THE PEDIATRIC VILLAGE

Fall Edition 2019

SentaraPediatricPhysicians.com

TABLE OF CONTENTS

3 Welcome To A New School Year

4 Kid’s Corner: A Different Kind of Senior Year

5 Ask the Doc

6 Read. Read. Read.

7 Mexican Make-Ahead Egg Muffins

8 Brush for Success

9 Focus Fuel

10 Eat Right. Get Active. Reduce Screen Time.

11 Reducing School Violence and Don’t Let the Flu Bug You

2 "It Takes a Village to Raise

a Child." -a West African Proverb

WELCOME TO A NEW SCHOOL YEAR

Optimum holistic health and quality of life for your family is what we strive to support and achieve. But how do we as a village combat circumstances that sometimes feel beyond our control? It seems that we are surrounded by images and stories that add to the normal anxieties and stress that occur with the start of each school year. However, we can continue to create a strong foundation for our children and help them succeed. Let’s get back to the fundamentals of what we know. By providing our children with the building blocks of good health and success such as proper nutrition to support the energy needed to focus in school; regular exercise and movement for mental, muscular and cardiovascular health; turning off the television and encouraging reading as a great family activity; meeting the world with a great smile by maintaining dental health; and listening to their thoughts and concerns, we may fortify our children with the most basic tools against these pressures – a sense of support, good health and higher self- esteem.

Vanessa L. Hill, MFA, MPH, Outreach Program Manager

3 KID'S CORNER (Articles written by our local youth in hopes of helping others)

A Different Kind of Senior Year Class of 2020! I so excited that I'm graduating! See that's how I should feel but I don’t. Terror, shock, and anger are my new feelings. Minutes from our school there was a mass shooting and we were placed on lockdown. I had never been so afraid in my life and at 15 the thought of not seeing my family again was just something I could not even begin to process. I immediately began to pray for courage because that's the only thing I could control in the moment. Focusing on classwork was the furthest thing from my mind and all I could think was: "I want to go Home!"

My mom texts to ask if I'm ok and that she’s on her way. She tells me they have the shooter. The announcement comes on that we are no longer under lockdown provides little comfort. My mom can't get here fast enough. Were they sure they had the shooter? Are there more? Are we next? No child should be worrying about things like this. We are supposed to be afraid of failing classes, driving, peer pressure and broken hearts. I wished I was home. No one is speaking. It is eerily quiet. The type of quiet before the monster comes out in the movies. All of a sudden the phone rings and I feel a sense of relief. My teacher looks around and I know she is about to say my name so I grab my bag. My heart drops and my eyes well with tears as she calls someone else’s name. I watch the boy in the blue shirt leave and all I could think is it should be me. I take my phone out to text my mom and realize it's only been 5 minutes. Why is time going so slow? All I can think about is how much I don't want to be here? My heart pounds. I look around the classroom with 28 other children sick with worry about going to school and never going home again. I wonder if their hearts are pounding too.

The phone rings and my teacher and I lock eyes. Before she can get my name out, I'm headed for the door. I practically run down the hallway, which now seems as long as a football field. Mom looks so tired and afraid. I grab her hand. I don't want her to know I'm terrified. I want her to hold me just like she used to when I was younger. The car ride is different now. Silence. I look out the window and see police cars and fear on people’s faces. Mom and I hold hands but we don't speak. When I see my house and my dogs, things that should bring me joy, I feel nothing. I go inside to my room and lie on my bed and cry. I cry for myself, my parents, classmates and teachers. I cry for the people who lost their lives. I cry because I'm 15 and now school makes me afraid that someone may bring a gun and end my life before it's really begun. I cry until I fall asleep. Mom’s knock on the door wakes me. She has that look again. She sits on my bed and tells me a friend of ours was killed today. I can't cry, I can't speak. I feel dry. I feel numb.

Fear crippled me to the point that it was all I thought about for months. Over the summer I enjoyed time with family, did volunteer work and even went to a few concerts. In each event I was always looking over my shoulder, watching and waiting for something to happen. Then the dreaded first day of school came. I wished my Mom would just let me do home school. At least I'd be safe there. My teachers are another story. It feels like they don't fully understand the fear and pressure we have just coming to school now. They push their authority more now but I wish they would speak consolingly sometimes. I'm not being disrespectful. But I have a constant fear that I may not make it home. My hope is that one day these fears will not be a reality for other children. As I navigate through my last year of high school I will try and enjoy being young just not carefree. Now I must be aware and attentive to the boy who is always angry and lashes out at his girlfriend, the guy who wears the large backpack and keeps to himself. Somehow as I watch I will try to enjoy being a senior in this different kind of senior year.

By Amaya K. 4 ASK THE DOC surfaces that you touch often with your hands is an effective tool in killing viruses and I’ve been hearing a lot of news lately about anti-vaccers bacteria. vs. the need for certain 4. Avoid contact with people who are visibly sick vaccines. I’m very concerned or have recently been sick. Do not touch about potential disease objects they have used, like utensils. Ask that outbreaks in my community. they not come around until they are well. This My children are going to school for the first time. How is especially important if you have very young can I make sure they are safe from those who may children or children with chronic health not like vaccinations and these diseases that we problems. thought were no longer an issue? - Monica W. 5. Keep your child at home if he or she is ill. 6. Cover when you cough or sneeze. If you do Hey Monica! not have tissue paper, cough or sneeze into First, you have already done the MOST important the bend of your elbow or in your upper thing to protect your children...you have had them vaccinated! Way to go mama! I definitely understand sleeve. your concerns about disease outbreaks. We as 7. Only use antibiotics if absolutely indicated. physicians have these same concerns and want to be For example, a simple viral cold does not sure parents are aware of what they can do to help need antibiotics to resolve the illness but their families remain healthy. strep throat does. When it doubt, always contact your pediatrician and they can give Though there are a growing number of folks choosing you the best guidance based on your child’s not to vaccinate, we hope that through more education and building good relationships with our medical history. patients, we will help decrease the numbers of folks 8. Eat a good and varied diet and drink lots of who aren’t vaccinating. The most vulnerable of our water. This can help boost the immune communities (those who can’t be vaccinated or those system so it is primed and ready. There is with serious chronic illnesses), fortunately are also some evidence that herbs such as: Black protected by something called herd immunity. Elderberry, Vitamin C and Zinc can be helpful Herd immunity is a form of indirect protection from in preventing and shortening illness duration. infectious disease that happens when a large 9. Avoid interactions with unvaccinated persons percentage of a population has become immune to until you or your children have been an infection, in this case, through immunizations, completely vaccinated especially if you or which then provides some protection for individuals your children are immunocompromised who are not immune. However, as great as vaccines are, there are certain things that can decrease the (decreased functioning immune system). vaccines’ efficacy like chronic illnesses, cancers, 10. And finally, when I doubt about protecting heart disease, or taking medication and we may lose your little ones, always contact your friendly our herd immunity. pediatrician to give you child-specific information to help guide your decide making. Try as we might, we can’t always protect our children. However, there are some things that you can do that may give them extra protection to prevent infections I hope that this helped to calm some of your of any kind, not just the vaccine-preventable ones (for fears/concerns. Thank you for reaching out to ask most healthy people, these things will be helpful). the question and for reading my response!

1. Follow good hygiene practices and wash hands with soap and water (if not available, use Latonya Russell, MD, MPH alcohol-based hand sanitizer): a. when hands are visibly dirty; Sentara Family Medicine & Pediatrics – b. before eating; Chesapeake c. after coughing or sneezing; (757) 252-5820 d. after blowing your nose; e. after using the toilet; and f. after being in a public place. 2. Avoid touching your eyes, nose, and mouth. These are entry points for viruses and bacteria. 3. Clean your surroundings regularly. I know, I know...with children this is quite a challenge. 5 However, cleaning your counters and other Now that school is started, parents are asking teachers, reading specialists and principals how to improve their child’s DRA score, increase their child’s independent reading time and improve the understanding of what their child has read. The best parent mantra for this 2019-2020 school learning year is…READ, READ, READ! It is the proven method to improving and increasing a student’s vocabulary, reading rate, fluency and text comprehension.

The traditional independent reading time for a child is a quiet, thoughtful and imagination building experience. If your child has trouble focusing on pages of text and/or difficulty with sounding out words accurately, then you can read to them and have them follow along with each page. You can use a line marker such as an index card or small ruler to help your child concentrate on the part of the text being read at that moment. Another method is for the adult reader to read a paragraph or two and then the child reads the next two paragraphs. Either way, when the oral reading session is done, ask your child to give your four pieces of information that they heard. Then ask them which vocabulary words were new for them. This discussion is an eye opener as to how your child reads in school for his/her daily assignments.

When a parent is busy, have your child read aloud using a phone app to record the session. When the recoding is played back, then both the adult reader and the child will hear vocabulary words that may need the old fashioned method of having the word placed on a post-it and stuck to the refrigerator or a cabinet door for some reinforcement practice. This recording also fascinates kids when they listen to how their voices sound to themselves and others and how much expression that they use or do not use when reading aloud. Additionally, remind your child…”When you read, you should be playing a video inside your head of what is happing in the story.” If you are worried about which books your child should be reading at home, check back to your child’s start of the school year DRA score. Go to your school website to see book titles by age/grade and DRA score that are listed for independent reading. The public librarians will also be able to provide you with suggestions of appropriate titles and authors. Scholastic has a very good webpage devoted to helping parents with reluctant reader suggestions, series of book titles by authors and listings of age, grade and genre titles.

The reading time does not have to be hours long. In fact, short 20-30 daily sessions work well for busy family schedules and reinforcement of skills. If your child can comfortably read in the car, then you are a captive audience traveling to sports practice, piano lessons, the grocery store, etc. So, remember your new family school year mantra…READ, READ, READ!!! Wishing you and your child a great reading experience!!

Dr. Maureen O’Reilly Winseck Educational Consultant

6 READ. READ. READ.

MEXICAN MAKE-AHEAD EGG MUFFINS These “muffins” are packed with brain boosting nutrients. They are also freezable so you can make ahead and zap in the microwave when it’s time for a quick breakfast or snack.

Ingredients 1/2 cup drained and rinsed canned black beans 1 cup frozen corn kernels or unsalted canned corn 1/2 cup shredded cheddar cheese 1-2 diced tomatoes 10 large eggs 1/4 cup skim milk or plain non-dairy milk

Instructions Preheat oven to 375 degrees F. Spray a muffin tin with cooking spray or line with muffin liners. Add the black beans to a large bowl. Lightly pat the beans with a paper towel to absorb any excess moisture. Add the corn, cheese, and tomatoes to the bowl. Lightly stir to combine. Use a spoon to divide the corn mixture evenly in the muffin tin.

In a large bowl, add the eggs and milk. Whisk until well combined. Optional: transfer the egg mixture to a large measuring cup for easy pouring. Pour the egg mixture over the corn mixture in the muffin tin, filling it until each cup is almost full. Bake for 20 minutes. Cool for at least 5 minutes before serving. Optional: Top with avocado, salsa, and wrap in a whole wheat tortilla.

**If making ahead, allow to cool and then freeze. Take out individually and microwave as desired. Don’t be afraid to be creative! You can mix and match different “add ins” to create an assortment of options! For example, try swapping the beans, corn, and cheddar cheese with chopped chicken, spinach, and mozzarella. Use your favorite ingredients to make a masterpiece your family will all enjoy.

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FOCUS FUEL Balancing your meals and snacks, so they are rich in a variety of nutrients, is key to continued energy and With the close of summer mental engagement. In addition, revolving your and the beginning of back to grocery list around whole, unprocessed, foods can school, your mind and body help you reach this goal more easily. For your is forced into a new routine. carbohydrates, look for whole grains like whole wheat This transition usually bread or brown rice. Whole grains digest more slowly, incorporates less physical providing a sustained supply of energy. When looking for protein sources, emphasize lean meats like chicken activity, early mornings, breast or plant based options like beans (which multitasking, and extended provide an extra punch of fiber!) Protein helps keep periods of sitting —- all you full which can make it easier to concentrate on the while trying to absorb and tasks at hand. For fats, look for sources that are learn. Even though this isn’t mainly unsaturated, as they boast benefits like an easy change for anyone, decreasing inflammation which can help encourage there are ways to properly proper functioning of cells in the brain. Nuts, avocado, fuel your body with nutrients or cooking with extra virgin olive oil are all excellent to keep you energized and sources of these fats. Foods rich in antioxidants, have also been shown to boost your brain. Lutein and focused! Fuel your mind Zeaxanthin, while mainly known for their benefits in and body so it is ready to eye health, have been linked to an improvement in partake in all the fun of a attention, visual memory, and reasoning. You can find new school year. these two antioxidants in eggs and dark leafy greens like kale or spinach. Lastly, consistency in meals and snacks is also important—- don’t skip meals! Food is fuel and you won’t run well on an empty tank!

8 Amber Hannon, MS, RD

BRUSH FOR SUCCESS!!!

As we get our morning routines together, help your children succeed in school, not only with a healthy breakfast, but having a healthy mouth. Studies have shown that many illnesses and missed days from school was due to lack of proper mouth care. Left untreated, tooth decay can lead to pain which impacts a child’s concentration and attendance in school. Tooth decay requires: 1) Tooth surface; 2) sugar; and 3) bacteria. Sugar can be reduced with healthier food choices. Bacteria in our mouths can be treated with consistent care. With proper oral hygiene, tooth decay is a preventable transmissible disease.

Brushing after breakfast helps remove plaque, disrupts bacteria and reduces the chance of tooth decay. We must also be mindful of what we feed our kids. There is a misconception that when HOW TO BRUSH IN 2 we say sugar, we only mean candy. Most foods MINUTES: such as breads, pasta, crackers, etc. have added or natural sugar. Many kids eat fail to brush before YOUNGER KIDS – SING A SONG school, increasing the chance of tooth decay. https://www.mouthhealthy.org/en/kids- brushing-playlist When eating foods with a high amount of sugar, it sticks to the tooth. Once sugar sticks, the bacteria OLDER KIDS – USE AN starts to absorb it. Acid is produced and lays on the ELECTRIC TOOTHBRUSH tooth. If left untouched, the acids from the bacteria, which was attracted to the sugar, which was stuck on the tooth, now has a chance to break down the enamel of the tooth and cause decay.

Brushing at night is even more important because most people eat and drink several times a day. We cannot eliminate bacteria completely and it would be hard to eliminate all sugar in our mouths, but we can brush and floss to disrupt the chance of tooth decay. IF we do not brush and floss at night before bed, there is residual food causing bacteria in the mouth. If we neglect brushing at night, while we are sleeping is enough time to begin tooth decay.

We must commit to reduce the amount of sugar in our mouths, brushing twice a day for two minutes and flossing every night before bed. It is important to be role models for our kids and participate in the proper oral hygiene for ourselves. Tooth decay can be prevented! Healthy mouths lead to successful days for our children. We must invest in their future! Healthy mouths, healthier bodies! Eat, Brush and Floss!

Michelle L. Stephenson, RDH

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EAT RIGHT. GET ACTIVE. REDUCE SCREEN TIME.

Eat Right Turn food shopping into family time after school or on the weekends! Bring your kids along and teach them to look out for healthy choices.

Get Active Kicking off the school year can be a busy time, leaving little room for physical activity. These three steps can help you find time to be active as a family. Try these great tips: • Walk your kids to school • Dance • Jump rope • Shoot baskets • Ride bikes after dinner • Walk the dog • Rake leaves • Play tag

Reduce Screen Time Kids spend a big part of their day sitting in the classroom, so you can help your children spend less time in front of the TV, computer, and video games—and more time having fun as a family— with these tips: • Families who eat together tend to eat healthier. • Limit screen time to two hours each day for children 2 or older. • Suggest playing outside after school and join in the fun. • Turn on some music and have a family dance party. Be a good role model. If you reduce your screen time and move more, your kids will too!

Retrieved from https://www.nhlbi.nih.gov/health/educational/wecan/downloads/tip-back-to-school.pdf 10 REDUCING SCHOOL VIOLENCE

“Back to School” concentration for students can be impaired if there has been gun violence in a community or elsewhere in the country. However, anxiety can be re-directed and alleviated by finding a purpose: plan a school community of caring inclusion and connection! Ideas of how to create such programs can come locally from VBStrong, and nationally from The Sandy Hook Promise.

A primary goal is to combat social isolation, which overwhelms people and makes them feel left out and lonely. Such young people can become victims of bullying, violence and depression. Many may pull away further from society and struggle with learning, social development or choose to hurt themselves or others.

The “Start with Hello” component of The Sandy Hook Promise teaches all students, educators, community leaders to notice someone alone, reach out and help: “Start with hello“ and a smile. Get to know each other and sustain an inclusive community.

Another component of the Sandy Hook Promise is “Say Something”. This initiative teaches and empowers children ten years and older how to recognize signs and signals, especially in social media of an individual who may be a threat to themselves or others. It reinforces the need to be an ”UPstander” and say something to a trusted adult before a tragedy takes place. By building a culture of looking out for one another, and reporting possible threats when someone hears, sees or reads something, entire communities will be safer. Lives will be saved. In 80% of school shootings, the attacker told people of his/her plans ahead of time. Additionally, 70% of people who complete suicide told someone of their plans and gave some type of warning or indication.

This is heavy subject matter but we know our children learn citizenship, social skills, including how to make friends, as well as academics at school. They are part of our hope for a kinder compassionate society with less mental illness and violence. Check out https://www.sandyhookpromise.org/ for ways you can bring these no-cost programs to your school.

Fanya Seagull, MD, FAAP Sentara Pediatric Physicians – Virginia Beach (757) 395-1925

DON’T LET THE FLU BUG YOU

Flu season is almost here – and we want to make sure you’re protected. So, during your next scheduled office visit, please make sure to ask your care team for a flu shot!

A flu shot is the single best way to prevent the spread of the flu and the U.S. Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6 months get an annual flu vaccine. So, don’t delay – schedule an appointment to get your flu shot today!

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