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Coping with the 'Too-Sick-to-Go-to-School' Blues

It's not surprising that some very young children fear going to preschool or kindergarten. If your child hasn't been away from home very often, the separation may be causing enough anxiety to give her a head- or tummy ache.Most school phobias -- commonly called "school avoidance/refusal" behaviors -- occur in 8- to 13-year-olds, though.Ironically, the problem may stem from careful, not lax, parenting. Families whoare close and loving may make it hard for the child to leave his safe environment for the outside world.


Often, kids with school avoidance fear being bullied, not fitting in with the other kids, or being criticized by their teachers. Other kids may fear certain activities, such as changing for gym class or taking the school bus. Some sensitive kids are afraid of problems occurring at home while they're at school, such as a sick grandparent dying.


When this happens, kids may develop symptoms such as vomiting, diarrhea, fatigue, headache, stomachaches and dizziness -- often in the morning before school or at school. If your child is feeling sick at the thought of school, here are some ways to help her overcome: 


 *Make attendance mandatory. Be firm in the morning, and don't ask your child how she feels. If she is running late and misses her bus or ride, have a prearranged way to get her to school. At the school, a quick, firm parting is best for her -- and for you.
*Be aware of actual illness. If he complains of feeling sick, try to make a doctor's appointment that morning. A fever (over 101º), frequent vomiting, diarrhea or cough, rash, earaches and toothaches are usually genuine symptoms of illness not related to school avoidance.
* Get help from the school. Work with your child's teacher to pinpoint problem areas, such as having to recite out loud, change for gym class or pick a partner for a project.School avoidance behaviors are so common that most teachers have good ideas on how to help overcome them.
*Talk to your child. Discuss what's bothering him at school or home and make plans together on how to improve the situation. 

If your child still doesn't respond to your efforts, you may want to seek professional help. Your child's doctor can suggest appropriate counselors.


Reviewed by: Patrick S. Pasquariello Jr., MD

Copyright Children's Hospital of Philadelphia


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GIVE ME MY SPACE! WHAT TO KNOW WHEN KIDS E-COMMUNICATE
For teens, it’s 24/7 connectivity. More than 50 million kids aged 14 and up are logging onto social e-networks such as MySpace®. When use of MySpace is not banned in schools, kids check it during study hall, computer class and lunch. Kids also keep MySpace open on their computers at home, and constantly check for messages. Once they've created a profile, online time is spent updating profiles, checking out other profiles, sending messages and reviewing the comments they receive.

On the positive side, the networks help satisfy a teen's need for peer interaction and can lead to new friendships. On the negative side, sexual predators and cyberbullies lurk online. As with all Internet use, parents need to monitor and protect their kids.

Here's what you need to know when your kids are networking online:
*  Predators peek. Despite warnings, some kids still believe only their friends or peers will view their pages. MySpace is available to anyone who registers, so that cute varsity basketball player from California may really be a 50-something with fake photos and profile -- and a penchant for underage kids.
*  Truth and consequences. For kids, creating a profile in cyberspace is as transitory as the bits and bytes that speed a computer's transmissions. Some kids put up images of themselves in sexual or substance abusing poses ­- or even boast about criminal activities. The information may be bogus, but should it be left up to coaches, an English teacher or the admissions director at a college to decide what is truth or fiction?
*  Pass the word. Kids should keep their pages private and password protected. Ask your child to ensure only friends be given the password.
*  Don't tell the world. Online surveys and forms may provide info that can get  into the wrong hands. Kids shouldn't list their schools, sports teams, their home town, favorite hangouts or other clues to identity. Kids also should check out their friend's pages to see what is being said about them. Too many details can give predators an idea of where to hang out.
* Protect the image. Computer images can be pulled off your child's profile and reproduced and changed. If kids slightly blur their images, that will help keep them from being easily identifiable or reproducible.
*  Give a 24-hour warning. The pages are public, so it isn't an invasion of famous teen privacy if you take a look. Let your kids know you will be viewing their profiles ­ and give them a few hours to clean up. Also advise them you will be consistently checking back.
*  Words can hurt. Ask to see what your child is adding to other profiles. If your child wouldn't say it face to face, it shouldn't be said online. Parents need to explain family expectations about cyberbullying and teach correct online behavior. They also need to let kids know they will help if they are ever victimized themselves. Bullied kids often are afraid that computer privileges will be taken away if they complain of cyberbullying, so let them know there are other solutions if the problem occurs. 
*  Provide face time. Overscheduled kids don't have the time to spend with friends -- and have fewer places to hang out other than the mall. Discuss ways you can help your teen enjoy friends in person. 


The Bottom Line: Take back your space. Discuss your values with your kids and let them know what you expect to find on their web pages. If they don't comply, pull the plug.


For further information about cyber safety, i-SAFE®, Inc. http://www.isafe.org/

For more information about cyberbullying: http://www.stopcyberbullying.org/


WINTER WONDERLAND: AVOIDING WINTER SPORTS INJURIES
The first real snowfall, and kids -- and maybe mom and dad -- are enjoying a "snow day." It's a great time for family fun when you dig out the sled, skates or snowboard and look for a place to play in the snow.

 The very nature of snow and ice, however, makes for a dangerous play surface. According to The National SAFE KIDS Campaign®, more than 69,000 kids were treated in U.S.Emergency Departments in 2002 for winter sports injuries from sledding, ice skating and hockey, snowboarding and skiing. 

 Here's what the experts suggest to help keep kids safe when enjoying snow sports:
*  Strap on the helmet. Here's why: the most common injuries among sledding, ice hockey and skating, snowboarding and skiing are to the head and neck:

-- For skiers, ski accident-based traumatic brain injuries are the leading cause of death among kids between ages seven and 17. 

-- For skiers and snowboarders, traumatic brain injuries are the most common non-fatal
injury. 

-- For ice-skaters, head injury is more likely than in comparable sports of skateboarding and inline skating. (That's because ice-skaters tend to fall sideways or backwards, rather than breaking a forward fall with their arms). And very young iceskaters have a higher center of gravity and less arm strength, so also may be at higher risk for head injuries. 

* Scope out the slope. The most common reason for sledding injury is collision. Check out a slope before the first run to identify rocks or other items under the snow. Avoid slopes that are covered in ice, not snow. Observe how crowded the slope is, and look for less trafficked spots. Skiers and snowboarders also should also know to check out the slope before they try to break speed records. Collisions with trees are the most common source of traumatic brain injury for skiers and snowboarders.

* Be equipped for the slide. When sledding, provide a sled with a steering handle­ not just anything that can slide down a slope. (This includes black garbage bags!) And advise kids to sit upright on the sled. Lying down makes a head or abdominal injury more likely if the sled flips. 

 * Look for signs. When ice skating, make sure your kids only do figure 8's on ponds or lakes that have been approved by the police department for skating. You'll know the ice is thick and safe enough when you see signs posted by the local police department or recreational department.

 * Take a lesson. Even very young kids can enjoy skiing or snowboarding. A few lessons will help them get off to a safe start. And make sure their equipment is properly fitted, including helmets and protective eye wear. 


The bottom line: Helmets protect young heads from injury in all outdoor sports.


SIT DOWN! KEEPING YOUR TODDLER SAFE IN A SHOPPING CART
As careful as you are with your toddler, you probably expose your child to something dangerous every week. The common shopping cart is responsible for more than 20,000 visits to Emergency Departments annually. Most of the injuries happened to kids ages 4 and under.

 Fractures are the most common reason for kids to be admitted to the hospital after a shopping cart injury. Other kids suffered from head and neck injuries or cuts and bruises. The injuries typically happened when kids tried to climb out of the carts, the cart overturned, they were riding outside the cart or they were pinched in the folding seat. 


Here's how to help keep your child safe when using a shopping cart: 

* Use restraint. Half of all kids are not buckled in when seated in a cart child seat. Cart restraints will keep your child from attempting to climb out or reach too far for an item. All carts should be equipped with safety straps; if your favorite store doesn't have mandated, up-to-date carts, complain. And never let children sit or stand in the main basket; this is a common reason for cart tipover. 

 * Stay within arm's reach. Unattended kids are most likely to be injured when they try to climb out of carts when an adult is not watching.
* Create no parking zones. Park the cart away from piled up displays that can very easily be toppled by a toddler's inquisitive reach.

* Make them walk. Don't let older siblings ride on the cart. This is another common cause of cart tipover. 

* Get some help. Look for stores that offer secure pickup areas so you don't need to push your cart through a bumpy parking lot. 

* Kick the cart. The American  Academy of Pediatrics® recommends that parents avoid transporting children in a cart whenever
possible. Current safety standards for U.S. shopping carts don't address tipovers or the adequacy of cart restraints. It may be difficult, but arranging to go shopping without your child is the safest way to avoid cart injuries.


DIARRHEA IN INFANTS: IS IT ROTAVIRUS?
Diarrhea happens occasionally to most infants. Sometimes, however, it can be the result of a serious ­ and potentially dangerous -- infection of the intestines. Rotavirus, a viral infection, is the most common cause of severe diarrhea in infants and young children in the U.S. It is also common: every kid in the U.S. is likely to be infected at least once with the virus by age 5. Winter is prime time for the infection; rotavirus cases increase each winter and spring.


Most kids will recover on their own from the virus, but others may require hospitalization as a result of severe vomiting, diarrhea and loss of fluids. A newly approved vaccine called Rotateg™ can protect kids against the virus. The American Academy of Pediatrics recommends giving the vaccine to infants at two, four and six months of age. 


How can you tell if your child is infected? Contact your pediatrician if your child has these symptoms:
--Moderate-to-severe diarrhea
--Persistently high fever
-- Blood in the stool
--Vomiting
 
Since rotavirus is transferred via contaminated hands, washing your and your child's hands after diaper changes can slow spread of the disease.


The bottom line: Seek medical advice if your child has moderate-to-severe diarrhea.

For more information: http://www.chop.edu/consumer/jsp/division/generic.jsp?id=83771


Reviewed by: Patrick S. Pasquariello Jr., MD

ABOUT THE CHILDREN'S HOSPITAL OF PHILADELPHIA..Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked today as the best pediatric hospital in the nation by U.S.News & World Report® and Child®
magazine.  www.chop.edu (c) 2007 by The Children's Hospital  of Philadelphia. All Rights Reserved.