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The Importance of Good Sleep for Teens

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The teen years are a time of tremendous physical growth, emotional changes, and vital brain development. Teens need 8-10 hours of sleep nightly to support this, but often fall short for multiple reasons. There are stressors like social challenges and academic pressure.  Many teens are juggling school, sports and extracurricular activities, and perhaps a job. Teens’ circadian rhythm (the internal 24-hour cycle) shifts to about 2 hours later, which can make it hard to fall asleep before 11 PM, and then difficult to get up early for school. No wonder they’re tired!

Less than 20% of teens get the recommended amount of ‘good’ sleep (meaning uninterrupted and refreshing sleep) consistently. Up to 40% of teens report daytime sleepiness and falling asleep without intending to- be it during history class or while driving. Especially relevant for young drivers, teens who get less than 8 hours of sleep nightly are at considerably higher risk of crashing.

Tired Teenager Resting

Smartphones interfere with sleep in many ways. Many teens text and are on their phones throughout the night. Ideally, phones are out of the bedroom at night, but if this seems unrealistic, putting the phone in “Do Not Disturb” mode and silencing it helps. Avoiding screens in general and phones in particular for the hour before bedtime is known to improve sleep. Smartphone social media apps can increase anxiety and depression which can interfere with falling asleep and staying asleep. 

Recent research published by the National Sleep Foundation showed that adequate sleep for teens is important for mental health, focus, resilience, cognition, and school performance. Sleep habits as teens can have far-reaching effects on later life including cardiovascular health and risk of chronic disease.

Suggest the following steps to your teen in order to improve their sleep and decrease their level of fatigue: 

  • Light: Open curtains or shades first thing in the morning which will help with feeling more alert and awake. Getting outside in natural light is even better. 
  • Routine: Have a consistent bedtime routine, “powering off” devices including phones for the hour before bed. Instead, try a calming activity like reading or meditation. The bedroom should be quiet and dark. Resist the temptation to ‘sleep in’ on weekends, or at least not more than 2 hours later than the weekday wake-up time. Napping interferes with nighttime sleep, but if occasionally unavoidable, limit naps to 30 minutes.
  • Exercise: Being active during the day promotes deep nighttime sleep, whether it’s organized sports or just walking, doing yoga, etc. Keep exercise light right before bed.
  • Nutrition: Regular meals with good nutrition are important to sleep as well as overall health. Avoid caffeine in the late afternoon and evening, and don’t eat late at night. 

If your teen’s sleep is not improving with the above suggestions, or there if is a concern of depression, illness, or ongoing fatigue, reach out to their health care provider. 

Resource

Teen Sleep Toolkit: https://www.thensf.org/teen-sleep-toolkit/

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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.

Motion Sickness in Children

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Summer is often a time of travel, and for some kids that may mean motion sickness related to being in a car, boat, or plane. Motion sickness can also be caused by amusement park rides that cause spinning or rapid up and down movements like a roller coaster.

Motion sickness occurs because the body, eyes, and inner ears are getting conflicting signals about movement. In a car, for example, if a child is sitting too low to see out of a window, their inner ears sense movement, but their eyes don’t get the same information. This triggers symptoms including nausea, vomiting, and dizziness. Children may also complain of a headache. Younger pre-verbal kids often cry or may appear restless and uncomfortable.

kids in airport

Motion sickness is common, occurring in about 25% of people. It often begins in childhood and can run in families. If a parent has motion sickness, a child has a 50% chance of developing it as well. Motion sickness in childhood may be related to having migraines later. 

There are steps you can take to help your child if they have had motion sickness:

·      Before travel, offer a light snack.

·      Have an airsickness bag or large Ziploc with you- just in case! Usually kids vomit just once with motion sickness.

·      Encourage your child to look outside of the car, ideally at the horizon; they should avoid reading, playing video games, or looking at a screen. 

·      If your child is over age 12 years old, they should sit up front. If they are in the back, the middle seat will allow them to look out the front window of the car.

·      On a plane, have your child sit next to the front part of the wing if possible.

·      On a boat, your child should be near the middle and focus on the horizon.

·      Keep a car window cracked for fresh air.

·      If there are symptoms while in the car, allow your kiddo to take a break if possible and go with them for a short walk.

·      Encourage your child to close their eyes and rest or sleep during the ride.

·      Try to distract your child with music or a story.

·      Lying down with a cool cloth placed on the forehead may be helpful.

If motion sickness is a significant problem, talk with your child’s health care provider about medication taken before travel. Over-the-counter antihistamines (like Dramamine or Benadryl) can help for kids over 2 years of age. Interestingly, it is the antihistamines which cause drowsiness that help, so your child may have grogginess as a side effect. Motion sickness typically resolves within 4 hours of the motion stopping. If your child’s symptoms last more than 8 hours or they appear more ill, call your child’s provider.

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Dr. Elise Herman

headshot of 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.

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.

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

headshot of Dr. Elise Herman
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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.

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

headshot of 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.

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.

toddler looking into drawer

  • 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

headshot of 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.

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

headshot of Dr. Elise Herman
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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.

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

headshot of 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.

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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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.

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.

more about The contributor

Dr. Elise Herman

headshot of 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.