How to Meet Your Goals with Behavioral Activation

Elise McNulty, LMSW

For me, the month of May means two things:  1.  May is Mental Health Awareness month, and 2. it’s finally spring in Michigan.  The flowers are starting to bloom, the grass is growing, and the sun is finally starting to show more of itself.  For a lot of us, this is not only a reminder of how much we have missed the sun, but also how different we feel during the winter season here in Michigan.  It is not uncommon to feel tired, sluggish, de-motivated, and overall, down during the colder and darker months (if these symptoms feel overwhelming or severe or long lasting, you should reach out to your health care provider to start a conversation).  The nicer weather often brings with it a desire to get out and increase your activity or get back to things that you might normally enjoy doing.  But even with that desire, it can be hard to know where to begin and we often get overwhelmed or intimidated before we can start.  We know that exercise, activity and doing things we enjoy are helpful for our moods, and our overall health, so how do we get back to those things after a pause?

When we are low in mood, energy and or motivation, we might find it difficult to carry out everyday tasks and activities. We find ourselves withdrawing from and avoiding these activities.  The longer we avoid or withdraw from activity, the harder it becomes to find that routine again, and the worse we may feel about it. 

Behavioral Activation is an approach that involves using our behaviors to influence our emotional state. Often our brains think in a way that tells us “When I am feeling better or feeling ready, I will get back to doing those things”.  Behavioral Activation (BA) tells us “I will get back to the things that make me feel good, so that I can feel better”. Behavioral health clinicians often use this with clients who suffer from a mood disorder and are not able to do the things they would normally enjoy. The idea behind BA is to start with very tiny baby steps and work your way up.  We know that this works with not only getting back to things that we enjoy doing, but also stressful or unpleasant things that we need to do like getting caught up on laundry or paying the bills.  The reason BA works is because it helps us to tap into our emotional reward center and use that as a drive to continue.  

For example:

When I avoid doing anything with the baskets of laundry because I don’t have the energy or motivation to get it done, the baskets of laundry pile up, the task feels overwhelming, and I feel bad about myself for avoiding this task.  This creates a lower mood and negative feedback loop, and the task becomes more and more difficult to face. 

When I tackle the overflowing baskets of laundry by doing 5 minutes of folding laundry per day, not only am I working towards my goal in a more manageable way, but my brain sees it as completing something, which provides a positive feed back loop.  I want to keep doing it because it feels manageable and rewarding. 

How can you apply this to the things YOU want or need to do?

  1.  Identify the activity or task
  2. Find an accountability partner
    • This person could be your spouse, partner, coworker, friend, neighbor, anyone!
  3. Set a plan for baby steps
    • Start with something you feel overconfident about being able to complete/ This might mean doing laundry for 5 minutes a day, 1 minute of stretching in the morning, a walk at lunch one day a week, etc.  Goals do not have to be scary or overwhelming to be worthwhile!
  4. Write down the plan and be very specific. 
    • What day are you going to do it, how long will you do it for, what time will you start and stop?
  5. Get to work! 
    • Follow-through with your plan and be observant about how you feel during and after completing the activity.
  6. As you move through this and begin to feel you are making progress, you can increase the duration of the activity as tolerated.  If it gets overwhelming, or something gets in the way (and it’s okay if it does) go back a step or start over. 

Choose goals from both categories: Things I want to do that are good for me, things I need to do to maintain responsibilities.  When we are getting things done, and taking care of ourselves, it’s a win all around.


Did you know our Collaborative Care Behavioral Health Program is available through many primary care locations? Ask your primary care provider if a referral is right for you.

Resources:

Spring Forward

Adjusting your mind and body to the time change

This weekend, we will all adjust our clocks and spring forward, but chances are, no one will be springing anywhere for a few days. Losing an hour of sleep can really throw off your sleep cycle leaving you groggy, tired and most likely running late. Plus, the darker morning tricks your body into thinking it’s not actually time to wake up. Luckily, it only takes a day or two to adjust your internal clock to the new schedule. Although short, those couple days can be rough, so we pulled together some quick tips to get through daylight savings.

Clear your mornings.

The Monday after springing forward can be brutal. Maybe Tuesday, too. It’s no small task to get up and going on an hour less sleep, and there’s a pretty good chance you’ll be running late. If possible, block your morning schedule, so you can ease into the day rather than rushing through the morning. If working from home is an option, this would be a great day to do it.

Eat to sleep.

Avoid foods and beverages that interfere with your sleep. About four to six hours before bedtime say no to sugar, alcohol and caffeine.

Go into the light!

Light suppresses the secretion of sleep-inducing melatonin. Exposing yourself to sunlight will help with the adjustment to the time change. Open the blinds and curtains! Let the natural light in!

Conversely, when it’s time for sleep, do not expose yourself to light. If you get up at night to go to the bathroom, use a nightlight rather than turning on the lights.

Turn-off when you turn-in.

Help your body adjust to the time change, by getting good sleep. Get your mind and body ready to snooze by turning your devices off. Laying in bed on your phone or tablet stimulates your body and brain. Read a book instead, take a warm bath, listen to calming music, pick-up an eye mask – whatever you find helpful in falling to sleep.

Take your hour back.

Allow yourself some extra time leading up to the time change and try to go to bed early to make up for the hour you are about to lose. Making-up for the lost time, ahead of time, can help your body transition into daylight savings.

Practice Safe Sleep

Safe sleep guidelines for parents of infants.

Source: American Academy of Pediatrics (AAP)

According to the Centers for Disease Control, there has been a major reduction in the number of baby deaths during sleep since the recommendation to place babies on their back to sleep was introduced in the 1990s. Today, there are a number of additional safe sleep practices to keep sleeping babies safe and sound. Read on for the latest guidelines for infant safe sleep from the American Academy of Pediatrics.

SAFE SLEEP:

  • Put the baby to sleep in a safety-approved crib. Never place your baby to sleep on a couch, sofa, or armchair. This is an extremely dangerous place for your baby to sleep.
  • Have your baby share your room, not your bed. Place your baby’s crib, bassinet, portable crib, or play yard in your bedroom, close to your bed. The American Academy of Pediatrics recommends room sharing because it can decrease the risk of SIDS by as much as 50% and is much safer than bed sharing. In addition, room sharing will make it easier for you to feed, comfort, and watch your baby.
  • Put baby to sleep on their back. Some babies will roll onto their stomachs. You should always place your baby to sleep on the back, but if your baby is comfortable rolling both ways (back to tummy, tummy to back), then you do not have to return your baby to the back. However, be sure that there are no blankets, pillows, stuffed toys, or bumper pads around your baby, so that your baby does not roll into any of those items, which could cause blockage of air flow.
  • Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the baby’s sleep area. These include pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides. If you are worried about your baby getting cold, you can use infant sleep clothing, such as a wearable blanket. In general, your baby should be dressed with only one layer more than you are wearing. Do not overdress as the baby could overheat.
  • If your baby falls asleep in a car seat, stroller, swing, infant carrier, or sling, you should move him or her to a firm sleep surface on his or her back as soon as possible.

SAFE CRIB:

  • A firm, tight-fitting mattress
  • No loose, missing or broken hardware or slats
  • No more than 2 3/8” between slats (width of a soda can)
  • No corner posts over 1/16” high
  • No cutout designs in the headboard or foot board
  • If you are unsure of the safety of your crib, call the Consumer Product Safety Commission (CPSC) at 1.800.638.2772
  • For more information, visit the American Academy of Pediatrics at healthychildren.org and the Consumer Product Safety Commission at cpsc.gov

If you have questions or concerns about safe sleep practices for your baby, get in touch with your pediatric provider. Rest assured, they will help you and your baby get some much needed ZZZ’s, safely.

Originally Posted July 2020

Toy Buying Tips

Pediatrician-approved gifts for every child.

The official kickoff to holiday shopping is just days away. Before you check-off your child’s wish list, check-out some pediatrician-approved gifts that every kid will love!

Pretend.

When a child is given the freedom to play without rules or guidelines, their imagination will take over. The American Academy of Pediatrics (AAP) said it best: “Pretending through toy characters (such as dolls, animals, and action figures) and toy objects (like food, utensils, cars, planes, and buildings) help children learn to use words and stories to imitate, describe, and cope with real life events and feelings. Imagination is the key here! Imaginary play is a large part of a child’s social and emotional development.”

Pretend Shopping List:

  • Play kitchen with accessories (food, utensils, plates, etc.)
  • Vehicles (diggers, cars, emergency vehicles, planes, etc.)
  • Dress-up clothing and accessories
  • Microphone
  • Chalk board

Assembly required.

A simple puzzle holds so many benefits for a young mind – problem-solving, fine motor, language and cognitive skills. Looks for age and developmentally appropriate building blocks, puzzles, train tracks.

Assembly Required Shopping List

  • Building Blocks
  • Puzzles
  • Train tracks
  • Magnet tiles

Art

It’s amazing to see what kids are capable of without restrictions. Consider give an art basket to build their creativity and fine motor skills.

Art Shopping List:

  • Crayons/Markers/Color Pencils
  • Age appropriate paints
  • For older children, encourage them to try new media like oil pastels, chalk pastels, ink, etc.
  • Blank sketch books (try different sizes, large and small)
  • Glue
  • Kid-friendly scissors
  • Clay
  • Art accessories: pipe cleaners, pom poms, tissue paper, stickers and anything else you can think of!

Skip the video games.

There are educational apps and video games that work to teach the ABCs, but what they are missing – creative thinking, emotional development and impulse control – are much more important factors in the healthy development of your child. According to the AMA, Research suggests tablet-based toys may actually delay social development for infants and young children, because they don’t include real life facial expressions, gestures, and vocalizations.

Skip the Video Games Shopping List:

  • Match games
  • Card games
  • Board games
  • Age and interest appropriate Books
  • Magazine subscription
  • Busy board with a variety of locks and latches

Play!

Especially in the winter months, getting physical activity is so important – for kids and grown-ups alike! Not only does it help to develop good habits for later in life, but being physically active also holds benefits for emotional health.

Play! Shopping List:

  • Hula hoop
  • Sports gear (football, baseball, basketball – choose based on what interests your child)
  • Twister
  • Indoor bowling set
  • Yoga mat paired with child appropriate exercise classes or DVDs
  • Roller blades (don’t forget the helmet and pads)
  • Gym shoes
  • Push and riding toys for little ones just walking

Many children look forward to playing with new toys carefully selected for them. To keep these experiences joy-filled, it’s important to carefully consider toy purchases and ways to avoid injury. The American Academy of Pediatrics offers its top 10 toy-safety buying tips for this holiday season:

  1. Read the label. Warning labels give important information about how to correctly use a toy and for what ages the toy is safe. Be sure to show your child how to use the toy the right way.
  2. Think LARGE. Make sure all toys and parts are larger than your child’s mouth, or can’t fit into a toilet paper roll, to prevent choking (especially for children less than 3 years).
  3. Avoid toys that shoot objects into the air. They can cause serious eye injuries or can cause choking if swallowed.
  4. Avoid toys that are loud to prevent damage to your child’s hearing. See 10 Tips to Preserve Your Child’s Hearing during the Holidays.
  5. Look for stuffed toys that are well made. Make sure all the parts are on tight and seams and edges are secure. It should also be machine washable. Take off any loose ribbons or strings to avoid strangulation. Avoid toys that have small bean-like pellets or stuffing that can cause choking or suffocation if swallowed.
  6. Buy plastic toys that are sturdy. Toys made from thin plastic may break easily with sharp edges.
  7. Make sure the label says “nontoxic.”
  8. Avoid hobby kits and chemistry sets for any child younger than 12 years. They can cause fires or explosions and may contain dangerous chemicals. Make sure your older child knows how to safely handle these kinds of toys.
  9. Electric toys should be “UL Approved.” Check the label to be sure.
  10. Be careful when buying crib toys. Soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation and should be kept out of the crib. Any hanging crib toy (mobiles, crib gyms) should be out of your baby’s reach and must be removed when your baby first begins to push up on their hands and knees or when the baby is 5 months old, whichever occurs first. These toys can strangle a baby.

“Make sure to check the age recommendations on toys, which not only helps prevent possible choking hazards but also tells you that these toys are best suited for your child’s needs and interests at this stage of development,” said Lois Lee, MD, MPH, FAAP, incoming chair of the Council on Injury, Violence and Poison Prevention.

Important information about recalled toys

One of the goals of the Consumer Product Safety Commission (CPSC) is to protect consumers a​nd families from dangerous toys. It sets up rules and guidelines to ensure products are safe and issues recalls of products if a problem is found. Toys are recalled for various reasons including unsafe lead levels, choking or fire hazards, or other problems that make them dangerous. Toys that are recalled should be removed right away. If you think your child has been exposed to a toy containing lead, ask your child’s doctor about testing for elevated blood lead levels.

This post was originally published November 2019.


IHA Urgent Care locations are open on holidays! Don’t spend your holiday waiting in a waiting room. Save your spot in line at an Urgent Care location near you and wait at home.

Talking to your child about school shootings

What do you say when you don’t know what to say? In the wake of the tragedy at Oxford High School, our Pediatric team created a list of resources to help parents talk to their child(ren) about school shootings. If you or your child need help, call your IHA Pediatric Practice. We’re here for you.

Take 2: Type 2 Diabetes

Take a proactive approach to preventing Type 2 Diabetes.

Author: Tendai Thomas, MD, FACP

Diabetes is a chronic disease that affects one in ten Americans today. Diabetes occurs when your blood sugar levels are too high. In normal circumstances, your pancreas is able to produce a hormone called insulin which regulates and maintains normal blood sugar levels. However, with diabetes, this process breaks down, causing blood sugar levels to rise to concerning levels. Diabetics have problems with high blood sugars due to a lack of insulin, or because their body does not know how to use insulin well.  It is important to either avoid developing diabetes or keep your diabetes well controlled because diabetes increases your risk for several other conditions including heart attacks, stroke, kidney disease, vision loss, nerve damage, and circulation problems.

There are two main types of diabetes. Type 1 diabetes often occurs in young individuals when the immune system attacks and destroys cells in the pancreas that make insulin. Subsequently, Type 1 diabetics need to take insulin every day to stay alive. Type 2 diabetes, which is much more common, tends to occur at an older age. Ninety percent of people with Type 2 diabetes are overweight or obese. These individuals produce insulin from the pancreas, but it is not used effectively to regulate blood sugar levels.

The top 7 risk factors for Type 2 diabetes include:

  1. Obesity
  2. Sedentary lifestyle (lack of physical activity or exercise)
  3. Unhealthy eating habits
  4. A family history of diabetes
  5. Increased age
  6. Hypertension and high cholesterol
  7. Diabetes during pregnancy

If you are at risk for developing Type 2 Diabetes, there are some steps you can take to delay or even prevent the diagnosis.

Start by knowing your risk level. Take this quiz from the American Diabetes Association to find out where you stand: https://www.diabetes.org/risk-test

Lose weight and keep it off. Maintaining a healthy weight is an important factor preventing diabetes. Losing 5% – 10% of your body weight can make a big difference in reducing your risk of getting the disease. Once you achieve your weight loss goals, work to keep the weight off. 

Stick to a healthy eating plan. Reducing your daily calorie, carbohydrate and sugar intake is key to weight loss. Consume smaller portions at every meal, eat less processed and simple sugar filled foods, and avoid drinks high in sugar. Remember your food groups when meal planning for the week. A healthy diet includes a variety of foods from every group!

Exercise 5 days a week. Exercise provides many benefits to your health. Make a goal to get 30 minutes of exercise 5 days a week. You can also consider obtaining an exercise partner to help keep you focused and on target. If exercise hasn’t been a part of your routine, talk to your physician for ideas to start slowly and work towards your goal.  

Don’t smoke. Smoking can contribute to insulin resistance and many other health conditions related to diabetes. If you do smoke, please talk with your doctor about different approaches you can take that will help you quit.

Go at your own pace. When we make major changes to our diet or activity level, it’s easy to get frustrated along the way. Go slowly and create goals that are realistic for you and your body. Start with small steps and small changes and work your way up! 

Keep your physician in the loop. Make an appointment to discuss your concerns with your primary care physician. They will help determine what else you can do to reduce your risk for Diabetes, and if you have already been diagnosed, they can help prescribe and manage any medications necessary to keep you feeling your best!

If you have already been diagnosed with Type 2 Diabetes, there are several treatments for managing your diabetes. For all individuals, nutrition is the key element for managing diabetes. In addition, since most people diagnosed with Type 2 diabetes are overweight, lifestyle changes that include regular exercise and weight loss are extremely important. Other therapies include the use of oral medications, injectables, and insulin administration. Talk to your primary care physician to find the best treatment for you.

Medicine Cabinet Essentials

Must-have items for illness or injury


By Melissa Heinen, DO, MPH & Matthew Ajluni, DO

If you have tried to read an expiration date on a medicine bottle through blurry eyes in the middle of the night, this post is for you. If you have used four band-aids to cover a knee scrape on a crying child, this post is also for you. A well-stocked medicine cabinet is a must-have for every household. An illness or injury can sneak up on you at any point, day or night, and emergency trips to the drugstore in your pajamas are no fun. Here’s our (pediatrician & urgent care physician approved) medicine cabinet inventory list. As we head into cold and flu season, there’s no better time to stock-up.

Always remember to check with your child’s pediatrician or your primary care physician before giving or taking any medications and if the illness sticks around for more than a day or two. Always keep all medications out of reach of children.


Pain Relief
You will want to have both Acetaminophen and Ibuprofen for both children and adults, on hand. A children’s does is based on weight, so be sure to check with your pediatrician before giving your child a pain reliver.
Acetaminophen:
o Medications containing acetaminophen can be used on headaches, muscle pains and fevers.
Ibuprofen:
o This one is more effective for strains and sprains, but can help with fevers, too. (not to be used in children less than 6 months of age)
• Ice Pack:
o For bumps and minor injuries, have a reusable ice pack in the freezer or ready to fill with ice. Look for a soft or flexible ice pack for children.

Skincare
From bug bites to rashes to burns, the skin can be vulnerable to injury. Here are a few things to keep in your medicine cabinet to treat multiple issues. •Petroleum Jelly
o A home-care basic, this can be used to treat dry or irritated skin, eczema rashes and diaper rash.
• Hydrocortisone Cream 1%
o A tube of this over-the-counter steroid can help relieve symptoms from a bug bite, eczema, and other rashes.


Allergy Relief

• Antihistamine
o It’s good to have a non-drowsy and preferably a long-lasting version of this medication for everyone in the house. Allergy symptoms (itchy nose and eyes, sneezing or skin irritation) aren’t always just seasonal.
o Make sure to check with your child’s pediatrician or primary care physician before giving antihistamines for kids

• Saline Nasal Spray
o This can be helpful when noses are blocked, itchy or dry. Remember to spray away from the center of the nose, toward the ear.
o The saline drops are great for babies and toddlers who can’t blow their nose well
• Eye Drops
o Long days of screentime can result in tired, dry eyes. If you spend a lot of time in front of a computer, have a bottle of lubricating eye drops in the house. A couple drops of “tears” will refresh and soothe dry eyes.

Cold Treatment
• Vics VapoRub
o This topical cough suppressant can be purchased in different strengths for babies, kids and adults, but for babies and toddlers, it can be more irritating than helpful so it’s typically not recommended until the age of 4 years old. Check with your child’s pediatrician before using it on babies or children. Rub a ¼ – ½ a teaspoon of this ointment on the chest and back to help relieve congestion and cough symptoms. This is especially useful at night when a cough keeps you awake.
• Cough Syrup
o Although this medication cannot be given to kids under 6 years old (and you should check with your pediatrician for ages 6-11), it can relieve an annoying cough for older children and adults in your house. When purchasing cough syrup, look for one with dextromethorphan and guaifenesin.
• Nasal Aspirator
o Before babies know how to blow their nose, a nasal aspirator can help relieve congestion.

Wound Care
• Bandages
o Look for a box with a variety of sizes. From fingertips to knees, you never know what size you may need. If shopping for children’s bandages, let them pick a fun design. It might make their injury feel a little less traumatic.
• Roll of Gauze and Medical Tape
o When a bandage won’t cut it, have a roll of gauze or gauze squares handy to cover the boo-boo. Use the tape to secure the gauze in place.
• Antibiotic Ointment
o Use an ointment like Neosporin to keep minor cuts, scrapes and burns from getting infected.
Tools
• Thermometer
o For infants less than 6 months of age, use a rectal thermometer and a temporal or oral thermometer for older kids and adults.
Tweezers
o Because splinters happen. Also, ticks can be safely removed with tweezers.


If you or a family member ever experiences an illness or injury more serious than the medicine cabinet and handle, contact your primary care physician or pediatrician.

Kids and the COVID-19 Vaccine: What Parents Need to Know

The COVID-19 vaccine is now available to children ages 5 to 11. Here’s what parents and children need to know about the safety and effectiveness of the vaccine, the possible side effects, and the benefits of getting vaccinated.
 
We Recommend the COVID-19 Vaccine for Children Age 5-11
 
On November 2, 2021, the Pfizer COVID-19 vaccine was authorized for emergency use for children ages 5-11. It is a 2-dose series taken three weeks apart. Each dose will be 1/3 the dosage of the adolescent/adult vaccine.  
 
The vaccine for children ages 5-11 years is effective:
·    90-100% effective in clinical trials.
·    There were no severe cases of COVID-19 in clinical trials.
·    The vaccine works against Delta and other known variants of concern.
 
IHA Pediatrics has been vaccinating children ages 12 and up since May of 2021, and we have confidence that the Pfizer COVID-19 vaccine is safe and effective for our patients. As of October 2021, more than 11.1 million adolescents have been vaccinated against COVID-19 with the Pfizer COVID-19 vaccine. 

Vaccine Appointment Available

IHA Pediatrics is now offering COVID-19 vaccines to current patients aged 5-11 however, availability may be limited. 
 
We are working quickly to begin vaccinating our younger patients and will share more information on how to schedule your child’s COVID-19 vaccine in the coming days. Please continue to check our website and social media for the latest updates. If your child has an appointment scheduled at IHA Pediatrics in the next few weeks and is eligible for the COVID-19 vaccine, please ask for it at your appointment.
 
We also encourage you to search vaccines.gov to enter your zip code and easily find locations where vaccines are available. 
 
Don’t Forget the Flu Vaccine! 
It is more important than ever to stay healthy and protect yourself against preventable illnesses. It is safe to receive the flu vaccine at the same time as the COVID-19 vaccine. 

Top Ten Questions Parents Ask about the COVID-19 Vaccine

Should I worry the vaccine is too “new”? No.

As of October 2021, more than 6.63 billion doses of the COVID-19 vaccine have been given worldwide, with more than 416 million doses in the United States. For adolescents alone, over 11 million doses of the COVID-19 vaccine tell us that this vaccine is no longer “new.” Scientists and pediatricians feel confident in the safety of the COVID-19 vaccine. Waiting puts you at higher risk for infection and illness.

The vaccine got to us fast due to: 

  • The vaccine research for mRNA started in 1961 and, in the last decade specifically, was focused on SARS.
  • The vaccine was released more quickly than other vaccines because the production started before the clinical trials. This was due to the pandemic, which provided funding and resources to make that happen.  
  • Due to high disease rates in our community during vaccine development, we didn’t have to wait for a minimum number of cases for clinical trials, as is standard with vaccine development. 

Will we need booster shots every year? We don’t know yet.

It depends on how many people get vaccinated and if the virus continues to spread and change. As the population becomes vaccinated, we reduce the spread of the virus, which helps to prevent it from continuing to change. We won’t need boosters if we are reducing and eliminating variants of COVID-19.

Does it affect puberty or fertility? No.

Based on our knowledge of mRNA, we are confident that the COVID-19 vaccine will not have long-term effects on puberty or fertility. mRNA cannot integrate with DNA or alter cells. 

  • Vaccine ingredients are cleared from the body quickly. mRNA is fragile and breaks down within 72 hours after injection. Ingredients do not linger in the body. 
  • Thousands upon thousands have gotten pregnant after receiving the COVID-19 vaccine. 
  • mRNA vaccine is not made up of COVID-19. It is only the protein. 
  • There are reports of menstrual cycle changes after the COVID-19 vaccine. This is due to the body mounting an immune response and a temporary side effect, like a fever. 

What are the most common side effects for children? They can vary but are minimal.

  • Side effects that have been reported are mild to moderate such as fever, fatigue, headache, chills, diarrhea, or muscle aches.
  • More children reported side effects with the second dose compared to the first dose.
  • Rare side effects can happen, such as swollen lymph nodes or skin sensitivity, but these are not long-term and resolved in most cases in a few days. 

How do we know about long-term side effects? Decades of research.

Based on our knowledge of mRNA and the human body, we don’t expect long-term side effects since it breaks down in the body in 72 hours.  

  • As with all vaccines, including the COVID-19 mRNA vaccines, concerning side effects have occurred 6-8 weeks after injection. Vaccine development is based on decades of research. Scientists have done a rigorous review of all available data before approving for children. Our history of science tells us that if there are no side effects in those first few weeks, we are confident that concerns that arise with any patient decades later are unlikely to be related to any vaccine.  
  • mRNA cannot be converted to or inserted into DNA. It’s not scientifically possible. 

How common is myocarditis for children after vaccination? Extremely rare.

​​​​Myocarditis means “inflammation of the heart muscle.” This can happen due to the robust immune response the vaccine can have on your body.

  • It is very rare, about 26 cases per 1 million.
  • Myocarditis has occurred rarely in some people following the mRNA COVID-19 vaccines, typically within a week after the second dose.
  • The risk is highest in males 12–29 years of age.
  • The risk of myocarditis after the mRNA COVID-19 vaccine is lower than the risk of myocarditis from the actual COVID-19 virus in adolescents and adults.
  • When myocarditis occurs in those with COVID-19 infection, it is more common, severe, and lasts long-term.
  • No cases of myocarditis were reported in the vaccine clinical trial among ~3000 children, ages 5–11 years.
  • Symptoms of myocarditis are most commonly chest pain, difficulty breathing, or a fluttering heartbeat.
  • Adolescents who have had this rare side effect are monitored closely. Most make a full recovery in 3-4 weeks by using anti-inflammatory medications like ibuprofen.
  • No children have died of myocarditis after the COVID-19 vaccine.

My child had COVID. Do they need the vaccine? Yes.

  • We know that “natural immunity” can be high at first. However, protection can drop off quickly or change based on circulating variants.
  • Getting a vaccine, even for those who have already had COVID-19, strengthens your immune response.
  • If you had COVID-19 once, it is possible to get a different strain again. The immune response after infection is not as focused. Evidence shows the vaccines protect you longer and for all the variants to date.
  • Most importantly, the vaccine gives protection and prevents hospitalization for several of the COVID variants. 
  • Your child can get the COVID-19 vaccine once they are out of quarantine. There is no “waiting period,” as another strain may come, and the vaccine will protect from getting hospitalized. 

Can children become very sick with COVID? Yes.

COVID-19 disease in children can range from no symptoms to severe illness. 

  • As of October 2021, over 6.3 million COVID-19 pediatric cases have been reported.
  • Only 43% of children under 12 have natural immunity.
  • 30% of hospitalizations for children with COVID-19 had no underlying medical conditionsAs of October 2021, there were 5,217 MIS-C cases linked to COVID-19 in children. This multi-organ system effect makes children extremely ill and requires hospitalization, often in the ICU. 
  • Long COVID, or lingering COVID-19 symptoms, can lead to learning problems, heart problems, exercise fatigue with sports, and respiratory issues. This has been reported in about 8% of children who have had COVID-19. 
  • Since the pandemic began, over 600 pediatric deaths due to COVID-19 have been reported. It is now a top 10 cause of death for children in the United States. 

What are the ingredients? Put simply, it’s fat, salt, electrolytes, and sugar.  

  • Lipids are the “fatty layer” that protects the delicate mRNA so it has time to work before getting chopped up. Polyethylene glycol (PEG), the most famous lipid, is also the main ingredient in MiraLAX (which you know about if your child has ever been constipated).
  • The ingredients are only just salt, some electrolytes, mRNA, fat, and sugar. These ingredients help keep the vaccine stable and are natural preservatives.

Is there less quarantine from school, sports, or activities if vaccinated? Yes.

  • This pandemic has been traumatizing, especially for children. Their lives were abruptly disrupted in March 2020, and their mental and physical health has suffered. Anxiety and depression rates are up. 
  • Based on the State of Michigan’s current guidelines, students who are vaccinated and exposed to COVID-19 can remain in school and wear a mask.  
  • We know that less quarantining will only benefit all children.

Trick or Treat

Source: American Academy of Pediatrics

With many adults and older children vaccinated against COVID-19, this Halloween is back to being scary in all the right ways. Still, as COVID-19 continues to spread, celebrating safely remains a priority. There are many households with young children that are not yet eligible for the vaccine, or friends and family that are immunocompromised, and for them it’s important to keep Halloween traditions safe. We pulled together recommendations from the American Academy of Pediatrics to ensure this year’s celebration is all treats, no tricks.

Giving Out Candy

  • Avoid direct contact with trick-or-treaters and give treats outdoors, if possible.
  • Set up a table with individually bagged treats for kids to take.
  • Wash hands or use hand sanitizer before handling treats, and in between trick-or-treaters.
  • Non-food items can be a nice change from the usual candy, too. Especially for kids that suffer from food allergies.

Trick-or-Treating

  • Stick with outdoor trick-or-treating when possible and stay in small groups.
  • Avoid large groups of kids huddled around a doorstep. Stand back and wait for your turn.
  • Wear a mask
    • Make the mask as part of the costume (think nurse or surgeon, superhero, ninja)
    • A costume mask is not a substitute for a mask with several layers of breathable fabric or a disposable surgical mask that fits over the mouth and nose snuggly.  
    • Do NOT wear a costume mask over a cloth mask. It can make breathing more difficult
    • Masks should NOT be worn by children under the age of 2 or anyone who has trouble breathing
  • Wash your hands
    • Bring hand sanitizer with you and use it after touching objects or other people
    • Use hand sanitizer with at least 60% alcohol
      • Parents: supervise young children using hand sanitizer
    • Wash hands with soap and water for at least 20 seconds when you get home and before you eat any treats

Indoor Activities

  • If you or your children do attend an indoor activity, be sure to mask up and keep a social distance. There will be a mix of vaccinated adults and teens as well as unvaccinated attendees and wearing a mask will reduce the risk of transmitting COVID-19 or other seasonal viruses.

If you decide not to take your kids trick or treating this year, here are some ideas how you can enjoy Halloween safely.

  • Decorate and carve pumpkins
    • Decorate your home for Halloween.
    • Carve pumpkins with members of your household or outside with neighbors or friends.
    • Walk from house to house, admiring Halloween decorations at a distance.
  • Visit an orchard, forest, or corn maze. Attend a scavenger hunt.
    • Go on an outdoor Halloween-themed scavenger hunt.
    • Visit a pumpkin patch or orchard. Remember to wash your hands or use hand sanitizer frequently, especially after touching frequently touched surfaces, pumpkins, or apples.
    • Go to a one-way, walk-through haunted forest or corn maze.
  • Other Ideas
    • Hide Halloween treats in and around your house. Hold a Halloween treat hunt (think like an Easter Egg hunt) in the house and yard. Try turning off the lights and hunting with flashlights!
    • Hold an outdoor costume parade or contest so everyone can show off their costumes.
    • Host an outdoor Halloween movie night with friends or neighbors or an indoor movie night with your household members.

If you have any concerns around upcoming holiday gatherings or general questions about your child’s health, contact your pediatric provider. They can help.


For more helpful information about kids and Halloween, check out these articles from the American Academy of Pediatrics:


Be Kind

Tips and reminders to help make this world a kinder place

With what seems like the whole world being understaffed, people are working harder than ever to get your coffee order right, deliver your lunch on time, keep the checkout line moving and get you in and out of your appointment without delay.

People are enduring stressful jobs, worry about finances, illness, difficult relationships, overwhelming responsibilities, and the unknowns of the future. You never know when you may encounter someone that is carrying a heavy emotional load. Simple acts of kindness can make a big difference in someone’s life. It’s not always easy to be kind. It takes effort sometimes, especially when faced with a frustrating situation. Here are a few tips and tricks for when you feel your patience wearing thin.

Practice patience.

Waiting is never easy. Not in a line, not for a phone call, not in a waiting room. It’s common to feel frustrated when an appointment isn’t moving as quickly as you would like. The ability to remain calm when feeling frustrated (aka: patience), doesn’t always come easy. It takes practice and reminders. Sometimes you may have to remind yourself to exercise patience. Here are a couple things you can do when you feel your patience fading.  

  • Identify your triggers. Next time you lose your patience, or feel like you are going to lose your patience, stop and think about what was happening just before you lost your patience?
  • Practice mindful breathing. Watch Dr. Alberto Nacif describe square breathing and how it can help calm you in times of anxiety or frustration.
  • Get your sleep. When a child skips their nap, they are more likely to act out and have a harder time managing their feelings. Adults are similar. When sleepy, feelings of anger and frustration can feel more intense and rise much more quickly.

Make eye contact.

We spend so much time communicating over a screen or a phone that when we are standing in front of another person it can be difficult or awkward remembering how to behave. Make eye contact with the person in front of you. This let them know they have your attention. Even behind a mask, your smile can be felt by the person across from you.

Practice empathy.

Empathy really starts with curiosity. When you seek to understand another person’s feelings, situation and perspective, you’re view of that person that was so frustrating to you may shift. When you master empathy, getting along with others – from your most loved one to a complete stranger – happens much more naturally. So, when you feel like you are losing your cool with the person in front of you, try asking yourself questions like “how would I feel if I were them right now?”

Live a compassionate life.

When we set out to live with compassion the hope is that others will be inspired to do the same, so when you are the one carrying that heavy load, may you also be met with the same compassion you have given.

There really isn’t a bad time to be kind. Kindness is a gift that you can give to others, but also to yourself. When you are treated with kindness you will feel good both physically and mentally. But, you will also feel good when you treat others with kindness.