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Teens & Gambling

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Parents do their best to watch for risky behavior as their kids get older, but one behavior that might not be as obvious is online gambling.

man holding cell phone

This is becoming a huge problem for youth and teens, especially boys. According to Common Sense Media, 36% of boys ages 11-17 have gambled in the past year. Kids learn about gambling on social media, via betting apps on cellphones, in video games, and while watching sports which now often have ads for betting.

Teens are drawn to gambling because their brains are not yet fully developed and they can be impulsive and take risks. They also may feel invincible and not understand the consequences of their behavior clearly.

Betting has exploded since the 2018 Supreme Court allowing states to legalize sports betting; this is now legal in 39 states, Puerto Rico, and Washington, D.C.

The legal age for betting is determined by the state and is either over 18 (as here in Washington state) or over 21. Kids get around the age restriction by using a fake ID, VPN, or the account of someone older. Gambling sites outside of the U.S. are also more lax regarding a user’s age.

Gambling behavior in kids often starts with betting in video games, making it hard to spot by parents. Bets in gaming may be for prizes or loot boxes (randomized “treasure chests”) using in-game or real currency. Video games often have ads and promotions for betting sites, tempting gamers regardless of age.

Betting is seemingly everywhere, including betting on sports during the game (“in-game betting”) often in a series of “microbets” which happen quickly, increasing the excitement and sense of urgency. There are apps that imitate casino-style gambling called “social casinos” which do not involve real money but do groom the user for actual gambling later.

The earlier kids get involved with betting, the more likely they are to develop problem gambling (gambling that feels uncontrollable and causes problems in a person’s life). Compulsive gambling increases the risk of substance abuse, depression, anxiety and suicidal thoughts.

How can you help your teen with this issue?

Have a frank and non-judgmental discussion, acknowledging any gambling you might participate in like lottery tickets or fantasy football. Be honest if you have had a problem with gambling yourself.

Look together at what your child is seeing that promotes gambling such as ads in video games and during sporting events, social media posts, etc. and discuss how tempting those might be.

Encourage your child to not focus on the promised “winnings” but the reality of losing and the consequences of gambling addiction.

Pay attention to signs of a problem like small unexplained charges on video game sites, more time on-line (especially if secretive), increased anxiety or depression, or worrying about money.

If you have concerns that your child may have a gambling problem, especially with anxiety or depression, schedule time for you and your teen to see their health care provider. There are good treatment options and intervening early gives your child the best chance of beating a gambling addiction.

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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.

Vitamin K Deficiency Bleeding in Newborns

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One of the most important medicines for your newborn is the vitamin K shot administered shortly after birth, given to decrease the risk of bleeding problems in babies. Vitamin K activates clotting factors which help control bleeding. Humans get vitamin K mostly from plants, with a small amount made by bacteria in the intestines. Newborns have very low levels of vitamin K because it does not cross easily from the placenta to the baby, and do not yet have enough gut bacteria to make adequate vitamin K.  Breast milk, otherwise the best nutrition for babies, is very low in vitamin K, while formula happens to be quite high.

newborn baby, skin to skin with mom

This vitamin K deficiency puts babies at risk of bleeding, called vitamin K deficiency bleeding (VKDB). There are 3 types- early, classic, and late. Early VKDB occurs within the first 24 hours, classic occurs in the first 2-7 days of life and late can occur any time up to age 6 months.

General signs of newborn or infantile bleeding are paleness, bruising, and bloody/tarry stools. A potentially deadly brain bleed may occur with any type of vitamin K deficiency bleeding but is most common and severe in the late type. It is the first sign of a problem in 50% of late cases, occurring with no warning. The baby may be lethargic or irritable, have a bulging soft spot, or develop seizures. Despite treatment with vitamin K by injection and surgery, the outcome is often tragic. 20% of babies who develop brain bleeds due to vitamin K deficiency die, and many survivors have brain damage. 

It is important to remember that vitamin K deficiency bleeding is rare because of preventative vitamin K 1 mg given by injection within 6 hours of birth. The vitamin K is stored in the liver and slowly released over several months. This injection decreases the risk of vitamin K deficiency bleeding to almost zero. There are no significant side effects of the shot other than the discomfort, slight swelling, and mild bruising/bleeding that may happen with any injection. Holding your baby while the injection is given can ease the discomfort. 

Some have wondered about giving vitamin K by mouth as a single dose or multiple doses over weeks, but that does not work as well. Absorption may vary, and there is no delayed release benefit. 

Making sure your baby receives their Vitamin K injection shortly after birth is vital to prevent bleeding which can occur without warning and be very dangerous. It is safe, simple, and extremely effective. 

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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.

Household Product Safety for Children

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A child’s natural curiosity may lead them to explore potentially dangerous household products. Exposures or ingestions of these are a very common cause of emergency department visits for kids, resulting in over 16,000 such visits annually due to household cleaning products alone. Here are steps you can take to help keep your child safe.


  • Cleaning products: These can be poisonous and very attractive to kids, like laundry and dishwasher pods. Ingesting detergent can cause choking, nausea, vomiting, trouble breathing and damage to the esophagus. Bleach accounts for about 30% of all injuries from cleaning products and can result in severe intestinal damage and even death if a high concentration is swallowed. Many cleaning product injuries occur from the product being sprayed into the child’s eyes. Opt for products with child-resistant caps. Keep all cleaning products secured and out of reach, ideally in a locked cabinet. Consider choosing less toxic, natural products instead- most grocery stores have a good selection of these.
  • Batteries: Button batteries found in fobs, remotes, singing greeting cards, toys,etc. can be deadly if swallowed due to the electrical current from the battery and its chemical seeping into the intestinal tract. Store batteries safely, keep items with batteries out of reach, and tape over the battery compartments to prevent children from accessing the battery.
  • Nicotine products: Nicotine can be very toxic to children. Nicotine products like pouches, patches, vapes, and e-liquid may be attractive to children because they can look like candy or juice. Toxic effects include high heart rate and blood pressure, tremors, seizures, and even death from cardiac arrest. All nicotine products should be locked up and out of reach of children.
  • Medications: All medicines, both prescription and over the counter, should be secured and out of reach. Be mindful of any visitors or houseguests who may have unsecured medications in their backpack, purse, etc.
  • CBD/THC and edibles: Cannabidiol (CBD) and tetrahydrocannabinol (THC) are compounds found in the cannabis plant. THC causes euphoria or a “high” while CBD has been shown to have various health benefits such as helping with pain, anxiety, sleep, and depression. Symptoms of cannabis toxicity may include drowsiness, dizziness, nausea, vomiting, breathing difficulties, and seizures. Edible cannabis products like snack foods, candies, and baked goods may be enticing to kids. Cannabis edibles should be stored as any potentially toxic medication would be. Avoid buying edibles that look like candy and make sure guests do not bring in unsecured cannabis products.

Keep in mind your child’s age and natural curiosity as you seek to make your indoor environment safe. Remember to use child-resistant locks to help keep your child away from potentially dangerous household products. In addition to taking the above steps, be sure to have the National Poison Help Line (1-800-222-1222) posted on your refrigerator and in your phone.

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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.

E-bike Use and Safety Issues for Children

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E-bikes, which have an electric motor and a rechargeable battery, can make bicycle riding more accessible to lots of people, as they can assist when the ride gets more challenging. However, e-bikes are more akin to a motorcycle than a traditional bicycle and present some risks especially for younger riders. 

family riding bikes on street

There are 3 classes of e-bikes. On Class 1 bikes, the motor only works if the rider is peddling. Class 2 bikes have a throttle that enables the motor to work without peddling and can go up to 20 mph. Class 3 bikes may or may not have a throttle but can go as fast as 28 mph. 

Laws vary by state regarding at what age a class of e-bike may be used. Age 14-16 years is the typical age allowed to use a Class 1 or 2 e-bike, with the cut-off commonly being over 16 years of age for Class 3. The Consumer Protection Safety Commission recommends no motorized vehicle use over 10 mph for kids under age 13 years.

Because e-bikes are heavier and faster than traditional bicycles, they are more dangerous with injuries to the head, neck, face, and internal organs more common. There are more than 20,000 US emergency room visits annually due to e-bikes with about 3,000 hospitalizations.  Adolescent males under age 16 are at particularly high risk of injury. Bike helmets are not sufficiently protective for e-bike riding; a helmet designed for motorcycle or motorized scooter use is recommended.

In view of the risks, what can parents do to help protect their kids regarding e-bike riding?

  • Do not allow e-bike riding under age 13 years.
  • Help your child learn about e-bike use and safety before riding.
  • Pay attention to state laws regarding age limits based on the class of e-bike.
  • Insist your child wear a helmet appropriate for a motorcycle or motorized scooter.
  • Make sure your kiddo knows not to ‘give a ride’ to someone else or be a passenger themselves on an e-bike.
  • Encourage protective clothing like close-toed shoes, long sleeves and pants, wrist guards, etc.
  • Do not allow the dangerous practice of modifying an e-bike to increase maximum speed.
  • Help your child learn about basic e-bike maintenance.
  • Make sure your child follows traffic rules for a standard bike if Class 1 or Class 2; there may be stricter rules for Class 3 (check local regulations on-line).
  • Have serious discussions about the responsibility and risks that go along with e-bike use.

Of course, e-bike riding is not essential, and you may feel it is not appropriate for your child given the risks. Knowing we cannot control everything our kids do, particularly as they become teens and beyond, having conversations about the potential dangers of e-bikes will encourage them to make a more informed decision about if and how they might use them. 

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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.

Why Well Child Checks are Important

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From infancy through the teen years, well child visits are important to make sure your child is in overall good health. In the first year, the American Academy of Pediatrics recommends 7 well-child checks; these get less frequent as your child gets older, and for kids 3 years old and up, are just once a year. These visits offer many vital benefits:

  • Tracking your child’s growth (weight, height and for infants, head circumference)
  • Checking development in terms of language, motor skills, social development, and in older kids, pubertal changes. School progress is also covered. Identifying delays means earlier helpful intervention.
  • Talking about nutrition, sleep, stooling, and urination
  • Discussing mental and emotional health
  • Supporting you as you navigate raising your child. Your provider will provide ‘anticipatory guidance’ about upcoming stages and issues such as discipline, behavior, etc.
  • Reviewing and discussing in detail any vaccines needed to protect your child
  • Providing information on important safety issues relevant for your child’s age
  • Completing sports PE paperwork if needed for your child to participate
  • Following up on any chronic health issues
  • Giving your teen some confidential one-on-one time with the provider, helping them form a trusting relationship. This can empower your child to share concerns with the provider as they get older.

You know your child best and are a vital part of the ‘pediatric team’- you, your child, and your provider. Well child visits are your opportunity to share any concerns you might have. Referrals to specialists can be made if further investigation or therapy is indicated. If your child has special needs and sees specialists frequently, well child checks are still important to look at their health holistically.

Even if your child is young, you can help make the visits go smoothly. Talk to them about who they will see at the visit, including the medical assistant/nurse and provider. Explain that they will have their growth and blood pressure checked with a snug cuff on their arm. They may be asked to change into a medical gown and sit on the exam table. The provider will then do the physical exam, explaining what they are doing as they proceed. You can pretend ‘going to the doctor’ at home beforehand, especially made fun and easy if your child has a toy doctor kit.

As a parent, you can prepare for the well child visit by having a list of any health concerns or questions ready. Make sure any relevant paperwork (for example, school evaluations) have been sent to the office or bring them with you. The American Academy of Pediatrics website has a Well Visit planner to help make the most of these important check-ups (see below).

Resource:  www.wellvisitplanner.org

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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.

Seasonal Affective Disorder in Kids

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The dark and grey days of winter can affect anyone’s mood. If the down feelings are frequent and last more than 2 weeks, this may be Seasonal Affective Disorder (SAD), a type of depression related to the shorter and darker days of fall and winter. While most common in teens and adults, SAD may also occur in children.

Decreased sunlight can cause the brain to make less of the chemical serotonin which helps to regulate mood. The increased darkness can result in excessive production by the brain of melatonin which helps to regulate sleep.  The result is feeling down, sluggish, and tired. Sleep problems may occur, including difficulty falling and staying asleep. This can then result in trouble waking up and oversleeping.

Mood changes such as irritability, negative thinking, and a lack of interest in what used to give pleasure are common with SAD. There may also be less interest in friends, socializing, and going out in general. Decreased appetite or changes in eating patterns are not unusual. If SAD is severe, there can be a deeper depression with thoughts of self-harm.

The ideal treatment for SAD is sunshine and more daylight, which is why it resolves in spring and summer. Until then, getting adequate exercise, especially outside (even in suboptimal weather) is helpful. If there are sunny days, encourage your kiddo to get out and enjoy it- better yet, go out together even if you have to bundle up due to cold temperatures.

 It is important to follow a regular schedule for sleep, which means no naps and no screen activities for the hour before bed. Even on the weekend, limit ‘sleeping in’ to no more than an extra hour or two because it can throw off the sleep schedule. If your child is struggling due to SAD, listen to how they are feeling, show support, and brainstorm together things that night help.

A UV light box (also called a sun lamp) is often recommended for SAD as it mimics natural sunlight and gives the brain better cues for healthy serotonin and melatonin production. Studies show that light boxes are effective if they provide 10,000 lux (‘light power’) and are used for at least 30 minutes each morning.  They are considered safe though it is important not to look directly at the light.  Check with your child’s provider to make sure light therapy is appropriate for your kiddo.

If symptoms are not improving despite the above suggestions, or last into spring and summer, your child’s provider should be consulted. If at any time your child has severe depression or thoughts of self-harm, seek care immediately.

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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.

Why Volunteering is Important for Your Child

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Encouraging your child to volunteer is a great way to help them think of others. Depending on the activity, kids as young as 2 years old can be involved, and starting young helps instill a service attitude that your child will carry forward throughout their life. The benefits of volunteering are many, not only to those receiving help or support, but for your child and your family.

  • Volunteering teaches caring, empathy, and selflessness. It raises awareness of those who are in need and teaches that even small acts of compassion are valuable.
  • Helping others increases self-esteem, as your child realizes their ability to make a difference on a personal level.
  • School performance and attendance are improved in kids who volunteer according to multiple research studies.
  • Some volunteer opportunities may provide information about possible careers in medicine, politics, conservation, etc. and listing volunteer involvement is helpful on a resume or college application.
  • Physical and emotional well-being are increased by volunteering, as are social skills especially if the activity involves working as a team. Group activities provide the opportunity to meet people of different ages and backgrounds.
  • In the wake of a tragedy or natural disaster, having the opportunity to help, for example by having a food drive, makes kids feel less powerless and overwhelmed.
  • Volunteering as a family connects kids and parents with a common compassionate goal.

There are lots of ways children of all ages can volunteer. Your local chamber of commerce or downtown association typically has a calendar listing about volunteering opportunities. Food banks often need helpers as well as food donations. Schools and houses of worship are good sources for more options. Look online for organizations that send letters to veterans, deployed troops, first responders, etc.; they love to have cards and notes written by kids to distribute. Think (very) local and see if there is a neighbor who needs help with raking leaves or maybe would appreciate a visit from you and your child. As a reminder, younger children should always be accompanied by an adult for one-on-one situations.

Volunteering helps us feel capable and connected, and yet only 25% of Americans volunteer annually. Coming up is more incentive to get involved– Friday, December 5 is International Volunteer Day. Knowing the benefits, start early making volunteering part of your family’s ‘brand’. You may well inspire others to do the same and we will all be the better for it.

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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.

Leading the Way in Rural Emergency Care

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Kittitas Valley Healthcare’s own Cody Staub, RN, CEN, has been named one of the Emergency Nurses Association’s 20 Under 40 honorees for 2025. Growing up in rural Idaho gave Cody a deep appreciation for the challenges small hospitals face and the importance of teamwork in overcoming them. As KVH’s director of emergency services, he’s helped connect healthcare organizations across the region to share training, strengthen emergency preparedness, and expand access to quality care close to home. Whether mentoring new nurses or leading community safety programs, Cody’s work reflects his belief that exceptional care shouldn’t depend on your zip code.

What I really enjoy is being able to tell people they can
come to a rural hospital and still receive great care, so that
they can feel better about living their lives,” – Cody Staub, RN, CEN

The 20 Under 40 program recognizes up-and-coming emergency nurses under 40, born after 1984, who are ENA members. Read the full October 2025 Newsletter HERE.

The Importance of a High Fiber Diet for Kids

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Kids have an increasingly processed diet, which contributes to higher risk of obesity and Type 2 diabetes, as well as overall poor nutrition. There is another concern: inadequate dietary fiber. Fiber is very important for kids’ health and may play a role in decreasing colorectal cancer in young people, which although still uncommon, has alarmingly tripled in 15-19 year olds in the last 20 years. A high fiber diet is associated with a lower rate of all cancers, so starting this habit in childhood can pay off in the long run.

There are 2 types of fiber: soluble and insoluble. Soluble fiber dissolves in water, binds to fats and lowers cholesterol, thereby helping to prevent heart disease.  The beneficial  bacteria in the gut feed on the soluble fiber, increasing the health of the microbiome (microorganisms in the intestinal tract). By controlling the blood sugar, soluble fiber also decreases the risk of Type 2 diabetes. Since soluble fiber causes a feeling of fullness, it helps regulate the appetite and assists with weight control.

Insoluble fiber does not dissolve in water. It softens stool, helping keep bowel movements soft and waste going through the intestinal tract. By preventing constipation, insoluble fiber also decreases the risk of hemorrhoids and diverticulitis.

Getting fiber through a healthy diet is better than relying on fiber supplements. Healthy fiber-containing foods also have other nutrients and vitamins that a fiber supplement does not. Good sources include fruits, vegetables, nuts, lentils, beans, and whole grains. Avoid peeling fruit if possible (except for oranges, etc.) and serve the whole fruit instead of juice which has no fiber but is high in sugar. Avoid processed foods which usually have little fiber.

Include a fruit and/or veggie at each meal and emphasize fiber-containing snacks such as nuts, dried fruits, and carrot/celery sticks. Not all whole grain foods contain adequate fiber, so do look at nutrition labels, aiming for at least 3 grams of fiber per serving.  Popcorn (ideally without butter) has 6 grams of fiber per serving so is fine as an occasional snack.

To estimate how much fiber your child should have daily, add 5-10 to their age. As an example, a 5-year-old should take in 10-15 grams of fiber per day. For comparison, an adult should have about 25-30 grams daily. Go slowly as you increase the fiber, otherwise bloating and discomfort may occur. If your child is old enough, you can look up recipes together using beans, lentils, and other high fiber foods and then have fun cooking up healthy meals. The whole family should make this change to a healthier high fiber diet together, with parents, as aways, leading by example.

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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.