On-Call with Dr. Nyiri Grigorian, LCSW, Phd....

College and Sleep habits” 2^nd blog in a special series on sleep.

Last month Dr. Grigorian shared with our readers’ techniques to use with youngsters and bedtime stories. This month she offer insight to understanding sleep habits at college 

Nyiri has been in private practice for twenty-five years treating children, adolescents, and adults, as well as families and couples. Dr. Grigorian not only specializes in anxiety and depression, but has treated couples in Parent Guidance for decades. She supervises a wide range of therapists professionally who are in the mental health field. Dr. Grigorian has lectured and conducted workshops on a wide range of topics, including sibling therapy, early intervention in childhood development, and prevention in mental health. She has also served as a consultant to many school districts and non-profit organizations identifying high-risk children and families. She has contributed to the body of research on treating siblings together as an alternative to traditional individual treatment. She has been part of long-term research group studying trauma.

You just dropped your kid at college and are awake worrying if they will ever sleep again.

The college student faces many challenges when it comes to sleep. The first few months are the hardest adjustment.

Why?

The nocturnal environment of college life is not just stimulating; it’s also about not being isolated.

Distraction and noise are only the simple problems.

Sleeping in a room with a roommate/possible stranger presents an emotional as well as physical challenge.

The initial snap judgments made in the beginning of a roommate relationship take time to season.

But, your kid may not know this and will lose sleep over worrying about the stranger beside them. Balancing a schedule with this stranger is difficult at best.

Negotiating a shared bathroom or dormitory hallway bathroom will disrupt sleep with worry and confusion. Some kids plan this and will rise early to shower; some go in late at night for privacy, and some suffer over urinating in the middle of the night.

There is a phenomenon that has been coined, “FOMO,” which means fear of missing out. Students are so afraid of missing opportunities to meet and greet friends and be part of what they believe is important to construct a social life. Like toddlers, they do not want to sleep and miss out on the fun.FOMO is especially prevalent amongst freshmen college students. This alone will change the sleep life of every college kid.

Erratic sleep schedules are created by class schedules as well as day-to-day changes of where and when to be at school.For example, if Wednesday and Friday contain a class that is held only in the afternoon, sleeping in might work for that morning but not for the others.

Sleep deprivation amongst college kids is an actual human experiment. Like sex and drugs, it is a time in life to push the limits of cognitive and emotional health standards and to learn self-regulation.

What can you do as a parent?

Well, try to remember that they are away at school for a reason. Perhaps in this instance, unless you receive an SOS or other smoke signal from the university’s powers that be, rest assured, your kid will figure out his/her new circumstances. Besides, you know they will not listen to your advice. What they need most now is the chance, just like a baby, to soothe himself or herself under duress and most importantly, as an autonomous person.

 As a relationship specialist for the Bedtime Network (www.bedtimenetwork.com) Nyiri contributes weekly stories providing advice on a variety of sleep topics. Pedimedica found the following published article to be beneficial to their readers and wanted to share her perspective on dealing with the difficulties of getting their youngsters to bed!

Dr. Nyiri Grigorian, LCSW, Phd.

Copyright Bedtimenetwork.com   published 9/1/12 issue

On-Call with Dr. Nyiri Grigorian, LCSW, Phd

"Can I Have One More Book Mom?” and other bedtime issues!

Nyiri has been in private practice for twenty-five years treating children, adolescents, and adults, as well as families and couples. Dr. Grigorian not only specializes in anxiety and depression, but has treated couples in Parent Guidance for decades. She supervises a wide range of therapists professionally who are in the mental health field. Dr. Grigorian has lectured and conducted workshops on a wide range of topics, including sibling therapy, early intervention in childhood development, and prevention in mental health. She has also served as a consultant to many school districts and non-profit organizations identifying high-risk children and families. She has contributed to the body of research on treating siblings together as an alternative to traditional individual treatment. She has been part of long-term research group studying trauma.

As a relationship specialist for the Bedtime Network (bedtimenetwork.com) Nyiri contributes weekly stories providing advice on a variety of sleep topics. Pedimedica found the following published article to be beneficial to their readers and wanted to share her perspective on dealing with the difficulties of getting their youngsters to bed!

“One of the most frequently asked questions in clinical practice with parents of young children revolve around BEDTIME strategies and difficulties. Sleep and how to get more of it is the number one question on parents’ minds! It can be at the root of parent fatigue, guilt, anger, and marital strife. Very often, for example, when treating couples in marital therapy, the theme of putting children to bed at night comes to the fore as a central focus. In some families, there is the dread over the impending bedtime and, it is often viewed as another chore at the end of a long day.

In the same way adults frequently feel it is never a good time to get married, get pregnant, buy a house, move, change jobs, or go back to school, they feel too, that there is never a good time to tackle a child’s bedtime issues. In a like manner to adult concerns, children are teething, sick, having separation anxiety, coping with the birth of a sibling; starting nursery school coping with a new babysitter etc…There never seems to be a good time.

One of the things most helpful to acknowledge before tackling bedtime problems is: always REMEMBER that when you are putting your child to sleep at the end of the day, you are at your most fatigued and vulnerable. Your mind could still be on the toys that are all over the floor downstairs, laundry that is undone, and…bills. Although it sounds simplistic, one of the most dramatic things a parent can do (if married or with a partner) is to be in AGREEMENT about the bedtime approach. For example, that means that one parent isn’t angry at the other while they are playing airplane and wrestling 20 minutes prior to bed or resentful that their partner jumps at every whimper, sound and move their child makes.

How can we create a stress-free bedtime? How young children sleep at night very often is connected inextricably to what goes on during the day. We need to remember that toddlers, preschoolers, and latency age children sleep dramatically better when they are tuckered out from plenty of exercise, fresh air, and activity during the day. Since children are consuming many hours of television a day and are involved with electronics at a VERY young age, they are exercising less and less. Passive activities have replaced playing at the park and playground, running and playing in the fresh air.

Napping can also be a major culprit when identifying difficulties at bedtime with young children. Parents can be reluctant to shorten naps or eliminate them altogether thereby enabling them to have more time to themselves. After all, who wants a cranky child on their hands? Phasing out naps slowly and shortening them can have a major impact on how easily and what time your child goes to sleep. One must work hard, for example, keeping your child awake in the car in the later afternoon so that he doesn’t go to sleep.

Consistent bedtime routines are KEY to a smooth transition at bedtime. Setting the same time every night is the single most helpful bedtime ritual and the addition of a soothing bath, brushing teeth with a special toothbrush, a small stack of books to choose from, or a short song can all make the pleasure and safety of bedtime better for children.

Since bedtime for children can summon up separation issues and fears, it is crucial for them to feel in CONTROL. For example, one can give them a choice of books to read, which stuffed animal to sleep next to and which “night-night” song to sing.

If children are frightened to be alone, one can sit in the room with them and leave for brief intervals, checking in every five, ten and fifteen minutes. Let them know you’ll be back to check on them. Don’t attempt any long-winded explanations of why they have to sleep. Keep everything loving, comforting, simple and short. Don’t forget to verbally and physically reward your child when for several nights in a row, they have gone to bed well. Three nights become one week, and one week becomes two weeks. Simple rewards and treats, for example, even a new colourful pack of markers or stickers, can show your appreciation. Before you know it, your child will be in the land of Nod.”

Dr. Nyiri Grigorian, LCSW, Phd.

Bedtimenetwork.com   published 10/1/11 issue

On Call with Dr. Lori Rosenberg

Dr. Rosenberg has all the answers to the questions you may have on what to expect when your newborn arrives and will provide you with prenatal advice as well, in her BABY PREP 101 seminar!
Are you having a baby?  Are you excited? Nervous?  Scared?  Have no idea what to expect?  Getting advice from your mother, mother-in-law, father, even father-in-law and from every friend who’s been pregnant?    Don’t know which book to buy, which friend to listen to and which side to sleep on (when you’re not waking up to use the bathroom every three hours)? 
To find the answers to all of your questions, come to BABY PREP 101.  Some of the questions that will be discussed are….

Q:  How do I choose a Pediatrician?

A:  Choosing the right pediatrician for your baby is very important.  You want to find a doctor that you can trust and feel comfortable with because for the first few years, the relationship will be between you and the doctor.  Most doctor practices will allow expectant parents to set up prenatal consults to find out more about the practice, hospital affiliations, on call hours, how appointments are scheduled and phone calls are handled, etc. 

Q:  What do I need to bring with me to the hospital for the baby?

A:  Not much initially.  All hospitals put your baby in diapers and t-shirts.  Some hospitals even provide pacifiers.  You can bring a pacifier from home if you desire.  Anything that you forget to bring, you will have at least a day or two to retrieve.  On the day of discharge, the baby will certainly need a fully assembled car seat and clothes to travel home (bring a few outfits, as one might get soiled prior to departure).

Q:  When does my baby get his or her first shot?

A:  Hepatitis B is offered in the hospital; however, it is not given without parental consent.  Some pediatricians choose to have the hospital administer it, others opt to self-administer at the first office visit.

Q:  How soon after birth will the pediatrician see my baby?

A:  Pediatricians come within twenty four hours to make rounds.  They typically arrive in the morning prior to office hours.  If there is a complicated delivery or emergency, there will always be a pediatrician at the scene (some hospitals have residents, some have house doctors and others will call in the private pediatrician).  Regardless whether the baby is seen at delivery or not, the pediatrician makes rounds daily as long as mom and the baby are in the hospital.
 
Q:  What can I do in my last trimester to prepare for my baby?

A:  Sleep as much as you can!  It might be difficult to do so with a newborn at home.  There are no books to buy or magic tricks to learn that can teach you as much as ‘on the job’ training will.

AND …come to my class:  Baby Prep 101, where you can find out the answers to all of your pre and postnatal questions.

Rid Your Teen of Acne Scars!

On Call with… special guest contributor and friend of Pedimedica William K. Boss, MD, FACS

Rid Your Teen of Acne Scars!

Adolescent acne, while not a threat to the health of young people, has always been a source of stress and psychological discomfort to teenagers in their formative years. Acne hits kids when they are most vulnerable to concerns over appearance and attractiveness. And both boys and girls are susceptible to these stresses. In some cases teens can suffer from significant acne scaring but fortunately, there are many options to treat scaring and Dr. Bill Boss has a takes a very unique approach…simple and easily available treatments for acne and other skin ailments.

A Unique and Highly Successful Approach to Acne Therapy

As a board certified reconstructive and cosmetic surgeon Dr. Boss focuses his efforts in treating acne scars with a very unique and individualized approach that yields excellent results in his patients. Dr. Boss works closely with many dermatologists in different geographical regions, so the treatment is an available option for many prospective patients.

 At the first visit, Dr, Boss needs to determine if the patient is a good candidate for reconstruction. The most important determinant is if the active acne has been under control for the past 6-12 months.  There is no point to treat scarring in patients with active acne because new scars will continually form and the patient will have wasted time, effort, and money.

 The treatment begins with a careful medical history and examination to determine the most effective and least invasive procedures possible.  As a plastic surgeon Dr. Boss can employ the largest variety of techniques possible to treat the scarring. For example, ice pick, deep contracted scars require excision and as a micro surgeon Dr. Boss uses magnification to excise the scars and build up the skin layers to minimize the scar.

Other scars require subcision followed by fractionated lasers or simply lasers alone.  There are also lasers that can treat discolorations and tiny blood vessels around the scars.

In some cases Dr. Boss will utilize long acting fillers when indicated, such as Restalyne, Perlane, Juvaderm, Sculptra and Radiesse.  There is also a new and exciting development in cell therapy that is currently undergoing FDA trials for treatment of acne scars and was recently approved by the FDA for correction of smile lines.  This treatment was invented by Dr. Boss and involves growing the patient’s own collagen producing skin cells known as fibroblasts in a certified laboratory. These cells are then re-injected into the dermis of the skin to help correct the problem.

Often times, the skin that has been ravaged by acne is loose and the face has lost volume; that is when more invasive treatments such as stem cell fat transfers and mini facelifts might be helpful. Fortunately there are many treatment options that are available and can produce tremendous results. However, it is important for the patient to make an appointment for a consult and go over the options with the doctor to determine which treatment is best for the individual.

William K. Boss, MD, FACS is certified by the American Board of Plastic Surgery. He is distinguished among his colleagues, patients and hospital staff for his professional skills, extensive experience and excellent results in cosmetic plastic surgery. Dr. Boss was the former Chief of Plastic Surgery at Hackensack University Medical Center and Assistant Clinical Professor at New Jersey School of Medicine and Yale University School of Medicine. Dr. Boss maintains memberships with various medical societies such as the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.

Cosmetic Surgery & Rejuvenation Center

385 Prospect Ave., Hackensack, NJ 07601

Tel. 201.488.1035 Fax 201.488.2264

info@drbossmd.com

On Call… with Dr. Mary Thomas

HPV Vaccine: A Pediatricians Argument to Vaccinate Your Daughters AND Sons !

Although millions of dollars and man-hours have proven again and again that our vaccines are safe, many parents are still afraid.  Each day that I am in my office I find myself making pleas to parents to vaccinate their children with routine vaccines recommended by the Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) and that are also required by New Jersey schools.  Imagine, then, how challenged I feel when faced with the task of vaccinating young girls, and even young boys with a vaccine that has garnered as much controversy as the HPV vaccine. 

 As a pediatrician, and a mom of three young kids I feel that one of my most important purposes in life is to protect children from illness and disease.  My vaccines are my most powerful tool in doing so.  I might even argue that the HPV vaccine is the sharpest tool in my belt because it is the only one that can protect our children from something that we all fear may sneak up on us – cancer. 

If this article has caught your attention you must have wondered about the HPV vaccine once or twice.  What is it and why is it so important?  HPV (Human Papilloma Virus) is a sexually transmitted virus that infects more that half of sexually active people at one time or another.  Usually it is a benign wart that may even be asymptomatic and will in many cases resolve without treatment.  However, in the US, 15,000 women will develop cervical cancer from that virus; and of those 15,000 women, 4,000 will die. 

Those statistics are very frightening, but for the first time in history, we can change them.  The HPV vaccine prevents most cervical cancer if the vaccine is received before first sexual contact.  This is why the optimal time to vaccinate is at age 11 or 12.  This is also the time when the body is primed to create the best immunity.

The schedule is simple.  The first dose is given and then the second will follow 1 to 2 months later.  A third dose is indicated 6 months after the first dose was received.  It seems easy, but we need to do better.  At present, only 32 percent of girls receive all three vaccines and only 1% of boys.

Yes, boys.  I guess you are thinking “Why should I vaccinate my son, who does NOT have a cervix?”  It is a good question.  On October 26^th the CDC recommended the vaccine for all males ages 11 to 12.  For them it can prevent both genital warts and anal cancer.  There is also evidence that it may prevent some types of head and neck cancer transmitted through oral sex by men who have sex with men.  Don’t write me off at this point, this is not just an STD that affects homosexuals.  At some point we all hope that our sons will find the perfect girl and marry.  This vaccine protects her and helps prevent your son from caring for a wife with a cancer that can be potentially fatal. 

These are things that are hard to think about as parents.  They are even harder to talk about with our children.  A recent study in pediatrics showed that daughters of women who have talked to their mothers about the risks of unprotected sex and the benefits of vaccination were more likely to elect for the vaccine.  Talk to your kids.  Protect them before sexual contact.  You may be saving their life! 

On Call with Dr. Basil Bruno

This month Pedimedica asks Dr. Bruno for his insight and recommendations on how to ease your child’s back to school anxiety.

How to Overcome School Anxiety

Going to school offers a wide range of emotions for parents as well as children. Whether it's dread or excitement, fear or euphoria, all of these feelings can be bottled up inside our kids. Remember that any one symptom of distress does not cement a child's fate or mean that their school year will be a failure. All kids, at some point in their academic career, will struggle, so try hard not to view their setbacks or anxiety as a permanent threat to their school career. Every year that your child goes through school will be filled with highs and lows, good moments and devastating ones. The emotions your child experiences before the start of school can also lead to a general sense of anxiety-a feeling most children won't be able to articulate.
As parents, we have to realize that our children rarely will open up to us if they are experiencing any problems or anxiety, whether at home or at school.  This can be due to embarrassment, fears of being punished, or retribution from siblings or classmates.   And sometimes they just can’t figure out what is bothering them, a common sign of anxiety. Sometimes there are signs that we can pick up on that may help us decide if there is a problem.  Significant changes in behavior sleep patterns, homework or grade patterns, and friendships may be signs that your child is experiencing school issues or anxiety. As parents, it’s our instinct to want to jump right in to protect and help our children.  Although it’s fine to initially address the situation with your child, it’s important to not be overbearing and to back off if you are met with resistance.  It might be helpful to talk to your pediatrician if this occurs.

It's important to remember that when placed in any new situation, all children (and parents, too) are going to need to take time to adjust. Realize that your child will require a period of time to figure out their comfort zone and what's required for them to fit in to their new environment. Fortunately, there are steps you can take as a parent to make the prospect less daunting-the key is to prepare your child both emotionally and physically so that they can have the best start possible this school year.

Proactive parents can help their kids overcome school anxiety. Dr. Bruno lists several tips for parents to employ:

• Identify and address anxieties you have about your struggling child.
• Set a time and place to discuss the issue when your child is most relaxed.
• Start the discussion with hopeful empathy.
• Help your child remember past successes.
• Form a plan.
• Familiarize your child with the school.
• Talk to your pediatrician if you notice any significant changes in behavior.

For Learn more about Pedimedica Hackensack Office, Please visit, www.pedimedica.com

On Call with Dr. Lona Yegen, Pedimedica, Closter Office

Understanding ADD and ADHD and their treatment options from a medical and behavioral approach.

Q.What is ADD and ADHD?
A. Attention Deficit (Hyperactivity) Disorder is a condition in which the child has the following symptoms that may or not be accompanied by hyperactivity:
1. Difficulty in paying attention and focusing.
2. Difficulty with impulsivity.
3. A lack of organizational skills.

Q.How do we diagnose ADD?
A.This is a clinical diagnosis.  It is usually diagnosed after a child enters school and because he/she is having difficulties there.  A child should have a complete physical exam with a Pediatrician to confirm that there are no medical problems that could be causing these symptoms including testing a child's vision and hearing.  There should be an evaluation by the child's' teachers and parents using guidelines to evaluate behavior. The child may be evaluated by a Neurologist, developmental Pediatrician, or a Psychiatrist to make certain the child fits the categories for ADD/ADHD and make sure there are no other concerns e.g. learning disabilities.

Q.How do we treat ADD/ADHD?
A.The medical therapies fall into three categories:
1. Stimulant medication e.g. Ritalin, Concerta, Focalin, Daytrana
2. Non stimulant medication e.g. Straterra
3. Anti-depressants e.g. Wellbutrin
Stimulant medications are the most commonly used medications.  There are side effects to all three classes of medication.  For example, stimulant medications can suppress appetite and growth and can cause difficulty with falling asleep. Therefore, they must be used with supervision by a medical professional to make sure they are well tolerated. The medical therapies will be managed by your pediatrician, neurologist, or psychologist so let us talks about behavioral therapies.

Behavioral therapies are multiple.
1. In managing behaviors there are technologies to improve memory and focus.  For example, while riding in a car, tell the child you are going to play a game.  You are going to name three things and you are going to ask the child to name them later. So, at the beginning of the ride, name three items, e.g. ice cream, bicycle, mountain and at the end of the ride, ask the child to list them.  If the child can name three things consistently, then go to five things.  There is also a board game called Memory which works on the same skills.

2. We also want to teach the child organizational skills.  Organizational skills can start at the beginning of the day.  Ask the child to list “what do I need for the day in school?” and make a check list of all items and assemble books, assignments, clothes e.g. gym clothes, lunch so that he/she is ready for the day.  If the morning is too hectic this can be done at night.  Organizational skills should be done throughout the day.  Give the child a notepad so he/she can write down assignments and a check list for all books so the child is prepared when he/she gets home.  Organizational skill should continue after school.Teach the child to make a schedule for what homework and chores need to be done that day and allot specific times for each subject and task with scheduled breaks for sports, play dates, and hobbies like music lessons.

3. School strategies include placing the child with ADD/ADHD in the front of the class so it is easier to focus on the teacher.  Also, the teacher and child can have a special signal that they choose to remind the child to stay on task.  For example, the teacher can raise her right thumb up as a sign so the child needs to look and listen to her.  No one else will know this special signal.

4. Homework should be done in a quiet place without distractions.

5. Goal setting should be clear and concise.  When a goal or assignment is completed there should be verbal rewards or approval with extra time for a pleasurable activity.

6. There are Psychologists and social skills courses for children who need help with their behavior or relationships.

Q.When should we use medication?

A.Consider the following indicators:

• When all the behavioral and psychological therapies are not working.
• When the child's school performance is below expectations due to his/her inability to concentrate on set skills.
• When the child is not able to control impulsive behaviors leading to relationship problems or when the child is disruptive to others in class.
• When there are concerns that poor academic performance is leading to low self esteem.

Q.When should we not use medication?

A.Consider the following indicators:

• The child is doing well academically in school.
• The child's behavior is not disruptive in class.
• The child's peer and family relationships are good.
• When the parents are concerned about long term use of medication.