SentaraPediatricPhysicians.com

THE PEDIATRIC VILLAGESpecial Summer Edition 2019

TABLE OF CONTENTS

Welcome To Our Village

Kid’s Corner

Ask the Doc

Good Mood Food

Mood Boost Bean Dip

Children’s Mental Health and Chiropractor Care

Pediatricians Are Your Mental Health Partners

Improve Your Mood. Get Moving.

Hot Humid Hampton Roads Summer Is Here and Back-to-School Physicals

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WELCOME TO OUR VILLAGE

There has been an onslaught of media articles and stories regarding mental health issues in our community. Specifically, we are more aware that depression and anxiety, left untreated, may sometimes lead to tragedies. During the school year, teachers, coaches, social workers and other adults, are trained to understand signs, symptoms and risk-factors that our children may be dealing with issues that affect their mood and behavior. These other sets of eyes, may provide reassurance to parents that troubling signs in the child may be observed early by these caring adults, setting in motion intervention and protocols to provide help. But what happens in the summer, when there is no school, and children may not have that additional support? This special edition newsletter provides insight and resources for parents and children to recognize and navigate any signs and symptoms associated with mental health issues. If you have any questions or wish to make an appointment, please feel free to reach out to one of our providers by contacting Sentara Pediatric Physicians.

Vanessa L. Hill, MFA, MPH,Outreach Program Manager

"It Takes a Village toRaise a Child."

-a West African Proverb

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KID'S CORNER

This article was submitted by one of our local youth to share her personal experience in hopes of helping others…

To me, anxiety feels like a weight sitting across your chest, making it impossible to speak your mind. Imagine this type of feeling on a student, sitting in class. The only thing he or she does is hope they can make it through the class without being called on. Most kids or teens I know who are suffering from anxiety or depression don’t tell anyone out of fear that others will look at them as if there is something broken or wrong with them. The biggest problem with parents trying to help their kids suffering is that the parents move too fast. It’s not the point of asking the right or wrong questions, the problem is that the right questions are usually asked at the wrong time. If kids come to you wanting help and are greeted by a ton of questions, they will shut down. I did.

Depression is the same, in the sense of the feeling of isolation. This could be a reason they feed off of each other. The problem is we’ve made mental illness something uncomfortable to talk about. So much so, that children in this new generation feel we just need to hide. We have to be told that suffering from depression or anxiety does not make us weak. If anything, we’re strong because we have to learn to live with it. We kids must take the step to get help because if we don’t, our mental health, we will always be uncomfortable. And the results will not be good.

Skylar T.

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ASK THE DOC These are indications that there may be more serious problems that should be addressed. Processing and/or evaluating our teens for Depression, Anxiety and other mental health issues begins with careful and loving observation by parents and/or family. If a problem is suspected we recommend open, loving, nonjudgmental communication and immediate assessment by the child's primary care physician (PCP). Often their PCP is the most trusted professional in the child's life. I have found that my adolescents want to hear from me, "It's OK to talk with a trained counselor, who can help you process your feelings and help you understand how to respond in a way that is healthy and self-preserving." After thorough assessment and evaluation the child's PCP will, likely, refer to Child Psychology/Psychiatry, and he/she may also initiate pharmacotherapy, if necessary, in coordination with counseling.

Adolescence is a difficult time in life for all; the popular, the shy, the "nerd", the athlete, etc. Rest assured that we, as general pediatricians and your children's "medical home", are here to help every step of the way!

Lagora Brooks, M.D., FAAPSentara Pediatric Physicians

Virginia Beach757-395-1920

I see so much on the news about an increase in depress-ion and mental health issues in children. How can I tell the difference in what may be a problem versus the normal development of a daughter experiencing puberty? - Amanda C.

Hi Amanda,With the increased pressures at school and increased exposure brought on by social media, our adolescents have a much larger burden of stressors. Whereas teens in the 1990's and earlier 2000's were able to retreat to home and family, today's teens are not able to enjoy the same. As parents, we know our children's personalities and understand best how they deal with every day stress and anxieties. Vocalizing stress through complaints or sarcasm, tears or indifference, brief withdrawal to process a situation are all healthy responses and can be categorized as "normal development". If/when your child begins to exhibit more peculiar behaviors that include extended withdrawal from family, prolonged sadness, poor eye contact, increased irritability/frustration, angry outbursts, loss of interest in their usual "fun" activities/sports, withdrawal from friend groups, loss of concentration, difficulty navigating public spaces; these are more ominous signs.

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Fresh fruit and vegetables – try getting an assortment of color, different colors=different nutrients!Avocado (or guacamole!)Hummus (dip with carrots, bell peppers, etc)Fresh salsa or pico de gallo Assorted Beans – perfect for a summer chili, topping on a hot dog, or a filling sideWhole grain crackers and bread – pairs great with peanut butter, cheese, hummusTrail mix – whip together a homemade version by mixing up assorted nuts, raisins, whole grain cereal, etcSalmon pouches – easy option to pair with crackers or make a sandwich Nut butters – peanut butter, almond butter, cashew butter, etc – delicious with apples, bananas, and other fruits

GOOD MOOD FOODEver notice changes in your mood and energy based the food you eat? A diet high in processed food and refined sugars may increase risk factors for mood disorders and depression. On the other hand, a diet packed with vitamins and minerals can be fuel for your mood! In fact, there are several mood boosting nutrients that are essential in brain health. Incorporating snacks that are rich in Vitamin C, Zinc, Magnesium, Selenium, Omega – 3 fatty acids, and B vitamins, into your daily diet can help support a healthy mind--- as well as boost your energy to keep you going all summer! Whole grains, fresh fruits, vegetables, nuts, and beans, are all full of at least of on the nutrients listed above. Mix and match to make your own *good mood food!* In addition, Vitamin D (also known as SUNSHINE) is another easy way to assist your body in protecting your brain.

Healthy Brain ChallengeTry a new brain boosting snack each week over summer break! Use the summer shopping list below to get a jumpstart of ideas for mixing and matching the foods that will fuel your mind.

Amber Hannon, MS, RD

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MOOD BOOST BEAN DIP Minutes to Prepare: 10Minutes to Cook: 20Number of Servings: 8

Ingredients2 15-ounce cans black beans, rinsed and drained1 15- ounce can diced tomatoes, rinsed and drained3 ears fresh cooked corn, kernels cut off the cob2 red bell peppers, diced2 cloves garlic, minced2 tablespoons minced shallots, from one medium shallot2 teaspoons salt2 tablespoons agave syrup9 tablespoons extra virgin olive oil 1 teaspoon lime zest (be sure to zest limes before juicing them)6 tablespoons fresh lime juice1/2 cup chopped fresh cilantro, plus more for garnish2 Hass avocados, chopped.

InstructionsCombine all ingredients except for avocados in a large bowl and mix well. Cover and chill for a few hours or overnight. Right before serving, add avocados and mix gently, being careful not to mash avocados. Garnish with a more chopped cilantro if desired. Serve at room temperature.

When approaching a child’s mental health disorder a multidisciplinary approach can often be the most effective. Mental health disorders are often a systemic matter, effecting not only the mind but the physical body as well. Mental health illness can manifest many body related discomforts, ailments, and issues, which may be your body’s way of coping. Chiropractors can offer relief, helping your child manage your life challenges.

Migraines are a common mental health disorder. If a trigger of a child’s migraines are musculoskeletal issues then chiropractic treatment may be one of your alternatives to medication. The University Maryland Medical Center (2011) reported “…that spinal manipulation therapy may help in the treatment of migraine headaches. In one study of people with migraines, 22% of those who received chiropractic manipulation reported more than a 90% reduction of attacks and 49% reported a significant reduction of the intensity of each migraine.”

Chiropractic care can be beneficial when looking at the link between the body and the mind. It helps at times to have another healthcare professional take the time to listen, as well as, offer a hands on approach.

Carol Hyun Kim, D.C.Sentara Therapy Center – Virginia Beach

757-507-0015

CHILDREN'S MENTAL HEALTH AND CHIROPRACTIC CARE

Chiropractors: • Trained doctors who

specialize in detecting andreducing misalignments ofthe spine that interfere withcentral nervous systemfunction without the use ofmedication.

• Treat the body as a whole,recognizing that the centralnervous system controls allfunctions of the body.

• Perform adjustments thatare safe for children andadults that can help reducepain, reduce anxiety,improve sleep and reducestress.

• Provide care that is a gentle,noninvasive and medicationfree alternative that offersresolutions for problemsassociated with the humanframework.

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Anxiety and depression can be scary concerns for children and adolescents. The prospect of mental health concerns may be even more frightening for parents who want to help their child feel better any way they can and may not know where to start. As pediatricians, we are here to help with all aspects of our patients’ health, both physical and emotional. When a patient comes in to discuss their emotional health, I like to set aside extra time in the schedule get a full picture of what their concerns are and what symptoms they have been having. Typically it is best to talk to the child with their parent or parents in the room, and also to spend some time alone with the patient so that they will hopefully feel more comfortable to speak openly in a confidential atmosphere.

Some of the time, children or their parents will know something is wrong, but will not immediately identify it as a mental health concern. Headaches, stomach aches, poor sleep, fatigue, and difficulty concentrating are a few common presenting symptoms of anxiety and depression. When a child presents with any of these symptoms, we will always get more information to rule out underlying physical problems, but must also keep in mind that these often are linked to mental health.

Once we feel confident that we are indeed dealing with anxiety and/or depression (and they frequently coexist), it is time to discuss treatment options. Therapy is typically recommended as a first line treatment. When therapy alone is not enough, or perhaps when patients have a more severe presentation, medication is often required. Every pediatrician is different, but many today feel comfortable prescribing SSRIs (or, selective serotonin reuptake inhibitors, commonly referred to as antidepressants) and possibly a few other medications. Naturally, our more complicated patients will need to be referred to a psychiatrist (a physician who specializes in treating mental health disorders) for medication management. I would encourage families with concerns that anxiety or depression are affecting their child’s functioning to speak their child’s pediatrician. We are here to help as much as possible, and can help connect you with the right resources for help you may need outside of our office.

Jennie Hurwitz Tabakin, MD, MPH, FAAPSentara Pediatric Physicians – Virginia Beach

757-252-9622

PEDIATRICIANS ARE YOUR MENTAL HEALTH PARTNERS

IMPROVE YOUR MOOD. GET MOVING.

"Overall, studies provide support for the benefits of physical exercise in children and adolescents on executive function, brain activity, and depressive symptoms. According to Healthy People 2020, the target for physical activity in adolescents is 60 or more minutes of daily aerobic activity."

• Releasing feel-good endorphins;

• Taking your mind off worries;

May help ease depression and anxiety by:

Psychological and emotional benefits include:

• Gain confidence.

• Get more social interaction.

• Cope in a healthy way.

Retrieved from https://www.psychiatrictimes.com/child-adolescent-psychiatry/mental-health-benefits-exercise-children and https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression-and-exercise/art-20046495

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HOT HUMID HAMPTON ROADS SUMMER IS HEREIn high humidity, cooling of the body by sweat evaporation is impaired. Children are more at risk of dehydration than adults. Let’s Hydrate!! Cold water is preferred over sports drinks. Goals of hydration are to consume 4-8 ounces every 15-20 minutes. This equals approximately 2 – 3 cups every hour.

Athletes should exercise in the coolest part of the morning or evening. Take breaks every 10-15 minutes for an activity lasting over an hour. Weigh athletes before and after each activity to ensure hydration to replace body water weight lost.

Be mindful of Heat Illness stages:

• Heat Fatigue: cramps with normal body temperature. Child must stop exercising, massage, stretch, and drink cool water or salt- containing fluid.

• Heat Exhaustion: elevated body temp to 104 F, fatigue, vomiting, dizziness, flushed, moist skin. This is more serious. Remove child to shaded or air conditioned area. If not able to self-hydrate or improve, call 911.

• Heat Stroke: temperature greater than 104 F – with confusion, seizures, shock, heart failure. The most serious, call 911 immediately and start cooling immediately.

BEAT THE BACK-TO-SCHOOL RUSHSummer break is in full swing with packed schedules of endless activities and long to-do lists for parents. But, summer break is also a great time to schedule your child’s back-to-school or sports physical before the August rush!

A back-to-school physical is the same as an annual check-up, so you and your child can expect the following:

Fanya Seagull, MD FAAP Sentara Pediatric Physicians – Virginia Beach

(757) 395-1925

• Full vitals

• Vision test

• Hearing test

• Learning assessment

• Developmentalassessment

• General healthassessment

• Immunizations as needed

Our dedicated pediatric team offers convenient hours and locations to get your child prepared for the upcoming school season.

Schedule Your Child's Back-To-School Physcial

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