Children’s Mental Health & Learning During COVID: A Series

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By Zach Clay, Licensed Marriage, Family, and Child Therapy

During this unprecedented and often challenging time in the world, we need to consider the impact everything has on children. The COVID-19 pandemic can be particularly tough for children’s mental health and their ability to learn. NOAH’s Behavioral Health team shares expert insight, best practices, and resources in this series of posts to help children maintain mental health in the era of COVID-19, social distancing, and distance learning.  

Identifying Depression & Developing Coping Skills for Children

Children experience the world around them – the good, the bad, the stressful, the happy, the uncertain – and sometimes need support to navigate everything. In many ways, children are similar to adults with mental health; identifying what is happening, talking about what is happening, and developing healthy coping skills. Here, we highlight ways to identify depression in young children and coping skills that are easy for children to do and remember.

Signs of depression in children

Children who are experiencing depression may show it in a variety of ways. They may express feeling hopeless, helpless, and discouraged and as caregivers, we should listen and help them explain what they are thinking and how they’re feeling. But we must listen without judgement, or without trying to “fix” things. Parents and other caregivers don’t need to agree with what they are saying but do need to let them know that they are heard and supported. For example, “I hear you. That sounds really hard and I’m sorry you are feeling sad. I love you.”

Symptoms of depression may include:

  • Changes to sleep patterns
  • Gaining or losing weight
  • Sadness or irritability
  • Loss of interest in activities they usually enjoy
  • Unusual sadness or irritability, even when circumstances change
  • Reduced feelings of anticipation or excitement
  • Sluggish or lazy
  • Overly critical of themselves, like “I’m ugly.” “I’m no good.” “I’ll never make friends.”
  • Feelings of worthlessness, hopelessness
  • Thoughts of or attempts at suicide

It’s important to understand that this is more than a bad day or two, or occasional behavior changes that go away. If you see one or more of these symptoms for two weeks, they can suggest depression and you should make an appointment to get them professional help and support.

Developing coping skills

An important part of managing anxiety and fear is with healthy coping skills. These skills help you deal with stressful situations in a healthy and productive way. Mindfulness techniques are beneficial for all ages and are especially helpful for children. Mindfulness means taking time to focus on the present, be thoughtful about your feelings, focus your thoughts, and be in the moment.

These exercises take a little effort, but the investment is worth it especially now when there is such uncertainty about the future and what our world will be post-pandemic. These activities can make mindfulness work for both parents and children.

  • Squeeze Muscles: Starting at your toes, pick one muscle and squeeze it tight. Count to five. Release, and notice how your body changes. Repeat exercise moving up your body.
  • Belly Breathing: Put one hand on your stomach and one hand on your chest. Slowly breathe in from your stomach (expand like a balloon) and slowly breathe out (deflate).
  • Meditation: Sit in a relaxed, comfortable position. Pick something to focus on, like your breath. When your mind wanders, bring your attention back to your breath. Do this for just a few minutes.
  • Blowing Bubbles: Notice and talk about their shapes, textures, and colors.
  • Coloring: Color something. Focus on the colors and designs.
  • Listening to Music: Focus on a whole song or listen to a specific voice or an instrument.

Mindfulness doesn’t have to be a big deal or extra work. Take a few minutes in the morning, after school, before bed, or a time that works for your child and family to practice mindfulness.

NOAH’s comprehensive team of behavioral health experts  can work with you, your child and your entire family to address stresses, depression, coping skills, and more.

Children’s Mental Health & Learning During COVID: A Series

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By Zach Clay, Licensed Marriage, Family, and Child Therapy

During this unprecedented and often challenging time, we should consider the impact it has on children. The COVID-19 pandemic can be particularly tough for children’s mental health and their ability to learn. NOAH’s Behavioral Health team shares expert insight, best practices, and resources in this series of posts to help children maintain mental health in the era of COVID-19, social distancing, and distance learning.  

Help children understand COVID

It is approximately 11 months after the COVID-19 pandemic began. In many ways, we are still adjusting to different phases of routines and “normal” life activities, and that includes children. Parents and caregivers should be able to talk about the impacts of the virus to help children understand without causing them to feel overly worried or anxious. NOAH experts support the following recommendations from the Child Mind Institute to help guide parents and other caregivers in these conversations with children.

  • Welcome their questions. Kids have questions! Any parent, teacher, grandparent, neighbor, babysitter, and friend knows that children have many questions. It’s a good thing because curiosity is an important quality in kids. Questions can range from serious, like “Will Grandma be okay?” to the much less serious, like “Will my favorite videogame store still be there?”. Encourage their questions and take their concerns seriously. Your goal is to help your children be heard and to answer their questions with fact-based information.
  • Don’t avoid questions you can’t answer. Telling a child “I don’t know.” is an acceptable answer when it is the truth. There is a lot of uncertainty right now, and things change frequently. While we want to tell our children that everything will be “back to normal soon,” we may not know. Helping your child learn how to accept uncertainty is key to reducing anxiety and helping them build resilience.
  • Be developmentally appropriate. Being honest is important, but that doesn’t mean giving too much information which can be overwhelming or confusing for children. Answer their questions honestly and clearly, and if they have follow-up questions they will ask because you have shown them you will answer their questions.
  • Deal with your own anxiety. We are living through a global pandemic and economic crisis. This isn’t an easy or normal situation for anyone of any age. It’s okay, and expected, for parents or caregivers to have sadness, stress, or anxiety about everything happening. But don’t try to talk to your children about their questions or stresses if you are feeling anxious or overwhelmed. Take some time before having a conversation or answering your child’s questions because it will be hard to help them if you are struggling. If you are experiencing stress and anxiety about COVID-19 or anything else, NOAH’s counseling team is available.
  • Be reassuring. Children may be worried that they will catch the virus or become afraid other people they care about will become sick. Reassure them that children don’t usually get very sick, and that as a family you are doing everything you can to keep them – and other people – safe and healthy by wearing masks, socially distancing, and following other recommendations.
  • Focus on what you’re doing to stay safe. Children will feel safe by having parents and other caregivers emphasize the safety measures that you, and others around you (like teachers, coaches, etc.) are taking. Remind kids that washing their hands is helping everyone by stopping the spread of COVID-19 and other viruses.

Keep talking to your kids. When they know you will answer their questions, help find answers together, tell them the truth, and help them feel calm and safe, they will likely keep talking. Many children (and adults) are visual learners and might enjoy learning about the virus with a comic book created by NPR. More on this series for Children’s Mental Health & Learning During COVID to come!

Understanding & Preventing Some Birth Defects

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By Dr. Lindy Truong

Birth defects are not uncommon. Every year, one out of every 33 babies is born with some kind of birth defect ranging from minor, to those with life-long challenges. Some are preventable, and many can be managed better with proper care and support from a medical team.

There are, however, some factors that increase the risk of having a baby with a birth defect. January is National Birth Defects Prevention Month, so here are ways to increase the chance of having a healthy baby. This year’s theme is “Best for you. Best for baby.”

Healthy Moms for Healthy Babies

One of the most important steps a patient can take to having a healthy baby is to make sure they are healthy themselves prior to getting pregnant and throughout pregnancy. One of the most important ways to do that is to maintain a healthy weight before becoming pregnant, since women will gain weight during pregnancy. Babies born to obese women have an increased risk of having birth defects, such as heart and spinal cord defects.

Folic Acid During Pregnancy

Folic acid plays a big role in a baby’s development during pregnancy. Women who are pregnant or might become pregnant should try to have 400 micrograms of folic acid every day. In early development, folic acid helps form the neural tube—a structure that begins forming in the first 3 to 4 weeks after conception. Later, the neural tube becomes the brain and spinal cord. Folic acid is important in preventing birth defects that affect the baby’s brain (anencephaly) and spine (spina bifida).

Prenatal Care

Starting prenatal care as early as possible during a pregnancy has shown to increase healthy, full-term deliveries. If someone is pregnant, they should start prenatal care as soon as they think they might be pregnant. It will be important to continue all prenatal appointments throughout the pregnancy. These appointments ensure that both baby and mom are healthy, monitor any medications because some can cause birth defects, and so much more.

Preventative Health

Being current on vaccinations is important to protecting both mother and baby. The two most important vaccines to have during pregnancy are the Flu and Tdap (tetanus, diphtheria, and pertussis a.k.a. whooping cough) vaccines. When mothers get these vaccines during pregnancy, it also protects them from the flu and whooping cough for a short period post-delivery as well!

What to Avoid

Last, but not least, it is very important to avoid substances like alcohol, smoking, and recreational drugs. These can seriously increase the risk for birth defects. Drinking any alcohol during pregnancy can increase the risk of fetal alcohol syndrome and defects. Smoking and recreational drugs similarly increases the risk that the baby will be born smaller and with birth defects.

Expecting a baby can leave the parents with many questions, which is why having a trusted medical home for you and your baby is so important. If you plan to get pregnant, take care of yourself and do what is best for you, because it is also what is best for the baby.

You can schedule a preconception visit with your healthcare provider before you even become pregnant, which is a good place to start. Being healthy before pregnancy sets a good foundation for a healthy pregnancy. Continue with regular prenatal visits for close monitoring along the way. These are simple yet important things one should do to prevent birth defects in their baby.

Childhood Obesity Awareness Month – Tips to Stay Healthy

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By Dr. Mason Wedel, MD PGY1

September is National Childhood Obesity Month, a time to raise awareness of this growing concern for children. Obesity is a major public health problem for children everywhere, putting them at higher risk for other chronic medical conditions such as diabetes and asthma. Having obesity as a child also makes children more likely to become obese adults.

“About 1 in 5 (19%) of children are obese today.”

According to the Centers for Disease Control and Prevention

Here are some tips to prevent or combat childhood obesity:

  • Eat More Fruits and Vegetables – serve more fruits and vegetables at meals and as snacks. Decrease the amount of high fat and sugary foods.
  • Stay Active – children are recommended to get 60 minutes or more physical activity DAILY. Include running, jumping, walking, bike riding as well as muscle strengthening exercises such as push ups.
  • Drink More Water – always encourage more water and make it available at all times instead of high sugar drinks such as soda. Limit juice intake.
  • Ensure Adequate Sleep – follow a sleep schedule by going to sleep and waking up at the same time each day, even on weekends. Remove electronics from bedroom and make sure the bedroom is quiet and dark.

These tips will help your child have more energy, control their weight, strengthen their bones, increase their self-esteem and live an overall healthier life. Be sure to have a medical home for your entire family and talk with your child’s doctor about any concerns like childhood obesity. Follow these tips daily and help stop the rising number of children with obesity.

Need a Sports Physical? What to Know Before You Go

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By Camilyn Tinoco, PA-C

With a new school year comes the excitement of fall sports. Participating in sports is not just a great way to improve health and physical fitness but also an opportunity to socialize and interact with other people in a wholesome setting!

Though most athletic activities have been suspended due to the COVID-19 pandemic, Arizona Interscholastic Association Executive Director David Hines says “We’re going to do everything we can to have some type of a season for all of our kids.”

With hopes that athletics will be able to resume in some form, it is important to obtain a sports physical before the season begins.

What is a sports physical and why is it important?

A sports physical includes a detailed medical history and physical exam which helps medical professionals decide if you can safely participate in a specific sport. Even though they can seem like a burden to obtain, they are incredibly important for making sure you are ready to go before practicing or playing in a big game. For example, a sports physical can help assess more common issues like concussions, hernias, or asthma. They can also help screen for potentially life- threatening issues like a cardiac abnormality. Most states require all students to complete a sports physical before being able to play; however, even if it is not required, a sports physical is important and encouraged. If you have questions, you can always ask your child’s pediatrician or your primary care doctor. If you don’t have one yet, NOAH can help you have a medical home.

What exactly happens during a sports physical?

There will be a list of medical history questions that you should fill out on the form prior to your appointment. Answer these to the best of your knowledge based off your personal and family history. If you have questions, bring them to your appointment and your provider will help guide you through the questions. It is very important to get a good history as this is one of the most important parts of the physical in ensuring you are safe to win that big game. We encourage you to ask family members about any family history questions you might not know the answer to.
When you come in for your physical, first, you will have your vitals taken to determine blood pressure, heart rate, height and weight. This is followed by an eye exam to assess vision. Once you are brought to the exam room, we will review your responses and likely ask some additional questions. Then we perform the physical exam checking things like your heart, lung abdomen, joints, etc.
If all appears okay, you will then get the “go-ahead” to start practicing! Yay!

What if something is wrong?

If there is any abnormality or concern, your medical provider will make sure you are set up with the appropriate follow-up with them or a specialist to hopefully get you out on the field as soon as it is safe to do so. Sometimes it is a simple lab check or consultation with a specialist before you get the green light to join the team, so do not get discouraged! More likely than not, you will be able to participate after that extra clearance.

What now?

Now that you are cleared, go enjoy that healthy physical activity and meeting other people in whatever form that may be! Your physical is generally good for a year after which you should come back for an updated physical if you are going to participate in sports again. We wish you a healthy and fun season!

Tips for Kids During The Summer Months by Katelyn Millinor, LPC

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“With summer temperatures usually exceeding 100 degrees, it’s safer to turn to indoor activities and keep kids out of the sun.”

Most families around the country are enjoying time outside engaging in fun summer activities. In the Arizona valley that seems almost impossible. Keeping our kids busy during the summer months can be challenging. Here are some low or no cost options for summer fun.

Indoor activities

  • DIY arts and crafts.
  • Board games/ card games.
  • Reading (consider audiobooks).
  • Puzzles.
  • Scavenger hunts.
  • YouTube videos to learn a new skill (consider cooking, yoga, painting).
  • Apps (find an age-appropriate app that encourages learning).
  • Remember, it only takes about 10 minutes of play to connect with your child. Consider making time to play with your child daily. Try to choose activities that match your child’s development and age.
  • Around the community.
  • Children’s Museum of Phoenix.
  • Local Public Libraries (most offer story time for younger kids as well as some classes/events for older children such as computer coding and college prep).
  • Arizona Science Center.
  • Local parks or pools.
  • Local sports (Minor League Baseball plays at 7:00PM throughout the valley from mid-June until early-September and it’s free to attend).
  • McCormick-Stillman Railroad Park.
  • Adobe Mountain Desert Railroad Park.
  • Local art/craft classes (City of Tempe hosts Free Art Friday for preschoolers and their parents).
  • Karate, gymnastics, or other types of classes available in the community.

Arizona has extreme temperatures during the summer. Here are some tips protect your child and family.

Sun and heat tips

  • Plan errands and recreational activities for the early morning and evening. Avoid being outside from 10 AM to 4 PM when the sun is the hottest. Consider starting each day with a morning walk or taking an evening bike ride.
  • Teach your children to wear shoes outside. The concrete or pavement can be hot enough to cause second-degree burns.
  • Check the temperature of buckles and car seats as they can reach the temperature of a hot skillet. Park in covered parking or under shade whenever possible or use a wind shield sunshade.
  • Keep water with you. Pack extra bottles in the car in case of an emergency.
  • Wear sunscreen. Make sunscreen part of your morning routine. Lather up your kids before dressing them to ensure they’re protected, even if you’re not around water.

Summer doesn’t have to be boring. Feel free to ask any of our NOAH providers for suggestions on summer activities in your community and how to stay safe in the heat.

Summer Fun – Pool Safety Tips

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By Amit Jain, MD FAAP MBA | Pediatrician

Swimming is a great way to beat the summer heat here in Arizona and is a fun activity for children to pass the summer by. Drowning is the third most common cause of unintentional – injury related deaths. Among children aged 1-4, drowning stands as the leading cause of unintentional deaths, placing them at the greatest risk. As such, we here at NOAH wanted to share some important water safety tips!

  • Never leave children alone, even for a moment, in or near pool areas or other bodies of water (lakes, beaches, and even bathtubs or buckets of water)!
  • Install a fence at least 4 feet tall around the pool, which should ideally surround the pool on all 4 sides and completely separated the pool from your home and yard. It should not have any gaps that a small child could slip over, under, or through. The gate should be a self-closing and self-latching gate that cannot be opened / reached by a small child.
  • Newer technology offers alarms, both for the gate and within the pool, that can alert you to anyone around the pool.
  • When any inexperienced swimmer is around the pool area, make sure there is a designated adult for supervision. This adult should not be under the influence, should not have any distractions (cell phone turned off or handed off to another adult), and preferably knows how to swim and perform CPR.
  • Keep rescue equipment such as a shepherd’s hook and a life preserver to reach / throw for rescues.
  • Avoid inflatable swim aids such as floaties, as they are not a substitution for proper life-preserving equipment such as life jackets.
  • Consider swim lessons for your child if over the age of 1, as it may reduce the risk of drowning. Talk to your NOAH Pediatrician about your child’s developmental readiness to take swim lessons.
  • Talk to your pool operator to make sure your pool / spa and its drains are compliant with the pool and spa safety act.

At NOAH, we want to make sure that you have the proper tools, education and resources to protect you and your family while swimming. Most importantly, we hope you have a safe and fun-filled summer!

Summer Fun – Sun Safety Tips

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By Amit Jain, MD FAAP MBA | Pediatrician

There’s nothing better than having fun outdoors during school vacations. However, especially during summer here in Arizona, we here at NOAH want to remind everyone of some sun safety tips to keep protected while having some outdoor fun.

Dr. Amit Jain, Pediatrician

Protecting yourself and your children from harmful ultraviolet light exposure is important to prevent melanoma, a deadly form of skin cancer, which often strikes those who have been severely sunburned, especially during infancy and childhood.

The first line of defense against the scorching summer sun is proper clothing and keeping in the shade.

  • Try to limit sun exposure during the peak intensity hours between 10am and 4pm.
  • Take frequent shade breaks if staying out in the sun for long periods of time.
  • Cotton clothing is protective and can also help whisk away moisture to keep you cool while playing outside. Pick tightly woven fabrics for best protection.
  • Wear a hat: wide brimmed for best protection of your child’s entire face, including the nose, cheeks, chin, ears, and back of the neck.
  • Get your children sunglasses with UV protection. Those from the dollar store, Walmart, Walgreen’s, or similar stores are nice, economical options that can be easily replaced if they break or get lost, as long as they’re labeled as having UV protection.

Sunscreen is another great option to help protect from the sun’s rays.

  • Protect your children with a sunscreen that has an SPF (Sun Protection Factor) of 15 or greater. SPF 15 or 30 should be sufficient for most common uses. Apply this to all areas not covered by clothing. Don’t forget the ears, back of the neck, arms, and legs. Carefully apply around the eyes, avoiding eyelids.
  • Choose a sunscreen that has the words “Broad Spectrum” on it – that will cover both UVA and UVB rays. Try to avoid sunscreens that contain oxybenzone that may have hormonal properties.
  • Before applying sunscreen for the first time, test a small amount on your child’s back for an allergic reaction.
  • Apply sunscreen at least 30 minutes before sun exposure, as it can take this long to become active.
  • Reapply sunscreen at least every 1 hour.
  • If playing in the water, reapply sunscreen every half an hour, and use a waterproof sunscreen.
  • For infants less than 6 months old, avoid direct sun exposure – keep them under shade with a canopy or under a tree. Use wide brimmed hats to help cover their face, ears, and neck. Dress babies in lightweight clothing that covers their arms and legs as well. If this is not available, apply small amounts of sunscreen with a minimum SPF of 15 to your baby’s face, hands, and legs.
  • Don’t forget to use sun protection even on cloudy days, as the harmful ultraviolet rays from the sun can even come through clouds.

Contact your NOAH pediatrician if your child experiences sunburn, rash, or blistering.

Family Summer Screen Time Plan by Dr. Patty Avila, Pediatrician

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It is officially summer, and the kids are out of school. Yay! During this time, it is especially important to find healthy ways to keep them happy and active. Putting together a routine will help make it easier for your child to avoid spending too much time being sedentary on their phones or watching television.

During the summer try to minimize screen time on the following devices:
– Television
– Computers
– Smartphones
– Video gaming systems
– Tablets

Not using screen time wisely can influence how children feel, learn, think and behave in unhealthy ways.
Having a “Screen Time Plan” can help your child learn how to use electronics wisely. Try setting up a routine that is easy to follow.

For example:
• Have you made your bed, cleaned your room, finished your chores?
• Are you ready for the day – eaten breakfast, brushed your teeth, combed your hair, and gotten dressed?
• Have you read for 20 minutes?
• Have you done some type of physical activity for at least 30 minutes -1 hour? (examples: playing outside, riding bike, jumping on the trampoline, playing a sport, dancing, tumbling).
• Have you done something creative today? (examples: draw, color, cook or bake).

If your child completes one or more of these activities, then YES, they can have some screen time. Place limits on the amount of time spent on electronics as well. Maybe for each activity completed, they earn 30 minutes of screen time. If you are struggling to find activities for your child to do or they are just unwilling to participate in their new summer routine, schedule an appointment with your NOAH provider. We would be more than happy to help you and your child develop healthy habits. To schedule an appointment, call 480-882-4545.

For more information about creating a family media plan, visit https://www.healthychildren.org/English/fmp/Pages/MediaPlan.aspx.

Summertime Family Fun by Dr. Patty Avila, Pediatrician

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“There are lots of ways to keep your children busy during the summertime that do not involve use of media and many of these do not require you to go anywhere or spend a lot of money.”

Dr. Patty Avila, Pediatrician

Creativity

  • String beads together to make jewelry.
  • Create leis with wildflowers.
  • Collect rocks and paint them to use as paperweights or pet rocks or leave on a hiking trial for people to find.
  • Use recyclable items to make crafts.
  • Paint canvas sneakers with fabric paint pens or acrylic paint.
  • Decorate a wall or walkway with chalk.
  • Play with playdough or clay.
  • Make your own instruments and record music.
  • Put on a play.

Keep your children physically active

  • Plan a dance party.
  • Build an obstacle course in your backyard and have a competition to see who gets through it the fastest.
  • Take a family bike ride together.
  • Play a sport together.

Make memories together

  • Create a scrapbook or Time Capsule.
  • Create a summer mural by using a long piece of craft paper that can include drawings/paintings/pictures of your summer activities.
  • Have a night where the kids get to plan and cook a meal for the family.
  • Plan family game nights.

Explore Nature

  • Go bird watching and take pictures. There are websites and free apps that help you identify birds in your area like https://merlin.allaboutbirds.org/.
  • Go on a nature walk/hike and take a bag to find “nature” and bring it home.
  • Hunt for bugs.
  • Plant an herb garden/butterfly garden.
  • Find a local farm that allows for you to pick your own berries, veggies, or flowers.