“What do I say to her?” The broken-hearted question asked by a mom when she learned her daughter’s friend had been one of those killed in a headline-grabbing triple murder/suicide this last Saturday.  As adults, it is hard for us to get our own minds around the idea that a child we know has been killed.  How then, do we begin to explain it to our children?

According to Dr. Dehra Glueck, Clinical Director, Child and Adolescent Psychiatry Center at Washington University School of Medicine, “The goal is to first elicit what the child knows and is worried about – especially with older children that may have different questions and fears”.

Here are some key points to giving children sad news about the death of a friend, and a few extras for this specific tragedy:

This acronym SADD NEWS can help you remember the key points:

• Setting: Prepare to talk to your child by doing some physical things that will allow you to be calm. Find a place that is quiet and neutral, not a bedroom. Pick a time that is quiet and not rushed. Turn off the TV. Pick a time when you won’t be rushing out the door or going right to bed. All of this allows you to be at your best and your child to have time to ask questions while you are together. If the news only impacts one child, make arrangements for the others to be out of the room or, if possible, out of the house to allow your child your full attention.
• Actual and Factual: Keep you explanation short and honest. Misleading or lying to a child leads to confusion later when he may over hear others talking. Talking too much can confuse children.  “I have to talk to you about something very sad. Your friend died last night “.If your child is under 4, explain further: “This means that she is gone forever and not going to come back.”
• Decompress and Decide: Give the child time to think while sitting quietly next to you. Respond to any questions or statements with short answers. Decide what to say based on if the information meets the goal of making your child feel safe and clarifies misunderstandings.

• Encourage your child to talk about her thoughts and feelings if she says nothing after a few minutes. Let her know it is ok to feel sad and  to ask questions: “This makes me very sad. How do you feel? What questions do you have?”
• Limit the amount of information you give.

When discussing more, remember:

1.  Need to know only: talking about how much blood was in a room, or the fact that someone lost an arm in the accident are not important and can frighten the child.
2. Explain what happened in simple terms. He died in a car accident. The fact it occurred at rush hour on Hwy 40, is not important. Keep it brief to allow child to process the information.
3. Wait for additional questions. Encourage your child to talk about questions and feelings as time passes.  If your child doesn’t ask right away how her friend died, it is ok to wait a day or two and then discuss more.
4. Support: Depending on the situation, you may also be dealing with difficult emotions.  Seek out support via friends, family, your physician or credible resources so you can emotionally equipped to support your child.

• What to say when a child was killed by the parent or someone commits suicide:

Her mommy was very sick. Not sick like you sometimes get when you get a runny nose or cough, but sick in her brain that made her think things that were not true. She was so confused that she did something to make Samantha die. This sickness doesn’t happen to many mommies. This is the first mommy I have ever known that got this kind of sick.

• Some examples for differing situations:
  • He died in a car accident. Car accidents are very rare. They don’t happen often. Dad drives slowly, and we all wear seat belts and sit in car seats to stay safe.
  • She died of cancer. Cancer is something that happens to very small numbers of kids. You can’t get cancer from being friends with someone who has cancer. Medicines can help many kids with cancer. Sometimes medicines don’t work, and the child dies. We go see to see your doctor for well visits so he can give you a check up and make sure you are healthy.

Great additional resources:

http://www.familiesnearandfar.org/resources/grief/explaining/

http://www.dougy.org/grief-resources/how-to-help-a-grieving-child/

http://www.dougy.org/grief-resources/activities/

 “Tick tock, tick tock.” What do those words make you think and feel as a parent?  Time is precious. Kids grow up so fast.

Do you take your time, allowing your preschooler to dress and put on her shoes by herself, saying encouraging words and smiling knowing you will be late? Or, do you swoop in, dress her, grab her backpack and run out the door to arrive on time?

Do you do the dishes, laundry and cleaning all night or do you lower your standards for the perfect house and sit down to help your son put together his new Legos model or your daughter play her favorite board game?

Time with your children, actively engaged, teaching and playing is so important to raising a happy, healthy child. All parents instinctively know this. But, putting aside life’s other demands to spend that time is a struggle. Many parents wonder if that time spent really matters.

It does. And there’s new research to prove it.

 A new study found, with brain imaging, the impact the time you spend with your children has on his brain; how much positive impact you can have just by spending time together.

The research shows that early maternal support and nurturing has a strong positive effect on brain development in young children. Studies done on children in orphanages years ago gave us a first glimpse at this knowledge. The children were given good physical care: food, warm clothing, etc. but lacked nurturing. Their health was impacted.  Some actually died from consequences related to lack of maternal nurturing and contact.

This new study shows that not only can nurturing prevent negative effects on the body, it can cause positive effects on the brain. Positive early nurturing can make the brain grow larger in certain areas. In this study, researchers found that supportive caregiving during the preschool years predicted larger hippocampal volume at school age in healthy children.

The hippocampus is an important area of the brain assisting with memory and stress modulation.

 ”This particular publication is unique in that it combines observational data of parent-child interaction at preschool with structural brain outcomes at school age,” Joan Luby, MD, professor of child psychiatry and director of the Early Emotional Development Program at Washington University School of Medicine in St. Louis, who led the study, told Medscape Medical News.

 In the study, children between the ages of 4 and 7 years, were closely observed and videotaped interacting with a parent, usually the mother, during a challenging and mildly stressful task.

How much or how little the parent was able to support and nurture the child in this stressful situation, which was designed to approximate the stresses of daily parenting, was evaluated by raters blind to the child’s health or the parent’s temperament.

“Whether a parent was considered a nurturer was not based on that parent’s own self-assessment. Rather, it was based on their behavior and the extent to which they nurtured their child under these challenging conditions. It was very objective,” said Dr. Luby.

Brain scans obtained at school age revealed that children without depression who had very nurturing mothers in preschool had a hippocampus almost 10% larger than their peers whose mothers were not as nurturing.

“It’s the first finding in humans of a clear link between early nurturance and hippocampal volume. A well-established link has been known in animals for more than 20 years,” Dr. Luby added.

My first thought after reading this study was, “How cool is that?” And how cool is it that Dr. Joan Luby is one of our own here at Washington University School of Medicine. I couldn’t agree with her more, and couldn’t be more proud to call her a colleague.

The house is decorated for Valentine’s Day. I decorate when the kids are gone, so they return to see the house transformed. The looks on their faces and the conversations that begin are as much fun for me as they are for them.

Decorations: bits of paper, glitter, ceramic and wood; a waste of time and money for some. But for us, they are the traditions that create our family story. Each year, I open the Valentine’s decorations box to see the foam magnet frames filled with their little preschool faces, the heart-shaped hand prints made of dough from kindergarten,  the weaved hearts from first grade. The kids are growing older and bigger and so are the contents of my box.  We enjoy seeing the decorations and remembering the events surrounding them.

 This weekend, after getting our “mom required” exercise at the gym rock wall, we made Valentine-themed, chocolate covered Pretzels. Then, we set the table with the heart covered plates, red cups and heart shaped bowl filled with spaghetti and shared a meal with friends.

 Decorations, home-made treats and celebratory meals: snap shots in life that create little happy memories amidst the struggle to maintain life-life balance. It is often called work-life balance, but all of us feel it whether we earn a living AND parent, or do any of the other multitude of opportunities life offers AND parent.

Holidays – secular, religious or cultural –  can be another thing on the endless “to do” list. Or they can be a chance to slow down and go through the annual rituals that give our children a sense of foundation, and give us the fuel to go racing back out there as adults.

 Valentine’s Day always makes me think of flowers. I’m a girl, what can I say? There is just something about rounding the corner and seeing a bouquet of fresh flowers  on the table. You can’t help but smile. I enjoy giving them as gifts, but I used to avoid buying them for myself, feeling guilty about spending the money. Then one week I splurged and spent $4.99 for a bouquet. They lasted 2 weeks. Every time I entered the room for those 2 weeks and saw the flowers, I smiled.

 Kids learn to drink out of a cup by watching adults drink out of a cup, how to put on shoes and kick a ball, by first watching us. They also learn how to care for themselves by watching how we care for ourselves.

 So what’s the connection?

 As women, we tend to give of ourselves to everyone else until we are tapped out. We feel it is our job as women. We are the nurturers. We struggle daily with finding the happy place in the life-life balance tug-of-war. If we step back and look through the eyes of our children at the example we set, if we remember the example of drinking from a cup, perhaps we would be kinder to ourselves. Each day, we model for our kids by our own behavior. If they see us harried, sleep deprived, running through life only doing for others and never ourselves, what are we teaching them? The unspoken message is “you don’t deserve to take time for yourself, to do nice things for yourself.” Is that what we truly want for them?

 If on the other hand, we say “no” to them and to others sometimes in order to care for ourselves; if we spend money on flowers or our nails and time on our spouse or our friends. Then, they get a different message. They learn to nurture themselves, to bask in the sun, to bloom. They learn by our example that they also are deserving. So, when Valentine’s Day comes around each year and you see all the heart-shaped decorations. I hope you will take a moment to remember the best way to love your children, is to show them that you love yourself.

  Buy the flowers.

Whether you are a Patriots fan, a Giants fan or neither, the NFL can do more for you at this time of year than give you a chance to scream at your TV; or, if you live in our house, an excuse to throw a great party.

An article two days ago on Bloomberg Business reported,

“Lawsuits filed against the National Football League over damages allegedly caused by repeated traumatic head injuries will be consolidated in federal court in Philadelphia.”

Hundreds of former players, including former quarterback Jim McMahon, have sued the NFL in more than a dozen complaints over allegations that the league ignored the consequences of head injuries in order to promote the sport.”

While the NFL denies claims it hid information about the effects of head injuries from the players, the NFL does not deny permanent head injury is a very high risk in playing football.

Most of us think sports-related head injuries are temporary, that given time the player improves – end of story.

Unfortunately, every time a player sustains a head injury, there is a risk the player will have permanent brain damage. The more injuries and the closer those injuries occur in time, the higher the risk of permanent damage.

At St. Louis Children’s Hospital, we are truly blessed to have one of the country’s leading authorities on athletic head trauma; THE guy who wrote the latest American Academy of Pediatrics guidelines on athletes and head injury, Dr. Mark Halstead. So, as a parent with kids who play sports, a Super Bowl party lover and a pediatrician lucky enough to work at Children’s Hospital with Dr. Halstead, here’s my boiled down, little take away nugget on what the NFL can teach us. I hope you will read it like a true American patriot and become a Giant fan.

6 Things the NFL Knows That All Parents Should Learn

1. Repeated head trauma causes neurologic damage that is both long and short term. The degree of damage can be life altering.

These former NFL players, most of whom are in their 40s and 50s, are experiencing permanent memory loss, decreased intelligence measures, ringing in their ears, chronic headaches and depression. For many, they have had only 2 or 3 documented concussions over their entire football careers. The long-term effects of concussions in athletes of all ages are cause for considerable concern. Young athletes face a particular risk, because their brains are still developing and may be more susceptible to the effects of a concussion. In addition to interference with sport performance, concussions can cause symptoms that interfere with school, peer and family relationships. These effects can be both immediate and long-lasting. Compared with similar students without a history of concussion, adolescent athletes with 2 or more concussions demonstrate  lower grade-point averages.

2. Football is the number one cause of sport related concussions.

One in every 1,000 football experiences results in a concussion. The second highest risk of sports related head injury is girls soccer. Click here for more on the relative risk in other sports.

3. Education and symptom recognition are the most important parts of improving the care of athletes with concussions.

Coaches, players, parents, school administrators and athletic trainers need education about concussions including: how to avoid them, recognition of symptoms and “Return to Play” Guidelines. Scientific studies have demonstrated poor knowledge of concussion recognition and management by players, coaches, and even doctors. Many coaches and pediatricians have received little training about concussions. Don’t assume your child’s coach or trainer is up-to-date. The CDC developed a free training kit called, “Heads UP” which is available via the web at  www.cdc.gov.

Suggest your child’s school and coach get and use the training kit. If you are worried your child has a head injury, have him or her evaluated.

4. Returning to play before full recovery can worsen the damage caused by the injury.

This is the crux of the players’ lawsuit against the NFL. While all acknowledge this fact, the players feel the NFL minimized their symptoms and pushed them to return to play, thus leading to the severity of their long term neurologic injuries.

Rest after injury is a “no brainer” if you have a pulled Achilles tendon. Ironically, the same approach is paramount to good outcomes in brain injury. Both physical rest and mental rest. Athletes with a concussion should be evaluated for severity and gradually return to heavy school work and sports following strict guidelines. Outcomes are much better when this occurs.

5. High quality protective gear helps…a little.

Previously, it was believed that helmets and mouth guards decreased concussions. Further studies didn’t fully support this, but recent helmet upgrades have been shown to decrease concussions. So, take home message, good quality, well-fitted helmets help in regard to concussions. Play restrictions, careful evaluation of players after head trauma and restriction of return to play help more.
When it comes to cycling, skiing and skate boarding, the data is very clear. Properly fitting helmets can be life-saving and prevent head injury. No helmet, no bike. Period.

6. You are your child’s best advocate. While the team coach may truly wish to prevent head trauma and injury, he or she has many other responsibilities during a game.

The NFL is trying to improve its care of players. Last year, it imposed a protocol on team doctors and trainers to assess players who have sustained concussions during games. This week, the league announced further moves to protect players using an independent designated evaluator. The league will employ a sports trainer positioned at a vantage point to view the game and then relay to team doctors any contact of significance that may require the player be evaluated for concussion.

Team doctors are at risk of missing significant head trauma occurring on the field and out of their vision while they are attending to other players’ injuries. This change will help prevent those misses. As a parent, this is your most important role. Watch out for your child. If you see a head injury, pull the child from the game unless you can clearly see someone who knows how to assess the head injury is performing a screening.

Playing sports and winning games is important. But life-long intelligence, happiness and memory are more important. Follow the maxim, “When in doubt, sit it out.”

Ok, now who’s ready for a beer and chili?

If you read my blogs, you know I usually write about upbeat topics. I love being a mom. I think it is truly the hardest job anyone can ever do. And I find it really fun writing  about parenting and hopefully being a “cheerleader” to other parents.

 My post today is different.

 For years before I became a mom, I was a doctor. One winter when I was in private practice, my office was overflowing with sick kids when I received a call to run to the ER. A baby had just arrived via ambulance with no heart rate and he wasn’t breathing. I ran across the courtyard and into ER trauma room 1, to find a very blue little baby who was not moving. As I had been taught and done many times, I went to work placing a tube to breath for him. The nurses were already working their magic with IVs so we could give medicines to restart his heart; someone was compressing his chest to keep the baby alive while we worked. For over 40 minutes, I gave directions and we all worked. Still, the baby was blue, lifeless and cold. Everyone did an amazing job, but a baby just cannot survive for hours without oxygen or a heartbeat.

The child had been sleeping in bed with his parents.

 Now the hardest part of my job began as I walked out to tell this little one’s mom and dad their baby was dead. As a doctor, there are things I’ve seen and sounds I’ve heard that I am so thankful few others will ever have to experience.

 The heart-wrenching, high pitched cry of a mother, who has just learned her baby is dead, is a nightmarish sound that you can never erase from your memory. Ever.

 Blue baby, mother’s scream followed by the sight of blood as the mother takes a pocket knife from her key chain and cuts her wrist in front of me.

 Those sounds still echo in my mind – my heart – with such clarity it could have happened moments ago, not years.

 I left the ER and returned to my overflowing office with kids and new moms and dads.  Returned to talk about baby safety:  hand-washing, car seats and placing babies on their backs to sleep in their own bed without blankets. I hope that when I teach it, parents understand it comes from my heart – reflecting my sincere hope that their children stay safe, and that they never have to experience some of the images of my nightmares.

 In the last couple weeks, we have seen an increase in the number of dead babies in the ER at St. Louis Children’s. There seems to be a resurgence of parents who are placing babies to bed on their bellies or who take them into their own beds. Perhaps, in part, because as parents, we are reading more and more on the internet.

 I recently read a post by an eloquent mom who has newborn twins. The day on which she reflected was a tough one for her. She was exhausted and her one twin, a high needs baby, was taking her to her emotional limit. As a mom of triplets, I could relate. I’ve been in that emotional place many times. I felt for her. I identified with her. I went on to read how she decided to place her baby on its belly to sleep and how the baby immediately settled and slept and she was then able to emotionally recover. The blog continues with her telling her readers how she lies to her pediatrician about putting the baby to bed on his belly. How the “smug” experts in Ivory Towers don’t understand and her baby was fine.

 As I read, I understood her emotions. I understood why she made that choice.

 But, blue, dead babies, the heart-breaking scream of a mother…she hasn’t experienced them.

 I understood just as I understand why many parents make choices that result in dead or hurt children. They aren’t stupid or careless any more than we, the doctor moms, are smug or uncaring. But, I also wondered why she didn’t feel her pediatrician would understand if she tried to talk honestly about it. Why did she feel her pediatrician would tell her to do something that had no outcome other than to make her life harder?

 Blue baby, screaming, heart-broken mom. I wondered, “Do  parents view their pediatrician’s advice as just a stern lecture, and  not the loving advice of a doctor who hopes to save them from unimaginable grief?”

 I then read the responses to her blog, and my question was answered. Each mom that responded said that she, too, puts her baby to bed on its stomach, that she also lies to her pediatrician, that she knows the pediatrician is smug and callus and uncaring too.

 As I read post after post after post, a knot formed in my stomach. Because, I know that my wish to never have to tell a mom her baby is dead, suffocated, gone forever, probably isn’t going to come true.

 As pediatricians, we want to teach parents everything they need to be great parents and part of that is how to keep their children safe. The advice changes as the children grow and change. We are careful to pick only the most important things and we try to present it in a way that is positive and encouraging. We teach it passionately, over and over.  And it’s more than advice we learn in our “ivory towers.” We have seen with our own eyes what can happen.

 I have had to tell parents their child was dead many times in my career. Some of those deaths were preventable, babies and children who won’t get to grow up and parents who will never be the same.

 I hope you will listen to the safety advice of your child’s pediatrician; that you will have a conversation if you think the advice doesn’t make sense. Blue, lifeless babies. The heart-wrenching sounds of a mother’s scream. With all my heart, I pray you never have to experience these images.

It is a new year and you’ve decided to get out there and begin dating. Now what? What do you need to know before you start, and what do you need to know about dating with kids to do it well?

Be Ready

The romantic poet, Shelley, wrote “Fear not the future, weep not the past.”
In getting ready to date, look briefly at the past, present and future.

1.  The future: take time to figure out now what kind of person you want in the future. This is your “must have’s” list. It will be easier to reach your destination if you know where you are aiming. If you meet someone who you find to be very physically attractive but that person lacks all your “must haves”, he isn’t right for your long term.
2. The past: Don’t dwell in the past, but do take time to look at it. Be honest with yourself. How did you contribute to the relationship ending? If you could do it all over again, what would you do differently? Owning the role you played will help you avoid repeating the same mistakes. Similarly, when you begin dating, if the person you are dating blames his x-wife or x-girlfriend for all that went wrong in the relationship, walk away very fast.
3. The present: Do you look like you are living in the present or do you still dress like you did in high school? Before you begin to date, assess your physical appearance. Men are very visual; you want to “be the belle of the ball”. Has it been ages since you updated your hair style, bought new clothes?  Ask your friends (the ones with good taste!) for honest feedback. If you haven’t been taking care of yourself with sleep and exercise, begin now. You deserve it. You will feel better and more confident about yourself.

What do you tell your kids when you begin dating someone new? Nothing! Here’s how and why:

There are 20 million children in the US living in single parent households. Most are the result of divorce. Those children have experienced the emotional loss of no longer having both parents in the same home as well as many other possible losses. It isn’t best for them to experience a “revolving door” of men coming into and out of their lives. Bonding with someone you are dating and then losing him in their life is really hard on them emotionally. Waiting until you have dated someone for 6 months is what experts recommend. Why? Because that is the length of time it takes in most relationships to be sure this person is someone who may be in your life long term and thus gets the amazing opportunity to meet the most important people in your life, your children.

Similarly, don’t rush into marriage. Marriages occurring after one year of dating or less have a higher failure rate. Why? Because the “honeymoon” period of dating is still occurring, these couples don’t know each other to the depth they should to make the lifetime commitment of marriage. Often, couples marrying this quickly also marry for the wrong reasons. Running back and forth between two households with kids can be stressful and expensive, it is tempting to marry sooner and “solve that problem.”  Don’t give in. You will just create many more problems if you don’t take the time to allow both families to really get to know one another.

Set Limits

1. If your children are old enough to read and see the name “Paul Smith” popping up on your phone all the time, they will begin to ask about that person. Consider setting limits in regard to when you accept calls from your dates. “I’m sorry; I can’t talk on the phone between 5:30 and 8:30. That is the time I devote to my kids.” If he truly likes you, he will support that commitment.
2. Consider not putting his name into your phone contacts until after 6 months when he has met the kids. If a number shows repeatedly on your phone instead of a name, your children are less likely to notice and ask questions.
3. Don’t have your date pick you up at your home in the very beginning, and later only when the children are not home. Unlike dating before you were a parent, with children in the home, letting someone come to your home and know where you live can be dangerous. Also, if the children see him, they will ask questions. Best to wait until you have dated 6 months and are ready to answer questions. Make sure to communicate this idea to your date so he doesn’t think you are homeless or secretly married!

Realize that if the person truly likes you, he will find a way to fit his life into your schedule.

When he asks, “When can I see you again?” give times that work for you and your family. Don’t stress yourself out by saying, “Oh anytime,” then struggling to find child care or transportation for your children. If you need to check your calendar before committing say, “I would love to go out again; can I check a couple things and get back to you?” No further explanation needed. When someone really likes you, he will respect this. If he is only willing to see you on his schedule, he isn’t likely to respect other healthy limits you set.

Work Hard to Have Fun!

Two houses, two full time jobs, two sets of kids…dating when you both have kids is tough. In the beginning, you go out to dinner, take walks together in the park and play. However, too quickly you can fall into the routine of ”just hanging out at home”, and then the spark can die before the relationship truly gets established. To build and maintain a healthy relationship, it is very important to plan fun times together. Start your dating relationship with this mind set. As you get to know him, set a common goal, like learning to cook Italian food or training for a marathon together, or plan a trip. Buy tickets to concerts or plays that are weeks away. Yes, bills need to get paid, broken faucets fixed, but it is important to model good behavior for your kids and life shouldn’t be just work. Work hard to keep the “fun” in your relationship.

This article is from the perspective of a single mother. There are many obvious gender and culture differences in dating from the father’s perspective. If you are a single father, what are your thoughts? Do you find this advice helpful?

“Are you ready for Christmas?”  That was the greeting I received December 5th from a very kind co-worker as I walked down the hall at work. Boy, did that make me crabby. Then, I started to think, “What was it about that very innocent question that made me grumble to myself the entire 5 min walk across the medical campus?”

I think it was this: Why is everything a race? Why, in so many ways, do we work so hard to win races that if we stepped back and thought about it, we wouldn’t enter to begin with?

For the record, not only was I not ready for Christmas, I wasn’t ready to be ready. I love Christmas, the season of giving. I love nesting with the kids: baking, decorating the house, making ornaments, decorating the tree, lighting candles, delivering goodies to the neighbors, going to party after party, singing Christmas songs as a family. I love eating potato pancakes with our friends who celebrate Hanukkah, visits to the botanical garden train display, the St. Louis Zoo Wild Lights, Tilles Park. I get excited planning my Christmas list, planning our Christmas card: the photo, the clothes, the colors on the card. I love all of it.

Thanks so much to my good friend whose card arrived the day after Thanksgiving. And thanks to my friends whose cards haven’t yet arrived. I love opening those cards and seeing photos, or hearing about each person’s year. If they all arrived by Dec 5th, I would be sad. When they keep arriving for weeks on end, going to the mailbox to find them amongst the bills and junk mail is a treat, a “double fudge sundae at the end of a liver and onions dinner”-sized treat. I don’t want to be done with all of it by Black Friday or even Cyber Monday. For me, celebrating the holiday is like a lazy drive in the country, not the Indy 500.

So, as I reached the other side of the medical campus, I reminded myself: Life isn’t meant to be rushed through. Don’t let others define your pace. Don’t measure your life’s successes with someone else’s yardstick.  And poof, the crabbiness was gone.                   

The Christmas holiday is over, I just celebrated a birthday and now we’ve turned the page on a new year. So, for me this time of year is a very introspective one. The holiday with friends and family was lovely. My birthday reminded me how blessed I am to have friends from so many different aspects and interests of my life and children who, at a young age, truly enjoy doing something nice to make someone else feel special. As I enter 2012, by my yardstick, 2011 has been a huge success. My wish for all parents in 2012 is that you think about, define, enjoy, and celebrate your personal yardsticks and help your children to create their own.  

Note to self: talk to kids about their yardsticks tonight.

You’re shopping, cooking, planning, budgeting, wrapping and otherwise stressing to fit everything in to create a perfect holiday.

STOP. Take a breath. Read this. The map to a happy holiday will not only help you evaluate this season, but can help you stay focused year-round.

1. Be a “man with a plan”, or in this case, a woman…
2. The only thing you really HAVE to do each day is eat, sleep and breathe, everything else is a choice.
3. Memories, not Things
4. Kodak moments
5. Hit rewind

Let me elaborate:

1. Have a plan: Make Today Count by John Maxwell is one of my favorite books. In it, he goes into great detail about, interestingly enough, Making Today Count. Definitely recommend reading it, after the holidays. But the core idea is that success and happiness are dependant on living life intentionally, in essence, having a plan. If you don’t know where you are going, it is much harder to get there. So, (the action), start the holiday season, and if possible each day, by taking 30 minutes to define what success looks like to you. Make a list of the things you have to accomplish in order to look back at this season and smile.

2. It is okay if at first that plan contains a list that looks like Santa’s toy list, 18 miles long. But then, (the action) step back and say, out loud, “The only things I truly HAVE to do each day are eat, sleep and breathe.” Now read the list again. What can you cross off? What things are on there because others say they “have” to be. Your life is your own, you get to decide what to do with it to make yourself truly happy. What truly HAS to be on it for you to look back and smile?

3. Think back on your childhood. Can you name every toy you received? What memories make you look back on your childhood with wamth and love? We remember MOMENTS and experiences, not THINGS. It is especially important to remember this idea if money is really tight for you this year and that is a big stressor. (the action) Baking cookies, lighting the Menorah, sleding on Art Hill. All of those things are essentially free and are the substance of what fills our childhood with warm and with loving memories.

4. Take pictures. Take pictures with YOU in them. (the action)Talk to your husband, boyfriend, your mother ahead of time and ask that their gift to you be that they make sure this holiday, you are in many pictures. No make-up? Gained 5 pounds? Get in the picture. If tragedy struck and you were gone tomorrow, would your kids care if your hair is a mess or would they just want you with them in pictures?

5. Hitting rewind is the key to parenting, no matter what the issue. (the action) At the end of the day, at the end of the holiday season, take time to reflect. What worked? What was a terrible mess? As Dr. Phil says, “How’s that workin’ for you?” All too often, out of necessity, we rush through the day, go to bed and repeat. Without reflecting, we are likely to repeat the same habits that don’t work for us as parents. Much of parental stress can be alleviated if we just step back and look at what worked and what didnt. Repeat what worked. Delete what didnt, replace it with a different plan. This gives us the opportunity to slowly “tweek” our parenting to move toward a picture that looks like our definition of “happiness” Ellen Miller says, “Live Intentionally and Leave a Legacy” If you have a map in your head of what the road to holiday happiness looks like and you refer to it often, you are much more likely to reach your destination.

 If you believe the adage ‘an apple a day keeps the doctor away,’ then by extension, shouldn’t apple juice do the same thing?  The FDA dismissed a recent report by TV host Dr. Mehmet Oz, which pointed to dangerous levels of arsenic in the apple juice our kids drink, calling it irresponsible because it failed to distinguish between organic arsenic, which is harmless, and inorganic arsenic, which can cause cancer.

Perhaps there were some seeds of truth.  Consumer Reports just released its own probe into the controversy and it turns out, claims of elevated arsenic may not be so fruitless after all.

The report reveals that, in 10% of the samples tested, apple and grape juice contained levels of inorganic, or cancer-causing arsenic, higher than the levels considered safe by the FDA for drinking water.  But what’s the appropriate level for juice? At this point in time, there is no official data.

It stands to reason that safe levels should be lowest in water, because we consume more water than anything else. So while it may not be time to panic just yet, this report does provide yet another reason for parents to evaluate the amount of juice they’re feeding their kids.

Medical experts recommend limiting your child’s juice consumption to 4 ounces or less a day. Check the labels on those juice boxes because many of them exceed the daily recommendation in just one serving.

Juice lacks the nutrients and fiber of real fruit, and it contains a lot of added sugar and calories. And add to that now the uncertainty over safe levels of arsenic.  (Is any arsenic really safe?)

As a physician and mother of three, I recommend feeding your children actual fruit and vegetables to meet the daily recommendations of 5 fruits and veggies a day.

Drinking one glass of juice probably won’t hurt your child, but you can’t go wrong by limiting the amount you serve, and replacing it with a healthier alternative.

Some parenting is easy. Your-two-year old wants gummy bears for breakfast, “No.” Your four-year-old wants to ride in the car without a seat belt, “No.”

Your 16-year-old wants to get plastic surgery to fix her nose. For some parents, that’s a bit harder.

She did inherit the Wilson family nose. It is bigger than most with a rounded, upturned end. When a new baby is born in the family, usually the first comment is, “Look, he got the Wilson family nose, poor thing!” or “Wow, she has a beautiful nose, it didn’t come from our family.”

Adolescence is a time of discovering oneself in all areas: physical, mental and emotional. It is a time characterized by a change in focus from parental approval to peer approval. Anything a teen sees as a barrier to fitting in can become a focus of anxiety or negative emotions:

“I’m too fat! I’d be happier if I were thinner, taller, had shorter arms, longer legs, curly hair, straighter hair, darker skin, lighter skin.”

Almost everyone wishes there was something they could change about their bodies. For many people, especially young teens, their whole self-esteem may temporarily be tied to appearance or body image.

Body image is a person’s opinions, thoughts, and feelings about his or her own body and physical appearance. Having a positive body image means appreciating your body for its strengths and accepting its imperfections. Body image is part of someone’s total self-image and thus impacts self-esteem. A person who has high self-esteem will make friends easily, do better in school, will be more in control of his or her behavior, and will enjoy life more. As parents, we want that for our children.

Emotional health has a really big effect on how people think they look. If you’re depressed, extremely self-critical, or have a distorted view of what you really look like (body dysmorphic disorder) you may think changing your looks will solve all of your problems.

Teens with these emotional difficulties will continue to have those emotions after plastic surgery; they may be very dissatisfied with the surgical outcome and go on to develop a preoccupation with another body part. Working out the emotional problem with a mental health expert is the true solution here. In fact, most doctors won’t consider plastic surgery for teens who are depressed or have other mental health problems.

If you’re considering plastic surgery for your teen, first try to answer a couple of important questions:

Is this an aspect of his appearance that realistically needs to change or one that needs to be accepted as a normal part of developing healthy self esteem?

Are these concerns impairing normal development of healthy self-esteem in an otherwise well-adjusted teen? In other words, does your teen need to change how he looks to feel good, or does he actually just need to change the way he sees his body and how he thinks about himself?

Sometimes these decisions may feel “gummy bear” easy:  a child with a cleft lip, a malformed ear or a birth mark covering the entire side of his face. Sometimes, they are more difficult: a perfectly formed, but large nose, mild breast asymmetry, ears that stick out.

The following are a list of plastic surgeries that are most common among teens:

• Rhinoplasty (“nose job”)
• Otoplasty (pinning back ears that stick out)
• Breast reduction
• Correction of breast asymmetry
• Correction of gynecomastia (abnormally large male breasts)
• Chemical Peels or microdermabrasion for acne and acne scaring
• Laser hair removal (especially in children on medications that cause excessive hair growth)

The bottom line is that while plastic surgery to correct serious physical flaws should be an option for teens, purely cosmetic procedures are not going to be the solution to improving self-esteem. Unless the physical flaw is health-related or seriously deforming, I recommend teens wait until their bodies have finished growing and they have developed a healthy self-esteem through life experiences in order to make an informed decision about a life-long change such as plastic surgery.

What do you think? Is it ever appropriate for a teenager to have plastic surgery?