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8 YEAR CHECK-UP

GROWTH

  • Your eight-year-old is probably growing about 2 inches and gaining about 6 pounds in a year.

DISCUSSING SEXUALITY
The earlier parents begin talking with their child about sex, the better for everyone. The best place for children to learn about sexuality is from their parents. If parents do not talk about sexual issues with their child, the child could possibly pick up inaccurate information from other children, TV, songs, or magazines.
-Usually the information that parents give can be guided primarily by the questions a child asks. Answer your child with clear, short, straightforward explanations. Follow up your responses with "Does that answer your question?" If questions are not asked by your child, use "teachable moments" from everyday life to discuss sexually related topics, such as:

  1. Pregnancy or birth of a baby in the neighborhood;
  2. Issues that occur during television viewing;
  3. Words that children may have heard that have sexual overtones; and
  4. Sexual behavior of pets or animals that your child has observed.

DISCIPLINE
With older children, it is possible to use a slightly more complicated behavior modification program called the "ABC" system:

  • A: Antecedent events or activities that usually proceed or contribute to the behavior (for example, dinnertime).
  • B: Behavior that is problematic: Parents need to clearly identify the behavior that needs changing (for example, fighting with a sibling) and note its frequency, duration, and intensity.
  • C: Consequences of the child's behavior: The emotional and behavioral responses that the behavior causes in others.

Step 1: Describe A, B, and C and write down - be specific.
Step 2: Initiate program that will eliminate, reduce or change the conditions in A. Step 3: Clearly state the agreed upon changes and expectations for B, including
a time frame.
Step 4: Change C by either ignoring the negative behavior or reinforcing any positive change in behavior by providing rewards that were previously decided.
Step 5: Review any changes in the behavior (frequency, duration, intensity) and compare to original measures to determine the success of the program. Repeat Steps 1-5 as needed.

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 by both buying and eating right. Lead by example!
  • 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.


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.

PUBERTAL BODY CHANGES

  • Teenagers are often very preoccupied with their physical appearance, and whether or not they are "normal." Every child will go through stages of physical development - often called Tanner Stages or Sex Maturity Rating Stages. In females, this development begins with the appearance of breast buds between the ages of 8 and 13. As the breasts grow, pubic hair will begin to appear on the inner borders of the labia. Females will experience very rapid growth, shooting up about three inches within several months! This is a good time to discuss menstruation and feminine hygiene with your teenager. Explain to her how to use a pad or tampon. Reassure her that she will be able to participate in sports and other activities and encourage her to ask any questions she may have. Menstruation usually begins in girls between 12-16 years of age.
  • Boys are as concerned as girls about their bodies. The first indications of puberty are a slight enlargement of the penis and scrotum, accompanied by the appearance of pubic hairs. Boys will grow about four inches during their year of most rapid growth, which is usually 2 years after pubic hair begins. Boys add fat before growing taller, then lose that fat and grow taller, giving them the appearance of being too thin. Usually boys will gain weight after their peak height spurt is over. Expect a significant increase in appetite. Soon they will develop muscle, their strength will increase, and they will "fill out."

PSYCHOLOGICAL DEVELOPMENT

  • Not only do many obvious physical changes occur during adolescence, but also cognitive capabilities expand and thinking eventually becomes more adult like. Teens begin to analyze the world around them and compare their values with others. As a result, they may raise questions about your beliefs, become critical of household rules, and challenge your authority. This is all normal and part of the maturing process. However, keep in mind that while they are rebelling, it is your responsibility to set appropriate limits.

DISCIPLINE

  • Early adolescents are striving for freedom, testing limits, and rejecting parental values. These youngsters also tend to be messy, have poor hygiene, don't complete assigned jobs, persist in irritating younger siblings, and seem dumbfounded if they are criticized or forced to do something. Even so, while you must tolerate their behavior to a certain extent, parents must impose limits and standards, and enforce them - within reason. Discipline is one of the best ways to show your love! For more information please go to Disciplining Older Children from the American Academy of Pediatrics. This is available for copying at the front desk.

CHALLENGES AND REWARDS
Early adolescence is a time when your teenager will experience many changes - both physical and psychological. Here is a partial list of challenges that all parents of teenagers may experience.

  1. Prepare for change. When a child enters puberty, it may seem like a stranger has come to live in your house, and a new relationship must be established.
  2. Prepare to be tested. Adolescents have a strong urge for independence and they will test their parents to determine the limits placed on them.
  3. Prepare for rejection. Most teenagers have a period when they temporarily reject one or both parents. Adolescents often need to determine if they can function on their own, without parental guidance.
  4. Prepare to be flexible. Teenagers should be permitted to test, explore, and communicate within limits. Show some tolerance of their striving for independence while retaining control over how far they can go. Research shows that once more maturation occurs, the adolescent's value system usually will closely parallel their parents' beliefs - so don't be too anxious about unusual clothing and hairstyles.

DISCUSSING SEX

  • Sexual intercourse among adolescents is not uncommon. By age 17, slightly more than half of all American adolescents have had sex at least once. It is very important for parents to discuss sex with their children. For girls, a good time to talk about sexual intercourse, pregnancy, and sexually transmitted diseases is when they experience their first period. How you talk about sex with your teenager depends on your own value system. Please consult some of the books listed in the bibliography.

ALCOHOL AND DRUGS
The majority of teenagers will have experimented with marijuana, alcohol and/or tobacco by the time they leave high school. Parents need to be aware of certain behavioral changes which may indicate a drug or alcohol problem.

  1. Excessive time spent alone.
  2. A decrease in family communication, frequent arguing, unusual secretiveness.
  3. Changes in the way they dress or groom.
  4. Deteriorating grades.
  5. A change in friends.
  6. Repeated or unexplained accidents or fights.
  7. Poor sleeping habits, sluggish behavior, and a lack of energy.
  8. Blood shot eyes.
  9. Mood changes, including irritability and depression.


We recommend yearly check ups. 

Contact Us

Pediatric & Adolescent Care, P.A.

(301) 869-2292
903 Russell Avenue, Suite 301 Gaithersburg, MD 20879