cavities and gum inflammation, both of which can cause bad breath.
  • Dry mouth: This can result from not drinking enough water, sucking of thumbs or fingers, chronic nasal congestion, or chronic mouth breathing.  A dry mouth means saliva is not adequate to wash bacteria and food particles away.
  • Infection or disease: Viral or bacterial throat, tonsil, or sinus infections can cause bad breath. The bad breath should improve once the infection resolves. If your child has fruity breath, this is quite unusual and could indicate a serious problem like diabetes, though other signs like excessive thirst and urination would typically be present as well.
  • Allergies: Chronic nasal congestion or postnasal drip due to allergies can create bad breath.
  • Foreign body: If a bead, piece of tissue, or some other small foreign body is stuck up in the nose, a foul odor and nasal discharge from one side of the nose may develop.
  • Large, pitted (having an irregular surface) tonsils: Although shallow pits are normal, they can trap bacteria, nasal secretions, and bits of food, which can become calcified, resulting in a tonsil ‘stone’ or tonsillith. This looks like a small whitish lump and can have a bad odor. It is not, however, pus and does not indicate a throat infection.
  • Certain foods: Eating foods with strong odors like garlic, onions, etc. can cause bad breath, but it is usually temporary.

There are multiple things to try if your child is having bad breath. Brushing teeth well (begin when teeth are touching) at least twice a day, flossing, and brushing the tongue is important. Make sure your child is drinking plenty of water throughout the day. Older kids can chew sugar-free gum with Xylitol which increases saliva, decreases bacteria, and lowers plaque buildup which can keep the mouth healthier overall.

If you observe chronic nasal congestion or mouth breathing, talk with your child’s health care provider.  If tonsil stones are noted, recall that these are harmless and usually go away on their own. Older kids can try gargling with salt water which may loosen the stone. If your child’s breath has a fruity odor especially if there are signs of diabetes, call your child’s provider right away.

Remember that in most cases bad breath is not serious and can be easily remedied. If your child’s breath is not improved by the above measures, a visit with your child’s healthcare provider and/ or dentist may be in order.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Preventing Hearing Loss in Kids

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Excellent hearing is crucial to a child’s health and development. Poor hearing, even if mild, can cause problems in communication, learning, speech, and social skills. There are multiple reasons a child may develop hearing loss, including chronic ear infections, trauma, certain medications, and vaccine-preventable serious brain infections like meningitis.

In 2023 the American Academy of Pediatrics released a policy statement concerning one of the most preventable causes of hearing loss—excessive noise exposure, calling this a “largely unrecognized … serious public health hazard”. This type of hearing loss can be temporary or permanent. Over 12% of kids aged 6-19 years and 17% of adults under age 70 have permanent hearing damage from loud noise exposure.

Because children have smaller ear canals, higher frequency sounds are more intense and potentially more damaging. Think of noise as ‘dose-related’; the longer the exposure, the more risk even if just slightly louder than what is considered safe. Sounds over 75 dB for older children and adults can cause damage, depending on length of exposure. Noises we consider routine like city traffic, TV, and lawnmowers can harm children’s hearing. Concern has also been raised about infant sound machines used to help babies fall asleep. Since infants can have damage beginning at 60 dB, it is recommended to keep a noise level at 50 dB or lower, but sound machines may exceed this.

Depending on your child’s age, hearing loss can present differently. They may not meet developmental milestones. A 3-month-old should alert to a sound and babble back and forth. By 6 months, you should hear some consonants (“mamamama”, “dadada”, etc.). A 1-year-old will follow simple directions like, “Look at Mommy!”. Toddlers and older kids with hearing loss may have unclear speech, say “Huh?” a lot, and want the volume of TV or music turned up. Acute loud noise exposure can also cause ear pain and ringing in the ears (“tinnitus”).

Personal listening devices (PLDs) such as iPods, smartphones with earbuds, and headphones for watching TV can magnify the risk. The World Health Organization estimates 1.5 billion people worldwide are risking hearing damage from ‘unsafe listening practices’.

We can start early to protect our child’s hearing. Checking decibels in your child’s environment is helpful although decibel apps on phones are not 100% accurate. Anything over 85 dB can harm an adult’s hearing, and over 70 dB can impact a child. The louder the noise, the faster it can cause damage. 

Infant sound machines should be at least 7 feet away from a baby and at 50 dB max. Consider avoiding loud noise exposure (concerts, fireworks, etc.) but if unavoidable, younger children can wear sound protecting earmuffs (plastic cups connected with a headband) over their ears. Ear plugs are safe for older kids and there are different types; ‘musician earplugs’ dampen volume yet preserve audio quality better than foam earplugs from the drugstore.

Be a good role model by setting good rules for hearing protection and wear ear plugs yourself when appropriate. Set clear expectations for protecting every family member’s hearing. Loud background noise can also be distracting, worsen a child’s mood, and disrupt learning, so routinely having a quiet home at times can be a benefit. If you have concerns, talk to your child’s health care provider about getting a formal hearing evaluation by an audiologist.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Indoor Activities with Your Child

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It is great for everyone to get outside daily but sometimes we are stuck inside, often due to stormy weather or extreme cold temperatures. It may be easy to default  to ‘screens’ like video games, iPads, and scrolling on smartphones, but there are lots of things your child can do that involve creativity, brainpower, and just simple play. Use your judgement with the following activities depending on the age of your child.

Art- In addition to drawing and painting, don’t forget Play-doh (home-made Play-doh recipe on-line), cut or torn paper, collages, etc.

Baking (with good supervision of course)

Crafts- Local craft and dollar stores have inexpensive materials appropriate for different ages. “C” can also be for ‘Charades’, the classic guessing game.

Dancing- Put on the classic music you grew up with and rock out with the kids!

Eggs- Use paints or markers to decorate the shells of hard-boiled eggs.

Fort- Let you child get creative making a fort of boxes, blankets, chairs, etc.

Giggling- Tell jokes, riddles, do hand clap routines, etc.

Hair- Have fun with wacky hair styles for the kids (and maybe for you—let them play hairdresser!).

Indoor scavenger hunt- Give kids a list of colors, shapes, and specific items to look for in one room or small area of the house.

Jump rope- This is great indoor exercise if you have enough space.

Kitchen duty can be fun when kids come up with a (simple) menu and you prepare food together.

Listen to music- Consider exploring music of different cultures and parts of the world.

Make music- Use real instruments or pots and pans, shaking a jar of beans, etc. Have a musical parade through the house- noisy but fun!

Necklace– Dye tube-shaped pasta using a small amount of food coloring mixed with white vinegar and let dry. Thread on yarn for a cute necklace (make big enough to go over the head).

Obstacle course-Your child can create a course with cardboard boxes, towels as ‘water’ to be jumped over, a length of string as a ‘tightrope’, throw pillows as rocks to be stepped on with the floor as ‘hot lava’, etc.

Pretending- Kids love to pretend, whether it is acting out a fairy tale or pretending to be a teacher. Endless options!

Quiet activities like puzzles and Legos are a nice way for your child to play independently.

Reading- The reader (either you or your child) can use funny voices and exaggerated emotions which make it very entertaining. Or try Racing in unusual ways: crab-walk, bunny hopping, while holding a big spoon of water, etc.  

Seal, swan, snake- Take turns acting like different animals and see if others can guess which critter is being imitated. Also do some ‘Science experiments’—you can find many ideas on-line.

Tell stories about when your kids were little or make up stories together about adventures their stuffed animals might have. There is a lot of guidance on-line for storytelling.

Uno or other kids’ card games are simple, fun and can encourage good sportsmanship.

Vet office for stuffed animals- Set up a pretend animal clinic- use a flashlight and other household items as ‘instruments’ to examine the ‘patients’.

Writing letters- Teach your kids this ‘lost art’ and let them experience how happy the recipients will be to get an actual letter!

X marks the spot- create a simple map of one room in the house and hide ‘treasure’ (small things like fridge magnets) and put an X on the map for their location. See how your treasure hunters do without too much help.

Yarn- Kids can learn finger knitting, crocheting, or standard knitting with on-line instruction.

Zinnia seeds- Plant zinnia or other (small) flower/ herb seeds in cups with seed or potting mix. A small UV light or a spot on a sunny windowsill will be needed once the seeds sprout.

more about The contributor

Dr. Elise Herman

Blog Posts
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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Mealtime without Screens

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Contributor Dr. Elise Herman

Mealtime should be a time to connect with our kids and enjoy healthy food in a stress-free environment. This idealized version is not always the case, and for many reasons, kids may end up eating in front of the TV, laptop, iPad, or smartphone. There are multiple problems with this—for both adults and kids.

Obesity:  In general, kids eat more in front of a screen. Some parents are happy to see their child (especially if they are a picky eater) eating more but being distracted while eating means eating mindlessly. This can lead to overeating in the long run since kids don’t pay attention to feeling full and therefore overeat. Research has shown that children who watch a screen during meals are more likely to be overweight.

Digestion: Digestion is aided by really noticing the aromas, the preparation and the sight of food. If attention is more on the screen than the food, digestion can suffer.

Missed social opportunities: When eating alone and watching a screen, kids miss out on connection with others over a meal, learning to make conversation and basic etiquette (taking small bites, not talking with your mouth full, etc.). Mealtime is a chance to slow down, enjoy our food, and socialize. You can model all of this to your child if you eat together, undistracted—powerful stuff!

Exposure to commercials: Commercials during kids’ programming are often for fast food or processed foods high in sugar and calories and aimed specifically at children. Not surprisingly, screen time during meals is associated with increased junk food consumption.

So how to change this behavior in your house? Anticipate that it may not be easy (for either of you) to break this habit, but keep in mind how important this is and stay with it. Here are some suggestions:

Make change gradual: Target one meal at a time, either eliminating screens altogether for that meal or decreasing the time. Substitute music, conversation, or reading books to your child (not having an app read a book). Starting with a no-screen snack is an easy way to begin.

Adults adopt the change, too: No screens for adults as well at mealtimes, not even to text. You can tell your child this is hard for you, too, but you know how important it is for everyone to make this change. Explain your plan to other adults who may provide meals (childcare, sitters, grandparents) so they are also on board with this—consistency is vital for success.

Follow a schedule: Eliminate screens at one meal or snack every 1-2 weeks and you will accomplish the overall goal within 1-2 months. Talk about how different mealtimes are now that you are connecting and eating more mindfully.

Be firm: Don’t give in to tantrums or your child eating less. This behavior will be short-lived, so don’t let it throw you off track. You can however have some occasional exceptions such as snacks while watching sports, but these should be infrequent.

Children age 8-12 in the US look at screens for 5 ½ hours daily and teens spend an average of 8 hours a day on their devices—pretty stunning statistics. Kids who watch a screen during mealtime spend more time on devices overall. Changing this behavior is a good place to start to take control of the excessive screen use in most of our lives.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.