Tag Archives: Parenting Tips

Setting Boundaries with Grandparents

By Michelle DeRamus, Ph.D.

Setting boundariesRules with our children’s grandparents is hard. We are taught since early childhood that talking back to our elders is not OK. So even when we need to do what we believe is best for our children, setting boundaries with our parents (or our in-laws) can feel like we are being disrespectful, making it very challenging. In addition, because many of us look to our parents as the best example of how to be parents, to go against something they want to do can make us question whether we are really doing the right thing. As children, many of us viewed our parents as superheroes who could do no wrong; as adults, we begin to realize our parents do sometimes make mistakes and incorrect decisions. That can be a tough realization for us. All of these issues can work against our desire of setting boundaries with grandparents or telling grandparents what we like and don’t like about how they are doing things with our children. However, to have a healthy core and extended family, boundaries are necessary. In our society, while we continue to respect and seek advice from our elders and extended family, we generally recognize the parents as needing to have the final say about how to raise their children. So how can parents set boundaries while still being respectful toward grandparents?

Family visits baby

First, communicate your wishes clearly. Sometimes other caregivers do things differently from parents simply because they do not know the parents’ wishes. Having everyone on the same page can often prevent, or quickly resolve, any conflicts about caregiving. State your wishes respectfully and calmly, without attacking or accusing. It’s best to have this type of conversation in private; none of us likes to be “called out” on our mistakes in front of others. Explain your reasoning for your preferences. Often, when others understand the reasons why we do things the way we do, they are much more understanding, supportive, and willing to comply with our requests. Be sure to listen if your parents or in-laws would like to explain why they did things differently or if they have questions. Good communication is key to solving any conflict.

Second, be willing to compromise sometimes, and know when to pick your battles. Just because grandparents do things differently does not necessarily mean it is wrong. Often, if we use good communication skills, we can discuss our differences and meet in the middle for a reasonable solution. We all know that grandparents like to “spoil” their grandchildren, and occasional indulgences are OK. For example, while you might not normally let your child eat French fries for lunch and dinner, having an extra serving of fries once a month while visiting grandma is not going to cause long-term harm. If we turn every difference of opinion about raising children into an argument, it will make for a very unpleasant visit with grandparents and can lead to long-term tension between you and your parents or in-laws.

Stand your ground on the things that are really important to you. While the occasional indulgence with grandparents may be fine, if grandparents are part of the regular, day-to-day caregiving for your children and they consistently let the rules slide, it can have a negative impact on children and family relationships in general. Children need consistency, and when caregivers have different sets of rules, it can lead to confusion about expectations for behavior, which can then lead to behavior problems both at home and at school. If parents feel that grandparents are “undermining” them or not respecting their authority as parents, it can lead to feelings of resentment between parents and grandparents. It’s best to address disagreements head-on (calmly and with good communication) so that long-term problems do not set in. Ultimately, as a child’s parent, you are responsible for making sure they are raised to be fully-functioning, well-adjusted adults. If you believe a grandparent is repeatedly acting in a way that is counter to that goal, you may have to set guidelines about time spent with grandparents. For example, if grandparents are consistently letting children watch scary TV shows that parents know are giving the child nightmares, you may decide that children can only visit grandparents if a parent is also present to provide supervision for TV viewing. Or if you have asked grandparents not to curse around your young children, but they continue to do so, you may decide to take the children home early the next time you hear a curse word.

While setting boundaries with grandparents can be an uncomfortable situation to navigate at times, just remember that at the end of the day, it’s nice to know that your children have so many people to love them and who want them to be happy.


Mom with friends

Avoiding New Sibling Jealousy

By Michelle DeRamus, Ph.D.

There’s a lot to think about when preparing for a new baby. For families who already have at least one child, that prep work should include making sure older siblings are ready for the new baby. A little preparation before the baby arrives and following a few guidelines after the baby is born can minimize new sibling jealousy and maximize helpful behavior from older children.

Jealous over new baby

When considering how to prepare siblings for a new baby, it is important to consider the developmental stage of the siblings. Toddlers and preschoolers are very sensitive to changes in their routines, so it can be helpful to make any big adjustments to daily routines (e.g., moving to a new bed/room, starting preschool, potty training) either several weeks before baby arrives or after baby is a few months old. Adjusting to baby will be a big change, and keeping all other routines as familiar as possible will help toddlers and preschoolers feel safe and comforted.

Older children may be less sensitive to minor changes in routine because they can better understand how and why the family is changing. However, older children are often faced with greater responsibilities and an expectation to act more “grown up” when a new baby is born. Be sure to keep expectations reasonable and age-appropriate. There are many websites available that provide suggestions for chores and responsibilities that are appropriate for different age groups. And, just like with younger children, adding responsibilities for older children gradually in the weeks before and after baby arrives can help the transition go smoothly.

Newborns require a great deal of time and attention. It can be a big adjustment for older siblings to have less of their parents’ attention. Many siblings go through a phase of new sibling jealousy. To minimize siblings’ jealousy, help big brother or sister get ready for baby by allowing them to be a part of some of the decisions and preparations before baby arrives, such as choosing a special toy for baby, decorations for baby’s room, or where to put some of baby’s belongingSibling Jealousys.

Siblings might want to “hand down” a special stuffed animal or toy from their own collection to share with baby, although it is OK for siblings to keep some toys as their own and away from baby’s reach. When baby arrives, be sure to praise siblings for all the helpful things they do, from little things like handing you a diaper to bigger responsibilities such as cleaning up their toys. Giving lots of praise is a good way to help siblings feel like they are still getting attention from you even though your hands may be occupied with caring for baby. Finally, even though babies need lots of time from you, it is important to carve out some one-on-one time with siblings on a regular basis. Even 10 minutes a day of special play time where you can give your undivided attention to siblings will go a long way for helping them feel valued and loved, which will cut down on new sibling jealousy of baby.

Additionally, it is important to acknowledge and validate the older child’s feelings. I would advise parents to problem solve with the child by saying things like, “I understand that you feel sad that you will have to share Mommy’s attention now; what can we do to help you feel that you are still just as important?” or “I understand that it upsets you when the baby cries and it’s really loud; how can we help you to feel better about this?” On the other hand, I would tell parents not to tell a child “Don’t feel that way.” It is OK for the older child to feel mad, sad or confused, which are all perfectly normal emotions, as long as those feelings are expressed in an appropriate way. For example, it would not be OK for the older child to act aggressively by hitting the baby, breaking baby’s toys, or hitting mommy’s stomach. If those things are occurring, discipline may need to be used, just as it would be used in similar situations when children are not following the rules.

Positive redirection can also be useful; for example, if a child was to say, “I hate the baby and wish he was never born,” parents could interpret why the child is feeling that way in this particular moment and respond by saying, “I understand that you really don’t like how the baby sleeps all the time, and we have to be quiet. What if we went to play outside later, just you and I, and let Daddy watch the baby? Then, you can yell and scream and get all of your energy out.” You are replacing strong words like “hate” and the idea that the baby is the problem and replacing it with the idea that the older child simply does not like a particular behavior and the effect that the particular behavior has in his/her own life. By offering a solution, such as a louder playtime outdoors later that day, the child will hopefully see that his/her life can continue even with baby in the house, and new sibling jealousy will gradually decrease.

After the birth of the baby,Sibling excited about new baby life will never be the same for your older kids, so advance preparation and a few steps taken by the parent can go a long way in easing a family through this major time of transition. Positive redirection and scheduling reserved one on one time for the older child to spend with a parent can go a long way in helping older siblings love and accept the baby. It takes kids different amounts of time to adjust; some love baby from Day 1, and other kids continue to be jealous of their younger sibling throughout their life.

If your child continues to express extreme negative emotions including aggression, extreme sadness, or excessive worrying about the family or even the baby itself, and you as the parent begin to feel that this issue is affecting the child’s quality of life or the overall family dynamic, you may seek assistance from a counselor or therapist.


Dr. DeRamus is a child psychologist with Preferred Medical Group and works at the Phenix City Children’s clinic. She specializes in Autism Spectrum Disorder (ASD) and provides diagnostic testing and therapy services for developmental delays, learning problems, ADHD, and behavior problems. She also helps children from infancy through 18 work through anger, anxiety, depression, family problems and peer relationship issues.

Eating Disorders/Body Image in Teens

By Michelle DeRamus, Ph.D.

The first time I remember being aware of my own body image was when I was in second grade. I was on the bus, and a girl a few years older than me asked with a smirk, “Do you think you’re fat? ‘Cause I don’t… I think you’re skinny as a rail.” I didn’t think I was fat, but I could tell by her sarcasm that she did. And so began the lifelong battle that so many of us face – developing and maintaining a positive body image.

So many things affect our body image, that is, the way we perceive their own bodies and how we think others perceive our bodies. It is influenced by our own personality, our life experiences with peers and family, and of course, what we are exposed to in the media. While most people have some difficulty with their body image at some point in their lives, girls and women tend to have a significantly greater struggle than boys and men, especially during the teenage years. The effects of a negative body image in teens can be devastating, leading to low self-esteem, unhealthy habits, depression, anxiety, and even eating disorders.

As we enter summer (and swimsuit season), following are some tips to help promote a more realistic and positive body image in your child or teenager.

  • Help your children have a realistic understanding of media images. As adults, most of us know that the models we see in the media have been airbrushed and “touched up” in a variety of ways. Several examples in recent years have given us the opportunity to see “before” and “after” pictures of models and actresses to help us understand that the final image we see is not reality. It is important for our teens to realize that the images they see in the media are not realistic. These images are also not attainable by approximately 95% of the population. Just because we see dozens of images of “beautiful people” each day does not mean that is the norm. However, if children and teens do not understand this concept, it can lead to expectations that most people look like those we see in the media, which creates unrealistic expectations for perfect bodies and creates poor body image in teens.body image in teens


  • Help your children develop a positive self-esteem. Everyone has strengths and weaknesses. It is important for children and teens to recognize their strengths across different aspects of life, whether it is sports, academics, personality and character traits, hobbies, other extracurricular activities, or social skills. Help your child identify and then strengthen their positive qualities. Guide them in understanding how these positive qualities can help them reach their goals and that success is not dependent on physical appearance.


  • Help your children develop good social skills. Much of our desire to look a certain way is driven by an underlying desire to fit in. Society, peers, and sometimes even family tell us that we will be more successful or better liked if we are a certain size or shape. However, the reality is that there are other ways to make friends and feel like you belong to a group. Children who know how to get along with others and have a positive peer group that supports and encourages them may be better able to keep their body image concerns in perspective.


  • Help your children learn how to focus on being healthy rather than focusing on looking a certain way, weighing a certain amount, or eating a certain number of calories. A focus on overall health can help children learn moderation in all things, both the excesses (e.g., desserts, sedentary activities) and the restrictions (e.g., limiting food intake). A focus on health also takes the emphasis off the image in the mirror and back onto how your child feels. Point out that your body is an amazing tool that can help you reach your goals, rather than something to be scrutinized and criticized.

Body Image 2 Mom and Teen

  • Help your children learn positive stress management techniques. Many unhealthy habits develop in response to stress. Teaching children and teens to manage stress appropriately with fun activities, social support, problem solving, exercise, and relaxation can prevent unhealthy habits from developing.


  • Be an example. Children, and even teens, learn the most about how to “be” from their immediate family members. Even at a very young age, children notice when adults are critical of their own bodies in front of their children. If children see other family members modeling poor body image, they will grow to think that is the norm. One of the best ways to teach the above strategies to your children is to follow them yourself.

While almost everyone struggles with body image at some time, most people are able to ultimately keep appearance in perspective as only one part of who they are as a person and do not develop serious consequences as a result of their perception of ideal body image. However, for some individuals, body image becomes so distorted or such a priority, that significant problems develop, such as depression, anxiety, or eating disorders. Some warning signs of body image issues in teens that preclude a more serious condition include:

  • Changes in eating patterns (e.g., decreased intake, binging, vomiting after meals) Body Image 1
  • Preoccupation with weight, food, calories, exercise, etc.
  • Dramatic changes in weight
  • Frequent comments or anxiety about being “fat” or overweight
  • Development of rigid food or exercise rituals
  • Withdrawal from friends, family, or previously enjoyed activities

If you are concerned your child may be experiencing emotional problems or an eating disorder as a result of poor body image, it is important to get help right away. Early treatment leads to better outcomes. Talk to your child’s doctor about resources in your area.

Dr. DeRamus is a child psychologist with Preferred Medical Group’s Phenix City Children’s clinic. She specializes in Autism Spectrum Disorder (ASD) and provides diagnostic testing and therapy services for developmental delays, learning problems and ADHD. She also works with kids with anger, anxiety, depression, family problems and peer relationships.


Helping Your Child Deal With a Break Up

By Michelle DeRamus, Ph.D.

Breaking off a romantic relationship is difficult at any age… Parents, here are some ideas about helping your child deal with a break up!

Breaking up is hard to do. Helping your child deal with a break-up is hard in a very different way. As parents, we want to protect our children and make their pain go away. Unfortunately, the older and more independent they get, the harder it can be to give that protection and remove that pain. Most parents want their children to eventually find happy, healthy relationships, but to reach that goal, almost all people go through a break-up (or two, or three…). While we cannot prevent this painful experience, we can help our children through the challenge of a break up by showing them LOVE.

L= Listen

One of the most helpful things a parent can do for a child going through a break-up is to be available. For some teens, this means being available to listen as they talk about what happened and how they feel about the break-up. Other teens may not want to talk about it with their parents, but they still may need support in other ways. If a teen does not want to talk, parents can be supportive and available by spending extra time with their teen doing other things, such as watching a movie, going on a walk, or playing ball together.Break Up 2 Dad and Son Fishing

Even if teens don’t want to talk, the presence of a parent can be comforting. During this time it is especially important to be fully “present;” give your teen your undivided attention (i.e., no phone calls, texting, etc.). This will help them know they are important to you and you are truly available with your full support. Let them know they can talk to you about the break-up when (and if) they are ready.

O= Offer Support

If a teen does want to talk, parents can be supportive by listening and acknowledging their pain. For example, saying things like, “I know you’re really hurting right now” or “It sounds like you’re dealing with a lot of different emotions” can be very helpful.

V= Veer away from minimizing the pain

It is usually not very helpful to say things like, “You’ll find someone else” or “It was only puppy love.” This can minimize a teen’s feelings. As adults we are better able to see the bigger picture, but to a teen, a break-up can be devastating. For many, this may be the first time they have experienced the loss of a significant relationship. It is also not typically helpful to join your teen in saying negative things about the ex. If parents say negative things about the ex, such as, “He was not good for you anyway,” it can make teens feel like their parents think they do not make good decisions. This can be particularly harmful if the couple gets back together.

E= Equip your child with coping skills by modeling them yourself

Finally, parents can help by modeling good coping skills. Staying involved in enjoyable activities, talking to friends and family, and taking good care of oneself physically (e.g., exercise, sleeping enough, eating healthy) are all good ways to get through a difficult time. If teens see their parents use these strategies when they experience difficult times, teens will be more likely to use them during a break-up.

When a child at any age is going through a hard time, whether it is a break up from a romantic relationship, loss of a friendship, or death of a loved one, he/she is going to experience grief at varying levels. As a parent, you must remember to LOVE your child through it:

Break Up 1

Listen attentively

Offer support

Veer away from minimizing the pain

Equip your child with coping skills by modeling them yourself


Dr. DeRamus is a child psychologist with Preferred Medical Group and works at the Phenix City Children’s clinic. She specializes in Autism Spectrum Disorder (ASD) and provides diagnostic testing and therapy services for developmental delays, learning problems and ADHD. She also works with anger, anxiety, depression, family problems and peer relationships.

Should Children Be Paid for Doing Chores?

Should Children Be Paid for Doing Chores?

Here is some insight from Preferred Medical Group’s Child Psychologist, Dr. Michelle DeRamus.

– Positive reinforcement (i.e., rewards for behaviors you want to see happen again) always goes a long way for developing good habits. It’s important to provide some kind of reinforcement for children doing chores, whether it’s money, a chance to do something fun on the weekend, or a high five or “Nice work on the dishes!”


– Just as positive reinforcement is important, so are consequences for not completing responsibilities. Whether the consequence for not completing chores is not earning money, losing privileges, or being grounded, it is important to be consistent and for both children and parents to be on the same page about what the expectations (and consequences) will be.

Paying Children for Chores


– The reward should be proportionate to the chore and age-appropriate. Paying children lots of money for daily tasks is unreasonable, and for most families financially not possible. If you choose to pay children for chores, it should be reasonable for your families finances and the difficulty of the chore.


– The “right” reward varies from family to family, and sometimes from child to child. Some children are very motivated by verbal praise, and it’s enough just to know they have made their parents proud by completing a chore. Other children are more motivated by activities (e.g., earning a chance to ride a bike, play a game, or go to the park), and others are more motivated by money. To maximize the chance your child will do chores with minimal complaining, get your child’s input on what he or she would like to work toward.


– Every family has “house rules” and expectations for responsibilities. Of course, we would like our kids to do everything we want them to do with smiles on their faces, but this doesn’t always happen! If your child is having trouble getting chores done, it might be time to add in a more motivating reward. Or, if you’re adding a new responsibility to the lineup, providing a little incentive might help get the new routine to become a habit; you can always increase expectations to get the reward down the road.


– Bottom line, there are certainly pros and cons to using money as a reward for doing chores. As one of my college psychology professors liked to say, the answer to almost every question is “it depends”! Ultimately, parents must be in tune to what motivates their child and what the balance of rewards and responsibilities will be for their family.

Parents, we want to hear what you think, too. Please comment below, or connect with us on Facebook.
Dr. Michelle DeRamus is a licensed child psychologist at Phenix City Children’s. She specializes in Autism Spectrum Disorder (ASD), and also helps kids who are experiencing anger, depression, anxiety, ADHD, behavioral problems, developmental delays and more.


Summer photo

Parents,  please keep these simple tips in mind to ensure that your child has a fun and SAFE summer break:


  •  Always have a designated person whose only job is to watch out for a drowning child; this is especially important at family functions where children are at the greatest risk of drowning because everyone thinks someone else is watching their children.
  • Be sure that CPR certification is on your list of things to do to prepare for water safety in case a child is in need of rescue due to a water-related accident.

2)      SUN SAFETY

  • All children 6 months and older should use sunscreen with an SPF of 15 or 30.Sunscreen photo
  • Infants less than 6 months old need to be completely covered by light clothes and protected from the sun via umbrellas and large hats.  Small amounts of sunscreen may be placed on infants younger than 6 months in very small areas but please remember they are more likely to accidently rub the sunscreen into their eyes which will cause significant burning, so always try to avoid the need to have to apply sunscreen on these younger infants.
  • Older kids should have access to shaded areas as well.  This is especially important between the hours of 10 a.m. and 3 p.m. when you are exposed to the most damaging UV rays that can cause cancer as early as in your 20’s.
  • Sunscreen should be applied every 80 minutes if getting wet and every 2 hours otherwise.
  • All children of all skin shades need sunscreen to protect their skin even when it is not bright or sunny outside.


  • All children and adults, regardless of how good a swimmer they are, should wear an appropriately sized life jacket at all times while boating. Substitutes for life jackets are never acceptable.
  • Drugs and alcoholic beverages should always be avoided while operating these vehicles.

4)      BIKE SAFETY  bike_helmet_boy_290x258

  • Helmets must be worn 100% of the time to decrease the risk of traumatic brain injuries that can occur even with a simple fall.  These helmets should be easily visible in all types of lighting and have a Consumer Product Safety Commission or Snell sticker attached, which means that they have been approved as a safety helmet and not just a designer helmet which provides inadequate protection.


5)      INSECT SAFETY – When enjoying the outdoors, care should be taken to avoid getting bitten by insects when at all possible to decrease the risk of diseases that they may be carrying or bacterial skin infections often self-induced from scratching those itchy bites.

  • Please apply insect repellent sparingly to exposed areas of skin, being careful to avoid spraying on the hands or anywhere near the mouth.
  • Repellents that contain DEET (frequent active ingredient in insect repellent) are safe for kids as young as 2 months of age in concentrations between 10-30% but should only be applied once. Multiple doses can be toxic, so avoid the sunscreen-DEET mixtures.

For more summer safety tips you can visit the following websites: cdc.gov or healthychildren.org.

Childhood vaccinations are a must…..says the pediatrician

By: Ritu Chandra, M.D.

I think it’s easy for those of us who live in the U.S. to lose sight of the very serious risk that diseases like polio and tetanus pose for kids. Most of these diseases have been eradicated in our country. Few of us have never ever seen a case of polio. Vaccines in the U.S. can seem like an arcane practice for an intangible danger, and fears about harmful side-effects about vaccines drive some parents to avoid them for their own children. I get that.

The reason we get to “not believe in vaccines” today is because we have eradicated many of these crippling and life-threatening diseases in our country. Here’s the kicker: we have vaccines to thank for that. What an incredible privilege to raise our children in a time and place where not many people have seen any of these deadly diseases.

Parents don’t need to go very far to find opposition to vaccination, whether in play groups or online. The Internet is teeming with information on every conceivable choice a parent may encounter. Though suspicion about vaccines is not new, a now widely discredited study published in 1998 linking the measles, mumps and rubella (MMR) vaccine to autism kicked the panic over vaccines into overdrive.April Vaccinations

During my training 30 years ago I myself saw numerous kids who were afflicted with the crippling Polio. During my internship in 1998, I saw a child with Diphtheria who ended up dying …I will never forget that sweet one-year-old baby and I cannot ever erase the memory of telling his parents that we could not save him. Today, we routinely administer the Polio, Diphtheria and other vaccines to all babies at the 2, 4, and 6-month visits, and boosters after that.

Prevnar, the vaccine against the pneumococcus bacterium, is one of the greatest pharmaceutical innovations of the past two decades. In children who are vaccinated, it has eliminated most of the pneumonia and meningitis that bacteria cause. It proved so effective, in fact, that fewer pneumococcal infections occur in people over 65 who have never gotten the vaccine, because the germs are no longer circulating. It has, quite simply, changed the world for the better.

In Columbus and Phenix City, pediatricians do not accept “non-vaccinators” or, those parents who refuse to vaccinate their children into their practices. As a pediatrician, I feel bad for the child whose parents choose to not vaccinate…I feel that as a pediatrician I should not abandon the child. However, from a practical standpoint, the non-vaccinators are putting at risk everyone else that they come in contact with. If a pediatrician knowingly allows an unimmunized child into the office, the pediatrician might be liable for that child potentially bringing in a communicable disease and exposing other kids in our office to the disease. A real-life example: Two years ago we had two siblings come to the Fort Mitchell Clinic with Pertussis that was confirmed by lab testing. These unimmunized siblings exposed our staff and doctor to Pertussis, and our staff had to take antibiotics because of the exposure!

As a mom myself, I can certainly understand the desire to protect one’s child from any potential harm. When parents bring up concerns regarding vaccines or the AAP schedule, I encourage them to discuss their anti-vaccination ‘research’ with me. In my role as a pediatrician, I try to empower parents to make informed decisions regarding their children’s health. I want parents to have reliable, complete, and science-based information, so that they can make the best decision for their child about vaccination. Pediatricians most often rely upon the American Academy of Pediatrics for providing reliable information.

Top 5 Questions I am Asked:

Q1: How are the timing and spacing of the shots determined?

A: Each vaccine dose is scheduled using two factors. First, it is scheduled for the age when the body’s immune system will work the best. Second, it is balanced with the need to provide protection to infants and children at the earliest possible age.

Q2: Why are there so many doses?

A: Researchers are always studying how well vaccines work. For many vaccines, three or four doses are needed to fully protect your child. The doses need to be spaced out a certain amount to work the best.

Q3: Why can’t the shots be spread out over a longer period of time? There are 25 shots recommended in the first 15 months of life; why not spread these out over 2 or 3 years?

A: First, you would not want your child to go unprotected that long. Babies are hospitalized and die more often from some diseases, so it is important to vaccinate them as soon as it is safe. Second, the recommended schedule is designed to work best with a child’s immune system at certain ages and at specific times. There is no research to show that a child would be equally protected against diseases with a very different schedule. Also, there is no scientific reason why spreading out the shots would be safer. But we do know that any length of time without immunizations is a time without protection.

Q4: I’ve seen another schedule in a magazine that allows the shots to be spread out.

It was developed by a pediatrician. Why can’t I follow that schedule? My child would still get his immunizations in time for school.

A: There is no scientific basis for such a schedule. No one knows how well it would work to protect your child from diseases. And if many parents in any community decided to follow such a schedule, diseases will be able to spread much more quickly. Also, people who are too sick or too young to receive vaccines are placed at risk when they are around unvaccinated children.

For example, following one alternative schedule would leave children without full polio protection until age 4. Yet, it would take only one case of polio to be brought into the U.S. for the disease to take hold again in this country. This schedule also delays the measles vaccine until age 3. We have already seen outbreaks of measles in some parts of the country because children were not immunized. This is a highly infectious disease that can cause serious harm–even death. The reason we recommend vaccines when we do is because young children are more vulnerable to these diseases.

Q5: Isn’t it overwhelming to a child’s immune system to give so many shots in one visit?

A: Infants and children are exposed to many germs every day just by playing, eating, and breathing. Their immune systems fight those germs, also called antigens, to keep the body healthy. The amount of antigens that children fight every day (2,000-6,000) is much greater than the amount of antigens in any combination of vaccines on the current schedule (150 for the whole schedule). Thus, children’s immune systems are not overwhelmed by vaccines.

So, why would parents not vaccinate?

As mentioned previously, a surge in the anti-vaccine movement can be tied back to the year 1998 and Andrew Jeremy Wakefield, a British former surgeon and medical researcher, best known for his fraudulent 1998 research paper in support of the now discredited claim that there is a link between the administration of the MMR vaccine and the appearance of autism and bowel disease.

In 2010, a statutory tribunal of the British General Medical Council found three dozen charges proven against Wakefield, including counts of dishonesty and the abuse of developmentally challenged children. It was proven that the researcher had misrepresented or altered the medical histories of all 12 of the patients whose cases formed the basis of the 1998 study that linked the MMR vaccine to autism and other diseases.

The Lancet, the world’s leading medical journal, immediately and fully retracted his 1998 publication. It was later found that Wakefield had planned to launch a venture on the back of an MMR vaccination scare that would profit from new medical tests and “litigation driven testing.”

Britain stripped Wakefield of his medical license immediately after the investigation. Meanwhile, the damage to public health continues, fueled by hype and incomplete reporting.

I strongly urge all parents to get their information from reliable scientific resources and not from sources that use anecdotal and non-scientific information. Please call upon your pediatrician as your ‘go to’ person to help you make informed decisions about your child’s vaccinations.









Having the sex education talk with your teen: A Pediatrician’s recommendation

By Shilpa Vernekar, M.D.

As a parent you have been by the side of your child, from the adorable infancy stage (and those not so adorable sleepless nights, trying in vain to rock the baby to sleep), through the “terrible two’s,” all the way up until puberty. You have been the one holding his/her hand and passing down small, golden nuggets of wisdom to help your child grow and excel. Then, the teen years start.  Having Talk with Teen 2

This is a turbulent phase for parents and children alike. Conflict is natural during this time, which we all know often comes with several big life changes for the child: the start of high school, the much-anticipated driver’s license (and subsequently terrifying driving lessons with Mom and Dad), perhaps the first serious romantic relationship for your child, and of course – the sex education talk.

As a parent, you may be wondering how to approach the topic regarding sex education and when to have the sex education talk. Those kids doubtlessly threw “the stork theory” away years ago along with Santa Claus and the tooth fairy. The teenage years, with high levels of hormones and emotions, are a time when kids may wish to explore the topic of sex, and curiosity is quite natural during this phase of life. However, they most likely do not wish to explore this topic with their…(gasp) parents!

Therefore, as a parent, one must think strategically about certain aspects of this conversation, such as when and where to have it.

When is the right time?

The day that your mind starts to think about providing sex education advice, that is the right time. You know your child more than the school teacher or his/her friends. So if you are wondering if this is the right time, then yes it is. Let it not be delayed beyond 13 years of age.

What is the right location?

A place where the chances of you both being uninterrupted is best. Also, a place that the teenager sees as familiar is desirable. For example, you could begin this conversation in the teenager’s room. If a straight eye-to-eye conversation makes you uncomfortable, you can do an activity together, such as cleaning the room. You can help to arrange things in their proper places until the ice has been broken and the conversation has started.

How do I start the topic?

Try to assess how much your child already knows. As much as you feel your teen might be clueless this area, the chances are that he/she already has information through school, friends, books, TV, or the Internet. Teenagers know way more than we think they know.

So, the best way is to hit right on the topic.

Talking with your teen about sex   Having Talk with Teen

What are the important aspects to be covered?

  • First, gather the information that your teen already has. Listen to him/her and then attempt to correct the information.
  • Secondly, explain what could be the possible consequences of having sex, including: emotional involvement, pregnancy and sexually transmitted infections (STI), and impact on school life and higher education.
  • Research has shown that having a baby in the teenage years permanently impairs the career opportunities for both the teenage mom and dad. Pregnancy and birth is a serious life-altering change that cannot be reversed. Hence casual sex should not be taken lightly.
  • Thirdly, make sure your teen is also aware about inappropriate touching, which can slowly evolve into sex. It is important for the teen to know that he/she should not be forced into having sex under any pressure.
  • Let them know how substances like alcohol and/or drugs can affect thinking and impair judgment. Discuss the very real possibility that using these substances could lead to sexual activity that the teenager is not ready for and could even potentially lead them to become a victim of sexual abuse.
  • Peer pressure, curiosity, and the desire to be loved are some of the reasons why teenagers have their first sexual experience before they are ready for it. Emphasize that you do not wish for this to happen to them because they may have regrets later if they participate in sexual activity that they are not ready for.
  • All of this conversation may not happen in one day.
  • Be patient. Just like you needed time to teach your child, his/her A,B,C alphabets, similarly you will need time to guide your child about sex. Gain his/her confidence, and emphasize that you will always be there to answer all of their questions and help them through this phase.
  • If you have any personal, family, religious or cultural beliefs, pass on this information as well to your child.
  • If you feel comfortable, you may share your positive/negative experiences about sex to your teen, which could help in the teen’s decision-making process.
  • Lastly, make sure your teen is aware about common birth control options. You can always visit his/her pediatrician to help you explain these options in detail.

Some common birth control methods:

  • Abstinence – Avoid sex. It is ideal but not always practical.
  • Withdrawal method- It has a high failure rate and does not protect against STI.
  • Barrier methods (Male and female condoms) – Effective if used the right way. Offers protection against STI, but not highly reliable to prevent pregnancy.
  • Hormonal methods- Birth control pills, Depo shot, patch, ring, implant and intrauterine device. These methods are more effective in preventing pregnancy, but they do not offer protection against STI.
  • Others- Basal body temperature method, cervical mucus changes and calendar method to predict ovulation. These techniques are unreliable in preventing pregnancy or predicting ovulation for a teenager who has irregular menses or fails to keep track of their menstrual cycles.

More detailed discussion on each of these methods can be easily provided by your teen’s pediatrician.

At the end of the conversation, feel good about helping your teen make the correct choices. Studies have shown that when parents have a positive approach towards sex and are willing to guide their teenagers through it, unwanted outcomes of sex are avoided and the teenager is more capable of making the right choice. When it comes to the birds and the bees, knowledge is power.


  1. Don’t wait too late to have “the talk.” If you feel this may be the right time, it most likely is.
  2. Open the conversation in a casual, light way. You could even be working on an activity together with your teenager, such as helping him/her clean their room.
  3. Remember to explain to your teenager that sex is not something to be rushed into prematurely due to peer pressure, curiosity or a desire to be loved.

This blog was first published on http://www.muscogeemoms.com

Taking the coal out of Santa’s sleigh-Santa as a discipline tool

By Michelle DeRamus, Ph.D.

For generations, adults have used the benevolent, jolly figure from the North Pole as a disciplinary tool to coerce children into behaving in the weeks leading up to Christmas. Some parents threaten “naughty” children with coal in their stockings.

The latest tale is that Santa’s helper –the reliable, yet somewhat mischievous Elf on the Shelf– is always watching and will make a report back to Santa, which will result in the gifts that the child will or will not receive. What many well-meaning parents do not realize is that using Santa Claus as a threat or a form of punishment is not the most effective disciplinary method for many reasons.

Let me start by saying that I do not believe that Santa Claus is bad in any way; alternately, he is an exciting, vital part of many families’ Christmas celebrations and should be seen as such.

However, when Santa’s gifts (or lack thereof) are seen to be dependent on a child’s behavior, it can dampen the merry spirit of Christmas for everyone. A child may understand that he/she has to be “good” for Santa to come. But, what does it mean to be “good?” A parent’s definition of “good” may vary from a child’s definition of being “good.” Rather than using a vague command to “be good”, it is more effective to list out specific tasks that you would like a child to complete or the things that he/she must do and then praise or punish appropriately.

Additionally, despite momentary frustration with a child’s behavior, the majority of parents will not actually return all of a child’s toys or follow through on idle threats for Santa Claus to give a child coal– or nothing – for Christmas. Thus, I encourage parents to use realistic rewards and punishments that they are willing and able to follow through with so that children will learn that a specific action leads to a specific reward or punishment.

Finally, the concept of Santa Claus cannot be used as a reliable form of punishment because the holiday season is brief. Sure, children are worried about making a good impression on Santa (or his elves) during December, but in January or February, the reward of Santa Claus coming is so delayed that it will not motivate a child to take specific actions that would lead to the desired gifts. Effective disciplinary techniques are applied consistently throughout the year.

What should I use instead of Santa Claus to make my child behave?

Child psychology research repeatedly points to using positive reinforcement, which can be defined as adding something to a situation that will make a behavior more likely to happen in the future.

For example, if you would like for your child to eat more vegetables at dinner, you would verbally recognize that child when he/she takes an extra helping of turnip greens. A parent might say, “John, I like how you are eating turnip greens tonight. I am proud of you for wanting to be healthy.” Another example of a positive reinforcement would be a teacher giving 20 extra bonus points on a test in order to reward the students who studied for the exam. Positive reinforcement recognizes the good actions that your child is taking each and every time.

Still, kids are going to misbehave sometimes even with positive reinforcement techniques, and parents will have to use age-appropriate punishments at times. Tip: If you give a warning about a punishment, make sure it’s something that you are prepared to follow through with. Realistic examples of punishment could be time-out for a few minutes or taking away a toy for the day. Unrealistic punishment might include taking all of a child’s toys away for a month or more because they were left out on the floor or telling the child that Santa Claus will not come because of his/her bad behavior.

Parenting Tips:

1.Rather than using a vague command to “be good”, it is more effective to list out specific tasks that you would like a child to complete or the things that he/she must do and then praise or punish appropriately.

2.Use realistic rewards and punishments that they are willing and able to follow through with so that children will learn that a specific action leads to a specific reward or punishment.

3.If you give a warning about a punishment, make sure it’s something that you are prepared to follow through with.

By taking the coal out of Santa’s sleigh, you will become a more effective parent, and Santa will go back to personifying the magical spirit of Christmas for everyone.

Next week, we will discuss some specific examples of behavior problems that parents often face during the holiday season.

This blog was first published on http://www.muscogeemoms.com

Surviving the Holidays with Kids

By Michelle DeRamus, Ph.D.surviving holidays with kids

Picture this as a mom: The kids are home for the holidays reenacting a loud Star Wars battle all over the house while intermittently screaming and hitting one another with light sabers. Toys are strewn everywhere, your husband is at work, and company is coming for dinner in 30 minutes—you haven’t even put the turkey in the oven yet! Many moms, at their wits end, might think to scream at their kids, to threaten them that Santa Claus won’t bring them any toys if they don’t behave (see last week’s blog), or even consider throwing them outside into the frigid cold and leaving them there. What you wouldn’t give for a Silent Night.

Tip: Identify and focus on desired positive behaviors

However, alternative methods are available to handle this situation (and many others). A wealth of psychology research points to positive reinforcement as a very effective strategy for behavior management for children of all ages. Positive reinforcement can be defined as adding something to a situation to make a behavior more likely to happen in the future. For example, if someone compliments me on a new blouse, I am more likely to wear it again. The behavior (wearing the blouse) has been reinforced (made stronger) with the compliment. From infancy to the terrible twos, to those rebellious teenage years, parents can rely on positive reinforcement to help children understand what is expected of them and motivate them to do things they need to do. Rather than define and fuss about all of the things our mom above would like her children to stop doing (running, fighting, and leaving toys out), it will probably be more effective to identify and focus on the desired behaviors (playing quietly, getting along, and picking up after themselves).

Tip: Use “first…then” statements

Once our mom has identified alternative, positive behaviors, she could use “first…then” statements with her children to focus on one or two key changes she would like to see in their behavior. “First, come to the living room and pick up all of your toys. Then, you can play your favorite board game in your room until it’s time for dinner.” The behavior (picking up toys) has been clearly defined and reinforced with the reward of playing a game. Rather than feeling fear of punishment or anger at our mom, her children will be more likely to feel positive about their relationship because mom is offering something fun as a reward instead of threatening to take things away. Our mom also benefits because she is less likely to have to yell or decide whether she is really going to follow through on those threats to ban Santa this year.

Tip: Follow up by acknowledging your kids’ good behavior

A next key step to keeping the good behavior going is to follow up. As soon as the children begin to follow her instructions, our mom should walk into the living room and verbally acknowledge their efforts. “You all are doing such a good job cleaning up. Thank you for picking up your toys,” she may say. Then, when they go off to play the game, she should check in again and thank them for playing quietly together. These positive reinforcements will encourage the children to repeat the desired behaviors.

Tip: Plan age-appropriate activities in advanceGingerbread house kids

Another common problem over the winter break is boredom. Kids aren’t used to being cooped up in the house for days on end, and parents aren’t used to being around their school-aged children 24/7. I encourage families to plan out age-appropriate activities (both as a family and individually) in advance. By again making expectations clear, preparation can help head off boredom and the fights and mischief that come with it. For example, one child may want to watch TV, and another child may want to paint a picture. To head off a potential conflict, a parent could suggest allowing each child to take a turn picking an activity. In addition to reducing conflict and boredom, this example also reinforces taking turns because Child A is rewarded for letting Child B have a turn to choose by getting to make his/her own choice next.

Tip: Comment on good behavior as it occurs

Also during the holidays, families are often cooped up together in a car for hours on end as they travel to Grandma’s for Christmas dinner. This can pose a challenge for young children – especially those with siblings– as boredom will inevitably arise and fights may break out. Most children are well behaved during the first five minutes after you load up into the car, so I would advise parents to comment on these behaviors within that time frame to reinforce what they would like to see throughout the duration of the trip. Dad could say, “I like how you guys are being so quiet.” If an argument does begin to break out, parents can emphasize the positive behaviors they do see, such as commenting on how the children are keeping their hands to themselves. Parents should encourage conflict resolution between the children to an extent—but they should also state that they are available for help and guidance if the children cannot solve the problem on their own. Again, advance preparation can head off many potential conflicts in the car. By stocking up on DVDs, video games, or other activities for the car ride, children are less apt to be bored and get into conflicts with their siblings.

Tip: Give small rewards for positive behaviorKid with stuffed reindeer

In conclusion, positive reinforcement adds something to a situation to make the behavior more likely to occur again. In the scenarios above, parents were often adding positive comments when the children were behaving well. Other ideas could be to give them small treats for positive behaviors, just as you might earn a bonus at work for performing exceptionally well. This is not to be confused with a bribe, but rather a reward for good behavior. These rewards do not have to be expensive. If children have done well playing independently while you catch up on housework, it might be nice to offer some one-on-one time with mom. Or, if they have been polite during a long (perhaps boring) visit with an elderly relative, you could offer to take them to Santa’s Village one evening as a special way of saying “thank you.” Adding small rewards like these will make children more likely to behave in those ways again.


I wish your family a happy and POSITIVE holiday season. Next week, one of our pediatricians will tell you a little bit about managing sugar intake so the kids aren’t bouncing off the walls while opening presents. After too many candy canes and chocolate snowmen, all of the positive reinforcement strategies in the world may not be able to calm them down!

This blog was first published on http://www.muscogeemoms.com

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