HEALTHY HABITS

Healthy activity habits: Reducing time in front of the TV or computer to less than 1-2 hours a day is the single best way to prevent a child from developing a life long weight problem. Reducing screen time increases activity level and lessens a child’s exposure to violence. Experts

especially do not recommend a TV or video game console be in your child’s bedroom. Instead of watching a video or TV, model healthy alternative activities such as sports, outdoor play, gardening, board games, art projects, music and reading. Time spent doing fun, healthy activities as a family gives children fond memories to cherish.

Healthy eating habits: Parents should model healthy eating habits for their children. Remember the numbers: “5-2-1-0” This means that your child (and other family members) should be getting “5” servings of vegetables and fruits (fruit juice doesn’t count), “2” maximal hours of screen time per day, “1” minimum hour of physical activity per day and “0” sweetened drinks (fruit

juices, soda, sports drinks, Sunny D, etc.) That’s right… “0”. Offer low fat milk and water instead. We ask that you avoid offering sweet or unhealthy foods as a reward (e.g. promising ice cream, candy or fast food after shots) and withholding food as a means of punishment. Mixing food with discipline can cause problems down the road. Because many kids can be picky eaters and we live in the rainy northwest, consider giving your child a daily chewable multivitamin with iron and 400 international units (IU) of vitamin D with a meal.

DEVELOPMENT AND BEHAVIORBy the time your child is 4 years old,

• You should be able to understand your child’s language. Your child should be able to use four-word or five-word sentences, use action words (verbs) and retell

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PEDIATRICS

BARGER MEDICAL BLDG.(541) 242-85004010 Aerial Way, Eugene, OR 97402

Tamara Barstow, MD Paul Benda, MD Kevin Marks, MD Lorna Wong, MD

RIVERBEND PAVILION(541) 222-85003377 RiverBend Dr., Springfield, OR 97477

Serena Black, MD Paul Bouressa, MD John Dunphy, MD Leita Dzubay, MD Lauren Herbert, MD F. Jeffrey Joehnk, MD Leslie Pelinka, MD Fay Sunada, MD

UNIVERSITY DISTRICT(458) 205-60611200 Hilyard Street, Suite 440 Eugene, OR 97401

Deborah Fuerth, MDChristopher Hammond, MD Sarah Holexa, MD Catherine Kordesch, MDW. David Lux, MD Jimmy Unger, MD Laurie Carmichael, MSN, PNP

SOUTH LANE MEDICAL GROUP(541) 942-66141515 Village Dr.,Cottage Grove, OR 97424

Christian Stowell, MD Katie Thomas, CPNP

stories that sound familiar. Children should be using words that tell about time (e.g., morning, afternoon, night, yesterday, or tomorrow) and, when asked, they can point to a wide array of different colors.

• For pre-writing (i.e. fine motor) skills, children should be able to pretend to write, scribble, plus copy a triangle and circle.

• For pre-reading skills, children should be identifying letters and turning the paper pages in a book one at a time.

• For self-help skills, children should be able to “mostly” get dressed by themselves.

• For big muscle and balance (i.e., gross motor) skills, children should be able to walk three steps putting one foot in front of the other with their heel touching their toe. Most will ride a tricycle at least 10 feet.

• For social-emotional (i.e., behavioral) skills, children enjoy pretend games with toys, dolls and even imaginary friends. They love playing hide-and-seek, cops-and-robbers and other games where you take turns and follow rules. They should not be intentionally trying to hurt others and should act concerned when another person gets hurt.

Remember that their immature brain is still developing and is heavily influenced by what you say and do. Violence or heated parental arguments should never occur in front of your child as this can be damaging to your child’s brain. If there is domestic violence in your household, please call the Parent Helpline (541) 485-5211 to speak to a professional parent educator and learn more about our community’s resources. It’s a free and confidential phone call. Growing up in a safe, predictable, loving environment is a key component to “school (and future relationship) readiness”.

SCHOOL READINESSAt 4 years, experts from the American Academy of Pediatrics (AAP) recommend a “kindergarten readiness” screening. You are welcome to complete a free, confidential online screening using the Ages & Stages Questionnaire (ASQ) (go to: http://www.asqoregon.com ) to accurately examine your child’s developmental milestones or the ASQ:Social-Emotional (ASQ:SE) to accurately examine your child’s behavior. Unfortunately, your child’s screening results will not be automatically shared with your child’s primary care provider. If your child’s screening results are

concerning or you have other strong concerns, a follow-up visit is recommended. A “structured”, high-quality preschool is encouraged one to two years prior to kindergarten entrance. Our hope is to give your child a “head start” with pre-reading, writing, drawing, pre-math, self-help and perhaps most importantly, socialization skills such as learning to share or taking turns. At home, reading to your child every day is a great way to prepare your child for school and potentially prevent future reading problems. While reading to your child, encourage letter and word recognition. Ask questions about the pictures and story. Politely listen and respond to your child’s comments and observations.

SLEEPFocusing on healthy sleep is not only a key component to “kindergarten readiness”, it is also a great way to avoid future health and behavior problems. If your child is having consistent difficulties falling or staying asleep, frequent nighttime awakenings, persistent snoring or abnormal breathing patterns during sleep, this could be a

DEVELOPMENT AND BEHAVIOR, continued

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sign of a sleep disorder. Sleep disorders seriously interfere with “kindergarten readiness”. Such concerns should be discussed with your child’s doctor. Children vary in their need for sleep but in general, most preschoolers stop taking naps at 4 years but need 11 to 13 of hours of sleep. Healthy sleep hygiene tips include:

• Avoid nighttime awakenings by setting limits on attention-seeking behaviors.

• Develop a simple, calm bedtime ritual such as “Brushing, Book, Bedtime” because rituals are a powerful sleep time cue.

• Provide a healthy sleep environment by keeping the bedroom cool, dark and quiet. Teach children to soothe themselves with a favorite bedtime toy. Make the bedroom a sleep-only zone.

• Establish consistent bed times and waking times. Waking times are more potent than bed times in establishing sleep rhythms.

• Do not allow too much evening fluids. However, allow your child to drink water (not juice) frequently throughout the daytime.

SAFETY• Carsafety: Have your child ride in back seat inside the car safety seat until he or she reaches the highest weight

or height allowed by the care seat manufacturer. Most all preschoolers are not heavy or tall enough to be safely switched to a belt-positioning booster seat. Never put a child under 12 in the front seat of the car, especially if your care has airbags.

• Poisoningprevention: Keep medicines, cleaning products and matches out of reach. This includes keeping dangerous items out of reach when children visit grandparents, other relatives or family friends. This includes keeping a mother’s purse out of reach.

• Gunsafety: Firearms in the home are a danger to your child and family. If a gun is kept in the home, make sure that the gun and ammunition are safely locked up in separate locations.

• Watersafety: Supervise children whenever they are near water such as a pool, hot tub, bath, well, lake or river. Getting your child involved in swim lessons is a fantastic idea but this does not necessarily mean that your child is safe around water without supervision.

• Streetsafety: Drivers often can’t see small children. Watch your child at all times near the street or parking lot. Repetitively remind your child about street safety rules. Children should not cross the street alone until at least eight years old.

• Injuryprevention: Children should wear a helmet and pads when riding a bike or scooter.

• Sexualabuseprevention: Please teach your child 3 important safety rules around adults: (1) No adult should tell a child to keep a secret from parents, (2) No adult should be interested in private parts, (3) No adult should ask a child for help with his/her private parts (but explain “private parts”).

DENTAL CAREYour child should to continue to take oral fluoride supplements (the best time is bedtime) and have adult assistance in tooth brushing twice daily to prevent cavities. Kids should be seeing a dentist at least once per year for routine check-ups and cleanings.

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IMMUNIZATIONSThe prevention of serious infectious diseases is a good thing for your child, your family and the society in which we live. Making sure your child’s vaccines are up-to-date is yet another component of “kindergarten readiness”. Every pediatrician at PeaceHealth Medical Group strongly supports the vaccine schedule as recommended by the American Academy of Pediatrics (AAP), the Center for Disease Control (CDC) and numerous other medical and public health agencies. We do not recommend delaying vaccines. We do not recommend alternative vaccine schedules like Dr Bob’s (Robert Sears’) schedule. We do not recommend skipping the flu vaccine. Nevertheless, if you have withheld, delayed or simply forgotten vaccines in the past, we can help your child with a “catch-up” schedule. If you have additional questions or concerns about the benefits or risk of vaccines, please visit the follow link from the AAP: http://www.healthychildren.org

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