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Boys in puberty. Most people think of teen boys eating them out of house and home, needing new clothes because they outgrow them every two weeks, and interesting smells. Well, there's more than that, and I'll help you navigate puberty in boys on today's Scope.

I've got a teenager at my house and one who is about to be a teenager. I can definitely say that all of those things that I just mentioned are absolutely true. But what exactly is going on in their bodies? There's going to be a lot of changes that they may come to you as parents to ask questions about. Puberty in boys can start as early as 9 but really hits between 11 and 14 and lasts for 3 to 4 years. Boys can continue to grow until they are 18 or even 20.

The first thing your boy will notice is that his private area will be changing. His testicles will get bigger, his penis will grow, and he will get pubic hair. Then comes hair under the arms and on his body, and that's usually when the body odor starts too. And you'll need to make sure to get your son some deodorant and you'll probably also need to stress the importance of hygiene.

Voice changes are next. Often boys get pretty embarrassed about how their voice cracks as it gets deeper. At our house, we pretty much just laugh about it because my boys know it's normal and it's happening to all their friends as well.

Their bodies will also start to bulk up, and their muscles will be getting bigger and stronger thanks to testosterone. Testosterone is also what triggers some mood changes in boys, especially the anger issues. So be prepared.

This is also when romances start to blossom so be sure you have the talk with your boys about your family's view on sex, birth control, and protection against sexually transmitted diseases.

Something else that testosterone causes is acne. Acne is not caused by not washing your face or by what you eat but by changing hormones. There is a lot of treatments for acne, including many that are over the counter.

Like I said, boys can continue to grow until they are 18 years old. They will usually have a growth spurt of about four to six inches towards the end of puberty. That's also when more body and facial hair shows up and boys need to learn about shaving beards and mustaches.

What about some of the more uncomfortable things that you may need to talk to your teen boy about? Well, boys start getting erections more, and sometimes they happen at embarrassing times like in the hall at school. They also start having nocturnal emissions, otherwise known as wet dreams. This is when they have erections and ejaculations during their sleep. It's normal. They have no control over it, and it can happen up to a few times per week.

Remember, puberty happens to all of us who make it to adulthood. While things change from each generation to generation, some things are constant, like the changes that happen to a boy's body as they go from being a little kid to being a man. It's a tricky time for kids, and if you or your child have any questions about what's going on in their bodies, be sure to ask your child's pediatrician for help.

Interviewer: Dr. Thomas Conover is a psychiatrist. He's board-certified in both child and adolescent psychiatry in general pediatrics. And you've noticed some signs that your child is engaging in self-harm which can be a scary and very confusing thing to deal with as a parent. So what do you do? That's what we're going to find out today.

I'm going to give you some information that'll help you identify if your child is actually engaging in self-harm, how you should respond, and also some resources for help and for treatment as well. So let's start with that very first question. As a general rule, what is self-harm? How do you define that as a psychiatrist?

Dr. Conover: Self-harm is any deliberate attempt or act to injure oneself. So the term is pretty straightforward, but self-harm includes, from a psychiatrist's standpoint, both non-suicidal self-injury, which is any self-harm that's inflicted without any intent to die and also suicide attempts. So suicide attempts are a form of self-harm and the difference between the two as we define them is really whether the person who's inflicting injury on themselves means to die by doing it.

Interviewer: So when I hear self-harm, I tend to think of cutting. Is that the only type of self-harm or there are some other types as well?

Dr. Conover: Making cuts there's scratches on oneself are by far the most common type of self-harm. We also sometimes see teens do other forms such as burning themselves deliberately, or hitting themselves, striking themselves with a fist or headbanging. Those are other forms that are fairly frequently seen. There are numerous other less common acts, but cutting or scratching on oneself is definitely the one that we see most frequently in emergency rooms or psychiatric specialty care.

Interviewer: What leads to that type of behavior?

Dr. Conover: We don't know the exact reasons why any individual might engage in self-harm. You know, for each individual teen, it may be different. Some of the reasons may be as a distraction or relief from some other thought or emotion. Sometimes it may be kind of the cliché or proverbial cry for help, you know, trying to express some emotion or demonstrate distress that are too difficult for the teen to articulate in words. Those are two of the most common reasons that we see teens engage in self-harm behavior.

Interviewer: Have you experienced with any of your patients the teen actually talking about self-harm before engaging in it? You said that self-harm is in itself a form of communication and could be an indication to a parent that I want to have a conversation about something with you, I just don't know how to do it, so I'm doing it this way. But could it happen in terms of words before behaviors?

Dr. Conover: It certainly can. Many times it may be expressed to someone other than the parent, to a friend or acquaintance, somebody that the teen is communicating with over texts or social media. And, in fact, that's often a way that parents discover that their teen is either thinking about or engaging in that behavior. One warning sign and one piece of good advice for any parent of a teen is to monitor the teen's social media use and texts with some frequency because sometimes that's who they may try to talk about that too. Now, if a teen is actually coming to a parent or other trusted adult and expressing thoughts that he or she may harm themself, I would say that that's . . . while that's a concerning situation, it's certainly a situation where at least the teen feels trusting enough and supported enough to bring that up verbally before doing it or even after doing it. And in some sense, in that situation, the teen and their caregiver are a step ahead of where they might be if the self-harm thoughts or behavior are completely concealed.

Interviewer: Is it generally pretty easy in your experience for parents to recognize if their teen is engaging in self-harm?

Dr. Conover: I don't think it is, but I think the barriers to recognizing it are complex. One of the main barriers being that no parent wants to think that their child is experiencing the kind of distress that would lead them to deliberately harm themselves or to attempt suicide. And so a certain degree of conscious or unconscious denial is a huge barrier to recognition. So I think to anybody who is listening to a podcast like this, to anybody who's wanting to know more about teens' mental health, I think having awareness is a way to bring that barrier down. You know, as much as a parent doesn't want to think that their child might be experiencing that distress, some awareness and a level of openness to the possibility brings that barrier down.

Supervision and support is another thing that brings that barrier down. When a parent pays attention to their teenage child, when a parent knows what he or she is doing, who they're hanging out with, who they're communicating with, when a parent enquires actively and openly with their teen in a way that lets the teen know that they're caring and concerned, those are also things that bring down the barrier and make it more likely that the teen might actually talk to the parent about such behaviors.

Interviewer: I would imagine if somebody is listening to our conversation right now and they found it via internet search, they probably should trust their instincts. Would you say that's a safe thing to say?

Dr. Conover: If the parent has a suspicion or a concern, then I think that they should not dismiss that. The most direct first step would really be to initiate a conversation. Initiating a conversation about self-harm needn't be accusatory. In fact, it shouldn't be because that's a sure-fire way to have a teen shut down in conversation for a parent to approach them and say, "Are you cutting yourself? You should never do that." Right?

Interviewer: Yeah.

Dr. Conover: To imply a judgment or to seem like you're interrogating. You know, a better opening line might move from the general to the specific in a manner like, "You know, some teens, when they're feeling upset or distressed, might even think about hurting themselves or even hurt themselves on purpose. Have you ever thought of doing something like that?" You know, you can hear the difference when you're talking about saying, "Hey, this is not something that you alone might have thought of or done. This is not something that I'm expressing any judgment about. I'm just saying it's something that people might do, And I'm wondering if that's something that you've ever thought about."

Asking about thoughts is a little bit of a softer entry too, right? Because the team doesn't necessarily have to confess, "Oh, yeah, I did cut myself once." Maybe they're not ready to say that, but they might be ready to say, "Well, yeah, you know, I've known some people who have done that or I've heard that people do that or I've even thought about it myself." And then the conversation can proceed from there. Like I said, it doesn't have to be accusatory or judgmental and it shouldn't be, but is it going to be a difficult and crucial conversation? Absolutely. There's no way to make that kind of an inquiry easy.

Interviewer: You bring that up with your teen, you ask them if they've ever thought about it, but there are obvious signs that something, you know, is going on. Is that the point that you say, "Well, I couldn't help but notice that on your arm there are scratches or on your legs, there's bruises?"

Dr. Conover: Yeah. I think that being gentle in inquiry is important, but we don't have to take it to the point of absurdity, right. You know, if what the parent is concerned about is something concrete like, "I found a text where you said to your friend that you were thinking of hurting yourself, or when we were at the beach last Saturday and you were wearing your shorts, I noticed that you had some cuts on your leg." I think that it's fair for a parent to start with the concrete thing that the parent observed. That's reasonable. Again, not being accusatory or judgmental, right? Not, "What on earth are those that I saw on your leg during our trip to the beach?"

Interviewer: Yeah. "What are you doing to yourself?"

Dr. Conover: "Who does something like that?" Exactly, right? But just saying, "I noticed this, or I found this, or when I was looking at your texts from last week, I saw something that concerned me." I think that mustering some calm and then actually inquiring with the child is perfectly appropriate. And I think that does point to signs that a parent may look for. You know, it is my experience that most often it isn't the case that the teen will come to a parent and simply say, "I'm thinking about this, or I'm engaged in this behavior." It would be nice if they did. It's a good sign about the parent and child's communication if a child can openly state that.

However, more often, I see parents discovering signs that this might be happening. Signs that one might look for include finding items that someone might use to harm themselves in a place where you wouldn't expect to find that thing, like a kitchen knife in a bedroom, or old-fashioned razorblades, you know, that you might use to peel paint or do things like that hidden somewhere in a child's room, pieces of glass or metal. Certainly, if any of those items look like they've been used because they have, you know, blood or something that looks like that on them.

So finding items that a youth might use to harm themselves, that's one very common sign that parents might first come upon. A very common way is through monitoring social media or texts. I think it's very important to note that monitoring social media and texts should be given and what I advise parents to do before they let kids use those technologies is to set down a very clear contract and expectation that they will be monitoring their activity because that's necessary and it also avoids the conflict that would arise if a parent was monitoring those things without having set that expectation.

Interviewer: When a parent recognizes these signs and they have addressed them with their teen and they've started out the way that you've recommended, being very non-accusatory, talking about the physical things that you're seeing as opposed to passing judgment and you get that conversation going, you had mentioned that sometimes self-harm is a way of communicating that there's something else going on. I love keeping that in mind. I think as you're having this conversation is ultimately the point then to get to what the actual problem is that's causing the symptom of self-harm or is that the time you would want to involve a professional, or where would you go from that point?

Dr. Conover: An older view in mental health was that deliberate self-harm or suicidal thoughts or acts were always secondary to some other problem or a symptom of another disorder, and that you would need to treat the disorder in order to treat the self-harm behavior or the suicidality. To an extent, that is true, but a more current and up-to-date view is that while self-harm and suicidal acts can be associated with another problem like depression, or trauma, or abuse being two of the most common, they do constitute a problem in and of themselves. I don't think that a parent is best served to then become the behavioral health provider or a detective, right? You know, to say, "I'm going to get to the bottom of this. I'm going to get to the bottom of this and find out what's ailing you and what's causing this problem you're having." That's not something a parent wants to pursue on their own.

I think the first step of asking your child, "Hey, what's going on? I noticed this, or I noticed that. I'm concerned about you." That is definitely the parent's job. The parent's next job is then to help their teen by seeking some additional help and support. Self-harm thoughts, self-harm behavior, those are always a concern and virtually always merit some further support, whether that be through seeking some crisis services, or counseling, seeking some outpatient therapy, getting some additional support from a medical provider like a primary care doctor or other practitioner who maybe already knows the family and the child as a first step are what I would advise if that first conversation happens, really, no matter how that conversation goes, because a parent can do the right thing and ask the question, but the teen may still respond with denial. And I don't think that I would be giving good advice if I said, "Okay, ask these questions and ask them in a non-judgmental way." And you think they might be hurting themselves and you ask, and they say, "No, mom, I'm not doing that." You can't really close the book on the conversation with just that negative reply if you've seen signs or have a strong suspicion.

Interviewer: So the purpose of this conversation is to really have a mutual acknowledgement that this thing is happening. That's the place that a parent wants to get to with their child, expressing concern them so then that they can have a conversation about what we're going to do about it, which is ultimately going to lead to going to a professional to assist at that point.

Dr. Conover: That would be the way that I would advise that things would go. Not all teens who deliberately harm themselves make suicide attempts, but there is a strong correlation between the two. So engaging in self-harm without an intent to die is a strong risk factor and has a strong correlation with eventually making a suicide attempt. And so taking it very seriously when there are signs of such behavior or when there is an admission or confirmation of such behavior is really important because ultimately, you know, we're not concerned about the long-term health implications of having a few cuts or scars on your arm or your leg. What we're concerned about is bigger issues of health and wellbeing and ultimately safety and preventing any very serious injury or death.

Interviewer: Do you have resources that could go beyond this conversation that could help a parent that finds themselves in the situation where they have to have this conversation?

Dr. Conover: Resources that a parent might reach out to would include primary care providers. I think that primary care providers are a great first resource for families for a number of reasons. Primary care providers such as a pediatrician or a family practitioner generally have an ongoing relationship with the teen and the family. And so any discussion or decisions that are made will have a lot of context, and that there's a higher likelihood that the teen and family will feel trusting and agreeable to any advice or interventions that a primary care provider can give. Also, it's generally, unfortunately, we don't have enough mental health providers as far as specialty mental health providers like psychiatric providers and therapists, and so it may be easier and more accessible to start with primary care. At any point where self-harm thoughts or behavior, including suicidal thoughts or suicide attempts are a concern, a parent can always access the crisis services that are available.

Here locally in Salt Lake City and in the entire state of Utah, the Utah crisis line is one such resource and the Huntsman Mental Health Institute crisis line, which are actually staffed by the same, very skilled, highly-trained crisis-intervening staff are both numbers that parents can call. And a parent might question, "Oh, is this big enough of a problem for me to call the crisis line?" As a practitioner, I would always give the advice, don't second guess yourself on whether you think this is a crisis. You are not going to call the Utah crisis line with a question about your child's self-harm or potential suicidal behavior and be told, "Hey, this isn't a problem. Why did you call us?"

So your daughter just had her first period. What's normal, what's not, and what to expect now.

A girl's first period marks her entry into womanhood. It's called menarche. And many parents, especially moms, seem to have a lot of anxiety and questions about it. Many moms readily admit to me that they have forgotten what periods were like when they started. So if something doesn't seem right, they get incredibly nervous that something is wrong with their daughter. Some worry that their daughter has started too early or too late. Actually, any time between ages 9 and 15 is normal.

Some worry that their daughter doesn't have a period every month like clockwork and that they need their hormone levels checked or some sort of treatment to make their periods regular. Well, it is hormones to blame for this. However, it's because hormones are still settling themselves out. It can take two to three years before periods become regular. If there is a family history of irregular periods, they might never be regular. And that's okay too. Parents really worry if their daughter's periods are not regular. But unless their daughter is sexually active or they go months between periods after having them for about a year, there really isn't anything to worry about. Irregular periods by definition happen either less than three weeks apart or more than five weeks between periods. Otherwise, they're normal.

Moms also get concerned about cramps. Sorry, but cramps are part of periods. Your daughter should not miss school or stop being physically active because of cramps. Being physically active has been shown to decrease cramps. I have parents wanting me to write letters so that every month their daughter can miss school during her period. Periods normally last 3 to 10 days. So that's a lot of school missed. I try not to do these letters and instead discuss ways to help their cramps. Over-the-counter naproxen really helps and so does a heating pad.

Some girls will even have nausea or vomiting with their periods due to hormone fluctuations. Treating them supportively with anti-nausea medicines can help.

Moms also get concerned about their daughter's becoming anemic. This does not happen usually. Girls normally lose between 30 to 40 milliliters per period. This is six to eight teaspoons of blood. So while it looks like a lot of blood during a period, it's not as much as it seems. If your daughter has something called menorrhagia, that is excessive blood loss and that is 80 milliliters or more of blood loss per period. And these girls normally pass blood clots that are larger than a quarter. These girls will usually soak through a pad or tampon every hour for several hours during the heaviest portions of their periods. They may also need double maxi pads for protection. If this is the case, then you should talk to your daughter's pediatrician about ways to help.

I often get asked by moms if their daughters could have endometriosis or fibroids or other gynecological issues. As a pediatrician, I can do basic period management and gynecology. I can do oral or injectable birth control to help with periods. But often the best thing for me to do is to refer my patient to a gynecologist if it's more than I can address. They are much better at diagnosing and managing female concerns.

Finally, moms also ask me if their daughters need Pap smears now that they have started their periods. No. That used to be the case, and it's pretty traumatic for a young girl. The current guidelines are if a girl is 21 or has been sexually active for three years, then they get a Pap smear, and that would be done by a gynecologist, not a pediatrician.

Bottom line, most period concerns are actually part of normal development. Your pediatrician can let you know when something is not normal and refer you to a gynecologist who sees teenagers for additional help when needed.

Interviewer: You've noticed a change in your teenager's mood. They're angry, moody, defiant, irritable, and in addition, their school performance or maybe interest in other activity is significantly decreased. You're worried about depression. Is it okay to talk to them about it, or could it cause more harm than good?

Dr. Thomas Conover is a psychologist at University of Utah Health, and what is your advice for parents about how to talk to their teens about these tough topics? Or should they even talk to them about them?

Dr. Conover: Communication is a real key. It certainly is protective and helpful for parents to communicate and inquire with their teen as to what's going on and how they're feeling. And that's something that I think most parents strive for but may struggle with. How do I talk to my teen? What do I talk to my teen about? Is it okay to ask? I would advance to say that it's always okay to ask your child about how they're doing. You seem really sad lately. Is there something bothering you? Is there any way I can help?

Interviewer: No. I mean you probably have to dig a little bit sometimes, huh?

Dr. Conover: You may. I think that there's value in setting an example and leaving the door open by saying those two things. In terms of setting an example, certainly communicating openly oneself is important. Right? So I've talked about various areas of function that a parent might look at for a teen child and use to try to evaluate how serious a problem that they're suspecting maybe. But a parent can show that those things are important themself. Right? A parent can demonstrate that being engage with social activity and self-care and physical activity, you know, which boosts mood, all of those things are important. So a parent may set the stage in their own family by doing those things.

It's always okay to ask your child about how you're they're doing. And even though a lot of times teens may seem outwardly like they don't want someone to ask, I think most of the time people who are struggling even in a small way do want someone to ask. I think it's helpful not to badger. I think if you're met with that initial no on a first inquiry, it's good for a parent to perhaps say, "Well, okay. You know, I hear that you're saying that there's nothing about it that you want to talk about. But just know that I'd be happy to talk to you if you do . . . if you change your mind about that, if you do want to talk about."

I think that's a tough one. It's a tough balance to strike, because I think if a parent is a concerned at all about their child and they try to make that initial ask, first off that's a hard thing to do. You know, you might be thinking about it all day or all week and then, finally on Friday you say, "Oh, we're sitting at dinner and my kid's actually home with me. I'm going to ask." And then, the first thing that they snap back with this, "No. Everything's fine." And the parent might feel kind of rejected by that and, you know, they might respond by shutting down. Right? Going like, "Oh, well, okay. I guess I shouldn't have asked."

I wouldn't advocate for that black and white of a response, nor would I advocate for a parent then saying, "Well, no, I know something must be wrong. I've been watching you all this time, and you just aren't acting yourself. You need to talk to me right now." You know, in most cases, that's not going to be the best approach either. It's, I think, always appropriate to ask and it's always appropriate to maybe give a little space and a little time for the teen to be able to absorb the question and respond. Now, that would be with the exception of a true emergency, and those emergencies do include threats or acts of self-harm or threats or acts of a suicidal nature or serious aggression.

Pacis, binkies, soothers, whatever you want to call them, pacifiers can be a great way to calm your baby. But what if your child is on them for too long and when is too long and how to get them off of the pacifier?

Pacifiers can be a lifesaver for some. My older son took one for a bit. But when he was about five months old, he learned to take it out and chuck it over his head when he was in the rear-facing car seat when we were driving. After a few times of it landing in the front seats or bouncing off the front window, we said, "You're done." He didn't miss it. I wish our younger son took a pacifier. He had colic. He had no interest in the pacifier.

The American Academy of Pediatrics recommends pacifiers be used at naps and nighttime to reduce the risk of SIDS. Also, new babies suck on things to calm down. It's a natural reflex for them. That's why they like pacifiers and their hands and your hands and anything else they can stick in their mouth. The problem I see often is that older kids, even up until kindergarten age, sometimes refuse to give the pacifier up. Also, some babies get so attached to the pacifier, even when they get older, that if they can't find the pacifier in the middle of the night, they will scream and wake you up and get you to put it back in their mouths.

So when is the best time to try and get off the pacifier? Well, up until age three, it's going to be based on what works best for the parent and the child. Usually, after age two, children should only be using it at night. They don't need it all day long. The American Academy of Pediatric Dentistry says that they should be off of it by age three because it really affects their tooth development and how their teeth fit together. Those pointed out top teeth that you know will require braces in the future, that's what I'm talking about. Yes, these are baby teeth, but when the mouth shapes itself, the jawbones and the palate become deformed with prolonged pacifier use and the adult teeth come in that way too. Dentists say that if your child stops using a pacifier by age three, their mouth shape often corrects itself. If your child is reluctant, it can lead to a lot of problems, including orthodontist bills and even sometimes speech therapy to help correct speech problems that result from the remolding of the mouth shape. And because kids who have a binky in their mouth all the time often have a delay in language development. In fact, some speech pathologists recommend getting rid of the binky before age one.

So how do you get your child off of their beloved pacifier? You can start by hiding it, losing it during the day so they only get it during the night. You can cut the tip off and say it's broken. Or for older children, you can have the binky fairy come and take all the binkies to new babies who need them more and replace them with fun, new toys. Some specialists even recommend going cold turkey and just throwing them away, enduring a few hard days and nights and replacing the pacifier with a new comfort object, such as a stuffed animal or a blanket that your child can learn to soothe themselves with.

If you're having a hard time with getting your child off the pacifier, talk to your child's pediatrician about some tips that might work for your particular situation. The good news is, eventually, kids do give up the binky.

Parents often ask when they should transition their babies from drinking out of a bottle to drinking out of a cup or a sippy cup.

Weaning a baby off a bottle is one of those things that's easier to talk about than to actually do. I see kids as old as 3 sometimes still with a bottle, and parents tell me that the kids cry and won't drink out of anything else. They're worried that their child will get dehydrated or won't get their milk intake in if they don't give in and let their child have the bottle. I always tell parents that if you give in to your child's demands, they are winning the power struggle. Not you.

Most babies can start transitioning from a bottle to a sippy cup as young as 9 months old. By 18 months, they should be weaned off the bottle completely. Start with the bottles during the day because the bedtime bottle will be the one your child will have the hardest time giving up. It's become part of their bedtime routine, and they'll fight you most on that one.

Prolonged bottle use results in something dentists call "baby bottle cavities." Milk sugars sit on the teeth and bacteria use that sugar as food leading to cavities. Prolonged bottle use is one of the biggest reasons little kids need caps or other dental work at such a young age.

Other problems with prolonged bottle use include iron deficiency anemia and toddler obesity. Why? Kids would rather drink their calories. Kids will drink more than you think if you just keep filling the bottle and letting them walk around with it. This causes increased calorie intake with milk.

They don't eat as much real food, and then the parents come into the clinic concerned that their child isn't eating and has a problem with food. Well, the problem is they're loading up on milk and not hungry for anything else.

Milk has no iron, and if they aren't eating iron-rich foods, that can contribute to anemia. The calcium in milk also competes for iron on the red blood cells, and that too contributes to anemia.

After age 1, kids don't need more than 16 to 20 ounces of milk per day.

The American Dental Association also warns that cavity-causing bacteria can also be passed from a caregiver to a baby through saliva. So don't clean your baby's pacifier or feeding spoon with your own mouth. I know it sounds gross, but I've seen lots of parents do it right in front of me in clinic.

So how do you get your child off the bottle? Start by eliminating one bottle feeding a day and instead offer milk in a sippy cup. Serve the milk with meals and don't let your child carry around a bottle with them. This way, they learn that milk is with meals. And then if they are old enough, let them have small cups of water during the day.

Children 6 to 12 months can have up to 4 ounces of water in a 24-hour period. Children 1 to 2 years can have 8 ounces of water per day. And children age 2 to 3 can have 16 ounces of water per day.

Some kids do well with the Bottle Fairy coming to their house and taking all their bottles to newborn babies who need them. The Bottle Fairy then gives them big kid sippy cups to drink from.

If your child is still on the bottle after 2 years old, and you're struggling to get them off the bottle, talk to your child's pediatrician about other ways to help.

Parenting during a quarantine is something very few of us have ever had to deal with in the past, and it's tough. Kids push the limits all the time normally, but now you're stuck with them, usually inside, and they're driving you crazy. It's a recipe for disaster. So how can you keep things on an even keel at home during this time?

Let's face it. We're all going a little crazy right now. Everything in our world has turned upside down. Parents are working from home. Some have lost their jobs. Kids aren't able to go to school. It's surreal. There's a little too much family togetherness for everyone. So let's tackle managing behavior issues one at a time.

First, and probably the hardest one, in my opinion, is to prevent kids from being bored. I know my kids are having issues with this. They can't play with their friends. They try to stay on top of school, but either get the work done too quickly, or they have a hard time getting motivated to do it in the first place. If you're trying to keep them on a schedule, like from 9:00 a.m. to 3:00 p.m., that's best. No TV, no phone time. It's schoolwork. And if they truly finish early, they can read or play outside. We're trying to do this at our house. Sometimes it works. Sometimes it's a battle.

Second, a lot of kids start acting out because of anxiety. Kids who are old enough to understand what is going on may be scared that they're going to get sick, that their parents or grandparents or teachers are going to get sick, that someone they know is going to die from this. Be sure to talk to your kids. Give them the facts. There's a lot of rumors out there. And even with facts, they seem to be changing on a daily basis. Let your kids know that if everyone they love follows the rules and tries to stop the spread of coronavirus, we'll be okay.

Next, what do you do when their behavior really gets out of hand? Remember discipline. But do it properly, like you did before all of this. Use timeouts. Redirect bad behavior if kids really didn't realize their choice was not a good one. As Kenny Rogers said, know when to walk away, know when to run from non-dangerous, bad behavior. Ignoring bad behavior that isn't dangerous can teach natural consequences. For example, if they eat two to three bags of chips a day from a multipack and you can't go to the store to get more because of the quarantine, then guess what? When there are no more chips, they'll have to eat the fruits and veggies you probably got at the store on the same trip that you got those chips. They'll be forced to have healthy snacks or no snacks at all.

What about if they do something good? By all means, let them know this. Point out good behavior and let them know when you see that they tried to do something that was hard for them and they were able to figure it out. Kids aren't getting those reinforcing good feelings from their friends right now. They need that from you.

Speaking of getting reinforcements from you, remember you're all they've got right now in terms of person contact. I've got to go into the office and still work, but my husband is able to work from home. The hard part is he is trying to do this full-time job he has while being a full-time dad and a homeschool teacher as well. It's virtually impossible to be all three at once. By setting up expectations on when they can have your attention and when you need to do your job, you can help let kids know that when work time is over, they can have parent time. Now, getting your kids to follow those expectations can definitely be difficult in itself.

Unfortunately, one negative trend that is being tracked by the American Academy of Pediatrics is the increase in number of cases of child abuse. Parents are stressed to the breaking point with a lot of what's going on, and unfortunately that leads to increased aggression towards children when they're acting up. If you find that you are getting to that point, walk away. Put yourself into a timeout if needed. That's what I often do. I literally will go lock myself in the bathroom. Often it's because my two boys start tackling each others. Neither one of them want to stop whaling on the other unless I get involved. But when I do, I just hear from one that the other is the favorite or something along those lines. So I'm trying to learn to just let them work it out themselves. I've talked to enough parents of boys to learn that this won't stop until they're adults and out of the house, and even then it apparently continues whenever they come back home. As long as no one is seriously hurt enough to need an emergency room visit, they need to learn to work things out on their own.

Finally, remember, take care of yourself as a parent. Try to get good sleep. Exercise when you can. Of course, you will probably have to find creative ways to be physically active, but you can always go on socially distanced walks. And be kind to yourself. This is a stressful time for all of us. Remember, if we all do our part, we can make it through this.

Dr. Gellner: Teens are tricky when it comes to helping them set healthy habits. I'll talk about helping your teen develop self-discipline for good sleep, eating, and exercise habits.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Teenage-hood is that odd time between being a little kid where parents micromanaged every part of your life, to being an adult where you're supposed to be responsible for all your own actions. Teens still need guidance on developing healthy habits.

Take eating, for example. Young children have their meals made for them, but when kids become teenagers, suddenly, they may have to fend for themselves. They should learn how to cook, so they don't always have to pop some frozen concoction in the microwave or hit up the closest fast-food joint. Many middle schools actually have classes where they start teaching cooking, and that's a great time to start getting your teen or pre-teen in the kitchen, so they can learn how to measure ingredients and learn kitchen safety. You can even sit back and have them cook for you one night.

And then, there's sleep. This one is made extra-hard because a teen's body wants to stay up late and sleep in. Unfortunately, that's not an option for kids, at least not during the school year. Teens need to be up and at school before their bodies really want them to be. Helping them establish good bedtime routines and keeping them on a pretty close schedule, regardless of if it's during the school year, on the weekend, or during the summer, will make this a lot easier. Also, don't have them rely on things like energy drinks to wake them up. Those may help in the short term, but then they will crash right in the middle of class, and that's not a good idea.

Finally, there's exercise. Teens don't have recess in the middle and high school anymore, and PE is taken out of schools more and more. Some kids only have it for a quarter now, rather than an entire school year. It's important to keep your kids active and stress the health benefits of exercise. It will help them with that sleep cycle issue. It will help with endorphins, those happy hormones which are often needed during the emotional roller-coaster of being a teen. And it will help them stay in shape. Childhood obesity is such a huge problem right now, and any little steps your teen can make to stay active will help make sure that they are at a healthy weight now and will set their ways to continue to be active as an adult.

While it can sometimes be hard for a parent to try to help their teen through this phase of growing up, especially how resistant some teens are to being told what to do, the best thing you can do to help your teen develop healthy habits is to be a good example and have them for yourself.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: When are school age kids able to stay home by themselves? I'll talk about preteens at home on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Back to school time doesn't just mean parents going out and buying new backpacks and pencils, but also time to think about where kids will be before and after school hours. The American Academy of Pediatrics released a statement in August recommending that elementary and middle aged school children still require adult supervision during those times.

As a parent, I get it, that's hard to do sometimes, especially as kids get older and the options for after school get less. For many kids, once they get to be double digits, especially if they start middle school around 11, parents think that they can stay home by themselves. And in some cases, that's okay depending on that child's maturity level, how safe the neighborhood is, are there adults around that the child could reach out to in case of an emergency, is there a way for a child to touch base with the parent to let them know they're home?

Some parents have the luxury of having another family member or a friend take care of their child. In these cases, parents need to stress that these caregivers need to follow the parent's rules about schedules, discipline, and homework. Kids are sneaky and they will try to get away with breaking those rules if they're being watched by somebody other than mom and dad.

If your child goes to an after-school program, make sure that the program has a good number of staff to take care of the children in the program and also make sure that they have a place your child can do their homework. Staff also need to meet state certification regulations for dealing with health issues, emergencies, and the facility itself needs to be inspected and approved as safe.

When it comes to homework, be sure that your child knows homework always comes first. Stress good study habits and make sure they have enough time available to do it, especially if they are involved in extracurricular activities. They should have a quiet place to do their homework as well, free of distractions like the TV and other electronic devices.

The bottom line is everyone needs to be on the same page, your child who needs to understand the importance of getting school work done and playtime comes later if they are home by themselves, after-school providers who need to be supportive of what each child needs and honor the request of the parents, and you as the parent, who needs to be able to set down these firm guidelines and make sure they are followed to ensure that your growing preteen or teen and those who are in charge of them, when you can't be, understand those expectations.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: Most kids play a sport when they're growing up, and that's a great thing. Today, on The Scope, I'll talk about the benefits of having your child play a sport.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Like many of you, I'm a soccer parent. My kids also do taekwondo. Having kids do sports goes way beyond the benefits of just keeping them active so they get tired. For starters, kids who participate in sports have stronger muscles and bones. It also helps keep their weight under control, which is important considering the child obesity problem we are seeing. Being active in sports will also help keep their heart healthy because it improves cardiovascular endurance. Being on a sports team also helps kids with social interactions, building teamwork, and leadership skills.

Teamwork requires cooperation and compromise. It can also teach empathy in the form of learning how to be a good sport when something doesn't go their way on the field. Being part of a team helps them with confidence and boosts their self-esteem when they're part of a group of peers with similar likes and goals. They also learn responsibility and discipline. They have to listen to and respect their coach and their peers when on a team.

Kids who participate in sports also seem to do better in school. High school students know they have to keep up a specific GPA in order to continue to play their sport, and so this is one way to encourage good study skills. Physical activity has also been shown to help keep their mind sharp as they build new problem-solving skills on and off the field.

Finally, there's perseverance. Athletes are often in high-pressure situations on the field. They have to figure out how to quickly adapt to these situations and work through them. This helps with coping skills and critical thinking as they face challenges in life.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: Parents know they want a good doctor for their child, but how should they go about actually choosing a pediatrician? I'll give you some pointers on how to find the best kid doc for your child on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: As a parent, we all want the best for our children, so when you go to find a new pediatrician, whether you're still expecting your first baby, have an insurance change, or move to a new city, finding someone to care for your child's health is a huge decision. Just like any other long-term relationship, you need to be comfortable with the person you are entrusting your child to. So how do you find a new pediatrician?

First, talk to your friends who have kids. I know a lot of my patients come to me and the parents say, "Oh, you see my neighbor's child," or, "You see my nieces and nephews," and they all said, "I just had to bring my kids to you."

If you are just changing insurances, ask your current pediatrician who they would recommend. Often we know the other docs in the area and who would be a good fit for your family.

Another good tip is to check out the American Academy of Pediatrics' website and use the "Find a Pediatrician" tool. It will help you find a board-certified pediatrician in your area, and then you can search that provider on various patient satisfaction websites to see what others think of that pediatrician.

Many practices actually have their own websites that answer a lot of questions for you. Often, you can look at each pediatrician's profile to see when and where they did their medical school and residency training, do they have any specific areas or interests, what are the clinic's office hours, and who takes care of any concerns when the pediatrician isn't in the office. And don't forget about looking to see what insurances the practice accepts.

Some parents choose to do a meet-and-greet appointment with a prospective pediatrician. You'd have to call to see if the provider does those types of visits and if a co-pay is required. You can then check out the office to see if the staff is comfortable with kids, is the facility kid-friendly, and does the pediatrician seem down-to-earth, easy to talk to, knowledgeable, and like they really enjoy working with the little ones.

Can your child be seen the same day for sick visits? Who covers for the pediatrician after hours? Does the pediatrician go to any hospitals? Usually, we know what information parents want when they come in for these types of visits, and so we can help you make sure you're not forgetting anything to ask.

Bottom line is you should feel absolutely comfortable with your pediatrician and feel like you can trust them to have your child's best interests at heart. If the fit doesn't feel right, move on until you find the best possible pediatrician for your family.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: Chores are something no one likes to do, whether you're a kid or an adult, but they have to be done. So how can you help get your child to do chores? I've got a few tips to help with this on today's scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Let's face it, if given the choice between playing a video game and doing laundry, you as a parent would chose the video game too. One of the most common arguments parents have with their kids is why chores aren't done. They'd rather do it later, and then later turns into next week with double the work and you about to pull your hair out.

Well, first thing that helps is making the chores mandatory and routine. They have to be done before anything fun. The choice should be you do your chore or you sit and stare at the ceiling. Well, maybe not that harsh. But once it becomes habit where your kids know they have a job to do and when it needs to be done, not pushed off, it becomes part of their routine. And kids thrive on routine.

Make chores part of their daily or weekly schedule so they know what is expected of them. Daily chores could be as simple as making their bed properly every morning or setting the table. While weekly chores could be cleaning their room or bathrooms or mowing the lawn. Make sure that the chore is age-appropriate as well. If your child thinks it's too hard because it's more than a child that age can really do, think of something else.

Another big reason kids don't like chores is because they feel that what they're doing is boring. And it's true. There's not the same instant gratification from washing the dishes as they get from getting to the next level in a video game. Kids will drag their feet, which makes the chore seem more like, well, a chore. Kids may understand that doing the chores is an important part of helping with what needs to be done as a family so everyone can have some relax time, but it's hard for them to put that knowledge into action.

So what happens when the chores pile up? It becomes a battle, parents versus kids, who will win? Parents think they're just reminding the kids to do what needs to be done, and the kids just think that the parents are nagging and using them as child labor. Well, instead of constantly being on your kids about their household chores, try figuring out how to motivate them. Find out what the holdup is on starting the chores, and then try to help your child come up with a game plan on how to get the work done properly and timely so they can go do what they really want to do.

Another tip is to give your child a specific time frame on when things need to get done and what the consequence will be if it is not. For example, tell them they have 30 minutes to have the bathroom cleaned thoroughly or they go to bed 15 minutes earlier that night. Alternatively, you can turn it into a reward. If they get the bathroom cleaned in the next 30 minutes, they can have an extra 15 minutes of video game time. Most kids will go for the reward over the consequence. An extra fun time is always a good incentive for a child to do better.

One big thing to watch out for, don't start making chores a punishment. For example, don't say if you don't stop bothering your brother, I'm going to make you vacuum the living room. Instead of making the chores something bad, make them something positive. If they do their chores, they get a reward.

For some kids, a chore chart works well. If they get their chore chart done for the week, they'll get extra playtime, or if they do all their chores for a whole month, they get to pick out a movie to watch for family night. Make the reward something meaningful for each child. For older kids, an allowance might be better. And to teach them the value of money, have them put half of their allowance into a savings account and the other half they can use for a special purchase.

Bottom line, no one likes doing chores, kids and adults included. But when everyone pitches in, then it means more fun time for all, and the kids can take pride in a job well done.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: Summer break means summer camps for many kids. I'm Dr. Cindy Gellner, and I'll tell you how to prepare your child for summer camp.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: It may be your child's first time to summer camp or their fifth time, but each time can be a little intimidating, not only for your child but also you. For many kids, it may be the first time a child is away from their parents or home for an extended period of time. They'll be away from familiar settings, sleeping in tents or cabins with other kids they've never met before, having camp counselors that are strangers and they've been taught not to interact with strangers.

It sounds scary just talking about it. So that's one of the first things you as a parent can do to help your child prepare is to talk about camp in a positive way. Tell them it's going to be a week of fun, new adventures, new friends, and making memories.

Another tip is to have your child pick out what summer camp they would like to go to. There are so many options out there. Find a camp that focuses on things they like to do. Let them look at websites with you to see photos of other kids having fun. Maybe they will have photos of the camp staff so your child will recognize someone in charge when they get there. Some camps even have kickoff picnics to meet the staff before the camp season begins. Sometimes just knowing who will be looking after them can be very comforting to a child.

Many campsites also have frequently asked questions sections for concerns parents have about what happens in common situations and also outline specific advice for how to get your child ready for camp in terms of what gear is needed, what the theme of the week is, etc. Having that information often helps reassure kids that another child has been through the same thing before and the camp knows how to handle it. This is where knowledge is power. Be sure to acknowledge their concerns and questions and answer them in a way that is reassuring and positive.

The bottom line is the more excited you are about all the cool things your child will get to do at summer camp, the more excited they will be about going and the more likely it is that they will have a great experience.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: Kids and veggies, kids either love them and we luck out without having to force our kids to eat their veggies, or they hate them and it's a power struggle. For those families in the second group, I'll give you five tips to sneak more veggies into your child's diet. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: I was one of those kids who hated most veggies. If you told me as a kid that one day I'd crave asparagus or Brussels sprouts, I'd tell you you were hallucinating. While some veggies are an acquired taste, others are easier to be sneaky with.

One of the easiest ways is a smoothie. Most kids love smoothies. Carrot juice is sweet and easy to add to many smoothies. And some kids are even okay with green smoothies where you can blend spinach into them.

Next are sauces. Kids love tomato sauce, and it's a great way to mix in veggies like bell peppers, onions and carrots, or you could do the opposite and put the sauce on the veggies. Many kids are happy to eat their broccoli if it's covered in cheese sauce.

Side dishes are a good way to make some substitutions. Kids love French fries. So introduce them to sweet potato fries. Those are more flavorful too. Cut up some veggies into designs and shapes and that'll make your child's plate more fun.

Also kids love to dip. Set out a plate full of cut-up veggies like carrots, celery, peppers and cucumbers, and a variety of dips and let your kids see which ones they like. Dips can include low-fat ranch dressing, mustards, cheeses, even peanut butter.

Finally, have your kids help grow the veggies they will eat. This will teach them the whole process about how vegetables go from seeds or tiny plants to what is on their plates. They will be so proud that they helped to grow dinner. The bottom line when it comes to getting your child to eat vegetables is be creative.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: Bedwetting is more common than you would think. But it's often something parents and kids don't want to talk about much because it's embarrassing. I'll talk about it on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: We've all been there as a parent, either during the potty training phase or as the parent of a bedwetter. Waking in the middle of the night to change your child's sheets after they've wet the bed, no fun. Even though it can be normal in kids until the teenage years, it's seen as something wrong. Most kids who wet the bed think they're the only ones that do it and that makes them feel even worse. Children normally gain bladder control through the night at different ages. Most gain control by 5, but about 15% of children continue to wet the bed after that. And by age 10, 5% still don't have control.

Bedwetting affects millions of children. And more often, these are boys and there are others in the family who've had the same issue. Frustrated parents think a child is wetting the bed because they're too lazy to get up and pee in the toilet. Kids worry that there's something wrong with them if their friends or siblings tease them. They avoid sleepovers, and it really affects their social lives.

The best thing parents can do is let their child know that this isn't their fault. In fact, scientists have even identified the genes for delayed nighttime bladder control. And just FYI, they're on chromosomes 8, 12, and 13. That's why we see this run in families so much. And if a parent had this problem, letting their child know this, and when they finally stay dry, really helps their child understand what's going on with their own body, and that it's not their fault.

Genetics isn't the only factor. Sometimes bedwetting is based on how a child's brain and bladder talk to each other when they're asleep. Sometimes it takes longer for the two to learn how to communicate with each other. Sometimes it's because kids are really deep sleepers and the message from the bladder saying it's full doesn't get to the brain in time.

Some kids have constipation problems, and the stool literally pushes on the bladder causing uncontrolled bladder contractions, which released urine. In rare cases, bedwetting can be a sign of infection, sleep apnea, or diabetes. Regardless of the reason, the vast majority of kids who bed wet are medically healthy.

Some kids who have gained nighttime bladder control will relapse if there's a new stressor like moving, parents divorcing, or a new baby in the house. But usually kids regain control pretty quickly. Pediatricians don't get concerned about bedwetting until age six. And even then, it's only a problem if the child or parent is overly concerned.

There are ways you can help out your child, such as making them pee twice before bedtime, no drinks after dinner, biofeedback techniques, and medications if they're going over to sleepovers where wetting maybe particularly embarrassing. Eventually, bedwetters do gain control of their bladders. But if your child is over 12 and they are still wetting or this is causing a lot of stress to you or your child, be sure to talk to your child's pediatrician.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.