While growing up as a child, I remember that my favorite subject was recess, which had the benefit of unstructured playtime. This usually took the form of capture the flag, hide-and-seek and Simon Says with family and friends.

While these activities appeared only fun, they were also beneficial, contributing to my ability to think creatively, solve problems, recall facts quickly, work well with others and stay focused on goals of the group. Clinicians refer to this as executive functioning, and reference the social-emotional, cognitive and self-regulation skills that accompany play. I call it “having fun,” and often write prescriptions to help my pediatric patients reap its benefits.

The American Academy of Pediatrics agrees and recently released guidelines to encourage children of all ages to participate in 30 minutes of unstructured playtime, whether it’s at school or at home. The recommendations, published in the Pediatrics journal in advance of the 2018-19 school year, have compelled some school systems to extend recess time for children.

If your child doesn’t have recess and your family is short on time, the good news is that a 30-minute prescription for play doesn’t have to be consecutive. While 30 minutes is recommended, any amount of playtime counts.

Here are four ways to integrate playtime into your schedule at home:

Before school

1. At the bus stop or walking to school: If you walk your children to school or to the bus stop, use this time – whether it’s five minutes waiting for the bus to arrive or 10 minutes en route to school – to get creative. Come up with a tradition that’s fun for you and your child and engages their creativity. For example, try counting the different colors of changing leaves, which engages children in the learning process, instead of relying on rote memory skills. Or, implement an I Spy game of spotting animals, such as neighborhood deer, foxes, birds and cats, which makes this learning interactive. If you live in an urban area, identify clouds that take the shape of recognizable objects, from cars and flowers to pumpkins, monsters and planets.

2. On the school bus: If your child is in middle school or high school, they may use daily travel time to study or complete homework. This is a smart use of time, especially in advance of a big test or exam. However, if you notice they are overscheduled or entering a busy period of the school year, you can talk to them about the benefits of using that 20- to 30-minute bus ride on the way to school or on the way back from a sports game to connect with friends and have fun. We’re still studying the pathogenesis of our molecular wiring, but we find lower levels of cortisol, a stress hormone, following periods of play. This makes a packed schedule more manageable and is a valuable tool students can use throughout stressful periods. Another benefit of play is that it enhances curiosity, which then promotes memory and learning. This may make it easier to recall tricky calculus equations and historical dates in advance of a big history exam.

After school

3. After-school errands: Do you often stop at the grocery store on the way home from picking your child up from school or sports practice? If your child is younger, engage the same creative processes with analyzing objects in their physical environment in the grocery store. Count apples from the local display if you’re waiting in line or ask your child to identify the colors of the rainbow if you’re in the produce aisle. Find something they like – whether it’s the wheels on the cart, their favorite color or their favorite food– and encourage them to get creative and play. When you see your child play, you can encourage this behavior by smiling, playing with them or giving supportive nonverbal cues. This takes less than a minute but sends a message that you support the behavior.

4. Making dinner: The magic of play is that it can take place anywhere and in almost any environment. If your child is younger, pick up wooden spoons or spatulas as you’re making dinner and create conversations or narratives between the kitchen utensils. This will help pass time as you’re waiting for dinner – and introduce children to unusual conventions at an early age. Later in life, this unique paring and the ability to think outside of conventional standards has led to innovations in creating new medical devices, artificial intelligence systems and processes to help solve contemporary problems. It’s never too early to cultivate these skills in children.


Kids get skin rashes from time to time, so when your little one has red patches on their face, how do you know if it’s eczema or another skin condition such as heat rash, acne or hives? Here are four ways you can spot signs of eczema on your child.

Uncontrollable itching

Eczema is commonly known as the “itch that rashes.” It causes skin to dry and flake, which leads to a constant itchy feeling that’s uncomfortable.

If you notice that your child is scratching a scaly, red rash all day and night, that may be the first sign that he or she is suffering from eczema. Babies don’t know how to use their hands to scratch their skin, so they will rub against anything, including bed sheets, to relieve the painful feeling.

The itchiness can be so severe that your child may be fussy and have trouble sleeping. But scratching the affected area can make the rash worse, leading to a thick, brownish scab that can ooze with blood.

Location plays a big part

Babies from 1 month to 2 years old tend to get eczema on their cheeks (especially when they are drooling) and scalp. Older children will generally have it on the folds of their wrists, knees and ankles. If your child has a red, itchy and scaly rash that isn’t in a classic location for eczema, it could be allergic contact dermatitis, meaning they might be allergic to something they’re coming into contact with such as soap, shampoo or lotion.

It goes away and comes back

Most skin rashes go away within a few days or weeks, but eczema goes away for a short period of time and then reappears. Everyday elements in the environment like smoke, pollen, pet dander and fragrances can cause eczema to flare up.

The best way to prevent eczema flare ups is to use a thick, fragrance-free moisturizer at least twice a day over your child’s entire body.

Age matters

If your 12-year-old has never had eczema and suddenly has a dry and itchy rash, it’s less likely to be eczema since eczema usually starts at a young age. But if a baby starts to get dry itchy patches, eczema is most likely the culprit.

There are many skin rashes that are red and itchy, so if you’ve tried using moisturizers on your child’s skin and that isn’t working, you should see a dermatologist for a diagnosis.

Helping Kids With Homework

Now that school is back in full swing, many households are dealing with how to handle homework. Helping your child be successful at homework is very important because it is a very critical part of children’s academic success. Homework helps children in several ways, including:

  • continues learning after the school day
  • teaches responsibility
  • helps parents stay aware of what their child is learning in school

Being involved in your child’s homework is important. As with all parenting endeavors, though, there is a fine line between being too involved and not being involved enough.

So, what’s a parent to do?

Step 1: Set expectations

Set up appropriate expectations for your child and their homework responsibilities. For example, depending on the age of your child, they might be responsible for determining which homework needs to be done, doing the actual homework and putting their completed homework into their backpack.

It is very important that the child take responsibility for the actual homework, not the parent. A parent might commit to finding a quiet space for the child to do the homework, checking answers, double checking that everything has been done, as well as being on hand to answer questions.

Step 2: Set up a good study space

There must be a designated homework space in the house free of noises and distractions. If possible, try to make this fun. For instance, a colleague of mine mentioned she got her kindergarten-aged son a “homework box” that has everything he needs including pencils, erasers, scissors, etc. He puts his homework folder by the box when he comes home and then has everything he needs. I think this is a great idea to help with organization for any age.

Step 3: Schedule when homework will be done

It is important to teach kids that homework must be done on time. Set aside a certain time of the evening for homework to be completed. Put it in the calendar like any other activity so that there is always time for it. Younger kids will need the schedule made for them. Children older than 10 years of age may be able to take charge of putting homework and specific assignments into the schedule and then have a parent check it for them.

For younger grades, there is usually homework that is shorter-term and due in quick succession, which can be easier to manage and plan.

For older kids, often there is advanced planning that needs to be done, for example a term paper. Help your kids learn how to break up long-term assignments into chunks and assist in planning when each section will be completed.

Step 4: Motivate!

Your encouragement goes a long way towards motivating your child to do homework. Praise your child for steps along the way, not just successful completion of homework. For example, praise them for remembering their homework, for stopping other activities without complaint when it is homework time, for continuing a challenging task or for good grades.

It is best to build internal motivation for homework, or the desire to complete it for their feelings of pride in good work done and for caring about their academics. However, some kids may benefit from external motivators, such as earning a pass from other chores in exchange for doing homework or earning the ability to engage in preferred activities when homework is done.

Getting Back To School

Back to school time is often filled with equal amounts of excitement and apprehension. Helping your children to cope with the back-to-school transition and start off the new school year on the right foot are important tasks for a parent.

Each child will have his own way of communicating his excitement and fears to his parents. Try to listen carefully to what your child is saying and how he is saying it for clues for how you can help.

What can parents do to help calm their child’s nerves?

For most kids, their anxiety about school is very normal and does not get in the way of their overall well-being. For these kids, parents can:

  • Talk to your child about the transition. Do a lot of listening and empathizing. Try not to do too much “problem-solving.” Just let them talk and acknowledge their feelings. A good book is How to Talk So Your Kids Will Listen and Listen so Your Kids Will Talk.
  • Sit down with your kids and help them make a list of all the things they are excited about in the coming school year.
  • Set up playdates with peers from their class so they can have a familiar face to look forward to seeing.

For some kids, school anxiety can be crippling and can lead to school refusal and avoidance. Often these kids will complain of headaches and stomachaches that aren’t linked to any known medical problems when it is time to go to school. It is important for parents to seek help in these situations.

  • Psychologists can be an important partner in decreasing school anxiety and helping parents manage their child’s fears.
  • A good resource for parents of anxious children is the book The Anxiety Cure for Kids.
  • If your child complains of frequent headaches or stomachaches, talk to your pediatrician to rule out any medical concerns.

Get back into a routine!

Summer is a great time to step out of the daily grind of the school year. However, getting back into routine is an equally important step to starting off the new school year right.

  • Sleep often changes over summer vacation with kids staying up late and sleeping in late. To get kids on a better routine for the school year, start moving bedtime earlier gradually and making sure kids are waking up early in preparation for the new year at least a week or two in advance of the first day of school. Read our guide to learn how much sleep children need.
  • Get kids into healthy eating routines. This includes eating breakfast every day, which is often skipped over the summer when kids are sleeping in.
    • Have good “grab-and-go” options for kids so that they can eat even when they are rushed.
    • Make sure to do a family dinner at least a few times a week and continue this during the school year if possible. Family meals are a good place to have a healthful dinner and for kids to talk to parents about school, which can alleviate much of their anxiety.

How Often Should My Child Bathe?

The American Academy of Pediatrics says that newborns, especially, do not need a bath everyday. While parents should make sure the diaper region of a baby is clean, until a baby learns how to crawl around and truly get messy, a daily bath is unnecessary. So, why do we feel like kids should bathe every day?

Bathing Frequency

There is no scientific or biological answer to how often you should bathe your child. During pre-modern times, parents hardly ever bathed their children. The modern era made it a societal norm to bathe your child daily. Many babies and toddlers, especially those who aren’t walking yet, don’t need to be washed with soap every day. If a child has dry, sensitive skin, parents should wash their child with a mild soap once a week. On other nights, the child may simply soak or rinse off in a lukewarm, plain water bath if they are staying fairly clean. Additionally, parents can soak their children in a water bath without soap most nights or as needed as part of a routine.

Causes of Skin Sensitivity  

Many problems with sensitive, irritated skin are made worse by bathing habits that unintentionally dry out the skin too much. Soaking in a hot bath for long periods of time and scrubbing will lead to dry skin. Additionally, many existing skin conditions will worsen if you over-scrub your child or use drying, perfumed soaps. Some skin conditions, like childhood eczema (atopic dermatitis), are not caused by dirt or lack of hygiene. Therefore, parents do not need to scrub the inflamed areas. Scrubbing will cause dry, sensitive skin to become even more dry.  

Tips for Bath Time

Some best practices for bath time for kids who have dry, itchy, sensitive skin or eczema include.

  • The proper temperature for a bath is lukewarm
  • Baths should be brief (5-10 minutes long)
  • To avoid drying out your child’s skin, use mild, fragrance-free soaps (or non-soap cleansers)
  • Use small amounts of soap and wash the child with your hands, rather than scrubbing with a soapy washcloth.
  • Do not let your child sit and play in the tub or basin if the water is all soapy.
  • Use the soap at the end of the bath, not the beginning.
  • When finishing the bath, rinse your child with warm fresh water to remove the soap from their body.  Let the child “dance” or “wiggle” for a few seconds to shake off some of the water, and then apply moisturizing ointments, creams, or lotions while their skin is still wet.
  • Simple store-brand petroleum jelly is a wonderful moisturizer, especially if applied right when the child leaves the tub while the skin is still wet.
  • Avoid creams with fragrances, coloring agents, preservatives, and other chemicals. Simple, white, or colorless products are often better for children’s skin.
  • Do not use alcohol-based products.

Sun Safety

Sun safety for kids is very important as the temperatures rise. Children and teens are exposed to the sun a lot more in the summer due to popular outdoor activities. The key to keeping your child safe during the summer is to minimize sun exposure and remember to use sunblock with a high sun protection factor (SPF).

Minimizing sun exposure

It’s healthy and important for children to play outside. The key is keeping your child’s skin safe from the sun’s ultraviolet (UV) rays when he or she is in the sun. Here are six tips for reducing sun exposure:

  1. Do not go out in the sun during peak hours (10:00 a.m. to 4:00 p.m.).
  2. Apply sunscreen 30 minutes before going out into the sun. Reapply every two hours and after swimming or sweating.
  3. Chemicals to avoid in sunscreens: oxybenzone, octinoxate, octisalate, octocrylene and homosalate. These chemicals can cause allergic skin reactions and change hormone function in the body.
  4. Wear a hat and/or sun-protective clothing specifically designed to shield against ultraviolet rays (which can cause sunburn).
  5. Sun protective clothing provides ultraviolet protection (UPF) of 30 to 50+. This blocks 96 to 98% of the sun’s harmful rays.
  6. There’s no need for sunscreen when your child’s body is covered with UPF clothing.

Applying sunscreen

The American Academy of Dermatology recommends that everyone use sunscreen that offers broad-spectrum protection (protects against UVA and UVB rays), has a SPF of 30 or higher and is water resistant. It’s easy for families to skimp on the amount of sunblock they apply to their kids. Putting a large amount of sunblock on your child or teen just once for the whole day is not enough. Everyone needs sunscreen, except for babies less than six months old because they should not be exposed to direct sunlight. It is also important to use a lip balm that has SPF in it as well. Just like your body, lips can get sunburned as well.

When applying sunscreen to your children, even teenagers, one ounce is the proper amount. That is the same amount it takes to fill a shot glass. The amount can vary based on the size of the child but this is the general amount to follow. Apply the sunscreen to dry skin 15 minutes before going outdoors. Re-apply sunscreen every two hours or after swimming or sweating according to the directions on the bottle.

Sunscreen should be worn everyday even when it’s cloudy. Use precaution when near water, snow and sand. They reflect the damaging rays of the sun, which can increase the likelihood of sunburn. If your children are in the sun, they should wear protective clothing and stay in shady areas. It’s especially important to keep teens away from tanning beds because the ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If teens want to look tanner they should use a self-tanning product like a lotion.

Recommended sunscreens

Be sure to look for a broad-spectrum sunscreen with an SPF of at least 30 that contains zinc oxide and/or titanium dioxide. We suggest the following:

  • Alba Botanica Kids Mineral Sunscreen, SPF 30
  • Blue Lizard Australian Sunscreen, Baby, SPF 30+
  • COOLA Baby Mineral Sunscreen Unscented Moisturizer, SPF 50
  • Bare Republic Natural Mineral Sunscreen, SPF 50
  • La Roche-Posay Anthelios 50 Mineral Ultra Light Sunscreen Fluid, SPF 50
  • Beauty Counter All Over Sunscreen, SPF 30
  • Neutrogena Pure and Free Baby, SPF 60+
  • California Baby Super Sensitive Sunscreen, SPF 30+
  • Thinksport for Kids Sunscreen, SPF 50+
  • Babyganics Mineral Based Sunscreen, SPF 50+
  • Goddess Garden Kids Sport Natural Sunscreen Lotion, SPF 30
  • Kiss My Face Organics Kids Mineral Sunscreen Lotion, SPF 30

It’s important to remember that your child’s skin is more vulnerable to sun damage than your skin. By following these recommendations for sun protection, you will help protect your child from burning and other skin damage.

Hand, Foot and Mouth Disease

Hand, foot, and mouth disease (HFM) is an illness caused by coxsackievirus which is spread from person to person. It can affect anybody, but it is most commonly seen in young children. HFM tends to spread more during the spring and summer.

How do I know if my child has hand, foot and mouth disease?

Symptoms can include:

  • Painful mouth and throat sores, that can sometimes be hard to see
  • Drooling (caused by painful mouth and throat sores)
  • Decreased eating and drinking
  • Rash on the body consisting of small red bumps or fluid-filled blisters, appearing most commonly on hands, feet, and buttocks
  • Fever (typically less than 102 degrees)

Is hand, foot and mouth disease dangerous?

Most children with HFM get better without any complications. The main risk is dehydration as children will often refuse to drink because of the painful mouth sores, but this can usually be managed at home with over-the-counter pain medication. Serious complications, such as meningitis, are rare.

How is hand, foot and mouth disease treated?

HFM goes away on its own, and because it is a viral illness, antibiotics will not work. You can, however, treat the symptoms.

Using the over-the-counter medications acetaminophen (Tylenol®) and ibuprofen (Motrin®/Advil®) to treat and control your child’s pain can be very effective. Ibuprofen can be given to children over 6 months old every six hours, and acetaminophen can be given every four hours (only 5 doseds in 24 hours, though). Some children experience the most relief from alternating these medications every three hours (for example, give acetaminophen,  then three hours later ibuprofen, then acetaminophen three hours after that, and so on).

Do not wake your sleeping child to give medications, but if they wake up uncomfortable, treat them. It is okay if your child does not want to eat much while they are sick, but they do need plenty of fluids. Cold fluids often feel the best on sore throats.  Avoid citrus and salty foods. The rash is usually not bothersome and does not typically need any topical treatments.

When should I call my child’s primary care provider?

If you are worried, you are never wrong to call or make an appointment with your child’s provider. Call your child’s provider immediately if your child:

  • Is dehydrated: look for dry lips and mouth or decrease in urine output (your child should make urine at least every six to eight hours)
  • Is listless or you are concerned about how sick your child looks, especially if he/she does not perk up after a dose of ibuprofen or acetaminophen
  • Has a stiff neck
  • Has a fever of more than 105 degrees, a fever that lasts more than two to three days, or is under 3 months old with a fever of more than 100.3

How long is my child contagious?

Children are most contagious at the beginning of the illness. Although viruses may last longer, children can go back to childcare once the fever has been gone for 24 hours and they don’t have open sores. I typically recommend waiting to return to childcare until after the rash stops spreading, but it does not have to be completely gone. The rash will slowly fade over the course of a week or so. Hand washing and disinfecting surfaces and shared objects are the best ways to help prevent transmission.

Helping Kids Who Are Afraid of the Dark

Being afraid of the dark is a very common complaint among young children and one worth addressing. Helping a child overcome this fear can give them confidence that they can face other fears in the future. Some children develop a fear of the dark without any specific reason. Others can point to a specific event, such as hearing a scary story, watching something scary on TV or living through a difficult experience, which started the problem. Regardless of how it starts, there are a few steps that parents can take to help their child in this area.

Listen to your child

The first important step is to listen to your child. Try not to be dismissive, even when you are trying to be helpful. Simply saying, “There’s nothing there, don’t worry and go back to bed” might make your child feel as though you don’t understand or feel empathy for him. It is more helpful to ask your child to tell you what they are afraid of. Let them know that you understand it can be scary in the dark. Allow your child to talk about the experience and listen, reflecting back what you hear.

For instance, listening calmly and then saying things like, “It sounds like you are scared when you can’t see anything because you are afraid something scary will be in the corner of your room. I can imagine that doesn’t feel very good.” Listening and showing empathy demonstrates that you take your child’s fears seriously and care that he is upset.

Don’t try to explain your child’s fears away simply by looking under the bed, in the closet, etc. This emphasizes the feared object, rather than the fear itself. It’s not very productive and may even make the problem worse.

With that caring and compassion, you are then free to help your child move past this fear. The first step is to help them confront the fear. Avoidance – for example, just allowing your child to sleep with a light or television on or sleeping in the room with them – can make the fear worse and certainly won’t help it go away. This also teaches children that avoidance is a worthwhile way to deal with a fear, which is not the case.

Read a story

Another easy place to start is to read a story or watch a video about being afraid of the dark. Since it is a common problem, there are lots of stories out there! For example, there is a good episode of “Daniel Tiger’s Neighborhood” on PBS where he learns not to be afraid of the dark, or try the book “There’s a Nightmare in My Closet” by Mercer Mayer. This gives a starting place to talk about how the things you think are scary might not be as scary as you imagine.

Problem solve

The next step is a great opportunity to teach your child problem-solving skills and ways to cope with fears. A good starting point is to ask your child what might help him feel less scared of the dark. A small (not too bright) nightlight, having a stuffed animal, a comforting bedtime routine or an object that empowers them (for example, some kids like a magic wand), are all some possible examples. You might be surprised at your child’s creative answers! Praise him for coming up with good ideas.

You can remind your child that he has a wonderfully creative imagination that helps him play, draw and tell stories. You can tell him that he should be glad he has such an imagination even though it sometimes means his mind plays some tricks on him. Help him learn to laugh at his mind’s ideas and start to tell himself what an interesting idea it is that there could be a monster under the bed. He can tell himself that even though it’s not true, his mind has done a good job thinking up an interesting story.

Praise your child

Last, but not least, praise your child for making an effort in any of these areas. Let him know you are proud of him for facing his fears. Also be sure to praise yourself for teaching your child not to feel bad when he is afraid of something, but to have the confidence and skill to learn more about it, challenge his own assumptions and come up with solutions to the problem. If you child can do that, he will be well equipped to handle many things in life!

Spring Allergies

As we welcome the warm weather of spring and watch flowers blossom in our backyards, we also understand that for some, spring is just the beginning of an uncomfortable allergy season. It can be anguish for children, who watch the weather change, and feel the daylight hours extend, only to be held back due to allergies. But there are some simple steps your family can take to help alleviate your child’s springtime allergy symptoms.

  1. Be proactive about body protection.

Prevention is the best way to avoid allergy-triggering stimuli like pollen and dust. Give your children sunglasses to prevent watery, itchy eyes, and avoid wearing clothing made of synthetic fibers, like polyester, nylon and spandex. When returning indoors for the day, take a shower to wash off anything that may trigger a reaction and to prevent pollen from lingering on clothes or in hair.

  1. Administer allergy medication in advance.

Antihistamines will be your go-to for managing allergy symptoms. Some antihistamines are short-acting, and some are on a time release, lasting up to 24 hours. They are safe for kids when administered correctly, so pay close attention to the drug facts on the back. Non-sedating antihistamines can be used during the day without causing drowsiness. Also note that:

  • It’s best to start allergy medication early before the allergy season starts. This will give the medication time to kick in, reducing your child’s discomfort.
  • Nasal sprays and eye drops also are good options. If the allergy symptoms still persist, ask your pediatrician about seeing an allergist to undergo allergy testing and discuss other options, such as prescription medication or allergy shots.
  1. Shut the windows and close the doors. 

It’s tempting to keep the doors and windows open in the springtime, but keeping doors and windows open will attract the outdoor triggers that can cause an allergic reaction. Close the doors once inside, and try to keep the windows shut to minimize indoor pollen.


Soothing a teething toddler can be a major concern for parents. Their frustrated faces, loud cries and aching gums all want relief as soon as possible.

Infants typically begin teething when they are 3 to 6 months old, but the “first year molars” usually come when children are 1 to 1 ½ years old. Because these are larger teeth than the first few that come in, they can be a bit more painful. Typical symptoms include an increase in drooling (though kids at this age drool a lot regardless), fussiness, putting things in their mouth (though again, this happens a lot regardless) and trying to chew on things. Often you can see the tooth beginning to break through.

Home remedies for teething pain

Teething tends to seem worse at night or when children are tired, as that is a time when they will be most bothered by discomfort and harder to distract. The gums can be quite sore, especially during the period when the teeth are close to erupting. My personal preference is to try non-pharmacologic remedies first before moving to medication.

What I find most effective is letting toddlers chew on a washcloth soaked in ice cold water. The cold helps with pain relief, and the texture of the washcloth is soothing on the gums. Other cold things can be helpful too – such as drinking ice water or cold fruit, but be careful of small things that could be choking hazards.

Medications and teething toys

There are two main types of teething medication – topical and oral. The topical medicine most used is benzocaine (Orajel). My feeling about this medication is that it is effective but only for a very short period of time. Topical gels can also be dangerous to use because they come with serious risks, such as local reactions or seizures with overdose. Also, benzocaine-containing teething gels should not be used in infants or children under two years of age. For a toddler who is really uncomfortable a teething gel can be a good temporary fix until the immediate pain passes.

Oral medications such as acetaminophen or Ibuprofen are longer acting and can also provide pain relief.

Teething toys can be effective, but are not really necessary. I think the best teething toys are those that you can freeze. If you decide to use teething toys, it’s important to make sure that they really are designed for young children to chew on, without small parts or materials that could break off and become choking hazards.

The most important thing is to remember that the pain and discomfort are only temporary!