How To Alleviate Back To School Anxiety (August 2022)

How to alleviate back-to-school anxiety
Back to school time means change and change often means anxiety. Neha Sharma, DO, a child psychiatrist at Tufts Medical Center explains how parents can find the root of what is causing the worry and how they can set expectations and routines that will help alleviate the stress that come naturally at the start of a new school year.

How parents can help
If a child is saying he or she doesn't want to go back to school, a parent should have a thoughtful conversation with him or her to figure out why. Dr. Sharma suggests parents "ask the child 'what is hard about school?' to try to come up with solutions." Once you find the problem, come up with a plan to combat the issue together, she adds.

Tips about common worries:

Sleep schedule
Solution: Dr. Sharma suggests involving the entire family in a new sleep schedule so that the child doesn't feel like he or she has to do it alone. Begin this new routine two weeks before school starts, or as early as possible.

Creating new relationships
Solution: If a child seems anxious about making friends, find ways to connect with parents that have children going into the same class prior to school. Pool parties or other gatherings can serve as icebreakers for everyone before the first day of school. Carpooling for school drop-off and pick-up is another great way to start forging relationships.

Entering a new environment
Solution: Parents can contact the school to set up a tour before classes begin. This way, the child is relieved from the fear of the unknown and can see that it isn't the scary place they envisioned in their mind. Parents can use this time to create a map of the school and their classrooms, which can be taped to the front of a binder.

Sometimes a school will have a mentor program, where older children can help younger children acclimate to a new school. This is worth looking into if your child is new to the area and/or is worried about making friends.
 
Parent separation
Solution: If a school-aged child is experiencing separation anxiety, often-times a child's family has been going through difficulties or a child's parent is ill. In this case, a parent or guardian of the child will need to provide them with extra reassurance.

"Special cases like these require the parent to show confidence and competency in taking care of themselves so that the child will feel okay leaving them for periods of time," explains Dr. Sharma. It is helpful to get the child used to being away from the parent for small periods of time before school starts - building the length of the separation each day.

If anxious behavior is going on for longer than two weeks, consult a pediatrician for further evaluation.

Why Your Child Is Stressed Out (July 2022)

Why your child is stressed out

It's easy to think of stress as an issue that only affects adults, not children. Adults have a lot to stress out about - common causes include financial troubles, problems at work, parenting or caregiving, and conflicts with your spouse or family. While your child may not stress over the things you stress over, they still experience stress and are just as affected by stress as adults are. They are also more vulnerable to stress because they haven't yet learned any coping mechanisms. "Stress in kids is a really important topic to talk about," said a clinical social worker in the Pediatric Primary Care Department. "We see young patients dealing with stress every day." So, what are kids worrying about and how can parents help?

Overscheduling or the pressure to "do it all"

It is more and more common for families to get caught up in playing every sport, learning every instrument and doing every extracurricular activity they can. For many kids, this can feel overwhelming. How to help: Keep it simple! Avoid overscheduling, and stick to one or two activities that your child can focus on to avoid burnout.

Changes at home

Kids are sensitive to changes in their family situation - whether it's divorce, a parent losing a job, moving, and more. How to help: Talk to your child in age-appropriate terms about what is going on. While you don't have to share every detail with them, don't assume that they don't notice when things around them are changing.

Bullying

If your child's attitude toward school or friends has changed, this could be a sign that they are being bullied. Remember that bullying takes on many forms and can include physical bullying, verbal teasing, and online harassment. How to help: Talk about what's going on at school. Keep open lines of communication with your child and monitor social media use.

Remember: not all stress is bad stress!

Successfully navigating stressful situations is an important part of child and adolescent development. Highlight the moments when your child deals with stress in an effective way so that they remember to use the same strategies again in the future.

Choosing A Pediatrician For Your Child (May 2022)

Choosing a Pediatrician for your Child

Whether you are pregnant and searching for a pediatrician or you have just moved and need a new pediatrician, Tufts Children's Hospital has the right doctor to address your specific needs. Having a primary care physician (PCP) for your child to see them when they are under the weather is important. Having a pediatrician that you see for routine visits to keep them well and to be proactive about their healthcare is also important.

You and your child will visit their pediatrician for many reasons including vaccinations, physical exams when they participate in sports, and to make sure they are reaching all of their milestones at the right time. It's important that you choose the right provider for your child. Here are some questions to consider:

• Do you prefer a male or female physician?
• Are clinic hours convenient for yours and your child's schedule?
• Can doctors see your child promptly when your child is not feeling well? Even on the weekends?

Tufts Children's Hospital has a number of doctors who are accepting new patients. If your child is an infant, you may want to consider choosing someone who will care for them through their teenage years. And, for your convenience, same-day sick visits and Saturday sick visits are available, should your little one need care urgently, but not emergently. Visit tuftschildrenshospital.org/primarycare to meet the team, learn more, and to request an appointment for your child.

Expert Care For The Smallest Patients (February 2022)

Expert care for our smallest
When Drs. **Lilian Chen** and **Abhishek "Sunny" Chatterjee** found out they were expecting a baby girl, they trusted Tufts Medical Center with their care. When Sophia was born at 27 weeks, they were thankful they did.

"Things could have gone very wrong, but they didn't because of the expertise, the communication…the absolute professionalism of everyone at Tufts MC," said Sunny.

Lilian first noticed a spike in her blood pressure at just 26 weeks into her pregnancy. After speaking to her obstetrician, **Dr. Thao Thieu**, she was quickly admitted to the hospital with preeclampsia where doctors and nurses began to monitor mom and baby closely. Unfortunately, Lilian progressed to HELLP syndrome, which can be life threatening. After collaborative discussion with their care team, Lilian and Sunny decided to urgently deliver their baby at 27 weeks. Sophia came into this world at 1 pound, 10 ounces and even surprised everyone in the surgical suite with her very first cry! She was then quickly taken to the Tufts Children's Hospital's **Neonatal Intensive Care Unit (NICU)** where she received extensive, highly specialized care for the next 90 days by an outstanding team of neonatal physicians and nurses.

At first, Sophia had breathing problems and required intensive respiratory support. She was given surfactant, a medication to help her lungs develop, and airway support with a breathing tube. She also had a heart condition which many premature infants have called a patent ductus arteriosus (PDA) which was able to improve with medication. She required a feeding tube to eat and was very slow to gain weight. She later underwent three hernia surgeries with Dr. **Artur Chernoguz**. Three months later, when Sophia weighed 6 pounds, 6 ounces, she was finally strong enough to go home and meet the rest of her family.

"My husband and I are so grateful for everyone who took care of us at Tufts. From the first moment we were admitted to Labor and Delivery to the excellent care our daughter received from the NICU team. Everyone took such great care of Sophia!" says Lilian. "It was in the NICU where my husband and I held her for the first time. The NICU nurses were especially great, and we were so relieved to have such a professional team who cared about our baby."

The couple has worked at Tufts Medical Center for five years. Dr. Chatterjee is the Division Chief of Plastic Surgery and Dr. Chen is the Division Chief of Colon & Rectal Surgery. When they found out they were pregnant, they researched the best place to have their first baby. "We spoke to many of our own colleagues who we trusted, and they recommended Tufts." says Sunny. "We knew it was the right decision because Tufts is our family. We knew we were going to be in the best of hands with our colleagues. The support we received during this difficult time is priceless. We don't have the words to thank everyone who helped us bring our baby home." Sophia was discharged on March 10th, 2021, her original due date, and now weighs 10lbs.

The Benefits Of The Flu Vaccine And How It Can Keep Your Child Safe (October 2021)

Flu vaccine and your children
Children ages 6 months of age or older can get the yearly influenza immunization (flu shot) now. This is an important step in reducing the impact of the flu virus, which will be occurring during the same time as other respiratory viruses including COVID-19. Some parents may have questions, however, about the safety and benefits of their children receiving the flu vaccine. Shirley Huang, MD, Chief of Pediatric Primary Care at Tufts Children's Hospital, answers some common questions about the seasonal flu vaccine.

Why should children get the flu vaccine?
Influenza is more dangerous than the common cold for children. Every year, many children need to be hospitalized when they get the flu. Complications can include pneumonia, dehydration, and in rare cases, even death. The best way to prevent the flu is by getting the flu vaccine.

Is my child too young to get the flu vaccine?
Children who are 6 months and older should get the seasonal vaccine each year.

Is the flu vaccine safe?
The flu vaccine is very safe. Extensive research is done each year to support the safety of flu vaccines. Any side effects of the flu vaccine are generally mild and go away on their own within a few days. Side effects of the flu shot may include soreness at the injection site, slight fever, headache, or muscle aches.

How effective is the flu vaccine?
Flu viruses are very smart and are constantly changing. A new vaccine is made each year to protect against the flu and make it as effective as possible. The flu vaccination's effectiveness wears off after a year so it's important to receive a new dose annually. If you have not yet received this year's vaccine, now is the time to get it!

Call your child's doctor to book an appointment. Learn more at **tuftschildrenshospital.org**.

Heads Up - Know The Signs Of Concussion And When To Seek Help (September 2021).

Ask a doctor at Tufts Children's Hospital's Pediatric Emergency Department what season it is and you won't hear about summer, fall, winter or spring. Around here, there are only two seasons: respiratory and trauma. Fall is still trauma season-and pediatric concussions head the list, thanks to outdoor activities and contact sports. Let's take a close look with Lauren Rice, MD , Chief of Pediatric Emergency Medicine.

No two concussions are the same
While contact sports like football and soccer often cause head injuries, a pediatric concussion can happen from something as small as two toddlers bumping heads-or a more serious fall down stairs. The real question is: How severe is it? "Different children with the same impact will act differently," says Dr. Rice. "That's why we do a full neurological exam."

Examining the symptoms
"We test the motor and sensory systems, pupil response, strength and reflexes, among other things," explains Dr. Rice. "We're looking for even subtle changes that might make us concerned about a head injury. The physical exam is the most important tool we have to evaluate for a concussion."

Early symptoms of a concussion often indicate how patients will recover. For example, a child suffering a mild concussion may show symptoms of vomiting and headache, but will typically pass the neurological exam and recover in a few days. A child who responds abnormally-confused, acting oddly, repeating things-may have a more severe concussion. While most children will recover quickly, some may develop post-concussive symptoms which can linger longer.

Recovery and prevention
As children recover from a concussion, it's important to minimize stimuli. That means no TV, video games or loud music (sorry, kids). It also means being patient before reengaging in strenuous or even normal activities-including cognitive activities like a school project. "The brain needs time to recover and the better you are about allowing your body to rest in the beginning, the faster you will be back to your normal routine," says Dr. Rice.

Be aware of recurrent head injuries, too. A child hurt by multiple concussions even weeks or months apart can face serious long-term health risks. Think about prevention; make sure your child wears an age-appropriate and properly fitted helmet for sports and activities such as bicycling, skateboarding, and riding a scooter. And know what to do if he or she shows signs of a concussion: vomiting, headache or confusion.

"Call your pediatrician immediately," recommends Dr. Rice. "If it seems urgent or you're concerned, go to the emergency department and get evaluated."

Our Pediatric ED physicians generally see patients within 20 minutes of arrival. Our pediatric specialists are available around the clock, seven days a week.

Learn more at **www.tuftschildrenshospital.org**.

Patient Story: An Allergic Reaction Leads To An Emergency Room Visit (August 2021)

An allergic reaction leads to an emergency room visit
It was your average Sunday evening. Nine-month-old Neela and her mom and dad were spending a quiet night at home. Mom was feeding Neela scrambled eggs for the first time, when almost immediately, Neela's lips started to swell. Mom and Dad suspected an allergic reaction but took to Google and a phone call to their pediatrician to confirm. Even though the swelling started to subside after a few minutes, Neela's on-call doctor recommended a trip to the Emergency Room, just to be safe.

Neela's first trip to the ED
"We weren't panicked but we went to be safe," said Neela's dad. "We live two blocks from Tufts Children's Hospital so we just walked over. When we got into the Emergency Room, we noticed there was an adult side and a pediatric side. As soon as we went to the front desk and mentioned an "allergic reaction," someone immediately popped out from behind the desk and escorted us right into the Pediatric Emergency Department (ED). From the time we walked through the front door of the ED to the time we got into a patient room was less than two minutes."

"Immediately, a nurse started taking Neela's vitals. Another person, who we later found out was a Child Life Specialist, came in just to amuse Neela and keep her comfortable. We saw a resident physician and an attending physician. Everyone was super friendly and knew their role. We were only there for a few hours, but people came in and out the whole time to answer any questions we had. It was all seamless."

A Child Life Specialist for almost every patient
The Tufts Children's Hospital Pediatric Emergency Department was one of the first to use Child Life Specialists throughout the treatment process, not just in the waiting room. Available from 10 am to 2 am, these experts intuitively understand the fears and anxieties of children in emergency situations. They are ready to put pediatric patients at ease, whether with a book, a teddy bear, or just a simple hug.

"The Child Life Specialist was squatting with her arms held out in a ring around Neela, presumably so she wouldn't tumble off of the exam table, for an hour," said Neela's dad. "She couldn't have been comfortable, but never once broker character in terms of her cheerful demeanor or engagement with Neela. We were so surprised at the resources they made available - all to make sure our baby was comfortable."

Getting health care in the era of COVID
"Even though we were in the midst of a pandemic, I wasn't too worried about bringing Neela to the hospital to receive care," said Neela's dad. "Neela's mom, however, was very nervous."

"Since the start of COVID-19, I've been very conservative about where I go and who I see," said Neela's mom. "I worried about myself, my kids and my elderly parents - one of whom is ill. So, the thought of having to take Neela to the hospital did make me nervous. But I was more worried about Neela - that preceded any fear I had about COVID. Once we got there, any worry I had quickly disappeared. They took us right back to a pediatric exam room. We never even sat in waiting room, which was good because common areas scare me the most. Their hygiene standards were amazing. I noticed that everyone was constantly washing their hands. Just seconds after entering, I forgot any concerns that I had."

Neela was soon on her way home
"Neela only needed a little Benadryl and observation," said her dad. "It wasn't quite an emergency when you think of some of the scenarios they probably see in the Emergency Department. But we never felt like we were an inconvenience taking up a room. It was clear they cared about Neela - and us - a great deal."

We couldn't have been more impressed with the level of professionalism coordination, and compassion than what we experienced that night at Tufts MC. The Child Life Specialist was amazing. We felt like we were the only patients in the hospital. Everyone was that kind, attentive and thorough. I can see how the staff might have felt tired and burned out during COVID, but everyone showed up all smiles and with such positive attitudes."

"It's heartening to know we have this great asset only a two-minute walk away. We feel really good knowing that Tufts Children's is there and wouldn't hesitate to go back for either our needs or Neela's."