During the holidays, there is an uptick in talk about depression. A topic covered far less is depression in teenagers. Often dismissed in younger kids without a thought and dismissed in teenagers as being moody or having an attitude, quite often, mood changes, and yes including that of the 'typical teenager' are often signs of depression that should be addressed rather than punished.

The first thing to remember is that while teenagers are often almost full grown on the outside, their minds still have up to ten years or more to develop fully. Many teenagers are going through chemical changes in the body and brain which cause stress all by itself. Yes, mere existence is stressful for a teenager based on biological changes.

Next, there are outside factors. We see things that cause teenager stress and anxiety and often laugh at the 'simple problems' of teenagers, ignoring two significant considerations: The first is the chemical changes in the brain that make things more stressful. A teenagers brain is more akin to an adult brain coming off of a 100 hour work week. With the workload of school, combined with puberty causing sleep disruptions alone, a teenage mind is in a constant state of exhaustion. Remember those days when you fly into a rage at something simple like forgetting to empty a dishwasher after an unusually long day? The teenage brain is like that for five years straight.

Another thing to consider is the impending doom of adulthood soon. As we talked about above, we have the teenager seemingly unable to cope with the simplest of choices such as what to eat or wear. Now imagine this level of stress on such a small issue and then apply it to the problems of adulthood. In just a few short years, this child who can barely manage waking up and getting dressed in an orderly fashion is going to have to be working and paying bills and managing their own house. We parents stop and reflect on this throughout our lives in terror with years of experience. Now image the prospect of being thrown into the void as a child.

Teen suicide and other dangerous behaviors are at all-time highs. We no longer have the luxury of ignorance and ignoring our children's mental well being. It is crucial to be mindful of your teen's mood and to take steps to help rather than ignore or punish depression and its related behavior.

The main things to look for are many of the same signs you see in adults. Loss of appetite or sleep, an increase in wanting to be alone, weight changes, low self-esteem and problems at school are all common signs.

It is also important to remember that exhibiting some signs of depression may not necessarily mean they are depressed. Recognizing the symptoms is why it is critical to talk to your kids. Having an open and honest relationship with your child is important as they reach the teenage years. If you do not have a positive relationship, trying to create one when you get worried is too late. Before you make any assumptions, it is good to find out why behavior changes are occurring. Sometimes there may be perfectly reasonable explanations for some behaviors which you will not know without conversation.

If your teen is facing depression, it is essential for them to feel safe and secure in talking to you and finding a responsible remedy. Some depression is normal in teens, but if this is an ongoing or severe problem that can cause further problems, help may be needed. It is critical that we raise our children to understand there is no shame in getting help before it is too late. If you are worried about your teen and are not sure how to approach the situation, please call our office, and we can discuss how to help.

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If there is one constant problem parents seem to have, it is getting a child to eat anything healthy. Children tend to learn that health food is not as tasty as other foods. Many children will shun any food they see as healthy. Before, we discussed how to deal with children who are picky eaters, now we will discuss your child’s veggies in particular.

Hide It In Other Foods

The first very effective method for getting a child to eat vegetables is to hide it in other foods when cooking. Spinach shredded and placed in ground beef is rarely discovered. Cauliflower in your starch is always a winner. shredded and mixed with rice or mashed potatoes, and the child (or adults!) will never even know! Mixing some vegetables into scrambled eggs may help as well. There are even veggie pastas you can buy and the kids have no idea each serving includes vegetables! There are so many ways you can sneak in veggies into your children's food. Pizzas are great as well, very few children refuse pizza. Add a blend of meat and vegetables to the pizza and make sure they get all or nothing works almost every time. Also, do not forget the power of sauces!  Variety being the spice to life starts early. If you continue to introduce a variety of foods into your child's meals, they will be less resistant as you introduce them with regularity. You can even make it a special event, one day per week or month, or have a special food night. If you can get the child excited over the event, with a balloon on his chair, a candle in the food, and dessert night with the new feature food, your child will be more likely to expect the excitement and even welcome the new food or veggie night!

Mess With Their Reality

Double up the amount A child needs to have 3 servings of vegetables and two servings of fruit per day. A good psychological trick is to give them double the servings of vegetables for a meal and then tell them they only have to eat half. This works as a great negotiation tactic, especially when there is something else they do not care for. They do not like the meat, they can hold off on the meat or starch if they eat the other serving of vegetables.

Make Eating Fun!

Making a game out of eating is not ideal, but works as a last resort. If you make eating fun, they are more likely to finish the game. Make animals and smiley faces out of the food. Another fun game is to tell them the broccoli is a tree, and the dinosaur nugget needs to eat the trees. Making eating fun takes some of the attention off of the taste and helps clear that plate.

Smoothies Are A Treat And Are Nutritious

Smoothies are an almost guaranteed winner for fruit and veggie intake in large amounts all in one shot. In one smoothie you can pack two servings of fruit and two vegetables in one glass, making that final vegetable serving a snap. There are so many smoothie recipes out there, it is almost impossible for your child to oppose them all. Here is a handy list of kid friendly smoothies 

In the end, with these tips alone, you can have the child drink a smoothie in the morning, hide one serving in food, and then make them eat one serving a day. You can provide all the vitamin nutrition necessary for a healthy child. Remember, variety is key. three servings of only cauliflower per day is almost as bad as nothing at all. If you are ever having difficulty with your children’s vegetable intake, be sure to give us a call or schedule an appointment. We can figure out a plan together to help your child’s healthy food and vitamin intake.

​Before your child starts school, you may need to get your child vaccinated. While there seems to be some debate among people on vaccine effectiveness and causes and effects, outside the rumor mill, the science is reasonably sound and reliable. This office is dedicated to a safer community in Austin through regular immunizations. Vaccines are beneficial and save lives. Please get the proper vaccines for your children before starting school.
A total of seven vaccines are needed throughout school years in Austin, Texas. Here is a list of what is needed for local schools:
Note: Vaccine list and notes have been copied directly from Texas DSHS Website for clarity. Please see https://www.dshs.texas.gov/immunize/
And https://www.dshs.texas.gov/immunize/school/school-requirements.aspx for full information)
DTaP(Diphtheria/Tetanus/Pertussis):
For K — 6th grade: 5 doses of diphtheria-tetanus-pertussis vaccine; 1 dose must have been received on or after the 4th birthday. However, 4 doses meet the requirement if the 4th dose was received on or after the 4th birthday. For students aged 7 years and older, 3 doses meet the requirement if 1 dose was received on or after the 4th birthday.
For 7th grade: 1 dose of Tdap is required if at least 5 years have passed since the last dose of tetanus-containing vaccine.
For 8th — 12th grade: 1 dose of Tdap is required when 10 years have passed since the last dose of tetanus-containing vaccine. Td is acceptable in place of Tdap if a medical contraindication to pertussis exists.
Polio:
For K — 12th grade: 4 doses of polio; 1 dose must be received on or after the 4th birthday. However, 3 doses meet the requirement if the 3rd dose was received on or after the 4th birthday.
MMR(Measles, Mumps, and Rubella):
For K — 12 grade: 2 doses are required, with the 1st dose received on or after the 1st birthday. Students vaccinated prior to 2009 with 2 doses of measles and one dose each of rubella and mumps satisfy this requirement.
 
Hepatitis B:
For students aged 11 — 15 years, 2 doses meet the requirement if adult hepatitis B vaccine (Recombivax®) was received. Dosage (10 mcg / 1.0 mL) and type of vaccine (Recombivax®) must be clearly documented. If Recombivax® was not the vaccine received, a 3-dose series is required.
Varicella:
The 1st dose of varicella must be received on or after the 1st birthday.
For K — 12th grade: 2 doses are required.
MCV4(Meningococcal) :
For 7th — 12th grade, 1 dose of quadrivalent meningococcal conjugate vaccine is required on or after the student’s 11th birthday.
Note: If a student received the vaccine at 10 years of age, this will satisfy the requirement.
Hepatitis A: The 1st dose of hepatitis A must be received on or after the 1st birthday.
For K — 9th grade: 2 doses are required.
Remember, vaccines are not just for your child, but for the other children that are not able to vaccinate. Vaccines are for the safety of all children and adults in the community, not just your own. If you have any questions regarding vaccines, please feel free to call our office with your questions and to schedule your immunizations to prepare your child for school.

"Summertime and the living is easy." That is unless watching your children during summer has become a full-time job. We all do our best to keep our children happy and safe always, and especially during the summer. But, we all also know that it can take two seconds of averted eyes to lose a child forever. Another thing we all know is as parents, reading that line made your heart sink and your eyes water in fear. Nobody wants such a thing, and we do not want it for you as well.
Summertime events and festivals are all over Austin this summer. We have compiled a list of some lesser known ideas for safety.
 
Children In Public
When bringing your child to a significant event, with the large volume of people in such a small area, losing a child can happen in the blink of an eye. No matter how hard you try or what you do, unless you chain your child to yourself, it is going to happen. You can lose a child by digging for your wallet to get them a drink. It happens, it is not your fault. Yet, there are steps we can take to keep your child safe.
The first thing to do is find a meeting place. You will want to find a spot that is easy to see from a distance to meet your child at if lost. When this writer was a child we went to Disneyland every year, I was told to go to Disneyland Castle if lost. I was also told no matter where they were the first thing to do was to locate one of the Disney characters. I did get lost once with my aunt, I ran to Disney Castle, and my aunt was there a minute later to save me. It works. Landmarks and certain people such as security are easy to locate for small children. It is helpful to take advantage of what they do know.
Write their name and phone number on their wrist, along with a phone number. Next cover it with liquid band-aid so it will not wash off. This way, even a fearful child may get the phone number wrong under stress. Having a number written on the child eliminates the problem of forgetfulness.
 
Hiring A Sitter
An alternative to safety at an event this summer is to hire a babysitter. These are not the days of old where finding referral is needed for a sitter, and often someone you did not know. Today, there are apps available with proof of certifications, references; you name it. They are even location specific so that you can search for not Austin, but by zip code and distance if you choose.
Make sure your sitter is well trained in first aid, CPR and emergency protocols.
Make sure you have a stocked emergency kit, go through it with the sitter, locks, first aid, flashlights, etc.
Finally, remember everyone's safety is essential. Make sure your sitter has a safe system of transportation to and from your home as well. Security is for everyone. Offer a ride or Uber home if necessary.
 
Stranger Danger
Stranger Danger is another thought that comes to mind when it comes to keeping children safe. Recently there has been more talk about rethinking stranger danger. What is now taught is WHICH STRANGERS are a danger.
The key to keeping children safe is to teach and point out to your children which strangers are safe. Law enforcement officers and other parents are safe. Adults alone are not. If you are at a mall, make a game with your child where they locate the employees. Teach your child that if they get lost, to find the right stranger. A store employee or authority figure is better than avoiding all strangers.
We hope you will remember these tips for keeping your child happy, healthy and safe this summer. While adventuring with your child in the local Austin area or even outside of Texas, these tips will be of help.

With Texas Summer sun fast approaching, we hope you are ready to have your children getting plenty of exercise while out of school for summer break. Summer is a perfect time for children to get some much-deserved relaxation and time to let their busy little minds rest and relaxation. With relaxation time we hope much of it is spent outside having fun rather than inside with too much screen time.
 While fun in the sun is the goal, one should keep safety in mind. The sun provides several benefits such as Vitamin D, lowers depression and increases energy levels. But, too much sun for too long can be harmful. Out of the possible damage, children under the age of 18 are most susceptible. It is always wise to send your children out covered even if you think it will only be a short while.
Sunburn Prevention
Skin cancer is diagnosed over a million times a year in the USA, and one in 5 Americans will get skin cancer at some point in their lifetime. Melanoma kills thousands of Americans each year. As always, prevention is the best medicine.
 Between the hours of 10AM and 4PM, you should be especially vigilant in making sure your child is protected from sunburn with sunscreen. If possible, try to avoid being outside too much during these times. If your child is going to be spending some time in the sun, you will want to make sure you apply sunscreen at least 30 minutes before going outside and reapply it every 2-3 hours. Cloudy days do not stop sunburns or harmful rays, either. Also, protective covering is beneficial always. Try to make sure you keep a hat and sunglasses handy for yourself and your children.
 Hydration, hydration, hydration!
If there is one thing we see a lot of in Austin, it is children who get dehydrated. In fact, this is common through all of Texas. Make sure your child is drinking water at regular intervals, and not when they are thirsty. By the time children want a drink, they are often already dehydrated.
Choose a proper sunscreen
When choosing a sunscreen for the extreme Austin heat, remember, not anything will work. You want to choose a full-spectrum sunscreen covering both UVA and UVB rays. The SPF should be as high as possible and no less than 50. If you will be near water, remember to select a waterproof sunscreen, and that needs to be applied every hour to hour and a half. Besides, lotions or creams are better than spray on, as you want to be sure the coat is liberal and full.
 We hope you take care when adventuring around Austin with your children.  Remember, you can always contact us at Capital Pediatric at 512-454-4545 if you have any concerns about what is safe. If a mistake happens and your child is injured from too much time in the sun, please make sure to contact us for advice. In a worst-case scenario, we to schedule an appointment if necessary. Remember, we at Capital Pediatric are always here to help. We would much rather see your child happy, healthy and safe than in our offices tending to a burn this summer.

​Technology use by children has become somewhat of a debate in recent years. Cell phone use and games are becoming prevalent as devices become more available, this debate is not going away. At Capital Pediatric we have noticed and want to be sure our family is happy and healthy in mind as well as body.
 While the jury is still out on exactly what effect technology may have on children, there are some points of consideration. Last year, Bill Gates made headlines when he stated he prefers to limit screen time for his children. Gates admitted he limits his children’s screen time, it then came out that several others did the same. Steve Jobs had similar rules. Mark Zuckerberg wrote a message to his children to spend more time exploring the world and less behind a computer. When the builders of our world do not want to expose their family to their creations, we should take note.
Why are we worried about this technology? The primary concern is what we call 'screen time'. Children show in studies not to be able to process time spent in front of a screen, whether it be a cell phone, tablet, computer or television. Screen time is not all bad, but excessive screen time can be dangerous.  Studies have shown that too much screen time can damage eyes. Yet, that is the least of the worries in comparison to the psychological effects. A child exposed to too much screen time can affect performance in school, concentration and depression. Years of compounded excessive screen time links to severe depression in adults.
There is no need to be concerned if your child is using computers or cell phones for entertainment; the key is moderation. Cell phone addiction is possible. The signs of screen time addiction are like other bad habits. If the child is obsessive about devices, using them or begging for them often. If they are always talking about them when not using them. Lack of concentration with devices around, depression and lack of motivation when not using the device are all signs of addiction.  This is not to say that talking about a device or game is wrong. If the child can not go 30 minutes without speaking about a device for hours at a time, there may be a problem.

What you can do to prevent a problem:
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-Limit screen time
My house has a 30-30-30 plan; we give the children 30 minutes each of tablet, computer and television time. They have every right to 'cap and trade' with other devices. For example, my son will watch two episodes of Power Rangers for 40 minutes before moving on to the tablet for 20 minutes.
-Split up time
After finishing one device, it is break time, meal time, or it is time to do something else like playing outside or read a book before moving on to the next.
-No use an hour before bedtime
This is a good thing to do regardless because screen time excites the brain and will leave them in an agitated state at bedtime. It is good to have children play or read in the time before bed, calming the mind and making sleep faster.
-Taking away time
While it is not a good idea to use such things as a reward for good behavior, taking it away for bad behavior is healthy for the child.

These tips will help you raise a healthy child. Pay attention to warning signs. If you have any questions, remember you can always give the doctors here at Capital Pediatric a call for helpful advice.

​Children enjoy exercising naturally. Young people getting enough exercise has historically never been very much of an issue until recent years with all of the technological advances of modern times. Both parents are usually working and when they get home are too tired to participate in exercising with their children. The problem of exercise is indeed one of all ages, but poor habits practiced by children are particularly concerning, as this sets a pattern for life.
There are technological problems; children spend more time watching television and playing video games than in the past. Cell phones are not only limiting exercising, but studies are showing ties to depression in children. Even in schools, with budget cuts come cuts to physical education programs and fear of litigation has severely limited what children are allowed to use to play. This creates a more motionless recess period.
The American Heart Association recommends children get at least an hour or two of exercise a day. Many children do not have that much play time in the school day, and once they get home, activity is even less. Unfortunately, lack of exercise creates a vicious circle in children as well as adults. Lack of physical activity creates less overall energy and depression in children, both of which lower exercise even more.  Physical activity lowers chances of obesity, and obesity as well reduces energy levels. It is essential today for parents to make sure children are getting the amount they need to stay happy and healthy.
Besides the many health issues related to lack of exercise, getting plenty of physical activity also has several benefits to the child. Children who are more active tend to be more active adults. When a child is more active during the day, it has been proven they show improved performance in school and behavior in the home as well. Exercise improving physical development has also shown to go hand in hand with mental development. Hand-eye coordination is improved as is cognitive development and problem-solving abilities involved with solutions to activity. Also, frequent exercise leads to higher self-esteem. Everything you want for your child is gained from exercise.
Now the question is how do you help encourage this?
The most obvious is to cut down on use of technology. Limit computer, cell phone, and video game use to 30 minutes to an hour a day. Same with television. Children will not be bored and will find something to do. If they are not able to think of anything else but technology, you may consider addressing addiction issues, as this is somewhat common in children, they are less able to regulate the mental dopamine boost from games and may suffer withdraws and not be able to think of anything else but the next game session.
Use exercise as a reward. Taking your child to the park to play is a simple way to get them exercising, they are out of the home element and in a different place where all the technological comforts are not available, getting your child's mind off of them.
Finally, try to remember to allow a child to engage in physical activity in the home. Try not to get upset when your child is running back and forth in the house flying like Superman making swooshing noises during your favorite show. Try to be patient and remember, as long as he is happy and getting exercise, it is far healthier than quiet video game time, even if it may be less peaceful at times. Health and happiness should come first.

​This year's flu season seems never to end. The flu season has claimed 38 lives in Travis County alone, which is by far the worst in over a decade. In most years, the flu season tends to die off about now; however, due to the severity of this year, many indicators show the end is not here yet. Many estimates are saying that this year, the season may extend into April or May.

This year, the flu has been no laughing matter. So far, there have been no child deaths yet in Travis County, there have been reports in other counties. In fact, on Wednesday, February 15th, five more deaths were reported in Dallas County in the one day alone, bringing the total in that county to 67. Also, these are not just affecting children and the elderly like many years, two of those five cases were a 42-year-old Farmers Branch resident and a 31-year-old Richardson resident.

The Centers for Disease Control are saying that hospitalizations are at the highest levels they have ever seen. Texas had 2,897 combined adult flu and pneumonia deaths and five flu-related pediatric deaths since Feb. 2 when the last report was released, and the numbers have grown substantially since.
For those of you who have considered passing on the flu vaccine this year, now may be a time to reconsider. While it can take up to two weeks for a vaccine to take full effect, there could be three months or more left in this years season, and with the damage caused so far, this is something that should be worth considering. While the deaths involving children this year have been lower, considering the severity, avoiding a vaccine may not be worth the risk, even at this point.

While a vaccine is one measure of prevention, remember, whether you get the vaccine or not, preventative steps should be taken to reduce your risk.
From the CDC website, they provide these reminders:
-Try to avoid close contact with sick people.
-While sick, limit contact with others as much as possible to keep from infecting them.
-If you are sick with flu symptoms, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone for 24 hours without the use of fever-reducing medicine.)
-Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
-Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
-Avoid touching your eyes, nose, and mouth. Germs spread this way.
-Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

Source: CDC Says “Take 3” Actions to Fight the Flu
https://www.cdc.gov/flu/protect/preventing.htm
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Remember, no matter what you do for the remainder of the year, please, stay clean and sanitary, be mindful of others around you who are ill. If you start to show some of the signs and symptoms of having the flu, especially for your child, give Capital Pediatric Group a call for an appointment. 
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Central Austin Office: 512-454-4545 
North Austin Office: 512-250-0220