The summertime is a wonderful time to help your child learn how to write sentences and paragraphs, which follow a logical sequence and include interesting details.

Children typically need to be encouraged to write. Students who believe they have interesting ideas and can write well generally develop their written language skills at a faster rate.

The initial step in helping your child to develop their written language paragraph writing skills is to ask your child to examine and study a picture you choose for them. Most written language assignments will include a picture to write about at the elementary and middle school level.

Spark Ideas

Ask your child the question, “What do you see in the picture?” Then ask, “What is happening in the picture?” Then ask your child, “What can you say about what is happening in the picture?” As your child answers your questions orally write down some of their answers on a scratch piece of paper. Next, go over their answers with your child and talk about their perceptions of the picture. If your child added details that are not in the picture, then nicely point out which details do not fit the picture.

Help Getting Started

Next, show your son or daughter how to write a quality opening sentence that describes the picture on their assignment. Numerous students with learning issues or those who struggle in school do not always understand how to write an excellent opening sentence. Talk about the opening sentence with your child and prompt them to study what is happening in the picture for a minute or two.

Instruct your child to include the main idea of the picture in their opening sentence.

The Middle

Ask your child to focus their middle sentences on two or three main ideas or details found in the assigned picture. The middle sentences can be made more interesting if they include a cause and effect or “because statement”. Often children can say the sentences orally better then they can write them.

Hint: If writing is a difficult area ask your child verbally to tell you the detail and stop them and say the detail back to them as they write it.

Tools

Use a thesaurus to help them locate two or three strong nouns or verbs, which can replace the more common ones they used.

Next, the student may wish to add a detail sentence or two about the sentences they have already written. Aim for five to seven sentence paragraphs and in some cases nine sentences.

The Ending

Lastly, ask your child to close the paragraph with a good sentence that answers the why or restates the opening sentence. Some students may wish to make a prediction about the subject of the paragraph in their closing sentence.

Parents it is important to complement your child on their effort and reread their paragraph with them for clarity.

If sequencing changes should be made, then nicely point out why the order should be different.

Thanks for joining me this past week on DrGreene.com. I wish to complement all the readers of my posts for your diligence in researching information to help your child reach their scholastic potential.  May you have a happy, fun-filled, educational summer with your children.

My heart goes out to the families and friends of those who lost their lives in this horrific tragedy. There are no words that can heal your pain. There is no action that can undo what has been wrongly done to you.

But it’s time to tackle this issue boldly. The tragic deaths of these 20 innocent children and of the 6 brave adults who stood up to the gunman are the tip of an iceberg. Thousands go through this every year. More American kids are killed by gunfire every year than all US soldiers killed in Afghanistan from 9/11 through 2012.  Combined.

The war is at home.

And it’s not inevitable. Almost 12 times more US kids are killed by guns than in any of 25 other industrialized nation. And when it comes to homicide, it’s 16 times more killed by gun than in the other industrialized nations combined.

This demands the question, what’s the difference?

Consider Seattle versus Vancouver. These similar neighbor cities have very different gun death stats. What’s the difference? It’s not a difference in video games or movies. It’s not a difference in security measures or in mental illness. One glaring difference between those cities – and between us and other countries – is the ease of obtaining guns.

And in 2011 a law was passed in Florida forbidding pediatricians from even talking with their patients about gun safety and keeping guns safely away from kids. We protect our gun owners more than our kids. Kids deserve freedom too.

Pediatricians come in all political stripes, but more than 90% of pediatricians favor some form of reducing easy access to guns.

We pediatricians understand that when it comes to kids health, the elephant in the room is guns. Guns are killing our kids. Through homicide, suicide, and accident they are a leading cause of death throughout childhood. And overall, the death rates of kids from guns are the same in urban centers and in farm country. It’s an issue for all of us, not just for people leaving someplace else.

I know there are many other aspects to this story – helping families cope, school safety strategies, teaching kids non-violent problem solving, etc. – but we need to wake up to the scope of the problem. Another Newton is not inevitable.

Continuing this is our choice.

The Food Pyramid: Gone and NOT missed! On June 1, 2011 I logged on to MyPyramid.gov for kids and played their Blast Off Game “An interactive computer game where kids can reach Planet Power by fueling their rocket with food and physical activity.” I registered as Alan, an 11-year-old boy. The results were slightly less horrifying than when I did this in 2006 (and reported my findings). But just barely.

When you launch the game, you’re invited to select food items and physical activity for the day from a list that varies occasionally if you play several times. When you’re satisfied with your choices, press the Blast Off button and the game will analyze your diet to see whether it would give your body the optimal fuel to complete your journey.

My Breakfast

To start the day I chose chocolate sugar cereal. Because the nonfat milk it came with seemed rather bland, I added a cup of chocolate milk to go with it. At this point an alert popped up, but perhaps not the alert you’d expect after a junk food breakfast with a double dose of sugary chocolate:

“STAR PILOT! It’s clear you know your facts. You’ve chosen 2 low-fat/fat-free foods. Great job!”

I was still hungry, so I added a white bread English muffin to my white flour and sugar breakfast.

My Lunch

At school I selected a Sloppy Joe sandwich on a white bun and received a 3-star alert, but again it might not be what you’d expect:

“Well Done! You have enough Grains!”

My Sloppy Joe seemed like it was missing something, so I added French Fries (deep fried). My meal still didn’t seem complete, so I added a second order of French Fries (deep fried). I was feeling a little guilty at this, so wasn’t surprised when an alert popped up – but was surprised at what it said:

“Well done! You have enough Vegetables!”

My lunch was missing something sweet, though, so I grabbed a glass of apple juice. Lo and behold, another alert:

“STAR PILOT! You just grabbed a 100% Fruit Juice. Good job!”

Being called a STAR PILOT is nice, so I went back and added some apple juice to my breakfast and chose apple juice for my afternoon snack, along with a glass of milk. I did receive an alert that whole or cut-up fruit is even better than fruit juice, the best advice I’d gotten so far. For physical activity I did some household chores. I set the table, I emptied the dishwasher, I made my bed, I put away some of my stuff. It seemed like it took an hour, but never got my heart pumping.

My Dinner

It’s been a long day! I chose fried chicken for dinner. This time I got TWO alerts. One suggested that more of my grain choices should be whole grains. I hadn’t expected fried chicken to prompt a grain alert, but I’m glad it did. This alert was one of two improvements I’ve seen in the 2011 version (the other is a much broader selection of healthy foods that a child could select. Kudos for that.). I also got another 3-star alert, this one expected given my Sloppy Joe and fried chicken:

“Well Done! You have enough Meats and Beans!”

Still, something seemed like it was missing from my dinner – from my whole day, really. And I knew just what it was: gravy! So I added an order of gravy for my fried chicken. That sounded so tasty that I chose a second order of gravy as well.

Ready for the Test

I was feeling stuffed, so it seemed like time to push the Blast Off button and have my diet analyzed. My food all tasted great, but I was a bit nervous about what they would suggest I change. How was my fuel? The big moment arrived. Mission Report Received! From Mission Control to Astronaut Alan:

• Grains: Congratulations! You reached optimal levels. (Remember my “optimal” grains? Refined grain sugar cereal, white bread English muffin, white bun. Not a single whole grain.)
• Fruits: Congratulations! You reached optimal levels. (Remember my “optimal” fruits? Apple juice. 4 servings.) ƒ
• Milk: Congratulations! You reached optimal levels. (I didn’t know sugary cereal with chocolate milk was optimal!)
• Meats and Beans: Congratulations! You reached optimal levels. (Sloppy Joe and fried chicken)
• Vegetables: Congratulations! You reached optimal levels. (WHAT??? I don’t remember any vegetables. Oh. Right. Two orders of French fries, and I think there were some chunks in the Sloppy Joe mix.)
• Activity: Congratulations! You reached optimal levels. (And I thought I had to run or dance or jump or do sports or play hard or get outside. I’m glad setting the table counts.)

“Based on your food choices the MyPyramid rocket ship landed on Planet Power. Everyone at Mission Control is very pleased with your fueling choices.”

My food choices made them happy. And to top it all off, I won a certificate! MyPyramid Mission Control Certificate of Commendation to Junior Astronaut Alan for piloting the MyPyramid rocket ship successfully to Planet Power by making healthy food and physical activity choices.

And that is why…

And that is the story of how I came to hate the food pyramid and why I am celebrating its demise. Viva la Plate!

Could this get any worse? See Part 2 of Alan’s Nightmare Food Pyramid Journey.

Alan’s Full Menu from his Nightmare Food Pyramid Journey

Some of our children’s food choices are made at home – but as they grow, many are made in childcare or at school. We need our schools and daycare centers to be working with us, not against us in teaching children to enjoy healthy amounts of good food, cultivating Nutritional Intelligence.

About half of all middle schools and high schools in the US permit advertising of candy, fast-food restaurants, and/or sodas at school! This practice is most common in Ohio (nearly 70 percent of schools) and least common in New York (24 percent).

Does advertising affect our kids’ food choices? Of course it does! And in more ways that you might think. The Institute of Medicine has found that advertising to children affects their preferences, purchases, and consumption – changing their habits for different food and beverage categories, in addition to specific product brands.

Some estimate that each year, nationwide, for every dollar spent on promoting junk food to our children only about 1/10 of a penny is spent promoting healthy food. Schools are one place where the opposite should be true. At least.

CDC (Centers for Disease Control and Prevention) Children’s Food Environment State Indicator Report, 2011.

IOM (Institute of Medicine). 2005. Food Marketing to Children and Youth: Threat or Opportunity? Washington, DC: The National Academies Press.

Yale Rudd Center for Food Policy and Obesity. “Fast Food FACTS: Evaluating Fast Food Nutrition and Marketing to Youth.” November, 2010

Every Child Deserves Fresh Fruits and Vegetables: The Great American Salad Bar Project

Frequently when I talk to groups about how to get their kids to enjoy food that’s good for them, I talk about the smell, taste and feel of the rich, round, red tomatoes that parents all over the world grow in their backyards (watch my short video, The Tomato Theory). I tell parents that one of the best ways to encourage their kids to enjoy fruits and vegetables is to engage them in preparation and serving – as far upstream in the process as possible. Let them help water the seedlings, gently pull the fruit from the vine, carefully slice the veggies for the salad and artfully create a colorful salad for the dinner table. The more children participate in the process, the more willing they will be to discover the fresh tastes (and nutrients!) that await them.

In a perfect world, all children would have access to the wonders of a family garden, and all parents would have enough time to help them discover it. But in today’s hectic world, not only do many backyards lack gardens – some kids rarely see fresh foods and healthy grains on their plates at all! More than 30 million children rely on the National School Lunch Program every school day, and the food that’s served in many school cafeterias is as far away from “garden fresh” as you can get – nachos, pizza, French fries and other high-fat, low-nutrition fast food staples.

That’s why I’m bursting with pride to be the vice president of a nonprofit organization that is launching the Lunchbox Project and the Great American Salad Bar Project. We’re working toward a healthy salad bar in every school across America so all kids have access to fresh fruits and vegetables, whole grains and healthy proteins every school day.

Between now and November, schools that are ready to seek to make real, healthy changes to their school cafeterias can apply for one of 300 grants. Each grant recipient will receive the equipment and training they need to set up their salad bars. Whole Foods Market has already raised close to $9 million so far with the goal of sponsoring salad bars in every community their stores serve.

My friend Chef Ann Cooper is the founder of the Food, Family, Farming Foundation, and I’m proud to be on the team that makes her dream a reality and helps bring flavorful, fresh food to our children’s tables. When you hear students say things like, “Looking across the vast salad bar options was like looking at an artist’s palate,” you know this project will teach kids to appreciate the beauty and nutrition of fresh, healthy food.

Take Action!

• Does your child’s school need a salad bar?   You need to click here to share the information with school leaders to apply for a grant.
• How’s your lunch box? Check out The Lunch Box online toolkits with Healthy Tools for All Schools to transform your school food into healthy and delicious meals for your kids.

Each day 3,000 kids start smoking.  One third of them will die from their addiction.

Most preschool children today view smoking as an unhealthy, negative behavior.  Somewhere around the time of kindergarten, however, this often begins to change.  They begin to think of positive aspects of smoking – that it is cool, that it can help you calm down, that it’s grown up, etc.  Many kids become quite ambivalent about smoking at this age.  Your greatest opportunity to prevent smoking lies between about the ages of 6 and 12.

When my son, Kevin, was a participant in the California State Scholastic Chess Championships.  During the lunch break, we grabbed a quick bite to eat.  Over lunch, another of my children (who shall remain nameless) picked up a straw, placed it still-wrapped in the mouth and began to pretend to smoke a cigarette – feeling very grown-up.  Quickly I checked to make sure no one in the restaurant recognized us (just kidding!).  Actually, we used it as an opportunity to talk again about all the people who are killed by cigarettes, and why smoking is not a game.

During this age, children need to hear you reinforce the consequences of smoking often, particularly the short-term consequences.  Get your kids talking about what they think about cigarettes.  Their ideas will guide your teaching.

Children also need to hear the truth about smoking from their schools.  Check to see that your children’s schools have smoking curricula.  The Center for Disease Control (CDC) and the National Cancer Institute (NCI) have free guidelines for curricula available, outlining what should be covered, how it should be communicated, and when these lessons are most important.  School-age children often look up to their teachers a great deal.  If the teachers’ lounge smells like smoke, children will notice the smell on their teachers.  When kids hear one thing from their teachers and see (or smell) another, the message is badly undermined.  If teachers who smoke wish they could quit (and a great many smokers do), it could be helpful to tell the children this, giving them a vivid example of the addictive powers of nicotine.

A teacher could even ask the class to encourage her in a stint at trying to quit – the class could function as a kind of support group.  If the teacher succeeded in quitting, the message to kids would be that they can be powerful health-promoters.  If the teacher failed, the message to kids would be that cigarettes are indeed terribly addictive.  In that case, she could promise to try again in a few months.

Avoid pretend smoking and candy cigarettes.  Some of the packages of candy cigarettes available look amazingly like the real thing.  If some other industry had their product copied, lawsuits would quickly ensue.  But not in this case!  The tobacco companies are glad to have kids imagine and model smoking behaviors.  Bubble gum is also available in packaging that looks like a tin of smokeless tobacco.

Help your child to notice the marketing campaign that is actively trying to deceive children and adults.  If your child sees a tobacco ad full of smiling, active people in a magazine, ask what the tobacco industry is trying to trick you into thinking about cigarettes (that smoking makes you happy and athletic).  Ask what the truth is (that smoking discolors the teeth, gives you bad breath, causes cancer in the mouth and throat, and decreases your athletic ability).  Kids can really get into this game, and it helps make them wiser.

In addition to emphasizing the health dangers of tobacco, children at this age need to be taught a vital skill – how to say “no.”  Throughout the school years, peer opinions and behavior gain increasing sway.  Sometimes children will start to smoke if they don’t want to, just because they’re afraid to refuse a friend.  Teaching refusal skills to your school-age child is well worth the investment.  A great way to do this is to practice.  If your child is able to say that cigarettes are harmful, ask “What would you say if your best friend offered you a cigarette?”  Let your child try out several answers.  Kids who have practiced and who have ready responses will be more free to make their own choices regarding tobacco, sex, alcohol, drugs, and nutrition.

When I see twelve year olds in our clinic, I still need their parents’ permission to treat them for strep throat or eczema. But parents’ permission, or even their knowledge, is not required for pediatricians in our state to provide contraception, or to treat pregnancy-related issues, sexually transmitted diseases, alcohol or drug abuse, or depression.

The middle school years are a time of enormous transition. Childhood is giving way to adolescence; the primacy of parents is giving way to the forging of peer relationships and networks that have deeper influence than ever before.

These changes are reflected in the changing role of the pediatrician. Starting in middle school, I begin asking the parents to step outside the room for a portion of each visit, to give the student, my patient, a chance to talk or ask questions confidentially. Meanwhile I ask some questions of my own: about school, friends, moods, smoking, sexual activity, etc. Being excluded from this conversation sometimes makes parents feel uncomfortable.

I see parents as vitally important to their children’s well-being, and encourage teens to communicate with them. Most teens I see only every year or two. So I offer some thoughts to parents on how to navigate these wonderful, tumultuous years. I have four kids of my own, ranging in ages now between 12 and 21.

1. Build a communication bridge with each child. Quietly develop an interest in some topic that your child is passionate about, learn the details, and keep up with what is new. Choose something that you can both relax and enjoy talking about, even in times of stress. Keep that topic free from any argument or nagging – a safe zone. And build a setting for conversation into the routine – family breakfast or family dinner can be a great conversation anchor. If you haven’t learned to be an agile texter, it’s a good time to start.
2. Build bridges to great peers. In middle school and high school, perhaps the greatest predictor of their behavior is the expectations of their friends and peers. Friendships are forged in shared experiences. Go out of your way to facilitate shared experiences for your children with the friends that bring out the best in them. These last few intense chauffeuring years, where you are a major source of transportation, are a real opportunity.
3. Build bridges to their dreams. Listen for their aspirations, both short- and long-term. Encourage them to dream. Find ways for them to try the dreams on – connect them with people, experiences, opportunities, books, movies to support their dreams. And don’t mind at all when the dreams change dramatically, and it’s time for them to explore something else.
4. Build bridges to memories. Think back on some of your favorite childhood family memories. This is a great time to create some for your own family, when your children are old enough to appreciate and remember them, and young enough that they are not pulled in as many directions as they may be soon. Use photos, videos, and stories to keep those great memories present.
5. Family traditions are important. When kids are entering into middle school, it’s a good time to re-think your traditions in light of what will work when they are in the busy high school years, when they move away to college, or when they out on their own. We try to have at least a few days every season set aside for something special (such as our annual Dad’s birthday weekend at the Russian River, not far from our home). This could still work when they all have families of their own. We’ve moved the date around considerably, as well as the location (this year won’t even be in California), but we always do “Russian River.”

Our teens will require our time, our attention, and our money one way or another. When we can, it’s better to invest these in building bridges than in rescue operations. Each family finds their own way. None of us is perfect. But it is certainly possible to enjoy the transition years, and to become even closer during them, as the nature of our relationship transforms as much as our children do.

What are your challenges, concerns, solutions, and thoughts on those years in the middle? What wisdom can you share? Humorous stories welcome. We all need to laugh.

We know that parents communicating with kids about sexuality can have powerful effects: on average it delays the age of first intercourse, increases the chance of contraception if they do have intercourse, and decreases the number of sexual partners – even if the talk doesn’t go as well as parents hoped. The National Institute of Mental Health and the CDC funded a study into “The Big Talk” to see what is most important about this talk for having the biggest positive impact. They especially considered which is more important, the breadth of topics covered or the number of times the conversation is revisited. The results were published online in Pediatrics in March 2008. Because sexuality is a sensitive subject to discuss with one’s children, parents often focus on limit conversations to “safe” topics, such as changes in the body during puberty, how babies are conceived, and possible negative consequences of sex, such as sexually transmitted diseases. Many parents avoid or rush through more delicate topics, such as masturbation, orgasm, sexual decision-making, and how to use condoms. Many teenagers feel a gap between the topics that their parents cover during sexual discussions and the more personal topics they really want to learn about. Many parents and teens feel a bit let down by the talk.

In this study, researchers analyzed the conversations for completeness by comparing them to a list of 22 topics, such as “how you will make decisions about whether to have sex,” “consequences of getting pregnant or getting someone pregnant,” “how to choose a method of birth control,” “what it feels like to have sex,” “how well condoms can prevent sexually transmitted diseases,” and “how to say no if someone wants to have sex and you don’t want to”). Teens whose parents covered more topics felt that their sexual discussions occurred with greater openness than did those who discussed fewer topics.

Repetition – discussing sexuality multiple times – was far more important than the breadth or depth of the discussions. Teens who had more sexual conversations with their parents felt closer to their parents, felt more able to communicate with their parents in general, felt more able to communicate honestly about sex in specific, and perceived that discussions occurred with greater openness than did teens who had fewer talks, or worse yet, just one Big Talk.

This is good news, taking the pressure off parents. The key isn’t getting one moment right, but at least once kids are in middle school, checking in with them early and often about sexual matters, answering whatever questions they may have.

Martino SC, Elliott MN, Corona R, Kanouse DE, Schuster MA. Beyond the “Big Talk”: The Roles of Breadth and Repetition in Parent-Adolescent Communication About Sexual Topics Pediatrics 2008;121;e612-e618.

MRSA infections now kill more Americans than does HIV/AIDS, according to a CDC report in the October 17, 2007 Journal of the American Medical Association. Most of these infections are in adults over age 65, but infections with resistant bacteria are on the rise, even among healthy children. The important bacteria for parents to know about are called Staph. Aureus,  often called just “staph”.

These bacteria are very common on the skin and in the noses of healthy kids. Sometimes they slip through a break in the skin and cause infections. In fact, they are among the most common causes of skin infections – usually just little pimples or boils.  In hospitals, though, the infections were sometimes lethal, because the bacteria became resistant to major antibiotics. Now resistant staph is showing up in schools. When the bacteria become resistant to antibiotics, they can spread rapidly through communities. In some places in the US, MRSA infections (methicillin-resistant Staph. aureus) now account for 75 percent of staph infections in otherwise totally normal children. These infections are more common where kids are in close skin contact, such as in daycare centers and in contact sports (perhaps daycare is a contact sport!). On average, they are more common in kids under 2 than they are in teens.

Most of these infections can be successfully treated, especially if caught early, but occasionally they progress to serious or even fatal infections.  This week, another previously healthy high school student died from MRSA. How do you know if your child might be infected? MRSA infections usually begin as infected bumps on the skin, or what people might think are just infected “insect bites” or “spider bites”. They usually start at a place with a scrape, bite, or cut – or a place on the body covered with hair. The American Academy of Pediatrics says in their 2007 MRSA management alert that any suspected insect bite or spider bite should now be considered MRSA until proven otherwise. And how do you prove otherwise? Have a doctor drain some of the pus from the middle of the lesion and send it for culture. In a previously healthy child, if the infection is small it can usually be treated with drainage (possibly adding a MRSA- appropriate oral antibiotic – TMP/SXT, clindamycin, or doxycycline for kids over age 8 – but NOT one of the typical antibiotics used to treat skin infections). If the wounds are large, though, or the children are very sick, they may need to be hospitalized for emergency treatment.

How do you help prevent MRSA? Keep scrapes and cuts clean and covered. Keep the hands clean with soap and water or instant hand sanitizers. Take a soapy shower after sports. Minimize sharing towels, razors, or other objects that rub the skin (and clean shared toys often).  But perhaps the most important take home message is just to be on the lookout for superbugs at school. Be sure your doctor knows about any red, swollen, or painful bumps that may be filled with, or draining, pus. Early treatment usually does the trick.