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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

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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.

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.

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

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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.

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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.

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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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.

How to Help Your Child Make Friends

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Contributor Dr. Elise Herman

As kids head back to school, it is easy to focus on the academics, but the social side of school, including friendships, is very important to a child’s development and overall success. You can help your child with the skills of making friends, keeping friends, and being a good friend, all vital to building social connections at school and beyond.

As the parent, you can be a good role model. Be friendly and social when you are out and about (and put away the phone, of course). Make conversation and express curiosity when interacting with others. At home, encourage conversation at the dinner table, taking turns asking and answering questions (again, no phones around). Having family game night or doing chores together teaches kids how to interact within a group. Let your child know that bragging and teasing will push other kids away.

Some kids need help reading others’ facial expressions; this is a skill that you can teach your child and practice at home. Active listening makes the other person feel heard and can be achieved with eye contact and verbal affirmations such as “uh-huh”, “yes”, and “tell me more”. Kids should also take turns speaking and let someone finish before jumping in and interrupting.  Role playing with your child for greetings, introductions, and conversation can help them feel more confident in social situations.

Bonding over a common interest or activity happens naturally, so encourage participation in clubs, sports, and other groups.  Arranging a playdate at a park or some other ‘neutral’ location is a great way for kids to build relationships. If there is a fellow student your child has mentioned positively, you may be able to reach out to their parent at school drop-off or a school event and discuss a get-together.

Help your child work on emotional regulation so interactions with other kids are positive and without anger or tantrums. Communicating calmly about feelings and stepping away briefly if upset are helpful strategies. Remind your kiddo to ‘let little things go’ and avoid being petty. Explain that annoying behaviors such as poking, imitating, and not respecting personal space can be very off-putting.

It is said that the best way to have a friend is to be one. Ask your child what they would want in a friend—and have them brainstorm how they can be that special person for someone else. Be positive about their efforts to master the important social skills needed to create friendships; this comes easier to some kids more than others. If your child is really struggling in this area, you may want to speak with your child’s health care provider or counselor.

more about The contributor

Dr. Elise Herman

headshot of 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.