cbd oil for anizity and depression in kids

Tag: anxiety

Things your teen can do to help them cope with anxiety, depression, insomnia, and other mental health issues.

What do we do when our kids are having mental health problems?

Whatever we do, there are times when they might need a little more help…

Mental Health Treatment Tips for Teens

Most importantly, teens with mental health issues, like depression and anxiety, should know what to do when these specific problems flare up (follow the links for detailed advice):

  1. extra anxiety – learn to manage anxiety when it attacks with different exercises, like deep breathing, focusing on their five senses, thinking positively for 12 seconds, or laughing at a video they typically find funny, etc. – are there specific social situations that make your anxiety worse during which you will need extra help
  2. extra sadness – learn grounding and mindfullness skills – teens who have trouble sleeping should learn about progressive muscle relaxation and guided imagery – call your health care provider if this happens most days and have a plan in case it happens once in a while
  3. wanting to self medicate – see your health care professional if you are turning to drugs or alcohol as a coping mechanism to deal with stress. Overeating is another negative coping skill to avoid.
  4. getting more easily distracted – talk to your health care provider, as this can be a sign of worsening anxiety and depression
  5. coping with a breakup – how can they deal with the heartbreak after a breakup?
  6. getting bullied – you’re not alone. – teens thinking of hurting themselves should know that they should seek immediate help

Whatever they are going through, it is especially important that your teen knows that things will get better!

Although that often doesn’t seem likely when you are in the middle of a crisis, it is true.

That can be easier to understand once you review these stories of hope and recovery!

What else can you do?

In general, things like keeping a journal, getting daily exercise, and talking to your friends and family members are positive coping skills that can be helpful.

Create healthy habits and avoid spending too much time online.

“We all need a little extra help sometimes. If you are feeling sad, afraid or overwhelmed, talk to someone you trust – whether it is a family member, close friend, therapist, or case manager. It is important to reach out for help if you need it.”

Hey Teens! Take Care of Your Mental Health

You can also always talk to your pediatrician or other health care provider.

More on Mental Health Tips for Teens

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Mask Exemptions for Kids During the COVID-19 Pandemic

If your child doesn’t want to wear a face mask, your pediatric provider might be able to offer more help than just an exemption.

Some parents who don’t want their kids to wear a mask at school might think about asking their pediatrician to write a mask exemption for their kids.

Before they do, they might understand that there are very few real medical reasons for these types of exemptions for wearing a mask.

Masks Control the Spread of SARS-CoV-2

More and more, we are learning that masks can help prevent the spread of SARS-CoV-2, the virus that causes COVID-19, protecting both the person wearing the mask and the people around them.

“The prevention benefit of masking is derived from the combination of source control and personal protection for the mask wearer. The relationship between source control and personal protection is likely complementary and possibly synergistic, so that individual benefit increases with increasing community mask use.”

Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2

Still, that doesn’t mean that everyone has gotten used to wearing them…

Hopefully, most folks do now understand why they are important though.

Wait, why are they important, especially if you are healthy and the people around you don’t have COVID-19?

  • up to two days before they start to show symptoms
  • up to two days before they test positive, even if they don’t have any symptoms

So if you are waiting to put on a mask until people around you have symptoms, then you will eventually get exposed, probably without even knowing it, and you might get sick, ending up in isolation, not being able to go to school or work.

And if you wait to put on a mask until you start to show symptoms, then you will likely eventually expose other people to the SARS-CoV-2 virus.

The alternative, if you want to reduce your risk of getting sick, is to just wear a mask any time that you can’t social distance (stay at least six feet apart) from other people.

Mask Exemptions for Kids During the COVID-19 Pandemic

So what are the medical reasons that kids, like adults, can’t wear a mask all day while they are at school?

“The Department supports actions by the airline industry to have procedures in place requiring passengers to wear masks in accordance with the CDC Order, CDC guidance, and TSA SD. At the same time, the ACAA and Part 382, which are enforced by OACP, require airlines to make reasonable accommodations, based on individualized assessments, for passengers with disabilities who are unable to wear or safely wear a mask due to their disability.”

Notice of Enforcement Policy: Accommodation by Carriers of Persons With Disabilities Who Are Unable to Wear Or Safely Wear Masks While On Commercial Aircraft

In general, a child over age two years should wear a face mask unless:

  • they have a physical or intellectual condition that would keep them from being able to remove their face mask by themselves
  • they can’t tolerate wearing a face mask because they have a condition such as autism spectrum disorder, intellectual disability, or a mental health disorder
  • they have a physical or intellectual condition and wearing a cloth face mask gets in the way of their ability to communicate

But shouldn’t these kids just do virtual school if they can’t wear a mask, instead of getting an exemption?

While that might be an option for some kids, others need the extra services that they get at school, which they can’t get with at home schooling.

In addition to a face mask exemption, some things that might work in some situations when a child won’t wear a mask include:

  • a face shield
  • a transparent face mask
  • using different fabrics for the mask
  • trying a bandana or gaiter
  • try to desensitize your child to wearing a mask

What about asthma?

In general, most kids with well controlled asthma should be able to wear a face mask. If your child’s asthma is so severe that it is made worse by wearing a face mask, then they likely need an evaluation by a pulmonologist and it might be best to avoid being around others during the pandemic.

If your child can wear a face mask, but just doesn’t want to, then it might help to allow them to pick their own mask, with a comfortable fabric and fit, maybe even getting a mask with a favorite character on it.

“Model it! Make it familiar by wearing a mask too.”

Getting Your Child to Wear a Mask

And don’t expect your child to want to wear a mask at school if you don’t wear a mask when you go out or if you don’t believe that wearing a mask is necessary.

More on Mask Exemptions

  • What to Know About Face Masks and COVID-19
  • Fact Check – Did a Doctor Prove That Face Masks Don’t Work?
  • 7 Things to Know About COVID-19
  • CDC – Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2
  • CDC – Disability groups and risk
  • WHO – Children and masks

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Screening Questionnaires in Pediatrics

These screening questionnaires can be a good starting point if you suspect that your child is having problems with anything from anxiety and depression to OCD and PTSD.

It’s no secret that the COVID-19 pandemic is having many effects beyond kids getting sick with COVID-19…

“Coronavirus disease (COVID-19) can affect children and young people directly and indirectly. Beyond getting sick, many young people’s social, emotional, and mental well-being has been impacted by the pandemic. Trauma faced at this developmental stage can continue to affect them across their lifespan.”

COVID-19 Parental Resources Kit

How we find these kids with social, emotional, and mental issues shouldn’t be a secret either.

Screening Questionnaires in Pediatrics

Of course, not all kids are having problems right now.

“Here are some quick ideas for how to get conversations started with children and young people about how they are feeling and what they are struggling with regarding COVID-19. You don’t have to use these exact words—you know best how to speak with your child, adolescent or youth. In addition, how we talk to children and young people varies depending on their age and developmental level.”

COVID-19 Parental Resources Kit

In addition to using some of the conversation starters in the COVID-19 Parental Resources Kit from the CDC and seeing your health care provider for a check-up, these screening questionnaires and checklists might help you discover issues that your kids are having.

You can’t ask your kids (whether you are a parent or a pediatrician) these types of screening questions if you don’t know these screening questionnaires exist…

While these aren’t necessarily designed for parents to use to screen their kids on their own, there are a large number of questionnaires and screening tools that your health care provider can use to make sure your kids are safe and healthy, including:

    (ASQ) – a suicide risk screening tool (PHQ-A) – PHQ-9 depression screening modified for teens – parent and teacher scales for ADHD with scoring instructions – screens for eating disorders (EAT-26) – screens for eating disorders – screens for drug and alcohol abuse (S2BI) – screens for alcohol, tobacco, and other drug use (BSTAD) – frequency of use questions to identify risky substance use by adolescent patients ages 12-17. – used to recognize psychosocial problems (SDQ) – a brief behavioural screening questionnaire about 3-16 year olds. (HAM-A) – assesses the severity of anxiety symptoms (GAD-7) scale (SCARED) – screens for signs of anxiety disorders in children -A Pyschosocial Interview For Adolescents – Comprehensive biopsychosocial assessment tools that cover many areas, including for substance use and mental health (FAST) – identifies factors that may influence problem behaviors. – identifies sleep problems in children (PSQ) – asks about snoring and other features of OSA (MOAS) – rates the patient’s aggressive behavior over the past week (YMRS) – screens for bipolar disorder (PQ-R) – screens for prevalent and targeted psychosocial problems such as parental depression and substance use. (WE CARE) – screens for family psychosocial problems (IHELLP) Questionnaire – screens for social factors impacting your patients’ health – food insecurity screening tool based – identifies and screens patients for adverse social determinants of health – Clinician-Administered PTSD Scale for DSM-5 – Child and Adolescent Version (CARTS) – screens for domestic violence

At the very least, these types of pediatric screening questionnaires can be a good starting point if you suspect that your child is having problems.

More on Pediatric Screening Questionnaires and Checklists

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Why Are Social Distancing Kids Still Getting Sick?

Why are some kids still getting sick if they are have been our of school and stuck in the house for weeks because of COVID-19?

COVID-19 has kept most kids out of school for some time now. Many are also out of daycare. And few are out playing with friends.

So why are some still getting sick? What else is going on with kids stuck at home while we are all social distancing to flatten the curve.

Why Are Social Distancing Kids Still Getting Sick?

The first thought of some parents and pediatric providers upon reading this might be, wait, what, kids are still getting sick?

And that’s because it does seem that in addition to flattening the COVID-19 curve, staying home from school and daycare, washing hands, and general social distancing techniques has worked to keeps from getting sick with the flu and most other contagious diseases!

So while pediatric providers are available to do telemedicine appointments, it certainly isn’t business as usual, even as their days have gotten quite unusual.

Some kids are still getting sick though, and while we know what you are thinking, most probably don’t have COVID-19.

It might be because:

  1. they aren’t social distancing as well as they think they are, keeping in mind that with many diseases, people can be contagious for a few days before they show symptoms and you can sometimes catch germs from touching fomites, or objects that a sick person has recently touched. That still doesn’t mean that they have COVID-19 though. If they have contact with others, they could catch almost anything.
  2. they caught something from someone who had a disease a few weeks or months ago and is still shedding. For example, some infants can shed RSV for as long as 4 weeks after they get better. And they can shed the virus that causes hand, foot and mouth disease (HFMD) for almost two months! Human parainfluenza viruses (HPIV), a common cause of colds and croup (seal bark cough), can also shed for many months.
  3. they caught something from someone who had a viral disease that causes a lifelong latent infection with periodic reactivation and shedding. Wait, what? While herpes (cold sores) is the main disease you might think of as causing a lifelong latent infection, there are others. You may not realize this, but after getting roseola (causes a high fever for a few days, followed by a rash after the fever breaks), HHV-6 (human herpes virus-6) kind of does the same thing. The big difference is that while you shed HHV-6 in your saliva from time to time, you don’t have any symptoms. You can get other folks sick though, especially older infants, once they lose the passive immunity they got from maternal antibodies.
  4. they have a sore throat caused by a virus, allergies, or reflux, but have tonsil stones and a positive strep test because they are a strep carrier. Nearly 20% of kids are thought to be carriers of strep, which means that every time they get tested, they will be positive, whether or not they actually have strep throat. That means that you don’t have to worry about testing the dog to see if they are carrying strep…
  5. they were exposed to a disease with a long incubation period. While the incubation period (the time between getting exposed to something to when you get sick) is just a few days for many diseases, it can be several weeks or months for others. In fact, your child might not get sick until 30 to 50 days after being exposed to someone with mono!
  6. they had a virus a few weeks ago and now have Gianotti Crosti syndrome (GCS), a post-viral rash on a child’s legs, arms, and buttocks. Although GCS might linger for weeks or months, it eventually goes away on its own. Another rash, this one likely caused by reactivation of the virus that causes roseola, might have you thinking your child is covered in ringworm (how would they get that if they haven’t left the house??). Instead, they likely have pityriasis rosea.
  7. their symptoms are caused by a non-contagious infectious disease that is spread from an animal or insect and not from another person – think Lyme disease (ticks), Cat scratch disease (cats), and West Nile virus (mosquitoes), etc.
  8. they got sick (bacteria, virus, or parasite) from contaminated lake or well water, which can cause diarrhea – giardiasis, Crypto, shigellosis, norovirus,
  9. they got sick (bacteria, virus, or parasite) from eating raw or contaminated food – giardiasis, shigellosis, norovirus, E. coli, salmonellosis
  10. their symptoms are caused by a non-infectious disease, which could be anything from allergies and asthma to poison ivy or herpes zoster (shingles).

It is also possible that their symptoms are being caused by anxiety, fear, and stress, which is not unexpected as they see schools closed, people getting sick and wearing masks, and are likely unsure about what’s coming next.

Has your child been sick recently?

Do you understand why now?

Now call your pediatric provider if you have questions and need help getting them well, especially if they seem anxious or have extra stress from being home all of the time and away from school and their friends.

You especially want to call if you think that they might actually have COVID-19. While most kids have mild symptoms or are asymptomatic, if your child has a fever, cough, and difficulty breathing, you should call your pediatric provider or seek medical attention.

More on Covid-19 Kids Getting Sick

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Kids and COVID-19

Kids might not be at big risk from COVID-19, but that doesn’t mean that they are immune from stress and anxiety from hearing about it all of the time.

One good piece of news that is easy to pick out from all of the doom and gloom about COVID-19 is that kids don’t really seem to be at extra risk from this new disease.

“In this preliminary description of pediatric U.S. COVID-19 cases, relatively few children with COVID-19 are hospitalized, and fewer children than adults experience fever, cough, or shortness of breath. Severe outcomes have been reported in children, including three deaths.”

Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020

So far, fewer than 2% of cases in the United States have occurred in children and teens who are less than 18 years old. And of those who did get COVID-19, “relatively few pediatric COVID-19 cases were hospitalized” and even were admitted to the ICU.

Many did not even have a fever or cough!

That’s good news, as kids are often in high risk groups and at extra risk for other infectious diseases, like flu, measles, and RSV.

Kids and COVID-19

So why don’t kids get infected by SARS-CoV-2 more often?

“There have been very few reports of the clinical outcomes for children with COVID-19 to date. Limited reports from China suggest that children with confirmed COVID-19 may present with mild symptoms and though severe complications (acute respiratory distress syndrome, septic shock) have been reported, they appear to be uncommon.”

Children and COVID-19

Well, we actually don’t know how many kids are getting SARS-CoV-2…

Right now, it just seems like most don’t get severe disease, but because of limited testing and a priority going to those with severe disease, it may be that many more kids are infected than we know.

“Though the evidence to date suggests this virus doesn’t inflict severe disease on children, there’s reason to think kids may be helping to amplify transmission. It’s a role they play to devastating effect during flu season, becoming ill and passing flu viruses on to their parents, grandparents, teachers, and caregivers.”

A critical question in getting a handle on coronavirus: What role do kids play in spreading it?

They could just be getting very mild disease or infection without symptoms.

While that’s certainly reassuring, we can’t ignore the possibility that kids could get and spread the SARS-CoV-2 virus to others in high risk groups, including older people and people with severe chronic health conditions.

“If parents seem overly worried, children’s anxiety may rise. Parents should reassure children that health and school officials are working hard to ensure that people throughout the country stay healthy. However, children also need factual, age appropriate information about the potential seriousness of disease risk and concrete instruction about how to avoid infections and spread of disease.”

Talking to Children About COVID-19 (Coronavirus): A Parent Resource

And we shouldn’t forget that there is one thing that children aren’t immune to right now – anxiety from hearing about COVID-19 all of the time!

More on Kids and COVID-19

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What Is the Evidence for CBD Oil?

Besides treating seizures, is there any evidence for giving kids CBD oil or CBD kids gummies?

Are you wondering if your kids should be taking CBD oil?

That’s probably not a question you would be thinking of asking just a few years ago, but now that CBD products are everywhere, with hundreds of millions of dollars in sales, and claims that it can treat everything from seizures and anxiety to cancer, you might be thinking you need to jump on this new fad.

What Is CBD Oil?

Many folks are likely skeptical when they hear about all of the benefits of CBD oil.

This is the stuff that is extracted from marijuana plants, right?

How is it even legal to sell CBD oil or gummies infused with CBD?

To understand that, you have to understand that cannabidiol (CBD) oil is the part of the marijuana plant that doesn’t get you high. That comes from tetrahydrocannabinol (THC).

And many of the products you see with CBD oil that is sold over-the-counter aren’t even derived from marijuana, but instead come from hemp plants.

Labeling something as hemp doesn’t necessarily make it legal though. Regulators in Ohio, for example, recently announced that CBD oil derived from hemp is illegal and that the only legal CBD oil will be dispensed in state-licensed dispensaries.

What Is the Evidence for CBD Oil?

There is definitely evidence that CBD oil can have beneficial effects in some medical conditions.

Except for treating some types of resistant seizures, there is no good evidence that CBD oil has all of these other benefits.

In fact, the FDA recently approved Epidiolex oral solution for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. Epidiolex is an oral solution of oil-based CBD that is extracted from marijuana plants.

What other medical conditions?

While it is not approved to treat any other medical conditions, cannabidiol is being studied to treat people with ADHD, anxiety, autism, schizophrenia, chronic pain, Multiple Sclerosis, Parkinson disease, Tourette syndrome, and substance use disorders.

Should You Try CBD Oil?

What does that mean right now if you have a child with anxiety or another disorder and you are interested in CBD oil?

Although it might be tempting to buy and try the CBD oil that you can find at your local health food store, remember that they aren’t the same thing as Epidiolex, the prescription version of CBD. When you buy an over-the-counter CBD product, you have no idea what dosage of CBD you are really getting.

Anyway, until further testing is done, you have no idea what dose to give your child with anxiety or any other disorder besides seizures anyway.

And like other drugs, CBD oil can have side effects.

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Mindfulness for Kids and Parents

There might not be much proof that it works, but mindfulness might be worth a try if you are just looking for a way to help you and your kids relax.

Have you ever heard of mindfulness?

These kids don’t look like they need any help focusing on the present moment – having fun playing with each other! Photo by Todd Fahrner

Once upon a time, you probably would not have if you weren’t Buddhist.

Mindfulness is a form of meditation.

“Most of the time, we are lost in the past or carried away by the future. When we are mindful, deeply in touch with the present moment, our understanding of what is going on deepens, and we begin to be filled with acceptance, joy, peace, and love.”

Thich Nhat Hanh on The Long Road Turns To Joy

But much like yoga, an ancient Hindu practice, mindfulness has become popular without understanding its spiritual ties.

Benefits of Mindfulness

Why practice mindfulness?

What are the benefits of mindfulness?

You can actually find some studies that have found all kinds of benefits of mindfulness, from increased immune functioning to boosting your memory and attention span.

Now, I would view any of those benefits with a lot of skepticism, but the benefits that do seem plausible include decreasing stress and anxiety and improving your sleep, etc.

“Mindfulness meditation on breath, perhaps the most well-known type, involves sitting quietly, resting or closing your eyes and bringing your attention to your breath. When your attention drifts away, which it is likely to do, simply usher your attention back to your breath without judgment.”

AAP on Just Breathe: The Importance of Meditation Breaks for Kids

The American Academy of Pediatrics even suggests that mindfulness meditation can be helpful for children, although it is a clinical report from the Section on Integrative Medicine that is examining “best-available evidence.”

Does Mindfulness Work?

Many of us would like mindfulness to work.

Stress and anxiety are big problems today, both among kids and their parents. Their pediatricians too. So should we all start reading books on mindfulness?

Or go to a mindfulness group parenting class or start mindfulness-based cognitive therapy?

“Despite existing methodological limitations within each body of literature, there is a clear convergence of findings from correlational studies, clinical intervention studies, and laboratory-based, experimental studies of mindfulness—all of which suggest that mindfulness is positively associated with psychological health, and that training in mindfulness may bring about positive psychological effects.”

Keng et al on Effects of mindfulness on psychological health: A review of empirical studies

Considering that many reviews have been critical and the one with the most praise could only find a suggestion of positive associations, although I have always liked the idea of mindfulness, I am skeptical of its use as a medical treatment.

“I think the best current summary is to consider mindfulness like yoga, or a specific form of exercise. There is evidence that doing yoga has specific health benefits. However, those benefits are likely not specific to yoga and are universal to exercise. It is therefore more accurate to say that exercise has many health benefits, and yoga is a form of exercise.”

Steven Novella on Is Mindfulness Meditation Science-Based?

Can we just say that being mindful is a way to help you relax?

And being able to relax has some health benefits?

Give mindfulness a try if you want. Just don’t expect miracles and realize that with all of the distractions that you likely have in your life, being truly mindful is going to be much more difficult than you could ever imagine.

And while you can sell mindfulness, it is now a billion dollar industry, you can’t really buy it.

You can start with turning off the TV unless you are watching a specific program. And putting your phone down when the kids are around. Basically, get away from always trying to multitask and focus on who you are with or what you are doing at any one moment.

What to Know About Mindfulness for Kids and Parents

There might not be much proof that it works, but mindfulness might be worth a try if you are just looking for a way to help you and your kids relax.

More About Mindfulness for Kids and Parents

    A Journey Into Mindfulness Featuring Thich Nhat Hanh
  • Study – Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation
  • Study – Meditation programs for psychological stress and well-being: a systematic review and meta-analysis.
  • AAP – Just Breathe: The Importance of Meditation Breaks for Kids
  • AAP – Mind-Body Therapies in Children and Youth
  • Study – School-Based Mindfulness Instruction: An RCT
  • Study – Effects of mindfulness on psychological health: A review of empirical studies

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Understanding and Treating Teen Sleep Problems

Although teen sleep problems are common, they can cause serious daytime issues for your teenager, which makes it important to learn about good sleep hygiene and that help is available from your pediatrician.

Do your kids have to get up too early because school starts too early?

Parents often ask for help getting their kids to fall sleep and then stay asleep all night.

At least they do when they are little.

Teens often have trouble sleeping too though, but parents often don’t recognize these sleep problems and might not think to ask for help. They do likely see some of the issues that can be caused by a poor night’s sleep though, which can include irritability, sadness, a poor attention span, and hyperactivity, etc.

Why Teens Don’t Sleep Well

From being over-scheduled and having to get up early for school to staying up late on a screen, there are many reasons why your teen might not be sleeping well.

There are also many different types of sleep problems.

To understand what is causing your child’s sleep problems, ask yourself these questions and share the answers with your pediatrician:

  • Does your teen sleep at least 8 1/2 to 9 1/2 hours each night?
  • Does your teen have trouble falling asleep or does he just wake up a lot in the middle of the night? Or does your teen seem to sleep enough, but is still always tired?
  • Does your teen snore loudly at night – a sign of obstructive sleep apnea?
  • Is your teen taking any medications that could cause insomnia, such as for ADHD (stimulant) or allergies (decongestant)?
  • Does your teen have poorly controlled allergies, asthma (late night coughing), eczema (frequent itching keeping him awake), or reflux?
  • Is your teen drinking any caffeine in the afternoon or evening?
  • Do you think that your teen is depressed or has anxiety, either of which could cause problems sleeping?
  • Have you noticed any symptoms of restless leg syndrome, including a strong urge to move his legs when he is sitting or lying down?
  • Does your teen have too much homework and is staying up late trying to get it all done?
  • What does your teen do just before going to sleep?
  • Does your teen fall asleep easier when he goes to bed much later than his typical bedtime or does he still have trouble falling asleep?
  • Are your teen’s sleep problems new?

And perhaps most importantly, what is your teen’s daily sleep schedule like? What time does he go to sleep and wake up, including weekends, and does he typically take a nap?

Treatments for Teen Sleep Problems

In addition to treating any underlining medical issues that might be causing your teen to have trouble sleeping, it will likely help if your teen learns about sleep hygiene and:

  • goes to bed and wakes up at about the same time each day, instead of trying to catch up on “lost sleep” on the weekends
  • keeps his room bright in the morning (let in the sunshine) and dark at night
  • avoids taking naps, or at least naps that are longer than about 30 to 45 minutes
  • avoids caffeine
  • is physically active for at least one hour each day
  • doesn’t eat a lot just before going to bed
  • turns off all screens (phone, TV, computer, video games, etc.) about 30 minutes before going to sleep
  • doesn’t get in bed until he is actually ready to go to sleep, which means not watching TV, reading, or doing anything else on his bed
  • gets out of bed if he doesn’t fall asleep after 10 to 15 minutes and reads a few pages of a book, before trying to go to sleep again

If you teen is still having sleep problems, encourage them to try some basic relaxation techniques, such as progressive muscle relaxation, guided imagery, and deep breathing or abdominal breathing. You do them at bedtime and again if you wake up in the middle of the night.

I especially like the idea of guided imagery for teens, as they can focus on something they like to do, whether it is building a sandcastle on the beach, or going horseback riding, surfing, hiking, or playing baseball, etc. They should focus on the details of the story they make up, coming back to it if their mind wanders, and hopefully they fall asleep as they get caught up in it.

With the deep breathing technique, they slowly breath in through their nose and out through their mouth. They can hold their breath for a few seconds or breath into their abdomen too (abdominal breathing).

Progressive muscle relaxation is another technique that might help your child relax at bedtime. They simply tense and then relax each muscle group of their body, one at a time, starting with their toes and working their way up. If they make it up to their forehead and aren’t asleep, then they should work their way down, perhaps doing 3 to 5 repetitions for each muscle group, or try another technique.

And be sure to talk to your pediatrician if your teen continues to struggle with sleep problems.

What To Know About Teen Sleep Problems

Although teen sleep problems are common, they can cause serious daytime issues for your teenager, which makes it important to learn about good sleep hygiene and that help is available from your pediatrician.

For More Information on Teen Sleep Problems

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Ten Things That Aren’t As Scary As Most Parents Think

Parenting can be a little less scary if you are prepared for when you child eats a bug, has a night terror, or wakes up barking like a seal.

Being a parent can be scary enough.

Don’t let these every day parenting issues freak you out even more.

Be prepared for when you child eats a bug, has a night terror, or wakes up barking like a seal.

  1. Breath holding spells – in a typical breath holding spell, a young child cries, either from a tantrum or a fall, etc., and then holds his breath (involuntarily) and briefly passes out. Although it sounds scary and the episode might look like a seizure, these kids usually quickly wake up and are fine after. Kids who have breath holding spells are often prone to repeated spells though, so you do want to warm other caregivers so they don’t freak out if your child has one. Eventually, kids outgrow having them.
  2. Febrile Seizures – parents often describe their child’s first febrile seizure as ‘the worst moment of their life.’ Febrile seizures typically occur when a fever rises rapidly, but although they are scary, they are usually brief, stop without treatment, don’t cause any problems, and most kids outgrow having them by the time they are about five years old.
  3. Nosebleeds – a nosebleed that doesn’t stop is certainly scary, but with proper treatment, most nosebleeds will stop in ten to twenty minutes (if not sooner), even if your child wakes up in the middle of the night with a bloody nose for what you think is no reason.
  4. Night terrors – often confused for nightmares, a child having a night terror will wake up in the early part of the night yelling and screaming, which is why parents think their child is having a nightmare. The scary thing though, is that their child will be confused, likely won’t recognize you, and might act terrified – and it all might last for as long as 45 minutes or more. Fortunately, night terrors are normal. Your child likely won’t even remember what happened the next morning. And they eventually stop.
  5. Eating a Bug – “Kids eat bugs all the time. Few if any symptoms are likely to occur.” – that’s a quote from the National Capital Poison Center, who must get more than a few calls from worried parents about their kids eating bugs. Or finding the evidence later – when you see a dead bug in their diaper…
  6. High Fever – pediatricians have done a lot of education about fever phobia over the years, but parents often still get scared that a high fever is going to cause brain damage or hurt their child in some other way. Try to remember that fever is just another symptom and doesn’t tell you how sick your child is.
  7. Playing Doctor – even though it’s natural for young kids to be curious about their bodies, the average parent is likely going to be scared and upset if they “catch” their kids playing doctor. Understand that it is usually a normal part of child development and don’t turn it into a problem by making it into more than it is.
  8. Hives – a child with classic hives might have a red raised rash develop suddenly all over his body. And since hives are very itchy, that child is probably going to be miserable, which can make hives very scary, even though without other symptoms (like vomiting or trouble breathing), they typically aren’t a sign of a serious allergic reaction. The other thing about hives that can be scary is that even when they go away with a dose of Benadryl, they often come back – sometimes for days, but often for weeks. And your pediatrician might not be able to tell you what triggered them.
  9. Croup – your child goes to bed fine, but then wakes up in the middle of the night with a strange cough that sounds like a barking seal, has a hoarse cry, and it seems like he is wheezing. Scary, right? Sure, but if you realize he probably has croup and that some time in the bathroom with a hot shower (getting the room steamy can often calm his breathing), you’ll be ready for this common viral infection.
  10. Choking – while choking can be a life-threatening emergency, most episodes of choking aren’t. In addition to learning CPR and how to prevent choking, remember that if you child “is still able to speak or has a strong cough” then you may not have to do anything, except maybe 911 if he or she is having some breathing difficulties. It is when your child is choking and can not breath at all (and can’t talk and isn’t coughing) that you need to quickly react and do the Heimlich Maneuver while someone calls 911.

Even with a little foreknowledge and preparation, many of these very common pediatric issues are scary. Don’t hesitate or be afraid to call your pediatrician for more help.

For More Information on Things That Scare Parents

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Helping Kids Cope With Stress

Get help recognizing signs and symptoms of stress in your kids and helping them cope when stress gets to be too much to handle.

Children, especially teens, often have stress in their lives.

Whether caused by the loss of a friend or loved one, a recent move, being teased or bullied, difficulties at home, or problems at school, childhood stress can lead to behavioral problems, anxiety, depression, headaches, drug use, and insomnia, among many other symptoms and medical problems.

Other symptoms of stress can include mood swings or temper tantrums in a younger child, withdrawing from friends and family, and aggression.

What Causes Kids to Have Stress?

Unfortunately, the source of stress for a child is frequently not so easy to recognize and parents are not always very good at noticing things that could be stressors, which can include things like:

  • a change at daycare for preschool age children, including attending daycare for the first time, moving to a new room, having a new teacher, or changing to a new daycare, etc.
  • having too much homework
  • being over-scheduled with sports and other extracurricular activities
  • having expectations for his performance that are unrealistic and too high or a fear of failure, despite of having good grades, having a lot of friends, etc.
  • a divorce or death in a friend’s family, which can raise fears that the same thing could happen to his own parents
  • poor self esteem
  • watching something stressful on the news, such as a school shooting, terrorist attack, or natural disaster
  • a chronic medical problem, like asthma or diabetes, or an acute medical problem, like a burn or broken leg
  • a medical problem in a family member
  • a traffic accident
  • financial problems at home

Keep in mind that common childhood transitions, such as moving to a toddler bed, starting kindergarten, going to camp, starting puberty, beginning high school, and going off to college, etc., can be very stressful for some children.

The other confusing thing about stress is that the symptoms of being stressed do not always immediately follow whatever is causing the stress and the same situations don’t cause stress in all children or even for the same child at different stages in their life.

Helping Kids Cope With Stress

Although overlooked as many parents and children look for a quick fix for their problems with stress, it is important not to overlook the importance of regular exercise, a healthy diet, and a good night’s sleep to help them cope with any problems with any stress they are having.

Other ways to help your child cope with stress can include:

  • scheduling more free time for your child, especially if being too busy is the source of her stress
  • spending quality time with your child and give them plenty of opportunities to talk about their worries and problems
  • eating dinner together each night as a family and having other routines or rituals that you stick to on a regular basis
  • helping your child set realistic expectations for himself
  • be prepared for stressful situations that you can anticipate, such as the birth of a new sibling, a move to a new city, or a parent who is going to have surgery
  • giving your child age appropriate responsibilities and allowing him to overcome simple challenges on his own without always bailing him out, which can help teach them basic problem solving skills that he will need throughout his life
  • teaching your child ways to relax, including diaphragmatic breathing, progressive muscle relaxation, visual imagery, listening to music, reading, keeping a journal, and drawing, etc.

Your pediatrician can be a good resource if your need help managing your child’s level of stress, especially if your child’s symptoms from the stress are not temporary. A mental health professional, such as a counselor, child psychologist, and/or child psychiatrist, can also be very helpful for the overly stressed child or even for a child who does not routinely handle stress well.

American Academy of Child and Adolescent Psychiatry. Facts for Families. No. 66; Updated Feb 2013. Stress Management and Teens. Accessed May 2016.

Treating Anxiety & Depression Naturally with CBD

Anxiety disorders and depression can be crippling mental health conditions that impact every aspect of your life. It can be especially difficult for patients who are struggling to find a medication that provides them with more benefits than side effects, or those who simply do not want to use medication to manage their condition. Now that medical marijuana is legal in Florida, CBD, or cannabidiol, has become a natural and attractive alternative in the state. Board-certified psychiatrist Dr. Daniel Bober may recommend CBD for anxiety and depression at his Hollywood, FL, practice, to help patients achieve a better quality of life.

Do Patients Find the Treatment to Be Effective?

What Is CBD?

Cannabidiol is a non-psychotomimetic constituent of Cannabis sativa. While CBD is a component of marijuana, it can be derived from both the marijuana and hemp plant which is a cousin of the marijuana plant [1] .While there is limited research on patients, some studies have also shown that CBD can have anti-anxiety and antidepressant effects [2] .

Is CBD Legal?

The use of CBD and its legality is complex as the government considers it in the same class as marijuana but does not typically enforce the same restrictive laws [1] . However, since CBD can be extracted from hemp plants, which do not qualify as marijuana in the state of Florida, many patients easily acquire low-THC CBD products online without a license.

For many patients, a combination of CBD treatment and therapy can be especially beneficial.

CBD is currently marketed as a supplement, so it is not regulated by the U.S Food and Drug Administration (FDA) [1] . As such, it can be nearly impossible to know which other active ingredients manufacturers are including. It is important to only use CBD provided by a trusted source.

Prevalence of Anxiety & Depression

While 40 million adults in the U.S. are affected by anxiety disorders each year, only 36.9 percent seek treatment [3] . Similarly, 173 million American adults have experienced at least one major depressive episode but 35 percent did not receive treatment [4] . It is alarming that a significant number of patients who are suffering from these serious conditions are not receiving the help they need.

Barriers to Treatment

Patients may be hesitant to seek treatment for several reasons including:

  • Personal choice
  • Financial restrictions
  • Lack of awareness
  • Shame

Dr. Bober is dedicated to erasing the stigma of mental health disorders and helping patients find an effective solution for their condition. CBD may the answer for you or your loved one.

How Does CBD Help Improve Anxiety & Depression?

By helping regulate the endocannabinoid system (ECS) [5] , CBD can improve [6] :

  • Ability to cope with stressors
  • Overall mood
  • State of mind
  • Muscular tension
  • Difficulties concentrating
  • Fatigue

Additionally, CBD may be able to help reduce social anxiety in patients [6] . In reality, CBD products are being used by individuals for widespread uses, from addressing specific conditions to improving overall well-being.

Are CBD Products an Effective Treatment Method?

CBD has been used for everything from anxiety, sleep, chronic pain, depression, and many other conditions. Despite the growing popularity of CBD, there is very little evidence that it works for most conditions. Several studies have found CBD to be harmless, which is to say safe, but that’s very different from proving its effectiveness. According to a study published in 2018, 62 percent of participants reported they were using CBD to treat a medical condition, primarily pain, anxiety, and depression [7] . Additionally, 36 percent reported that CBD was treating their medical condition “very well by itself” [7] .

Important Factors to Consider

To date, the FDA has approved only one drug for previously uncontrollable pediatric seizures. So why all the hype? Well for many, it’s financial motivation. CBD is becoming a multi-billion dollar Industry.

The other problem is a lack of reliability and consistency within the industry. In a 2017 study, Marcel Bonn-Miller, an adjunct assistant professor in the psychiatry department at the University of Pennsylvania’s Perelman School of Medicine, said his team found that nearly 70 percent of the CBD products they analyzed were mislabeled. Many of these products contained less than the reported amount of CBD. Furthermore, because research has been limited to date, there is no consensus on what dose of CBD to use for what conditions.

Anyone who decides to use CBD should do so with products that have been independent laboratory third-party tested to ensure the vendor’s label and advertising are accurate. All this being said, CBD has shown promise (albeit anecdotally) for a number of conditions and the absence of evidence is not the evidence of absence. More studies are needed to separate these purported benefits from placebo effect and until then, patients must proceed with caution and with skepticism.

Is There a Risk of Marijuana Addiction?

Many patients and loved ones are concerned about marijuana addiction and safety when considering CBD treatment. However, the World Health Organization (WHO) Expert Committee on Drug Dependence (ECDD) found that “CBD exhibits no effects indicative of any abuse or dependence potential”, including signs of withdrawal. This is especially true since many CBD products are available with such low quantities of THC that they provide no intoxicating effects [6] .

Additionally, the WHO reports that CBD is “generally well tolerated with a good safety profile” [6] . However, some negative effects may be experienced when CBD is taken in combination with certain medications. As such, your treatment and CDB usage should be closely managed by a professional.

Your Treatment

As a board-certified psychiatrist, Dr. Bober can prescribe the proper dosage of CBD to safely manage your anxiety disorder or depression. The ratio of CBD to THC is important and varies from patient to patient. Typically, he will start off with a lower dosage and, if that is not effective, it can easily be increased to provide the relief you need. It is important to note that using CBD for anxiety or depression does not mean you should stop therapy. For many patients, a combination of CBD treatment and therapy can be especially beneficial.

With over a decade of experience, Dr. Bober is extensively knowledgable in the treatment of anxiety and depressive disorders. His patients’ health and safety are his primary concerns and he will only recommend CBD if he believes it is the very best solution for your needs or can complement other treatment methods. He can also work in collaboration with your therapist and doctors.

Find Relief with CBD

If you or a loved one are suffering from anxiety or depression, do not let medication deter you. CBD may be an alternative that can change your life. Call (954) 994-1115 to schedule your consultation with Dr. Bober at his Hollywood practice.

Not Your Parents’ Pot: Teen Cannabis Use Raises Red Flags

Marijuana. Mary Jane. Weed. Pot. Skunk. Shake, shatter, and pre-rolls. No matter what you call it, thanks to expanded medical and recreational availability of cannabis in the United States, a growing number of adolescents are using the drug — with potentially dangerous and mostly unintended consequences. And both parents and practitioners are being caught off guard.

Deborah, a parent in Boston (who requested that her name be masked to protect her family), knows the risks first-hand. Last year, her 19-year-old son landed in the emergency department, and subsequently a behavioral health facility, after smoking pot with his friends. Only days earlier, she had dropped him off for his sophomore year of college.

“He’s been a regular cigarette smoker since 10th grade, and an occasional [user] of alcohol and pot. But he got really unlucky,” Deborah told Medscape Medical News.

“He had a paranoid reaction, cannabis-induced psychosis they call it, and three days later he was still having delusions that friends [on social media] were saying things that they didn’t say, that people in his apartment were talking about him.”

After he was hospitalized and placed on the antipsychotic drug olanzapine (Zyprexa), prior red flags became apparent: social anxiety, depression, a family history of bipolar disorder. One year later, he remains in treatment, is attending community college, and is doing well, with one caveat: “The doctors tell us that we now have to treat pot like a life-threatening allergy,” she said.

A Convergence of Risks

Deborah’s experience is far from unique.

As of November, 36 US states and four territories had legalized medical cannabis, and 18 states, four territories, and Washington, DC, had enacted legislation allowing for recreational use. Although national data do not demonstrate an explosion of cannabis use in youth since legalization, researchers and clinicians alike have expressed concerns over the convergence of risks: adolescents as young as 12 or 13 starting to use the drug, a market dominated by highly potent cannabis products, and short- and long-term effects of exposure, especially with regard to the developing brain.

Dr Krista Lisdahl

“My work, as well as the work of a lot of other colleagues, has shown that younger kids do have more negative consequences from more regular cannabis exposure,” said Krista Lisdahl, PhD, director of the Brain Imaging and Neuropsychology Laboratory at the University of Wisconsin-Milwaukee and principal investigator in the National Institutes of Health’s ongoing Adolescent Brain Cognitive Development Study. “What we tend to see is mild to moderate reductions in verbal memory, complex attention — like cognitive control — problem solving, and psychomotor states.”

Lisdahl has found that cognitive function starts to recover within a few weeks if use stops. Three prospective longitudinal studies in 3762 identical and fraternal twins published last April in PNAS further support her research: While use of cannabis is associated with greater rates of mental health problems in youth — including major depression, anxiety, and antisocial personality, as well as substance use disorders — the effects are mostly temporary.

Researchers are trying to determine if early use leads to adverse outcomes in adults. They also wonder if disparate state laws may be driving easier access to and greater use of cannabis among adolescents who might not understand the need to consume lower amounts of the drug and titrate appropriately.

“We’ve created this patchwork of products with varying regulation from state to state, but what we don’t have is federal regulation,” Sharon Levy, MD, MPH, director of the Adolescent Substance Use and Addiction Program at Boston Children’s Hospital, said.

From Initiation to Abuse

The National Institute on Drug Abuse reports that in 2021, roughly 7.1% of 8th graders, 17.3% of 10th graders, and 30.5% of 12th graders used cannabis in the past year. These statistics are hardly surprising; this week, a study published in the Journal of Studies on Alcohol and Drugs highlighted that despite state regulations against advertising cannabis products to youth, recreational producers are creating content — promotions, discounts, health benefits, even swag like T-shirts or hats — that appeal to adolescents. Moreover, according to the study authors, many of these marketing strategies are designed to circumvent rules across social media platforms and lack oversight from the companies who created the rules in the first place.

The study highlighted that aside from driving awareness, cannabis marketing messages are aimed at driving behaviors, which in this case might be quite dangerous, the researchers said. Rapid brain spikes of tetrahydrocannabinol, or THC (the main psychoactive compound in cannabis), coupled with adolescent impulsivity and propensity to seek rewards, can quickly lead to problematic use. In fact, recent estimates from the 2020 National Survey on Drug Use and Health demonstrated that roughly 4.1% of US teens reportedly suffer from cannabis use disorder (CUD).

Data gathered from a sample of US teens between spring 2019 and fall 2020 also indicate that many adolescents have turned to cannabis to cope with pandemic-related isolation, although 80% indicated previous substance use as a coping strategy.

“There’s a phase during adolescence when kids have a heightened interest in trying psychoactive substances and there are neurological [underpinnings],” Levy said. “They have more dopamine receptors in the brain; they’re at a phase where they are more impulsive.”

Social and cultural influences; mental health issues including depression, anxiety, and attention deficit hyperactivity disorder; a history of trauma; and genetics also appear to drive risky behaviors in adolescence, especially when it comes to the decision to try cannabis.

Meanwhile, the proclivity for risk taking and reward has blurred the line between recreational and medicinal consumption of the drug — an important consideration for clinicians.

On weekends, teens might use cannabis “to enjoy the company of friends and to remove some social anxieties, but it may also be [a way] to support other areas of health, things like mental health, or struggles with sleep” during the week, Lauren Kelly, PhD, MSc, assistant professor of pediatrics and child health at the University of Manitoba, Winnipeg, Canada, and scientific director of the Canadian Childhood Cannabinoid Clinical Trials, said. “Opening these discussions may be able to help reduce cannabis use and suggest alternatives that have more evidence behind them.”

Kelly also stressed the importance of understanding the numerous types of products that are now available. “Someone may say that they are using cannabis and it might be cannabidiol [CBD] oil, or cannabinol [CBN], or something else that is very different [from] a high-potency THC product; these products are very different in terms of effects and risk,” she said.

On the clinical side, screening at regular checkups is essential for understanding who is using, why they’re using, and what they’re using. Levy and her colleagues have developed a validated and easy-to-administer online screening tool with which clinicians can quickly and accurately identify adolescents with moderate to severe substance use disorders.

Major institutions like NIH are devoting research dollars toward better understanding how cannabis affects adolescent development and long-term health outcomes. In the interim, parents and practitioners should not be passive, Lisdahl said: “It’s important to be talking openly about these topics without stigma so we can really develop the best treatments and best environments for adolescents to flourish.”

Lisdahl, Levy, and Kelly have disclosed no relevant financial relationships.

Liz Scherer is an independent journalist specializing in infectious and emerging diseases, cannabinoid therapeutics, neurology, oncology, and women’s health.