How do you keep a 1-year-old from heading toward the VCR? What should you do when your preschooler throws a fit? How can you get a teenager to respect your authority?
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Whatever the age of your child, it's important to be consistent when it comes to discipline. If you don't stick to the rules and consequences that you set up, your child isn't likely to either.
Here are some ideas about how to vary your approach to discipline to best fit your family.
Ages 0 to 2
Babies and toddlers are naturally curious. So it's wise to eliminate temptations and no-nos — items such as VCRs, stereos, jewelry, and especially cleaning supplies and medications should be kept well out of reach. When your crawling baby or roving toddler heads toward an unacceptable or dangerous play object, calmly say "No" and either remove your child from the area or distract him or her with an appropriate activity.
Timeouts can be effective discipline for toddlers. A child who has been hitting, biting, or throwing food, for example, should be told why that behavior is unacceptable and taken to a designated timeout area — a kitchen chair or bottom stair — for a minute or two to calm down (longer timeouts are not effective for toddlers).
It's important to not spank, hit, or slap a child of any age. Babies and toddlers are especially unlikely to be able to make any connection between their behavior and physical punishment. They will only feel the pain of the hit.
And don't forget that kids learn by watching adults, particularly their parents. Make sure your behavior is role-model material. You'll make a much stronger impression by putting your own belongings away rather than just issuing orders to your child to pick up toys while your stuff is left strewn around.
Ages 3 to 5
As your child grows and begins to understand the connection between actions and consequences, make sure you start communicating the rules of your family's home. Explain to kids what you expect of them before you punish them for a certain behavior. For instance, the first time your 3-year-old uses crayons to decorate the living room wall, discuss why that's not allowed and what will happen if your child does it again (for instance, your child will have to help clean the wall and will not be able to use the crayons for the rest of the day). If the wall gets decorated again a few days later, issue a reminder that crayons are for paper only and then enforce the consequences.
The earlier that parents establish this kind of "I set the rules and you're expected to listen or accept the consequences" standard, the better for everyone. Although it's sometimes easier for parents to ignore occasional bad behavior or not follow through on some threatened punishment, this sets a bad precedent. Consistency is the key to effective discipline, and it's important for parents to decide together what the rules are and then uphold them.
While you become clear on what behaviors will be punished, don't forget to reward good behaviors. Don't underestimate the positive effect that your praise can have — discipline is not just about punishment but also about recognizing good behavior. For example, saying "I'm proud of you for sharing your toys at playgroup" is usually more effective than punishing a child for the opposite behavior — not sharing. And be specific when doling out praise; don't just say, "Good job!"
If your child continues an unacceptable behavior no matter what you do, try making a chart with a box for each day of the week. Decide how many times your child misbehave before some punishment kicks in or how long the proper behavior must be displayed before it is rewarded. Post the chart on the refrigerator and then track the good and bad behaviors every day. This will give your child (and you) a concrete look at how it's going. Once this begins to work, praise your child for learning to control misbehavior and, especially, for overcoming any stubborn problem.
Timeouts also can work well for kids at this age. Establish a suitable timeout place that's free of distractions and will force your child to think about how he or she has behaved. Remember, getting sent to your room may have meant something in the days before computers, TVs, and video games were stored there. Don't forget to consider the length of time that will best suit your child. Experts say 1 minute for each year of age is a good rule of thumb; others recommend using the timeout until the child is calmed down (to teach self-regulation).
It's important to tell kids what the right thing to do is, not just to say what the wrong thing is. For example, instead of saying "Don't jump on the couch," try "Please sit on the furniture and put your feet on the floor."
Ages 6 to 8
Timeouts and consequences are also effective discipline strategies for this age group.
Again, consistency is crucial, as is follow-through. Make good on any promises of discipline or else you risk undermining your authority. Kids have to believe that you mean what you say. This is not to say you can't give second chances or allow a certain margin of error, but for the most part, you should act on what you say.
Be careful not to make unrealistic threats of punishment ("Slam that door and you'll never watch TV again!") in anger, since not following through could weaken all your threats. If you threaten to turn the car around and go home if the squabbling in the backseat doesn't stop, make sure you do exactly that. The credibility you'll gain with your kids is much more valuable than a lost beach day.
Huge punishments may take away your power as a parent. If you ground your son or daughter for a month, your child may not feel motivated to change behaviors because everything has already been taken away.
Ages 9 to 12
Kids in this age group — just as with all ages — can be disciplined with natural consequences. As they mature and request more independence and responsibility, teaching them to deal with the consequences of their behavior is an effective and appropriate method of discipline.
For example, if your fifth grader's homework isn't done homework before bedtime, should you make him or her stay up to do it or even lend a hand yourself? Probably not — you'll miss an opportunity to teach a key life lesson. If homework is incomplete, your child will go to school the next day without it and suffer the resulting bad grade.
It's natural for parents to want to rescue kids from mistakes, but in the long run they do kids a favor by letting them fail sometimes. Kids see what behaving improperly can mean, and will probably not make those mistakes again. However, if your child does not seem to be learning from natural consequences, you should set up your own consequences to help modify the behavior more effectively.
Ages 13 and Up
By now you've laid the groundwork. Your child knows what's expected and that you mean what you say about the consequences of bad behavior. Don't let down your guard now — discipline is just as important for teens as it is for younger children. Just like the 4-year-old who needs you to set a bedtime and stick to it, your teen needs to know boundaries, too.
Set up rules regarding homework, visits by friends, curfews, and dating and discuss them beforehand with your teenager so there will be no misunderstandings. Your teen will probably complain from time to time, but also will realize that you're in control. Believe it or not, teens still want and need you to set limits and enforce order in their lives, even as you grant them greater freedom and responsibility.
When your teen does break a rule, taking away privileges may seem the best plan of action. While it's fine to take away the car for a week, for example, be sure to also discuss why coming home an hour past curfew is unacceptable and worrisome.
Remember to give a teenager some control over things. Not only will this limit the number of power struggles you have, it will help your teen respect the decisions that you do need to make for him or her. You could allow a younger teen to make decisions concerning school clothes, hair styles, or even the condition of his or her room. As your teen gets older, that realm of control might be extended to include an occasional relaxed curfew.
It's also important to focus on the positives. For example, have your teen earn a later curfew by demonstrating positive behavior instead of setting an earlier curfew as punishment for irresponsible behavior.
Rabu, 03 Desember 2008
Diet's Impact on Fertility
Diet's Impact on Fertility
Five issues that impact your ability to get pregnant.
By Karen Collins, MS, RD, CDN, American Institute for Cancer Research
Karen Collins (c) AICR.org
More than 15 percent of women may have difficulty becoming pregnant at some point during their lifetime. The term infertility is used when pregnancy does not occur after at least one year of trying. Since infertility affects about 7.3 million couples in the U.S., interest is growing in how diet and lifestyle might affect fertility.
About a third of infertility cases are attributed to the male partner, a third to the female and a third to a combination of both partners (or no cause is found). Male infertility is usually attributed to an insufficient healthy sperm count. Women with infertility can trace their issues to a number of different causes: problems with the structure of the uterus, blocked fallopian tubes or, most often, failure to release healthy eggs.
Several diet and lifestyle issues may also have an effect. Here's a list of the most common:
Weight
A woman's weight can affect her fertility. In fact, weight issues account for about 12 percent of all infertility, according to the American Society for Reproductive Medicine. Too little body fat reduces estrogen levels so much that the reproductive cycle starts to shut down. Too much body fat raises estrogen levels, acting like birth control pills to suppress ovulation (egg release). Obesity is even linked with decreased success of fertility treatments.
And women aren't the only ones whose fertility is threatened by excess weight. Several studies link excess weight in men with decreased semen and increased production of abnormal sperm. Some researchers suggest that eating plenty of vegetables and fruits, which provide antioxidants to prevent damage to sperm, may protect men's fertility. But overall, research results have been very mixed.
Polycystic ovarian syndrome
PCOS is an endocrine disorder and the most common reason for infertility due to lack of ovulation. In women with the disorder, insulin and reproductive hormones are at abnormal levels, and egg production and menstrual cycles often halt. Besides infertility, PCOS is linked with greater risk of developing diabetes, heart disease and some types of cancer. Fortunately, a modest weight loss of about five percent is often enough to normalize hormones and improve fertility. Regular physical activity seems important as well, and a diet that includes more dietary fiber and whole grains may also help.
Anemia
A lack of healthy red blood cells is linked with female infertility, caused by both lack of iron or inadequate vitamin B-12 or folate. Although more research is needed in this area, women can avoid most anemias through a healthy diet. To start, make sure to get enough folate by eating plenty of vegetables, beans and grains–both whole grains and enriched grains. If you don't eat animal products (including dairy) make sure to get adequate vitamin B-12 from fortified foods or supplements.
Diet
Overall balanced eating habits may also help with infertility. One large study involving over 17,000 nurses reported that women who follow healthy eating practices experienced up to 66 percent lower risk of infertility due to ovulation problems. The women who benefitted had a diet high in healthy monounsaturated fat (found in olive oil and nuts, for example), low in trans fat and rich in vegetable-based protein and whole-grain foods. These eating habits may help by promoting normal insulin levels and by providing a variety of antioxidants that could promote and protect pregnancy.
Tobacco
Tobacco use threatens both male and female fertility. It makes a woman's eggs more prone to genetic abnormalities and has been linked with abnormal sperm, decreased sperm and impaired sperm movement. Nicotine and other chemicals can also affect ovulation by decreasing estrogen.
One note of caution: We must be careful when interpreting results from many of these studies, since observational data can only speak to associations between various diet and lifestyle choices and fertility, not causation.
Find more from Karen Collins.
Five issues that impact your ability to get pregnant.
By Karen Collins, MS, RD, CDN, American Institute for Cancer Research
Karen Collins (c) AICR.org
More than 15 percent of women may have difficulty becoming pregnant at some point during their lifetime. The term infertility is used when pregnancy does not occur after at least one year of trying. Since infertility affects about 7.3 million couples in the U.S., interest is growing in how diet and lifestyle might affect fertility.
About a third of infertility cases are attributed to the male partner, a third to the female and a third to a combination of both partners (or no cause is found). Male infertility is usually attributed to an insufficient healthy sperm count. Women with infertility can trace their issues to a number of different causes: problems with the structure of the uterus, blocked fallopian tubes or, most often, failure to release healthy eggs.
Several diet and lifestyle issues may also have an effect. Here's a list of the most common:
Weight
A woman's weight can affect her fertility. In fact, weight issues account for about 12 percent of all infertility, according to the American Society for Reproductive Medicine. Too little body fat reduces estrogen levels so much that the reproductive cycle starts to shut down. Too much body fat raises estrogen levels, acting like birth control pills to suppress ovulation (egg release). Obesity is even linked with decreased success of fertility treatments.
And women aren't the only ones whose fertility is threatened by excess weight. Several studies link excess weight in men with decreased semen and increased production of abnormal sperm. Some researchers suggest that eating plenty of vegetables and fruits, which provide antioxidants to prevent damage to sperm, may protect men's fertility. But overall, research results have been very mixed.
Polycystic ovarian syndrome
PCOS is an endocrine disorder and the most common reason for infertility due to lack of ovulation. In women with the disorder, insulin and reproductive hormones are at abnormal levels, and egg production and menstrual cycles often halt. Besides infertility, PCOS is linked with greater risk of developing diabetes, heart disease and some types of cancer. Fortunately, a modest weight loss of about five percent is often enough to normalize hormones and improve fertility. Regular physical activity seems important as well, and a diet that includes more dietary fiber and whole grains may also help.
Anemia
A lack of healthy red blood cells is linked with female infertility, caused by both lack of iron or inadequate vitamin B-12 or folate. Although more research is needed in this area, women can avoid most anemias through a healthy diet. To start, make sure to get enough folate by eating plenty of vegetables, beans and grains–both whole grains and enriched grains. If you don't eat animal products (including dairy) make sure to get adequate vitamin B-12 from fortified foods or supplements.
Diet
Overall balanced eating habits may also help with infertility. One large study involving over 17,000 nurses reported that women who follow healthy eating practices experienced up to 66 percent lower risk of infertility due to ovulation problems. The women who benefitted had a diet high in healthy monounsaturated fat (found in olive oil and nuts, for example), low in trans fat and rich in vegetable-based protein and whole-grain foods. These eating habits may help by promoting normal insulin levels and by providing a variety of antioxidants that could promote and protect pregnancy.
Tobacco
Tobacco use threatens both male and female fertility. It makes a woman's eggs more prone to genetic abnormalities and has been linked with abnormal sperm, decreased sperm and impaired sperm movement. Nicotine and other chemicals can also affect ovulation by decreasing estrogen.
One note of caution: We must be careful when interpreting results from many of these studies, since observational data can only speak to associations between various diet and lifestyle choices and fertility, not causation.
Find more from Karen Collins.
Study Warns of Risk From Cardiac Surgery Drug
Another Study Warns of Risk From Cardiac Surgery Drug
Patients given Trasylol have a higher death risk, data review finds
-- Robert Preidt
Patients given Trasylol have a higher death risk, data review finds.
TUESDAY, Dec. 2 (HealthDay News) -- A new study casts more doubt on the safety of the drug Trasylol (aprotinin), used to limit bleeding in patients undergoing surgery.
Trasylol is already the subject of controversy in the United States, where it was removed from the market in 2007.
In the new study, Canadian and Australian researchers reviewed findings from 49 randomized clinical trials. They concluded that Trasylol posed a higher risk of death for patients than other anti-bleeding drugs, called lysine analogues.
While Trasylol was somewhat more effective at controlling blood loss and transfusions than lysine analogues, its higher risk of death and significantly higher price are deterrents to its use, said the authors. They recommended tranexamic acid or aminocaproic acid as alternatives to prevent blood loss during surgery.
"Lysine analogues are almost as effective as aprotinin in controlling blood loss, are cheaper, and appear not to increase mortality," concluded Dr. David Henry and his co-authors of the study, which will be published in the Jan. 20 issue of the Canadian Medical Association Journal.
The findings were released early in advance of a Health Canada expert advisory panel meeting scheduled for Wednesday. The panel is expected to make a decision about the use of aprotinin.
The review included new information from the Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART) study published by the New England Journal of Medicine earlier this year. That study found that patients treated with aprotinin were 53 percent more likely to die than those treated with two similar drugs, Cyklokapron (tranexamic acid) and Amicar (aminocaproic acid). The death rates were 6 percent, 3.9 percent and 4 percent, respectively.
Due to the significant risk of death associated with Trasylol, the BART study was stopped in October 2007, before the schedule completion date.
In November 2007, Trasylol manufacturer Bayer AG suspended the drug's marketing in the United States after the preliminary results from the BART trial were released. Bayer removed all remaining stocks of the drug from the U.S. market earlier this year. However, the German drug maker continues to sell Trasylol in some areas of the world.
Trasylol has been on the market since 1987 and widely used. At the time of the BART study's release, one expert questioned why the truth about the dangers of the drug took so long to come out and how many patients may have died "because of this misadventure in therapeutics?"
"Did the clinical community accept it too readily? Was the manufacturer not willing to do the appropriate trials?" asked Dr. Eric J. Topol, director of the Scripps Translational Science Institute and dean of the Scripps School of Medicine.
The U.S. Food and Drug Administration is high on the blame list, Topol told HealthDay.
"The FDA has to be considered part of the problem," he said. "Why weren't trials like this part of the early approval process, rather than getting the data many years later?"
More information
The U.S. National Heart, Lung, and Blood Institute has more about coronary artery bypass surgery.
Canadian Medical Association Journal, news release, Dec. 2, 2008
Patients given Trasylol have a higher death risk, data review finds
-- Robert Preidt
Patients given Trasylol have a higher death risk, data review finds.
TUESDAY, Dec. 2 (HealthDay News) -- A new study casts more doubt on the safety of the drug Trasylol (aprotinin), used to limit bleeding in patients undergoing surgery.
Trasylol is already the subject of controversy in the United States, where it was removed from the market in 2007.
In the new study, Canadian and Australian researchers reviewed findings from 49 randomized clinical trials. They concluded that Trasylol posed a higher risk of death for patients than other anti-bleeding drugs, called lysine analogues.
While Trasylol was somewhat more effective at controlling blood loss and transfusions than lysine analogues, its higher risk of death and significantly higher price are deterrents to its use, said the authors. They recommended tranexamic acid or aminocaproic acid as alternatives to prevent blood loss during surgery.
"Lysine analogues are almost as effective as aprotinin in controlling blood loss, are cheaper, and appear not to increase mortality," concluded Dr. David Henry and his co-authors of the study, which will be published in the Jan. 20 issue of the Canadian Medical Association Journal.
The findings were released early in advance of a Health Canada expert advisory panel meeting scheduled for Wednesday. The panel is expected to make a decision about the use of aprotinin.
The review included new information from the Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART) study published by the New England Journal of Medicine earlier this year. That study found that patients treated with aprotinin were 53 percent more likely to die than those treated with two similar drugs, Cyklokapron (tranexamic acid) and Amicar (aminocaproic acid). The death rates were 6 percent, 3.9 percent and 4 percent, respectively.
Due to the significant risk of death associated with Trasylol, the BART study was stopped in October 2007, before the schedule completion date.
In November 2007, Trasylol manufacturer Bayer AG suspended the drug's marketing in the United States after the preliminary results from the BART trial were released. Bayer removed all remaining stocks of the drug from the U.S. market earlier this year. However, the German drug maker continues to sell Trasylol in some areas of the world.
Trasylol has been on the market since 1987 and widely used. At the time of the BART study's release, one expert questioned why the truth about the dangers of the drug took so long to come out and how many patients may have died "because of this misadventure in therapeutics?"
"Did the clinical community accept it too readily? Was the manufacturer not willing to do the appropriate trials?" asked Dr. Eric J. Topol, director of the Scripps Translational Science Institute and dean of the Scripps School of Medicine.
The U.S. Food and Drug Administration is high on the blame list, Topol told HealthDay.
"The FDA has to be considered part of the problem," he said. "Why weren't trials like this part of the early approval process, rather than getting the data many years later?"
More information
The U.S. National Heart, Lung, and Blood Institute has more about coronary artery bypass surgery.
Canadian Medical Association Journal, news release, Dec. 2, 2008
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