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Reach Out and Read

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Contributor: Dr. Elise Herman

The pandemic has affected so many things for our children, including their education. Despite incredible efforts by devoted teachers and school staff, progress in reading has suffered significantly, with many more students at risk of not learning to read than prior to the pandemic. Kids who do not learn to read in elementary school are at greater risk of dropping out, earning less, and getting in trouble with the law.

A valuable community resource for helping children become good readers may surprise you—it’s your child’s healthcare clinic. The national literacy program for children, Reach Out and Read, has been at Community Health of Central Washington for about 10 years and started at Kittitas Valley Healthcare pediatric and family medicine clinics this month. Reach Out and Read (ROR) was founded in 1989 by a group of pediatricians and educators. It promotes reading by giving out free books at every well child visit from age 6 months through 5 years, and is the only children’s literacy program endorsed by the American Academy of Pediatrics.

The books chosen are age appropriate and culturally sensitive to be ideal for each child. At the well child check, the provider shows the book to the child, perhaps modeling for the parents how to engage with their child through reading, while encouraging the child to handle and explore the book. This is typically an extremely positive part of the visit for all!

The effects of reading together with kids early and consistently are impressive. This activity and the extra love and attention that go along with it help promote brain development, especially important in the first three years of life. Children who are read to tend to develop better recognition of letters and sounds, have a bigger vocabulary, and become better listeners. The connection between parent and child while reading is also reassuring and soothing.

Research has shown that kids who are part of Reach Out and Read show better language scores (both speaking and listening) and their language development continues to improve with ongoing involvement with the program. ROR parents are twice as likely to read to their kids at least 3 times a week, and report increased enjoyment with reading together.

Here are a few tips to best encourage reading in your home:
  • Read together daily, especially at bedtime
  • Encourage your child to hold the book and turn the pages
  • You don’t have to read the words exactly, especially to young children; you can just talk about the pictures
  • Encourage your child to point to things in the book and ask your child questions Simple books, with rhyming and repetition, are perfect for young kids
  • Bilingual books and books about people from different cultures build empathy and understanding of others
  • Be a good role model and regularly read yourself, ideally using traditional books as opposed to an electronic device
Early Literacy Resources in Spanish

more about The contributor

Dr. Elise Herman

Blog Posts
Provider 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 retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Encouraging Healthy Eating Habits for Your Child

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Contributor: Dr. Elise Herman

As parents, we want our children to eat well. Yet all we can do is set the stage for healthy eating; it is up to the child in terms of how much and exactly what they eat from the food offered. Here are some guidelines that help kids develop healthy eating habits; starting early with these habits can help prevent childhood obesity, diabetes, and other problems.

Have family meals

Eating together encourages conversation, connection, and healthier food choices and portion sizes. Research has shown that teens who have regular family dinners have lower rates of depression, substance abuse, eating disorders, and obesity. And remember– no TV or electronic devices at the table for kids and adults alike.

Avoid struggles around food

Toddlers tend to be picky, and preschoolers often have a decreased appetite. It is better to look at their intake over a week as opposed to pressuring your child to ‘clean their plate’ or eat what is served at any one meal. Children actually eat less overall if they are coaxed to eat, and mealtime is not much fun. Trust your child to eat what they need to stay healthy. 

Go by “MyPlate.gov”

This is the government’s recommendation for healthy eating that has replaced the Food Pyramid (more information at MyPlate.gov). Half of the ‘plate’ should be fruits and veggies (with slightly more veggies than fruit), the other half should be split between grains and protein. Half the grains should be whole grains like oatmeal, whole wheat bread and brown rice. Protein may include non-meat sources such as beans, lentils, plain yogurt, and tofu. Turkey, chicken, and lean ground beef are appropriate choices if your family eats meat, though meat is not needed every day. 

Kids Activity Downloads / Fun Word Search Crossword Puzzle

Offer appropriate portion sizes

Portion sizes that are too large encourage overeating. An easy way to judge is to compare portions to the size of your child’s hand (this conveniently works as your child grows). Fruits, veggies, cereal, and rice servings should be about the size of a closed fist. Meat portions should be the size of the palm and added fats such as butter and mayonnaise should be about the size of the tip of the thumb. If kids want seconds, make it salad or veggies. 

Don’t forget the beverages

Water should be your child’s mainstay. From age 1-2 years, whole milk is recommended (unless your child is still breastfeeding) and thereafter choose low fat milk. 16-24 ounces is a good daily maximum. After age 2 years, 2-2 ½ cups of dairy (be it milk, cheese, yogurt, etc.) is recommended. Drinking milk excessively may decrease the appetite for healthy solids and interfere with iron absorption which can lead to severe iron deficiency. Remember to stop bottles by age 1 year and to limit juice (if any) to a max of 4 ounces a day. It is much better to eat a fruit (with its healthy fiber) than to drink juice which contains as much sugar as soda. No sugar-sweetened drinks should be given on a regular basis (this includes chocolate milk).

Be smart about snacks

Avoid chips and processed snack foods and instead choose healthy snacks such as fruits, veggies, peanut butter, and plain yogurt. Adding a bit of honey or jam to plain yogurt is better than fruited yogurts which are high in sugar. Canned fruit is fine but choose “no sugar added” types.

Be a good role model

Talk about enjoying nourishing yourself with healthy food. Don’t discuss any food struggles you may have (dieting, poor body image, etc.). Model the idea of stopping eating when you are satisfied and full. Limiting fast food and processed food is important, but still OK to enjoy occasionally. 

Get your child involved

Kids love to help and can do so by looking at recipes, setting the table, assisting with cooking when age appropriate, and learning to pick healthy foods at the grocery store. This may translate to more enthusiasm at the dinner table as well as good training for when they are older and more independent.

more about the contributor

Dr. Elise Herman

Blog Posts
Provider 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 retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

COVID-19 and Children- Infection and Vaccines

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Contributor: Dr. Elise Herman, KVH Pediatrics

Parents know too well what “pandemic fatigue” is. They are tired of it all- the masking, the distancing, the quarantining, the disruption of life, and the loss of a “normal childhood” for their kids. But this is a critical time in the COVID-19 pandemic as the Omicron variant surges; Omicron is certainly targeting the unvaccinated, and many of those are children.

The number of daily cases of COVID-19 in the US is over 900,000 as of January 7, 2022. 17% of these are children and most concerning is the huge jump in pediatric hospitalizations. There recently has been a 50% increase in COVID hospitalizations for kids under age 5, the biggest increase since the pandemic started. Over 82,000 kids have been hospitalized with COVID thus far, and there is now a new record for hospitalizations of kids under age 18 years- almost 800 daily. Some of these are as young as 2 months old.

Pediatric hospitals are feeling the strain, including Seattle Children’s Hospital, according to staff pediatric infectious disease specialist Dr. Danielle Zerr. Dr. Zerr noted in a recent New York Times article that the number of young children in Seattle Children’s Hospital with COVID is much higher than with previous Delta surges. Some of these very sick children have risk factors such as asthma or obesity, but many were previously healthy children without underlying problems.

Omicron seems to cause milder disease overall but can cause severe illness and is much more transmissible than the Delta variant. With so many more people getting infected, even if a smaller percentage get very sick, the total number of those who get severely ill will be very large. The unvaccinated are most at risk, and of course this includes kids under 5 years since they are not eligible for the vaccine yet. A parent’s best strategy to protect their child is straightforward: vaccinate if eligible, avoid crowded spaces (especially inside), continue masking and social distancing. Additionally, make sure all the older kids and adults in their family are vaccinated.

Those who are vaccinated can still get COVID, especially with the Omicron variant, but they are less likely to get a severe illness, and less likely to be hospitalized. If kids are fully vaccinated and exposed at school, they do not need to quarantine. Those who are vaccinated are less likely to transmit the virus, helping to keep their family healthy and their school open.

As of December 5, 2021, almost 4.8 million US kids ages 5-11 had received at least one COVID vaccine dose. There have been no cases of heart inflammation (myocarditis) in this age group which was noted to be a very rare side effect of the vaccine in young adult and adolescent males previously. It is important to remember that COVID infection itself is much more likely to cause heart problems in this age group than would the vaccine. We have had enough experience now to know the vaccine is safe and effective.

Can we imagine a time when there is ‘background’ COVID, like influenza, but not huge surges that overwhelm our healthcare systems, shutter schools and businesses, and disrupt our lives? That is the “learning to live with the virus” scenario that may be our future. To get there we need to have many more people vaccinated (including our children) to minimize the rise of new variants. Increased access to testing and better therapies to fight COVID infection will also be important. We all really do have the opportunity to help move us along towards that goal, and towards a better future for our children.

more about the contributor

Dr. Elise Herman

Blog Posts
Provider 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 retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

MIS-C Awareness Week

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A rare and severe condition associated with Covid-19 is MIS-C (Multisystem inflammatory syndrome in children). This condition can cause “different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. We do not yet know what causes MIS-C. However, we know that many children with MIS-C had the virus that causes COVID-19, or had been around someone with COVID-19. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care.”

– CDC (Español)

For more information about this syndrome and to help bring awareness please follow the FB event and share!

What to do if you think your child is sick with MIS-C

Contact your child’s doctor, nurse, or clinic right away if your child is showing symptoms of MIS-C:

Ongoing fever PLUS more than one of the following:

  • Stomach pain
  • Bloodshot eyes
  • Diarrhea
  • Dizziness or lightheadedness (signs of low blood pressure)
  • Skin rash
  • Vomiting

Be aware that not all children will have all the same symptoms.

How to Recognize: Multisystem Inflammatory Syndrome in Children (MIS-C)
MISC_symptomsDownload
MISC_symptoms_spanishDownload

CDC Data

Find More Here: CDC Covid Data Tracker

MIS-C Patients By Age Group
MIS-C Patients by Race & Ethnicity
MIS-C Patients By Sex
Reported MIS-C Case Ranges by Jurisdiction, on or before Nov 30, 2021

References & Resources

Covid-19: Pediatric Insights

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medical providers that the family and the child trust can be an invaluable source of information and a big part of the decision making – Dr. Elise Herman

The AHA, American Academy of Pediatrics and Children’s Hospital Association host this panel discussion on how pediatricians and hospitals can work with parents to build trust in the safety and efficacy of the COVID-19 vaccine for children.

American Hospital Association

Insights from pediatric health care leaders on COVID-19 vaccines for children

Earlier this week Dr. Elise Herman, KVH Pediatrics, joined other pediatric health care leaders for a panel discussion hosted by the American Hospital Association (AHA), American Academy of Pediatrics and Children’s Hospital Association.

To learn more visit www.aha.org/vaccineconfidence

Resources mentioned by Dr. Elise Herman:
Speakers:
  • Yvonne (Bonnie) Maldonado, M.D., Chief, Division of Pediatric Infectious Diseases, Stanford University School of Medicine
  • Lee A. Savio Beers, M.D., FAAP, Professor of Pediatrics and the Medical Director for Community Health and Advocacy at Children’s National Hospital, President of the American Academy of Pediatrics
  • Elise J. Herman, M.D., Pediatrician, Kittitas Valley Healthcare-Ellensburg, Washington
  • Andrew Pavia, M.D., Chief, Division of Pediatric Infectious Diseases, Primary Children’s Hospital
  • Moderator: Roxie Cannon Wells, M.D., President, Cape Fear Valley Hoke Healthcare, and AHA Trustee

Tick bites in children

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Contributor: Dr. Elise Herman, MD, KVH Pediatrics

Ahhh, summer! As that much anticipated warmer weather comes, it brings with it the risk of tick bites and the diseases they can cause. Knowing how to prevent tick bites, what to watch for if your child is bitten and how to remove ticks can make us feel more ready for outdoor adventures with our kids.

Ticks have 8 legs, flat oval bodies, and vary in size from the tiny deer tick (size of a poppy seed) to the wood/dog tick (size of an apple seed). They can swell to two or three times their usual size when they have had a blood meal. After sucking blood for 3-6 days, ticks fall off on their own, often leaving a small red bump. As it feeds on the blood, some of the tick’s spit gets transmitted to the host’s body and can cause infection. Ticks must be attached for at least 36 hours to spread infection.

Washington has fewer tick-borne diseases compared to other parts of the country, but we do have cases of Lyme Disease, babesiosis, tick paralysis, and tularemia. Lyme Disease is the most common tick-borne disease in our state and the US. It is most prevalent in the Northeast, mid-Atlantic, upper Midwest, and to a lesser extent on the West Coast. It is spread by the very small deer tick. 80% of Lyme Disease starts as a circular or oval red bull’s eye rash called erythema migrans at the tick bite location within 3-30 days of a bite. It can expand to up to 12 inches and lasts 2-3 weeks. Other signs of early Lyme Disease are fever, body aches, headache, chills, and neck stiffness. If Lyme disease is diagnosed early and treated with antibiotics, progressing to later stages of the disease is very unlikely. The later stages can involve bull’s eye rashes elsewhere on the body, joint pain, temporary facial paralysis, and limb weakness.

There are steps you can take to help prevent tick bites. Avoid dense, grassy or wooded areas, and stay to the center of the trail. Ideally, everyone should wear hats, light colored clothing, long sleeves, and long pants tucked into socks. You can spray permethrin on clothing (not the skin) to decrease tick attachment. Insect repellent containing 20-30% DEET is safe for children but you should minimize its use on very young children and infants. Do not use products that combine DEET and sunscreen since sunscreen needs to be applied more frequently than DEET. Do not apply DEET to the hands of young kids or near their eyes or mouth.

Do a tick check of your child right after being outdoors where there might have been tick exposure. Look at the clothing first, then the skin and scalp. Don’t forget behind the ears, in the armpits and groin area. Showering may help prevent attachment. If you do find a tick, use tweezers to grasp it close to the skin; pull gently and slowly to remove. Try not to crush it when doing this and wash the area well afterwards.

It is important to remember that the chance of a tick bite causing any disease is extremely low. Only 2% of deer tick bites will cause Lyme Disease even in high-risk areas and here in Washington state we are at low risk of any tick disease. So, wherever your outdoor adventures take you and your kids this summer, a bit of planning to prevent tick bites and knowing how to handle them if they happen will help you to all enjoy those long summer days!

Talking about racism to children

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Contributor: Dr. Elise Herman, KVH Pediatrics

Racism is front and center now, and parents may wonder how to have important conversations with their child about diversity, equality, and discrimination. It helps to keep your discussion age-appropriate, share your feelings and listen to your child.

Under age 5 years – Studies have revealed that even infants notice different skin tones and preschool kids have been shown to view those who look like themselves more positively, so addressing racism early is important. Kids relate easily to the concept of fairness so it can simply be explained as treating someone unfairly based on how they look. Young kids may ask about why people’s skin colors are different. Explain simply that darker skin has more of the pigment melanin in it and that no skin color is ‘better’ than another. Celebrate human diversity by noting that “we are all human but can have lots of differences, too, making everyone special!”. Encourage your young child’s appreciation for diversity by reading books and playing with toys featuring people of different races.

6-11 years old – At this age, children are more aware of current events based on what they have heard and seen from adults, other kids and on the news or in social media. Ask your child about what they know and what questions they have. Kids this age understand empathy so discussing how it would feel to be judged unfairly can be helpful. Children of all ethnicities can be assured that people world-wide are upset about racism and are working to make things better.

12 and older – Kids this age are often very informed and have developed their own opinions about issues such as racism and protests. Discussing the news and current events and how it affects them opens the door to a deeper conversation. The same concepts of fairness and empathy apply, but now taking action may be a logical next step. It may be sharing something on social media, reading more about the history of oppressed peoples or attending an event.

All kids benefit from social experiences with a variety of people. Cooking food and listening to music of different cultures broadens our horizons. It is alright to let your child know that you are upset or sad about what is happening, but you also need to assure your child that they are safe in what can be a frightening time. This conversation will look different for families of color where the issue hits a lot closer to home than for whites.

As always, what we do and say speaks volumes to our children. It is vital that as parents we confront our own prejudices and biases and work to be more open and understanding. Let your kids see you speaking out against racism, embracing diversity and calling for justice for all people.

Traditional vs. Electronic Books and Your Child

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Contributor: Dr. Elise Herman, KVH Pediatrics

Simply put, reading to your child daily is one of the best things you can do as a parent. But does it need to be a traditional (paper) book or is an electronic book pretty much the same experience for your child? There have been studies that suggest reading a traditional book does have some advantages.

The Journal of the American Medical Association published a study in September 2019 that showed fewer ‘back and forth’ interactions between parents and toddlers when using an electronic tablet. This type of interplay is important as it builds connections in the brain and helps develop communication and social skills in children.

A recent study from the University of Michigan found that parents and kids interact more when reading a paper book and that communicating this way helped encourage healthy child development. Parents often asked how the story related to the child’s experiences or about the story and its characters. They also posed more open-ended questions, such as asking what the child liked about the story, which created more opportunities for a conversation between the two.

When parents and children are reading from a device, be it a table, computer or smart phone, interactions tend to be more focused on the technology itself. Comments about the device, instructions to not push buttons, how to set the volume if applicable, etc., can dominate the conversation. There has been research showing that “enhanced” digital books that have sound and animation can be distracting and therefore children do not remember the content as well.

So how best to read with your child? Although there seem to be real advantages to traditional books, reading from electronic books is still fine in addition to paper books. Here are some tips to make reading to your child the best experience:

– Read daily including at bedtime – and try not to rush
– Let your child choose the book at least some of the time (going to the library together also builds excitement for reading)
– Let your child hold the book and turn the pages
– Avoid electronic books that are “enhanced” with sound and animation
– During reading, ask questions about the story (“What do you think will happen next?”) and relate the story to your child’s life (“Remember when we went to the park and played like that?”)
– Encourage your child to point to things in the book (“Where is the rainbow?”)
– Read books with simple rhymes and repetition; your child will be more likely to ‘read’ along with you
– Make it fun! Silly voices and acting out the story makes reading very engaging to kids of all ages
– It is also good to encourage your child to look at books independently regardless of whether they can actually read yet

Be a good role model to your child, and read a lot at home. Since we don’t want our kids to see us always looking at electronic devices or a computer, make it a habit to read from traditional books, magazines and newspapers. And remember that whether it is a traditional book or at times an electronic book, it is wonderful that you are sharing reading with your child. Well done, Mom and Dad!

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Positional Plagiocephaly Prevention and Treatment

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“‘Tummy time’ while awake should start right away…”

Contributor: Dr. Elise Herman, KVH Pediatrics

When your infant is seen for a Well Child Exam, checking growth and development are the top concerns. Additionally, careful attention should be paid to your young child’s head shape. We are now in the middle of an ‘epidemic’ of head flattening, medically known as positional plagiocephaly, meaning a change in head shape due to positioning of the baby. Typically this is flattening of either side of the back of the head or symmetric flattening of the entire back of the head. This is not just a cosmetic concern as significant health issues can result from the altered head shape.

The flattening that can develop is related to a baby’s skull being relatively soft until about age 5-6 months. Babies spend a lot of time on their backs between sleeping (the recommended sleep position is on their back to decrease the risk of SIDS) and while awake until they are old enough to be rolling, sitting up,etc. If the head is turned to one side when sleeping (for example if the baby is turning to look towards a parent), this can result in localized flattening of one side of the back of the head. With this flattening on one side, it is then harder for the baby to turn their head to the opposite side. Over time the neck muscle on the flatter side can become tighter and shorter, causing the neck to stay in a twisted position (this is called torticollis). This may affect the shape of the face with jaw asymmetry and other changes. In some cases it can be related to problems with development if left untreated.

It is important to be pro-active to minimize the risk of infant head flattening. Your baby should absolutely sleep on their back, but otherwise should be up and off the back of their head a lot. ‘Tummy time’ while awake should start right away and not only helps head shape but increases the strength in your baby’s neck, chest and arms. Options for tummy time include having baby lay with their face/ chest on your chest or baby laying down over your lap. You can also have baby lay on the floor with a rolled small blanket to prop up their chest only until they are strong enough to push up on their arms. Begin with 5-10 minutes 3 times a day with a goal of about 60-90 minutes total a day by age 4 months. Babies often don’t like tummy time at first (it’s a lot of work for your little one!) but it gets easier as they get stronger.

If a baby has flattening on one side of the head, the baby can be laid down to sleep alternating their head in opposite ends of their crib or bassinet each night. This means they will have to turn their head the opposite way to continue to look at their parent and can improve head shape. Parents should alternate which arm they hold the baby in for feeding as well. Upright chairs like the Bumbo for babies not sitting yet are recommended at age 3-4 months. Front packs also help your baby be upright during the day.

If a baby has significant head turning with neck twisting (torticollis), physical therapy is usually started and can be very helpful to restore normal movement of the neck. If by 4-5 months there is significant flattening despite increasing tummy time, etc., a referral may be made for helmet therapy. Wearing a custom soft helmet with a foam liner that is adjusted over time, the head shape becomes more rounded. Helmet therapy is most effective between 4 and 12 months of age, and babies usually accept the wearing of the helmet very well. Most babies are treated with helmet therapy for 1-4 months.

Having some degree of head flattening even with lots of tummy time and upright positioning is fairly common and is not a problem if it is mild. Talk with your health care provider if you have concerns about your baby’s head shape; they can help determine if any specific treatment is needed.

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Play time for children

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KVH Contributor*
Elise Herman
Dr. Elise Herman
KVH Pediatrics

Play time for children

As a pediatrician, I often tell parents that with the exception of books (which are free from the library), they have everything they need within them to raise a happy and healthy child. Reading to your child, getting outside, and playing cost nothing, are technology – free, fun and easy.

Play in particular is generating a lot of interest right now; it has been shown to promote brain development as well as social and emotional well-being. ‘Unstructured’ play (no adult control or directing) allows kids to explore their world, try on different roles and work through their fears. Kids learn how to interact in groups, lead and share, and resolve conflicts, thereby developing vital positive behavioral skills. This type of play encourages creativity and experimentation. It also helps kids work on their “executive function” which is important with decision making and controlling impulsivity. There is evidence that neural pathways in kids’ brains are enhanced through the skills that develop with unstructured play.

Of course the physical benefits of playing including running, jumping, throwing, climbing, etc., are obvious. Playing outside offers even more benefits. Kids tend to burn more calories playing outside than inside, important in our current fight against childhood obesity. Fresh air and contact with nature are helpful in reducing stress levels. Research has shown that kids who play outdoors regularly tend to stick with tasks longer, be more curious and self-directed.

Quite simply, then, play is crucial to child development and learning. Unfortunately, play is threatened on a variety of fronts. There is increasing pressure on children (even kindergartners) to perform academically, and school days can be packed with ‘orderly activities’ with less time for unstructured and especially outdoor play. Many school districts have decreased the amount of recess time as well as PE. The draw of passive entertainment (TV, computer, you tube, video games) is such that the American kids age 5 to 16 spend an average of 6 ½ hours a day in front of a screen, much of it on personal devices such as tablets and smart phones. These personal devices mean kids are usually by themselves without parental involvement—not ideal. Unstructured play is getting squeezed out by this, and our children are the worse for it.

In general, children seem to have a lot more scheduled activities in their increasingly busy days, leaving less time for unstructured play. Between sports, music, etc. parents often feel they hardly have enough time to meet for dinner with their children (but please make time for those family meals!). So how to make time for this important activity? Something may have to give for your child to have the recommended minimum 60 minutes a day of unstructured play, but keep in mind that the benefits of this type of play are many and long lasting. And although unstructured play means you won’t be directing the play, you can still be involved – just let your child lead. Good for everyone!

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.