Two Minutes until Tantrum: Kids, Technology and Transitions

If you are like most parents today, a common refrain you find yourself saying is something like this, “two more minutes and iPad time is over.” We parents give these kinds of warnings frequently—for time on the playground, for time to get ready for school, etc. We think they are helpful because they give the child some warning that a transition is about to happen.

Technology-transitions-and-toddlersWell, it turns out, that in the case of technology and preschoolers, these warnings of the end of tech time, may actually make matters worse. A recent study examined just this issue to see if the “two-minute warning” helped or hindered kids’ transition to another activity.

The study was small (28 families) but it considered quite a lot of detail of how families of toddlers and preschools managed screen time (including TV, iPad, phones, tablets). One notable finding was that families reported that the majority of the time (59%) transitions away from technology actually went quite well, with the child responding in a neutral way. Parents reported that about 22% of the time, children had a negative reaction to the end of screen time.

The research clearly showed, however, that these negative reactions occurred most commonly when the parent gave the “two-minute warning” regarding the end of screen time. The researchers examined the data many ways and controlled for other factors and this finding still held true.

Interestingly, when the end of screen time was part of a regular routine, it was met with less resistance from the child.  For example, if the child knows that the iPad always goes off once breakfast is ready, then they were much less likely to resist this transition. This information is very helpful as a parent. We all know that kids usually respond best and thrive in the context of routines. It turns out that routines regarding the use of technology seem to work best as well.

The other situation in which children resisted the end of screen time least was when it was in the content of a natural end or transition in the video or game they were using. So, for instance, if screen time was stopped at the end of a TV show or after the finishing of a game, children tended to respond much more positively.  This is also informative for both parents and technology developers. If parents can time the end of screen time at a natural stopping point, transitions will likely go much smoother. Similarly, if technology developers could add features to allow parental control options to time at the end of a show or game, this could turn out to be a very useful feature.

In the end, children in the toddler and preschool age often struggle with transitions of many types. They are at an age, when their burgeoning independence is developing and they have limited self-control. As a parent, this is difficult at times, but it’s helpful to know that routines, in many forms, can help ease the struggle. Kids of all ages have to learn when and where it is appropriate to use technology and routines can help with this learning process. Just as children eventually learn to eat with utensils, not to put their feet on the table, and all number of other household rules, they will eventually learn (with parents’ help) the guidelines for your household’s technology use as well.

See the full study here:

http://media.wix.com/ugd/a0f093_d8ef5b72642c43279e3a2bc09187bd5b.pdf

Study: Iron Pills in Pregnancy Cut Low Weight Births

“Daily iron in pregnancy reduces small baby risk,” BBC News reports, with a similar story in the Daily Express.

The news stories follow a major review of the best available evidence on the link between use of iron supplements during pregnancy, and pregnancy and birth outcomes.

The pooled results suggest that, compared with no supplements, taking iron supplements increases the mother’s haemoglobin levels, and halves the risk of the mother becoming anaemic during pregnancy.

Supplements also resulted in the baby being on average 41.2g heavier at birth and reduced the risk of low birthweight by 19%. The findings showed a dose-response relationship, with higher doses being associated with lower risk of maternal anaemia and lower risk of low birthweight.

Different Types of Anaemia

baby boy on weight scaleThere are several different kinds of anaemia, with iron-deficiency anaemia being the commonest. However, anaemia can also be caused by vitamin B12 or folate deficiency.

Overall, this offers evidence to back iron supplementation during pregnancy. However, this review focussed on low, middle and high income countries. Women do need increased iron during pregnancy, but in the UK, should be able to get all the iron they need in their diet (such as from leafy vegetables).

Currently, iron supplements are recommended if pregnancy blood tests show that the mother is anaemic. They are not routinely offered to all pregnant women due to the potential for side effects. Folic acid supplements are, however, recommended while trying to conceive and during the first 12 weeks of pregnancy.

Where did the story come from?

The study was carried out by researchers from Harvard School of Public Health, Harvard Medical School and Imperial College, London. Funding was provided by the Bill and Melinda Gates Foundation. Additional support came from the Saving Brains Program, Grand Challenges Canada Grant.

The study was published in the peer-reviewed, British Medical Journal.

The news stories provide a representative view of the findings.

What kind of research was this?

This was a systematic review and meta-analysis. It pooled the results from randomised controlled trials and observational cohort studies that examined the relationship between use of iron supplements during pregnancy, and pregnancy and birth outcomes.

The researchers say that iron deficiency is the most common cause of anaemia during pregnancy worldwide. Because of this, the World Health Organization recommends the use of antenatal iron supplements in low and middle income countries, and it is also recommended in some high income countries.

Observational studies are said to have found suggested links between iron deficiency anaemia and premature birth, and clinical trials have given inconclusive results on the link between iron levels and birth outcomes.

This review aimed to address this question by identifying all observational studies and clinical trials investigating the issue, and pooling the results in meta-analysis to see whether there is a link between use of iron supplements during pregnancy and haemoglobin levels in the mother and birth outcomes. A systematic review is the best way to examine the current evidence related to this issue.

What did the research involve?

The researchers conducted a search across medical databases up to May 2012, including randomised controlled trials in pregnant women investigating the use of daily oral iron or iron and folic acid supplements compared with inactive placebo pill or no treatment.

They excluded trials that investigated multiple vitamins or minerals, or in women with significant illnesses (such as mothers infected with HIV). Trials were required to have examined maternal outcomes such as anaemia (defined as haemoglobin <110g/l) and iron deficiency (defined as serum ferritin <12 micrograms/l), and birth outcomes, such as premature birth, birthweight and infant death around the time of birth.

Their search also included observational cohort studies that prospectively followed the association between baseline anaemia and birth outcomes.

The researchers assessed the quality of included studies, and pooled their results where possible, taking into account the differences between the findings of the individual studies (heterogeneity).

What were the basic results?

Findings from clinical trials

The researchers identified 48 randomised controlled trials (27 in high income countries and 21 in low/middle income) which included a total of 17,793 pregnant women.

Most of these trials (34) compared the use of daily iron supplements to no iron or placebo. Others compared iron in combination with folic acid to no treatment, or iron in combination with other micronutrients to the micronutrients without iron.

The dose of iron in the majority of included trials ranged from 10mg to 240mg daily. Duration of supplementation varied from seven or eight weeks through to 30 weeks during pregnancy.

When they pooled the results of 36 of these trials, they found that iron supplements increased the mother’s haemoglobin concentration by an average difference of 4.59g/l compared with the control groups (95% confidence interval (CI) 3.72 to 5.46g/l). Heterogeneity between these trials was non-significant, suggesting that all trials gave broadly similar results. When they pooled the results of 19 trials they found that iron supplements (with or without folic acid) significantly reduced the mother’s risk of anaemia by 50% (relative risk (RR) 0.50, 95% CI 0.42 to 0.59).

However, there were significant differences (heterogeneity) between these trials, suggesting that the results of the individual trials were quite different from each other for this outcome. When the researchers pooled trials looking at other markers of anaemia, eight trials also found that iron supplements (with or without folic acid) reduced risk of maternal iron deficiency by 41% (RR 0.59, 95% CI 0.46 to 0.79), and six trials found they reduced risk of iron deficiency anaemia by 60% (RR 0.40, 95% CI 0.26 to 0.60).

The researchers estimated that for every 10mg increase in iron intake per day, up to 66mg/day, the risk of maternal anaemia decreased by 12% (RR 0.88, 95% CI 0.84 to 0.92).

  • When they looked at trials examining birth outcomes they found that iron supplements led to a 19% reduction in risk of having a low birthweight baby (RR 0.81, 95% CI 0.71 to 0.93 from the pooled results of 13 trials).
  • They found that babies whose mothers were given iron supplements were an average 41.2g greater weight than babies of mothers not given iron (95% CI 1.2 to 81.2g difference). This was from the pooled results of 19 trials, which again did have quite high heterogeneity, suggesting that the results of the individual trials were quite different from each other.
  • They estimated that for every 10mg increase in iron intake per day, birthweight increased by 15.1g (95% CI 6.0 to 24.2g) and risk of low birthweight baby decreased by 3% (RR 0.97, 95% CI 0.95 to 0.98).
  • Iron supplementation was not found to have an effect on the risk of premature birth.

Findings from observational studies

Forty-four cohort studies were included (22 from high income countries), including 1,851,682 women. Anaemia was said to be variably defined by these studies, and measured at different times during pregnancy.

The pooled results of six of these observational studies found that anaemia during the first or second trimester of pregnancy was associated with a 29% higher risk of low birthweight baby (odds ratio (OR) 1.29, 1.09 to 1.53), but no significant association when considering only studies from high-income countries (OR 1.21, 95% CI 0.95 to 1.53).

Seven studies found that anaemia during the first or second trimester was associated with a 21% higher likelihood of premature birth (OR 1.21, 95% CI 1.13 to 1.30). The association between third trimester anaemia and premature birth was non-significant (OR 1.20, 95% CI 0.80 to 1.79), however, the results for these third trimester studies varied considerably.

How did the researchers interpret the results?

The researchers conclude that daily iron supplements during pregnancy increase maternal haemoglobin and substantially improve birthweight in a dose-response fashion, leading to a reduced risk of a low birthweight baby.

Conclusion

This was a well-conducted systematic review and meta-analysis. It looked at the findings from 48 randomised controlled trials, including almost 18,000 women, that reviewed the effects of iron supplementation during pregnancy (with or without folic acid) upon maternal anaemia during pregnancy and birth outcomes.

The pooled results of the trials provide good evidence that iron supplements increase the mother’s haemoglobin levels (by an average 4.59g/l compared with the control groups) and halve the risk of the mother becoming anaemic during late pregnancy or around the time of birth. Supplements also resulted in the baby being on average 41.2g heavier at birth and decreased the risk of the baby being of low birthweight by 19%.

The findings showed a dose-response relationship, with higher doses being associated with lower risk of maternal anaemia and lower risk of low birthweight.

There were, however, differences between the results of individual trials, possibly a result of the trials’ differing methods and included populations, meaning the risk reductions calculated may not be precise.

Evidence from observational cohort studies found an association between iron supplementation and lower risk of premature birth. However, the randomised control trials do not support this observation.

Randomised trials are the better study design to test the effect of an intervention, as cohort studies may be influenced by other confounding factors. This is because, for example, women in cohorts are choosing to take supplements, and their choice may be associated with other improved health and lifestyle factors, such as better diet, that improve outcomes for mother and baby.

The researchers acknowledge a further limitation of their review: that they lacked data for some outcomes (such as stillbirths, newborn illnesses and early death).

Overall, the study provides evidence to support the use of iron supplementation during pregnancy. However, the results of this review covers low, middle and high countries. It is true that women need increased iron during pregnancy, but woman should be able to get all the iron they need through their dietary sources (such as from leafy vegetables).

Current UK guidance recommends that iron supplements are considered if pregnancy blood tests show that the mother is anaemic. But iron supplements are not offered routinely to all pregnant women due to the potential for side effects. Folic acid supplements are, however, recommended while trying to conceive and during the first 12 weeks of pregnancy.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Daily iron in pregnancy reduces small baby risk,” BBC News reports, with a similar story in the Daily Express. The news stories follow a major review of the best available evidence on the link between…

Links to Headlines

Links to Science

  • Haider BA, et al. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. Published online June 21 2013





Child Health & Safety News Roundup: 07-18-2016 to 07-24-2016

twitter thumbIn this week’s Children’s Safety News: How to Report Social-Media Harassment: A Practical Guide https://t.co/L8tqNHnoYI

Welcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use Twitter and Facebook to communicate relevant and timely health and safety information to the parents, medical professionals and other caregivers who follow us. Occasionally we may miss something, but we think overall we’re doing a pretty good job of keeping you informed. But for our friends and colleagues not on Twitter or FB (or who are but may have missed something), we offer you a recap of the past week’s top 20 events & stories.

PedSafe Child Health & Safety Headline of the Week:
Can Pokémon Go get you in trouble?  https://t.co/Np3Mt89PFR

Ghostbusters is Sensory Friendly Tomorrow at AMC

New sensory friendly logoAMC Entertainment (AMC) and the Autism Society have teamed up to bring families affected by autism and other special needs “Sensory Friendly Films” every month – a wonderful opportunity to enjoy fun new films in a safe and accepting environment.

The movie auditoriums will have their lights turned up and the sound turned down. Families will be able to bring in snacks to match their child’s dietary needs (i.e. gluten-free, casein-free, etc.), there are no advertisements or previews before the movie and it’s totally acceptable to get up and dance, walk, shout, talk to each other…and even sing – in other words, AMC’s “Silence is Golden®” policy will not be enforced during movie screenings unless the safety of the audience is questioned.

Does it make a difference? Absolutely! Imagine …no need to shhhhh your child. No angry stares from other movie goers. Many parents think twice before bringing a child to a movie theater. Add to that your child’s special needs and it can easily become cause for parental panic. GhostbustersBut on this one day a month, for this one screening, everyone is there to relax and have a good time, everyone expects to be surrounded by kids – with and without special needs – and the movie theater policy becomes “Tolerance is Golden“.

This month, AMC and the Autism Society’s “Sensory Friendly Film” are offering the chance to see Ghostbusters on Tuesday, July 26th at 7pm local time. Tickets are $4 to $6 depending on the location. To find a theatre near you, here is a list of AMC theatres nationwide participating in this fabulous program (note: to access full list, please scroll to the bottom of the page).

Coming in August: Suicide Squad (Tues, 8/9); Pete’s Dragon (Sat, 8/13 & 8/27); War Dogs (Tues, 8/23)

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Editor’s note: Although Ghostbusters has been chosen by the AMC and the Autism Society as this month’s Sensory Friendly Film, we do want parents to know that it is rated PG-13 by the Motion Picture Association of America for supernatural action and some crude humor. As always, please check the IMDB Parents Guide for a more detailed description of this film to determine if it is right for you and your child.

4 Easy Ways to Raise Caring Kids

Teaching-kids-to-communicate.jpgI was flying on a five-hour flight to Orlando and heard a bizarre sound: silence! The plane was packed with kids, but none were talking and then I realized why: they were all plugged into a digital devices. I’m sure we’ve all seen the same scene in restaurants, shopping malls and sporting events. Common Sense Media reports that the average school-age child is now plugged-in about seven and a half hours a day. Thirty-nine percent of two to four year olds use a smartphone, MP3 or tablet! There’s no doubt that those gadgets are parent sanity savers and will expand our children’s cognitive abilities. But as an educational psychologist my concern is how all that plugged-in and limited face-to face time may reduce our children’s people skills and most especially empathy–the ability to feel with another.

The ability to empathize affects our kids’ future health, wealth, happiness and academic success. It also helps build healthier relationships, resilience, and motivates our kids to care. Empathy can be nurtured, but the best ways to do so are always face to face.  Here are four strategies from my new book, UnSelfie: Why Empathetic Kids Succeed in Our All-About-Me World, that will help us raise caring kids who have the people skills to thrive and survive in today’s plugged-in world.

  1. Boost emotion literacy. A crucial people skill is the ability to read emotions. Emotional literacy is also crucial for developing empathy. After all, how can you care about or comfort them if you don’t realize how they feel? This first skill is simple to teach: just find natural ways to use feeling words with your kids. Start by naming the emotion you think your child feels: “You seem sad.” Or: “Do you feel happy?” Then help her read emotions by pointing out other people’s facial expressions, voice tone and body language: “Look at Daddy’s slumped shoulders. How do you think he feels?” Use books and films as well: “Look at Dumbo. How does he feel that everyone is teasing him about his ears?” Finally, activate her empathy to care: “If you think Sally is sad, how can you help?”
  2. Teach sharing. Without the ability to share and take turns, your child’s people skills and empathy quotient will be greatly jeopardized. But instead of telling your young child to share, show how. Get on the floor and gently roll a rubber ball back and forth between you. As you do, say: “My turn, now it’s your turn. Roll it back to Mommy.” Your child will begin to get the idea that sharing means taking turns with friends. For older kids, dust off those old game boards such as Monopoly, Clue, Chutes and Ladders, Checkers then graduate to playing catch, Frisbee, video games, and ultimately work projects in the home, yard, or community so he gets the idea that life is a “We” and not “Me” affair.
  3. Teach eye contact. Eye contact is how kids learn to read people’s emotions, so face your child and be at eye level when you communicate. Then teach one essential people skill: “Always look at the color of the talker’s eyes.” The simple rule helps kids use eye contact and pick up on other’s facial expressions, voice tone, and emotional cues. Holding eye staring contests to see how long family members can maintain eye contact without breaking their stare is a fun way to help kids feel more comfortable looking at one another.
  4. Teach good listening. A key skill that boosts empathy, people skills and school success is listening. Our digital natives often need to learn to focus on what others are saying. Just teach these four listening skills. The best way is by showing (not telling) the child what it looks and sounds like. Model each step with your child so he will copy your example. Practice each step until he can use it without your guidance, and then add the next step and the next. Younger children or those with shorter attention spans will need lots of gentle reminders. Teach at the pace that works best for your child. The acronym “SALE” helps older children recall each part).
  • S Sit or stand still so you pay attention to the speaker. It lets the person know you care about his thoughts and feelings and helps you be a good friend.
  • AAcknowledge the speaker. Let the person know you are listening by saying: “I see.” “Oh.” “I didn’t know that.” You can also nod and smile to show you care.
  • L Look and listen for how the speaker feels in his facial expressions, voice tone and body language. If you think you recognize the feeling, say it. “So you’re mad.” “You look happy.” Your friend will tell you if you’re right or not.
  • E Eye to eye. To help your child stay focused, look at the color of the talker’s eyes. After all, you can’t learn to listen unless you are tuning in.

The best moments to nurture empathy and teach people skills are usually not planned – they just happen. Capitalize on those moments to help your child understand the power that “feeling with others” can have.

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UnSelfie 140x210Teens today are 40 percent less empathetic than they were thirty years ago. Why is a lack of empathy—along with the self-absorption epidemic Dr. Michele Borba calls the Selfie Syndrome—so dangerous? First, it hurts kids’ academic performance and leads to bullying behaviors. Also, it correlates with more cheating and less resilience. And once children grow up, it hampers their ability to collaborate, innovate and problem-solve—all must-have skills for the global economy. The good news? Empathy is a trait that can be taught and nurtured.  UnSelfie is a blueprint for parents and educators who want activate our children’s hearts and shift their focus from I, me, and mine… to we, us, and ours.  It’s time to include “empathy” in our parenting and teaching!  UnSelfie is AVAILABLE NOW at amazon.com.

Saturday, Ice Age: Collision Course is Sensory Friendly at AMC

New sensory friendly logoSince 2007,  AMC Entertainment (AMC) and the Autism Society have teamed up to bring families affected by autism and with other special needs ”Sensory Friendly Movie Screenings“ – a wonderful opportunity to enjoy their favorite “family-friendly” films in a safe and accepting environment.

The movie auditoriums will have their lights turned up and the sound turned down. Families will be able to bring in snacks to match their child’s dietary needs (i.e. gluten-free, casein-free, etc.), there are no advertisements or previews before the movie and it’s totally acceptable to get up and dance, walk, shout, talk to each other…and even sing – in other words, AMC’s “Silence is Golden®” policy will not be enforced during movie screenings unless the safety of the audience is questioned.

Does it make a difference? Absolutely! “It can be challenging enough to bring ANY child to a movie theater” says PedSafe Special Needs Parenting Expert Rosie Reeves. Ice Age Collision Course“For a parent with a special needs child attempting an outing like this may seem overwhelming. And yet getting out, being with the community and sharing in an experience with an audience can be invaluable for just such children”.

On Saturday July 23rd at 10am local time, Ice Age: Collision Course will be screened as part of AMC and the Autism Society “Sensory Friendly Movie Screenings” program. Tickets are $4 to $6 depending on the location. To find a theatre near you, here is a list of AMC theatres nationwide participating in this wonderful program (note: to access list, please scroll to the bottom of the page).

Coming July 26th: Ghostbusters

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Editor’s note: Although Ice Age: Collision Course has been chosen by the Autism Society as this month’s Sensory Friendly screening, we do want parents to know that it is rated PG by the Motion Picture Association of America for mild rude humor and some action/peril. As always, please check the IMDB Parent’s Guide for a more detailed description of this film to determine if it is right for you and your child.