Are you the parent of a tween or teen? Do you worry about your child’s weight? Does your child worry about their weight? Have you ever heard your child say “Ugh! I’m so fat!”? Did it leave you speechless and panicked? Are you worried that your child has an eating disorder or is over-weight? Are you at a loss when it comes to talking to your child about health, weight, and the importance of being active? Well, then I suggest you grab a cup of tea, get comfy, and have a listen to this wonderful conversation I had with Dr. Dianne Neumark-Sztainer, a researcher and professor at the University of Minnesota. She is the author of “I’m, Like, SO Fat”: Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight-Obsessed World.
Over the summer I read an article in the NY Times which hi-lighted the importance of avoiding commentary on your child’s weight. Dr. Neumark-Sztainer was featured in the article, and it reminded that I had read her book a while back. I decided to reach out to her to see if she would be willing to chat with me. Of course, I was thrilled when she said yes, and excited to share our conversation with you. We discuss how to talk to your teen, how to create a health-promoting environment at home, how to approach teens that want to be vegan, the importance of family meals (of course!), and much more.
I hope you enjoy our conversation, and as always, I welcome your comments, feedback, and suggestions.
This quick and easy slaw makes a great side to round out a meal. I served it this past Sunday along side aloo gobi, a spicy, lemony dal and Basmati rice. But, it would also be great on top of a veggie burger or as a crunchy side to your favorite wrap or sandwich.
Unlike a typical coleslaw, this Gujarati version is not drenched in a heavy dressing and has just a hint of spice. The slaw is only lightly cooked, leaving the vegetables with a nice crunch. Growing up, my mom always made it with green cabbage, but I just couldn’t resist this beautiful purple cabbage at the market. I’d definitely give the green cabbage version a try (my family actually prefers that one!). I liked this version equally and loved the punch of color.
For a recipe as simple as this, it’s important to have all of your ingredients prepped and ready to go because it comes together in minutes. I find this dish to be very sensitive to salt. Depending on how small or big your cabbage is, you may need to adjust the level of salt. Of course, I recommend you start with the smaller range of salt and add seasoning to taste. This dish can be eaten warm but it’s equally good at room temperature. In fact, one of the beautiful things about this slaw is that you can make it ahead of time and just leave it at room temperature until you are ready to eat.
Asafoetida is a bit of an unusual spice and you may not have heard of it before. If you don’t have it, I wouldn’t let it keep you from making this dish. But, if you have an Indian grocery store within a reasonable distance, I think it’s worth the effort to add it to your spice rack. It has a very pungent aroma, and the smallest pinch is all that is needed. I’m not even sure you could pick out the individual flavor in the dish, but it seems to add a little something special to the slaw. It’s used in many Indian dishes as a flavor enhancer and is said to add notes of onion/garlic flavor to the dish. Traditionally, it’s felt to aid in digestion and even serve as an antidote to flatulence. Which, I suppose, is good thing if you plan on eating half a head of cabbage:)
I’ve started back to work over the last few months and it’s been such a gift. I didn’t realize how much I missed being in an office environment, and seeing patients again has been rewarding. The days are long, and the juggling of work, family and all the rest of it has been challenging for sure. Something I’m working on is to use my weekends for more serious meal planning so that dinner can come together easily on busy work days. I find that prepping and chopping vegetables ahead of time, anticipating leftovers, and relying on my freezer have been an enormous help. I’m still getting the hang of things and hope to share many more quick and delicious recipes that can come together in a snap.
It’s hard to believe that the start of another school year is already here. Summer travel and a loosened schedule contributed to the sparsity of my posts over the last few months. But, as the kids head back to school, I’m preparing for my own new schedule as well. I’m hoping to return to clinical practice soon and will continue to write and explore about family health and well being. Some upcoming projects that I am looking forward to include a workshop on family meals, attending the Plant-Based Nutrition Healthcare Conference and an insightful talk on how to better understand our teens being given by Dan Siegel (Brainstorm: The Power and Purpose of the Teenage Brain).
As the busy weeks start to replace summer days without homework and soccer practice, this tofu tikka masala can be just the thing you need to ease into back to school mode. It takes advantage of summer tomatoes that are still at the market and can be made ahead of time. If you set your rice cooker, dinner will be ready right between piano practice and that last little bit of homework.
You may have eaten a dish similar to this at one of your favorite Indian restaurants. A few things make this version different. First of all, it’s entirely plant-based. Most restaurant versions include chicken or paneer and a generous helping of heavy cream. This tofu tikka masala obviously has tofu instead and a scant half a cup of coconut milk is all that is needed to give it a rich and creamy flavor. It’s not quite as rich as the restaurant version, which is a welcome change for an every-day, weekday meal. If you’ve never used sprouted tofu before, consider giving it a try. It can be used in pretty much the same way that firm (or extra-firm) tofu is used. It is made from sprouted soybeans and the texture is a bit spongier. The sprouting yields tofu that is more easily digestible, higher in protein, calcium and slightly higher in fat.
1 green chili, cut in half lengthwise and de-seeded (keep the seeds if you are brave!)
1 large yellow onion, diced
3 cloves of garlic, minced
1 tablespoon of fresh ginger, minced
4 ripe tomatoes, roughly chopped or pulsed in food processor to fine consistency
2 teaspoons of ground cumin
1/2 to 1 teaspoon of ground red chili, depending of level of spice desired
1/2 teaspoon of ground turmeric
3/4 teaspoon of garam masala
1 teaspoon of Kosher salt
1/2 cup coconut milk
1 cup frozen peas
Drain and press the tofu for a couple of hours. If you have the time, this step really does make a big difference in the overall texture of the dish. To press the tofu, simply wrap the drained tofu in a dish towel or paper towels. Place a small baking sheet or cutting board on top and weigh it down with something heavy (can of beans, etc.).
Once the tofu has been pressed, cut into roughly 1-inch cubes. Spray a baking sheet with non-stick cooking spray and bake the tofu at 375 degrees for about 15 minutes. The tofu should firm up but not become browned. Set the tofu aside.
As the tofu is baking, begin to prepare the sauce. Warm the olive oil in a medium-sized pot (I love a Dutch oven for this recipe).
Once the oil is warmed, add the cloves, cinnamon and bay leaf. Cook for just about a minute, until fragrant.
Next, add the onions and sauté until just beginning to brown.
Once the onions are golden, add the garlic and ginger and sauté for an additional minute, being careful not to let the garlic and ginger brown.
Add the tomatoes and sauté until they are cooked down a bit (about 5 minutes).
Next, add the remaining spices, including the salt, and cook until fragrant and the spices have been incorporated into the mixture.
This next step is optional, but I recommend it to create a smooth and creamy sauce. Carefully fish out the cloves, cinnamon, green chili and bay leaf. Allow the mixture to cool and transfer to a food processor or blender. Carefully purée the mixture until smooth.
Return the mixture to the pot. Add about a cup of water to your food processor or blender and swirl it around to capture the bits of sauce that are clinging to the side. Add this additional water to the pot. (This a little trick my mother taught me to make sure you don't waste one bit of the flavorful sauce.)
Bring the sauce (including added water) to a simmer and stir in the coconut milk.
Add the tofu and frozen peas. Cook on medium low heat for 10 to 15 minutes to allow the flavors to meld. Season with additional salt and pepper to taste.
As with most of the recipes I feature, this one welcomes your substitutions and additions. Chickpeas, potatoes and cauliflower would be wonderful or maybe even some colorful bell pepper or generous handfuls of baby spinach. Served over a steaming bowl of basmati rice and maybe a simple green salad, it’s sure to clear your family of any back to school blues, not to mention that the leftovers are perfect for lunch tomorrow.
As we all begin the start of a fresh, new school year with all of its hustle and bustle, I encourage you to make family meal time a priority. Setting the table, sharing a meal and sitting together for the 20 minutes that most families spend at the dinner table is a simple ritual with often complex results. Research has shown that shared family meals are associated with improved academic achievement and language development as well as decreased rates of substance abuse and greater physical and emotional well being. Though there may be quite a bit of work behind the grocery shopping, meal prep and co-coordinating of schedules to make those 20 minutes a reality, I would argue that those 20 minutes are well worth the effort and often the best part of the day.
I’d love to hear your suggestions and ideas for the upcoming school year. Feel free to use the contact page or email me at firstname.lastname@example.org.
A few weeks ago I happened to catch Episode 557 (Birds & Bees) of This American Life. The show focused on having difficult conversations with kids. It covered topics such as race, sex and death. The last segment was particularly interesting to me because it provided a unique perspective on helping children manage grief. They featured the Sharing Place, a grief support center for families in Salt Lake City, Utah. I contacted the center to see if they would be willing to continue the conversation with me. Jill Macfarlane, their Development Director and Family Placement Coordinator, was kind enough to share some of her time with me and answered a few of my questions that came from listening to the piece.
I was really impressed by how direct some of your conversations with kids about death and grief are. Can you speak a little bit about your approach to talking to children?
I want to preface the answer by saying that here at the Sharing Place, despite what the piece portrayed, we don’t focus just on “how the person died” but rather, on the person and the memory of that person. We say over and over again that it does not matter how someone died but just that we loved them.
We do talk about the ways in which people die when kids have questions so that that they can process it in the correct way. Developmentally, kids, especially for the younger ones, tend to have imaginative thinking such that they feel they caused the death of a parent or that they are going to catch their little brother’s cancer.
We advise parents that if the child is not asking the questions, don’t give them information that they may not be ready to hear. They will ask you the questions when they are ready. We just have to be there to answer them when they are, not when we are ready to “tell them” but when they are ready to listen.
I can imagine that when a parent or another adult is dealing with their own grief that there can be a tendency to sometimes over-share.
So often, the questions will come in stages. The child may ask “how did dad die”. The parent might say, “he died from suicide”. Then the child may ask “what does suicide mean?”. And the parent can offer that suicide means that he chose to make his own body stop working because he had a sickness called depression. Then maybe six months to a year later the child may ask, “well how did he make his body stop working?”. And that may lead to more questions. As the child is ready to learn more, they will ask more questions. You don’t need to sit a four-year-old down and talk about suicide but if the child asks the question, you should definitely answer it truthfully.
What’s the best advice you can give for someone that may be more peripherally involved in a child’s life, such as a teacher, friend or even a pediatrician, to express their concern in way that is helpful for the child?
I would say don’t ask questions. Just be validating and supportive vs. peppering them with questions. Using reflective listening is really important so that the child feels heard. Instead of asking questions, we just listen and validate so they feel heard. Sometimes it’s scary for adults to hear children use big words like suicide so they just ignore it and change the subject (maybe to protect other children in the room). So the kids don’t feel heard, and in fact, they feel like their feelings don’t matter.
Another thing I’ve heard from families over and over again is how much they appreciate when you bring their person up and use their name. It can be scary because you don’t want to upset someone or open up a wound. Often times people just won’t mention their person. But really it can be so meaningful to families. So instead of saying “how was it for you on Johnny’s birthday, was it hard for you?” offering “ hey, I just remembered that it was Johnny’s birthday last week and I wanted you to know I was thinking about him”. Again, it’s the questions. People don’t want questions; they just want to know that their person is remembered and that they are loved.
I’ve often seen situations where parents will feel they need to keep their emotions in check in front of their children. What’s the best way for parents to support their children when they are dealing with their own feelings of grief and loss?
I think it’s important for parents to normalize emotions in front of kids – “mom’s sad and it’s ok for mom to be sad because mom loved dad very much”. We talk a lot about all of your feelings are ok. The behaviors that may come along with the feelings may not always be ok, but every feeling you have is ok.
We’ve often heard kids say mom didn’t’ care about dad because she never cried, and then, the kids don’t cry. There is a huge disconnect because everyone’s hiding their feelings from one another. Now if the parent isn’t getting out bed in the mornings, that may not be okay, but it’s ok for them to know you’re sad.
What’s the typical way in which you work with families in terms of time frame?
It really does vary from family to family. Some families call us two hours after the death, others may call after the funeral, and some families may not reach out to us for a year after the death. I would say after the first 6 months is when we usually see families. There are exceptions but we do have a waiting list for services so that’s when we typically start to see families. The average family stays in our program for about two years, and we’ve really found that kids do their best grief work about a year after the death. That’s when life is beginning to come back to a routine, and that’s when it really hits kids that they are not coming back.
Do you manage crisis type situations and what do you do when a family’s needs are outside of the “normal” grief process?
We do not provide therapy. We are a support group, which is completely different from therapy. Therapy and support groups work well together. We have an incredible list of therapists and resources in the Salt Lake area and we refer out for that acute, crisis management. The Sharing Place is here for long-term grief support and not necessarily the acute management. We do also have lots of community resources such as local food banks and mental health specialists.
It’s wonderful how you are able to facilitate some of these really difficult conversations with families and be such a resource and support for them during a challenging time.
This American Life did a great job on the piece but in terms of the editing I just wanted to say that with regards to the “way people die”, we don’t speak to every family about how someone died. Many, many families have already done a wonderful job talking to their kids. There are some situations, though, where families have a hard time, and they just can’t find the words. That’s when we are able to help them with the conversation.
Are the conversations usually pretty heavy or are you able to bring any joy or laughter into the groups?
That’s the beauty of the group sessions. You have these families that are new and so raw, and then you have these families who are 2 or 3 years out and at point where they can smile and laugh. It’s such a great mentoring system, that these families on this end say “wow, I can get there” and the families on the other end are saying “look how far I’ve come”.
I tell kids all the time, especially the teens, that we have fun here. Our teens tend to stay the longest. They are the hardest to get here but they stay the longest. Our groups always focus on the memories of the people. Sometimes we cry but most of the time we share, we laugh and really get to know one another.
Is it hard to say good-bye to the families once they’ve completed the program?
Yes, it is hard. We have a process called a closing. The families have to tell us three times that they are leaving before they leave group. We have a really wonderful ritual where we say good-bye. It’s sad to see them leave but at the same time, we are happy to see them move on without us.
Who decides when it’s time to leave group? Once they leave, do they come back?
They decide. There’s no time frame on our end. Once they leave, they’re done. Leaving is about a 6-week process and we are very thoughtful about it. If a new loss occurs, they can get back on the waiting list but that is very rare.
What do you think is the biggest misconception surrounding grief, and what do you think kids would want us to know?
I think they would want you to know that they want to talk about it. That they want you to remember their person and acknowledge them. They don’t want their person to be forgotten and they don’t wanted to be treated any differently. Especially for teenagers, they feel like they’ve become “that person whose brother died” and they don’t want to be treated any differently but they still want their person to be remembered.
Do you have any suggestions on helping children with loss, perhaps not at a personal level but a more global level like a death in the community or for instance the earthquakes in Nepal?
I would say it’s the same basic message – be honest in a developmentally appropriate way. Little kids may not understand earthquakes and school shootings. When they ask questions be prepared to answer them. If they aren’t asking the questions you don’t necessarily have to sit them down to talk about it. If they do ask, it’s important that the questions are answered truthfully and in language that they can understand.
At what age do those sorts of question tend to come up?
Usually 5th and 6th grade — the pre-teens are the ones that ask those sorts of questions. The younger kids are usually focused on their four walls. The pre-teens are beginning to see that there’s this whole world around them.
Do you have any resources for parents that may not be in the Salt Lake City Area?
The first group support center for children was The Dougy Center located in Portland, Oregon. We are a Dougy Center model. They have training centers all over the country. They have a tremendous amount of resources on their site – tip sheets, how to talk to kids, a teen section, etc. There’s also the National Alliance for Grieving Children and they have a resource at childrengrieve.org that helps families find local support groups.
I hope that this piece brings some insight into the ways in which we can help children manage grief and to encourage families to seek out community resources. I thank Jill Macfarlane for taking the time to speak with me and for the wonderful work that centers like hers do every day. I’m sharing some of the links that Jill provided below, and of course, I encourage you to listen to the original piece from This American Life.
Parents face many challenges during their children’s adolescent years, one of them most certainly being the struggle to ensure that their teens are getting adequate sleep. As my oldest is about to turn 13 in a few short weeks, we’ve certainly noticed some changes in her sleep routine and so I thought it would be helpful to review “normal” sleep patterns at this age, some common myths and what we as parents can do to support our teens in establishing and maintaining healthy sleep.
Dr. Mary Carskadon is Professor of Psychiatry and Human Behavior at the Alpert Medical School of Brown University as well as the Director of the Chronobiology and Sleep Research Lab at EP Bradley Hospital. She is an expert on childhood and adolescent sleep and circadian rhythms and has conducted extensive research in the area. She was kind enough to share some of her articles (referenced below) with me and I hope to provide you with an overview of the information.
To start with, a brief review of adolescents and sleep. There are two main things that influence adolescent sleep patterns. The first involves biological changes that occur during puberty and regulate sleep. Contrary to popular belief, adolescents actually need the same (if not more!) sleep than school-aged children. During puberty, most teens undergo a sleep-wake “phase delay” meaning that their internal clocks become wired to stay awake later and want to wake up later as well. This shift can be as much as 2 hours. This is thought to occur because of a delay in nighttime melatonin secretion through adolescence, thus causing a shift in their circadian rhythm. Another contributing factor is a change in the “sleep drive”. The sleep drive is the pressure we feel to fall asleep. During puberty, this pressure accumulates more slowly, ultimately making it more difficult for teens to actually fall asleep. Subsequently, many teens find it challenging to fall asleep before 11 PM. If we understand that their sleep requirements do not decrease during puberty, you can easily see that if your teenager is required to get up much before 8 AM (which is true for almost every family I know!) that it can become quite easy for teens to become sleep deprived.
The second contributing factor that influences teen sleep pattern are psychosocial factors. Teens have an increasing need for independence and autonomy. Bedtime can be one of the areas in which teens choose to exert that autonomy. Throughout the course of adolescence, your child will likely take more control of setting his/her bedtime. (Interestingly, however, even though older kids took more control of setting their own bed time, these same kids actually required a parent or alarm clock to wake them up in the morning compared to younger kids who woke on their own.) Additionally, kids at this age face increasing pressures on their time. Between after school activities, sports and maybe even a part-time job, teens are often completing homework assignments late into the night. Finally, the use of technology and its effects on sleep have been well documented. Carskadon summarized this nicely in her article:
The preponderance of studies report shorter, later, and/or more disrupted sleep, as well as such daytime consequences as sleepiness or disruptive behavior, for children and adolescents as TV watching, computer/Internet/electronic games use, or mobile phone use in the evening before bedtime is greater. These activities are arousing in and of themselves and usually more easily accessed by the older adolescents, taking advantage of increased accessibility of technology and of the changes to the sleep regulatory systems that make it easier to stay away later. Indeed, to the extent that the activities involve light exposure—perhaps particularly blue-spectrum light exposure to which the circadian clock may have greater sensitivity—evening light has the phase-specific effect of delaying circadian rhythms, thus pushing sleep timing later.
All of these factors show how adolescent sleep patterns can be disrupted but why is sleep so important? Other than the obvious, that well rested teens tend to be more pleasant to be around and that they will be more focused and attentive at school, researchers have actually found some other important reasons to encourage you to help your teen get the sleep they need. In addition to improved mood, attention, behavior, grades, and health (overweight and immune problems), sleep has the following associations:
One study showed that teens whose parents set a bedtime of 10 PM or earlier (compared to after midnight) were significantly less likely to suffer form depression or thoughts of suicide.
Another study found that teens who had parents set a bedtime (vs. no bedtime) were more likely to go to bed earlier, get more sleep and reported less daytime fatigue.
These studies seem to suggest that having a fixed (parent set!) and earlier bedtime not only helps to counter some of the effects of the circadian phase delay seen in adolescence by providing extended amounts of sleep but that, in fact, the benefits of longer sleep periods go beyond being able to stay awake in class.
So, how exactly do we determine how much sleep our teens need? The topic of sleep requirement and the research surrounding it can be quite complicated. Generally speaking, teens need roughly 8.5 to 9.5 hours of sleep a night. As mentioned previously, contrary to popular thinking, sleep requirements DO NOT go down during the teen years. In fact they remain the same (if not increase). Some indicators of insufficient sleep include, excessive daytime sleepiness, difficulty paying attention, irritability, hyperactivity, mood swings, difficulty getting up in the morning and falling grades.
If sleep need does not decline, we know that due to the circadian shift experienced during adolescence, that teens are naturally inclined to sleep later in the day and the start of their day remains fixed (some schools actually have middle and high school students starting the day even earlier) then it’s easy to see how teens can become sleep deprived. In fact, in August of 2014, the American Academy of Pediatrics issued a policy statement in support of delayed (no earlier than 8:30 AM) school start times for middle and high school students for precisely this reason. However, not all families have access to schools with later start times. Though later start times make sense in terms of teens’ biologically mediated sleep patterns, they also pose certain problems for districts and families if they are not implemented in a well thought way. Many families have daycare/childcare restrictions and often older teens are responsible for caring for younger siblings after school.
So what’s a parent to do? In addition to encouraging your district to adopting a later start time for middle and high school students, here are some strategies you can use at home to help your teen get better sleep:
Work together to set a reasonable bedtime and try to be as consistent as possible (even on the weekends!).
Take a look at after school activities and simplify where you can.
Try to maximize light in the morning and minimize it in the evening (this can help with the circadian rhythm shift).
Avoid late afternoon napping (anything past 4 PM).
Avoid caffeine, especially in the afternoon.
Encourage a calming, relaxing pre-sleep routine and avoid overly stimulating, high-energy activities before bed.
Limit screen time before bed and consider removing electronic devices in the bedroom if they continue to be a problem. Some teens have a difficult time regulating these things on their own and may need our help to set limits.
Create an environment where your teen can wake up as late as possible. If their internal clocks are wired to go to bed between 10 and 11 PM, the only way to give them more sleep is to let them sleep in as much as possible. Simple solutions like showering at night, having their clothes picked out the night before and making sure back packs and all necessary items are ready to go could give them more than 1/2 an hour of additional sleep.
The ultimate goal would be to have a smooth bedtime routine that allows for enough sleep that your child can either wake up on their own or with minimal intervention. She should be able to get through the day without feeling overly tired and remain attentive in class. If you find your child sleeping until noon on the weekends, that may signal that she isn’t getting enough shut eye on school nights. One final thought would be to model good behavior around sleep. Adequate sleep is an essential ingredient in a healthy lifestyle. Whether we realize it or not, our children look to us to show them the way.
Carskadon MA. Sleep in adolescents: the perfect storm. Pediatr Clin North Am. 2011; 58(3):637–647
Carskadon MA. Sleep’s effects on cognition and learning in adolescence. In Hans P.A. Van Dongen and Gerard A. Kerkhof, editors: Progress in Brain Research. 2011; 190: 137-143
School Start Times for Adolescents. Pediatrics 2014;134:3 642–649