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Kids Need Child-Driven Playtime

By: The Kid's Doctor Staff
Updated: January 26, 2012
Remember playing outside with your friends after school and on the weekends?  These days you're more likely to find a child in the house on the computer, or at a scheduled sports event. Research suggests that the lack of adult-free outdoor playtime may have serious consequences for a child's development and mental health.

There was a time, not too long ago, that parents encouraged their kids to get out of the house and "go play." Today, many parents are so involved in their children's lives that kids are not being allowed the freedom to have unsupervised play.

So what's keeping kids indoors? Experts say many parents are afraid. They worry that their child might be abducted, hit by a car or bullied.  All this involvement is not easy on parents either. Many feel as if they are running on a treadmill trying to keep with all the activities that are scheduled. There is also a concern that their child may fall behind some arbitrary line that points toward success.  There is considerable pressure on families to participate in this hurried lifestyle. Free child-driven play known to benefit children is decreased, and the downtime that allows parents and children some of the most productive time for interaction is at a premium when schedules become highly packed with adult-supervised or adult-driven activities.

"Into the 1950s, children were free to play a good part of their childhood. If you stayed in your house around your mom, she'd say 'go out and play.' The natural place for a kid was outside," said Peter Gray, a research professor of psychology at Boston College.

"Today, it's quite the opposite. Parents are not allowing kids the freedom to play. And even if they do, there are no other kids out there to play with, or the mother may have such restrictions on the child, such as 'you can't go out of the yard' that the kids don't want to stay out there," added Gray.

The importance of play:
When children are allowed to play, several things start happening. They make-up games - using their creativity skills, negotiate rules - using their personal interaction skills, and solve problems on their own- using critical thinking skills.

Theses are all attributes that can serve them well as they grow older.

Through free play, "they are acquiring the basic competencies we ultimately need to become adults," said Gray, author of two studies published recently in the American Journal of Play.

Research has also shown that today's highly supervised children are more likely to experience anxiety, depression, feelings of helplessness and narcissism, all of which coincides with a decrease in play and more monitoring and managing of children's activities by parents.

Peter LaFreniere, a professor of developmental psychology at the University of Maine, writes in a separate article, that boys - in particular - need some rough and tumble play to help teach them how to control their emotions. Boys learn that if they want to keep their friend, they can't let things go too far or truly hurt the other child -- a skill that helps boys grow into men who keep aggression and anger in check, LaFreniere said.

"It's better to make the mistakes when you're 4," he said. "Children learn there are consequences to their actions; they learn to regulate the aggression even in the heat of the moment."

There are certain circumstances in which children should probably not play outside unsupervised. High crime areas are not safe for children to be in without the watchful eyes of a parent.

It would be wrong to assume that the current trends are a problem for all children; some excel with a highly driven schedule. Because we need skilled young people to be well prepared to be tomorrow's leaders, we must recognize the advantages to the increased exposures and enriched academics some of our children are receiving. In fact, many of our children, particularly those in poverty, should receive more enrichment activities. But even children who are benefiting from this enrichment still need some free unscheduled time for creative growth, self-reflection, and decompression and would profit from the unique developmental benefits of child-driven play.

There has been a significant increase in studies; discussions and articles on the positive affects of child-driven playtime, but a decrease in the amount of time kids are actually playing.

One survey Gray cited asked a nationally representative sample of parents to keep track of their kids' activities on a randomly selected day in 1981 and another in 1997. The researchers found that 6- to 8-year olds of 1997 played about 25 percent less than that age group in 1981.

Another study from about a decade ago asked 830 U.S. mothers to compare their children's play with their own play when they were kids. While about 70 percent of the mothers reported playing outdoors daily as children, just 31 percent said their own kids did. Mothers also said when their kids played outside; they stayed outside for less time. If anything, that trend has accelerated in the ensuing decade, Gray said.

Hara Estroff Marano, author of "A Nation of Wimps: The High Cost of Invasive Parenting." offers a rather harsh assessment of today's parents. "The home of the brave has given way to the home of the fearful, the entitled, the risk averse, and the narcissistic," Marano said. "Today's young, at least in the middle class and upper class, are psychologically fragile," Marano said in an interview published in the journal.

Marano believes that parent's dominated by fear, are raising children unable to cope with life's ups and downs because they have no experience doing so.

The American Academy of Pediatrics also promotes the benefits of child-driven playtime. While academics and social-enrichment programs are important; play is a cherished part of childhood that offers not only fun and relaxation for children, but great developmental benefits as well.

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So, this 2 year old complained that his leg hurt. Enough pain that he limped and woke up at night crying that his thigh hurt. He had no history of trauma and also was otherwise well, in other words no fever, vomiting, cold symptoms etc.

After several days of watching him without resolution of his pain the mother noticed 3 little spots on his thigh, which she thought might be a bite. The little boy was seen and the diagnosis of herpes zoster (shingles) was considered.  In children the differential diagnosis of localized leg pain in the absence of a rash would not normally include shingles.

According to the pedi dermatologist (that I consulted) shingles in children occurs more frequently on their lower extremities (not for adults) and may involve the back on the same side.   Unlike adults, most cases of zoster in children are only mildly painful and resolve fairly quickly.

Well, this little boy didn't read the book and his rash continued to get worse and spread, and was quite painful for days. Prior to this, he was a perfectly healthy little boy and had received his first varicella vaccine when he was 1.  

Since the widespread use of the varicella vaccine (chickenpox vaccine, see old post), the incidence of chickenpox has decreased dramatically, and vaccination should also reduce the risk of developing shingles later in life. In otherwise healthy children shingles (zoster) tends to develop at a younger age among vaccinated children than in those who have had a natural chickenpox infection.  When shingles occurs after vaccination it represents either a new infection with wild-type virus (an exposure to chickenpox or shingles) or reactivation of the vaccine virus.

Once a child has received 2 doses of varicella vaccine as recommended, the immunity is boosted and should further reduce the risk of developing shingles. Varicella zoster virus can be transmitted via contact with skin lesions of those who have either chickenpox or shingles.  Infection is less likely after exposure to shingles. Transmission of the virus occurs until all lesions have crusted over. In this case, the little boy was ultimately started on an oral anti-viral therapy with slow resolution of his rash and pain and a return to normal around his house.

Note to self, weird pain may precede the rash in herpes zoster by several days.  Even though unusual, herpes zoster may occur in a healthy child who no history of varicella exposure and who has received all or part of their chickenpox vaccine.

That's your daily dose for today. We'll chat again tomorrow.

Kids Injured, Dying From Dangerous Stunts

Millions of people watch YouTube and other social media videos. There's everything from music to medical procedures, comedy clips and cooking shows you name it and there's a video for it.

There are also videos showing teens and pre-teens choking each other and beating each other to a bloody pulp. These are videos that encourage dangerous and sometimes deadly games. It appears the more outrageous you can be, the bigger audience you'll have.  Unfortunately a lot of kids end up in emergency rooms or worse, dead.

Last week a 15-year-old boy died while copying a YouTube video he and his friends had seen. While standing, he passed out, and fell forward crashing into an empty drinking glass. His collarbone broke the glass and a shard sliced through his interior and exterior jugular vein. He died shortly after arriving at the hospital. It's called the choking game.

The asphyxiation-to- get-high videos are popular with young adults, teens and even preteens.

Other popular games include jumping off a moving vehicle, salt and ice, extreme fighting, the cinnamon challenge and hitting someone over the head with a folding chair.

Dr. Thomas Abramo, the chief of pediatric emergency medicine at Vanderbilt University Medical Center, said he sees all of it in his ER. Although teens have acted on risky behavior fads throughout his 30-year career, he said he's seeing trends catch on faster than ever before, and he thinks it's because of YouTube and social media.

"If you get one kid doing it, you tend to see more kids doing it," said Abramo, who said two of his patients have died playing the choking game. "The spread of the event is definitely faster."

One challenge that scares Abramo involves being hit on the head with a bench or a folding chair to "see if you can take it," he said. A lot of the time, they can't.

"Fractures, concussions, lacerations," Abramo said. "Just the things you would think would happen."

"Once you see some of these videos, you go, 'Oh my God,'" the doctor said. The "Darwin award" videos, which involve varying dangerous challenges, are the worst he's seen. "Survival of the stupidest. I can't believe it happens. It defies logic," Abramo said.

 YouTube says its guidelines prohibit videos that encourage dangerous behaviors, but they depend on viewers to flag objectionable posts before they are removed.

"We count on our users to flag content they believe violates the rules," a YouTube spokesman said. "We review flagged videos around the clock and remove all those that violate our policies."

That policy doesn't seem to be working very well because there are plenty of these videos to watch.

Dr. Alan Hilfer, a child psychologist at Maimonides Medical Center, said he thinks the existing videos validate risky behavior for teens and give them a way to get notoriety if they post a video. He said he hears a lot about YouTube's amateur ultimate fighting videos, which show teen fights with are no rules -- just bare knuckles.

Videos of kids self-mutilating and encouraging eating disorders are also being posted on social media sites.

However, Dr. Carol Bernstein, a psychiatry professor at New York University's Langone Medical Center, said she doesn't think YouTube alone is to blame for teens engaging in challenges that could seriously injure them because many factors are involved. She said other environmental factors, physiology, and temperament contribute to a child's decision to emulate a video.

"Stress here should be on knowing our children, watching behaviors and having conversations with them," Bernstein said. "There's no substitute for parents and teachers who are engaging with their kids in general."

Many parents don't know that their kids are acting out these videos until their child is injured. But not all parents are unaware.  A mother in St. Louis was arrested after posting a video of her young children beating each other.  You could hear her egging them on in the background. Fortunately she's the exception rather than the rule.

Most parents are concerned about their kids doing drugs or drinking alcohol but they should add dangerous games to the list of topics to talk to their kids about.

"Adolescence is, developmentally, a time when young people experiment with cigarettes and other behaviors that aren't so smart for their health," says John Santelli, MD, MPH, president of the American Society of Adolescent Health and a Columbia University pediatrics professor. "Some of the consequences can be pretty tragic with these dangerous games."

Webmd.com provides a list of the 7 Dangerous Games Parents Must Know About as well as tips for how parents can approach their kids about the subject.

Keep the lines of communication open and talk to your child about what videos he or she and their friends are watching. Ask them what they like about the videos to get a feel for what excites them.    

Experts suggest that you know what websites your kids are viewing and discuss stories that feature kids who have gotten hurt carrying out these types of games. Ask them what they think about this kind of behavior and listen carefully to what they say. Their answers may surprise you.

Make it a point to learn about these dangerous games. You can't protect your child from everything that our high-tech society is throwing at them, but understanding what is going on in their teen and pre-teen world can help you be aware of what may be trying to influence them. That's a start.

Sources: http://abcnews.go.com/Health/dangerous-stunts-youtube-hurting-killing-teens/story?id=17342485#.UGZxZbQuqcN

http://www.webmd.com/parenting/features/dangerous-games-parents-must-know-about

Treatment Strategies for Bedwetting
The best way to attack the problem of bedwetting begins when you and your child have had a discussion about their feelings related to bedwetting. This often happens as they get older and continue to have problems with bedwetting and they are anxious or embarrassed. If you bring up the subject and they would rather just wear a pull up at night, and go back to playing outside rather than discuss strategies for staying dry, it is not time to tackle the issue. Timing is everything! As you start to discuss strategies to stop bedwetting, begin with having your child keep a calendar of their dry nights. This gets them involved and gives you an idea of their level of commitment. Then start setting their alarm clock to awake them in the morning and see if they can get up on their own. If the alarm doesn't wake them up for school it is probably not going to awaken them in the middle of the night. Remind them to recognize their need to go to the bathroom during the day too, and have them go every several hours to feel the sensation of their bladder filling throughout the day. Many of these kids are infrequent voiders during the day and have actually stretched their bladder wall and hypertrophied the bladder muscle. Lastly, make sure that they are not constipated and put them on something like Miralax to ensure that they do not have stool that also compresses the bladder (the colon sits right above the bladder and can push on the bladder). Talk about a reward system that they would like to use while working on the problem. It doesn't have to be a major reward, small things work equally well. I think the rewards should be given by the week, rather than the day. I also give rewards for effort, not just for dry nights. Trying is the whole idea. Sometimes the brain and bladder are just not ready and you do not want your child to feel defeated even though they have tried their hardest. If all of this is successful it is then time to set up a bedwetting alarm system (numerous ones available over the internet). The alarms consist of a bell and pad. The alarm sounds when the pad senses moisture. The alarms that actually buzz are more effective than those that only vibrate. Remember, your child is already hard to arouse and vibration alone will probably not work. Once you begin using the alarm and you hear the alarm go off, you will need to go into their rooms and call their name or shake them too, to actually get them awake and to the bathroom. In the beginning it may almost be like sleep walking them to the bathroom. Then rinse off the pad and reset the alarm and put them back to bed. Over time they should arouse more easily and the time spent awake and going to the bathroom should shorten. As you can see this is disruptive to everyone's sleep so best done over the summer or a long winter break. It often takes at least a month for bedwetting to stop and the alarm system should really be used for several more months to reinforce the process. There is also a drug call DDAVP that works on the kidneys to reduce the flow of urine. This medication works when given but does not cure the problem. I often use this for children who are worried about a camp or overnight experience, before they have started the alarm system regimen. It has not been shown to be as effective as the alarm system, but in difficult cases I have used it in conjunction with the alarm system. You might want to discuss the pros and cons of this drug with your pediatrician. Remember this takes time, motivation and determination on both the parent and child's part. Remain positive and optimistic throughout the training process. It is not a sprint but a longer race, and don't expect overnight success. Remind them of their other childhood accomplishments and that with time and determination they will be successful with bedwetting too. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!
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