Growing Up

You’ve lived through 2 a.m. feedings, toddler temper tantrums, and the back-to-school blues. So why is the word “teenager” causing you so much worry?

When you consider that the teen years are a period of intense growth, not only physically but emotionally and intellectually, it’s understandable that it’s a time of confusion and upheaval for many families.

Despite some adults’ negative perceptions about teens, they are often energetic, thoughtful, and idealistic, with a deep interest in what’s fair and right. So, although it can be a period of conflict between parent and child, the teen years are also a time to help kids grow into the distinct individuals they will become.

Understanding the Teen Years

So when does adolescence start? Everybody’s different — there are early bloomers, late arrivers, speedy developers, and slow-but-steady growers. In other words, there’s a wide range of what’s considered normal.

But it’s important to make a (somewhat artificial) distinction between puberty and adolescence. Most of us think of puberty as the development of adult sexual characteristics: breasts, menstrual periods, pubic hair, and facial hair. These are certainly the most visible signs of puberty and impending adulthood, but kids who are showing physical changes (between the ages of 8 and 14 or so) also can be going through a bunch of changes that aren’t readily seen from the outside. These are the changes of adolescence.

Many kids announce the onset of adolescence with a dramatic change in behavior around their parents. They’re starting to separate from mom and dad and become more independent. At the same time, kids this age are increasingly aware of how others, especially their peers, see them and are desperately trying to fit in. Their peers often become much more important than parents as far as making decisions.

Kids often start “trying on” different looks and identities, and they become very aware of how they differ from their peers, which can result in episodes of distress and conflict with parents.

Butting Heads

One of the common stereotypes of adolescence is the rebellious, wild teen continually at odds with mom and dad. Although it may be the case for some kids and this is a time of emotional ups and downs, that stereotype certainly is not representative of most teens.

But the primary goal of the teen years is to achieve independence. To do this, teens must start pulling away from their parents — especially the parent whom they’re the closest to. This can feel like teens are always at odds with parents or don’t want to be around them the way they used to.

As teens mature, they start to think more abstractly and rationally. They’re forming their moral code. And parents of teens may find that kids who previously had been willing to conform to please them will suddenly begin asserting themselves — and their opinions — strongly and rebelling against parental control.

You may need to look closely at how much room you give your teen to be an individual and ask yourself questions such as: “Am I a controlling parent?,” “Do I listen to my child?,” and “Do I allow my teen’s opinions and tastes to differ from my own?”

Tips for Parenting During the Teen Years

Looking for a roadmap to find your way through these years? Here are some tips:

Educate Yourself

Read books about teenagers. Think back on your own teen years. Remember your struggles with acne or your embarrassment at developing early — or late. Expect some mood changes in your typically sunny child, and be prepared for more conflict as he or she matures as an individual. Parents who know what’s coming can cope with it better. And the more you know, the better you can prepare.

Talk to Kids Early and Often

Starting to talk about menstruation or wet dreams after they’ve already begun is starting too late. Answer the early questions kids have about bodies, such as the differences between boys and girls and where babies come from. But don’t overload them with information — just answer their questions. If you don’t know the answers, get them from someone who does, like a trusted friend or your pediatrician.

You know your kids. You can hear when your child’s starting to tell jokes about sex or when attention to personal appearance is increasing. This is a good time to jump in with your own questions such as:

• Are you noticing any changes in your body?
• Are you having any strange feelings?
• Are you sad sometimes and don’t know why?

A yearly physical exam is a great time to talk about this. A doctor can tell your preadolescent — and you — what to expect in the next few years. An exam can be a jumping-off point for a good parent/child discussion. The later you wait to have these talks, the more likely your child will be to form misconceptions or become embarrassed about or afraid of physical and emotional changes.

And the earlier you open the lines of communication, the better your chances of keeping them open through the teen years. Give your child books on puberty written for kids going through it. Share memories of your own adolescence. There’s nothing like knowing that mom or dad went through it, too, to put kids more at ease.

Put Yourself in Your Child’s Place

Practice empathy by helping your child understand that it’s normal to be a bit concerned or self-conscious, and that it’s OK to feel grown-up one minute and like a kid the next.

Pick Your Battles

If teenagers want to dye their hair, paint their fingernails black, or wear funky clothes, think twice before you object. Teens want to shock their parents and it’s a lot better to let them do something temporary and harmless; save your objections for things that really matter, like tobacco, drugs and alcohol, or permanent changes to their appearance.

Ask why your teen wants to dress or look a certain way and try to understand how your teen is feeling. You also might want to discuss how others might perceive them if they look different — help your teen understand how he or she might be viewed.

Set Expectations

Teens might act unhappy about the expectations their parents place on them. Still, they usually understand and need to know that their parents care enough about them to expect certain things such as good grades, acceptable behavior, and sticking to the house rules. If parents have appropriate expectations, teens will likely try to meet them. Without reasonable expectations, your teen may feel you don’t care about him or her.

Inform Your Teen — and Stay Informed Yourself

The teen years often are a time of experimentation, and sometimes that experimentation includes risky behaviors. Don’t avoid the subjects of sex and drug, alcohol, or tobacco use. Discussing tough topics openly with kids before they’re exposed to them actually makes it more likely that they’ll act responsibly when the time comes. Share your family values with your teen and talk about what you believe is right and wrong, and why.

Know your child’s friends — and know their friends’ parents. Regular communication between parents can go a long way toward creating a safe environment for all teens in a peer group. Parents can help each other keep track of the kids’ activities without making the kids feel that they’re being watched.

Know the Warning Signs

A certain amount of change is normal during the teen years. But too drastic or long-lasting a switch in personality or behavior may signal real trouble — the kind that needs professional help. Watch for these warning signs:

• extreme weight gain or loss
• sleep problems
• rapid, drastic changes in personality
• sudden change in friends
• skipping school often
• falling grades
• talk or even jokes about suicide
• signs of tobacco, alcohol, or drug use
• run-ins with the law

Any other inappropriate behavior that lasts for more than 6 weeks can be a sign of underlying trouble, too. You may expect a glitch or two in your teen’s behavior or grades during this time, but your A/B student shouldn’t suddenly be failing, and your normally outgoing kid shouldn’t suddenly become constantly withdrawn. Your doctor or a local counselor, psychologist, or psychiatrist can help you find proper counseling.

Respect Kids’ Privacy

Some parents, understandably, have a very hard time with this one. They may feel that anything their kids do is their business. But to help your teen become a young adult, you’ll need to grant some privacy. If you notice warning signs of trouble, then you can invade your child’s privacy until you get to the heart of the problem. But otherwise, it’s a good idea to back off.

In other words, your teenager’s room, texts, e-mails, and phone calls should be private. You also shouldn’t expect your teen to share all thoughts or activities with you at all times. Of course, for safety reasons, you should always know where teens are going, when they’ll be returning, what they’re doing, and with whom, but you don’t need to know every detail. And you definitely shouldn’t expect to be invited along!

Start with trust. Tell your teen that you trust him or her, but if the trust gets broken, he or she will enjoy fewer freedoms until it’s rebuilt.

Monitor What Kids See and Read

TV shows, magazines and books, the Internet — kids have access to tons of information. Be aware of what yours watch and read. Don’t be afraid to set limits on the amount of time spent in front of the computer or the TV. Know what they’re learning from the media and who they may be communicating with online.

Teens shouldn’t have unlimited access to TV or the Internet in private — these should be public activities. Access to technology also should be limited after certain hours (for example, 10 p.m. or so) to encourage adequate sleep. It’s not unreasonable to have cellphones and computers off limits after a certain time.

Make Appropriate Rules

Bedtime for a teenager should be age appropriate, just as it was when your child was a baby. Teens still need about 8-9 hours of sleep. Encourage your teen to stick to a sleep schedule that will meet those needs.

Reward your teen for being trustworthy. Has he or she kept to a 10 p.m. curfew on weekends? Move it to 10:30 p.m. And does a teen always have to go along on family outings? Encourage a reasonable amount of family time together, but be flexible. Don’t be insulted when your growing child doesn’t always want to be with you. Think back: You probably felt the same way about your mom and dad.

Will This Ever Be Over?

As kids progress through the teen years, you’ll notice a slowing of the highs and lows of adolescence. And, eventually, they’ll become independent, responsible, communicative young adults.

So remember the motto of many parents with teens: We’re going through this together, and we’ll come out of it — together!

About Preemies

Premature infants, known as preemies, come into the world earlier than full-term babies. Prematurity occurs when a pregnancy lasts less than 37 weeks; full-term infants are born 37 to 42 weeks after the mother’s last menstrual period (LMP).

Often, the cause of preterm delivery is unknown and not within a mother’s control. Sometimes it’s caused by the mother’s health conditions during pregnancy, such as gestational diabetes, hypertension, heart or kidney problems, an infection (particularly involving the amniotic membranes, or genital or urinary tracts), or bleeding due to abnormal positioning of the placenta.

Other times preterm birth can be caused by a mother’s lifestyle choices, such as poor nutrition, smoking, illicit drug use, or excessive alcohol consumption during pregnancy.

Also, early deliveries can be due to a structural abnormality or overstretching of the uterus from carrying more than one fetus (twins, triplets, or more).

Preterm deliveries are more common in women younger than 19 or older than 40, and those with a previous preterm delivery. However, any pregnant woman may deliver prematurely and many who do have no known risk factors.

Preemies have many special needs that make their care different from that of full-term infants, which is why they often begin their lives after delivery in a neonatal intensive care unit (NICU). The NICU is designed to provide an atmosphere that limits stress to the infant and meets basic needs of warmth, nutrition, and protection to ensure proper growth and development.

Due to many recent medical advances, more than 90% of premature babies who weigh 800 grams or more (a little less than 2 pounds) survive. Those who weigh more than 500 grams (a little more than 1 pound) have a more than 60% chance of survival, although their chances of complications are greater.

A Preemie’s Basic Needs

Warmth

Premature babies lack the body fat necessary to maintain their body temperature, even when swaddled with blankets. So incubators or radiant warmers are used to keep them warm in the NICU.

Incubators are made of transparent plastic, and completely surround babies to keep them warm, decrease the chance of infection, and limit fluid loss. Radiant warmers are electrically warmed beds open to the air. These are used when the medical staff needs frequent access to the baby for care. A tiny thermometer taped to the baby’s skin senses his/her body temperature and regulates the heat.

Nutrition and Growth

Premature babies have special nutritional needs because they grow at a faster rate than full-term babies and their digestive systems are immature. Neonatologists (pediatricians who specialize in the care of sick full-term and preterm infants) measure their weight in grams, not pounds and ounces. Full-term babies usually weigh more than 2,500 grams (about 5 pounds, 8 ounces), whereas premature babies weigh anywhere from about 500 grams (about 1 pound, 1 ounce) to 2,500 grams.

So, what are premature babies fed? Breast milk is an excellent source of nutrition, but premature infants are too immature to feed directly from the breast or bottle until they’re 32 to 34 weeks gestational age. Most premature infants have to be fed slowly because of the risk of developing necrotizing enterocolitis (NEC), an intestinal infection that primarily affects preemies.

Breast milk can be pumped by the mother and fed to the premature baby through a tube that goes from the baby’s nose or mouth into the stomach. For women who can’t provide breast milk (or can’t provide enough of it), doctors may recommend giving the baby pasteurized human breast milk from a milk bank, which is considered a safe alternative. Formula also may be given to babies whose mothers are not able to provide breast milk when donor breast milk is not available.

Breast milk has an advantage over formula because it contains proteins that help fight infection and promote growth. Special fortifiers may be added to breast milk (or to formula if breastfeeding isn’t desired), because premature infants have higher vitamin and mineral needs than full-term infants.

Nearly all premature babies receive additional calcium and phosphorus either by adding fortifier to breast milk or directly through special formulas for preemies. The baby’s blood chemicals and minerals — such as blood glucose (sugar), salt, potassium, calcium, phosphate, and magnesium — are monitored regularly, and the baby’s diet is adjusted to keep these substances within a normal range.

Some preemies who are very small or very sick cannot use their digestive systems to process food. These babies require intravenous (IV) feedings — called TPN, or total parenteral nutrition — made up of fats, proteins, sugars, and nutrients. TPN is given through a small tube inserted into a large vein through the baby’s skin or umbilical stump.

Common Health Problems of Preemies

Premature infants are prone to a number of problems, mostly because their internal organs aren’t completely ready to function on their own. In general, the more premature the infant, the higher the risk of complications.

Hyperbilirubinemia

A common treatable condition is hyperbilirubinemia, which affects 80% of premature infants. Babies with hyperbilirubinemia have high levels of bilirubin, which is produced by the normal breakdown of red blood cells. This high bilirubin level leads to jaundice, a yellow discoloration of the skin and whites of the eyes.

Although mild jaundice is fairly common in full-term babies (about 60%), it’s much more common in premature babies. Extremely high levels of bilirubin can cause brain damage, so premature infants are monitored for jaundice and treated quickly, before bilirubin reaches dangerous levels. Jaundiced infants are placed under special blue lights that help the body eliminate bilirubin. Rarely, blood exchange transfusions are used to treat severe jaundice.

Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is the most common and serious intestinal disease among preemies. It happens when tissue in the small (“entero”) or large (“colo”) intestine is injured or begins to die off (“necrotizing”). This causes the intestine to become inflamed (“itis”) or, in rare cases, develop a hole.

When this happens, the intestine can no longer hold waste, so bacteria and other waste products pass through the intestine and into a baby’s bloodstream or abdominal cavity. This can make a baby very sick, possibly causing a life-threatening infection.

NEC typically affects babies born before 32 weeks gestation, but can occur in full-term infants who have health problems, like a heart defect. Babies with NEC usually develop it within the first 2 to 4 weeks of life. Treatment may involve stopping normal feedings and giving babies intravenous (IV) nutrition for a period of time, draining the stomach and intestines, and/or giving antibiotics. Sometimes surgery is needed to remove a diseased portion of the intestines.

Most infants who develop NEC recover fully and do not have further feeding problems.

Apnea

Apnea is another common health problem among premature babies. During an apnea spell, a baby stops breathing; the heart rate may decrease; and the skin may turn pale, purplish, or blue. Apnea is usually caused by immaturity in the area of the brain that controls the drive to breathe. Almost all babies born at 30 weeks or less will experience apnea. Apnea spells become less frequent with age.

In the NICU, all premature babies are monitored for apnea spells. Treating apnea can be as simple as gently stimulating the infant to restart breathing. However, when apnea occurs frequently, a baby may require medication (most commonly caffeine) and/or a special nasal device that blows a steady stream of air into the airways to keep them open.

Anemia

Many preemies lack the number of red blood cells (RBCs) necessary to carry adequate oxygen to the body. This complication, called anemia, is easily diagnosed through lab tests. These tests can determine the severity of the anemia and the number of new red blood cells being produced.

Preemies may develop anemia for a number of reasons. In the first few weeks of life, infants don’t make many new RBCs. Also, a baby’s red blood cells have a shorter life than an adult’s. And the frequent blood samples that must be taken for testing make it difficult for RBCs to replenish. Some premature infants, especially those who weigh less than 1,000 grams, need red blood cell transfusions.

More Common Health Problems

Low Blood Pressure

Low blood pressure (hypotension) is a relatively common complication that may occur shortly after birth. It can be due to infection, blood loss, fluid loss, or medications given to the mother before delivery. It’s treated by increasing fluid intake or prescribing medications. Infants who have low blood pressure due to blood loss may need a blood transfusion.

Respiratory Distress Syndrome

One of the most common and immediate problems facing premature infants is difficulty breathing. Many things can cause breathing difficulties in premature infants, but the most common is respiratory distress syndrome (RDS).

In RDS, the baby’s immature lungs don’t produce enough of an important substance called surfactant. Surfactant allows the inner surface of the lungs to expand properly when the infant goes from the womb to breathing air after birth. Fortunately, RDS is treatable and many infants do quite well.

When premature delivery can’t be stopped, most pregnant women can be given medication just before delivery to hasten the production of surfactant in the infant’s lungs and help prevent RDS. Then, immediately after birth and several times later, surfactant can be given to the baby if needed.

Although most premature babies who lack surfactant will require a breathing machine, or ventilator, for a while, the use of surfactant has greatly decreased the amount of time they spend on the ventilator.

Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD), or chronic lung disease, is a common lung problem among preemies, especially those weighing less than 1,000 grams (2.2 pounds) at birth. The exact mechanism for this disease is still unclear, but extreme prematurity, severe RDS, infections before and after birth, and the prolonged use of oxygen and/or a ventilator needed to treat a lung disease all play a major role in the development of BPD.

Preemies are often treated with medication and oxygen for this condition. Their lungs usually improve over the first 2 years of life, but many of them continue to have asthma-like symptoms.

Infection

Infection is a big threat to preemies because they’re less able than full-term infants to fight germs that can cause serious illness. Infections can come from the mother before birth, during the birth process, or after birth. Practically any body part can become infected. Reducing the risk of infection is why frequent hand washing is necessary in the NICU.

Bacterial infections can be treated with antibiotics. Other medications are prescribed to treat viral and fungal infections.

Patent Ductus Arteriosus

The ductus arteriosus is a blood vessel that is an essential part of fetal blood circulation, allowing blood to bypass the lungs, because oxygen for the blood comes from the mother and not from breathing air.

In full-term babies, the ductus arteriosus closes shortly after birth, but it frequently stays open in premature babies. When this happens, excess blood flows into the lungs and can cause breathing difficulties and sometimes heart failure.

Patent ductus arteriosus (PDA) is often treated with a medication called indomethacin or ibuprofen, which is successful in closing the ductus arteriosus in more than 80% of infants requiring these medications. However, if medical therapy fails, then surgery may be required to clamp the ductus.

Retinopathy of Prematurity

A preemie’s eyes are especially vulnerable to injury after birth. A serious complication is retinopathy of prematurity (ROP), which is abnormal growth of the blood vessels in an infant’s eye. About 7% of babies weighing 1,250 grams (2.75 pounds) or less at birth develop ROP, and the resulting damage may range from mild (the need for glasses) to severe (blindness).

The cause of ROP in premature infants is unknown. Although it was previously thought that too much oxygen was the primary problem, further research has shown that oxygen levels (either too low or too high) play only a contributing factor in the development of ROP. Premature babies receive eye exams in the NICU to check for ROP.

After the NICU

Preemies often require special care after leaving the NICU, sometimes in a high-risk newborn clinic or early intervention program. In addition to the regular well-child visits and immunizations that all infants receive, premature infants receive periodic hearing and eye examinations.

Careful attention is paid to the development of the nervous system, including the achievement of motor skills like smiling, sitting, and walking, as well as the positioning and tone of the muscles.

Speech and behavioral development also are important areas during follow-up. Some premature infants may need speech therapy or physical therapy as they grow up. Babies who had complications in the NICU may need additional care from medical specialists.

Family support is also important. Caring for a premature infant is even more demanding than caring for a full-term baby, so the high-risk clinics pay special attention to the needs of the family as a whole.

Lots of kids and teens have to cope with acne. It’s a common part of puberty, but adults and preteens get it too. Because it’s so common, acne is the subject of much discussion — and many myths. By clearing up some of the common tales about acne, you can help your son or daughter get through it!

Myth: Getting a Tan Helps Clear Up Skin.

Fact: Even though a tan may temporarily cover the redness of acne, there’s no evidence that having tanned skin helps to clear up acne. People who tan in the sun or in tanning booths or beds run the risk of developing dry, irritated, or even burned skin. They’re also at increased risk of premature aging and developing skin cancer.

Encourage kids to keep skin safe by wearing protective clothing, hats, and sunglasses when outdoors. They should also wear a sunscreen with a sun protection factor (or SPF) of at least 30 that’s labeled “noncomedogenic” or “nonacnegenic,” which means the product won’t clog pores. Discourage the use of tanning beds or booths, even for special occasions such as proms or vacations. Ask your doctor whether a sunless tanning product would be a better alternative.

It’s especially important for kids who use prescription acne medications (including oral contraceptives, which are often prescribed to help clear up acne) to stay out of the sun and away from tanning beds. These drugs can make skin extremely sensitive to sunlight and the rays from ultraviolet tanning booths.

Myth: Washing Your Face Often Prevents Breakouts.

Fact: Hygiene isn’t related to the development of acne, either. Washing the face each day gets rid of dead skin cells, excess oil, and surface dirt, but too much cleansing or washing too vigorously can lead to dryness and irritation — which can actually make acne worse.

Dermatologists usually recommend gently washing — not scrubbing or rubbing — the face no more than twice a day with a mild cleanser and patting the skin dry. Kids should steer clear of harsh exfoliants or scrubs, which can actually irritate blemishes. In addition, toners containing high concentrations of alcohol can dry out the skin and should be avoided.

Myth: Popping Pimples Makes Them Go Away Faster.

Fact: Though popping a pimple may make it seem less noticeable temporarily, popping can cause the zit to stay around longer. Popping a pimple pushes bacteria from the zit further into the skin, making the area around the acne even more reddened and inflamed. Pimple-popping devices — such as “blackhead extractors” advertised in magazines — aren’t any safer. Sometimes, popping a pimple will cause a brown or red mark to form that could last months. Scars, in the form of dents and pits, can last forever.

If your child is bummed because a huge zit arrived just in time for a special event, apply a dab of benzoyl peroxide gel to dry it. A dermatologist might be able to recommend treatments for a teen with severe scarring.

Myth: For Clear Skin, Don’t Wear Makeup or Shave.

Fact: Kids don’t have to forego cosmetics as long the products used are labeled oil-free, noncomedogenic, or nonacnegenic, which means they won’t cause breakouts. Some concealers now contain benzoyl peroxide or salicylic acid, which help to fight acne. Tinted acne-fighting creams may also help to fight pimples while hiding them.

However, if any product seems to be irritating the skin or causing breakouts, have your child stop using the product and call your dermatologist.

Cosmetics labeled “organic,” “all natural,” or those containing herbs have gained popularity, but they may contribute to clogged pores and acne, so it’s best for kids who are prone to breakouts to steer clear of them.

Teen boys who have acne and shave can use either safety or electric razors, but should shave lightly around blemishes to avoid nicking the skin and causing irritation and infection.

Myth: Use More Acne Medication to Prevent Breakouts.

Fact: When it comes to over-the-counter acne medication containing active ingredients such as benzoyl peroxide and salicylic acid, more isn’t better. Using too much medication can actually worsen acne because it leads to dryness, irritation, and more blemishes.

But kids can get help for acne. A dermatologist can suggest acne treatments if your child:

• has tried over-the-counter acne treatments with little or no success
• has developed acne scars
• has painful, large pimples
• is dark-skinned and has acne that’s causing dark patches to form
• has low self-esteem or a reduced enjoyment of life because of acne

Prescription acne medication may take up to 8 weeks to have a noticeable effect, so remind kids to use the medication exactly as directed. If the acne doesn’t improve within 6 to 8 weeks, talk to the dermatologist.

About Breath-Holding Spells

Many of us have heard stories about stubborn or willful toddlers who hold their breath until they turn blue in the face. These might sound like amusing “terrible twos” tales, but they’re not funny to the parents of these toddlers. Breath-holding spells can be terrifying for parents because kids often hold their breath until they pass out.

But these spells aren’t intentional — they’re an involuntary reflex, which means kids have no control over them. Although they’re upsetting to watch, breath-holding spells aren’t harmful and pose no serious health risks. A spell typically lasts less than a minute before a child starts breathing normally again.

Breath-holding spells can happen in healthy children between 6 months and 6 years old, but are most common during the second year of life. They can be more common in kids with a family history of them.

In most cases, breath-holding spells can be predicted and even prevented once triggers are identified. Kids usually outgrow them by age 5 or 6.

Types of Breath-Holding Spells

Breath-holding spells differ by cause and characteristics:

• Cyanotic breath-holding spells happen when a child stops breathing and turns blue in the face. These spells are often triggered by something that upsets the child, like being disciplined. While crying, the child exhales (breathes out) and then doesn’t take another breath in for a while. Parents who have witnessed prior cyanotic spells know exactly when another one is about to happen because their child’s face slowly turns a shade of blue, ranging from light blue to almost purple.
• Pallid breath-holding spells are less common and more unpredictable because they happen after a child has gotten a sudden fright or startle (like being surprised from behind). Unlike with cyanotic spells, kids turn very pale, almost white, during the spell.

Both types of spells cause kids to stop breathing and sometimes lose consciousness for up to a minute. In the most extreme cases, kids might have seizures. Having a seizure does not cause any long-term harm or put a child at risk of developing a seizure disorder.

If a Child Passes Out During a Spell

Most of the time, you don’t need to do anything during a breath-holding spell. Your child should stay lying down until the spell is over.

If your child passes out for a brief time, stay calm and:

• check your child’s mouth for food or any object that could pose a choking hazard once your child regains consciousness
• roll your child over onto his or her side
• remove all objects or furniture within reach in case your child has a seizure
• begin giving CPR if your child does not start breathing again after several minutes

When to See the Doctor

If this is your child’s first breath-holding spell, get medical care. Although breath-holding spells aren’t harmful, it’s good to get your child checked out. A doctor can determine whether it was in fact a breath-holding spell or another medical condition that looks like one.

These spells are an involuntary response to strong emotions (like being angry, scared, or frustrated) and tend to happen in healthy children. Because they’re involuntary (not done on purpose), they’re not a behavioral problem. A doctor can help parents understand what triggers a spell in their child, how to prevent future spells, and how to deal with them if they do happen.

Sometimes, iron deficiency anemia might cause kids to have breath-holding spells. So a doctor might do a blood test to check for anemia. Treating the anemia may help reduce the number of the spells.

Preventing Future Spells

Once kids mature and develop better coping skills, they usually outgrow breath-holding spells. But in the meantime, parents can face a challenge greater than witnessing the spells themselves: finding ways to discipline their child that won’t trigger another spell.

Your doctor can work with you to help you find coping strategies for you and your child. Try not to give in to tantrums and stubborn behavior — young kids need limits and guidelines to help them stay safe and become well-adjusted emotionally.

With experience, courage, and your doctor’s help, you can learn to cope with breath-holding spells while providing a safe and structured environment until your child outgrows them.

Are there any parents who haven’t felt complete and utter love for their toddler and, at the same time, frustration and anger?

Our beloved little ones test our nerves because they’re testing boundaries all around them. Every day, little by little, they’re mastering new abilities and accomplishing new feats, and are anxious and excited to use these skills.

Sometimes it’s tough to reel in a toddler, but it can be done. And setting rules and limits now — when your child is learning what behaviors are acceptable — will help prevent bigger problems down the road.

Here are some ways to help you keep your youngster on the right track.

Be Consistent

When it comes to discipline, it’s important to be consistent. Parents who don’t stick to the rules and consequences they set up don’t have kids who do either. For example, if you tell your toddler that a timeout is the repercussion for bad behavior, be sure to enforce it. Only issue warnings for things that you can follow through on. Empty threats undermine your authority.

And don’t forget that kids learn by watching adults, particularly their parents. So make sure your own behavior is role-model material. When asking your child to pick up toys, you’ll make a much stronger impression if you’ve put away your own belongings rather than leaving your stuff strewn around the room.

Eliminate Temptation

By now, you’ve figured out that your toddler wants to explore and investigate the world. Toddlers are naturally curious, so it’s wise to eliminate temptations whenever possible. That means items like TVs, phones, and video equipment should be kept out of reach, as well as choking hazards like jewelry, buttons, and small items that kids can put in their mouths.

And always keep cleaning supplies and medications stored safely away where kids can’t get to them.

Use Distraction

If your roving toddler does head toward an unacceptable or dangerous play object, calmly say “No” and either remove your child from the area or distract him or her with another activity.

It’s important to not spank, hit, or slap your child. At this age, kids are unlikely to be able to make a connection between the behavior and physical punishment. The message you send when you spank is that it’s OK to hit someone when you’re angry. The American Academy of Pediatrics (AAP) discourages spanking, which is no more effective than other forms of discipline, such as timeouts.

Practice Timeout

If you need to take a harder line with your child, timeouts can be an effective form of discipline. A 2- or 3-year-old who has been hitting, biting, or throwing food, for example, should be told why the behavior is unacceptable and taken to a designated timeout area — a kitchen chair or bottom stair — for a minute or two to calm down.

As a general rule, about 1 minute per year of age is a good guide for timeouts. Shorter timeouts can be effective, but longer ones have no added benefit and can sometimes undermine your efforts if your child gets up (and refuses to return) before you signal that the timeout has ended.

How to Avoid Temper Tantrums

Even the most well-behaved toddler can have a tantrum from time to time. Tantrums are common during toddlerhood because kids can understand more than they can express and this often leads to frustration when they can’t communicate their needs.

Toddlers get frustrated in other ways, too, like when they can’t dress a doll or keep up with an older sibling. Power struggles can ensue when your toddler wants more independence and autonomy too soon.

The best way to deal with tantrums is to avoid them in the first place, whenever possible. Here are some strategies that may help:

• Make sure your child isn’t acting up simply to get attention. Try to establish a habit of catching your child being good (“time-in”), which means rewarding your little one with attention for positive behavior.
• Give your toddler control over little things. This may fulfill the need for independence and ward off tantrums. Offer minor choices that you can live with, such as “Would you like an apple or banana with lunch?”
• When kids are playing or trying to master a new task, offer age-appropriate toys and games. Also, start with something simple before moving on to more challenging tasks.
• Consider the request carefully when your child wants something. Is it outrageous? Maybe it isn’t. Choose your battles; accommodate when you can.
• Know your child’s limits. If you know your toddler is tired, it’s not the best time to go grocery shopping or try to squeeze in one more errand.

When Tempers Flare

If your child does throw a tantrum, keep your cool. Don’t complicate the problem with your own frustration. Kids can sense when parents are becoming frazzled and this can just make their frustration worse. Try to understand where your child is coming from. For example, if your youngster has just had a great disappointment, you may need to provide comfort.

Ignoring the outburst is another way to handle it — if the tantrum poses no threat to your child or others. Continue your activities, paying no attention to your child but remaining within sight. Kids who are in danger of hurting themselves or others during a tantrum should be taken to a quiet, safe place to calm down.

Some kids will have a hard time stopping a tantrum. In these cases, it might help to say to say, “I’ll help you settle down now.” But whatever you do, do not reward your toddler by giving into desires. This will only prove that tantrums are an effective tactic for getting what he or she wants. Instead, verbally praise your child for regaining self-control.

As their language skills improve and they mature, kids become better at handling frustration and tantrums are less likely. If you’re having difficulty handling you child’s temper tantrums or have any questions about discipline, ask your pediatrician for advice.

Helping to prepare your teen for life after high school is one of the most important tasks you’ll have as a parent. Although it can be difficult to imagine your baby as an adult, with the right approach, helping your teen make the transition into adulthood can be rewarding.

Going to college, getting a job, or taking time off are the common choices your teen will likely face. Here’s how you can help your adult-to-be make the best decision.

College or Technical School

Although you may remember starting your own college search in the fall of your senior year, many teens these days need to get started earlier because of the extensive research involved and the deadlines for early admissions programs to competitive programs. In fact, many students begin as early as the fall of their junior year.

A good preparation for your teen is to sit down and start writing — this is great practice for the application process. Teens should list their goals as well as their accomplishments, even if they haven’t yet decided on a field of study. Ask your teen to write down a list of:

• academic and personal strengths and weaknesses
• extracurricular activities
• awards
• grade point average (GPA)
• class rank
• SAT, ACT, or AP scores

Next, teens should think about and list the qualities they’re looking for in a college: do they want to go away to school, stay close to home, or take online courses, for example?

Armed with this preliminary information, it’s time to begin the research. Guidebooks, the Internet, and counselors at school are particularly helpful resources. As your teen chooses potential schools, start visiting campuses and talking with students who go there.

Experts suggest narrowing the choices to a diverse mix of about six to 10 schools where the odds range from low to high for gaining admission. Applications should be filled out completely and neatly, including the essay, which your teen should revise until confident that it’s his or her best work. Many schools offer help in these areas.

And don’t cross college off the list because you’re afraid the tuition will be too steep. Many kids can receive financial help. For info about scholarships and other programs that may help, ask:

• the school counselor
• the colleges’ financial aid offices
• your employer, who might offer scholarship programs

Federal aid programs are also available and can be researched online.

Job Options

If college isn’t an option or your teen needs extra time to earn money for tuition, going directly into the work force offers many choices and benefits, such as health insurance and tuition reimbursement programs.

Entering the military can be an excellent choice for a teen who feels uncertain about the future. Discipline, earning money, saving for college, learning a trade — all of this is often possible in the armed forces. Veterans are also entitled to many benefits both while in the service and after.

However, your teen should carefully explore all the pros and cons of a military career. After all, if teens don’t like the service or if the thought of going to war seems too scary, they can’t easily drop out. If your teen wants specific training through the military, make sure the contract he or she signs includes that.

Getting a job immediately after high school remains a good choice. Teens who go this route need to learn how to search for employment, write a resume, and develop interviewing skills.

Many companies reimburse their employees for continuing education in areas related to their employment. Your teen should ask about this benefit through the human resources departments of potential employers.

Another option is an internship. Over the course of a year, your teen could potentially participate in two or three internships to explore career choices. But most internships are unpaid, so planning ahead is crucial if your teen needs to save money for living expenses.

Internships provide participants with the opportunity to learn about many facets of a particular career. They’re also a great way to make contacts and develop mentoring relationships.

Taking Time Off

For some teens, taking a year off between high school and the “real world” can be beneficial. This can be a good time to travel, do community service, or even live in a foreign country before the responsibilities of life make it harder to do so.

Community service organizations offer a wide variety of choices that teens can match with their skills and interests. Americorps, for example, offers hundreds of programs across the United States with a small stipend, plus a chance to obtain money for college or vocational training. Many religious organizations provide community service programs as well.

However, teens should keep in mind that a brochure may look different from reality, such as with work and service camps in developing countries. They should expect difficulties but know that the rewards of community service often outweigh the hardships — and can actually change the direction of a person’s life. Speaking with previous participants should give a more realistic view than promotional material.

And taking time off doesn’t necessarily put a teen at a disadvantage for college admission. For many teens — especially those who choose an internship or international service — it can actually be an advantage.

While researching colleges, find out if they have delayed admissions programs. If not, ask the colleges what their stance is on students who take time off and a teen’s chances of getting in if he or she reapplies.

It’s Your Teen’s Life

When the subject concerns the future, some teens may try to shrug it off. Here’s how to get the ball rolling and keep communication flowing:

• Really listen to your teen and resist the temptation to provide unsolicited advice. If your teen is struggling to make a decision, a story or two about a tough choice you had to make could be very reassuring.
• Provide respect and support while giving up some control. Trying to direct your teen’s future probably won’t be a benefit in the long run. This is the time for teens to develop decision-making and problem-solving skills.
• Prepare your teen to be self-sufficient away from home. This includes making major decisions regarding dating, drugs, alcohol, and sex, as well as mastering day-to-day living skills (cooking, cleaning, laundry, grocery shopping, paying bills, and managing a budget).
• Don’t be afraid to set limits on how much you can financially support a teen who decides to take time off. It’s important for teens to learn independence.

Where to Get Help

The Internet is a good starting point for researching information on your teen’s interests. Also enlist the help of school counselors, who can help steer kids in the right direction or refer them to other good sources of information.

And don’t overlook your local library. In addition to books and magazine articles on subjects of interest, the librarian can be a wealth of information.

There are many associations, both local and national, for thousands of occupations. Find out where they’re located and get information how to pursue particular career paths.

Your teen may also be able to attend meetings or arrange to interview people at their workplaces to find out more about what they do. Make use of friends, relatives, or others you know in different industries. After all, there’s often nothing more flattering than having someone ask about what you do.

Finally, resist the temptation to lecture and try to remain supportive and enthusiastic, even if your teen keeps changing his or her mind. Your teen needs your positive influence during this transitional time.

“She’s not really good at soccer and she doesn’t really like it, but all her friends are doing it.”

“If I miss a practice, even for a doctor’s appointment, I get benched.”

“If my son didn’t have an after-school activity every day of the week, he’d sit around eating junk and playing video games.”

“I don’t really like lacrosse, but I have to do it because it’ll look good on my college application.”

“She wants to take gymnastics, art, dance, and cooking, and she goes to afternoon religious school twice a week. I’m not pushing her.”

These are typical explanations and complaints from kids and parents. Clearly, some kids have too much to do and not enough time to do it. And it’s hard to tell if it’s due to parents pushing or kids trying to keep up with their peers.

Whatever the reason, one thing’s for sure — something’s got to give. Is your child too busy?

Why Are Kids So Busy?

For some families, kids may be driving the schedule because they don’t want to feel left out. Teens may feel pressure to boost their roster of activities to get into the college of their choice.

Some parents feel it’s more productive to keep their kids constantly occupied rather leave free time for playing, exploring, and learning on their own. They might also feel that their kids will miss out on key experiences if they aren’t doing what other kids are.

But most parents usually just want what seems best for their kids. Even when intentions are good, though, kids can easily become overscheduled. The pressure to participate in a handful of activities all the time and to “keep up” can be physically and emotionally exhausting for parents and kids alike.

Of course, organized activities and sports are beneficial, too. They foster social skills and are opportunities for play and exercise. They teach sportsmanship, self-discipline, and conflict resolution. Most of all, they’re fun! The key is to keep them that way and ensure that kids — and parents — aren’t overwhelmed.

Signs That Kids Are Too Busy

Sooner or later, kids who are too busy will begin to show signs. Every child is different, but overscheduled kids may:

• feel tired, anxious, or depressed
• complain of headaches and stomachaches, which may be due to stress, missed meals, or lack of sleep
• fall behind on their schoolwork, causing their grades to drop

Overscheduling can also take a toll on kids’ friendships and social lives. Family life also can suffer — when one parent is driving to basketball practice and the other is carpooling to dance class, meals are missed. As a result, some families rarely eat dinner together, and may not take the extra time to stay connected.

Plus, the weekly grind of driving kids all over the place and getting to one class, game, or practice after another can be downright tiresome and stressful for parents.

Tips for Busy Families

Even those parents who try to help their kids cut back on some activities can run up against coaches who won’t tolerate absences and kids who want to keep up with their friends. However, it’s important for parents to step back and make sure that their kids aren’t burning out.

The key is to schedule things in moderation and choose activities with a child’s age, temperament, interests, and abilities in mind. If something’s too advanced, the experience is likely to be frustrating. If it isn’t engaging, kids will be bored. And when kids do something only to please their parents, it defeats the whole purpose.

Depending on a kid’s age and interests, it’s possible to set reasonable limits on extracurricular activities and make them more enjoyable for all.

Here are some simple suggestions:

• Agree on ground rules ahead of time: For instance, plan on kids playing one sport per season or limit activities to two afternoons or evenings during the school week.
• Know how much time is required: For example, will there be time to practice between lessons? Does your child realize that soccer practice is twice a week, right after school until dinnertime? Then there’s the weekly game, too. Will homework suffer?
• Keep a calendar to stay organized: Display it on the refrigerator or other prominent spot so that everybody can stay up-to-date. And if you find an empty space on the calendar, leave it alone!
• Even if kids sign up for the season, let them miss one or two sessions: Sometimes taking the opportunity to hang out on a beautiful day is more important than going to one more activity, even if you’ve already paid for it.
• Try to carpool with other parents to make life easier.
• Try to balance activities for all of your kids — and yourself: It hardly seems fair to spend time and energy carting one kid to activities, leaving little time for another. And take time for yourself, to do the things you enjoy, and to spend time together as a family.
• Create family time: If you’re eating pizza on the run every night, plan a few dinners when everyone can be home at the same time — even if it means eating a little later. Schedule family fun time, too, whether it’s playing a board game or going on bike ride or hike.
• Set priorities: School should come first. If kids have a hard time keeping up academically, they may need to drop an activity.
• Know when to say no: If your child is already doing a lot but really wants to take on another activity, discuss what other activity or activities need to be dropped to make room for the new one.
• Remember the importance of downtime: Everyone needs a chance to relax, reflect on the day, or just do nothing.

Slow It Down

Take a moment and think about your child’s life. If it’s hectic, sit down together and decide where you can cut back. If it’s overly structured, set aside time for blowing off some steam.

Riding a bike, taking a walk, playing a game, listening to music, or just doing nothing for a while can give kids some much-needed downtime. And never forget how important it is for kids to simply get together to play. Kids need time to just be kids.

“The gimmes” are all around us during the holiday season. It can be hard for kids — and parents — to look beyond all of the product-driven hoopla and remember what the holidays are really about.

It’s not the gifts but what’s behind them that’s important — the spirit of giving. Help your kids learn the fun of giving, and how rewarding it can be to look for, make, and wrap something special — or do something special — for people they care about and others who are in need.

Here are five ways to curb materialism in your kids and reinforce the real reason for the season:

1. Teach Kids to Question Marketing Messages

From the TV commercials during cartoons to the promos on the backs of cereal boxes, marketing messages target kids of all ages. And to them, everything looks ideal, like something they simply have to have. It all sounds so appealing — often, so much better than it really is.

The ads kids see around the holidays can help foster unrealistic expectations and lead to disappointment. After imagining their “wish list” items all around them, it’s hard for reality to measure up when they actually open their gifts.

Of course, it’s nearly impossible to eliminate all exposure to marketing messages. You can certainly turn off the TV or at least limit your kids’ watching time, but they’ll still see and hear ads for the latest gizmos and must-haves.

Explain, when your kids ask for products they see advertised, that commercials and other ads are designed to make people want things they don’t necessarily need. And these ads are often meant to make us think that these products will make us happier somehow. Talking to kids about what things are like in reality can help put things into perspective.

• Ask what they think about the products they see advertised as you’re watching TV, listening to the radio, reading magazines, or shopping together. Ask thought-provoking questions, such as “Do you think that product really looks, tastes, or works the same way as it seems to in the ad?”
• To limit exposure to TV commercials, choose public television stations, recorded programs (without the ads), and children’s videos and DVDs.

Teach your kids that not everything they want can always be theirs. The key is to want things in moderation and to fully appreciate what you’re given. Emphasize that the holidays are a special time to be with family and friends, and that a lot of love and thought is put into gift giving.

2. Focus on Family Traditions

Traditions that focus on family or friends can be a great way to put meaning back into the holidays. Here are a couple of ideas:

• Talk about which family traditions your family loves the most. Then figure out how you can put more emphasis on them. If you love the tradition of lighting the menorah, get together as a group to make your own candles. If you enjoy the family trip to pick out a tree, make it an all-day event and head to a tree farm to choose your own.
• Find out what the holidays mean to others. Have your kids talk to a grandparent, parent, uncle, or aunt about how they spent the holidays growing up. Some holiday traditions that used to be strong — such as neighborhood caroling — are all but lost today. Maybe you’d like to revive some of these as a way to share some holiday spirit with your family, friends, or community.
• Build some new traditions. If you don’t have any family traditions, it’s never too late to start. Get together around activities that you all enjoy, such as cooking or ice-skating. Ask your kids what they would enjoy doing every year and make an effort to do it. If you can’t all decide on one thing, make traditions out of several, so that everyone feels like part of the festivities.

3. Teach Kids to Give of Themselves

Volunteerism, especially around the holidays, offers an ideal opportunity for families to have fun and feel closer to each other at the same time. Community service helps to drive home the message that giving is much more than laying down cash for the hot gift of the season or scrambling around to buy mounds of presents.

Volunteerism can show kids that giving your time, effort, and kindness is more rewarding than just expecting to receive lots of presents.

Also, if volunteering begins at an early age, it can become part of your kids’ lives — something they just want to do. It can teach them:

• that one person can make a difference. A wonderful, empowering message for kids is that they are important enough to have an impact on someone or something else.
• the benefit of sacrifice. By giving up a toy to a less fortunate child, a child learns that sometimes it’s good to sacrifice. Cutting back on recreation time to help others reinforces that there are important things other than ourselves and our immediate needs.
• tolerance. Working in community service can bring kids and teens together with people of different backgrounds, abilities, ethnicities, ages, and education and income levels. They’ll likely find that even the most diverse individuals can be united by common values.
• to be even more appreciative of what they have. By helping others who aren’t as fortunate, kids can better see all the remarkable things to be grateful for in their own lives.

Choose to help an organization or group that fits with your family’s values and the things you believe in. Just a few ways you can help out in your community and beyond:

• Sponsor another family in need or purchase some presents for less fortunate children through a holiday donation program. Let your kids pick out and wrap the gifts themselves.
• If your kids love animals, talk to your local animal shelter. Many distribute staples like pet food to low-income pet owners over the holidays and need volunteers to help.
• Give back to the elderly in your area. Help out at a nursing home; visit with older people who could use a little extra joy and company around the holidays; bring gifts or meals to those who are homebound; or lend a hand to elderly neighbors with decorating, cooking, or wrapping presents.
• Volunteer your family’s time by helping out at a children’s hospital or homeless shelter or building or refurbishing housing for people in need.

Community service can teach kids that giving comes in many forms, not just as presents. Emphasize that giving of their time, effort, and caring can mean so much more — and last longer — than any gift that money can buy.

4. Give Gifts With Meaning

Of course, gift giving will always be a large part of the holiday season. And with good reason — it can teach kids to really consider what might make others happy and what’s important to people they care about. Watching loved ones’ faces as they open presents that your children put a lot of heart and thought into can make the holidays more worthwhile for your kids.

But presents don’t always have to be purchased in a store. Teach your kids how to put some real meaning and feelings into their gifts this year and beyond. Making their own presents can help show just how much kids care and can make the experience of giving more rewarding for both kids and their gift recipients.

Here are some ideas to get your family started:

• Make homemade gifts together.
  • Create photo albums that family members can carry around with them. Not only does this capture precious memories and show just how much they mean, making photo album gifts also shows loved ones that a lot of thought and time was put into their presents.
  • Print and frame favorite digital photos of friends and loved ones.
  • Create customized stationery for people on your family’s list using your home computer and printer.
  • Have your kids create their own customized artwork — collages, paintings, drawings, etc. — and put them in fun frames. They can even decorate the frames.
  • Create a customized family tree for family members (something grandparents would especially appreciate).
  • Make your own batches of presents, like potpourri or ornaments, or wrapping paper and customized home decorations like wreaths.
  • Create personalized family videos for long-distance friends and loved ones.
• Give philanthropic gifts. Many communities hold fairs where you can buy gifts by making a donation to causes your family and friends care about. Others offer actual gifts made by people with special needs. Check out charity organizations’ websites for information on donating money on behalf of others and about gifts whose proceeds go to the charity itself.
• Instead of giving gifts of things, teach kids to consider giving gifts of time. For example, their grandmother may welcome their help in learning how to use a computer program. Or their little sister may want to learn how to knit. Have family members create special gift certificates (e.g., “two free car washes,” “five free specially prepared meals,” “10 free loads of laundry,” etc.). These days, when everyone’s so stretched, a gift of time can be more meaningful than one that costs big bucks.

Be a Good Holiday Role Model

Show your kids that the holidays can be joyous and fulfilling, not just a stress-ridden time that revolves around marathon shopping trips. Emphasize early on that it’s not about tons of presents, but giving and receiving a few heartfelt gifts.

By starting early with traditions that emphasize the true meaning of the holidays and the caring thoughts behind gift giving, you can help to mold your kids’ perspectives on the holiday season and what it means to both give and receive all year long.

The teen years can be difficult — for both teens and parents. Physical changes during puberty can make adolescents feel awkward and unsure of themselves.

This is especially true for girls when it comes to menstruation. For a girl, getting her first period is a physical milestone and a sign of becoming a woman. But it also can be confusing and scary, particularly if she has certain problems, like irregular periods or premenstrual syndrome (PMS).

Common Menstrual Problems

Premenstrual Syndrome (PMS)

It’s common for women to feel a few symptoms, such as mild bloating or breast soreness, before a period. But women with PMS have a wave of emotional and physical symptoms that start in the second half of the menstrual cycle and end after a period begins.

PMS includes many physical and emotional symptoms, such as:

• acne
• bloating
• backaches
• sore breasts
• headaches
• constipation
• diarrhea
• food cravings
• depression or feeling sad
• irritability
• anxiety

PMS is usually at its worst during the 4 days before a period. It tends to disappear 2 to 3 days after the period begins. PMS can happen at any time in women of childbearing age. Not all women get PMS, and some only get the worst symptoms when they are older or closer to menopause.

Although the exact cause of PMS is unknown, it seems to happen because of changing hormone levels in the body and changing chemical levels in the brain. During the second half of the menstrual cycle, the amount of progesterone in the body increases. Then, about 7 days before the period starts, levels of both progesterone and estrogen start to drop.

Some girls’ bodies seem to be more sensitive to these hormone changes than others. Talk to your daughter’s doctor if her symptoms are severe or interfere with her normal activities.

Cramps

Many girls have abdominal cramps during the first few days of their periods. They’re caused by prostaglandin, a chemical in the body that makes the smooth muscle in the uterus contract. These involuntary contractions can range from dull to sharp and intense.

The good news is that cramps usually only last a few days. Using heating pads can help soothe the pain. Over-the-counter ibuprofen, given for 2 to 3 days as soon as a period begins, also can help. Call your daughter’s doctor if she has severe cramps that keep her home from school or from doing stuff with her friends. Also let the doctor know if the cramps do not improve with home treatment.

Irregular Periods

A girl’s body usually does not develop a regular cycle until 2 to 3 years after she begins her periods. During that time, the body is adjusting to the influx of hormones unleashed by puberty. And what’s “regular” varies from girl to girl. The typical cycle of an adult female is 28 days, although some are as short as 24 days and others are as long as 38.

Changing hormone levels might affect the length of a period. A girl’s period may last just a few days during one month and up to a week the next. She may skip months, get two periods very close together, or alternate between heavy and light bleeding from one month to another.

If your daughter’s period still hasn’t settled into a fairly predictable pattern after 3 years, or if it becomes irregular after she’s had several normal periods, make an appointment with her doctor to check for possible problems.

Also, let your daughter’s doctor know if her cycle is less than 24 days or more than 38 days, or if she goes for 3 months without a period.

Delayed Menarche

Girls go through puberty at different rates. Some reach menarche (the medical term for the first period or the beginning of menstruation) as early as 9 or 10 years old. Others don’t have their first periods until they’re well into their teen years. So if your daughter is a “late bloomer,” it doesn’t necessarily mean there’s something wrong.

Genetics plays a big role in determining when girls get their periods. Girls often start menstruating at about the same age at which their mothers or grandmothers did. Also, certain ethnic groups, on average, go through puberty earlier than others. For instance, African-American girls generally start puberty and get their periods before Caucasian girls do.

Let your daughter’s doctor know if she hasn’t gotten her period by age 15, or by 3 years after starting puberty, which begins with breast development.

Problems That May Be Cause for Concern

Although most period problems are harmless, a few conditions can be more serious and require medical attention. These include:

Amenorrhea (the Absence of Periods)

Girls who haven’t started their periods by the time they’re 15 years old or 3 years after they’ve shown the first signs of puberty have primary amenorrhea. This is usually caused by a genetic problem, a hormone imbalance, or a problem with the way the reproductive organs developed.

Hormone imbalances also can lead to secondary amenorrhea, which is when a girl who had normal periods suddenly stops menstruating for more than 6 months or three of her usual cycles.

Since pregnancy is the most common cause of secondary amenorrhea, a girl with skipped periods should have a pregnancy test. In addition to hormone imbalances and pregnancy, other things that can cause both primary and secondary amenorrhea include:

• stress
• significant weight loss or gain
• anorexia (amenorrhea can be a sign that a girl is losing too much weight and may have anorexia)
• stopping birth control pills
• thyroid conditions
• other conditions that can affect hormone levels

Exercising too much (often in sports like distance running, ballet, figure skating, or gymnastics) combined with a poor diet also can lead to amenorrhea. This happens because a girl may lose too much weight or not gain weight during key periods of growth.

But this doesn’t include the usual gym class or school sports team, even those that practice often. To exercise so much that she delays her period, a girl would have to train vigorously for several hours a day, most days of the week, and not get enough calories, vitamins, and minerals.

Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) is when periods are very heavy, last much longer than normal, or don’t come regularly. The name might sound serious, but most AUB isn’t a problem and doesn’t need treatment.

Most cases of AUB are due to an imbalance between the levels of estrogen and progesterone in the body, which allows the endometrium (the lining of the uterus) to keep building up. This may lead to the period coming early or late. And when the period does come, the shedding of this thick endometrium can result in very heavy bleeding.

A girl with heavy periods could soak through a sanitary pad or tampon every 1-3 hours. Or, she may have periods that last longer than 7 days. This heavy or prolonged bleeding may keep a girl home from school or social functions because she’s worried she won’t be able to control the bleeding in public.

Because many adolescents have slight hormone imbalances during puberty, lots of teen girls have heavy periods. But in some cases, heavy menstrual bleeding can be caused by problems such as:

• fibroids (benign growths) or polyps in the uterus
• thyroid conditions
• clotting disorders
• swelling, irritation, or infection in the vagina or cervix

If your daughter has heavy periods or periods that last longer than 7 days, talk to her doctor.

Dysmenorrhea (Painful Periods)

There are two types of dysmenorrhea, which is painful menstruation that can interfere with a girl’s ability to attend school, study, or sleep:

1. Primary dysmenorrhea is very common in teens and is not caused by a disease or other condition. Instead, the culprit is prostaglandin, the chemical behind cramps. Some prostaglandin can lead to mild cramps. But large amounts of prostaglandin can lead to nausea, vomiting, headaches, backaches, diarrhea, and severe cramps. Fortunately, these symptoms usually only last for a day or two.
2. Secondary dysmenorrhea is pain caused by some physical condition like polyps or fibroids in the uterus, endometriosis, pelvic inflammatory disease (PID), or adenomyosis (when tissue that usually lines the uterus grows into the muscular wall of the uterus).

Having cramps for a day or two each month is common, but if your daughter has symptoms severe enough to keep her from her normal activities or cramps that last for more than 3 days, discuss it with her doctor.

Endometriosis

In this condition, tissue normally found only in the uterus starts to grow outside the uterus — in the ovaries, fallopian tubes, or other parts of the pelvic cavity. It can cause abnormal bleeding, dysmenorrhea, general pelvic pain, and lower back pain.

Treatment

To determine whether a problem requires treatment, the doctor will ask several questions and do a physical exam. The doctor may do a pelvic exam, blood tests, or urine tests. If there might be a structural problem, an ultrasound or CT scan might be done. These tests can help the doctor decide how to handle a condition.

Growths such as polyps or fibroids often can be removed, and endometriosis treated with medicines or surgery. If a hormone imbalance is to blame, the doctor may suggest hormone therapy with birth control pills or other hormone-containing medicines. Conditions like clotting disorders or thyroid problems also may require treatment.

For menstrual pain not due to any medical problem, anti-inflammatory medicines like ibuprofen are the most effective treatment.

When to Call the Doctor

Although most period problems aren’t cause for alarm, certain symptoms do call for a doctor visit. This is particularly true if a girl’s normal cycle changes.

So take your daughter to her doctor if she:

• Hasn’t started her period by the time she’s 15 or her period hasn’t become regular after 3 years of menstruating. The most likely cause is a hormone imbalance (which may need treatment), but this also might point to another medical problem.
• Stops getting her period or it becomes irregular after it has been regular. Also let your daughter’s doctor know if her cycle is less than 24 days or more than 38 days, or if she doesn’t get a period for 3 months at any time after first beginning to menstruate.
• Has heavy or long periods, especially if she gets her period frequently. In some cases, significant blood loss can cause iron-deficiency anemia. Also, heavy bleeding could be a sign of a growth in the uterus, a thyroid condition, an infection, or a blood clotting problem.
• Has very painful periods. Having cramps for a couple of days is normal, but if your daughter isn’t able to participate in her normal activities, or has cramps for more than 3 days, let the doctor know. She might have a medical problem, such as endometriosis, causing the pain.

Helping Your Daughter Feel Better

When your daughter’s having a particularly bad bout of PMS or cramps, you can help make her more comfortable. Suggest that she:

• eat a balanced diet with lots of fresh fruit and vegetables
• reduce her salt intake (salt can cause water retention) and caffeine (which can make her jumpy and anxious)
• include foods with calcium, which may reduce the severity of her PMS symptoms
• try over-the-counter pain relievers like acetaminophen or ibuprofen for cramps, headaches, or back pain
• take a brisk walk or bike ride to relieve stress and aches
• soak in a warm bath or put a hot water bottle on her abdomen, which may help her relax

If you notice that your daughter’s periods are causing her great discomfort or interfering with her life, talk to her doctor to make sure nothing else is causing the problem and to see if anything can help. Sometimes hormone treatment, often in the form of birth control pills, can help ease many symptoms of uncomfortable periods.

Most important, talk to her and explain that most annoying or uncomfortable parts of menstruation are normal and may improve over time. And be understanding when she’s cranky and unhappy. After all, no one’s at her best all the time.

The Benefits of Sports

Organized sports can help kids grow in many ways. From soccer to fencing, sports offer chances for kids to:

• learn and master skills
• work with their peers and coaches
• challenge themselves in a safe environment
• learn the value of practice and the challenge of competition

And on top of all that, sports provide fun opportunities for kids to be active.

But before signing your kids up for sports, consider each child’s age, personality, and abilities to help make sure that being involved in sports is a positive experience for everyone.

When Should Kids Start Playing Sports?

As you think about signing kids up for organized sports, consider how emotionally and physically ready they are to participate. If they’re too young or not ready, it will be frustrating for everyone, and can turn kids off from sports for good.

Although there are sports programs designed for preschoolers, it’s not until about age 6 or 7 that most kids develop the physical skills and attention span that most sports need. Preschoolers can throw and run, but it usually takes some time before they can coordinate the two skills. And it may not be until kindergarten or first grade before kids understand the rules of the game.

That doesn’t mean kids can’t play sports when they’re younger. Sports can be fun for toddlers and kindergartners, but these should be less about competition and more about learning skills and having fun while being active. So even if young kids inadvertently score a goal for the other team or spend the entire game chasing butterflies, as long as they’re enjoying it, that’s OK.

If you do decide to sign your 5-year-old up for a team, be sure to choose a league that emphasizes fun and basic skills.

Choosing the Right Sport

When choosing a sport, consider your child’s unique temperament. Some kids are naturally inclined toward team sports, while others may feel more comfortable in activities where the focus is on individual efforts. There’s something for everyone — from soccer and baseball for team-oriented kids, to tennis, fencing, karate, dancing, and swimming for kids who’d rather go solo.

Don’t be surprised if it takes a few tries — or a few seasons — to find the sport that’s right for your child. It often takes time for kids to figure out which activities they enjoy.

Some kids may just not be interested in team sports, but they can still keep fit by engaging in other activities that don’t emphasize competition. No matter what they choose, kids should be physically active for at least 60 minutes a day.

Before Signing Up

Kids should have a physical examination before beginning any sports or fitness program. Those with certain medical conditions, vision or hearing problems, or other disorders may have difficulty playing some sports. Rarely, a doctor may find an undiagnosed condition that can affect participation.

Although you should share your interests with your kids, it’s never a good idea to force them into an activity just because you once enjoyed it. And once they choose a sport, be sure to head out to the field, gym, or pool to cheer them on.

Family Factors

When kids show an interest in sports, it’s important to think about how practices and games might affect their day-to-day life — and yours:

• How will it affect how much time your child has for things like homework, other activities, and time with friends and family? You may want to get the schedule of practices and games and map out a typical week on a calendar with your child.
• It’s important for kids to have downtime to rest, think creatively, and play freely when they’re not engaged in something else. This can help give them the energy they need for their activities.
• How will the sport affect the rest of the family’s plans? Many teams only practice and play games during the weekend, which can be a problem if your family likes weekend getaways.
• If you have more than one child playing sports, how will you coordinate transportation to practices and games?
• How involved do you want to be in the sport, and how involved does your child want you to be? Sports leagues usually look for parents to volunteer with everything from coaching to team snacks and transportation. Being involved — either as a coach or in another role — can be a great way to spend time with your kids and show them you’re interested in what they do.

When Kids Want to Quit

However kids feel when they enroll for a season of sports, there may come a time when they want to quit. If your child comes to you with this plea, try to find the reason behind it. It might have to do with something small and fixable, like a bad-fitting uniform, or it may be a bigger issue, like how comfortable your child feels with the coach or the kids on the team. It could also be that your child just doesn’t enjoy the sport.

Is it OK to let kids quit? If your child is on a team that depends on his or her participation, you may want to explain the importance of sticking it out for the season. If that’s not the case, then think about what you want your child to get out of the experience, and how quitting would affect that.

When kids are overscheduled or unhappy, quitting may be the right thing. But it’s still important for all kids to be physically active every day, even if they’re no longer playing an organized sport.

These are general guidelines to keep in mind. Kids mature at their own pace and develop their unique skills at different times, so consider your child’s emotional and physical maturity before you commit to a season of sports. There’s no point in forcing sports on kids of if they’re not having fun.