3 Things to Know about Mother-Child Relationships

By Sarah Edwards, DO

  1. Healthy moms = healthy children and families. Healthy moms are essential to building children’s healthy brains and helping everyone in the family grow well and love well. Maternal depression, anxiety and stress can affect how a mother interacts and develops a relationship with her baby. Babies need a safe and stable connection with a caregiver for social, emotional and cognitive development. If this attachment is not strong, it can have lasting effects on a child’s brain, and puts children at risk for behavior and emotional problems.
  2. Family bonding is key to a healthy family. The good news is that there are effective ways to help caregivers bond with their children and promote a healthy relationship for the whole family. Finding joy in themselves and each other helps everyone feel loved and part of something important: their family.
  3. Help is available. If you have concerns about your relationship with your young child, contact the University of Maryland Medical Center’s Secure Starts Clinic at 410-328-3522 to make an appointment.

Dr. Edwards is the medical director of child and adolescent psychiatry services at University of Maryland Medical Center and an assistant professor of psychiatry with the University of Maryland School of Medicine. For a consultation, call 410-328-3522.

Fertility: 12 things you didn’t know (and 1 to never ask)

By Katrina Mark, MD

1. Fertility naturally declines as we age

That alone doesn’t mean you should start to worry. The general advice I give a woman is if she has been trying to become pregnant for a full year with no luck, she might consider a fertility evaluation. For a woman over age 35, she might consider it after six months. If a woman is younger and has irregular periods, it’s likely she isn’t regularly ovulating, so she might want to be evaluated sooner.

2. Sometimes there’s a reason for infertility – and sometimes, there’s not

There are some things we know cause infertility. About 20 percent of the time, we find no reason for it. For a woman, infertility can be due to a condition that causes you to not ovulate regularly such as diabetes, thyroid disease and polycystic ovaries. It can also be caused by blocked fallopian tubes or a history of ectopic pregnancy. For men, it can be due to semen issues such as a low sperm count.

Early menopause in women under the age of 40 is rare, but it can run in families and cause infertility. Lifestyle factors such as smoking and obesity contribute to infertility in both women and men.

3. Taking birth control for long periods of time does not hurt fertility

No, taking birth control stops you from getting pregnant, but it doesn’t hurt fertility once you stop taking them.

4. If you are having trouble conceiving, consider these culprits:

  • Lifestyle factors: If you smoke, try to quit. If you are obese, try to lose weight. Vigorous exercise and low body weight can also cause ovary issues. Marathon runners and gymnasts have this issue frequently. Luckily, increasing body fat percentage or decreasing exercise a small amount can often correct it.
  • Chronic conditions: If you suffer from a chronic condition such as diabetes or hypertension, make sure you are managing it and keeping it under control.
  • Ovulation issues: For women who aren’t ovulating regularly, the first line is usually Clomid, a pill that makes a woman’s body produce eggs and ovulate each month. Many OB-GYNs will prescribe this, so you don’t necessarily need to see a fertility specialist.

If there’s no known reason trouble conceiving, your OB-GYN may refer you to a fertility specialist for treatment. Fertility specialists and even some OB-GYNs perform intrauterine insemination (IUI), where sperm are placed directly in the uterus around the time the ovary releases one or more eggs to be fertilized. In vitro fertilization (IVF) is when the sperm and egg fertilize outside the woman’s body and then the fertilized egg is implanted in the uterus.

5. Your OB-GYN can often provide some fertility assistance

If a woman is trying to conceive, she should share this with her OB-GYN. If she is having trouble, an OB-GYN can provide a general evaluation to look for causes, as well as provide education, which often is very helpful.

6. Don’t worry if it’s been a month or two and you’re not pregnant

Ninety percent of couples get pregnant within a year. Don’t worry if it’s only been a few months. This is normal and usually there’s nothing wrong with you.

7. The overall rate of infertility hasn’t changed

Although more are seeking treatment. In this age, more women may be delaying fertility because of better access to education and career opportunities. The average age of a woman when she has her first child has gone up over the last few decades. Delaying childbearing increases the likelihood for a woman to experience fertility issues. There also may be more people pursuing fertility treatment now because there is better access to treatment.

8. Egg freezing is much better than it used to be

Typically, egg freezing is recommended for those who desire it when a woman is between the ages of 35 and 38. If a woman is interested in having eggs frozen, she should speak with a fertility specialist. This technology has gotten better in the last several years and there has been better success. Fertility specialists can now freeze eggs without having to fertilize them. Insurance generally doesn’t cover egg freezing unless there is a medical reason.

9. Fertility treatments have come a long way

Overall, fertility treatment has high success rates these days. In vitro fertilization (IVF) has a very high success rate. Even for women who have premature ovarian failure, which is loss of ovary function before the age of 40, can opt for a donor egg and carry a pregnancy. Sometimes it depends on what a person is willing to go through and what you can afford, although many insurances cover some fertility treatment. Most don’t cover everything and it can be expensive.

10. There are reasons not to consider fertility treatment

Some treatments can be quite expensive. Some people may have moral objections. In some cases, a woman may have a chronic condition that it wouldn’t be recommended or safe to pursue pregnancy, such as certain heart conditions. Sometimes if either partner has a genetic disorder that is hereditary, they may not want to risk passing it along to a child. If a couple chooses not to pursue fertility treatment but still wants to have children, adoption or a donor egg are also options.

11. Fertility treatments aren’t just physically demanding

They’re also mentally draining. There have been studies that have shown a woman going through fertility treatments may experience the same level of depression as someone going through cancer treatment. The psychological aspect of fertility treatments is under-recognized. We view pregnancy as a positive thing because you get a baby at the end, but fertility treatment can make a person anxious and terrified – while trying to conceive and also during pregnancy and after the baby is born. Some women are traumatized from the experience and develop an anxiety disorder. Women often go through these struggles in private because they often don’t want to tell anyone. The same is often true with miscarriages. Many women experience very real grief and depression during these times. It’s important to make sure people are getting counseling because a lot of times they aren’t even talking to their friends or family about it. If you have breast cancer, people bring you food. There is no greeting card for infertility.

12. Don’t shy away from a friend who’s having trouble conceiving

If you someone close to you who is going through fertility issues, don’t completely ignore it or become distant. Be a friend, act normal and open yourself up to the person for conversation if he or she wants to talk. A lot of times people want to talk about it but don’t know how. Give them the hope and space to talk as much or as little as they want. Everyone deals with a loss and struggles differently; some are private about it and don’t want to talk about it, but others do.

Don’t ever ask a woman when she’s going to have a baby

For someone who is going through fertility treatment, being constantly asked when they’re going to have a baby can be devastating. You don’t know what someone may be going through.

Dr. Katrina Mark is an OB-GYN at University of Maryland Medical Center and Assistant Professor of Obstetrics, Gynecology and Reproductive Sciences at the University of Maryland School of Medicine.

 

 

 

Brain Injury Awareness Month

By Jameson Roth, Communications Intern

At UMMC, we recognize individuals who have experienced Traumatic Brain Injury, directly and indirectly, throughout the month of March with the acknowledgment of Brain Injury Awareness Month.

Traumatic Brain Injury (TBI) is defined as a complex injury caused by an outside force on the brain, which can result in the permanent or temporary loss of brain functions. Individuals who have survived a TBI may experience symptoms such as memory loss, impaired cognition, headaches and mood swings following their injury.

The leading causes of TBI include motor vehicle crashes, said Karen McQuillan, lead clinical nursing specialist at the R Adams Cowley Shock Trauma Center. As a 30-year veteran of trauma nursing, McQuillan has seen it all. Other causes of TBI include sports activity, physical assault, gunshot wounds, domestic violence and falls. “Falls dominate the cause category for individuals aged 65 and over for TBI,” McQuillan said.

McQuillan is an active proponent of TBI prevention tactics. To prevent TBI in individuals age 65 or older, McQuillan suggests removing floor obstacles and installing wall railings in home hallways and bathrooms. One way to prevent motor vehicle crash-related TBI is by putting a stop to distracted driving. “A motor vehicle crash is 23 times more likely while texting,” McQuillan said. For individuals who ride bikes or drive motorcycles, McQuillan suggests wearing a helmet for head protection.

While not all individuals diagnosed with TBI make a full recovery, McQuillan suggests for an optimal recovery:

  • When appropriate, formalized rehabilitation
  • Plenty of rest
  • Reliance upon a strong support system
  • Patient-specific cognition activities to help patients overcome deficits

To learn more about the R Adams Cowley Shock Trauma Center’s role in TBI recovery, please visit http://umm.edu/programs/shock-trauma/patients/survivors-network

What Can Women Do to Prevent Early Menopause?

About Early Menopause

The average age a woman goes into menopause is 51. Menopause is considered abnormal when it begins before the age of 40 and is called “premature ovarian failure.” Common symptoms that come with menopause include hot flashes, night sweats, sleep problems, sexual issues, vaginal dryness, pain during sex, pelvic floor disorders (urine, bowel leakage, pelvic organ prolapse), losing bone mass, and mood swings.

Menopause is mostly genetically predetermined, which means you generally can’t do much to delay it from happening. What you can do is work to counter-balance or prevent the symptoms and effects that tend to develop during menopause.

What You Can Do

Women can do a lot of things to prepare themselves for changes that will come with menopause. These include modifying your lifestyle so you are eating a healthy diet and exercising regularly.

Diet and Exercise

Related to diet, women should look into their caloric intake and make adjustments like eating smaller meal portions, and eating a well-balanced diet that includes lots of fiber and protein and less carbohydrates. Avoid eating late at night or snacking, which means no eating two to three hours before bed time.

Take calcium and vitamin D supplements for bone health to prevent osteoporosis. Well-balanced food with decreased caffeine intake also helps to decrease night sweats.

Exercise is one of the most important and modifiable factors that all women must take advantage of. Cardio workouts including walking or jogging three times a week will boost your cardiovascular system and endurance, and also help you control your weight. It’s also important to do weight-bearing exercises regularly to build up bones and prevent osteoporosis.

Kegels

Kegel exercises can help prevent pelvic floor disorders (urine, bowel leakage, pelvic organ prolapse). Kegel exercises should ideally be done every day three times a day. Every woman needs to know how to do Kegel exercises properly. Unfortunately, many women think they do Kegel exercises when, in fact, they do not, because the muscles are hidden inside the body. Your physician should be able to help you with it. You can do long squeezes for 10 seconds, or fast squeezes. This helps to maintain strength and endurance of the pelvic muscles in order to prevent urinary or bowel leakages in the future.

Mental Health

If possible, I recommend having regular sex. It improves vaginal lubrication and helps to prevent vaginal dryness and pain with intercourse. It is also good for your overall mood.
Finally, every women should work on developing a positive attitude, and spending time in a healthy environment helps – for example, taking frequent walks in a park or whatever makes you feel good; finding a way to de-stress and/or control any stress in your life. This will improve your mental health.

Hormone Therapy

Hormonal treatment for early menopause and menopause has been out of favor because of concerns with breast cancer, cardiovascular disease, and stroke. With that said, it is still gold-standard treatment especially for hot flashes and night sweats. Hormonal therapies could offer significant benefits to women especially those going through early menopause. Talk to your doctor about what is right for you.

Fertility

A woman going through early menopause is still fertile. Unless you don’t have periods at all anymore, there is still a risk that you can get pregnant, so it’s important to use some form of contraception to avoid pregnancy.

Harry Johnson, MD, is Assistant Professor of Obstetrics, Gynecology and Reproductive Sciences at University of Maryland School of Medicine and Division Head of Urogynecology at University of Maryland Medical Center.

 

 

Child Life Month

How Play is Helping UMMC’s Youngest Patients

By: Colleen Schmidt, System Communications Intern

As many parents know, the hospital can be a scary and unfamiliar place for a child. To help relax these fears, UMMC’s team of child life specialists and assistants use a variety of techniques to help children adjust to the hospital setting. Child life specialists, or CLS, aim to provide a positive and non-traumatic hospital experience for all patients at the University of Maryland Children’s Hospital.  UMMC’s Child Life team consists of six CLS and two assistants. They work in the Pediatric Progressive Care Unit (PPCU), Pediatric Intensive Care Unit (PICU) and the Pediatric ER.

Members of the Child Life Team

 

Play is one technique often used by child life team to help normalize the child’s hospital experience.  Various types of play are thoughtfully used to help children meet developmental milestones, express emotions, and understand their medical situation.  For example, during a practice called medical play, a CLS will provide their patient with a “hospital buddy” or small doll that the child can decorate. Next, with the guidance of a CLS, the child is introduced to medical equipment that they can explore and use on their new hospital buddy.  According to Aubrey Donley, a CLS at the pediatric ER, medical play is helpful in addressing misconceptions the child has about medical equipment.

“It gives them a sense of control and mastery over their hospital experience and over what they’ve been through,” she explains. Medical play empowers patients and allows them to have an active role in their hospitalization. Helping the children understand their environment lessens the chances of confusing or traumatizing them.

In addition to medical play, the child life team uses therapeutic play to help children work through a variety of issues that may accompany hospitalization. Sometimes, children who are hospitalized have experienced severe trauma. Unlike adults, children may not be able to verbalize their feelings. Play is how they express themselves and work through their experiences. For instance, one of Donley’s young patients survived a house fire and used play to understand what happened to him. “He was running around in a fireman costume pretending to put out a fire. For an onlooker, it might seem like he was just playing but we understand he is trying to make sense of the chaos and trauma that he had witnessed,” she explained. Therapeutic play can also help children who are at the hospital for long periods of time meet their physical and cognitive milestones.

With backgrounds in child development, the child life team is able to make individual plans for each child that matches their medical, physical, and emotional needs.  The team advocates for the children they support, and work with an interdisciplinary team of medical professionals to provide a comprehensive plan for that child. Child life specialists also provide educational and emotional support for families. All services provided by the child life team come at no charge to families.


For more information on our child life services please visit: http://umm.edu/programs/childrens/services/inpatient/child-life

Answering Your Colon Cancer Questions with Dr. Jiang

A new study released by the National Cancer Institute shows colon and rectal cancers have increased dramatically and steadily in young and middle-age adults in the United States over the past four decades. Dr. Yixing Jiang, a Medical Oncologist at the University of Maryland Greenebaum Comprehensive Cancer Center, answers all the questions you’re now asking yourself about colon cancer.

Q. What are the risk factors for colon cancer?

A. The risks for developing colon cancer are: obesity; insulin resistance diabetes, red and processed meat; tobacco; alcohol; family history of colorectal cancer; certain hereditary syndromes (such as familial adenomatous polyposis (FAP)); certain genetic mutations (APC mutation); inflammatory bowel disease (ulcerative colitis or Crohn’s disease); being a patient long-term immune suppression (transplant patients) and a history of abdominal radiation.

Q. Who had always been traditionally has always been at risk for colon cancer?

A. Most colorectal cancer happens sporadically. But patients with familial syndromes (FAP or Lynch syndrome), inflammatory bowel disease, certain genetic mutations, a family history of colon cancer or a history of polyos are at higher risk of developing colon cancer.

Q. What’s the best way to protect myself against colon cancer?

A. To reduce the risk of colon cancer, exercise regularly; eat less red meat, eand eat a diet high in fresh vegetables, fruits, fibers, vitamin D, and omega 3 fatty acids.  Asprin and NSAIDs been shown a degree of protection against colon cancer. Of course, the best way of preventing colon cancer is screening with a colonoscopy.

Q. What’s the best screening tool for colon cancer?

A. The screening guidelines varies depending on the recommending agencies. For example, the Center for Disease Control recommends the following: For average general population, the recommendation is to start screening colonoscopy every 10 years at age of 50; fecal occult blood test annually and flex sigmoidoscopy every 3 years. The US Preventive Services Task Force recommends screening between the ages of 50 and 75.

The most used screening test for colon cancer is a colonoscopy.

Q. Is colon cancer treatable? What’s the best treatment options?

A. Colon cancer is a very treatable disease if discovered early. For stage I cancer, surgery cures more than 90% of patients. For patients with a more advanced stage cancer, surgery alone is usually not enough. Additional chemotherapy is generally required to increase the chance of a cure. Today, with more therapies available and better surgical techniques, we are able to cure close to 30% patients with stage IV disease.

For more information on diagnosing and treating colon cancer, please visit UMGCCC’s website, umgccc.org. 

Joint Replacement Q&A with Dr. Theodore Manson

Theodore Manson, MD is an Orthopaedic Surgeon at the University of Maryland Medical Center and an Associate Professor of Orthopaedics at the University of Maryland School of Medicine.

Dr. Manson specializes in hip and knee replacements and orthopaedic trauma. Below he answers the most common questions about joint replacement.

 

Q. What advances have there been in joint replacements including new technologies, changes in patient-management and rehabilitation?

A. One significant advancement in the last 10 years has been around pain management and early recovery protocols. The goal is to minimize the amount of narcotics patients require after surgery. Today, we manage pain through many different types of medicines in addition to narcotics. There’s been a lot of success recently with joint (intra-articular) injections of anesthetic around the hip or knee joint at the time of surgery. This injection limits the amount of pain patients have when they first wake up from surgery. We know that if you limit that first pain sensation, it helps with the whole pain management process going forward.

Another significant advancement is infection prevention. Patients’ skin is now pre-operatively prepped with the antiseptic and disinfectant chlorhexidine both at home prior to surgery and at the hospital as well. In addition, we optimize patients’ nutrition and health pre-operatively. These two things have drastically cut down on infection rates. We did not use to address patient nutrition. Now, we assess patients’ nutritional status before surgery. If a patient is at a higher risk for nutritional deficiencies – those with chronic illness, diabetes or poor appetite, we then work in conjunction with a nutritionist so their infection rates are lower.

Borrowing from the aviation industry, there have been substantial improvements to patient safety in the hospital postoperatively as well.  Standardized protocols, safety checklists and quality control monitoring have dramatically reduced untoward events in joint replacement patients.

Q. What new innovations in joint replacement surgery (hardware and techniques) are noteworthy and why?

A. There is a lot of marketing material on the internet regarding various joint replacement approaches, minimally invasive surgery, robotic surgery and use of custom hip and knee replacement parts.  It is important to realize that none of these things has been shown to be of any benefit. When considering joint replacement, choose a surgeon who performs a high volume of hip and knee replacement surgeries and who you get along with well on a personal level.

While there haven’t been any substantial innovations with implants in the last five years, we do have long-term data on our current implants and techniques that shows them to be functioning extremely well.

Q. Who should get a joint replacement? What factors should a person consider? How should a potential patient decide?

A. In general, joint replacement is an elective procedure. If the patient is falling due to their hip or knee arthritis, it can be a very dangerous situation, so falls are an indication they should go ahead with a joint replacement. If a person is no longer able to climb stairs, if the hip/knee pain keeps him/her up at night, or if s/he is constantly dependent on an assistive device like a cane, then I think they should strongly consider a joint replacement. For others with less severe symptoms, a joint replacement may still be of great benefit to them, but they should consider surgery when the time is right and shouldn’t feel pressured into a surgical option.

Q. What should a patient expect?

A. Once they have scheduled the surgery, most patients undergo pre-habilitation prior to the joint replacement. Many patients find it useful to go to a preoperative joint class at the hospital where they’re going to have the surgery. This helps to alleviate anxiety about the procedure and educate them on what is to come. For those who are substantially debilitated preoperatively, going to prehab (physical therapy) to strengthen the operative leg is helpful and helps us foresee any challenges that may arise postoperatively.

If you have a body mass index (BMI) of 40 or greater, you should delay joint replacement until you can get below 40. This is because infection rates increase substantially for people who have a BMI of 40 or greater.

Q. Does the type of implant used depend on patient activity and age? How?

A. In the past, different implants were used based on age, but for the vast majority of surgeons we use the same type of implants no matter the age. Occasionally patient with poor bone quality will require different implants, but usually we use the same regardless of age or activity level.

Q. What is the target recovery period and regimen for various categories of patients?

A. Patients see the majority of their improvement six to 12 weeks after surgery. They reach their maximum improvement six to 12 months after hip/knee surgery.

Q. What is the lifespan of replacement joints and do you expect the lifespan to grow longer soon?

A. The lifespan of replacement joints have a 1-percent-per-year failure rate, so with 20 years, you have a 20 percent risk of needing the joint replacement redone. I expect this will grow longer as we get better at preventing infection rates. If you are over 60 years old, the odds are you’ll probably never need to have the joint redone.

Q. Have risk factors (infections, failures, etc.) declined or increased (and for whom)?

A. Risk factors have declined because of more critical evaluation and optimization of risk factors for infection around the time of surgery.

Q. Are revision surgeries more or less common these days and why? Do you expect that to change? How and why?

A. Revision surgeries are more common these days simply because of the number of people who have gotten a joint replacement is increasing, and the number of baby boomers having joint replacement is increasing. I expect the number to continue to go up just because the number of people having a joint replacement is going up.

To make an appointment with Dr. Manson or one of our other orthopaedic specialists, please call 410-448-6400.  For more information on joint replacement or other orthopaedic issues, check out the University of Maryland Orthopaedics’ website.

Winter Wives’ Tale

The University of Maryland Children’s Hospital sets the record straight…

Put on your hat since you lose most of your body heat through your head.”
This is not necessarily true! Your body heat escapes from any exposed area- so if you had on snow pants and a T-shirt and you forget your hat and jacket, the most amount of heat would escape through your arms- since that would be the largest exposed part of your body. Putting on winter accessories such as hats, mittens and scarves is still a very good idea to avoid the outside dangers of frostbite and hypothermia.

You will get sick if you go outside with wet hair.”
This is another winter wives’ tale. While your kids may be cold, they won’t actually catch a cold by venturing outdoors with a wet head. Germs are spread by people, and temperature simply doesn’t play a part.

 

Setting the Table for Celiacs: Q&A with Celiac Disease Program’s Nutritionist

University of Maryland Medical Center nutritionist Pam Cureton answers questions about celiac disease and gluten-free diets.

pam-cureton-rdQ: What is gluten?

A: Gluten is a protein found in wheat, rye and barley. These grains in any form must be avoided. Foods labeled gluten free are safe to eat but if a food item is not labeled gluten free look for these six words in the ingredient list to see if it contains a gluten containing ingredient: Wheat, Rye, Barley, Malt, Brewer’s yeast and Oat (only use oats that are labeled gluten free).

Q: What exactly is wrong with gluten?

A: The problem with gluten is that it is not completely broken down into smaller amino acids that can be easily absorbed by the intestine. For the majority of people this presents no problem at all but in individuals with celiac disease, the body sees this protein as a toxin and this sets off a string of reactions leading to intestinal villous damage.

Q: What cross contamination problems should I look for in the kitchen?

A: Preventing gluten free foods from coming in contact with gluten containing foods make the difference in your guest enjoying a wonderful holiday meal or becoming ill and leaving early. Guest with celiac disease cannot simply take the croutons out of a salad or eat the meat from the wheat bread sandwich. Gluten free foods can be contaminated by using the same spoon to mix or serve foods, putting wheat products next to the gluten free dips, “double dipping” the knife into a condiment then gluten containing product then back into the condiments or using the same toaster.

Q: Can you taste the difference between gluten-free foods and their gluten counterparts?

A: Gluten free foods have come a long way in their taste and texture to be very close to their gluten containing counterpart. There are so many great tasting gluten free products on the market today that no one should be eating something they do not like.

Q: What are the symptoms of Celiac Disease:

A: Celiac disease can present itself in many different forms. Untreated, celiac disease causes multi-system complications such as diarrhea, constipation, gas, bloating, iron deficiency anemia, decreased bone density, failure to thrive, short stature, and behavior problems. If you have any concerns, please check with your primary care provider before you start a gluten free diet.

Q: I have severe reactions when I eat bread, such as stomach bloating and pain in my joints. Does this mean I could have celiac or gluten sensitivity?

A: We recommend that you see your primary care provider and ask to be tested for celiac disease. However, do not start a gluten free diet before this testing is done. The first step is a simple blood test for screening. If all the tests are complete and you do not have celiac disease, then try a gluten free diet to see if you improve as it may be non-celiac gluten sensitivity.

Q: How common is late-onset celiac disease and is there any way to know if other family members are at risk of developing it later in life?

A: It is possible to develop celiac disease at any age. You may have had celiac disease for many years before being diagnosed because symptoms may have been attributed to other conditions or you may not have had any symptoms with the active disease. We recommend that all first degree relatives be screened for celiac disease after the relative had been diagnosed and if negative at that time, repeat the screening labs every 2-3 years or if symptoms appear.

Q: Is there a cure for Celiac Disease?

A: Currently the only treatment for celiac disease is the gluten free diet. In most cases, this treatment works very well but it can be expensive, socially isolating and, at times, difficult to follow. Also, there are people that do not respond completely to the diet or take up to 2 years to heal after diagnosis. For these people, additional therapies are need to prevent additional complications of celiac disease.

 

Learn more about the Celiac Disease Program or call 410-328-6749 to make an appointment.

vegetables

 

“No Screens Under 2” Q&A with Dr. Brenda Hussey-Gardner

brenda-hussey-gardnerHi, my name is Dr. Brenda Hussey-Gardner. I am a developmental specialist who works with the Department of Pediatrics at the University of Maryland Children’s Hospital. I attended the American Academy of Pediatrics conference in San Francisco to share the results of research that I have done with colleagues here at the University of Maryland and to learn what other researchers are doing across the nation in order to bring this new knowledge back to the hospital to better serve our children and their families. At this conference, the American Academy of Pediatrics released their new guidelines regarding screen time and children.

Please see the Q&A here for more information on these guidelines.

Q: What is the “No Screens Under 2” rule and in what ways is it changing?

A: The American Academy of Pediatrics (AAP) previously recommended no screen time for children under 2 years of age. In its new guidelines, the AAP offers slightly different recommendations for children less than 18 months and those 18 to 24 months of age.

Children less than 18 months

The AAP discourages parents from using digital media with one exception: video-chatting (e.g., Skype, FaceTime). This form of interactive media can be used, with parent support, to foster social relationships with distant relatives.

Children 18 to 24 months

The AAP recommends that parents, who want to introduce their child to digital media, do the following:

  1. Only use high-quality educational content.
  2. Always watch shows or use apps with your child. Talking about what the child sees helps foster learning.
  3. Never allow your child to use media alone.
  4.  Limit media to a maximum of 1 hour per day.
  5. Avoid all screen time during meals, parent-child playtime and an hour before bedtime.

Q: Can you provide some insight into how the decision was made? What research was taken into account?

A: The AAP Council on Communications and Media reviewed research on child development, television, videos and mobile/interactive technologies to develop their current recommendations. Research shows that children under the age of 2 years need two things to develop their thinking, language, motor and social-emotional skills: (1) they need to interact with their parents and other loving caregivers, and (2) they need hands-on experiences with the real world. In fact, researchers have demonstrated that infants and toddlers don’t yet have the symbolic, memory and attention skills needed to learn from digital media. Importantly, research also shows evidence of harm (e.g., delayed thinking, language and social-emotional development; poorer executive functioning) from excessive media use with young children.

Q: Why do these new guidelines matter to parents, and should they affect the ways parents and their young children interact with technology?

A: AAP guidelines matter because parents want their children to be well adjusted and smart, and they don’t want to do anything that may harm their child’s development. As such, parents should try their best to avoid screens with their children who are less than 18 months of age and realize that it is their interactions with their child that are the most important. Then, from 18 to 24 months of age, parents should strive to use only the highest quality educational technology with their child. As hard as it is, parents should try to avoid using technology as a babysitter and try to understand the negative impact that it can have on their child’s development.

Q: What is your biggest take-away from the session?

A: A parent’s lap is always better than any app!

Q: What is your opinion on the new guidelines and do you think it will affect your clinical practice? If so, how?

A: I believe that the new AAP guidelines, while a little more flexible, may still be difficult for parents to adhere to, as screen time is so pervasive in our society. However, it is very important for parents to make smart choices about digital media and screen time if they want to help their infant and toddler develop into a child who is healthy and ready for success in preschool. It is my goal to develop a pamphlet summarizing the research findings and AAP guidelines to help parents make the best choices for their child and family.

 

For more information about media, screen time, and child development, parents are encouraged to read the AAP recommendations located within the publication “Media and Young Minds,” and to read the “Early Learning and Educational Technology Brief” published by the U.S. Department of Education and the U.S. Department of Health and Human Services.