EXERCISE

• Encourage physical activity. Exercise can improve your child's fitness, make them feel better and strengthens the cardiovascular system. There are many city, county, and private organizations for sports such as swimming, basketball, baseball, soccer, football, gymnastics, and tennis.

SIBLING RIVALRY
Every parent with more than one child has experienced sibling rivalry. As children grow and mature, the rivalry can worsen. Here are some guidelines for parents to help manage sibling rivalry.

1. Be fair.
2. Avoid making comparisons between your children.
3. Encourage children to work out their own differences.
4. Avoid taking sides on sibling conflicts. Be impartial, and do not show a preference for one child or another.
5. Set guidelines on how children can disagree and resolve conflict.
6. Discourage tattling.
7. When it is necessary to punish, do it in a private place.
8. Use regular family meetings for all members to express their thoughts and feelings, as well as to plan the week's events and give positive reinforcement and rewards.

HOMEWORK

• Parents need to help their child develop good homework habits. Choose a regular time and location to work on daily assignments. The location needs to be well lit and quiet, without distraction from the TV, other children playing, or others talking on the telephone.
• There is no absolute right time to do homework. You may have to experiment to see what works best for you and your child. Let your child have some say in this decision. If you can both agree on a regular time and place for homework, you can eliminate much of the homework-related conflicts that occur between parent and child.

TELEVISION

• Parents can control the amount and quality of TV their children watch. Limit television time to a preplanned hour or two daily. Encourage homework and chores to be completed before TV. You can provide alternatives to TV, such as after school sports, hobbies, chores, and family activities. It may be helpful to have your child plan his TV viewing time in advance to avoid conflict. Consult the TV listings - this will also help to monitor the quality of your child's TV viewing. Do not permit TV watching while eating - this habit encourages overeating and interferes with quality family time that may only be possible during the evening meal.

CHADIS- Child Health & Development Interactive System

• Our practice is pleased to announce that we are expanding our use of CHADIS, an interactive online system developed by Johns Hopkins University pediatric specialists, which screens for developmental, social, emotional and behavioral problems.
• his system allows the child's caregivers to provide more in-depth observations of their child to the child's health care providers through the use of confidential online questionnaires. Done prior to the office visit, the information you provide will help in the early identification and treatment of these important issues.
• The use of pre-visit questionnaires like CHADIS is supported by the American Academy of Pediatrics.

We are currently using the CHADIS system for all check-up visits and all behavior visits. For this tool to be successful, we need your help by completing these brief questionnaires a few days prior to your office visit. Please follow these instructions:

1. Go online to http://www.chadis.com and register your child.
2. The "invitation code " for our office is our phone number 3018692292. Create your password.
3. For checkups , when asked visit type, choose "well child/checkup visit." You will see the age appropriate tests for your child. Select "begin" and complete all the questionnaires listed. It is normal for some of the questions to seem too mature for your child.

Your provider will discuss the results at the check-up or behavioral visit. We appreciate your participation as it helps us provide your child with the best care possible.

We recommend yearly check ups.

10 YEAR CHECK-UP

GROWTH AND DEVELOPMENT

• You have probably noticed that your child has become stronger, has more muscle mass, while strength and coordination have improved. The first sign of puberty in girls - breast buds - usually starts around age 10. The peak growth period in girls occurs about 1 year after puberty begins. Menstruation usually starts about 2 years after the onset of puberty, usually just before girls turn 13. Puberty, for boys, starts about one year later. The first sign is an enlarging of the testes and a reddening tone of the scrotum, which usually happens around age 11. The peak growth period for boys occurs about 2 years after beginning puberty.

CONTRACTS

• A popular method of changing behavior that can be used with an older child is the contract method. Contracts allow the child to demonstrate independence and responsibility. First, identify a mutually agreed upon area of concern or potential area of concern (such as deciding whether or not to buy a pet). The child and then the parents should each state their needs, desires, and responsibilities and also state what each thinks are appropriate rewards, punishments or consequences of the child's behavior. Then the parent and child can negotiate an agreement or compromise. This agreement should be written down and it should clearly spell out what activities are permissible and what actions will be taken if the contract is not successfully completed.

IS MY FAMILY NORMAL?
You may wonder if your family life is "normal." Some characteristics of a functional family include loving and caring for family members, providing support, security and a sense of belonging, open communication, and making each person feel important, valued, and respected. Here are some other questions to consider when evaluating your family life:

1. Is there enough humor and fun in your daily lives?
2. Does your family have clearly stated rules and expectations and are these rules flexible and responsive to new situations and changes within the family?
3. Are the personal needs of each family member being met?
4. Do parents and children have genuine respect for one another, demonstrate love, caring, trust, and concern - even when there are disagreements?
5. Is your family able to mature and change without everyone getting upset or unhappy?

NUTRITION

• Your child should consume a variety of foods, including meats, dairy, vegetables, and fruits. This amount of variety is hard to achieve every day, but most kids will accomplish it each week. Unless your child is under/over weight, let them eat in accordance with their own appetites. If your child is a picky eater, or does not eat a lot of meats or vegetables, you may want to consider giving them a daily chewable vitamin with iron.
• Don't make food an area of contention. Children need some control over their own life and parents will usually fail in attempts to control what and how much their children eat. Parents should demonstrate healthy nutrition
• We recommend a daily multivitamin, to ensure adequate Vitamin D for your child.

EXERCISE

• Encourage physical activity. Exercise can improve your child's fitness, make them feel better and strengthens the cardiovascular system. There are many city, county, and private organizations for sports such as swimming, basketball, baseball, soccer, football, gymnastics, and tennis.

SIBLING RIVALRY
Every parent with more than one child has experienced sibling rivalry. As children grow and mature, the rivalry can worsen. Here are some guidelines for parents to help manage sibling rivalry.

1. Be fair.
2. Avoid making comparisons between your children.
3. Encourage children to work out their own differences.
4. Avoid taking sides on sibling conflicts. Be impartial, and do not show a preference for one child or another.
5. Set guidelines on how children can disagree and resolve conflict.
6. Discourage tattling.
7. When it is necessary to punish, do it in a private place.
8. Use regular family meetings for all members to express their thoughts and feelings, as well as to plan the week's events and give positive reinforcement and rewards.

HOMEWORK

• Parents need to help their child develop good homework habits. Choose a regular time and location to work on daily assignments. The location needs to be well lit and quiet, without distraction from the TV, other children playing, or others talking on the telephone.
• There is no absolute right time to do homework. You may have to experiment to see what works best for you and your child. Let your child have some say in this decision. If you can both agree on a regular time and place for homework, you can eliminate much of the homework-related conflicts that occur between parent and child.

TELEVISION

• Parents can control the amount and quality of TV their children watch. Limit television time to a preplanned hour or two daily. Encourage homework and chores to be completed before TV. You can provide alternatives to TV, such as after school sports, hobbies, chores, and family activities. It may be helpful to have your child plan his TV viewing time in advance to avoid conflict. Consult the TV listings - this will also help to monitor the quality of your child's TV viewing. Do not permit TV watching while eating - this habit encourages overeating and interferes with quality family time that may only be possible during the evening meal.

CHADIS- Child Health & Development Interactive System

• Our practice is pleased to announce that we are expanding our use of CHADIS, an interactive online system developed by Johns Hopkins University pediatric specialists, which screens for developmental, social, emotional and behavioral problems.
• his system allows the child's caregivers to provide more in-depth observations of their child to the child's health care providers through the use of confidential online questionnaires. Done prior to the office visit, the information you provide will help in the early identification and treatment of these important issues.
• The use of pre-visit questionnaires like CHADIS is supported by the American Academy of Pediatrics.

We are currently using the CHADIS system for all check-up visits and all behavior visits. For this tool to be successful, we need your help by completing these brief questionnaires a few days prior to your office visit. Please follow these instructions:

1. Go online to http://www.chadis.com and register your child.
2. The "invitation code " for our office is our phone number 3018692292. Create your password.
3. For checkups , when asked visit type, choose "well child/checkup visit." You will see the age appropriate tests for your child. Select "begin" and complete all the questionnaires listed. It is normal for some of the questions to seem too mature for your child.

Your provider will discuss the results at the check-up or behavioral visit. We appreciate your participation as it helps us provide your child with the best care possible.

We recommend yearly check ups.

INFORMATION FOR PARENTS OF ADOLESCENTS

PHYSICAL GROWTH

• Physical growth during puberty is very impressive. During the year of greatest growth, a boy will grow about four inches and by the time his growth spurt is over, he will be about eight inches taller! Females will grow about three inches during their peak years; however, the rate of growth for girls slows significantly after menstruation begins. By the end of puberty the average boy will have gained about forty pounds and the average girl about twenty-five pounds.

NUTRITION

• To support this dramatic growth during puberty, the body requires increased calories, protein, vitamins, and fat. Boys require about 2,800 to 3,000 calories per day during puberty and girls, about 2,400 calories per day. Unless your adolescent is under/over weight, let them eat in accordance with their own appetites. Here are some specific guidelines:
• Your child should consume a variety of foods, including meats, dairy, vegetables, and fruits. This amount of variety is hard to achieve every day, but most kids will accomplish it each week.
• Iron: Adolescents need about 18 mg of iron daily. Boys need iron for muscle development and girls particularly need iron to replace what is lost through menses. Foods high in iron include red meats, green vegetables, iron fortified cereals, peanut butter and dried fruits.
• Don't make food an area of contention. Children need some control over their own life and parents will usually fail in attempts to control what and how much their children eat. Parents should demonstrate healthy nutrition by both buying and eating right. Lead by example!
• We recommend a daily multivitamin, to ensure adequate Vitamin D for your child.