After the Florida Mass Shooting: PTSD in Teens

Can just listening to the news and viewing disturbing images cause PTSD in teens? This is a question some parents are asking in the wake of the mass shooting at Stoneman Douglas High school, in Parkland Florida. These parents wonder if their teenagers’ sleeplessness, nightmares, and frightening thoughts are more than just strong but temporary reactions to the news. The answer is a definite yes: if your teen is experiencing such symptoms, it could be posttraumatic stress disorder (PTSD), and your child should be seen by a mental health professional.

Florida Mass Shooting

Perhaps thought you’d done as good a job as any parent might do in explaining the awful news coming out of Florida to your teen, but here it is, two weeks later, and your child still can’t get through the night without waking up drenched in sweat and shaking. Is this a genuine mental health issue or is it something that will pass with the healing qualities of time? What should you be doing to support your teen?

Dr. Robin Goodman of A Caring Hand, a nonprofit that specializes in helping children cope with bereavement, confirms that even teens outside of Florida can experience posttraumatic stress disorder as a result of the mass shooting, “We do know that direct physical exposure (witnessing the event or being there) or emotional exposure (knowing someone who was injured or who died) as well as indirect exposure (seeing and reading about the event in the news and on social media) can impact teens and lead to trauma reactions,” says Goodman.

Knowing that teens even far from Parkland can suffer emotional trauma from the fallout of the mass shooting is one thing. But what are the symptoms of PTSD in teens? What should parents be watching for?

Jessica Tappana, of the Aspiring trauma counseling center, says that teens can be impacted by PTSD every bit as much as adults. The difference is that teens may hesitate to reach out to the adults in their lives for help. That means that their parents may not even know their children are struggling. And not all of the complicated feelings teens may experience after a mass shooting like the one in Florida can be labeled as posttraumatic stress disorder.

Healthy Response

“In the immediate aftermath of the traumatic shooting, it is normal to expect youth to be shaken and more anxious. Certainly students returning to Stoneman Douglas this week are going to feel anxious, but youth across the country who have watched the news coverage of Stoneman Douglas and the many “copycat” threats since are experiencing anxiety as well. Some of this nervousness is a normal response to the trauma.

“In the weeks following the trauma, you can expect teens to be processing this anxiety and talking about the trauma; their personal experiences; and their reactions. This is their way of trying to make sense of the experience, and facing their emotions about the situation is actually a healthy response,” says Tappana.

Teens protest the Parkland, Florida mass shooting in TallahasseeSo when does a teenager’s reaction to the traumatic school shooting become an issue of concern?  When do you seek professional help? “If time goes on and your child’s anxiety about the shooting is impacting his or her ability to function, you may want to seek professional help. PTSD develops when the brain doesn’t heal from the trauma and instead sees danger around every corner,” explains Tappana.

“Teens developing PTSD might be avoiding situations that remind them of the school shooting (i.e. school, the news, etc). They may be thinking about the shooting constantly or even having nightmares.

“For teens who were at Stoneman Douglas or who have attended another school where there was a threat, there may be ‘flashbacks’ where it feels like they’re experiencing the threat all over again.  Withdrawing or reacting to everyday situations in an extreme manner can also indicate a problem.

Wait Three Months?

“Traditionally, mental health professionals wait until about three months after a trauma to diagnose PTSD. That said, it’s better to err on the side of caution. Speak to a mental health professional regarding whether counseling might help children process their reactions to the shooting. This is especially true if children’s concerns are interfering with their ability to feel safe at school, interact with peers, or otherwise function on a day-to-day basis,” says Tappana.

Dr. Sal Raichbach of the Ambrosia Treatment Center cautions parents that PTSD isn’t just something that happens to soldiers, “When we think of PTSD, we often think of active soldiers or veterans who have seen wartime and are plagued with flashbacks from the battlefield. But PTSD is a lot closer to home than we think. Any traumatic event can trigger PTSD, from abuse in the household to a school shooting, like the one we’ve witnessed in Florida,” says Raichbach.

But that doesn’t mean that teens are going to experience PTSD the same way as those in the military, or war veterans. “PTSD in children usually differs from that seen in adults, and teens fall somewhere in the middle. Kids tend to reenact their trauma during play or watch for signs that the trauma will recur and try to prevent that from happening. Teens, on the other hand, will often show more aggressive behavior and potentially engage in self-harm or use drugs and alcohol as coping mechanisms.”

Unprocessed Trauma

Why do teens experience symptoms of PTSD after incidents like the mass shooting in Florida? “PTSD is the body and mind’s response to unprocessed trauma. When trauma is processed properly, with enough expression either through shaking in the body, through crying, or through the expression of rage and fear, it becomes ‘resolved.’ This means the body and mind won’t be haunted by the experience forever, which might lead to nightmares, chronic and constant fear, and the feeling of being perpetually unsafe,” says psychoanalyst Claudia Luiz.

Why do teens outside of Florida experience PTSD? It may be because of the extensive and inescapable media coverage of the event. “Research from 9/11 has shown that people can develop PTSD just from watching a traumatic event on television over and over again. Teens have been fascinated by this school shooting more than others because the distressed students have continued to speak out,” explains Dr. Carole Lieberman, author of Lions and Tigers and Terrorists, Oh My! How To Protect Your Child in a Time of Terror, who adds that the most important thing parents can do to help kids with PTSD is to acknowledge their reactions to the event as understandable. “It is important to talk about what happened and to get them to express their feelings about what happened. Ask them if they’re worried that this will happen at their school. Ask if they know anyone who they think has angry feelings and might be ready to explode like Nikolas Cruz. Ask if they know any classmate who has guns. Ask if they themselves sometimes get angry feelings that make them fantasize about hurting people or hurting themselves.

“If they have feelings about hurting others or themselves, get them into therapy. Also, if their symptoms of PTSD don’t resolve on their own in a month, get them into therapy,” says Lieberman.

Practical Tips

Dr. Fran Walfish, a Beverly Hills family and relationship psychotherapist, author, The Self-Aware Parent, and regular expert child psychologist on The Doctors and CBS TV offers the following practical tips for parents:

  • Before injecting too much information into your teen, first ask “What did you hear?”
  • Listen not only to what your teens say, but also pay attention to what they do.
  • Emphasize to your teen “You are safe.” Explain details of the measures schools have already taken to reinforce safety, for instance locking school doors and practicing emergency lockdown drills.
  • A senseless school shooting at their school or anywhere else can make teens (and adults) feel powerless. Give your teen a sense of control by suggesting she write a letter send it to a surviving child or family affected by a school shooting. Or offer to help your teen have a bake sale so she might send the proceeds to the families. These actions are proactive and also offer your teen an opportunity to feel helpful and giving.
  • Limit exposure to TV news, online broadcasts, and social media. Repeated exposure to the violent stories and graphic pictures can re-traumatize your teen.

What if you can’t tell whether your teen is experiencing PTSD or just normal teenage angst? “In my opinion, parents are the first line of defense against mental illness in children. They interact with their children more than anyone else, so they are usually the first to observe signs and symptoms. If you know your child or teen has experienced a traumatic event, talk to them and keep an eye out for any further signs of PTSD,” says Raichbach.

Dr. Goodman adds that teens aren’t the only ones affected by the mass shooting at the school in Parkland, Florida. “Parents must take care of themselves and get their own support so they can best support their teens.”

Ban Best Friends in Schools??

At Prince George’s school, best friends are banned

Should schools ban best friends to encourage inclusivity? British parenting expert Liz Fraser thinks so, but the public wildly disagrees (and so does this author). Fraser cites four-year-old Prince George’s school, Thomas’s Battersea, as setting a positive example for its ban on best friends.  According to the Daily Mail, Fraser, a mother of four, told Good Morning Britain that having a best friend is too “territorial.” “It immediately [separates] this friend out as being different from all other friends, which immediately sets you into a mini group,” explains Fraser.

“Some children don’t have a best friend. I didn’t have a best friend. If I did have a best friend, I think it’s because no one wanted to be friends with us.”

The British expert also asserts that men don’t have best friends (which would appear to contradict the concept of “bros before hoes”).

“Boys don’t have best friends,” said Fraser. “They have mates, whereas girls have a best friend. It’s very territorial, it’s quite possessive, and for me there’s an element of it’s actually not to do with this friendship, it’s more about telling everybody else this is my best friend.

“I think it’s a good idea to try and keep things a bit more broad.”

Two good buddy-roos.
Boys can so too be best friends!

Fraser urges elementary school teachers to encourage children to be friends with groups of children, rather than with just one best friend. But psychologist Dr. Mark Rackley, appearing on the same segment, disagrees, stating that having a best friend teaches children how to form relationships. Moreover, said Rackley, best friends can be crucial for only children, who don’t have the benefit of long-term, supportive sibling relationships.

Viewers agreed with Rackley, with the backlash against Fraser, severe. Some called the idea of banning best friends “ridiculous,” while others called the concept “rubbish” (and worse). The controversy was so huge, it made its way over to the United States, where Dr. Barbara Greenberg weighed in in a column for U.S.News:

“The phrase best friend is inherently exclusionary. Among children and even teens, best friends shift rapidly. These shifts lead to emotional distress and would be significantly less likely if our kids spoke of close or even good friends rather than best friends. And, if kids have best friends, does that also imply that they have ‘worst friends?’ A focus on having best friends certainly indicates there’s an unspoken ranking system; and where there is a ranking system, there are problems. I see kids who are never labeled best friends, and sadly, they sit alone at lunch tables and often in their homes while others are with their best friends.”Two young girls lying on the grass in opposite directions, smiling best friends

Nonsense, says Bryan G. Stephens, in a reader op-ed he contributed to the conservative website Ricochet called, Ban Best Friends?

“Adults deciding who kids get to be friends with? That will not only breed resentment, it will reduce engagement in school. I have seen children without a best friend at school (in 6th grade I was one), and it hurt my performance in school. In 12th grade, when my then best friends and I broke up, I made it a point to find a new best friend, one whom I am still best friends with, so take that, social do-gooders.

“Think of all the friends I ‘excluded’ by having this one.

“To look at it another way, having someone force the kids in 6th grade who did not like me to be my ‘friend’ would have made things 100 times worse. I was already being bullied. Having teachers force apart cliques to include me would have [bred] resentment on their part, and guess who would have [borne] the brunt of their ire?” wrote Stephens.

Little boys, best friends, hugging, facing camera


Stephens’ brief defense of best friends had a positive response from readers. So positive that not a single reader disagreed with him. Readers at Ricochet, it seems, saw a nefarious political motive behind the drive to ban best friends in schools. One commenter described such bans as coming from “Big Brother,” with others suggesting the ban on best friends as a construct of the radical left, or in reality, a desire to ban the “free market.”

Like Stephens, this author has been on both sides of the equation. Bullied and excluded in the early years of primary education, then quite popular for a time, with best friends coming and going from 6th grade through high school graduation and beyond into adulthood. To ban best friends would have meant grudging acceptance, which would have caused immense hurt. It would have hindered, not helped my self-esteem to be tolerated.

Best friends, on the other hand, are invested in keeping a relationship going, much as a married couple wants to keep a marriage healthy and strong. It takes work to build and maintain any long-term relationship. Through the months and years, best friends learn to listen to one another and grow. Best friends acquire experience in what makes things worse, and perhaps more important, they learn what makes things better.

Little girl best friends take a selfie

Is there a down side to best friends? Not if you’re teaching children to be kind and nice to everyone. Having a best friend doesn’t mean you have to be mean to, or exclude anyone who is not your best friend.

Children should be taught to include other children at play and in activities so their feelings won’t be hurt. They should either invite all their classmates to their birthday parties or give out invitations outside of school (so the one or two children not invited won’t find out they’ve been excluded). Children should be taught not to mention party invitations within hearing of children who might not have been invited. Empathy for less popular children should be stressed and inclusion encouraged. Children should be asked, “How would you feel if no one wanted to play with you?”

But that doesn’t mean that schools should ban best friends or that children should not form best friend relationships. Being nice to all and having a best friend are not mutually exclusive concepts. Think about it this way: you can be friendly to people and still be committed/married to a single partner/spouse. You can be inclusive and still be exclusive and this is not at all a contradictory idea.

Two teenage girls show joy in each others' company.

Yes. Teach these concepts to children: Be nice to all. Don’t bully or tease less popular kids. Try to include them in your parties, play, and other activities.

But say yes, as well, to BFFs. In allowing your child to have a best friend, you’re giving your child an opportunity. You’re allowing your child to learn how to have a close relationship. This is a crucial life skill.

By having a best friend, your child learns about commitment and trust; how to listen and get past disagreements; and yes, even how to be married and parent children. Long-term relationships—whether with a parent, a sibling, a spouse, or best friend—all involve the same critical skill sets.

Two young girlfriends eating treats on the beach, smiling at each other.

So schools, please don’t ban best friends. A ban on best friends would only keep children from acquiring the experience they need to cultivate and maintain life-partner relationships. A school ban on best friends would eliminate the possibility of experiencing what it means to be extra special to just one person. It would mean not having the chance of gifting that feeling of being extra special to someone else.

And finally, you’d be robbing students of the joy and pleasure of having someone who understands them better than anyone else in the world, in a world that is darned confusing.

Know this: a best friend is an anchor and a rock and a pleasure.

Now why would anyone want to take that away from our children?

Type 1 Diabetes in Children and Teens

Type 1 diabetes (T1D) is a disease that is marked by the body’s inability to manufacture insulin. Without insulin, the body cannot process the glucose from the food we eat. The result is that glucose levels rise dangerously high which can lead to a variety of serious health problems. There is currently no cure for run-of-the-mill diabetes with no complications, but the disease can be managed with daily doses of insulin. Type 1 diabetes affects some 450,000 U.S. children.

Type 1 diabetes is scary for parents of newly diagnosed children and their parents. The disease is unfortunately, all too common. Each year, some 13,000 children are diagnosed with type 1 diabetes in the United States, alone. There’s no magic wand to wave type 1 diabetes away, but the disease can be controlled and managed, with careful attention.

Diabetes affects the way the body uses glucose, which is a type of sugar in the blood. Glucose is a byproduct of the food we eat. Most people use this glucose as the main source of energy to fuel the various functions of the body.

After eating a meal, the body breaks down food into nutrients, such as glucose. These nutrients are released into your bloodstream by way of the gastrointestinal tract. This causes the level of glucose in the blood to rise after a meal. In healthy people, this rise in the level of glucose, or blood sugar, tells the pancreas to make a hormone called insulin, and to release this hormone into the bloodstream.

Type 1 Diabetes and Insulin

In people with type 1 diabetes, however, the body stops making insulin. This makes it impossible for the body to get energy from glucose-producing foods, without help. Since the body can’t use glucose without insulin, glucose remains in the bloodstream, with blood levels of glucose rising higher each time food is eaten.

An easy way to understand the role of insulin is to think of it as a key that unlocks the potential of the glucose we get from the food we eat. Insulin unlocks the “doors” of the blood cells, letting the glucose in. When there is no insulin, it’s like not having the key to the door: the glucose can’t enter the cells. That means the glucose remains in the bloodstream, unused. As blood glucose rises, a number of health problems can occur.

Type 1 diabetes used to be called juvenile diabetes, or insulin-dependent diabetes. This type of diabetes occurs when the body attacks itself, and the immune system destroys the cells in the pancreas responsible for producing insulin. Once these cells are destroyed, the body has no way of making insulin, ever again.

Type 1 Diabetes Causes

No one knows why this autoimmune response, of the body attacking the pancreatic cells that make insulin, occurs. Scientists think it may be partly genetic, running in families. There is probably at least one more factor that causes type 1 diabetes. It could be a virus or something like a virus that causes the body to attack itself.

As it stands, there is no practical way to prevent type 1 diabetes. There is also no way to know in advance who will contract the disease. This means that a child or adult can’t be said to have done something to cause the disease.

Once someone has type 1 diabetes, that person will always have type 1 diabetes. The person with type 1 diabetes will need to treat the disease, every day, for his or her entire life. Children, teens, and adults with type 1 diabetes are dependent on daily doses of insulin to control their blood glucose levels. Insulin is given by injection or with a pump.

Sometimes the symptoms of type 1 diabetes are subtle. It can take a while for a parent to figure out that a child is sick, which means it can take time for the child to be diagnosed with type 1 diabetes. Type 1 diabetes can develop over time, or all of a sudden.

Type 1 Diabetes Symptoms

Here are some common early symptoms a parent might see in a child with type 1 diabetes:

  • Pees large amounts, often. When the body fails to make insulin, the kidneys try to flush out the excess glucose in the blood by causing the child to urinate (pee) frequently and in larger amounts than usual.
  • Extreme thirst. Because the child is peeing so much and so often, dehydration (loss of body fluids) becomes a problem. The child become very thirsty, to offset the drying effect of all that peeing. The child with type 1 diabetes will seem to constantly want drinks. This is an effort to keep body levels of fluids in balance.
  • Weight loss or lack of weight gain as the child grows. The child eats plenty, but is either losing weight, or not gaining as is normal in a growing child. Children and teenagers who develop type 1 diabetes seem to eat more than usual, yet stay the same or lose weight. This happens because the body can’t access the glucose in the body for fuel. The result is that the body begins to use its fat stores, and even breaks down muscle in its effort to feed its starving cells.
  • Tired much of the time. Since the body can’t access glucose for fuel, the child gets no energy from food, and feels tired.

Uncommon Symptoms

Less common early symptoms of type 1 diabetes include:

  • Bedwetting in a child who had been dry at night.
  • A vaginal yeast infection (Candida) in a girl who has not yet reached puberty.

Serious Symptoms

If these early symptoms of type 1 diabetes go unnoticed and untreated, more significant symptoms can occur. These symptoms are the result of a build-up in the blood of chemicals called ketones. When ketones build up in the bloodstream of a person with type 1 diabetes, this results in a serious condition called diabetic ketoacidosis (DKA). The symptoms of diabetic ketoacidosis can be mistaken for those of appendicitis, or the flu. Here are common symptoms of diabetic ketoacidosis:

  • Stomach pain
  • Nausea
  • Vomiting
  • Breath smells like fruit
  • Difficulty breathing
  • Loss of consciousness

Adult Complications

Type 1 diabetes can cause long-term health problems in adults, though not in children. These health issues come with having type 1 diabetes for a long time. Children and teens haven’t had diabetes long enough to have these issues.  The kinds of health problems that comes from having type 1 diabetes for many years, also tend to happen in cases where the person wasn’t doing a good job of managing the disease. Here are some of the common health problems that are associated with type 1 diabetes over the long-term:

  • Heart disease
  • Stroke
  • Kidney damage
  • Vision impairment
  • Various problems with the blood vessels, nerves, and gums

The important thing to know about type 1 diabetes is that it can be controlled, and the risk greatly reduced through proper treatment. It’s also easy to diagnose diabetes through a simple blood test that measures the level of glucose in the blood. Children, and especially teens with type 1 diabetes, may need lots of support and encouragement. They don’t like feeling different than their peers and may take risks with treatment. For this reason, researchers are always looking into new and easier ways of administering insulin, such as the insulin pump.

If your child’s doctor suspects or makes a diagnosis of type 1 diabetes, your child may be referred to a pediatric endocrinologist. A pediatric endocrinologist is a doctor who is a specialist in childhood diseases having to do with the endocrine system, for instance diabetes. The endocrine system is made up of the glands in the body, such as the pancreas. In type 1 diabetes, the pancreas sustains damage and stops producing insulin.

Girl Tests her glucose levels

Children and teens can find it painful or demanding to test their blood glucose. Testing blood glucose involves producing a drop of blood to test for glucose by means of a pin prick. Children can feel the same way about insulin injections as a way of replacing the body’s lack of insulin. It’s also awkward for teens and children to treat their disease when their friends are around. It can be a challenge to find privacy for treating type 1 diabetes, and (insensitive) peers might make them feel uncomfortable about their differences.

Type 1 Diabetes Medical Advances

Medical advances have been made to make treatment of type 1 diabetes easier on children and teens. There is now, for instance, the insulin pump, which mimics the natural way the pancreas reacts to glucose in the bloodstream in healthy people. The insulin pump is a portable device that attaches to the body. The pump delivers a continuous amount of short-acting insulin by way of a catheter that is placed under the skin. The device takes the place of multiple injections over the course of the day. The user also has more control over blood glucose levels because the insulin pump can be programmed to give faster or slower rates of insulin at specified times, such as while the user is asleep. The pump is slightly larger than a pack of cards.

Diabetic teen with insulin pump eating source of glucose

Another device in the works is the artificial pancreas. This device will be implanted or wearable and is an insulin pump that is connected to a device that automatically measures the blood glucose levels at all times.

Not relevant to most children and teens with type 1 diabetes is the major step of a pancreas transplant. While the transplant can cure diabetes, and remove the need for blood glucose monitoring and treatment, the transplant comes with the potential for a host of problems. In general, a person is only considered for a pancreas transplant when there are complications from diabetes, for instance, kidney damage necessitating dialysis. A pancreas transplant is often, in fact, done in conjunction with a kidney transplant. The child who would be considered for a pancreas transplant would be rare, indeed.

While no one thinks it a good thing for a child or teen to develop type 1 diabetes, it is not the worst thing in the world, and certainly not a death sentence. It helps to maintain a positive attitude as you guide your child through learning how to adapt to having a chronic disease. If your child sees you can cope, he or she will understand that everyone has challenges, and the main thing is to meet them face on, with bravery.

Does your child have type 1 diabetes?

How did you feel when you learned your child has type 1 diabetes?

Does your child with type 1 diabetes take risks with monitoring blood glucose levels and treatment? How have you coped with this situation?

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Croup Treatment: The Dreaded Barking Cough

Croup treatment is all about getting that child into a steamy bathroom; using a cool mist humidifier; or taking the child out into the cool night air. These are all effective ways to ease the dreaded barking cough of croup. Other than that, acetaminophen (or ibuprofen for older children) can make the child more comfortable, especially if there’s fever.

Croup Treatment: What is Croup?

Croup is an infection in a child’s upper airway. The infection causes swelling. The swelling makes it hard to breathe. The swelling of the airway also causes the barking cough.

Croup affects children between the ages of 3 months and 5 years. The most common age for a case of croup is at around 24 months. Croup occurs more often in the fall and in early winter. Boys are more likely to get croup than girls. Croup stays contagious for a few days or until the fever is gone.

Croup Treatment: The Barking Cough

Croup is caused by a virus. The virus causes the vocal cords (larynx), windpipe (trachea), and bronchial tubes (bronchi) to swell. It is the swelling of these parts of the upper airway that causes the barking cough, scratchy voice, and high, squeaky, breathing sounds. When the child coughs, air is pushed through passageways narrowed by swelling. The results are a cough that sounds like a seal barking, and breathing that sounds like a whistle (stridor).

Croup is frightening to parents and their children. The good news is that croup usually sounds worse than it is. Most of the time, croup is not serious. Croup can usually be managed at home. Kids with croup tend to recover within 3-5 days.

Croup Treatment: How Croup Begins

We parents know it’s croup when we’re awaked by that dreaded barking cough in the middle of the night. But when we look back on how it all began, a parent may recall that the child already had symptoms of a cold, for instance a stuffed-up or runny nose, and maybe some fever. Once the airways begin to swell, the child’s breathing becomes more difficult. In addition to the whistling noise made when the child breathes in (stridor), you might also see the child’s skin pulling in between the ribs (retractions). In more serious cases of croup, the child may seem pale or blue around the lips, which suggests the child may not be getting enough oxygen.

Croup Treatment: Symptoms of Croup

Croup symptoms tend to worsen at night. The symptoms also worsen when a child is crying and upset. Of course, when your cough sounds like a seal or a dog; you have a fever; and it’s hard to breathe, it’s natural to feel upset and to cry, which only makes things worse. This is why it’s important to appear calm to your child and to make an effort to calm the child down. If your child sees you are calm, he has less reason to be afraid or nervous.

Here are common symptoms of croup:

  • Barking cough (sounds like a seal or a dog)
  • High-pitched breathing (like a whistle)
  • Hoarse, raspy voice
  • Breathing fast
  • Labored breathing
  • Noisy breathing
  • Stuffy nose
  • Runny nose
  • Fever

Children under the age of 3 years have smaller airways. That means their symptoms are likely to be more severe. You can expect your child to have symptoms of croup for three to five days.

Croup Treatment: Causes of Croup

Croup comes in two varieties: viral croup and spasmodic croup. The symptoms of both are the same. Croup is caused by the same sort of viruses that bring on the common cold. The most common virus behind croup is the parainfluenza virus.

There seems to be a seasonal component to croup, since children are more likely to have croup in fall and early winter. Age and gender also play a factor in a bout of croup. Boys get croup more than girls. The peak age for a bout of croup is 24 months. Kids generally don’t get croup after the age of 5 years.

Croup is contagious. Your child may catch a virus by breathing near someone who sneezes. Sneezing can release droplets of virus into the air. That’s why it’s smart to sneeze into a tissue, instead of into the air.

Child sneezes into elbow
Sneezing into an elbow can help prevent others from getting sick.

When someone sneezes into air, the droplets of virus can fall onto toys or other surfaces that children handle. The virus can live on such surfaces for quite a while. If another child should touch a contaminated item or surface, and then touch his eyes, nose, or mouth, a virus may set in.

Even when children use tissues, some droplets of virus can escape. These droplets can end up on the hands or clothes. Teaching children to wash their hands after sneezing is one way to prevent the spread of viruses.

Croup Treatment: Diagnosing Croup

The doctor diagnoses croup by listening to the child’s barking cough, and the high whistling sound of the child’s breathing (stridor). You may be asked whether the child has had any recent cold symptoms such as a stuffy or runny nose, and/or a fever. The doctor may also want to know if the child has had past problems with croup or health issues of the upper airway.Doctor applies stethoscope to child's back.

If symptoms of croup are severe, and don’t respond quickly to treatment, the doctor may order a neck x-ray. If the child has croup, the x-ray will show the “steeple sign” in which the top of the airway narrows to a point.

Croup Treatment: Treating Croup

Croup sounds scary but children tend to quickly get better with home treatment. The main thing is to keep the child calm, since crying and being upset worsens the symptoms of croup. If the child has a fever, acetaminophen can help the child feel better. If the child is older than 6 months, you can offer ibuprofen. Your doctor can give you instructions on dosing: how much, how, and when to give acetaminophen, or for the older child, ibuprofen.

Children with croup feel better when they breathe moist air. You can offer moist air to your child through any of these methods:

  • Run a cool-mist humidifier in the child’s bedroom
  • Run a hot shower in the bathroom (with door closed) until the room fills with steam. Sit there with your child for ten minutes
  • Take your child outside in cooler weather
  • Go for a ride in the car with the windows open a bit to let in the cool breeze
  • Sit with the child near an open window

Make sure your child is drinking lots of liquids. Kids tend to dry out from the coughing, difficulty breathing, and fever. If your child resists drinking, try using a spoon, or even a medicine dropper to offer fluids. Your child should also rest as much as possible.

Some children need stronger measures to combat the symptoms of croup. These children may need to go to the hospital for more intensive croup treatment. Croup treatment in these cases may include a breathing treatment, or steroid medication to lessen the swelling in the upper airway. Sometimes kids with croup will need to spend a short stay in the hospital until their breathing improves.

Croup Treatment: When to Get Help

For most children, croup goes away quickly and everything is once again fine. Some children, however, are prone to complications from croup. Children who were born prematurely, or who have asthma or other lung problems, for example, are more susceptible to complications of croup and may need further croup treatment. Even so, only around 5 percent of children who go to the emergency room for croup need to be hospitalized.

If your child has any of the following symptoms with croup, call the doctor or get immediate medical attention:

  • Makes loud, high-pitched whistling sounds (stridor) both when breathing in and breathing out
  • Breathing sounds are becoming noisier
  • Has trouble swallowing, drools
  • Seems nervous and hyper
  • Is listless, lacks energy, hard to awaken
  • Child’s breathing is faster than usual
  • Child is struggling to breathe
  • The skin around the nose, mouth, or fingernails looks blue or gray (cyanosis)
  • The child is too short of breath to walk or talk
  • You can see the neck and chest muscles pulling in as the child breathes
  • The child is dehydrated (not peeing enough, pee is dark, eyes look sunken, few or no tears when child cries, dry or sticky mouth)

Croup Treatment: Preventing Croup

Defending your child against the viruses that cause croup means staying away from people with colds. It also means washing hands often and well. Teach your child to stay away from people who are sick. Have your child learn to sneeze into the elbow, when tissue is not available.

Has your child had croup?

What helped your child most?

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Spanking? The Jury is in: It’s BAD

Spanking was never proven to be a bad thing, at least not scientifically. That is until now. University of Michigan researchers have looked at the data and finally and absolutely concluded that being spanked as a child may lead to an assortment of mental health issues in adulthood.

This new study was undertaken by Andrew Grogan-Kaylor and Shawna Lee, both assistant professors of social work at the University of Michigan. The work they did in tandem with their colleagues points to spanking in childhood as a form of violence, which leads to mental health issues such as depression, attempts at suicide, and moderate-to-heavy levels of substance abuse, such as alcohol or illegal drug use, later in life.

“Placing spanking in a similar category to physical/emotional abuse experiences would increase our understanding of these adult mental health problems,” says Grogan-Kaylor.

Spanking and Physical Abuse

The researchers noted the similarities between spanking and physical abuse: both involve using force and inflicting pain. Both are linked to similar mental health outcomes. These similarities caused the researchers to wonder whether spanking should be categorized as an “adverse childhood experience.” That would place spanking in the same basket with, for instance, abuse, neglect, and household dysfunction. Household dysfunction would include, among other things, divorce, or a parent in prison.

To a layman, the questions that comes to mind are: are the scientists looking to label spanking as abuse? Could it be that parents who are likely to spank their children are also more likely to use physical abuse, neglect their children, or run dysfunctional households? Just how big a study was this?

Also: can we finally lay this to rest and rule, unequivocally, that spanking is bad? Or is this just some psychobabble being spouted? Must we, as parents, pay attention?

It bears noting here that the study is based on data pulled from the CDC-Kaiser ACE study. “ACE” stands for “adverse childhood experiences.” The ACE study definitely represents a large enough sample to be statistically relevant. The number of participants stands at over 8,300, with an age range of 19-97 years. As for the methodology, the data was gathered by having people answer questionnaires when visiting an outpatient clinic for routine checkups.

Clinic patients were asked how often they were spanked during the first 18 years of life. They were also asked to describe their childhood households and whether an adult had abused them. Physical abuse was defined for the participants as pushing, grabbing, slapping, or shoving. Emotional abuse was described as being insulted or cursed.

Almost 55 percent of those who filled out the questionnaires reported having been spanked as children. Men were more likely to have been spanked compared to women. Minorities, except for Asians, were more likely, compared to whites, to say they’d been spanked.

Spanking and mental health connection according to gender and color
(photo credit: Michigan News)

Participants who reported being spanked as children, were more likely to be suffering from depression and other mental health problems.

What constitutes “spanking” in this study? Is spanking any time the hand is applied to the bottom, whether or not the parent is angry at the time? The researchers came up with this definition: “spanking is defined as using physical force with the intention of causing a child to experience pain, but not injury, to correct or control the youth’s behavior.”

A fair enough definition. But how do we know it’s spanking that is causing the mental health issues later in life and not some other factor? This author put the question to researcher Grogan-Kaylor, who responded as follows: “The question is a great one. The key question is whether we are comparing children who are otherwise alike. That is to say, are we comparing families and children that are otherwise alike with the exception of spanking? Statistical techniques allow us to ensure that we are comparing like to like, and to rule out a number of other alternative factors as possible causes.”

Spanking as “Adverse Childhood Reaction”

Grogan-Kaylor shared with this author two other papers he’d co-authored, The Case Against Physical Punishment, and, Unpacking the impact of adverse childhood experiences on adult mental health. Both papers lend evidence to the theory that spanking can be seen as an “adverse childhood experience,” and therefore causes harm to the child, which may manifest only in adulthood, in the form of mental health issues. The former study illustrates this harm to the child through three theories: the attachment theory, the social learning theory, and finally, the coercion theory.

The attachment theory suggests that a child needs to feel absolutely sure of a parent’s love and care in order to flower. This sense of secure attachment to the parent is founded on parental empathy and sensitivity to children. Spanking then, is a way of responding to a child’s need for attention that erodes the child’s secure attachment to the parent by making the child feel degraded and rejected. Such children can develop feelings of being unworthy, which in turn can lead to depression and anxiety.

The social learning theory has children learning from example. The theory here is that when parents punish children for bad behavior by spanking them, children learn that violence is an acceptable method for correcting the misbehavior of others. Further complicating the message, is the fact that spanking stops the poor behavior, so that children learn that violence is an effective way to control and cope with interpersonal relations and for dealing with social interactions in general. In other words: violence is the way to work things out with people/relationships.

Coercion theory describes a cycle that occurs when the child rebels against the parent’s punishment. The parent may say, “If you don’t stop doing that, I’m going to spank you.”

Spanking: Vicious Cycle

The child may react with hostility to this situation, which causes the parent to “step up his game.” The intensification of the parent’s response comes with anger from the parent, which makes the child more rebellious. This “coercive cycle” continues to worsen until one side gives in. The parent may give up disciplining the child or the child may give in to his fear and pain and do as the parent wishes. In any event, one side “loses” and feels defeated. Defeated, one might emphasize, as opposed to feeling as though a problem has been resolved, or a lesson learned.

The latter paper shared with this author by Grogan-Kaylor does a fairly good job of showing that spanking in childhood is a risk factor for later mental illness independent of such adverse childhood experiences such as neglect; a parent in jail; or divorce. This suggests that spanking should also be included in an expanded understanding of the “adverse childhood experience.” This idea led to the current study, which concludes that spanking is absolutely an adverse childhood experience.

In terms of real life examples of how spanking is or isn’t used as a parent-rearing method, this author has often heard one mother say, “I don’t need to hit my children.”

The implication here is that there are other ways to make children behave, and they don’t involve violence.

Spanking as negative association

Another friend said she spanked her child just once, when her child ran out into traffic. This mother spanked her child out of equal measures of love and fear, out of a desire to preserve her child’s safety. It was a protective, knee-jerk reaction. In spanking her child this one single time, this mother meant to create an association: run into traffic=receive an unpleasant smack on the butt.

That child is today, what seems to be, to this author’s eyes, a well-adjusted adult, with no apparent mental illness. Also, that child never again ran into traffic. Thus, at least on a basic level, the parent achieved her aim: to create a negative association so the child would never repeat the behavior. Would that lesson have been driven home as effectively in any other manner?

There may be a generational factor in parents who did spank and parents who never do. Today, there is a greater awareness of abuse in all its forms. A parent may be reluctant to spank due to the perceived association between spanking and physical abuse. Back in the 1980’s, however, there was much less awareness of abuse and its effects. Even today, this is study is groundbreaking in that it suggests that spanking actually hurts children in terms of their future mental health.

Lead author of this study, Tracie Afifi, associate professor at the University of Manitoba, suggests we too often think about child abuse and its prevention, but not so much about harsh parenting. Afifi believes we need to put thought and effort into preventing this sort of parenting before it occurs. “This can be achieved by promoting evidence-based parenting programs and policies designed to prevent early adversities, and associated risk factors,” says co-author Shawna Lee, who is also a faculty associate at the U-M Institute for Social Research. “Prevention should be a critical direction for public health initiatives to take.”

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Energy Drinks and Bars: Deadly Teenage Treats?

Energy drinks and bars attract teenagers by holding out twin promises of increased strength and ability on the playing field, and better concentration in the classroom. These food products are especially appealing to teenagers, since they never get enough sleep. When teens wake up late for school, they don’t have time for breakfast.

Even when teens have the time to sit and eat breakfast, energy drinks and bars attract, because they need no preparation. Teens don’t even need to sit down to eat or drink them. You open them up and hold them in one hand. Teens can eat or drink them as  they walk to school.

Teens may know that energy drinks and bars are not as nutritious as a home cooked meal, and still, readily purchase these treats. They figure it’s better they use these products than starve. The problem is, energy drinks and bars may not be better than going hungry, because they may actually be dangerous.

Energy drinks, for instance, may contain large doses of caffeine. The caffeine may give teens a feeling of increased alertness. When that feeling wears off, the teen may drink another one. At a certain point, the teen is developing a dependence on caffeine. Caffeine can be dangerous to the health, and in large amounts, may even cause heart attacks.

Energy bars may be loaded with sugar. The result of eating sugar-laden energy bars is a sugar high, followed by a crash. The sugar high makes the teen think the energy bar is giving him energy. When the crash comes, the teen does the logical thing and eats another energy bar. Without realizing it, he’s using sugar like a drug.

But the convenience of energy drinks and bars is irresistible. They’re more nutritious than a bag of corn chips or a candy bar, and they’re so convenient. Not to mention: they taste good, too.

So how do the experts come out on energy drinks and bars for teens? Are they danger in a convenient package or are they safe as long as teens don’t overindulge? It seems the important thing to do is to become educated consumers. We need to read the labels and research the ingredients and educate our teenagers to do so, as well.

Here is some information about common ingredients in energy drinks and bars and some pros and cons for using these products:

Obesity and Energy Drinks and Bars

Energy drinks and bars are loaded with sugar and calories. The rate of obesity in teens, meanwhile, has more than doubled over the past three decades. Using energy products is only going to contribute toward excess weight gain, and may also lead to tooth decay. Teenagers who are heavy into high-intensity sports such as weight training or football, on the other hand, do burn more calories. For these teens, the occasional energy drink or bar does no harm and may even supply the extra energy they need to perform.

Caffeine and Energy Drinks

Energy drinks aren’t just loaded with sugar. They’re also filled with caffeine. Drinking one may give teens the jitters, tummy aches, headaches, and insomnia. But drinking more than one can be deadly.

On April 26, 2017, David Allen Cripe, a 16-year-old boy, died after drinking three caffeine-laden drinks within the space of two hours. He drank a cafe latte at 12:30 PM, followed by a large Diet Mountain Dew and an energy drink. Cripe collapsed at school at 2:30 PM and by 3:40, was pronounced dead.

David Cripe didn’t have a heart problem. He hadn’t been drinking alcohol or using drugs. What happened is as simple as this: the amount of caffeine in those three drinks, drunk within a short time span, made his heart give out.

At a press conference following the teenager’s untimely death, South Carolina’s Richland County Coroner Gary Watts said, “Parents, please talk to your kids about the dangers of these energy drinks.”

The caffeine in energy drinks can cause the heart to beat irregularly or too fast. Caffeine can cause the blood pressure to spike, and in large amounts, may even cause hallucinations or seizures. That’s in perfectly healthy teens with no preexisting medical conditions.

Now let’s say a teen starts out drinking one energy drink a day. Then it seems not to have the same effect. So he drinks one before lunch and another before football practice after school. This suggests the teen has begun to develop a tolerance to the effects of caffeine. The teen may drink more energy drinks to get the same boost in energy, until the point where, like Cripe, he’s taking in much too much caffeine within too short a span of time—to the point where his energy drink habit becomes life-threatening.

Do speak to your teen about the danger of energy drinks. If your child used to drink one energy drink and now drinks two, it’s time for him to change his habit. One way to do that is to add water to dilute the energy drink, rather than drink a second one.

Energy Drinks Vs. Sports Drinks

Teens should also be taught that energy drinks are not the same thing as sports drinks. Sports drinks hydrate the body. Energy drinks do the opposite. The caffeine in energy drinks acts as a diuretic, pulling moisture from the body. Put simply: energy drinks dry you out. If it’s hydration he needs, your teen would do better drinking from the water fountain at school.

Other Dubious Ingredients

Caffeine and sugar may be the culprits most familiar to teens when they’re reading the labels of energy drinks and bars (if they read them at all). But there are other substances that are found in these products. Substances like guarana, taurine, yerba mate, and ginseng have been found in energy drinks and bars. Guarana and yerba mate contain caffeine, taurine is an amino acid that may increase the effects of caffeine, and ginseng isn’t regulated by the U.S. Food and Drug Administration (USFDA). Research into ginseng is not conclusive, as there are many types of ginseng, and studies aren’t always clear about the type of ginseng investigated.

Teens should be wary of the food products they purchase. If a product contains an ingredient they haven’t heard of, they shouldn’t buy the item without further research. This warning is doubly important for teens who have chronic health issues or who take regular medications that might interact with an ingredient in energy drinks or bars.

Proprietary Secrets? Nah.

Energy drinks and bars may claim to have all manner of special or secret ingredients. But there’s nothing all that secret or special about these ingredients. The mineral chromium, for instance, is found in some energy items. Chromium can help regulate blood sugar by increasing insulin sensitivity. When you control blood sugar, in theory, you may be regulating body energy. You don’t need to buy an energy drink, however, to get chromium. The mineral is found in beef, broccoli, and bananas.

One popular sports drink combines amino acids with a kind of lactic acid, which produces alpha L-polylactate, said to help athletes sustain energy and lessen fatigue during endurance training. The presence of alpha L-polylactate proves the point that this drink is meant for athletes rather than regular, ordinary teens. Some studies have shown that this compound can cause stomach problems.

Drinks like Red Bull and the like, often contain inositol and taurine. These ingredients aren’t specific to these drinks, nor do they have any special powers. Our bodies do a fine job of making both inositol and taurine from the food we eat. Inositol is found, for instance, in brown rice, corn, and beans. Taurine is found in meat, chicken, fish, and eggs.

Mixed Results

Some energy drinks are infused with rhodiola rosea, sometimes in combination with cordyceps mushroom. Rhodioloa rosea is an herb said to fight fatigue and improve mental and physical performance. But little is known about the herb and the results of studies are contradictory. The cordyceps mushroom has likewise not been well investigated by researchers. Some experts feel that cordyceps mushroom can provide an energy boost to young athletes.

Energy Treats Cost Big Time

It’s important to note that energy drinks and bars are more expensive than soft drinks or granola bars. The companies that manufacture energy drinks and bars figure they can charge more because their products supposedly have special ingredients with special effects. A teen may spend $3 on an energy bar, when he might have spent less money and received more nutrient value by buying and eating a whole grain bagel with cream cheese.

Meal Substitute?

Teens may grab energy bars because they think they have the same nutrition as breakfast or dinner. But while the bars may contain the same number of calories as breakfast or dinner, they don’t offer the same nutritional value or satisfy in the same way as a real meal. Illustrate this by asking your teen to think how he feels after a nice meal. Then ask him to pay attention to how he feels the next time he eats an energy bar. Teens should never opt to replace meals with energy bars if they can possibly help it.

It’s hard for teens to resist the marketing hype behind those energy drinks and bars. If a teen is feeling tired and hungry, a flashy package promising energy may seem like a good bet. That is why parents have to educate their teens about marketing and reading labels.

Teens must be taught that food products can’t make them better athletes or perform better in class. Doing well on the playing field or in the classroom depends on doing the work. Teens need exercise, sleep, study, and good nutritious food. There’s no such thing as a little something extra a teen can buy to perform better.

It’s pretty simple, actually. When teens and other people lead healthy lives, they feel good and have lots of energy. If they’re doing everything right and still don’t feel energetic, then it’s time to get a checkup. An energy product is never the right answer.

Devil’s Advocate

To play devil’s advocate, not all energy drinks are created equal. Some will keep teens going longer than others. Those based on sugar and caffeine may give teens a surge of energy. The rush from consuming sugar can last from 30 minutes to an hour, while the rush from caffeine can last up to around two hours. Then comes the crash and a serious loss of energy.

Energy bars containing complex carbohydrates, on the other hand, will help provide more of a lasting boost, which is useful for endurance sports. This is especially true if the source of carbohydrates is fiber rich, since fiber takes longer to digest.

Missing: Phytonutrients

Energy bars rich in protein can give an athlete greater stamina and strength. Protein builds the muscles and helps to regulate how energy is produced by the body. The problem is, while these manufactured treats may be fortified with vitamins and minerals, they’re still missing important phytonutrients, beneficial chemical compounds found only in plants.

Phytonutrients include carotenoids that give carrots their color, the isoflavones in soybeans, and polyphenols in tea, Phytochemicals do all sorts of wonderfully good things for our bodies. Some improve memory, while others are known to reduce cholesterol, or kill viruses.

Nutritionists suggest teens substitute a sandwich and a piece of fruit for that energy bar. These items can still be held in one hand, but are more nutritious than energy drinks and bars. Choose whole grain bread and you’re getting fiber, plus protein from the sandwich filling, and finally, phytonutrients from the fruit. Accompany the sandwich and fruit with a glass of milk and you’ve just added calcium and vitamin D.

Better Choices

When one is fatigued and hungry, it’s difficult to think what it is your body needs. That can make a teen grab for an energy drink or bar. But there are better choices. Next time your teen wants to grab something quick, choose one or several of the items listed here:

  • Yogurt
  • String cheese
  • Nuts
  • Dry whole grain cereal
  • A spoonful of peanut butter
  • Whole grain toast
  • A smoothie
  • Fruit, such as bananas, grapes, nectarines, or apples
  • Trail mix
  • Dried fruit
  • Chocolate bar

If faced with a choice between junk or fast food, an occasional energy drink or bar is probably the better choice. Teens in training for high activity sports may find that energy bars and gels serve as a useful addition to a healthy diet. But teens should never think that energy drinks and bars can replace a meal.

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13 Reasons Why Your Teen Should Not See This Show

Think of this as a sort of companion piece to last week’s blog piece, How to Prevent Teen Suicide. That piece was meant as a resource for parents. This piece has a different focus. It’s about the Netflix series, 13 Reasons Why. I just watched the first season of this compelling drama and I had to (somewhat) concur with my teenage son, “Don’t watch it. You’ll just want to kill yourself.”

It’s not that I want to kill myself after watching the series. It’s that I think teens will want to kill themselves after they watch this show, or at least some teens, many teens (thankfully, my son is still with us).

I think a lot of us forget how intense it felt to be a teen.

13 Reasons Why captures that intensity and makes the case that it just feels like too much sometimes and that the only way to get away from it—from all that stress and pain—is to end your life.

See, I remember that and even if I didn’t, this show was going to bring it back to me. It’s brilliant. The kids, though they’re from a more modern era, aren’t all that different from the kids with whom I went to school. The dynamic is exactly the same. The kinds of things that happened then, those are the same things that happen now, if the show is to be believed.

And the show is utterly believable.

Experts are warning people not to let their children watch 13 Reasons Why. They say that teen suicide is “contagious.” They say they’ve known for more than three decades that when kids watch TV shows that depict suicides, it makes them kill themselves.

They say the show makes suicide glamorous.

I agree. I watched all those shiny, pretty teens, and I felt like I knew them. I felt totally involved in their drama. It was like I was one of them. I kind of wanted to be one of them.

Now imagine a kid watching that, instead of yours truly, a woman of 55 years and counting.

The problem with 13 Reasons Why is that it shows us, shows our kids, that there’s nothing to do and nowhere to go to get away from stress, abuse, rape, drugs, and alcohol. That suicide is really the only way out, the only option. Otherwise, you’ve just got to go through it, deal with it, live with it, cope. And it’s just too much to bear.

Is that really the message we want to give our teens?

Now, the actor that plays one of the main characters in this story, Dylan Minette (Clay Jensen), told Ellen Degeneres, that the show is about starting the conversation on a very difficult topic.

But I don’t buy it. Minette is not a psychiatrist or someone in the mental health profession who works with teens. He’s an actor and this is his bread and butter. Of course he doesn’t want to admit that the show may be dangerous to teens. He’s suddenly famous and he wants that to continue.

The thing is, Minette as Clay Jensen, the good guy/nice teen in this series, seems credible That means we’ll be sure to take his word for it when he says the show is safe. That it’s just a conversation starter. Right?

Wrong. He’s an actor. We must NOT take his word for anything that impacts on the safety of our children.

And truthfully? No matter what Selena Gomez, the co-producer of 13 Reasons Why says about teen suicide being a difficult discussion that has “to come no matter what,” no matter what Dylan Minette says on Ellen, it’s not possible for either of them to assure any parent that it is safe to watch this show, that there is absolutely no danger that kids will watch this and follow suit. Because that’s absolutely the opposite of what this study found:

We examined the relation between 38 nationally televised news or feature stories about suicide from 1973 to 1979 and the fluctuation of the rate of suicide among American teenagers before and after these stories. The observed number of suicides by teenagers from zero to seven days after these broadcasts (1666) was significantly greater than the number expected (1555; P = 0.008). The more networks that carried a story about suicide, the greater was the increase in suicides thereafter (P = 0.0004).

These findings persisted after correction for the effects of the day of the week, the month, holidays, and yearly trends. Teenage suicides increased more than adult suicides after stories about suicide (6.87 vs. 0.45 percent). Suicides increased as much after general-information or feature stories about suicide as after news stories about a particular suicide. Six alternative explanations of these findings were assessed, including the possibility that the results were due to misclassification or were statistical artifacts. We conclude that the best available explanation is that television stories about suicide trigger additional suicides, perhaps because of imitation.

And it’s also the opposite of what this, newer study, found:

Increasing evidence suggest that imitative behavior may have a role in suicide among teenagers. We studied the variation in the numbers of suicides and attempted suicides by teenagers in the greater New York area two weeks before and two weeks after four fictional films were broadcast on television in the fall and winter of 1984-1985. The mean number of attempts in the two-week periods after the broadcasts (22) was significantly greater than the mean number of attempts before the broadcasts (14; P less than 0.05), and a significant excess in completed suicides, when compared with the number predicted, was found after three of the broadcasts (P less than 0.05).

We conclude that the results are consistent with the hypothesis that some teenage suicides are imitative and that alternative explanations for the findings, such as increased referrals to hospitals or increased sensitivity to adolescent suicidal behavior on the part of medical examiners or hospital personnel, are unlikely to account for the increase in attempted and completed suicides.

Now if you think about the quality of television shows in the 70’s, at the time of the first study cited above, and even during the mid-80’s when the second study was performed, and compare it to the quality of a Netflix series, you know there’s just no comparison. Today the acting and the videography is so much more real and compelling. A series from the 80’s looks wooden, stilted, by comparison.

Imagine your child watching a true-to-life depiction of Hannah Baker in a bathtub with running water, scared but determined, slitting her wrists (deeply—the blood gushes). Then think of Hannah panting from the effort as she settles in and closes her eyes, waiting for the end. Because that is what your child will see in this series.

I went to the experts to see what they had to say.

A specialist in dialectical behavior therapy (DBT), Nechama Finkelstein sees suicide as the result of depression and hopelessness, in tandem with deficits in problem solving.

“The show exacerbates and feeds this issue—faulty problem solving—by portraying suicide as a logical solution to Hannah’s troubles. In fact while this show seems to be about the 13 reasons that explain Hannah’s suicide, the true reason she committed suicide is 1) depression and 2) her lack of reaching out for proper help when the school counselor failed her. Hannah spent more energy and time on her revenge tapes then trying to get help.

“Viewers find themselves nodding along with Hannah and getting pulled into this sick and twisted logic,” says Finkelstein.

“I can see some benefits and yet I can see even more dangers that teens can have from watching this show. A struggling teen viewing this show is in danger of being influenced by the lack of any problem solving or a more proactive search for help. The message to stop teen bullying and prevent suicide is lost through Hannah’s sensationalized revenge,” explains Finkelstein. “Hannah’s choice, to teen viewers, seems empowering, and she is presented as a winner instead of a loser.

“I would recommend any teen battling depression, bullying, or any form of emotional instability to stay far away from the show.”

Dr. Fran Walfish, a Beverly Hills family and relationship psychotherapist and author of The Self-Aware Parent, says that if teens are going to watch the show, parents should be watching it with them. “Suggest watching this show, or others that address the complexities of adolescence, together with your teen. If not literally together, then at least watch it at the same time and decide upon a shared meal to talk about the latest episode. If your teen is too embarrassed to talk about it with you, then he/she may not be developmentally ready to watch it,” says Walfish, who refers parents to talking points from the National Association of School Psychologists, for having that conversation about suicide with their teens.

Walfish feels that parents need to fill in the gaps left by the writers of 13 Reasons Why, “Mental health issues and their effects on teens are only minimally addressed in this show. Instead, the very premise of the show is the idea that other teens ‘caused’ the main character’s suicide. By downplaying the character’s depression and lack of appropriate intervention, this show fails to address the complexity of mental illness,” says Walfish, who suggests parents visit the website on the National Alliance on Mental Illness to read up on teens and mental health. “Genetic history, self-concept, biochemistry, coping strategies and access to support systems are just a few of the many factors that play into mental illness and suicidal ideation. This is why there is a critical need to help teens understand mental health more completely.”

As a response to complaints by mental health professionals, Netflix has added a warning to the beginning of most episodes of 13 Reasons Why. But from my purview as a parent, you know what Netflix doesn’t give you? Any place to turn to if you feel you or your teen need help after watching the show. There should be hotline information on that final screen of each episode—a way for parents and teens to get help if they feel triggered or hopeless after watching the show.

Instead there is nothing of the sort.

13 Reasons Why Classified in New Zealand

New Zealand, a country with the highest rate of teen suicide in the developed world, has banned teens from watching the show without their parents. The show was given a new classification, RP18. The New Zealand Classification Office issued a long explanation on its predicament with the show. Here is an excerpt:

The most immediate concern for the Classification Office is how teen suicide is discussed and shown in 13 Reasons Why. Hannah’s suicide is presented fatalistically. Her death is represented at times as not only a logical, but an unavoidable outcome of the events that follow. Suicide should not be presented to anyone as being the result of clear headed thinking. Suicide is preventable, and most people who experience suicidal thoughts are not thinking rationally and therefore cannot make logical decisions.

Which gets us to the next big issue. The show ignores the relationship between suicide and the mental illness that often accompanies it. People often commit suicide because they are unwell, not simply because people have been cruel to them. It is also extremely damaging to present rape as a ‘good enough’ reason for someone to commit suicide. This sends the wrong message to survivors of sexual violence about their futures and their worth.

13 Reasons Why does not follow international guidelines for responsible representations of suicide. The scene depicting Hannah’s suicide is graphic, and explicit about the method of suicide she uses, to the point where it could be considered instructional. As The Mental Health Foundation New Zealand notes of the scene in which Hannah dies, “It was detailed and lengthy, and is likely to have caused distress and an increased risk of suicide in people who are vulnerable. Research has demonstrated an increased use of particular methods of suicide when they are portrayed in popular media.

Reading this statement I can’t help but wonder why the United States has not followed New Zealand’s good example. Suicide is the second highest cause of death in U.S. teens. We should be doing everything in our power to keep our children safe.

The upshot? If your child has already watched this show, sit down and have a talk together (or two or three). Make sure your child isn’t thinking about suicide. If s/he is, get your teen to a mental health professional immediately.

Don’t blow this off as no big deal. You really don’t want that on your conscience.

Netflix’s 13 Reasons Why, in my opinion, fails teens utterly, by making suicide attractive and by failing to offer teens the resources to seek help. The bottom line for me, as a parent, is that Netflix may have found a good draw to bring in the big bucks, but the television programming monolith has done so at the expense of our children’s safety. I find that completely unforgiveable.

As should you.

How to Prevent Teen Suicide

Teen suicide is the second leading cause of death in young people aged 12-18. Only accidents come in ahead of suicide at robbing young lives, according to the Centers for Disease Control (CDC). Some 12 teenagers commit suicide each day which comes to around 5,000 teenage suicides every year. Of those 5,000 teen suicides, 84% are young men.

Just like with adults, more teens try to commit suicide than actually succeed. For every teen suicide you hear about, some 25 suicide attempts have been made. Young girls have a higher rate of suicide attempts but more young men succeed.

After being on the decline in the 80’s and 90’s, the number of teen suicides is sharply rising. Teen suicides, as of 2015, now account for 13% of all U.S. suicides. Teenage girls have the steepest rise in suicide rates, that rate having tripled over the past 15 years.


The causes of teen suicide may be psychological, environmental, or social. Mental illness such as clinical depression is an example of a psychological cause of suicide. Suicide as a way to escape an abusive home environment would an environmental cause of suicide. A lack of friends or social life, meanwhile, could be a social motivation for suicide. Mental illness is the leading cause of teen suicide.

If you have a teenager, you know that teens are emotional. Teens experience emotions and issues more deeply. That means their stress levels are higher, too.

Here are some stress factors that might cause a teenager to think about suicide:

  • Violence in the home
  • Death of a friend or relative
  • Physical or sexual abuse
  • Being bullied in person or online
  • Humiliation and frustration due to sexual development or orientation
  • Academic failure
  • Rejection
  • Conflict in a romantic relationship
  • Conflict with a parent

Sometimes, just trying to understand how the world works can seem overwhelming and confusing to a teen. Add out-of-control hormones to the picture and it’s easy to see why some teens try suicide.  They’re looking for a way out of their problems.

As a parent, you want to keep your child safe. Ensuring your child’s safety begins with recognizing the causes and factors that put your child at risk for suicide. If your child has risk factors for suicide, you’ll want to take preventive measures to protect your child.

Teen Suicide Risk Factors

Having risk factors for suicide doesn’t mean your child will try to commit suicide. It does mean that his risk for attempting suicide may be higher than for some other teens. It’s also important to know that some risk factors are things you can fix while others are not.

You may be able to lower your child’s stress levels, for instance, by giving him fewer chores. A family history of suicide, on the other hand, is something you cannot change. While a parent may not be able to take away all of a teen’s risk factors for suicide, it’s still possible to take many steps to keep your teenager safe.

Here are some common risk factors for teen suicide that parents should view as very serious:

  • Past suicide attempt(s)
  • Mental health issues such as depression, anxiety, and schizophrenia, for instance
  • Physical illness
  • Family suicide history
  • Drug and/or alcohol abuse
  • Feeling hopeless
  • Problems with impulse control
  • Acts out, aggressive
  • Loss of income/has financial problems
  • Social issues
  • Loss of or lack of social network, isolation
  • Loss of relationship
  • Ease of access to suicide methods/means
  • Knows someone who committed suicide

Teen Suicide Protective Factors

Protective factors can serve to cancel out risk factors to lower your teen’s risk for suicide:

  • Easy access to treatment for physical, mental, and drug and alcohol abuse disorders
  • Limited access to methods and items that could be used to commit suicide
  • Unconditional support from family, friends, and community
  • Good relationships with and easy access to physical and mental health care professionals and personnel
  • Skills in problem-solving and in non-violent conflict-resolution
  • Strong household or personal religious and/or cultural beliefs that discourage suicide

Depression and Teen Suicide

When we speak of depression and teen suicide, we’re not talking about passing moods. Anyone can feel blue from time to time. But clinical depression is different. It lasts longer than a few days and the signs and symptoms can be severe. If you suspect your child is suffering from depression, it’s important to see a mental health professional for diagnosis and treatment.

Depression is diagnosed when there are at least five of these symptoms present:

  • Feels sad, or irritable and angry, most of the time
  • A loss of interest in day-to-day activities
  • A loss of or increase in appetite, noticeable weight loss or gain
  • Has trouble sleeping or sleeps too much
  • Feels nervous and revved up or listless
  • Is tired all the time, has no energy
  • Feels worthless or guilty without cause
  • Can’t concentrate, is indecisiveness
  • Thinks about or talks about death and dying and suicide. May have a suicide plan.

Preventive Measures and Teen Suicide

Parents of teens at risk for suicide should make the effort to limit the teen’s access to items that can be used to commit suicide. If you own a gun, make sure it remains locked away. Other items that should be kept away from teens at risk for suicide are ropes, knives, pipes, and medication.

Suicide Threats

There’s a belief that people who seriously want to commit suicide, tend to just go ahead and do it, rather than merely threaten to commit suicide. Even so, parents should take any talk about or threat of suicide as if it were the real deal and treat it as a true emergency. If a teenager talks about killing him or herself, contact a mental health care professional immediately. Not sure whom to contact? Begin with the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

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What is Fifth Disease?

Fifth disease. It’s the common name for a usually minor virus that mostly affects preschool and school-age children aged 5-15 years in the springtime. The medical name for fifth disease is erythema infectiosum and it is caused by parvovirus B19.

Fifth disease passes quickly and most children get better without complications. A parent might think the child coming down with fifth disease has a cold virus. At the start, there’s low fever, a headache and a stuffy or runny nose. Then the symptoms leave and the child seems to be all better.

A few days later, the rash comes out. The rash is bright red and starts with the face, eventually traveling down to the chest and back, buttocks, arms, legs, and bottoms of the feet. At first the child will look like someone slapped his face. In fact, doctors call it the “slapped cheek rash.” As the rash spreads downward, it looks more like red blotches.

By Andrew Kerr (Own work) [Public domain], via Wikimedia Commons

Fifth Disease: A Lacy Pink Net

After a few days, the rash changes and begins to look like a lacy pink net, covering the skin. Sometimes the rash itches. It can take from 1-3 weeks for the rash to go away.

Fifth disease got its name by being the fifth childhood virus with a rash. The other viral rash diseases of childhood are measles, rubella, chicken pox, and roseola.

Not every child with fifth disease gets the rash. The rash is more common in kids below the age of 10 years. In 78% of older teens and adults, fifth disease can come with swollen, painful joints. The swelling and pain may last weeks or months. In rare cases, chronic joint pain and swelling can last for as many as 9 years.

Some adults with fifth disease only have painful joints and no other symptoms. This is called polyarthropathy syndrome. The affected joints are usually in the hands, feet, and knees. More women develop polyarthropathy syndrome than men. Most of the time (in 90% of cases), the pain lasts 1-3 weeks and goes away without any long-term issues.

It’s less common, but sometimes fifth disease comes with sore throat, reddened eyes, swollen glands, and diarrhea. Sometimes the rash is different and looks more like bruises or blisters. In other cases, some 20% of the time, a person with fifth disease will have no symptoms at all. Even without symptoms, the infection can spread to others.

Because of the way the rash spreads, a parent may think the child is getting worse. As the rash spreads and becomes lacy, however, it’s getting ready to fade away for good. Here’s the ironic thing about fifth disease: when you see the rash, the illness is usually no longer contagious.

The rash is the body’s way of reacting to the infection. This immune system reaction to parvovirus B19 happens only after the infection has cleared out of the system. Fifth disease is contagious during the early days of mild fever and cold symptoms, and usually not when the telltale bright red rash appears. In other words, fifth disease is only contagious when you don’t yet know what it is!

Fifth disease is difficult to prevent. There’s no vaccination for fifth disease. It’s hard not to spread the disease, since it seems like just a mild cold during the time fifth disease is contagious. The best thing to do is to wash your hands a lot whenever you or anyone you care for has cold symptoms.

It takes 4-14 days to develop fifth disease after being exposed to the virus. Parvovirus B19 is usually spread through the saliva, phlegm, or nasal mucus of an infected person who coughs or sneezes. The virus can also be spread through the blood, which is why a pregnant woman can pass fifth disease to her baby.

The doctor usually knows your child has fifth disease by looking at the rash. In the case where there is no rash, the doctor may need to do blood tests to find out if your child has fifth disease. A blood test can identify antibodies to parvovirus B19 only during the first two months after becoming infected. After that, a blood test can determine only whether someone had the virus at some point in the past.

Rest up!

As for treatment, well, it’s a virus. You can’t cure a virus with antibiotics. Antibiotics kill bacteria germs but do nothing for viruses. Fifth disease is mostly about resting up until it passes. The rash may be a bit uncomfortable. Talk to the doctor. Sometimes antihistamines may be prescribed for the itch. For joint pain, acetaminophen can be helpful. Just DO NOT give aspirin to your child, since aspirin use in children has been linked to Reye syndrome, a serious illness.

If your child isn’t uncomfortable from the rash of fifth disease, there’s no reason for him not to go to school. He isn’t contagious once the rash comes out. The teacher may want to see a doctor’s note confirming that the child is not contagious.

It’s important to note that while fifth disease is usually no big deal in healthy children, it can be a much bigger hazard for a child with a weakened immune system from leukemia or other cancer, an organ transplant, or HIV infection. The parvovirus B19 can slow or even stop the body from producing red blood cells. When this happens, there’s a danger of serious, chronic anemia. This complication may require treatment in the hospital. A person with a weakened immune system may also remain contagious with fifth disease for a longer period of time.

A pregnant woman who gets fifth disease is also in a special category. The developing fetus can be endangered by the mother’s infection with parvovirus B19. This is especially true during the early months of pregnancy. If you are pregnant and your child has fifth disease, it’s a good idea to consult your physician. A blood test may show you’ve already had fifth disease. If not, you should be monitored with extra care.

There isn’t much to do about fifth disease except to let it pass. But if your child develops a rash, or joint pain, it’s a good idea to speak to your doctor. Otherwise, make sure your child gets plenty of rest, drinks lots of fluids, and eats a healthy diet.

It’s no fun getting sick or having a rash. The good news is that once your child has had fifth disease, he’ll most likely have lifelong immunity and won’t ever get it again.

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Science is Sheepish: Spirituality Makes Us Healthier, Happier People

All along, the majority position of Psychiatry has been that Psychiatry has nothing to do with religion and spirituality. Religious beliefs and practices have long been thought to have a pathological basis, and psychiatrists over a century have understood them in this light. Religion was considered as a symptom of mental illness. Jean Charcot and Sigmund Freud linked religion with neurosis. DSM3 portrayed religion negatively by suggesting that religious and spiritual experiences are examples of psychopathology. But recent research reports strongly suggest that to many patients, religion and spirituality are resources that help them to cope with the stresses in life, including those of their illness. Many psychiatrists now believe that religion and spirituality are important in the life of their patients.

The above is the introduction to a study published in 2008 on the subject of Spirituality and Mental Health. The semi-apologetic nature of this lead in to a rigorous scientific study underscores the irony of scientists encountering the spirit and religion as therapeutic and beneficial to their patients.

Here is the thing: science doesn’t like to acknowledge the existence of a higher power. Science likes to acknowledge nice, hard, provable facts. Which is why it may be an irksome thing for scientists to acknowledge the absolute fact that spirituality and religion can have a positive impact on health, both physical and mental.

And so, when forced to acknowledge the benefits of belief, they, the scientists, must remain detached and apologetic, explaining that while religion is a crock, if it helps their patients, it’s no skin off their teeth. But for the rest of us, those of us who are regular people, we are quite happy to acknowledge that striving to be spiritual people makes us better. We don’t care who says we’re being silly or imagining things. We believe what we believe.

And it makes us well. Makes us better people.

Yes. Everyone knows, for instance, that 12 step programs help people get sober. One of the reasons these programs work is that acknowledging a Higher Power is at the core of all of these programs, beginning with the mother of them all: Alcoholics Anonymous. That is what really sets apart 12-step programs from other types of substance abuse treatments and makes them work.

And this can be proven. In a study of teens aged 14-18, for instance, increased spirituality concurrent with receiving treatment for substance abuse was found to improve the likelihood that the participants would achieve abstinence, increase positive social behaviors, and lessen narcissistic behavior. One-third of the teens in this particular study entered this program for substance abuse as self-declared agnostics or atheists. Two-thirds of them were subsequently discharged claiming a spiritual identity.

What about mental health, quality of life, happiness? There too, it can be proven that having a spiritual side makes everything better. Scientists studied 320 children and found that strong spiritual beliefs were a strong predictor of greater happiness. In fact, the researchers found that it was possible to attribute up to 27% of the difference in happiness levels to spirituality.

But here’s a study that will really make your head spin: scientists found that people with a family history of deep spiritual ties were at a lower risk for depression. The reason? They had a relatively thicker cortex, the region of the brain found to be thinner in those with depression. In other words, if your mom believes in God (and maybe your grandmother before her), you’re less likely to become depressed. A family history of spirituality actually changes the physical contours of the brain! Mind-blowing (well, let’s hope not!).

By Patric Hagmann [CC BY 2.5 (], via Wikimedia Commons
The funny thing is, it doesn’t matter what religion you are, or what you believe in. It’s all good from the standpoint of your mental health. Dan Cohen, an assistant teaching professor of religious studies at the University of Missouri says that’s because it’s more about spirituality acting as a personality trait. In the study he authored, no matter what faith the participants: Buddhist, Muslim, Jewish, Catholic, or Protestant, the more spiritual they were, the better their mental health. The more spiritual participants had lower levels of neuroticism and tended to be more outgoing.

“Our prior research shows that the mental health of people recovering from different medical conditions, such as cancer, stroke, spinal cord injury and traumatic brain injury, appears to be related significantly to positive spiritual beliefs and especially congregational support and spiritual interventions,” said Cohen. “Spiritual beliefs may be a coping device to help individuals deal emotionally with stress.

Cohen thinks that being a spiritual person aids mental health by reducing self-centeredness and by helping people see they are a part of a much larger whole. Forgiveness is also part of the dynamic, as it is a central theme for all the major religions. Being able to forgive means being able to let go of blame and recrimination after an accident or during serious illness.

With all of this evidence that having a spiritual life is healthy, there’s a tendency to sneer at the religious, to see them as immature or even a bit weird. Those who embrace spirituality, however, couldn’t care less what others think. Hunger Games actress Jennifer Lawrence, for instance, spoke about her spiritual life in a 2012 interview with Marie Claire, “In the South it’s very normal. It would be weird for me to go to sleep without praying,” said Lawrence.

Meanwhile, Jim Gaffigan, of Comedy Central, expressed the belief that, “When we were kids it didn’t matter if someone was religious, it just mattered if they were annoying.

Could it be Gaffigan longs to return to that time when no one cared what you believed as long as you didn’t foist it on others? It’s not difficult to empathize. No one likes to have a belief foisted on them.

Oprah Winfrey said it well in a talk she gave at Stanford University on spiritual practice, “I’m not telling you what to believe or who to believe, or what to call it,” said Winfrey. “But there is no full life, no fulfilled or meaningful, sustainably joyful life without a connection to the spirit.”

Rabbi Avi Davidowitz is Camp Rabbi at TheZone, Oorah’s summer camp facility. Oorah, of course, is a Kars4Kids affiliate charity, with the latter funding many of Oorah’s programs. At TheZone, Rabbi  D., as he is known to the campers, sees daily evidence of the power of spirituality and the interplay between religious development and personal growth.

Spirituality: Elisheva E.

One day, Rabbi D. was approached by a girl at the beginning of his lesson. She asked if she could tell her personal story to the assembled campers and Rabbi D., of course, gave his consent. “We were spellbound as Elisheva E. spoke about her reading disability and how she pined to pray the shmoneh esrei prayer, also known as the Silent Benediction just once in her life. This young girl said it took her 45 minutes to say shmoneh esrei. She wanted to stop when almost all the other campers had already gone on to their activities, but her camper partner, Alana L. who also struggles with reading from the prayer book, stood there next to her as if she too were still praying, and with this friendship and encouragement, Elisheva kept going until she finished.”

The two of them stayed at it until they both were able to read through the entire prayer.  Rabbi D. remarked that, “They spoke to us about never giving up: if we keep trying, Hashem (God) will help us out.”

This aptly illustrates the power of belief and spirituality: the idea that a difficulty can be conquered if you believe in God and if you try hard enough. It also shows how belief in God led to empathy between two individuals, both struggling with difficulties, one in the past, one in the present.

Spirituality: The Donation

Another striking Oorah story that shows how belief helps children strive to be better comes from Rabbi Avraham Krawiec, who served as Director of TheZone for many years.  “A girl just back from a camp outing walked over to me, telling me that she had to speak with me. She became emotional and said, ‘I just won some money in a raffle and I want to give back to Oorah knowing how much you do for my family.'”

Rabbi Krawiec was torn. On the one hand, he didn’t want to take her money, at the same time, he didn’t want to take away her right to a good deed, either, and that is what made him accept her modest donation of $15

As Rabbi Krawiec put it, “It was only $15 but it was the best $15 donation I ever received.”

Here a child has learned the value of charity, a central belief of Judaism. Her spiritual development has led her to the concept of paying it forward and helping others. As a result, the girl is growing up to be a kind person—someone who will surely be an asset to any community lucky enough to include her as a future adult!

Spirituality: Delayed Gratification

Belief in the tenets of religion can also teach us about self-control and delaying gratification for a higher purpose. Aryeh, a TeenZone division head at TheZone, kept in touch with one camper calling him just after the Rosh Hashana holiday to see how he was doing. As it turns out, the boy was not doing well at all.

He’d wanted to observe the holiday with orthodox rigor, but could not stop himself from using his mobile phone, a no-no for the orthodox. The camper begged Aryeh to help him come up with a plan so he wouldn’t repeat the error on the upcoming Yom Kippur holiday, when phones are similarly off-limits for the very religious.

The boy intuited that his phone was coming between him and his relationship to the Divine. The phone was not in the spirit of the Ten Days of Repentance when we look back over the year past, to see where and when we failed to stop ourselves from doing things we wanted to do in the moment, instead of pushing to come closer to God. After discussing with Aryeh various ways he might keep himself from using the phone on the holiday, he got a brainstorm idea: he’d mail his phone to Aryeh!

Well, this plan certainly worked. Aryeh’s phone rang right after the holiday, and the boy’s voice was filled with joy. He’d done it. Observed Yom Kippur from start to finish, as it was meant to be observed. He’d felt nothing but holiness all that day.

Is it any wonder that the following summer, on the very last day of camp at TheZone, as the buses were already beginning to leave, that the boy went over to Aryeh and asked him to remind him to mail his phone to him for safe-keeping over the Rosh Hashana holiday?

Here was a boy who had learned that contrary to everything he’d always thought, it is quite possible to delay gratification, to patiently endure whatever trials and tribulations come our way, and come out all the stronger for it! Here was a boy who had learned that being a believing Jew on Rosh Hashanah meant putting away the phone and looking into his own heart instead of a screen.

The scientists may not like it, but there it is: being in touch with our spiritual side makes us better, healthier people, kids or adults.

And that’s a fact.

It makes us strive to achieve the seemingly unachievable and well, it makes us happier, too

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