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Tips of the Week for April, 2013

Screen-free Week: Focus on Reading

The American Academy of Pediatrics and other organizations have designated this week as "Screen-free Week."  I would hope we could all spend some time this week reflecting on the implications of ALL our screens on the early brain and language development of our children.

Today, one in three of our third graders is not reading at grade level and a similar number of our kindergarten students need speech and language services.  We can predict school drop-out by third grade reading scores; I understand that in Virginia, authorities plan prison construction according to third grade reading scores!  And think of the negative effects school drop-out has on our future work-force and economy!

We can predict first grade academic performance by evaluating vocabulary at age 2 years.  The children who will do the best in first grade are the ones who have the largest vocabularies at age 2 years.  These are the children who hear their parents say the most words in the first two years of life. 

Research shows that when the TV is on in the home, adult talking stops.  In many homes, the TV is on all the time, and children watch non-educational TV all by themselves for too many hours a week.  If we add smart phones, iPads, laptops, and video game boxes to the myriad of HD TV's in our homes, our lives are consumed by screens.  Studies show that 8-16 year-old Hispanic and African American youth spend around 13 hours a day with screens, while white youth spend over 8 hours a day.  And this screen-time is predominantly social, not educational!

I am all for technology and find technology essential to doing my daily work as a pediatrician.  However,  young children need to have really good language and reading skills IF they are to take advantage of all our marvelous technology. Our primary goal in the first 8 years of life should be to assure that ALL our children are reading proficiently when they leave third grade.  Therefore, we must follow the recommendations of the American Academy of Pediatrics:

No TV/screens for children under the age of 2 years.

No TV/screens in children's bedrooms.

Limit TV/screen time to 1-2 hours a day.

Parents should watch educational TV with their young children.

At Goldsboro Pediatrics, we have learned that only about 50% of parents read to their children every day.  We utilize the Reach Out and Read Program to promote parent-child interaction and reading in the preschool age-group.  Through this excellent program, we give age- and culturally-appropriate books to all children at all well-child check-ups between 6 months and 5 years of age.  When we give the books to the children, we try to educate the parents about the importance of reading and face-to-face talking with babies and young children.  We elaborate on this theme by encouraging parents to require the child to sit in front of the parents for all feedings; it creates over an hour of face-to-face talking when the child sits in front of the adult for three meals and three snacks a day.  We discourage allowing children to walk around the house eating and drinking, since these habits lead to obesity and tooth decay.  We encourage parents to spend time playing games on the floor with their children, and remind the parents to turn off all screens when the children are awake, to maximize conversation.  We point out other opportunities for having conversations with children:  bath time, outside play time, riding in the car.

It would be great if our entire community could focus on the goal of assuring that ALL our children are talking well by kindergarten and reading proficiently by third grade.  Thank you for using this Screen-free Week to think about how you can encourage the young children in your families to become better talkers and readers.

 David T. Tayloe, Jr., MD, FAAP

Goldsboro Pediatrics, PA

Talking to Children About Disasters

Children can cope more effectively with a disaster when they feel they understand what is happening and what they can do to help protect themselves, family, and friends. Provide basic information to help them understand, without providing unnecessary details that may only alarm them.

For very young children, provide concrete explanations of what happened and how it will affect them (eg, a tree branch fell on electrical wires and that is why the lights don't work). Let children know there are many people who are working to help them and their community to recover after a disaster (such as repair crews for the electric company, or firefighters, police, paramedics, or other emergency personnel). Share with them all of the steps that are being taken to keep them safe; children will often worry that a disaster will occur again.

Older children will likely want, and benefit from, additional information about the disaster and recovery efforts. No matter what age, start by asking children what they already know and what questions they have and use that as a guide for the conversation. Limit media coverage of the disaster—if children are going to watch media coverage, consider taping it (to allow adults to preview) and watch along with them to answer questions and help them process the information. While children may seek and benefit from basic information about what happened so that they can understand what is happening in their world, they (and adults) don't benefit from graphic details or exposure to disturbing images or sounds.  In the aftermath of a crisis is a good time to disconnect from all media and sit down together and talk as a family.

Be sure to ask children what questions or concerns they have. Often they have fears based on limited information or because they misunderstood what they were told. Reassure children when able to do so, but if their fears are realistic, don't give false reassurance. Instead, help them learn how to cope with these feelings.

Help Children Cope:

After a disaster or crisis, children benefit from adults who can help them learn how to cope effectively. Although it is not useful for adults to appear overwhelmed by the event, it is helpful to share some of their feelings and what they are doing to deal with those feelings. Children can't be expected to cope with troubling feelings if no one models effective coping. Allow children to "own" their feelings. Let your child know that it is all right to be upset about something bad that happened. Use the conversation to take the opportunity to talk about other troubling feelings your child may have. A child who feels afraid is afraid, even if adults think the reason for the fear is unnecessary. If you feel overwhelmed and/or hopeless, look for some support from other adults before reaching out to your child.

Don’t feel obligated to give a reason for what happened. Although adults often feel the need to provide a reason for why someone committed such a crime, many times they don’t know. It is okay to tell your child that you don’t know why at this time such a crime was committed.

Children are not only trying to deal with the disaster, but with everything else that follows. They may have to relocate, at least temporarily, and could be separated from friends or unable to attend the same school. Parents may have less income and the change in finances may impact their ability to participate in activities they enjoyed or travel to visit family out of town. Allow children to express their regrets over these "secondary losses" (without accusing them of being selfish) and help them figure out ways to minimize the impact or find alternatives.

Children, just like adults, often feel helpless after a disaster. Help them figure out what they can do—that is meaningful to them—to help others in their community impacted by the disaster. For more information on helping your child cope, click here.

Support Grieving Children:

Children who have experienced the death of a family member or friend need to understand and grieve a personal loss, above and beyond adjusting to the disaster itself. For more information on how to support grieving children, click here.

Talking to Children about the Economy:

The current economic situation is impacting adults throughout the United States and abroad. The effect that it may have on children and adolescents may be less direct—they may be worried about changes they see in their parents' mood or behavior because their parents are concerned about finances—but it is still something that parents and pediatricians should address. Talking to children about the economy, and the impact it is having on their family, can help them develop strategies for coping with the current financial situation and their day-to-day life.

Talking to Children in the Aftermath:

Click here for resources and information to help children cope with the aftermath of community or school shootings. If you have concerns about your child’s behavior, contact his or her pediatrician, other primary care provider, or a qualified mental health care specialist.

Additional Resources:

Getting Your Family Prepared for a DisasterHow to Prepare for Disasters

Communicating with Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information

Tips for Talking to Children After a Disaster (Substance Abuse and Mental Health Services Administration)

School and Family Resources (National Center for School Crisis and Bereavement)

Catastrophic Mass Violence Resources (National Child Traumatic Stress Network

Talking to Children About Earthquakes and Other Natural Disasters (AACAP)

Tips for Talking to Children in Trauma  (Substance Abuse and Mental Health Services Administration)

How to Help Kids Cope After a Disaster (eHealthMD)

Last Updated  4/19/2013


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Source:  American Academy of Pediatrics (Copyright © 2012)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


What to Know about Child Abuse

What do I need to know about child abuse?

Child abuse is common. The newspapers and TV news are so full of reports about child mistreatment that you cannot help but wonder how safe your child really is. Although it is a mistake to become overprotective and make your child fearful, it is important to recognize the actual risks and familiarize yourself with the signs of abuse. Approximately three million cases of child abuse and neglect involving almost 5.5 million children are reported each year. The majority of cases reported to Child Protective Services involve neglect, followed by physical and sexual abuse. There is considerable overlap among children who are abused, with many suffering a combination of physical abuse, sexual abuse, and/or neglect.

Most child abuse occurs within the family. Risk factors include parental depression or other mental health issues, a parental history of childhood abuse, and domestic violence. Child neglect and mistreatment is also more common in families living in poverty and among parents who are teenagers or are drug or alcohol abusers. Although it is certainly true that child abuse occurs outside the home, most often children are abused by a caregiver or someone they know, not a stranger.

Sexual abuse is any sexual activity that a child cannot comprehend or consent to. It includes acts such as fondling, oral-genital contact, and genital and anal intercourse, as well as exhibitionism, voyeurism, and exposure to pornography. Studies have suggested that up to one in four girls and one in eight boys will be sexually abused before they are eighteen years old. Physical abuse occurs when a child’s body is injured as a result of hitting, kicking, shaking, burning, or other show of force. One study suggests that about 1 in 20 children has been physically abused in their lifetime.

Child neglect can include physical neglect (failing to provide food, clothing, shelter, or other physical necessities), emotional neglect (failing to provide love, comfort, or affection), or medical neglect (failing to provide needed medical care). Psychological or emotional abuse results from all of the above, but also can be associated with verbal abuse, which can harm a child’s self-worth or emotional wellbeing.

Signs and Symptoms

It is not always easy to recognize when a child has been abused. Children who have been mistreated are often afraid to tell anyone, because they think they will be blamed or that no one will believe them. Sometimes they remain quiet because the person who abused them is someone they love very much, or because of fear, or both. Parents also tend to overlook signs and symptoms of abuse, because they don’t want to face the truth. This is a serious mistake. A child who has been abused needs special support and treatment as early as possible. The longer he continues to be abused or is left to deal with the situation on his own, the less likely he is to make a full recovery.

Parents should always be alert to any unexplainable changes in the child’s body or behavior. While injuries are often specific for an incident of physical abuse, behavioral change tends to reflect the anxiety that results from a stressful situation of any type. There are no behaviors that pinpoint a particular type of child abuse.

Physical Signs

Behavioral Changes that Raise Concern about Possible Abuse

  • Fearful behavior (nightmares, depression, unusual fears)
  • Abdominal pain, bedwetting (especially if the child has already been toilet trained)
  • Attempts to run away
  • Extreme sexual behavior that seems inappropriate for the child’s age
  • Sudden change in self-confidence
  • Headaches or stomachaches with no medical cause
  • Abnormal fears, increased nightmares



  • Failure to gain weight (especially in infants) or sudden dramatic weight gain
  • Desperately affectionate behavior or social withdrawal
  • Big appetite and stealing food

Long-Term Consequences

In most cases, children who are abused or neglected suffer greater emotional than physical damage. Emotional and psychological abuse and neglect deny the child the tools needed to cope with stress, and to learn life’s lessons. So a child who is severely mistreated may become depressed or develop suicidal, withdrawn, or violent behavior. As he gets older, he may use drugs or alcohol, try to run away, refuse discipline, or abuse others. As an adult, he may develop marital and sexual difficulties, depression, or suicidal behavior. Identifying a child victim is the first step. Recognizing the importance of early trauma to future development is crucial to assisting the victim.

Not all abuse victims have severe reactions. Usually the younger the child, the longer the abuse continues, and the closer the child’s relationship with the abuser, the more serious the emotional damage will be. A close relationship with a very supportive adult can increase resiliency, reducing some of the impact.

Getting Help

If you suspect your child has been abused, get help immediately through your pediatrician or a local child protective agency. Physicians are legally obligated to report all suspected cases of abuse or neglect to state authorities. Your pediatrician also will detect and treat any medical injuries or ailments, recommend a therapist, and provide necessary information to investigators. The doctor also may testify in court if necessary to obtain legal protection for the child or criminal prosecution of a sexual abuse suspect. Criminal prosecution is rarely sought in mild physical abuse cases but will occur in cases involving sexual abuse.

If he has been abused, your child will benefit from the services of a qualified mental health professional. You and other members of the family may be advised to seek counseling so that you’ll be able to provide the support and comfort your child needs. If someone in your family is responsible for the abuse, a mental health professional may be able to treat that person successfully, as well.

If your child has been abused, you may be the only person who can help him. There is no good reason to delay reporting your suspicions of abuse. Denying the problem will only make the situation worse, allowing the abuse to continue unchecked and decreasing your child’s chance for a full recovery.

In any case of abuse, the child’s safety is of primary concern. He or she needs to be in a safe environment free of the potential for continuing abuse.

Preventing Abuse

The major reasons for physical and psychological mistreatment of children within the family often are parental feelings of isolation, stress, and frustration. Parents need support and as much information as possible in order to raise their children responsibly. They need to be taught how to cope with their own feelings of frustration and anger without venting them on children. They also need the companionship of other adults who will listen and help during times of crisis. Support groups through local community organizations often are helpful first steps to diminish some of the isolation or frustration parents may be feeling. Parents who were themselves victims of abuse as children are in particular need of support. Confronting, addressing, and healing old wounds take uncommon courage and insight, but doing so is often the best assurance that the cycle of abuse is not passed on to the next generation.

Personal supervision of and involvement in your child’s activities are the best ways to prevent physical and sexual abuse outside the home. Any school or child care program you select for your child should allow unrestricted and unannounced parental visits without prearrangement. Parents should be allowed to help in the classroom on a volunteer basis and be informed about the selection or changes of staff members. Parents should pay careful attention to their child’s reports about and reactions to his experiences at school. Always investigate if your child tells you he’s been mistreated or if he undergoes a sudden unexplained change in behavior.

Although you don’t want to frighten your child, you can teach him some basic rules of safety in a nonthreatening manner. Teach him to keep his distance from strangers, not to wander away from you in unfamiliar territory, to say “no” when someone asks him to do something against his will, and always to tell you if someone hurts him or makes him feel bad. Always remember that open, two-way communication with your child provides the best chance that you will know when a problem occurs. Emphasize that he will not get in trouble if he tells you about abuse or other confusing events. Emphasize that you need to know this to be able to keep him safe and that he will be OK if he tells you. Instead of teaching him that he’s surrounded by danger, teach him that he is strong, capable, and can count on you to keep him safe, as long as he can tell you about it. Teach him that it is not OK for adults to touch his body if he does not consent or understand what is happening.


Last Updated 3/19/2013


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Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


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