Tips to help teens get more sleep!

Research indicates how teenagers need an average of 9 hours of daily sleep; however, the average American teen reports sleeping around 7 hours daily. A recent NPR article reported on how varied and unpredictable schedules, in addition to stress from school and social activities, can cause teens to have trouble falling asleep, staying asleep, or waking up. In addition, over fifty-percent of parents believe that their children’s constant use of electronic devices causes sleep problems. Although electronic devices may contribute to the issue, experts suggest that parents should listen and speak to their kids about other barriers to getting good sleep, and how the family can address them. On NPR, researchers Sarah Clark and Mary Carskadon suggest a number of tips on how to improve sleep quality. CHIL has pulled some other tips from various clinics and online resources that can hopefully help you too!

  • Try to keep the same daily wake-up time: Try also having the same bedtime! When you have consistency in your schedule, it helps set a sleep-wake cycle in your body. Even on weekends, try not to deviate from your schedule by more than an hour.  

  • Exercise helps!: When you exercise, your body tends to get better quality sleep and longer sleep. Exercise helps increase the amount of time you spend in deep sleep, which is a sleep phase that helps improve immunity and manage stress. Also, when you exercise and use a lot of energy earlier in the day, your body feels ready to go to sleep by nighttime. The benefits can be even greater when exercise is a regular part of your schedule!

  • Time management is key: School can be stressful, especially with what feels like never-ending work. Experts suggest to section your work into chunks of time during the whole day, such as the extra time you have between two classes or the time you have before a meeting. This may help with efficiency and finishing your work before your bedtime.

  • Do not nap too late in the day: Napping after 5:00pm makes it harder to fall asleep or stay asleep at night. Also, make sure that your naps are short! Long naps can have you feeling groggy while waking up, or affect your sleep quality at night.

Let us know if you have any additional tips you would like to share!

Disaster & child health in the wake of Hurricane Florence

Hurricane Florence hit the shores of North Carolina, South Carolina, and Virginia a little less than two weeks ago. While the storm has passed, the damages are daunting. Recovery from the disaster will take immense efforts in certain areas, given some homes and businesses experienced massive flooding. But the hurricane didn’t just impact  physical infrastructure—amidst recovery conversations, it’s important to bear in mind the toll natural disaster takes on mental health and emotional well-being as well.

In a recent Atlantic interview, Shannon Self-Brown, the chair of health policy and behavioral science at Georgia State University’s School of Public Health, explained children are particularly at risk of developing lasting emotional trauma from natural disasters because they might not be old enough to understand why the event happened specifically to them. Studying the impacts of Hurricane Katrina, She and her colleagues found that 71% of the 426 children were resilient, showing no signs of Post Traumatic Stress Disorder (PTSD) like hyperarousal or reexperiencing the event in their heads. 25% of kids showed temporary signs of PTSD, meaning the symptoms went away within 2 years, and the remaining 4% of kids studied had signs of chronic PTSD. Unsurprisingly, increased exposure to the hurricane correlated with worse PTSD outcomes. Good social support, on the other hand, correlated with more resiliency.

But establishing good social support—meaning an active and strong peer group—after a natural disaster can prove challenging for families that have been displaced. Often, by encouraging experience-sharing and establishing routines, this is where educators can play a role, even for children who have had to change schools.

In applying other aspects of her research to the present aftermath of Hurricane Florence, Self-Brown recommended opening up a dialogue with kids about the disaster and what happened. This can be done in a number of ways, like coming up with a song, drawing a picture, writing a story, or having a simple conversation. If behavioral changes are occurring in children under the age of 4, Self-Brown notes caretakers should self-evaluate for stress of their own. Toddlers repeatedly acting up can be an indication they sense Mom isn’t doing okay.

The stress of dealing with an unexpected disaster cannot be overstated. Family upheaval affects even the youngest family members, who don’t necessarily understand the nitty gritty of, say, insurance coverage. Other resources for coping with hurricane recovery can be found on the National Child Traumatic Stress Network’s website, and more general information is posted on affected states’ department of human and health services websites.

Are toddlers more similar to adults than we realize?

The Millennial generation has inspired a number of names over the years, from Generation Y to Trophy Kids. The term ‘Trophy Kids’ comes from a common conception that millennials are spoiled, entitled, and seek acknowledgment as “winners” from a young age just for participating in an activity. Many older generations believe that children should only be rewarded for achieving a goal through hard work, and that kids will not learn this value if they are awarded medals for “just showing up” every time. In contrast to this belief, recent research shows that children from a young age may not favor all types of “winners”, but rather individuals that “win” using appropriate means.   

A recent article in NPR describes how young children are similar to adults in that they notice social ranks. In the 1970s, research at daycare centers showed how young children form social hierarchies as early as 18 months old. New research from Harvard and University of California, Irvine demonstrates how toddlers specifically favor “winners” that are dominant yet win fairly.

In one study, toddlers were shown two scenarios in which two puppets crossed a stage to opposite sides and bumped into each other mid-way. In the first scenario, when both puppets bump into each other, one puppet yields and allows the other puppet to pass to reach its goal on the opposite side of the stage. In the second scenario, when both puppets bump into each other, one puppet pushes the other one out of the way and continues moving to the other side of the stage. Toddlers tended to favor the puppet that “won” the scenario when the other puppet gave way. The toddlers did not prefer the puppet that “won” by using force to push the other puppet out of the way.

The research described above provides evidence on how most individuals, toddlers and adults alike do not favor bullies or people who put others down in order to achieve success. One scientist hypothesized that as we created communities and adapted to living with other humans thousands of years ago, the way we socially interact may have become wired in us. Who knew that toddlers could be just like adults!

The costs of pursuing an American tradition: Long-term risks of football injuries start in youth leagues

From youth leagues to the NFL, fall in the United States brings the beginning of football season. American football has been around for centuries and keeping people active since its inception. Not only is it a great source of exercise for kids, it also builds on skills like teamwork which apply both on and off the field. For some young athletes, it’s their ticket to college admission and/or scholarships. However, like many recreational activities, playing football carries risk of injury. In the past decade,, a growing body of research (reported in the New York Times) has been linking football to Chronic Traumatic Encephalopathy, or CTE.

CTE is a brain injury resulting from repeated blows to the head—not just concussive blows, but any “closed-head impact injury.” This means football players may be developing CTE despite showing no signs of brain trauma, like concussions or even headaches. Once CTE progresses to a certain point, symptoms like memory loss, confusion, depression and dementia arise. Notably, these symptoms can begin years after the hits to the head have stopped. And the risk is clear: when Dr. McKee, a neuropathologist and director of the CTE Center at Boston University, examined the brains of 111 deceased NFL players, she found evidence of CTE in 110 of them.

Moreover, CTE does not solely affect professional football players. A Boston University study found that starting tackle football before the age of twelve was associated with emotional and cognitive problems later in life. In response, football league leaders have changed some of the rules for youth leagues, including decreasing the number of players on the field and, in some regions, promoting flag-football (a version with no tackling and much fewer hits to the head).

Given these findings on CTE, some scholars outside the football world have gone so far as to suggest football be outlawed. Of course, this brings up debates about individual autonomy and the right to participate in activities which put health at risk. Dr. Lee Goldstein, another lead CTE researcher at Boston University, told his high school football-playing neighbor: “I know I might not stop you, but I feel like education [about the risks of football is] the most important thing here.” As much as he had hoped his neighbor would stop playing football after learning about CTE, Dr. Goldstein understood that the issue was not so cut-and-dry.  

Football is deeply ingrained into some American families. It’s not just a recreational sport: it’s their social world, and it contributes to their livelihoods. The New York Times reports, “Education in America is widely seen as a path to success, but all kids don’t have access to the same paths. The system is girded by property taxes, leaving residents of poorer neighborhoods with underfunded schools.” For kids in these neighborhoods, football can provide an alternative “path to success,” fostering social mobility where public education is failing. Dr. Goldstein just aims to make sure football players and their families are informed participants, but, ultimately, until other structures like America’s public school system are repaired, poorer and minority students may continue to take on football’s risks (even when well-informed).

Football has a distinct hold on American culture, but we should pay attention to the growing research on its potential risks for young adults. We’ve provided an overview of the CTE issue, but we encourage families (especially families who participate in football) to seek additional information on the risks of CTE online or from a physician.

The importance of addressing perinatal depression

During pregnancy, expectant mothers may worry about high blood pressure, miscarriage, or any illnesses that could impact the baby. However, many mothers are often surprised by a different kind of complication called perinatal depression, a condition common among many pregnant and new mothers that can last up to 1 year after a baby’s birth.

Prominent celebrities such as Serena Williams have recently detailed their struggles with perinatal depression and the lack of discussion on the topic. Recently, the U.S. Preventive Services Task Force released recommendations on this issue, asking physicians to screen for new mothers and pregnant women that “are at risk of becoming depressed.” The screenings are important considering that approximately 1 in 7 pregnant women and new mothers are depressed during pregnancy or within a year after giving birth. For young mothers and mothers at the lower end of the socioeconomic spectrum, as many as 1 in 3 women are at risk for perinatal depression.

Depression during or after pregnancy not only impacts the mother, but also the child and the entire family unit. Studies have shown that perinatal depression is linked to premature birth, babies with lower birth weight, and also cognitive delays for children. In severe episodes of perinatal depression, mothers may even become suicidal or harm herself and the baby.

What makes perinatal depression so difficult to prevent in our healthcare system? First and foremost is access to care. Generally, cities have better access to mental health care services compared to rural areas. In addition, many OB-GYNs are not properly trained to treat perinatal depression. Most only know how to screen and diagnose for depression, however the physicians may not have the necessary skills or easy access to psychiatric services to address mental health complications that come during and after pregnancy.

Certain states like Massachusetts have established programs to increase access to psychiatry services for new mothers. However, such programs are not established in many states yet. Due to a lack of state sponsored programs, it is important for women to discuss with their doctor during their pregnancy about the possible complications of depression, especially if they have a history of anxiety, depression, or other mood disorders. It is also important for new or expectant mothers to surround themselves with a solid support system in the case they experience unanticipated depression. Hopefully, the recent focus on perinatal depression in the news can be leveraged to start new preventive initiatives across the country, or at the very least, open dialogue between healthcare professionals and new mothers.

California makes restaurant kids’ meals healthier, puts children’s health first

On Tuesday, California became the first state to pass explicit legislation holding restaurants more accountable for children’s health. The new law, referred to as the “healthy kids’ meal bill,” requires that restaurants include healthy beverages like milk or water as the default with their kids’ meals. Though children or their accompanying adult(s) may still request to substitute the child’s default drink with a more sugary alternative like juice or soda, policymakers hope this menu change will reduce kids’ consumption of unhealthy drinks at restaurants. This change comes after six top chain restaurants—including Wendy’s, McDonald’s, and Dairy Queen—already have taken soda off their kids’ menus altogether.

This kind of legislation had started in several California localities before becoming state law. Right now, other cities like New York City, Baltimore, and Louisville are considering implementing a similar bill. California’s precedent sends an important message to beverage industries, which have previously lobbied against public health measures that potentially threaten sales: “the movement to address sugary drink consumption and protect public health marches forward,” the Center for Science and Public Interest reports.

 

The notion that requiring “opting-out” of a default healthier choice will lead to more of its use than requiring “opting-in” is not new. In fact, behavioral economists have long studied this type of subtle nudging, and it already exists in many legislations around us. For example, schools expect enrollees to have received certain immunizations before the start of classes. Of course, students can receive exemptions from this stipulation, but if these immunizations were optional altogether, then schools would see many fewer students getting their shots than they do under the current “opting-out” scheme.

California’s new policy shows the state’s commitment to improving children’s health. If previous “opting-out” laws are any indication, their “healthy kids’ meal bill” will be able to reduce aggregate sugary drink consumption, while still ultimately preserving consumer choice. This is only one small step toward encouraging healthier diets for kids, but it is a step forward nonetheless.

France bans smartphone use in schools: implications

Recently, France enacted a law that bans young students, ages 3 to 15, from using smartphones at school. The law was introduced to address phone addiction for children, and to encourage children to be active and interact more with each other, rather than stare at a screen. Although schools can enact the ban in how they deem appropriate, students are still required to turn their phones off or leave them at home during school hours. There are also some exceptions to the rule. Students with disabilities can use technological devices if necessary, and instructors can still use technology for educational purposes.

France’s law is not the first to address the issue of phone addiction. New York City previously banned smartphones in public schools for eight years. However, the law was overturned in 2015 due to parents complaining about the difficulty of contacting their children if necessary during school hours. In addition, multimedia companies like Apple and Google have introduced new initiatives to address the addictive nature of smartphones. Parents can now monitor their child's phone use through Apple’s Family Sharing and Google Play settings.

It seems that with this measure, France does not want personal technology use to overtake children from having a “real” childhood during school hours. It is also laudable that the French government views it as a “public health message”, since according to the American Academy of Pediatrics, screen time and exposure to digital media should be minimal for children. Previous studies have indicated how teens addicted to smartphones show less attentiveness and higher levels of insomnia, impulsiveness, anxiety, and depression. In addition, a 2016 survey by Common Sense Media showed that roughly 50% of teens “felt addicted to their devices” and 72% of teens “felt pressured to respond immediately to texts, notifications and social media messaging.” The ban seems promising, however it will be interesting to see how France balances their smartphone ban with parental needs, and whether schools, cities, or states in the U.S. follow suit.

What’s children’s health got to do with criminal justice reform?

Much of the recent discourse on criminal justice reform centers around incarcerated individuals themselves and the crimes that put them in prison. The impact of imprisonment on inmates’ families, however, often flies under the radar. Dr. Nia Heard-Garris of Northwestern University and her team recently took a closer look.

In their study published by the American Academy of Pediatrics last month, Heard-Garris et. al. use a survey to determine the effects of mother and/or father incarceration on adolescent health. They find associations between parent incarceration and forgone medical care and prescription drug abuse. Since caregiving responsibilities are likely to shift when a parent begins a prison sentence, these correlations make sense. Disruptions in what used to be regular doctors’ appointments become the new normal. Mother incarceration, specifically, correlates with a higher number of emergency department visits by her child(ren). This is a problem as emergency rooms aren’t meant to be sites for primary care. It also could indicate children of incarcerated mothers (or their new caretakers) are too often waiting until their ailments become absolutely urgent before seeking care. Father incarceration, on the other hand, correlates with illicit injected drug use by his child(ren).

Given the U.S. has the highest incarceration rate in the world, and nearly 60% of incarcerated adults in the U.S. are parents to minors, these findings are extremely significant. Notably, Heard-Garris et. al. limited the definition of parents in their study to biological father and mother, suggesting that the impact may be even greater if imprisonment of any primary caregiver were studied.

The study highlights how problems of the criminal justice system extend beyond just convicted felons. Furthermore, young black adults in the survey experienced disproportionate rates of parent incarceration, raising concerns about the community experience of parent incarceration (in addition to the individual impacts the study evaluated). For example, what does it mean for a child to experience parent incarceration alongside many his friends also experiencing parent incarceration? The authors’ research underscores the importance of considering the children of convicts amidst critical conversations on criminal justice reform.

Coverage for transition-related healthcare may be in trouble for transgender youth

In 2015 and 2016, new anti-discrimination federal rules required insurance plans to cover preventive services for transgender and gender non-conforming youth, in addition to prohibiting plans from denying insurance and service coverage for transgender youth. The expansion and victories for transgender-based rights during this period were momentous, however recent national discussion to remove the anti-discrimination laws is worrisome.

The number of transgender children and youth is rising, as seen by the increase in individuals seeking care for gender dysphoria. Gender dysphoria is defined by the American Psychiatric Association as “a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify,” which can often lead to feelings of strong discomfort and distress. Gender nonconformity (or gender expansiveness) is not the same thing as gender dysphoria, as gender nonconformity relates to “behaviors not matching the gender norms” of an individual’s gender assigned at birth.

Research shows how transgender-based youth are high at risk for self-harm, depression, anxiety, substance abuse, and other mental-health concerns, with many also facing harassment and discrimination in every-day life. Utilizing gender-affirming healthcare such as hormone therapy, puberty-blockers, or gender-reassignment surgery can minimize the challenges many children, youth, and adults face, providing a better quality of life. This fact is what makes recent policy shifts more troubling.


NPR recently featured an article about one particular youth who initially lost coverage for a gender-reassignment operation in Wisconsin, when the state’s Group Insurance Board voted to “exclude coverage for gender reassignment or sexual transformation” for state employees. The  decision came during the recent national rhetoric of many socially conservative politicians calling the 2016 anti-discrimination rule “unlawful”. Although the youth was ultimately able to get her surgery by striking a deal with her hospital to pay about $20,000 upfront, many people may not be able to afford this privilege. There are more stories out there of children and youth facing difficulty with transgender-based insurance coverage and experiences in the healthcare setting. It is imperative that policymakers and local and national officials realize the negative consequences of discriminatory national discourse and policy changes for the mental, social, and physical health and wellbeing of transgender-based children and youth.  

The Benefits of Breastfeeding

Earlier this month at a United Nations assembly, the Trump administration’s delegate opposed a resolution encouraging breastfeeding. This has re-sparked some decades-old debates on breastfeeding versus formula and the strong arm of the baby formula industry, both in the United States and globally.

CHIL has looked to the literature on breastfeeding, which informs international maternal-child health policy like the World Health Organization and UNICEF’s recommendation of exclusive breastfeeding for the first 6 months after birth (their recommendation, of course, is directed toward women for whom breastfeeding is an option). Here’s what we’ve found:

  • A history of breastfeeding correlates with “a reduction in the risk of acute otitis media, nonspecific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma, obesity, type 1 and 2 diabetes, childhood leukemia, and sudden infant death syndrome” among babies

  • The correlation between breastfeeding and reduced obesity risk carries into the child’s adulthood

  • Breastfeeding is associated with higher intelligence and cognitive ability in children

  • Mothers who breastfeed experience reduced risk of type 2 diabetes, breast, and ovarian cancer

  • Breastfeeding saves families money

Note that most of these findings show correlation, not causation, and may have confounding influences like family income or education level. Nonetheless, given all of the positive incentives for children and mothers, CHIL follows global health organizations in encouraging breastfeeding for women able to choose. For mothers unable to breastfeed, whether due to physical or lifestyle constraints, formula certainly can be a strong alternative offering convenience and variety. Be sure to discuss your feeding options with your OBGYN and/or your child’s pediatrician. Additionally, there are abundant resources online to help guide formula selection.

 

What we can teach our children about the environment

A recent article in the Philly Voice discusses the value of teaching our children to be eco-friendly, and how respecting our planet can lead to healthier surroundings and families. However, “being green” can be expensive. Underserved communities may not be able to prioritize green living as a result, although they still bear a large burden from environmental degradation. Even small steps can help communities move towards more sustainable living, and families can still be friendly and conscious of the environment on a budget. We have compiled a list of easy things parents and children from all walks of life can learn and do to live a greener and healthier life.

  • “Reduce, reuse, recycle” -- Whether it be getting takeout food with your own reusable containers, using hand-me-downs, or recycling boxes and bottles; these are all great habits to teach your kids and practice yourself. Even setting an alarm for showering or other types of water or electricity consumption can be helpful to make these actions eventual habits! New York City and Philadelphia also provide information on recycling spots in different neighborhoods. A simple Google search for other communities may help you find out where you can recycle and when your neighborhood recycle collection days are!

  • Rethinking Plastic -- Buy some cheap cloth bags that can be used when going grocery shopping, instead of receiving plastic bags from the market. Even this small gesture can make a huge difference in the way families consume plastic.

  • Parks & Beaches -- In some of our previous blog posts, we’ve discussed the value of taking children outdoors and keeping their brains occupied, especially during the summer. Trade in a movie marathon one day for a walk in the park.

  • Walk, Bike, Carpool, or Use Public Transportation! -- Not only can these options be cheaper than using a car, but they also reduce the amount of toxins or greenhouse gases released into the air. Encourage your children to do the same, and teach them the value of eco-friendly transportation options!

  • Back to the Basics -- Practicing the following habits at home and teaching them to children can go along way in living a greener life:

    • Use both sides of paper in notebooks and for school homework

    • Turn off the lights when you leave the room

    • Don’t keep the faucet running while brushing your teeth or washing the dishes

Parents can also encourage their kids to grow vegetables or fruit of their liking inside or outside of the house, or go to a local library to check out books about environmentally friendly practices like The Lorax by Dr. Seuss. There are plenty more ways to learn and practice living a greener life. Check out this website for more tips!

Persisting pregnancy discrimination hurts health of mothers, children

Last month, the New York Times published an article entitled “Pregnancy Discrimination Is Rampant Inside America’s Biggest Companies.” Authors Natalie Kitroeff and Jessica Silver-Greenburg had interviewed several women regarding their experiences in various workplaces. Their findings are troubling.

One woman, whose job at Walmart involved lifting heavy boxes, informed her boss that her doctor advised she perform light duty for the remainder of her pregnancy. When her boss dismissed the doctor’s orders, the woman had to choose between regular 50-pound lifting and a paycheck. She had to choose between putting her baby’s life at risk or putting her family’s livelihood at risk. She continued the heavy lifting. Towards the end of her pregnancy period, after inquiring about maternity leave, she was laid off. Walmart would “no longer be needing [her] services.” She remained unemployed for an entire year.

This type of pregnancy discrimination threatens both the health of the mother and the life of her unborn child. Moreover, pregnancy discrimination across industries indirectly hurts children by compromising the income of mothers (or future mothers). Given the health care and living expenses of raising newborns, new mothers especially cannot afford to be unemployed (and perhaps without health insurance) long-term.

Even for women working in offices and without direct, physical danger to their babies during pregnancy, their professional progress is hindered. The NYT reports each child reduces mothers’ hourly wages by 4%. At the same time, fathers’ wages increase by 6%. This subtle discrimination reinforces traditional gender roles: Mom is the primary caregiver; Dad’s career comes first. These norms are passed on to children as they observe their working parents. And families without the nuclear mother and father—single mothers, lesbian mothers—may not receive the family salary boost statistically awarded to fathers.

This report illuminates the persisting structural sexism within the professional world, and the risks it imposes on the health of women and their children. While legal battles may help some individual families, the comprehensive, long-term solution for families lies in a broader culture shift away from the unfair bias against pregnant women and mothers in the working world. CHIL encourages readers to stand up against pregnancy discrimination in your workplace, and actively set an example of treating the professional abilities of mothers equitably—for both your coworkers and children.

More than what we see: the role of fathers in the wellbeing of children

This past June 17th, Father’s Day was celebrated around the country and globe. Even with a day dedicated to commemorating fathers, we often overlook the crucial role fathers play in the development of their children, beyond what is conventionally considered or is traditionally applied to mothers.

In any type of family, traditional or nontraditional, the family unit involves teamwork in a child’s upbringing regardless of who raises the child. For those families with a father present, recent research showcases that the involvement of a father in his child’s life can have a large impact on the child’s diet, discipline, and exercise, among other aspects of the child’s immediate well-being. More engaged fathers can also affect long-term development of children, such as improving self-esteem, enhancing performance in school, and leading to lower rates of depression, anxiety, or teenage pregnancy.  

This does not mean that a father’s involvement in his child’s life is required to be of the same nature as a mother’s. A father can occupy his own “unique role” in a child’s upbringing, different from the mother’s--in fact, recent studies show that the way mothers and fathers interact with a child stimulates “different parts of a child’s brain.”

For many fathers, it can be difficult to be highly involved in a child’s life, especially in a country like the United States, where most states and companies do not provide paid paternal leave. In fact, the United States is the only country in the industrialized world that has no paid family leave for mothers or fathers. This can make it especially challenging for fathers to spend quality time with their children after birth, or even cope with the stressors that afflict many families after welcoming a new child. For instance, many new fathers face similar challenges to new mothers, such as gaining weight or experiencing depressive symptoms after the birth of a child.

However, countries like Sweden are trailblazers when it comes to addressing these issues. Sweden has sought to increase the involvement of fathers in family roles and improve gender equality by legally providing 480 days off from work (to be shared by both parents) for each child in their home. The goal of such policies is to improve “social benefits” while also allowing women more freedom to “become more active members of the workforce.” Paid family leave is the norm in Sweden--many Swedes claim that it can even be looked down upon if a father does not take days off from work after the arrival of a new child. Regardless of whether such policies will eventually come to the U.S., one thing is for certain--in families with dads, fathers play a more crucial role than we realize.

CHIL’s Guide to Community Health Clinics

In CHIL’s blog post last week, we mentioned Mary’s Center, a community health clinic in Washington D.C. This week, we want to emphasize that clinics like this one are available all over the nation. In fact, there are about 1,400 community health clinics (CHCs) in the U.S. While undocumented immigrants and Dreamers are ineligible to enroll in the federally-subsidized health insurance plans provided via the Affordable Care Act, CHCs often offer a good alternative for anyone seeking affordable health care—both citizens and non-citizens alike.

Additionally, these clinics do not operate under any low-income or insurance coverage eligibility requirements; that is, a family with a working parent covered by some form of health insurance is welcome at places like Mary’s Center, too. Medical costs in the United States’ largely privatized system indeed can be overwhelmingly burdensome, even for people with steady employment.

So, how do CHCs operate? What services do they provide for individuals and families, and at what cost?

CHCs are nonprofits that receive funding from a myriad of sources including federal, state, or local grants and/or Medicaid payments. Some may partially rely on private funding sources as well. Because several institutions finance each CHC, in most cases, this provides the centers with a safety net. If one funding source is compromised—something common in the U.S. as administrations shift—CHCs have other means to remain afloat.

In order to qualify for public funds, CHCs must:

  • Be located in a medically underserved area or serve medically underserved populations (determined by the federal government)

  • Provide comprehensive primary care

  • Adjust fees according to a sliding scale based on patient income

  • Be governed by a community board, of which at least 51% of members are patients of the CHC themselves

Apart from providing comprehensive primary care, CHCs may address local needs like care in foreign languages or medical translators (for which their local community board can advocate). Another example is Mary’s Center partnership with Briya Public Charter School. Briya holds classes at Mary’s Center, providing an educational space for both parents and their children. Briya’s model works well for teenage parents who otherwise may have had to forgo public education. They also offer a counseling and educational group for (future) parents to attend throughout pregnancy; a program called "centering." These two programs are particularly useful for the areas Mary’s Center serves, where there are many young families.

The localized care many CHCs provides sets them apart from other medical facilities and makes them integral to the health of thousands of children living in the U.S. today, particularly living in vulnerable and underprivileged families. If you or your kids are in need of affordable health care, CHIL recommends looking into your local CHCs for medical services. This search tool can help: https://findahealthcenter.hrsa.gov/.

The detrimental and lingering effects of migrant family separations

In the past couple weeks, immigrant officials at the U.S.-Mexico border have separated migrant children from their parents, prompting national outcry. Despite the signing of an executive order last week to halt the practice, evidence shows that trauma from separation can persist in a child, even after reuniting with their parents.

Children are susceptible to the same stress response as adults. However, not having a parent to comfort or alleviate their stress can cause harmful and sometimes irreversible effects. Their immune systems may become weaker and less able to fend off infections. In addition, the stress response in children can induce long-term effects such as post-traumatic stress disorder (PTSD), depression, or substance abuse.

Some migrant children are able to join foster parents; however, many others are held at detention centers across the country. The detention centers’ ability to provide support to children is often complex and ambiguous, due to strict rules sometimes limiting physical contact between staff workers and children. Although children crossing the border in the past couple years were predominantly adolescents, many children detained recently are younger than age five and  have very different needs. In addition, even if placed with foster families, children with trauma display abnormal behavior for their age, such as crying constantly, having separation anxiety, and being unable to leave their foster parents’ side. It surely does not help that some of these children are also fleeing violence in their home countries, facing residual trauma from those experiences as well.

A recent executive order now allows families to be kept together when taken to detention facilities at the U.S. border. Moreover, a recent court ruling requires previously separated minors to be reunited with their families within thirty days by U.S. officials. Of utmost importance is the provision of mental health services to migrant children--not only to those separated in the past month, but also those crossing the border today, with or without family. Programs like the Mary’s Center in Washington D.C. work toward this goal, by providing therapy and assisting migrant children in schools. However, public services to aid undocumented individuals are oftentimes limited in the U.S. In addition, many undocumented individuals may find it difficult to seek help due to fear of retaliation. Given the adverse health effects migrant children may face, efforts to alleviate the long-term traumatic consequences of immigration on inculpable and vulnerable minors is imperative.

Helmets provide protection, but they get a bad rep. How can adults encourage kids to wear them?

Summertime and bike riding go hand in hand. The pleasant weather invites cyclists of all ages, and for kids, bikes grant independence. They can get from place to place using environmentally friendly transportation and without relying on Mom or Dad for rides. This can be especially important during long summer days because, unfortunately, most parents and/or caretakers don’t get a summer vacation from work. Moreover, they are free to use! Even if the initial investment is a financial burden, many cities offer free or subsidized bike-sharing programs.

CHIL encourages kids to take advantage of this prime bike-riding time. At the same time, we support the use of bike helmets as they improve safety. We know they’re hot and sweaty, they give you helmet hair, and the chances of getting in an accident, statistically, are small. We get it. Wearing a helmet requires taking on a short-term cost with an unknown reward.

In fact, one of the major fears of policy-makers considering requiring helmet usage is that the reluctance to wear a one will actually reduce bike-riding popularity altogether. This would be an unwanted consequence given biking is such an accessible form of exercise. Nonetheless, the research gathered on helmets, bike accidents, and fatality are in largely in agreement. In her review of bicycle helmet research, including five well conducted case‐control studies, Dr. Rebecca Ivers found that “helmets provide a 63–88% reduction in the risk of head, brain and severe brain injury for all ages of bicyclists” and “the review authors concluded that bicycle helmets are an effective means of preventing head injury.”

Ivers makes it clear that wearing a helmet is good for your health—so much so that some health insurance companies even offer monetary incentives (both positive and negative) to helmet-wearing, like covering the cost of helmet or revoking coverage in accidents where the rider is without helmet. We want to emphasize that wearing a helmet while bike riding makes an already-healthy activity even more healthy.

When it comes to children, the bike-riding beginners, it’s important to instill the habit of helmet-wearing perhaps before they even think of it as a short-term cost. We’ve gathered the following tips to incentivize kids to wear helmets:

  • Encourage good habits. From the first time they start riding with training wheels, have them where a helmet. Make it clear that putting the helmet on and getting on the bike should happen simultaneously, just like putting on a seatbelt in the car.

  • Let them pick out the helmet they would like. Many retailers carry a plethora of options with different colors and décor. Stickers are also fair game. The helmet can become a fun accessory, and unlike clothes, kids won’t outgrow them every year!

  • Set an example for them by always wearing a helmet when you ride.

  • Point out celebrity cyclists (or other admirable figures in their lives) wearing helmets.

  • Be sure to use positive reinforcement—praise children when they do wear their helmets rather than only scolding when they don’t.

Bike riding should be fun, but it also should be done safely—especially when it comes to younger riders. Wearing helmet should not have to compromise the enjoyment of biking for kids, and with the right encouragement, it doesn’t have to.

 

Prioritizing Well-Being Over Stress

It’s important to motivate children and teens to succeed and do what they love, but a recent newscast in NPR talks about the risks of pushing kids too hard to do well. (The NPR newscast includes a 7-minute talk about this topic which you might find interesting!) It is not a stretch to say that students today feel immense pressure to compete against their classmates and friends to do well, and this stress can be a major contributing factor to anxiety and depression.

 

Some parents admit that they “totally bought into the idea” that their job is to push their kids to succeed and overcome obstacles. But if the pressure is too much, this effort can backfire. One high school in New York invited a psychologist to evaluate the student body using the Youth Self-Report, and found evidence of high levels of stress. This includes internalizing symptoms, or feelings of sadness, anxiety and depression; physical symptoms like headaches and stomachaches, and drug and alcohol use.

 

According to experts, substance abuse is actually something that affluent teenagers may use even more than inner-city kids, as “a form of self-medication” against the stress of high expectations to do as well as peers or parents.  This means that the need for conversation around mental health applies to inner-city and wealthy suburban schools alike.

 

Parents can play a huge role in promoting well-being as a priority that takes precedence over grades. They can have constructive conversations about stresses their families face, which are not likely to be ones they face in isolation. They can also work with schools in order to improve environments at school and at home. Research-based “resilience training programs” that teach “coping and happiness skills” are taking off at school, even for elementary students. Researchers today are finding that “resilience training can help reduce symptoms of depressive or negative thinking among children”

 

Student-directed initiatives also give students an opportunity to talk with each other about topics they might not readily share with parents or teachers, and gives them an active role in their own mental health.

 

All of these efforts should be directed towards valuing well-being and celebrating diverse kinds of passion and success. As a society, we should acknowledge that “a culture shift” is necessary to value all kinds of success instead of prioritizing and zeroing in on certain academic successes or career paths.

 

#WhereAreTheChildren: concerns for the well-being of immigrant children in the age of viral hashtags

As #WhereAreTheChildren flooded Facebook and Twitter posts this past week, CHIL is taking a closer look at the role of social media in issues like child immigration policy and why such policies are relevant to children’s health in the first place. Given the nuanced nature and diverse moving parts, we will cover this topic in a series of posts.

There are millions of immigrant children living in the U.S., some of whom have undertaken incredibly risky journeys along the way. From on-the-ground Border Patrol agents to broad, federal immigration policy, how our government treats minors upon arrival can impact their health and well-being. The #WhereAreTheChildren trend caught America’s attention by exposing the alarming number of 1,475 children unaccounted for on the part of the Department of Health and Human Services (HHS).

Much confusion followed this news. The New York Times clarified that the 1,475 are a fraction of 7,635 children who migrated mainly from “Honduras, El Salvador and Guatemala, and were fleeing drug cartels, gang violence and domestic abuse, according to government data.”  

So where are these 1,475 kids?

In the worst-case scenario, some kids may have fallen victim to smugglers or human trafficking. However, experts caution many of these children are likely still safe with their sponsors, who are often parents or family members already living in the U.S. Eric Hargan, secretary for HHS, said in a statement that often sponsors cannot be reached because they themselves may be living as undocumented immigrants and are hesitant to talk with federal authorities.

The lack of sponsor communication raises concerns about the health and safety of the children for whom they’re responsible. Even if a child is out of harm’s way, the sponsor could still fear using beneficial federal resources for the children. For example, undocumented children have the same right to public education as American citizens. In some states, there are federally-funded health clinics which are required to treat all people regardless of documentation status. However, if sponsors are reluctant to use federal systems in effort to avoid governmental authority, they and their children lose access to necessities like basic education and medicine. The 1,475 missing follow-up calls manifest the prevalence of this reluctance.

Moreover, while interest in the well-being of immigrant children has spiked in recent weeks, the issue itself is decades old. Albeit much misinformation followed #WhereAreTheChildren, at the very least the hashtag drew much-needed attention to this vulnerable population of young kids. It forces us, as children’s health advocates and more broadly as Americans, to reflect on how we can better fight for the health of vulnerable populations; that is, fight for vulnerable populations not based on the media or political attention they accrue but rather based on their genuine need for allyship and aid.

In the coming weeks, CHIL will take a look at current immigration policies in place to protect the health of immigrant children. Stay tuned.

Let’s keep our minds engaged over the summer!

School’s almost out, and as families prep for the summer, it can be good to help kids’ brains stay active and healthy. Stimulating the mind over the summer, which of course can be combined with relaxation and play, makes it easier for kids to transition back into school mode in August. As we all know, the mind and body are linked, so we came up with some ideas that can keep your child engaged inside or outside the house during the long summer days! Definitely check out our previous blog on some good ideas to make exercise fun and motivating for children over the warmer months.

  • Blow bubbles: It can teach deep breathing, which is healthy for the heart and mind. Besides bringing a calming energy, it can also get your child out and about!

  • Visit the local library: There are always fun summer activities planned at the library, as well as reading challenges and the opportunity to win prizes. It gets kids using their brains and some time out of the house!

  • Visit museums and local parks: Maybe you can check out a book from the library about a topic from the museum that interests your child, or a book about nature to take with them to the park!

  • Try learning Yoga: Not only does it involve both the mind and body, but just like blowing bubbles, it can be a good start or end to an active day. Cosmic Kids Yoga even has videos up for kids to follow and have fun with!

  • Teach your child how to use a stopwatch: This mom tried it and surprisingly it got her daughter to stay engaged with her own experiments in the house, like how long she could stand on one foot for!

  • Try cooking together: Have you checked out our recipe post on making blueberry muffins yet? When it gets too hot outside, this can be a perfect indoor activity!

  • Encourage volunteering: If your child loves animals, call your local animal shelter if they accept young volunteers! Some may accept children within a certain age to volunteer, or if they come with an adult. Habitat for Humanity has a youth program that offers volunteer opportunities to students as young as age five. Some other ideas include nursing homes, soup kitchens, or the local zoo. Here is also a resource guide with some websites to search for civic engagement opportunities: it’s never too early!

With that, happy summer!

Children’s health news updates from the White House

The month of May has brought a host of new actions from the White House regarding children’s health. CHIL breaks down the recent news below.

First, the President has called on Congress to cut $7 billion in funding from the Children’s Health Insurance Plan (CHIP). CHIP is a federal program that provides health insurance to 9 million otherwise-uncovered kids and over 300,000 pregnant mothers. (CHIL covered this issue in several posts if you need a refresher). It’s particularly special because it’s one of the few programs that has had bipartisan support for decades.

After a hard fought congressional battle in 2017, CHIP received a necessary decade-long funding extension in January 2018  (CHIP CHIP Hooray!). Despite the win for children’s health in the beginning of the year, the Washington Post reports, “Congress can ‘rescind’ money it has previously authorized if it secures a majority of votes in the House and then the Senate using powers under the Congressional Budget and Impoundment Control Act of 1974.” This is the act President Trump would rely on to cut money from CHIP at this point, though the law hasn’t been employed to rescind funding in over 20 years.

If faced with a ex post facto funding cut from the federal government, many states may be left with no choice but to scale back their CHIP enrollments and/or benefits. We caught a glimpse of the detrimental impact jeopardized federal resources can have on CHIP back in late 2017, when some states took preemptive measures in anticipation of losing their CHIP funding. Connecticut, for instance, froze enrollment in December. Colorado and Virginia had plans to phase out coverage for pregnant women starting in January.

CHIP is an extremely important measure for child health, as CHIL expressed back in September and October, and it heavily relies on federal government money. We hope that the vital health insurance program will continue to receive the Congressional support it needs to adequately aid its worthy beneficiaries: disadvantaged women and children. Notably, while President Trump has operated at odds with CHIP this month, by contrast First Lady Melania Trump unveiled her “Be Best” initiative to improve child well-being on May 17th. She has followed many of her predecessors--namely, Michelle Obama, Laura Bush, Barbara Bush, and Nancy Reagan--in specifically focusing on children’s issues. As mothers themselves, after all, children’s topics hit close to home regardless of political ideology.

Though the details of the “Be Best” campaign have yet to unveil, the initiative’s three goals are to improve child well-being, take on cyber bullying amidst today’s increased social media presence, and tackle the opioid crisis so as to reduce the number of children born with addictions (an ongoing issue CHIL wrote about last week). Ms. Trump’s outlined goals are promising, and CHIL is looking forward to learning the specifics of her children-centered plans in the coming months.