Skills children need to succeed in life — and getting youngsters started

All parents want their children to be successful in life — and by successful, we mean not just having a good job and a good income, but also being happy. And all parents wonder how they can make that happen.

According to Harvard’s Center on the Developing Child, it’s less about grades and extracurricular activities, and more about a core set of skills that help children navigate life’s challenges as they grow. These skills all fall under what we call executive function skills that we use for self-regulation. Developing strong executive function skills, and finding ways to strengthen those skills, can help people feel successful and happy in life.

What are five important core skills?

  • Planning: being able to make and carry out concrete goals and plans
  • Focus: the ability to concentrate on what’s important at a given time
  • Self-control: controlling how we respond to not just our emotions but stressful situations
  • Awareness: not just noticing the people and situations around us, but also understanding how we fit in
  • Flexibility: the ability to adapt to changing situations.

While these are skills that children (and adults) can and do learn throughout their lifetimes, there are two time periods that are particularly important: early childhood (ages 3 to 5) and adolescence/early adulthood (ages 13 to 26). During these windows of opportunity, learning and using these skills can help set children up for success. In this post, we’ll talk about that first window of early childhood.

The best way to learn any skill is by practicing — and we are all more likely to want to practice something if it is fun and we feel motivated. Here are some ways that parents can help their children learn and strengthen executive function skills.

Planning

It’s natural for parents and caregivers to do the planning for young children, but there are absolutely ways to get them involved, such as:

  • Planning the day’s activities with them, whether it be a school day or a play day. Talk about all the day’s tasks, including meals, dressing, bathing, and other things; help them see it as part of a whole, and something that they can help manage.
  • Cook or bake something together. Put together the shopping list, go shopping, go over the recipe together, and help them understand all the steps.
  • When getting ready for a holiday or a party, include them in thinking about what everyone would like to do and how to do it.

Focus

The explosion of device use has definitely caused all sorts of problems with focus in both children and adults. There is an instant gratification to screens that makes it hard to put them aside and focus on less stimulating tasks. Now, more than ever, it’s important to:

  • Enforce screen-free time, even if they complain (parents need to abide by this too).
  • Have the materials on hand to make or build things. Find projects that will take an hour or two. Do it with them!
  • Read print books out loud together, including chapter books. Having to picture things themselves rather than seeing it on a screen helps children learn to focus.

Self-control

This is one where being mindful of your own reactions to situations is important. How do you react to anger and frustration? Is road rage a problem for you? Remember that children always pay more attention to what we do than what we say. To help your child learn self-control, you can:

  • Talk about feelings, and about strategies for managing strong emotions — like taking a deep breath, stepping away from the situation, screaming into a pillow, etc.
  • Help them understand how their behavior affects others, and why it’s important to be mindful of that (which also teaches awareness).
  • Debrief after tantrums or upsets. What could everyone have done differently?

Awareness

This one can be fun to teach.

  • Go for walks. Visit places together. Listen and watch. Imagine together what people might be doing or thinking.
  • Join community service activities; show children that anyone can make a difference.
  • Have rituals of checking in as a family, like at dinner. Give people a chance to talk about the best and worst parts of their day, and talk about ways you can work better as a family and treat each other well.

Flexibility

We tend to cater to our children and their needs, making our schedules and plans around them. Some of that is pure parenting survival. But ultimately, it’s not always helpful; life has a way of messing up even the most careful plans. Kids need structure, sure, but they also need to be able to adjust to the inevitable curve balls.

  • Don’t always say no to something that might happen during a naptime or mealtime. It’s okay if schedules occasionally vary.
  • Be spontaneous when you can. Go for an unplanned outing, and otherwise make last-minute plans sometimes.
  • When plans change or fall through, be upbeat about it and make the most of it. Be a role model.

In helping your children learn these skills, you might just learn something about yourself — and learn some new skills too.

Follow me on Twitter @drClaire

Do I have to yell so much?

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You’ve been trying to get your point across, but it’s not getting through. It’s getting you frustrated, maybe a little offended, so you go for a different approach.

You yell.

Now, concert-level volume has its place, like for saying, “There’s a bear behind you” or “Power line down.” But the big question is, how often do those situations come up? The answer is, rarely.

Next question: How often do you reach that intensity? “Too often” is that answer. You know that it doesn’t work. It never feels good. It never makes the situation better. You would just like to stop doing it.

It’s good to have that desire, but you need more to make it happen. What helps is to play detective to uncover your triggers, then set reasonable expectations, because underlying the yelling is stress, something that isn’t disappearing. The question, as Dr. Antonia Chronopoulos, clinical psychologist at Massachusetts General Hospital, asks, is “How do you regulate yourself in a tense situation?”

Start with the basics

Before you can stop, it helps to understand why we yell in the first place.

We could be in a debate and feel like we’re not being heard. We take it as an insult, get frustrated, and the brain’s limbic system sees it as a threat and sets off the fight-or-flight response.

Our blood pressure rises, breathing becomes shallow, and muscles tense up. Since our history factors in, we can start making assumptions. Adrenaline makes everything go faster, and our attention narrows. “When we’re in survival mode, we’re not thinking about creative solutions as effectively,” she says. “The prime directive is to defend, escape, or fight.”

It’s also not a solo act. We’re yelling at someone, and our attempt to control the situation triggers that person, setting off the aforementioned emotional and physiological reactions, and possibly creating a shoutfest (which is anything but festive).

And there’s one more part, which gets overlooked: the flight element. If we decide to not yell and end up holding anger in, the same process is still taking place: the tense muscles, shallow breathing, narrow focus. We might not be making a lot of noise, but we’re far from calm or looking to improve the situation. “It’s almost like a freeze response,” Chronopoulos says.

The goal is to find the middle ground: not fighting, not flighting, and where you can be more in tune with the other person.

How you get there

It’s not impossible to calm down while yelling. You can find a way to break the dynamic with deep breathing, pausing the conversation, and/or walking away from the trigger, but it is difficult. The best course is to practice strategies before you need to call upon them, because fear is a primitive emotion, and once we’re in it, the body becomes hijacked. “You can’t just relax in a heated moment,” she says.

It starts with awareness

Log your behavior over one week, noting what prompted the yelling and rating your anger from zero to 10. Think about everything involved: the people, topics, location, and whether you had eaten or slept well, because self-care affects your ability to handle stress.

When you give your anger a number, it becomes more objective. You can feel the difference between a 1, 4, and 8, and are more able to control something in the early stages. And when you write down your observations, you can see patterns and start thinking about how to prevent trouble spots. It might be carrying food, avoiding certain people, or scheduling a potentially tough interaction for when you’re at your best.

Deep breathing can help

There’s no magic count. People have their own approaches. Chronopoulos suggests to just notice your breathing, or even walk away and count to 10. The result is similar. Your mind is off the stress and onto something practical and concrete. One more exercise is to progressively relax your muscles when you’re calm. You’ll then be better able to distinguish between when your body is at ease and when it’s tense. Chronopoulos calls it “discrimination training.” With this knowledge, you can remind yourself to do something as simple as lower your shoulders or unclench your hands.

Imagery is another tool

Preview your day and play out how you’ll handle the sticky moments. When the real thing happens, it won’t be the first time you’re experiencing it.

In the actual situation, use assertive dialogue over yelling or silently seething. It’s about keeping things in the first person, naming the problem, and avoiding calling out the other person. Clearly say, “When you say X, it really upsets me,” then shift into asking, “What can we do to make this work?” It goes from competition to negotiation. “Our voice can become the tool to resolve the conflict,” she says.

You can aspire to never yelling, but it may still happen

And finally, realize that none of the above is foolproof. You can’t predict every situation or be constantly mindful. You can also have different reactions to the same situation, because each day is different. “We’re never in a static state of mind,” Chronopoulos says. “But by taking these measures, we’re putting ourselves into a position for having more control of our emotions and being able to respond in a way that’s more effective.”

Gastroparesis: A slow-emptying stomach can cause nausea and vomiting

If you have a daily commute, a backup of traffic or road work may delay you, but you’ll eventually reach your destination. Gastroparesis, a digestive condition, can be imagined as a slowed commute through the stomach. But the delay involved can cause uncomfortable symptoms, and may have other health consequences that can affect nutrition and your quality of life. Although gastroparesis affects millions of people worldwide, many people are much more familiar with other gut problems, such as acid reflux and gallstones, that can cause similar symptoms.

What is gastroparesis?

Gastroparesis is a condition that causes delay in the emptying of the stomach. When you swallow food, it travels through your mouth and into a long tube called the esophagus before entering your stomach. Your stomach serves two separate functions: The first is to relax to accommodate food and liquid until you feel full. The second is to churn the food and liquid into a slurry that then passes into your small intestine to be digested. When either function is disturbed, slower-than-normal emptying occurs.

What are the symptoms of gastroparesis?

Nausea and vomiting are two of the most common symptoms of gastroparesis, most likely stemming from the sluggish emptying of the stomach. Typically, these symptoms occur toward the end of meals or soon after meals are finished. A third common symptom is abdominal pain caused by a combination of motor nerve and sensory nerve dysfunction. When motor nerves aren’t working properly, food and liquid can be detained in the stomach. When sensory nerves aren’t working well, signals between the gut and the brain are not communicated effectively, which can cause pain, nausea, and vomiting.

A growing body of evidence suggests that gastroparesis overlaps with a disorder of gut-brain interaction called functional dyspepsia, which is recurring indigestion that has no apparent cause. Other health problems can cause similar symptoms as gastroparesis, such as gastric outlet obstruction and cyclic vomiting syndrome, or even conditions beyond the gut, such as glandular disorders. So it’s important to discuss any symptoms that are bothering you with your doctor to get the correct diagnosis.

Who is more likely to experience gastroparesis?

Many misconceptions exist about the typical person with gastroparesis. For example, it’s not true that people must have diabetes to have gastroparesis: only 25% of people with gastroparesis have diabetes. Most commonly, no clear cause for gastroparesis can be found among people who have the condition.

Additionally, people are more likely to experience gastroparesis if they

  • take certain medicines, such as opiate pain medications and some medications for diabetes
  • have had surgeries, radiation, or connective tissue disorders that affect the function of the nerves of the gut
  • are female, because women are several times more likely than men to have gastroparesis.

Thus far, there is limited information on health disparities among people with gastroparesis, although one study shows that diabetes is more likely to be the cause of gastroparesis among Black and Hispanic patients than white patients. It’s not yet clear why, although socioeconomic inequities that affect health outcomes may be a factor (as is true for many other conditions).

How is it diagnosed?

Diagnosing gastroparesis and deciding on the best treatment strategy requires a careful patient history, blood tests, imaging tests, and sometimes endoscopy. Usually, people first discuss their symptoms with a primary care doctor who can rule out some possible causes and refer them to a specialist to discuss next steps, such as imaging or endoscopy, if necessary.

A common imaging test used in the US is called a gastric emptying scan, which takes four to five hours. The person having the test eats a standardized meal, such as an egg sandwich, that contains safe levels of medical-grade radiation. At certain intervals, images are taken to see how much of the meal remains in the stomach. During normal digestion, about 90% of the stomach is emptied within four hours and 10% is left behind; more than this amount remaining meets a key criterion for gastroparesis.

It’s worth noting that the exact amount of stomach emptying in four hours may fluctuate and may be influenced by other health factors, such as uncontrolled blood sugar, or certain medications, particularly opiate pain medicines.

How is gastroparesis treated?

The main goal of treatment is to address the symptom that bothers you the most. Depending on your diagnosis and symptoms, treatment might involve one or more of the following:

  • Medications. Erythromycin and metoclopramide speed up emptying the stomach. A newer medicine called prucalopride may have the same effect. Other medications, particularly for people who are finding pain and nausea more problematic, target disordered gut-brain interaction using neuromodulators, such as older forms of antidepressants and neuropathy medications. These medicines may improve sensation of the gastrointestinal tract.
  • Procedures and surgeries. A gastroenterologist may suggest different endoscopy techniques that improve stomach emptying by disrupting a valve between the stomach and the small intestine called the pylorus. One approach, called a per-oral pyloroplasty, does not require surgery. A surgical approach called laparoscopic pyloroplasty reshapes the muscle of the valve between the stomach and small intestine to help the stomach empty more quickly. Less often, surgically implanting a gastric stimulator to help improve the signaling between gut and brain may be considered.

If you have gastroparesis, be sure to discuss all these treatment options to see which one is best for you.

Follow me on Twitter @Chris_Velez_MD

Can blue light-blocking glasses improve your sleep?

Recently, my brother mentioned he was sleeping better since he got new prescription glasses with a blue-light filter. He wears his glasses mostly for reading screens (both computer and smartphone) during the day while at work. So I was intrigued, but a little skeptical: could daytime use of blue light-filtering glasses make a difference in how well he slept? How, when, and why blue light affects us seemed like good questions to pose to an expert before deciding whether those glasses could help me, too.

What is blue light?

Visible light includes a short segment of wavelengths tucked into the electromagnetic radiation spectrum. Together, the wavelengths of visible light captured by our eyes are translated into white light by our brains.

You may remember looking through a prism to bend the wavelengths that make up white light into a rainbow of colors. At one end of this rainbow, blue light shades toward violet. Sunlight has a lot of light at all visible wavelengths.

Measured in nanometers (nm), visible light wavelengths range from 400 to 700 nm. Blue-light wavelengths lie between about 450 and 495 nm. And different slices of blue-light wavelengths have different effects on our bodies, including on sleep and alertness.

How does light affect our bodies?

In addition to helping us see, light also has nonvisual effects on the body, says Dr. Steven Lockley, a neuroscientist at the Division of Sleep and Circadian Disorders at Harvard-affiliated Brigham and Women’s Hospital.

The 24-hour circadian clock in the brain regulates sleep and wake cycles, hormonal activity, eating and digesting, and other important processes within the body. “Special photoreceptors in the eye detect light to control our circadian rhythms,” he says. These cells contain a nonvisual photopigment called melanopsin, which is most sensitive to 480 nm light at the blue-green end of the visible light spectrum. Other visual photoreceptors called cones allow us to see even shorter wavelengths of blue-violet light at around 450 nm.

How can blue light affect sleep?

During the day blue-enriched light is desirable, because it helps synchronize our circadian clocks to a 24-hour day. So, exposure to a regular light-and-dark cycle is vital to achieve and maintain good sleep.

Stimulation from certain wavelengths of blue light helps us stay alert, whether this comes from a natural source like the sun in daytime hours, or from electronic devices that emit blue light. While the stimulation is helpful during the day, at night it can interfere with sleep. Blue-light exposure in the evening — for example, binging a TV series on your laptop right before bed — will stimulate the melanopsin-containing cells and alert the brain, making it think it is daytime. That can make it harder to fall asleep and may affect the quality of your sleep.

Blue-light filtering: Can it help a tired body and tired eyes?

Although a recent systematic review suggested that blue light-blocking glasses may help people with insomnia, Dr. Lockley says there’s not enough detail about the studies to draw that conclusion. Most commercially available blue light-filtering glasses, and special coatings added to prescription lenses, aren’t standardized. So you have no way of knowing which wavelengths are being blocked, and whether this affects only visual function, or important nonvisual functions such as alertness and the circadian clock. Also, the timing, duration, and nature of the nighttime light exposure in the summary of these studies was not clear.

If you want to block stimulating blue light that could interfere with sleep, avoid screen use as much as possible after dusk — especially within two to three hours of bedtime. You can also try using computer software that reduces the amount of blue light emitted. Examples include Night Shift (available on Apple devices) or f.lux, a free download available for all computers and related devices. You should also try to address other issues that affect your sleep.

To help reduce eye strain, a common concern for people who use screens often, the American Academy of Ophthalmology advises taking regular breaks using the 20-20-20 rule. Every 20 minutes, look away from your screen at an object about 20 feet away for about 20 seconds.

You should also get as much daylight exposure as possible in between screen use to provide a strong circadian and alerting stimulus, particularly if you spend most of your time indoors.

As for my brother, he doesn’t watch much television and tends to prefer reading print books in the evenings. He agreed that he might be experiencing a placebo effect from the blue-light filter on his new glasses — or simply that he is sleeping better now that he has the correct prescription, and therefore less eye strain.

Cancer survivors’ sleep is affected long after treatment

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Once the stress of a cancer diagnosis and its intensive treatments have passed, the hope is that life can return to normal. But we know that this is not true for many people who have had treatments for cancer, and sleep is often impacted for a long time after treatment.

Researchers at the American Cancer Society studied responses from 1,903 cancer survivors from across the US. These survivors were diagnosed with cancers such as breast cancer or prostate cancer about nine years before the study. As part of the research, these cancer survivors were asked questions about their sleep and cancer history, and their overall physical, mental, and social health. Even though these men and women had been diagnosed with cancer almost a decade ago, a staggering 51% reported that their sleep had been disturbed over the prior month!

Why do sleep problems continue after cancer?

Findings suggest that the residual effects of cancer may continue to negatively affect a survivor’s sleep. Not surprisingly, poor sleepers were more likely to report that they had more physical and emotional distress. Perhaps more unexpected were results that showed survivors who were sleeping poorly were also more likely to be having some economic hardship, and expressed worries about money and a fear of cancer recurrence.

These are common burdens for cancer survivors. Financially, cancer survivors not only have to shoulder the medical costs associated with their initial treatments, but also ongoing bills from managing the lasting effects of those treatments. Additionally, survivors may have had to change their work situation, or leave their job entirely, in order to manage their health.

Other research has shown that fear of cancer recurrence is common among survivors. Despite having completed their treatments many years prior, people struggle with chronic distress regarding their health and well-being, often at levels equal to that experienced when they were initially diagnosed with cancer.

What can cancer survivors do to improve their sleep?

It is critical that cancer survivors raise the issue with their medical team. There are a number of different sleep disorders that require thorough evaluation and accurate diagnosis. For example, insomnia disorder and obstructive sleep apnea are common among middle-aged and older men and women. If sleep disorders are left untreated, they can lead to a host of negative health outcomes, including cognitive dysfunction, mood disorders, cardiovascular disease, and more.

Medication is a common treatment to help sleep, but it’s not always the best choice, as there are concerns about medication tolerance (needing a larger dose to get the same effect), dependence, and daytime side effects. In the study previously mentioned, 28% of respondents reported using a sleep medication within the past month. While there is certainly a time and a place for medications designed to help with sleep, long-term use is not advised for cancer survivors, especially if the problem is insomnia disorder.

Rather, cognitive behavioral therapy for insomnia (or CBT-I) is recommended as first-line treatment by both the American Academy of Sleep Medicine and the American College of Physicians. Instead of masking the symptom (poor sleep), CBT-I targets the problematic sleep behaviors and thoughts that continue to cause a person to sleep poorly. For example, a patient receiving radiation therapy may be fatigued during the day and take extended naps. During active treatment, this can be helpful. But they may develop a habit of continuing to take naps, which can affect their ability to fall asleep at night. As part of CBT-I, cancer survivors can expect to track their sleep, develop a sleep period that is better aligned with how much sleep they need, learn to avoid problematic sleep behaviors in the bedroom, and change the thoughts that can make it more difficult to fall asleep or stay asleep.

What are the key takeaway messages?

Sleep difficulties are common among cancer survivors, even if they were successfully treated for their cancer years ago. Sleep disorders should be evaluated by a medical provider trained in sleep medicine. There are a number of excellent treatment options that can improve sleep for cancer survivors, such as CBT-I. With increasing virtual access to medical care, telemedicine and online interventions are exciting possibilities for cancer survivors struggling with their sleep.