Back-to-School Anxiety

The new school year is upon us.  Kids have already started returning to school and many of them may be experiencing some type of back-to-school anxiety.  Younger kids may be anxious about leaving their parents.  Teenagers may be more anxious about academic performance or social pressures.  This year, with the pandemic still in full swing, and many schools going back to in-person learning for the first time in over a year, many more students are likely to be anxious about the return to school.  Let's talk about some ways that you can recognize their anxiety and how you can help them deal with it.

According to the Centers for Disease Control and Prevention (CDC) prior to the pandemic, about 7.1% of children aged 3-17 were diagnosed with some type of anxiety.  The prevalence of anxiety and related mental health issues has increased worldwide since the start of the COVID-19 pandemic for both children and adults.   

What challenges could your child face this school year?

• Anxiety about health and the future – Children pick up on more than you might realize.  As COVID-19 and the Delta variant continue to spread, students may be worried about their own health or the health of a loved one or friend.
• Rusty social skills – With less social interactions during the pandemic due to virtual learning, kids are out of practice when it comes to connecting with peers.  
• Grief – Some students have lost loved ones to COVID-19.  Others have family members who have recovered from COVID-19 but are dealing with residual effects.  
• Bullying and peer pressure – While this is not a new cause for anxiety, there may be new aspects to it.  For instance, wearing a mask may become a social divider among students.  In situations where not all students choose to wear a mask, students who will wear a mask to school may worry that they will be bullied because of the mask.
• Fear of failure – Some kids may worry that they fell behind their peers over the past 18 months.

What should you look for to determine if your child may be anxious about getting back to school?

Not all children or teens will have the same visible signs of stress or anxiety.  Here are some common changes that you might notice in your child:

• Excessive crying or irritability, or increase in defiant behaviors
• Returning to behaviors they have outgrown, such as bedwetting or toileting accidents
• Sleep disturbances, such as insomnia or nightmares
• Lower energy level
• Loss of appetite
• Frequent headaches, stomach aches, or other unexplained physical symptoms
• Avoiding or losing interest in activities they have enjoyed in the past
• Refusing to go to school, skipping school in older children, or poor academic performance
• In older children or teens, use of alcohol, tobacco, or other drugs

How can you support your child if they are anxious about returning to school in person?

Children and teens do look to adults, especially their parents, and react based on how adults are coping.  When adults deal with COVID-19 in a calm and confident way, children see that and are comforted by it.  Here are some other things that you can do to help your child:

• Talk with your child openly about COVID-19 and answer their questions about the pandemic in a way that they can understand, depending on their age.
• Validate their feeling and listen to their concerns.  Rather than saying "There's no reason to be worried.", you might start a conversation by saying "I understand that you're worried about [whatever it might be].  What is it that worries you most?."  
• Focus on things that they can control.  We all get more stressed when things seem out of our control.  For instance, you might talk with them about washing their hands, or wearing a mask at school as a way of controlling their environment.  Or if they have social worries, you might focus on ways they can be kind to others or ways to make new friends or rekindle old friendships that have suffered from the time away from each other.
• Teach them healthy ways to cope with stress.   Learning good coping strategies during childhood and adolescence will serve them well for the rest of their life.
• Try to keep up regular routines, especially getting back to a good sleep routine that allows them the recommended amount of sleep for their age.  If you are still doing remote learning (or return to it), create a schedule for learning with plenty of breaks for exercise or fun activities.
• Limit exposure to the news or social media.  If children do hear news coverage about the pandemic, talk with them to be sure they were not frightened by it or did not misinterpret it.
• Make the time to enjoy meaningful activities with your children regularly, such as playing board games, exercising, reading together, or spending time together outdoors in nature.
• Be a role model for them.  Take care of your own mental health in ways that are visible to your child, such as exercising, eating healthy foods, getting plenty of sleep, taking breaks from work, and keeping in contact with your friends and family.

Here are some helpful resources that you might find useful:

NIMH: Getting to Know Your Brain: Dealing with Stress (nih.gov)

NIMH: Guided Visualization: Dealing with Stress (nih.gov)

NIMH: Stand Up to Stress! (nih.gov)

NIMH: Stress Catcher (nih.gov) 

Families & Children | CDC

pediatricsleepdurationconsensus.pdf (aasm.org)

If you have any questions about back-to-school anxiety, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

How Children Benefit from Learning in Nature

Last week we talked about the benefits of spending time in nature.  While we focused more on the benefits that adults see, children have even more benefits when they spend time in a natural environment.  They particularly benefit when they are learning outdoors in nature, instead of spending most of the school day indoors in a classroom.  Let's talk more about it.

What are "forest" or "nature" schools?

In Scandinavian countries, there is a long tradition of "forest schools" for younger children.  This essentially means that a majority of the learning throughout the school day, and school year, takes place outdoors, in natural settings.  Children in this type of school spend almost all of their school day outdoors.  They are outdoors no matter the season and sometimes in less than ideal weather.  There is a Scandinavian saying that essentially means "There is no bad weather, just bad clothing."  

In the US, there is a movement to bring more learning outdoors for children.  Preschools that are primarily outdoors have been called "nature schools" and they are popping up all over the country.  With the outdoors as their classroom, children use natural materials to learn math, art, music, literacy, and of course science.  These schools also embrace the idea that there is no such thing as bad weather!  They appreciate that dealing with changing weather helps children to develop resiliency.  When kids are dressed appropriately for the weather, they enjoy rain, snow, and mud just as much as they enjoy sunshine!  Of course, they don't stay out in dangerous weather.  

Elementary schools around the country are also trying to incorporate more outdoor natural environment learning.  This can be done by improving the natural areas around a school, including the playground, and holding classes outdoors in these areas, and by going on field trips to natural environments more frequently.  

How do children benefit from spending time in nature?

There are numerous benefits for children when they spend time in nature and more specifically when they learn in nature.  Here are some of the benefits:

• Nature exposure for expectant mothers can promote better fetal growth for healthier birth weights.  This gets children off to a healthier start.
• Time spent in natural sunlight when children are young can reduce the development of nearsightedness.  
• Exposure to sunlight also increases vitamin D levels, which is important for growing bones.
• Outdoor play in nature leads to increased physical activity and reduces the risk of obesity.
• Learning in nature can improve relationship skills.
• Nature-based learning can reduce stress, anger, and aggression, and improves impulse control.
• Children with ADD or ADHD show increased focus and attention and decreased overall symptoms of ADD or ADHD when learning in nature.  The greener the setting, the better the focus.
• Exploration and discovery through outdoor experiences in nature can promote a child's motivation to learn by increasing enthusiasm for learning and improving engagement.  
• Learning in a natural environment can lead to better academic performance, across all subjects.
• Nature-based learning also enhances critical thinking, and problem-solving skills.  
• It supports and encourages kids' natural curiosity about the world around them.
• Learning in a natural environment enhances creativity.
• Learning in nature helps children to develop empathy for others.
• Children also develop a better sense of community and learn to care for the world around them.
• Children learn resilience by dealing with different types of weather and other obstacles present in nature.

If you have small children, or grandchildren, you might want to do some outdoor learning with them.  You might also want to speak to their teacher or school principal about increasing the amount of outdoor learning. 

If you have any questions about the benefits of outdoor learning, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

The Benefits of Spending Time in Nature

With our modern lifestyle, we spend most of our time indoors.  In fact, on average, Americans spend nearly 93% of their time indoors.  I think people seem to know instinctively that spending time outdoors in nature is a good thing, but can we prove it?  Over the last 20 years, there have been about 1000 different research studies that do just that.  They show how important it is for us to spend time in nature.  Time spent in nature (as long as you feel safe) benefits us both physically and mentally.  It benefits people of all ages.  Let's talk about how nature can help us live a more healthy and happy life.

What are the physical benefits of spending time in nature?

Your risk of heart disease, stroke, and even cancer can be lowered by spending time in nature.  This happens because spending time in nature can:

• Lower blood pressure
• Lower levels of stress hormones
• Lower heart rate
• Increase Vitamin D levels
• Improve immune system function
• Reduce nervous system arousal
• Improve the rate of healing
• Reduce muscle tension
• Reduce chronic pain

What are the psychological benefits of spending time in nature?

Nature provides many benefits mentally and emotionally.  Here are a few:

• Improves concentration and memory
• Improves creative thinking
• Enhances relaxation
• Enhances the sense of well-being
• Reduces aggression
• Reduces the amount of time you spend dwelling on negative issues
• Reduces anxiety
• Results in a sense of belonging to the wider world, which is vital for mental health
• Improves personal relationships by improving feelings/behaviors of generosity and empathy
• Improves depression - If your depression is serious, you should see a mental health professional, in addition to spending time in nature.

How much time do you need to spend in nature to see a benefit?

This can vary from one person to the next, but studies indicate that 120 minutes a week is the magic number.  According to the research, most people have a noticeable change in measurable outcomes (like blood pressure and pulse rate) within 10 minutes of being in nature.  But to see those benefits follow you back home, it looks like 120 minutes a week is the goal you should be trying to achieve.  

Two hours may seem like a lot, but when you consider that you can spread that 120 minutes over the entire week, I think that is goal we can reach.  That is less than 18 minutes a day.  You might want to shoot for 10-12 minutes a day during the week, then make up the other time on the weekend days.  

Remember that 120 minutes is the low end of the goal.  If you can spend 4-5 hours a week in nature, that is even better!

Just what counts as being in nature?  

Some of the benefit comes from the activity that we tend to do in natural settings, such as walking, hiking, biking, etc., but it doesn't take much activity to see benefits.  Just being in nature, just sitting there surrounded by the natural world, provides great benefit.  This is true during all seasons of the year.  It does not have to be the perfect summer day.

You may be thinking that "nature" is not close enough for you to get to it every day.  Can I just watch a nature video?  However, it is not just a visual thing.  It is the combination of the shade of the trees, the sounds of the birds and the wind in the trees, the array of colors, particularly green, the smells of wood and flowers and even dirt, the sunlight on your skin, the wind blowing on your skin and through your hair, and the disconnecting from the devices, that all come together to cause these wonderful health benefits.  Of course, if you cannot get out in nature, having a view of trees from your window, or watching a nature video can provide some benefit.  But nothing beats the real thing!

You can get these benefits by taking a walk in a local city park, preferably one with plenty of trees.  Maybe there is a walking trail in your area that goes through some green spaces.  If you have trees in your yard, have a picnic under the trees.  If there is a state park where you can go for a hike on the weekend, that is even better.  

Take the kids, leave the phones at home (maybe bring one in case of an emergency that is turned off unless you need it) and let nature help you live a happier, healthier life.

If you have any questions about the benefits of spending time in nature, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Snake Bites: Fact vs. Fiction

In the United States, thousands of venomous snakebites occur each year.  Because reporting of snakebites is not mandated, the exact numbers are difficult to determine.  This time of year, many of us enjoy activities like hiking and camping, which can put us in a snake's natural habitat and that increases our likelihood of having a dangerous run-in with one.  After a natural disaster, such as a flood or a forest fire, snakes may have been forced from their natural habitats into areas where you would not expect to see them.  

There are numerous myths and misconceptions about snakebites and how to respond to them.  Let's talk about what you need to know about snakebites to keep you safe.  

First let's talk about the basics.

Most snakes are not dangerous to humans.  Only about 20% of snakes in the US are venomous.  These venomous snakes include the rattlesnake, water moccasin (also called a cottonmouth), copperhead, and coral snake.  A bite from one of these snakes can cause severe injuries and sometimes death, but not always.  About 25-30% of venomous snakebites are dry, meaning there is no venom deposited with the bite.  It is always best to treat all snakebites as a medical emergency unless you are absolutely certain that the bite came from a non-venomous snake.  Any delay in treatment following a venomous snakebite could result in death or serious injury.

What are the symptoms of a snake bite?

Sometimes you may feel a bite or stinging sensation but not see what bit you.  You may think it is another kind of bite or scratch.  If you are in an area where snakes might be present, you should be suspicious.  The symptoms of a snakebite can differ depending on what type of bite it is.  A dry snakebite will usually just cause some mild redness and swelling around the bite.  A venomous snakebite can cause widespread symptoms that can include:

• Bite marks on the skin, which may be puncture wounds or smaller marks that may not look like a snakebite.  These are usually on arms or legs as this is the most common place for a snakebite.
• Pain around the bite, which may not start right away.  Pain can be sharp, throbbing, or burning.  Pain may progress to involve the entire limb that was bitten.  Keep in mind that not all snakebites cause pain, particularly the bite from a coral snake can be almost painless at first.
• Redness, swelling, bruising, in the area of the bite, which can progress to severe tissue damage.
• Low blood pressure, a faster heart rate, or a weaker pulse.
• Nausea and vomiting, headaches, dizziness, blurred vision.
• Increased sweating and increased saliva production.
• Difficulty breathing.
• Weakness, numbness, or tingling in the face or extremities.
• Abnormal blood clotting or bleeding.

Some people have an allergic reaction to a snakebite.  This would cause additional symptoms, including:

• Tightness in the throat and/or tongue swelling, which may cause difficulty speaking.
• Coughing or wheezing, with difficulty breathing.
• Significant paleness.

What should you do if you or someone with you is bitten by a snake?

Get immediate medical attention.  This is the first and most important thing to do.  Call 911 or get to an emergency room as soon as possible.  Even if the bite isn't painful, it could be life-threatening.  Here are some other things that you can do:

• Move out of the snake's striking distance.
• Remove jewelry such as rings or watches and any tight clothing before swelling starts.
• Try to remain calm.  Do some slow deep breathing to calm yourself.
• Lie down and be still without unnecessary movement, with the area of the bite either at or below the level of the heart.
• If possible, clean the area with soap and water and cover it with a clean, dry dressing.
• Try to remember what the snake looked like, including color, size, shape,  and markings, so that you can describe it to medical providers.  You can even try to take a picture of it from a safe distance, but only if that will not delay your treatment.

What should you NOT do?  

There are a number of myths or old wives' tales about how to respond to a snakebite that are not only not helpful, but they can also be harmful.  

• DO NOT use a tourniquet of any kind.
• DO NOT cut the wound or try to remove venom in any way.  DO NOT use any type of suction.
• DO NOT apply ice or put the bitten area in an ice bath or in water.
• DO NOT try to capture or kill the snake.  First, this can delay your treatment.  Second, it might result in a second bite either to you or those with you.  Third, even dead snakes can cause a "bite" that injects venom.
• DO NOT drink caffeine or alcohol, which might speed your body's absorption of venom.

How can you prevent a snakebite?

• Wear boots and long, loose-fitting pants when hiking or in snake-prone areas.
• Stay on trails when hiking, away from tall weeds and underbrush.
• DO NOT touch or disturb a snake, even if it looks like it is dead.
• Always look for a concealed snake before picking up rocks, sticks, or firewood.
• Do not hike alone in remote areas.  Having a hiking partner is important to help in a crisis.
• Teach children to respect snakes and to leave them alone.

If you have any questions about snake bites, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor