Don't ignore warning signals or bad vibes. The downside is that they might live and/or work nowhere near you, and they might just be in it for a holiday fling. Do new things to flirt better, like surprising your crush by turning up with tickets to her or his favorite movie or show. Be sure to always have a cell phone and cash for a cab so that you never feel you have to rely on your date for a ride home. Listening is a Chicago Dating Websites part of creating humor. How to Find a Date at the Beach. Don't be shy towards him. Pursue online dating like you would a job When you're on the hunt for a new job, you invest time in putting together a clean résumé that presents you well and searching for the perfect positions to apply for. Don't obsess about the details. Tell him if you're shy or quiet - he loves you, so he'll understand! Be playful. And if you're thinking you're all high and mighty because you're not single and don't need this, well, goody goody gumdrops for you, but be a saint and share this shit with your single friends.

Looking to donate breast milk?

Some nursing mothers are able to produce more milk than their own babies can drink.

If you have an excess supply of breast milk, you might wish to donate it to someone who could use it.

Choose a donation facility that is non-profit, accredited and safe. Generally, a mother would answer a series of health-related questions, and have some blood testing. Then the facility would send packaging materials, and the family would ship the breastmilk (with “cold packs”) back to the facility. There should be no cost to you. (But you should also not accept payment for the milk you donate, beyond covering your costs.)

Here are two facilities that I recommend:

OhioHealth Mothers’ Milk Bank
(614) 566-0630
milkbank@ohiohealth.com
Ohiohealth.com/mothersmilkbank

Nemours Breast Milk for Babies
(844) 341-1477
Nemours@prolacta.com
www.nemours.prolacta.com

Local hospitals such as Christiana Hospital, and Children’s Hospital of Philadelphia, are not currently accepting donations of breast milk.

Donating your excess breast milk is a very generous thing to do!

—  Dr. Epstein

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ADHD in preschoolers? Be cautious.

More than 10% of school-age American children have been diagnosed and treated for Attention Deficit Disorder.  Many are helped by medication; treatment can truly be life-changing for them and their families.

But some children younger than school-age are being prescribed ADHD medications, and it may not be appropriate.

An article in the Washington Post this past May 3 points to data from the CDC, suggesting that too many children under 6 may be prescribed medication, although behavioral therapy may be more appropriate.

The cardinal symptoms of ADHD include easy distractibility, short attention span, and impulsive behavior.  In school-age children, these symptoms can cause poor academic progress, because the child finds it hard to learn, and even harder to demonstrate what you’ve learned and do classwork, if your learning style is impulsive and disorganized.  In addition, children with ADHD find it hard to cooperate with adult routines. And the social life may suffer because other children find it difficult to be friends with a kid who is distractible and impulsive.

But with pre-school children, I am impressed that distractibility, short attention span, and impulsiveness is normal behavior!  Most kids this age have some difficulty managing their impulses; their task in “growing up” is to learn self-restraint.  As with any other skill, some kids learn self-restraint faster than others.  We should be cautious about “medicalizing” such normal behavior.

I agree with the American Academy of Pediatrics that kids under 6 who have behavior problems should generally be evaluated by a psychologist or other behavior health professional, before starting medication.  Frequently, such behavioral therapy can teach a child (and their parents) techniques to alter behavior, so that their behavior becomes more socially acceptable and they can integrate with their peers.  If behavioral therapy is not successful in orienting the child towards more acceptable behavior, then medication might be more appropriately considered.

Why does this not happen?  Why are young children being treated more often with stimulants and other neurologically active medications?  Behavioral therapy may not be easy to arrange, or to follow through with, especially if trained therapists in the area are in short supply.  And the dramatic (and apparently easy) success of medical treatments in older children can be seductive.

We are fortunate in our area to have seen the number of well-trained child therapists increase recently, and I am pleased that I have such resources available to my patients.

If your preschool children are acting out, don’t assume that they have ADHD – seek a professional evaluation first!

To see the Washington Post article, click here:
https://www.washingtonpost.com/news/to-your-health/wp/2016/05/03/cdc-warns-that-americans-may-be-overmedicating-two-to-five-year-olds-with-adhd/

To read an essay about “responsibility and cooperation” on my website, click here:
http://www.dmpkids.com/index.cfm?fuseaction=trees.pageDetails&p=28-2-33

For a list of some local pediatric psychologists that I have had good experience with, click here:
http://www.dmpkids.com/index.cfm?fuseaction=trees.pageDetails&p=48-2-53

—  David Epstein MD

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Iron for infants helps development.

A new study shows that giving iron supplementation to young infants helps their gross motor development.

The study followed more than 1000 infants, most of whom were solely or mainly breastfed.  Iron supplementation (or a placebo) was started by 6 weeks of age, and continued every day until 9 months.  By that age, an improvement in gross motor scores was seen in the infants who received the iron supplementation, compared to placebo.  No side effects were reported.

Vitamin D and iron are found in breast milk only at very low levels.  For many years, experts have recommended that breast-fed infants should be supplemented with daily oral Vitamin D.  But there has been no consensus about iron supplementation for breast-fed babies; the American Academy of Pediatrics has at times recommended it, but the AAP’s own breastfeeding committee has disagreed.

I have recommended iron supplementation for breast-fed babies (along with the Vitamin D), because some children do show low iron levels or even iron-deficiency anemia on the one-year routine blood screen recommended by the AAP.  The only preparation with both iron and Vitamin D that I’m aware of is “Poly-vi-sol with iron.”

This new study confirms to me the value of routinely supplementing breast-fed infants with iron.  (It should be noted that mainly formula-fed infants already receive iron and vitamins in the formula, so they should not usually be given any extra supplements.)

—  David Epstein MD

Rosa M. Angulo-Barroso, PhD, et al.:  PEDIATRICS Volume 1 37, number 4 , April 2016: e2 0153547

 

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Old-style toys are better.

Children’s toys and books sell because they engage.  So any “doodad” that catches the eye of a kid, or his parents, helps to generate sales.  Nowadays, lots of kids’ toys make noise or flash lights – even board books and  traditional games like Monopoly have electronic versions.  And screen-based entertainments have proliferated; apparently 3/4 of kids have their own cell phone or tablet by age 4.

Is this good?  I think not.  Kids need to learn language and social skills, as well as self-regulation.  Toys that “do the work” for the child may entertain, but kids don’t learn these difficult skills by reflexively responding to noises and lights.

Now, a new study supports this view.  According to a study in JAMA, such toys suppress language interactions between parents and children.  “Conversational turns during play do more than teach children language. They lay the groundwork for literacy skills, teach role-playing, give parents a window into their child’s developmental stage and struggles, and teach social skills such as turn-taking and accepting others’ leads,” according to pediatric researchers. (Click here for a commentary.).

Kids learn more from open-use toys that require imagination, not just rote following directions or completing tasks.  Old-style toys such as legos, building blocks, plastic dolls and animals, “craft” activities, and board books fit the bill.  (You might have noticed that I have filled my waiting rooms with such toys; this is intentional.)  Give a kid a rubber ball, and watch what happens!

Newer toys are also available.  The “Melissa and Doug” line of toys will give gift-givers more ideas.  And consider EBay for inexpensive used options, such as Playskool Village (about $15).

I haven’t tried “Bunchems” but they look cool (but keep them away from long hair!).

As you sort through all the presents this year, encourage your kids to keep the non-electric toys at hand.

— David M. Epstein, MD

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Non-drug treatment of ADHD

Parents often ask how their children’s symptoms of ADHD can be treated without “stimulant” medication such as Focalin or Adderall.

In fact, we know that treatment of ADHD with stimulant medication has a stronger unsecured bad credit installment loans research basis, and more data, than any other treatment.  But often parents rightly ask, “Isn’t there treatment besides drugs?”

Certainly, “alternative” therapies such as herbal treatments, dietary manipulations, and chiropractic treatment for ADHD work no better than placebo.  But there are some important strategies that parents can and should try, before (or along with) a trial of stimulant medications.

Note that each of these suggestions is thought to have a long-term effect, if the intervention is sustained.  This is different than the impact of medication, which works quickly but wears off by the end of the day.

–  Sleep deprivation impairs judgment and memory, and increases impulsiveness and irritability.  So not getting sufficient sleep mimics and exacerbates the symptoms of ADHD.  ADHD patients must be sure to get enough hours of sleep.  Just as importantly, poor quality of sleep should be addressed.  ADHD patients should get to bed at a reasonable hour, and electronics and third party loans “screen time” should be restricted within an hour or so of bedtime.  Quality-of-sleep issues, such as insomnia, sleep apnea or snoring, must also be addressed.

–  A study this past July demonstrates that teens who increase their physical activity, such as joining a sports team, helps improve their ADHD behavior 3 years later.  (J Am Acad Child Adolesc Psychiatry, 2015 July; 54:565-70. http://www.jaacap.com/article/S0890-8567(15)00288-9/abstract

–  Excessive “screen time” is well known to stimulate subsequent ADHD symptoms, even as early as age 1.  It is recommended to limit total TV and movie watching, video games, “smart phone” and tablet use to 1-2 hours per day.  Pleasure reading, hobbies, and family activities such as cooking together are good alternatives.  (Pediatrics April 2004; Vol 113(4):708-713) http://pediatrics.aappublications.org/content/113/4/708

–  Pediatricians recommend good nutrition for all our patients, such as encouraging milk, fruits and vegetables, and grains over a diet high in fat, salt, sugars and processed starches.  There is some research to suggest that these recommendations may also help improve ADHD symptoms, though it is hard to prove.

–  Musical training seems to cause more rapid development in the areas of the brain related to “executive functions” such as motor planning, and emotion and impulse regulation.  This development was measured by noting thickening of the brain cortex on MRI.  (J Am Acad Child Adolesc Psychiatry, November 2014, 53(11): 1153–1161.) http://www.jaacap.com/article/S0890-8567(14)00578-4/abstract

–  Early evidence suggests that long-term dietary supplementation with Omega-3‘s, like those found in fish oils, unsecured payday loans might improve ADHD symptoms.  The benefit is “modest” compared with that of traditional stimulant treatment for ADHD, and the optimal dose is unknown, but there is probably no harm and might be some benefit.  (J Am Acad Child Adolesc Psychiatry, October 2011: 50(10):991–1000.) http://www.jaacap.com/article/S0890-8567(11)00484-9/abstract

Other studies suggest that more complex interventions such as mindfulness training, behavioral training, and even Canine-assisted therapy might be of some benefit; parents must balance the effort involved (for both them and the affected student) against the suggestion of benefit for these interventions.  Other therapies, such as chiropractic treatment and vision exercises, have been shown not to carry any benefit.

One particular intervention that has been shown NOT to be helpful is the accommodation of extended time for school exams.  Neither the patient’s score on tests, nor their learning, have been shown to improve by giving ADHD students extra time to complete their exams.  (J Atten Disorders, February 2015, (19)2:167-172 ) http://jad.sagepub.com/content/19/2/167.abstract

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Egg Allergy and Vaccines

There are three vaccines that are manufactured using chicken eggs:  MMR, influenza, and yellow fever vaccine.  If your child has a history of allergic reactions to eggs, you might be concerned about reactions to these vaccines.  But for most children, they are perfectly safe.

Experts are much less concerned about reactions in children with mild allergic reactions to eggs, such as hives or other rashes, vomiting or diarrhea.  Severe wheezing or “anaphylaxis” might be of more concern, but even in these children, reactions are very unusual.

MMR vaccine has been extensively studied.  Serious reactions to MMR vaccine in people known to be severely allergic to eggs are extremely rare; serious reactions in people who are only mildly allergic to eggs are nonexistent.  This is not surprising, because the vaccine is produced using egg fibroblasts (a type of cell found in eggs), not whole chicken eggs.  Children with known allergy to eggs should receive MMR vaccine as usual, although for safety the child should be observed for reactions.

Most flu vaccines are produced using whole eggs.  But there are very few reports of dramatic reactions after flu vaccine is given to children with severe egg allergy.  Most experts recommend that flu vaccine should be given as usual to children with severe egg allergy, with an observation period in the office afterwards.  For children with milder allergy, flu vaccine may be given without special concern.

(For more information, see this CDC website:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm#Influenza_Vaccination_Persons_History

Yellow Fever vaccine is also produced using chicken eggs.  We do not administer this vaccine.  If you are visiting a 3rd-world country which recommends it and your child is allergic to eggs, you should discuss the risks and benefits with the provider who administers the vaccine.

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Too much fast food!

Hello world!

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“Life before vaccines.”

The February 16th issue of New Yorker magazine included a thoughtful article about the anti-vaccine movement.  (Click here to read it.)

One interesting “letter to the editor” commented on the article with a remembrance of life BEFORE vaccines, by a woman old enough to have “been there.”  People were hurt by these infections.  Here are her comments.

“There are still a few of us around who remember life before vaccines.  It’s hard watching each generation reinvent the wheel, when we wish that they could learn from our memories:

“Of the two children in my mother’s family who died of diphtheria; of the big red signs on houses under scarlet-fever quarantine; and of the little girl up the street who died of the disease show.

“The one vaccine available to us was smallpox:  nobody questioned whether to get it.  secured bad credit personal loan We lined up at school to receive the little scratch on the arm, and delighted in comparing scabs afterward – they meant that the vaccine “took.”

“As a naval-aviation cadet during the Second World War, my husband fell behind in his class when he came down with the mumps.

“We all knew somebody who limped f personal loan collateral or life – or worse – as a result of polio.

“Measles, mumps, chicken pox, whooping cough – I had them all.  I’d have gladly risked the “hazards” of the vaccines.”

Vivian Douglas Smith, Falls Church, Va.

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We’re making progress (a little) with childhood obesity.

Rates of obesity in young children, age 2 to 5, have dropped 5% in the past 10 years.  (Click here to see a review of the study.)  This is a good thing!  But pediatric obesity rates in older children have not changed.

It all has to do with simple choices about food and lifestyle.  Unfortunately, it’s easy to be swayed by our culture and our friends into using “convenience” processed foods, and electronic entertainments.

I’ve been speaking with my patients frequently about lifestyle.  Click here for a look at my routine recommendations; they’re not difficult to implement with a little attention.

It’s worth remembering that the lifestyle kids live with are really hard to change as they get older.  The life you save may be your kids’!

— Dr. Epstein

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