Monthly Archives: April 2012


How much sexual activity is going on in middle school? There is some, but not as much as you would think if you only listened to news reports and the scores of rumors that make the rounds among parents. But the truth is that there really is no hard data on sexual activity in this age group. Some studies estimate that 20% of young teens (under the age of 14) have engaged in some form of sexual activity. But according to Dr. Elizabeth Rose, an adolescent medicine specialist practicing in New Jersey, the studies are anything but conclusive or accurate. Reliable large-scale studies have just not been done. In her own experience in her suburban practice, “All the kids are talking about it, but very few are actually doing it.”

So as a parent of a middle school student, what should you do? You want to discuss this with your child, but you don’t know how? And should you bring this subject up at all?

The answer, according to Dr. Rose is yes. Throughout their school they are hearing about it and many kids are very anxious about it. Many of them are not ready for physically or emotionally for any sexual activity. We may call them Tweens, but developmentally, kids in this age group are more like children, than teenagers. And remember, even in the studies that have been done, 80% of middle school students are not sexually active in any way. So this is frightening for many young teens especially those aged 9-12 many of whom have barely hit puberty. The most important thing that parents, doctors, and health educators can do is to help dispel the myths and relieve these fears.

Remember, the media has saturated your young teens world with sexual images and references. Television, Movies, and Music have had increasing levels of sexual content for some time, but it is the Internet and social media that has brought this content even closer to your children on their computers, their iPads, and their smart phones. They are constantly exposed to a culture with a level of sexuality that is unprecedented. And they are not ready for it. I remember my daughter at the age of 12 coming to me and complaining with a sigh, “Mom, why is everything about sex?” I couldn’t give her an answer, but I remember it led to a good talk.

So how do you begin the conversation?

Pick the right moment,
While driving in the car, you have a captive audience, and even if a child doesn’t look at you he or she may be listening. Or while watching TV with your child (which I highly recommend) look for examples on TV to bring a subject up. (There will be plenty of opportunities if you watch programming for teens)

How do you start the conversation?
Always start by asking about other kids, it’s a safer starting point. For example, “I read something today that bothered me and I want to get your opinion.” Or “I was wondering do kids in your class actually date?” or “Do any of your friends have (girlfriends or boyfriends)?”

How do you get into the tricky stuff?
Once the conversation has started, be direct. Start with something like: “Do you know what sexting is?” “Do you know if this is something that some kids are doing in your school?” Then you can move into other areas such as questioning them about their knowledge of oral sex or intercourse. When I asked patients in my practice these questions, as pediatricians and adolescent medicine doctors are trained to do, the answers were very similar. “Yeah I heard some rumors but I don’t know anyone who was really doing it.” When I would ask how do you feel about this? Often the answers were, “It makes me nervous” “I don’t want to go out with boys because I don’t want to do that” “I think it is gross. “These kids needed to vent their anxiety and were relieved if I told them they were in good company.

Then what do you do?
First of all, make sure they have all the correct information. It’s very common for kids to get the facts all wrong. For example, according to Dr. Rose, many teens do not believe that oral sex is a form of sex or that they can get sexually transmitted diseases if they engage in this. Once you are sure they have all the facts, ask their opinion about the issues. Be sure to listen, and then express your own opinion. Allow room for discussion. Reassure your child that not everyone is doing this. If the talk leads to other issues about sexuality, consider yourself lucky. If your child doesn’t respond, just give them some time to digest the information.

What role can your doctor play?
Most pediatricians are trained to discuss these issues with your child beginning at age eleven or twelve. You will probably not be in the room. Your pediatrician will discuss these issues in a responsible and age appropriate way with your young teen. If you know that your child has been engaging in early sexual behavior or if you are having more serious problems, your pediatrician can refer you to an adolescent medicine specialist, like Dr. Rose, who has even more extensive training with adolescents.

But having a pediatrician or adolescent specialist speak to your child is not a replacement for a parent conversation. Statistics do show that kids, who are involved with their families, are less likely to engage in early sexual activity. It may be a conversation that’s hard to start, but the unspoken message to your child will be: that you understand, you care, and you are there.

What is inbeTWEEN?

What happened to middle childhood? You thought you would have a few more years before your child became a teenager. But suddenly your nine or ten year old is dressing like Miley Cyrus or wants Justin Bieber’s hair cut and is giving you “attitude” about everything. You hear your child talking about things you probably didn’t even learn about until you were much older. You have a TWEEN.

A TWEEN is a child between the ages of nine and thirteen. They are half child and half teenager. Very inbeTWEEN the age groups developmentally. It used to be a time when kids were just still kids and the real teen years didn’t start until age thirteen or even fourteen. But today our society is putting a lot of pressure on this age group to grow up quickly. Just look at the advertisements, the TV shows and movies, and the music aimed at this age group. Then add the internet, social media, You Tube, sexting, and cyberbullying. This list increases daily of how your child’s world can be invaded and their “childhood” prematurely ended.  Your child is experiencing pressures that previous generations did not have.

But the truth is your child is really not ready for all of this. So it’s important for you to understand what is happening to your child now and how you can help him or her to cope with all of these pressures.

What is happening to your tween?
PHYSICAL CHANGES: Normal puberty can begin any time after age nine. Most tweens will have some pubertal changes in the years between 9-12, but this will vary depending on your family history.
But there may be hormonal changes before the physical changes. This accounts for some of the mood swings and even some of the “attitude” you may suddenly be experiencing.

PSYCHOLOGICAL CHANGES: Tweens are still very concrete thinkers, and not very analytical. They see the world in black and white. It is difficult for them to change their opinions. They will often read something and believe it and they will tend to believe peers over adults.

EMOTIONAL CHANGES: Tweens are beginning the stage of separation and individuation and are frustrated by their dependence on you. If this sounds familiar, remember the terrible two’s. This is a return of the negativity that you experienced many years ago as your toddler tried to do everything by him or herself.

What pressures are affecting your tween?
PUBERTY: Tweens experience a great deal of anxiety about the physical and emotional changes they are experiencing. and they are confused about sex and sexual issues. They may be concerned about developing too early or too late.

PEERS: Within their peer group they may be having trouble with friends who may shift alliances, cliques that threaten exclusion, teasing and meanness, and at the same time they may be having their first “crush”.

SCHOOL AND EXTRACURRICULAR ACTIVITES: Some kids are feeling pressure about college or careers at a much younger age. At the same time schoolwork is suddenly more demanding. Add to this pressure from extracurricular activities, and intense sports or artistic training, after school jobs or volunteer work.

FAMILY: family responsibilities, relationships with siblings, struggles over privacy and the inner struggle with their own feelings of dependence and independence.

MEDIA: Now add a media and advertising world that is aimed at their insecurities, and packaged for their “concrete ” thinking. Make no mistake about it. Your children are the target of a sophisticated industry that understands your TWEEN psychologically and emotionally better than most parents and teachers. And the media now invades in subtle and not so subtle ways using social media and technology that reaches right into your child’s cell phone.

What can you help your TWEEN survive these pressures?
First try to understand the physical, emotional, and psychological place your child is in at the moment. Since puberty happens at different ages for different kids, early or late puberty can be a source of concern. Your pediatrician should speak to your child and answer any questions they have about what is happening to his or her body.

Be sensitive to your child’s stress level. Try to tease out what are the greatest sources of stress for your child at this time and see if you can relieve some of this pressure or at least let them know you understand.

Don’t have unrealistic expectations. Expect your child to be civil, but not always pleasant. Don’t expect them to be present for “every” family event.

Allow for mood swings Don’t overreact- the storm will blow over quickly and then your child will not understand why you are still upset about something that happened thirty minutes ago.

Expect the “Push- Pull” :Push you away then need a hug. There will be dependency swings- “I can live on my own” to “You never do anything for me”

What’s the best way to talk to your TWEEN?
Have a family meeting to discuss your expectations about behavior For example they can say that they are angry but they cannot smash a wall.

Talking back with disrespect. Describe how that makes you feel when they do that. Make sure that they know respect is a two ways street Describe consequences for truly mean or disrespectful comments.

When you talk with your child use open -ended questions. Use car time (they can’t escape). Remember they are anxious about: growing up and the physical changes, peer relationships, expectations that everyone has for them (parents teachers, peers) sexual activity and even their own sexuality. If your tween will not talk to you about these issues, make sure your pediatrician or family physician will bring up these issued at the next check up.

Parenting Teens Successfully

adolescentThe very idea of adolescence strikes fear in the hearts of countless parents nationwide. But if your 11-13 year old child has recently entered that challenging period of development we call adolescence, don’t panic. Contrary to what popular culture suggests, adolescence is not necessarily synonymous with dangerous behavior and constant conflict.

The media would have us believe that every teenager smokes, does drugs, engages in risky sexual behavior or suffers from an eating disorder or some other “disease of the week”. The truth is that while there is certainly a percentage of teens who do have significant problems, most adolescents are healthy, happy, and actively involved in school activities, sports, and the arts. This is not to say that they will be easy to get along with at home, or won’t ever break the rules, take risks, or challenge authority — but it does mean that there’s a good chance your teen will emerge on the other side of adolescence as a healthy young adult.

Studies have shown that teens who live in households that are too strict (“my way or the highway” on all issues) or too permissive (“All teenagers drink. It’s part of growing up”) are more likely to engage in high-risk behaviors and develop more serious problems. Rather, it is the parenting strategy that falls somewhere in the middle of these two extremes that has been proven most successful. This “authoritative” parent who parents by combining love with limit setting seems to have the right balance and a strategy that best resonates with teens.

Following these guidelines can help put you on the right path to parenting an adolescent in an authoritative way.


Be a parent! Don’t try to be a “friend” to your teen. He or she has plenty of those. Your teen needs you to be strong, supportive and to set limits. Whether or not they agree or disagree with a decision, having “limits” helps them to feel safe. As a parent of an adolescent, you need to be able to tolerate your teen’s inevitable anger towards you when things don’t necessarily go their way and stick firmly by the choices you have made.

Acknowledge your teen’s individuality. Although it may be difficult, by accepting your adolescent’s choices with respect to clothing, appearance, music etc., you demonstrate respect for your teen. You are letting them know that you recognize that they are becoming their own separate person. You can still express your opinion about these matters but never ridicule their choices. Remember the phrase “pick your battles” … If you allow your teen some flexibility in these less important areas they will be less likely to act out in major ways in order to prove they are different.

Listen when your adolescent speaks. Focus on their concerns. This may be difficult if it comes at a busy moment for you, but try to allow time to really listen. Don’t offer advice unless asked directly and remember not to use every discussion as an opportunity to preach about something.

Allow your teen to express his or her opinion. Really listen and respect that opinion even if you do not agree with it. Share your own concerns, experiences, and feelings on the matter, but don’t try to win the debate.

Respect their silence. Sometimes teens just want to be alone with their thoughts. Share your day, but don’t press your adolescent to do the same. They may be listening even if they are looking out the car window. A rule of adolescent communication is that when you want to talk, you will get one -word answers, and when they want to talk, you will get volumes.

Encourage independent problem solving. Remember that college is only a few years away. If your teen brings up a problem or concern, ask what they are planning to do to solve the problem, before you jump in with advice. Praise your teen when you recognize how they solved a problem by themselves. This encourages the kind of problem solving skills and independent thinking they will soon need.

Maintain a close connection even if your teen pulls away. Regardless of what is going on in their lives, most teens still want to be connected to their families and they may even remain connected through arguments or angry tirades. This may seem like a contradiction, but it is how your adolescent can maintain a connection while pulling away at the same time. It is striking this balance between attachment and independence that is one of the central tasks of this stage of their lives.

Know your teen’s friends and try to get to know their parents. Maintain communication so that you are all on the same wavelength. Don’t be afraid to check out stories. I.e. that parents will really be home at that party.

Share meals as much as possible. Despite the hectic pace of today’s lifestyle for most families, it is still important to share family meals as much as possible. Even one weekend meal together allows for discussion of important or even unimportant topics. A recent study revealed that teens reported that sharing meals with family members was very important to them. To many parents who struggle daily with their adolescents, this news may be a shock. But it is a very revealing piece of information about teenagers – again, that despite the need to pull away, the need to be connected is even stronger.


Set clear and reasonable limits. Establish rules and “achievable” expectations and communicate these to your teen. Be very specific and concrete. Let them know that there will be consequences if they break the rules and be very clear about what those consequences will be.

Enforce the rules consistently. Do everything possible to make sure that both parents (even if living in separate households) are in agreement about rules and consequences. Even in families not affected by divorce, this will require constant communication between both parents. Teens are experts on manipulation when they sense there is disagreement on an issue.

Let teens experience the natural consequences of their behavior within reasonable safety limits. Consequences like missing assignments, being late for school, compensating someone for damaged property, or writing apologies to others when appropriate can prove valuable learning experiences for your teen. Having that said, under no circumstances should you allow a teen to enter into a dangerous or illegal situation, like driving while under the influence, for example, just to prove a point.

Share with your teen how you feel about issues that might affect his or her life. It is important to voice your opinions and concerns about issues such as smoking, alcohol and drug use, sexual activity, violence, harassment of others and destruction of property. Even if they occasionally break the rules, they will store this information somewhere in the back of their minds and it may just help influence a difficult decision when you are not there to prevent them from making a serious mistake.

Let your teen know you will be there to support (but not necessarily to rescue) him or her no matter what happens — then follow through. If they break the law or cause harm to another person or property they will have to face the consequences of their actions, but need not fear they will “lose” their parent as a result.

Grant freedom in stages. Tie increased privileges to responsible behavior. If a teen violates a rule, privileges, as well as a parent’s trust, may have to be earned back. By balancing control with independence, you maintain your right to parental authority.

Who’s In Charge?

boy-playing-soccerWe have all seen them. In a restaurant, doctor’s waiting room, the supermarket, and even in our own relative’s homes: out of control children…

We cringe at how they seem to have no respect for anyone or anything. We are horrified when we see them punch, kick, or verbally assault a parent. And we are shocked at how their parents do nothing and allow them to be destructive, rude, or aggressive. It’s easy to say you could never have a child like that. But the reality is that if you don’t act early, your child will more than likely also be out of control.

So ask yourself a few key questions: Who is in charge? Can you tolerate your child being angry with you when you set limits or discipline them? And are you afraid to discipline your child when they cross the line of acceptable behavior?

The first answer should be obvious. You must be in charge. You are the parent. Your son or daughter is the child. This is a very important concept and one that many parents do not fully appreciate. Children need to have limits set on their behavior. What’s more, they need to know that you are in control, and you are the one who has set and will enforce those limits with the help of any other caregivers in your child’s life.

How does this translate into your everyday parenting? It means being able to tolerate their protests and anger at your rules. Some parents are afraid that if they make their child unhappy, that they will not love them. And so they do everything they can to make the child happy and give in to all demands. They then become afraid to discipline them. Now who is in charge?

Discipline works when it is consistent among all caregivers, and not harsh. It is the consistency and not the severity that is effective. Children have very little self-control at this age and although they may not always act like it, they really want your help. On some level they understand that you must help them learn self control and will not let them “go wild”. They want parents to be strong. It makes them feel safe.

Here is an analogy that may help clarify this issue. In our society, we are not always happy with the decisions of our government and we may even stage a protest; however, most people still understand that we need laws to keep our society safe and will abide by the law even as they protest it. Your child is the same and really wants to be a member of their family and ultimately this society.

To successfully guide your child through the inevitable behavioral problems of the preschool years requires inner strength. Setting limits on a young child’s behavior is very important. You cannot begin this when the child is older, and most definitely not when they hit the teen years. You are the teacher of how your child will act in the world, what kind of person they will become, what type of citizen they will be and what kind of spouse or parent they will ultimately become. Remember — a wise teacher treats his or her students with respect but does not allow them to teach the class.

Feeding Solid Food

infant_feedThe American Academy of Pediatrics recommends beginning solid food between the ages of four and six months. Nutritionally, your baby does not need to eat solid foods until six months when his iron stores become depleted.

Eating from a spoon is a new experience. It may take some time before your baby learns to swallow solid food.

How do I know if my baby is ready?
Eating solid food from a spoon is a new developmental task for your baby. Some babies are ready early and others are not. There is no reason to rush. Signs of readiness include good head control, interest in your food, and a shorter time between feedings. If your baby is pushing the food out with his tongue, crying, or closing his lips, it is too early. Wait a few weeks and try again. When your child is developmentally ready, eating is an enjoyable experience for parent and child.

What should I start with?

Most pediatricians recommend starting with a simple single grain cereal like rice . The cereal should be iron fortified to help increase the baby’s iron supplies to help prevent anemia.

How should I mix the cereal?

To start, mix a tablespoon of cereal with one to two ounces of breastmilk or formula. Make the mixture more liquid in the beginning and then increasingly thicken the mixture. Most four to six month old babies will not eat more than two tablespoons of cereal (before mixing) at one feeding. After your baby is eating cereal well, try adding a little fruit to mix up the taste.

What if my baby has a reaction to a new food?

Remember to introduce only one new food at a time. Allow three to four days between new foods to make certain your baby does not have a sensitivity or an allergic reaction. Signs of sensitivity to food include vomiting, diarrhea and gas. True allergy involves the immune system. Signs of allergy in infants include skin rashes, wheezing, vomiting and diarrhea. If this occurs, you should notify your family practitioner or pediatrician right away. If your baby tolerates the new food, it can be combined with other foods that have already been introduced. For example, if you already have given rice cereal, you may add applesauce at the same meal.


Common Questions Regarding Starting Solid Food
How do I know if my baby is ready?
What should I start with?
How should I mix the cereal?
How much should the baby
What time of day should the meal be?
When should I start a second meal?
In what order should solid food be introduced?

All Babies Are Not Created Equal

2mooldwithmomI have always felt that the first two months of a baby’s life are like an extension of the nine months in the womb. They need total care and sustenance from you, and they spend most of their time sleeping .

Occasionally their eyes meet yours and a dreamy connection is made. But it is not until about two months of age that not only do their eyes open widely at the sight of your face, but they give you back something wonderful- a smile.

What an honor! A baby’s smile is the first social gesture that they make in this world. And you are the first to receive it. This is the beginning of your relationship with your baby and it signals the end of the newborn period and the beginning of infancy.

Every month your baby will grow at a rate faster than at any other time in their life besides adolescence. They will develop large muscle skills, fine motor skills, the beginnings of language, and an increasing ability to socialize with the world. When your baby first smiles it means that he or she understands that connecting with others is what life is all about.

Discovering the uniqueness of your baby is one of the joys of becoming a parent. You will soon learn that your baby is a unique combination of innate traits, genetic material, environmental influences, and something called temperament. All of these combine to form your baby’s personality — who they are and how they interact with the world and with those who share our world.

Throw away the idea that all babies are created equal. Since every baby is different from the start, what works for one baby-parent may not work for another. If you are having difficulty, it’s easy to think, “I’m a terrible parent” as you see other mothers “easily” handling their infants. But try not to get too discouraged, and don’t take it as a reflection of your skills as a parent. It is true that some babies are innately more of a challenge than others, and it may be that you have been blessed with just that – a challenge! Remember – the “easy” parent’s next baby might not be so compliant. Then they too will understand the trials, and joys, of raising a more challenging child.

You will, however, receive so much advice from so many sources that you may begin to feel unsure of yourself. Remember that because of the special bond that begins with that first smile, no one else will be able to understand your baby better than you do. Trust your instincts and keep it simple. Babies need only to be fed, kept reasonably clean, played with by you, and loved a great deal. Enjoy your baby.