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Tips of the Week for October, 2017

Easing Infants & Toddlers into Halloween Fun: Tips from the AAP

​​​​​​​​​By: Dina DiMaggio, MD, FAAP

If you are celebrating your little one's first, second, or third Halloween this year, it is important to know how to make the night safe and fun for even the tiniest monsters!

Here are 8 Tips for a Smooth and Safe Halloween with Little Ones:  

1. Allow for plenty of time to fright-prep. 

As a parent, you know your child best. Keep a look out for fears and anxieties about Halloween. The best way to handle fear and get a toddler ready is to discuss what's going to happen. Reading books and stories to your child about trick-or-treating—and Halloween in general—are great ways to help that discussion. You might even want to have your child practice in his or her costume before the big day. Toddlers need to know that Halloween is just for fun and the scary stuff is all pretend. If your little one doesn't want to partake in Halloween, then let that be okay. There is always next year, and 12 months can make a big difference!

2. Play with pumpkins.

Allowing your baby or toddler to squish his or her hands around the insides of a pumpkin can be a great sensory activity. For little ones who "hate getting dirty," there are plenty of no-carve pumpkin decorating options to try. 

3. Go out before dark. 

Infants and young children thrive on routine, and it is easy for Halloween festivities to throw those routines off-track. If your schedule permits, try trick-or-treating while it's still light outside so you can stick to your child's regular bedtime. If your child is sleeping, try putting a "please knock" sign on your door for other trick-or-treaters.

  • ​If Halloween doesn't start until after dark where you live: Check your local newspaper or recreation center for Halloween activities offered earlier in the day.

4. ​Watch for tripping-toddler hazards. 

Even on their best days and in the best conditions, it is still a struggle for some toddlers to walk without falling. While you won't be able to prevent all of the tumbles, choosing a costume that is not too long or too bulky will help a great deal. Be sure to check the forecast before you go out and try to include layers if needed. Also remember to help your little one climb up and down any steps and porches.

5. Always have a "Plan B" costume. 

From leaky diapers to spit up to toilet training accidents, this age is always reason to pack a backup costume and plan for the unexpected. If potty-training is still a new thing and there's a narrow window between "I have to go" and an accident, you might want to rethink a complicated costume. There is also no harm in putting him or her in an easy-on, easy-off diaper. 

6. Be ready to pack it in early if needed. 

A house or costume that's too scary, a trip or a fall, or just a hard day can send your child into the temper-tantrum zone. But all is not lost! If your toddler quickly loses interest in trick-or-treating, see if he or she would prefer to answer the door and hand out candy to all the "big kids" instead. Plus, it can help you reinforce those important sharing skills!  

7. Take precautions with added sugar. 

Although Halloween and sugar often go hand in hand, the AAP recommends limiting the amounts of sugar kids get each day. This may not be an easy task when most Halloween treats are packed with added sugar and artificial colors your little one doesn't need. Look out for snacks and treats that may seem "healthier" but still contain added sugars—flavored yogurts, flavored milks, sugary cereals, granola bars, juices, and fruit gummy snacks. Other options for trick-or-treating toddlers, or those who choose not to give out candy, include crayons and notepads, stickers, stamps, chalk, bubbles, tattoos, playdough, or stuffed animals.

  • If your baby is six months or older and is just starting solid foods: You can get him or her into the Halloween spirit with some pumpkin purees. Whether canned, frozen or fresh, pumpkin is packed with nutrients for your growing baby—beta-carotene, vitamin A, potassium, vitamin C, calcium, and more. Other fall-themed options include butternut squash, sweet potato, or roasted apple purees. You can even mix in a pinch of cinnamon or nutmeg to add in fall-inspired flavors.

  • Ideas for older toddlers: Seasonal treats may include soft bites of roasted apples or apple sauce, baked sweet potato fries dusted with cinnamon, apple zucchini muffins, pumpkin-inspired smoothies, or fruit ice pops made with fun Halloween molds.

​​8. Watch for any treats that can be a choking hazard. 

Keep an eye on what your child has in his or her mouth at all times while on the trick-or-treat trail—it's so easy to get distracted! It's best to avoid eating while walking or running. Once your child is ready to enjoy treats at home, keep in mind that babies and toddlers should not have any hard candies, caramel apples, popcorn, gum, small candies (jelly beans, etc.), gummy candy, pumpkin seeds, or anything with whole nuts. Candy wrappers, stickers, small toys, or temporary tattoos can be a choking hazard, as well. As all parents know, babies and toddlers will put just about anything into their mouths!

Additional Information from


About Dr. DiMaggio: 

Dina DiMaggio, MD, FAAP, is a board certified pediatrician at Pediatric Associates of NYC and at NYU Langone Medical Center. She is the co-author of The Pediatrician's Guide to Feeding Babies and Toddlers, a comprehensive manual written by a team of medical, nutrition, and culinary experts. Follow her on Instagram @Pediatriciansguide.


Dina DiMaggio, MD, FAAP
Last Updated
American Academy of Pediatrics (Copyright © 2016)
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.

For additional information including links and audio, please go to to view this article.

10 Things Parents Can Do to Prevent Suicide

As children grow into teenagers, it becomes more challenging for parents to know what they are thinking and feeling. When do the normal ups and downs of adolescence become something to worry about?

It's important to learn about the factors that can put a teen at risk for suicide. Spend some time reading these ten ways you can help prevent a tragedy from occurring. The more you know, the better you'll be prepared for understanding what can put your child at risk.
1. Don't let your teen's depression or anxiety snowball.

Maybe your child is merely having a bad day, but maybe it's something more if this mood has been going on for a couple of weeks.

Fact: 9 in 10 teens who take their own lives were previously diagnosed with a psychiatric or mental health condition or disorder—more than half of them with a mood disorder such as depression or anxiety.

Depressed people often retreat into themselves, when secretly they're crying out to be rescued. Many times they're too embarrassed to reveal their unhappiness to others, including Mom and Dad. Boys in particular may try to hide their emotions, in the misguided belief that displaying the feeling is a fifty-foot-high neon sign of weakness.

Let's not wait for children or youth to come to us with their problems or concerns. Knock on the door, park yourself on the bed, and say, "You seem sad. Would you like to talk about it? Maybe I can help."
2. Listen—even when your teen is not talking.

Not all, but most kids who are thinking about suicide (this is called suicidal ideation) tip off their troubled state of mind through troubled behaviors and actions. Studies have found that one trait common to families affected by a son's or daughter's suicide is poor communication between parents and child. However, there are usually three or more issues or factors going on all at once in a child's life at the time when he or she is thinking about taking his or her life.
These include but are not limited to:

Major loss (i.e., break up or death)
Substance use
Peer or social pressure
Access to weapons
Public humiliation
Severe chronic pain
Chronic medical condition
Family history of suicide

If your instinct tells you that a teenager might be a danger to himself, heed your instincts and don't allow him to be left alone. In this situation, it is better to overreact than to underreact. See How to Communicate With and Listen to Your Teen.
3. Never shrug off threats of suicide as typical teenage melodrama.

Any written or verbal statement of "I want to die" or "I don't care anymore" should be treated seriously. Often, children who attempt suicide had been telling their parents repeatedly that they intended to kill themselves. Most research supports that people who openly threaten suicide don't really intend to take their own lives; and that the threat is a desperate plea for help. While that is true much of the time, what mother or father would want to risk being wrong?
Any of these other red flags warrants your immediate attention and action by seeking professional help right away:

"Nothing matters."
"I wonder how many people would come to my funeral?"
"Sometimes I wish I could just go to sleep and never wake up."
"Everyone would be better off without me."
"You won't have to worry about me much longer."

When a teenager starts dropping comments like the ones above or comes right out and admits to feeling suicidal, try not to react with shock ("What are you, crazy?!") or scorn ("That's a ridiculous thing to say!"). Above all, don't tell him or her, "You don't mean that!." Be willing to listen nonjudgmentally to what he or she is really saying, which is: "I need your love and attention because I'm in tremendous pain, and I can't seem to stop it on my own."

To see your child so troubled is hard for any parent. Nevertheless, the immediate focus has to be on consoling; you'll tend to your feelings later. In a calm voice, you might say, "I see. You must really, really be hurting inside."​
4. Seek professional help right away.

If your teenager's behavior has you concerned, don't wait to contact your pediatrician. Contact a local mental health provider who works with children to have your child or youth evaluated as soon as possible so that your son or daughter can start therapy or counseling if he or she is not in danger of self-harm. However, call your local mental health crisis support team or go to your local emergency room if you think your child is actively suicidal and in danger of self-harm.
5. Share your feelings.

Let your teen know he or she is not alone and that everyone feels sad or depressed or anxious now and then, including moms and dads. Without minimizing his anguish, be reassuring that these bad times won't last forever. Things truly will get better and you will help get your child through counseling and other treatment to help make things better for him or her..
6. Encourage your teen not isolate himself or herself from family and friends.

It's usually better to be around other people than to be alone. But don't push if he says no.
7. Recommend exercise.

Physical activity as simple as walking or as vigorous as pumping iron can put the brakes on mild to moderate depression.
There are several theories why:

Working out causes a gland in the brain to release endorphins, a substance believed to improve mood and ease pain. Endorphins also lower the amount of cortisol in the circulation. Cortisol, a hormone, has been linked to depression.
Exercise distracts people from their problems and makes them feel better about themselves.
Experts recommend working out for thirty to forty minutes a day, two to five times per week.
Any form of exercise will do; what matters most is that children and youth enjoy the activity and continue to do it on a regular basis.

8. Urge your teen not to demand too much of himself or herself.

Until therapy begins to take effect, this is probably not the time to assume responsibilities that could prove overwhelming. Suggest that he or she divide large tasks into smaller, more manageable ones whenever possible and participate in favorite, low-stress activities. The goal is to rebuild confidence and self-esteem.
9. Remind your teen who is undergoing treatment not to expect immediate results.

Talk therapy and/or medication usually take time to improve mood. Your child shouldn't become discouraged if he or she doesn't feel better right away.
10. If you keep guns at home, store them safely or move all firearms elsewhere until the crisis has passed.

Fact: Suicide by firearm among American youth topped a 12-year high in 2013, with most of the deaths involving a gun belonging to a family member, according to a report from the Brady Center to Prevent Gun Violence. Any of these deaths may have been prevented if a gun wasn't available.

If you suspect your child might be suicidal, it is extremely important to keep all firearms, alcohol, and medications under lock and key.
Additional Information:

Mental Health and Teens: Watch for Danger Signs
Teen Suicide Statistics
Childhood Depression: What Parents Can Do To Help

Last Updated

Committee on Psychosocial Aspects of Child and Family Health (Copyright © 2015 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.

All information provided by For additional information including links and audio, please go to the following website:

Behavior Therapy for Children with ADHD

Most experts recommend using both medication and behavior therapy to treat ADHD. This is known as a multimodal treatment approach.

There are many forms of behavior therapy, but all have a common goal—to change the child's physical and social environments to help the child improve his behavior.

Under this approach, parents, teachers, and other caregivers learn better ways to work with and relate to the child with ADHD. You will learn how to set and enforce rules, help your child understand what he needs to do, use discipline effectively, and encourage good behavior. Your child will learn better ways to control his behavior as a result. You will learn how to be more consistent.

Behavior therapy recognizes the limits that having ADHD puts on a child. It focuses on how the important people and places in the child's life can adapt to encourage good behavior and discourage unwanted behavior. It is different from play therapy or other therapies that focus mainly on the child and his emotions.
How can I help my child control her behavior?

As the child's primary caregivers, parents play a major role in behavior ­therapy. Parent training is available to help you learn more about ADHD and specific, positive ways to respond to ADHD-type behaviors. This will help your child improve. In many cases parenting classes with other parents will be sufficient, but with more challenging children, individual work with a counselor/coach may be needed.

Taking care of yourself also will help your child. Being the parent of a child with ADHD can be tiring and trying. It can test the limits of even the best parents. Parent training and support groups made up of other families who are dealing with ADHD can be a great source of help. Learn stress-­management techniques to help you respond calmly to your child. Seek counseling if you feel overwhelmed or hopeless.

Ask your pediatrician to help you find parent training, counseling, and support groups in your community. Additional resources are listed at the end of this article.
Tips for helping your child control his behavior:

Keep your child on a daily schedule. Try to keep the time that your child wakes up, eats, bathes, leaves for school, and goes to sleep the same each day.
Cut down on distractions. Loud music, computer games, and TV can be overstimulating to your child. Make it a rule to keep the TV or music off during mealtime and while your child is doing homework. Don't place a TV in your child's bedroom. Whenever possible, avoid taking your child to places that may be too stimulating, such as busy shopping malls.
Organize your house. If your child has specific and logical places to keep his schoolwork, toys, and clothes, he is less likely to lose them. Save a spot near the front door for his school backpack so he can grab it on the way out the door.
Reward positive behavior. Offer kind words, hugs, or small prizes for reaching goals in a timely manner or good behavior. Praise and reward your child's efforts to pay attention.
Set small, reachable goals. Aim for slow progress rather than instant results. Be sure that your child understands that he can take small steps toward learning to control himself.
Help your child stay "on task." Use charts and checklists to track progress with homework or chores. Keep instructions brief. Offer ­frequent, friendly reminders.
Limit choices. Help your child learn to make good decisions by ­giving him only 2 or 3 options at a time.
Find activities at which your child can succeed. All children need to experience success to feel good about themselves.
Use calm discipline. Use consequences such as time-out, removing the child from the situation, or distraction. Sometimes it is best to simply ignore the behavior. Physical punishment, such as spanking or slapping, is not helpful. Discuss your child's behavior with him when both of you are calm.
Develop a good communication system with your child's teacher so that you can coordinate your efforts and monitor your child's progress.

Additional Information on

Understanding ADHD: Information for Parents
Common ADHD Medications & Treatments for Children
How Schools Can Help Children with ADHD
Common Coexisting Conditions in Children with ADHD

Additional Resources:

The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community.

National Resource Center on AD/HD
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) or 800/233-4050
Attention Deficit Disorder Association or 856/439-9099
Center for Parent Information and Resources
National Institute of Mental Health or 866/615-6464
Tourette Association of America or 888/4-TOURET (486-8738)

Last Updated

Understanding ADHD: Information for Parents About Attention-Deficit/Hyperactivity Disorder (Copyright © 2007 American Academy of Pediatrics, Updated 6/2016)

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

All information provided by For additional information including links and audio, please go to

What's the Latest With the Flu? A Message for Caregivers & Teachers

2017-2018 Influenza Season

It's time to prepare for the 2017-2018 influenza (flu) season, as the flu is often more serious than the common cold in children. Each year, millions of children get sick with the flu, which can result in hospitalization or death.

The 2016-2017 flu season resulted in the hospitalization of thousands of children and the reported deaths of 106 children. One death from influenza is one death too many. In past seasons, between 80% and 85% of flu-related deaths were in children who had not gotten a flu vaccine that season. Take steps now to prevent the flu! Get your influenza vaccination by the end of October, if possible. It's critically important for everyone to get vaccinated against influenza every year, including children, parents, and child care staff. Influenza immunization is the single best way to reduce flu illness.

For the second season in a row, the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) do not recommend that the nasal spray flu vaccine (live attenuated influenza vaccine or LAIV4) be used at all this flu season because of its poor effectiveness the past few years. Therefore, people should only receive a flu shot this season.

Why Vaccination is Important

Annual influenza vaccine is recommended for all people 6 months of age and older. Children younger than 5, but especially children younger than 2 years old, are at an increased risk of hospitalization and complications due to influenza. Since infants younger than 6 months are too young to get their own flu shot, the best way to protect these very young children is for all family members and caregivers to get the flu vaccine. This is called "cocooning", and it is especially important for adults who care for infants younger than 6 months. Children who have chronic medical conditions, such as asthma, diabetes or neurologic conditions, are also at higher risk for serious complications due to influenza; parents and caregivers can help protect more vulnerable children by vaccinating both the children and themselves.

By getting a flu shot during pregnancy, a mother can pass on protection against flu to her newborn baby that will last through the first several months of life. In addition, pregnant women are at high risk of severe illness from influenza, as changes in the immune system, heart, and lungs during pregnancy make pregnant women (and women up to two weeks postpartum) more prone to severe illness and even hospitalization from flu. Flu shots may be given to pregnant women at any time during pregnancy. The vaccine is a safe way to protect the mother and her developing baby from serious illness and complications from flu.

Child care providers can support influenza vaccination in their program by:

  1. Checking influenza vaccination records regularly to ensure each child in their care is up to date on their vaccinations.

  2. Educating staff and ensuring that all staff receive their flu vaccine each season.

  3. Educating parents in their program and helping connect them to credible resources.

This Season's Flu Vaccine

The flu vaccine protects against either three virus strains (trivalent) or four virus strains (quadrivalent). Included in the vaccine are the strains that are anticipated to circulate in the US this flu season:

  • Influenza A (H1N1)

  • Influenza A (H3N2)

  • Influenza B (2 strains)

The quadrivalent vaccine protects against the same three strains that are in the trivalent vaccine and both influenza B strains. The AAP and the CDC do not have a preference of one vaccine over another this season. The important thing is to make sure everyone gets a flu vaccine!

Take Steps TODAY to Help Your Program Prepare

  1. Get your flu vaccine by the end of October, if possible, and encourage all staff, children, and parents to get the flu vaccine. Everyone needs a flu vaccine each year!

  2. Examine and revise your program's written plan for seasonal flu.

  3. Invite a pediatrician or child care health consultant to provide influenza prevention education to your staff.

  4. Use CDC posters and handouts to educate caregivers and staff about proper hand hygiene and cough/sneeze etiquette.

  5. Update family contact information and child records, so parents can be reached quickly if they need to pick up their sick child.

Plan Ahead to Prevent the Spread of Germs

Once flu season starts, it can be challenging to keep germs from spreading. While you can catch the flu any time of the year, in the United States the virus is most common in the fall and winter usually peaking between in January, February, and March. But don't forget that flu activity may start as early as November and as late as May.

It can be difficult to tell the difference between flu and the common cold based on symptoms alone. The flu is often worse than the common cold. Some people, however, can be infected with the flu virus and have no symptoms, but still spread the virus to others.

Policies in your child care center can limit the spread of the influenza and should focus on encouraging vaccination and implementation of everyday preventive actions like good respiratory etiquette, hand washing; cleaning, sanitizing, and disinfecting; and excluding children and caregivers who have respiratory symptoms (cough, runny nose, or sore throat) and fever. The child can return to the center when the fever has resolved (without the use of fever-reducing medicine), the child is able to participate in normal activities, and staff can care for the child without compromising their ability to care for the other children in the group.​​

Additional Information from 

Additional Resources:

9/29/2017 12:00 AM
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