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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.

Sore Throats in Kids

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As we move into fall, viruses and bacteria begin to circulate. Kids often complain of a sore throat this time of year, which is usually caused by a virus. Viral sore throat occurs with typical cold symptoms including runny nose, congestion, cough, low grade fever, and hoarseness. Because this is due to a virus, antibiotics do not help, but the illness typically resolves on its own in about a week. Home care includes encouraging adequate fluids and Tylenol or Advil if needed for pain and discomfort; dosing depends on your child’s age and weight.

In children the most common bacterial throat infection is due to Group A streptococcus, known simply as “Strep throat”.  This illness comes on quickly and is not accompanied by cold symptoms. Strep throat causes pain with swallowing, redness of the throat, and swollen neck glands. The tonsils, which are located on both sides of the back of the throat, become red and swollen with white pus on them. There may be bright red spots on the back of the roof of the mouth. Headache, nausea and vomiting, abdominal pain, and a sandpaper-like red body rash may also occur.

Strep causes 20-30% of pediatric sore throats. It is most common in kids aged 5-15 years and is very unlikely in those under age 3. Testing is done with a rapid test on a swab from the back of the throat with results are ready in minutes. Sometimes a throat culture is done to confirm a negative result though this takes 1-2 days. If there are ulcerations in the mouth or cold symptoms with a sore throat, strep testing is not usually done since the cause is almost certainly a virus.

Some kids and adults are ‘strep carriers’ meaning they carry a light amount of strep but do not typically get sick with it or spread it to others. Up to 1 out of 5 children are strep carriers. They will have a positive strep test, but do not need treatment. If kids do not have strep signs and symptoms, it is best to not test since you may pick up a carrier state which does not need antibiotics.

Strep throat is treated with antibiotics, usually a 10-day course. It is paramount to finish the antibiotics, even though kids usually feel better within 2 days. The full course of antibiotics shortens the illness and decreases the risk of spreading strep to others. Antibiotics also cut the risk of inflammatory complications after strep throat such as kidney disease and rheumatic heart disease. Kids may return to school and activities after 12-24 hours on antibiotics if they are improving and without fever. Your child should also switch to a new toothbrush after antibiotics are completed.

Home care for strep includes ensuring your child is drinking adequately and getting some nutrition, which may be challenging in view of the throat pain. Cool soft foods like smoothies or popsicles are usually easiest to swallow. Avoid acidic foods like orange juice. Tylenol or Advil are fine for fevers and discomfort but follow age and weight guidelines. Aspirin is not safe for children.

Strep spreads quickly and easily by respiratory droplets when an infected person sneezes or talks and by sharing personal items like cups or water bottles. Since strep can be transmitted for 3 days before someone develops symptoms, it is best to routinely avoid sharing silverware, glasses, etc. Frequent handwashing and avoiding touching one’s eyes, nose and mouth help limit spread of strep and other illnesses- especially important this time of year.

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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.

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.

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

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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.

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

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.

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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.

‘Phubbing’ and Its Effects on Children

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Contributor Dr. Elise Herman

Smartphones are a mixed blessing. As amazing as they are, they take our attention away from what is right in front of us—and that can include our children. The term ‘phubbing’ describes snubbing someone we are with by paying attention to a smartphone, and ‘parental phubbing’ means interacting with a phone instead of one’s child. For kids over age 2, we do not have to be interacting with them constantly, but we do need to be emotionally available if they have a question or need us in some way, and being tethered to the phone impairs this.

When a parent chooses looking at their phone over paying attention to their child, the interaction between them suffers- the parent is less engaged with their child who may at first ask for more attention, but then soon give up. The child may become frustrated and sad and act out. Over time, this pattern of phubbing can lead to poor self-esteem and less confidence with other social interactions. Parental phubbing is also related to increased anxiety and depression in children and adolescents.

Research has shown the negative impact of parental phone use on babies, too, who may become more irritable and behave negatively when their parent ignores them to be on their phone. Studies of maternal phubbing revealed babies showing signs of stress (such as increased heart rate and emotional distress) and less effective learning. We know that simple eye contact between an infant and their parent builds brain development, so it is not surprising that taking this vital connection away can have a negative consequence for the child.

While most parents acknowledge that their cell phone usage gets in the way with interacting with their child, they may feel they ‘need it’ to be in touch with others, to keep track of their calendar, take photos, etc.  The more a parent uses their phone and especially ‘phubs’ their older child, the more that tween or teen will use their own phone similarly. Kids learn that it is OK to not be available and connected to those around them and miss out on how to relate to others emotionally.

So how to avoid parental phubbing? It takes real effort to break this habit, and both parents (and other adults in the child’s world) need to be invested in changing. Some suggestions include:

  • Have phone-free times for the whole family- at meals, at the park, while playing games, when out in nature, etc.
  • Have phone-free zones in the house such as the dining area, your child’s bedroom, and the playroom. If you have something urgent to take care of on your phone, explain this to your child and use it as quickly as possible
  • Disable notifications and put your phone on silent or ‘Do Not Disturb’ if you have it with you when you are with your child. If you forget to do this and hear a ‘ping’, ignore it (and then put it on silent mode)
  • Encourage mindfulness; pay attention and really notice what is in front of you. Even when not directly interacting with your child, make pulling out your phone intentional, ask yourself, “Do I really need to use my phone now?”
  • Work on dealing with boredom or ‘empty time’ (such as waiting in line) without reaching for your phone; you will be less likely to do this as a habit when you are with your child
  • Have a ‘code word’ for your child to let you know if they are feeling ignored by your being on your phone; this can be done in a playful manner and will encourage your child to speak up about phubbing

It is not easy to change our habits with technology, but our time with our kids is fleeting and vital to their social and emotional well-being. Being truly present with our children is one of the most important things we can do as parents. In addition, your child is watching, and you have an opportunity to be a good role model in how you handle your smartphone.

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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.

Helping Your Shy Child

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Contributor Dr. Elise Herman

By nature, some kids are more outgoing than others. Many children are shy and reserved when younger but become less so as they grow up. Being shy, however, just characterizes a child’s approach to the world (especially new situations) and does not have to be seen as a negative. There are felt to be some benefits of this personality trait as these children tend to be more observant and less impulsive. Shy kids may be slower to warm up and more cautious about jumping into a new social situation but given time and the opportunity to be involved when they feel ready, do fine socially.

You can help your child if they fall into the ’shy’ category:

  • Don’t allow people to label your child as ‘shy’ which can make them feel negatively about themselves. You can say something like, “He just sometime needs a little time to observe and warm up”. You can suggest your child give a little wave or smile if they are not ready to talk to someone.
  • Accept your child’s shyness and acknowledge their feelings, but don’t be overprotective. Gently encourage them to try challenging situations such as answering a question in class, ordering an item at a restaurant, or saying ‘hi’ to a child they see on the playground.
  • Create opportunities to practice social skills especially in low-risk settings such as going on playdates, casually getting together at a park with another family, etc.
  • Roleplay certain situations such as meeting new adults and approaching kids at school. It is fine to be near your child if they ‘need’ you, for example when meeting other kids at a playground, but try to let them speak for themselves. If they seem comfortable, you can move away while reassuring your child that you will be nearby.
  • Participation in group activities can build social skills and confidence. Small groups or classes such as scouts, dance, sports, or music give your child a chance to get to know a group that they will see regularly and so become increasingly comfortable.

It is important to separate common shyness from social anxiety disorder, which is more severe, long-term, and interferes with everyday life to a greater degree. Those with this issue worry excessively about social interactions and seek to avoid social situations when possible. This can negatively impact school, friendships, and overall emotional well-being. Talk to your child’s healthcare provider if you think your child may have social anxiety disorder as counseling and other treatments can be very helpful.

But don’t fret if you have a shy child—things will get easier! Accepting your child for who they are and supporting them as they work on social skills will help them gain the confidence they need as they grow.

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.