- Dr. Mary Rogers M.D. FAAP
Q: My 7th grade daughter has hit a growth spurt and towers over her friends. She is very self-conscious about her height. She hates being tall and feels very awkward. Any advice on how to help her feel normal?
A: The middle school/pre-teen years can be the toughest and most amazing times for our kids. They're establishing a solid foundation of self-identity, which involves self-doubt and questioning. This can result in friend shifts and enhanced sensitivity. Add in hormones, changing bodies and it is understandable that most kids this age are self-conscious.
The typical girl will grow 2.5 inches in her 12th year, her fastest growth year on average, and girls typically 'sprout up' earlier than boys. Most importantly what we can do as parents (and doctors) is validate her experience, because they really want to be heard. You might offer something like this: "It sounds like it's hard to experience your body changing so much while many of your friends haven't started those changes, yet," or "It sounds like it's tough to hear people commenting on how tall you are," or "You're strong and smart and a good friend, and you just happen to be growing faster than others." Keep in mind her reactions are mostly about feeling awkward and different.
When your teen wants to share with you that she's feeling insecure and uncomfortable, this is a good indication that you're doing a great job as a parent. Just continue to listen, validate, understand and support.
Q: My five-month-old baby seems a little lethargic. He is just way too easy going compared to other babies we meet. I notice that other kids his age cry or laugh a lot, but it seems like my baby is always asleep. I'm not complaining but am starting to worry about him.
A: It's normal to compare to others (even when everyone tells you not to!). And it's tough to tease out what is normal baby behavior/habits and when you should worry. As a pediatrician, I have learned to appreciate the wide spectrum of "normal" and what's unique to every child. While we have general and specific markers that are tracked and monitored, under the developmental umbrella there is much variability. Sleep has a huge range of "normal." Five-month babies are often transitioning from three to two naps per day, and yet some are still sleeping up to 12 to 16 hours per day. If your little guy is napping and sleeping well, but he's engaging, wanting to play and active when awake, I typically wouldn't worry much about it.
The term lethargic often means something very different to a pediatrician, so I do want to clarify that. When medical providers use the word lethargic it's defining 'sluggish' or 'diminished arousability.' However, most every time a family uses the word lethargic they are referring to being extra sleepy or laying around from being sick. That said, a parent's gut instinct is very important as you're closer than anyone to your child. If you're breastfeeding, make sure your supply hasn't dipped and he gets a weight check. And, as always, it never hurts to see your pediatrician if you think he is sleeping too much, or you are worried about him.
Q: I hear there is a new strain of influenza going around. What is it? Should my child get more than one flu shot per year?
A: We have been seeing a lot more influenza these last few weeks of winter. Preliminary data from this season shows the main strains circulating are H1N1 and H3N2 influenza viruses. The CDC is reporting that the H3 strain is more severe this year and there is speculation that we may continue to see influenza into early May. The "variant" strain that you likely heard about is the H3N2 strain, which is making up nearly 47 percent of the positive cases to date. The vaccine for this season is showing better protection to H1N1 (62 percent) and 44 percent effective to H3N2.
There is not an updated vaccine that has better coverage for the H3N2 strain and so there's not a recommendation to get a booster or other flu vaccine. The data, even on years when we get a variant strain, shows that the vaccine protects against hospitalizations, severe illness and death from influenza. It's always disappointing to get influenza from a variant strain when you have gotten the vaccine, however, vaccinated individuals have less severe symptoms and better outcomes.