Do You Discipline or Punish?

By Mary B. Hammock, MSN, CPNP

Do You Discipline or Punish?

Punishment controls behavior by using pain or unpleasantness to end a wrong behavior. Thousands of studies show that punishment teaches fear, aggression, and avoidance. Punishment is typically carried out in anger, frustration or in an attempt to establish dominance and immediate obedience. If your goal is to change a negative behavior, punishment should be the last tactic you choose.

What is Obedience Worth?

A high value is placed on obedience. Discipline helps teach children a value system and the benefit of doing what is right. It builds self-esteem, teaches responsibility and helps to develop self-control.

When to Disciplin

While it is very important to be swift and consistent in disciplining, try not to correct your child in front of others, including grandparents. This will embarrass your child and likely cause resentment, just as you wouldn’t want your boss to correct you in front of your peers.

You are The Example

As always, set a positive example. If it is not appropriate for your child to scream at his brother or call him names, don’t lead by bad example. If you find it appalling that your four year old slapped her friend because she took her red crayon, be sure she is not being slapped or spanked as a discipline method in your home.

A Great Tool For Obedience

Another tool to obedience is to teach and to practice. Children are not mind readers and were not born knowing how to clean their room, pick up their toys or clean off the table – especially to our particular liking. Tell your child why it is not acceptable, demonstrate the correct way to do the job and practice until they get it right. And of course, the power of praise will reinforce the great job that was done. Sometimes it is necessary to practice on your schedule and not theirs. Waking them at seven on a Saturday morning to practice cleaning their room can have more of an impact than 4 o’clock on a Thursday.

Children Want To Be Important Contributors

Children are more likely to choose positive behaviors and choices when they see themselves as capable individuals and responsible community members. Parents using positive language can help children build that self-perception. Name concrete, specific behaviors your child is displaying. “I was really proud when you gently took your sister’s hand and walked with her through the parking lot” is more effective than “Good work.” It is equally important to use a warm tone and avoid being over sentimental. “Thank you for inviting your brother to play the game with you” is more appropriate than “You are mommy’s good girl.” As a bonus, your language helps those within earshot form a positive perception of your child, which further enhances your child’s self-perception and promotes positive behavior.

Being a good parent is a full-time job. Rewards can come slowly in the trenches of daily life. It is easy to get overwhelmed and exhaustion can lead to poor choices resulting in punishment, instead of discipline. No change comes quickly but even small changes in your disciplining methods will result in big changes in your child’s obedience and self-worth. Healthy Steps Pediatrics is helping to grow healthy children one step at a time. Call 678-384-3480 for your appointment today.

Children of Divorce – Collateral Damage

By: Mary B. Hammock, MSN, CPNP

Each year more than one million children become collateral damage in their parent’s divorce. While I understand ending a marriage and dividing a family is a gut-wrenching decision, helping your children through the divorce and its aftermath MUST be top priority!

Take Care of You

Divorce is stressful and being a single parent can be overwhelming. Depression is common and it is necessary to minimize its effects by staying on routine, getting good rest, eating healthy and exercising regularly. Avoid pursuing mundane tasks, such as watching TV just to “zone out.” Seek counseling or medical advice as soon as possible as needed.

Emotions Need To Be Expressed

Express your emotions with a peer of the same sex – not with your children. Aligning yourself with your children can develop an “us against the world” mentality and that will lead to hurt and trust issues. Expressing yourself to an opposite sex adult can be easily misinterpreted as a romantic interest instead of a caring ear. If you don’t have an adult you can go to for emotional support, consider a recovery support group.

Realistic Expectations

Set realistic expectations for yourself. You no longer have a partner to share the parenting load. Don’t try to do everything, just the important things. Take advantage of carpools, pick up a healthy meal and don’t over-extend your schedule.

Taking Care of Your Children

Many children think they had something to do with the divorce. It is extremely important to set the record straight. It may be necessary to give a kid-friendly explanation and to repeat why you chose divorce. Be truthful and respectful of your spouse, while avoiding blame. Tell your children that you love them and your feelings for them haven’t and will not change. It is extremely important that you be patient. Your children may seem to understand one day and be confused the next. Reassure them as often as you need too. Reassure them that both parents will be part of their lives and that things won’t always be easy but that they will work out.

Your children must learn to cope with their new and changing circumstances- where they will live, will they have to move, who they will be with on holidays, can they still go to gymnastics, etc. Listen to your children’s feelings and schedule regular time with your children to talk about how they are feeling. Put your own emotions aside to keep from losing site of theirs. This should simply be a time of listening and understanding.

Keep your word. Being a reliable and predictable parent will help to rebuild your children’s trust. Keep your promises and do your best to be on time. This is extremely important in lowering anxiety- theirs and yours.

Positivity and Being Nice

Taking time for positive touch –hugging, rocking, hand-holding, even cuddling in bed to read – can provide security and help to restore trust. Children don’t get spoiled by too many hugs or comforting words. Resist the urge to drop routines and lavish them with gifts or let them break rules. When life calms down, you may have great difficulty with unruly behavior.
Finally, be nice. If you have nothing nice to say, say nothing. Don’t put your children in the middle or use them to send messages back and forth. Communicate civilly with your ex and take negative discussions away from the children. If it is hard – work on it!! Remember, your children didn’t ask for this.

Healthy Steps Pediatrics is helping to GROW healthy children one step at a time. Please contact us with any questions or concerns about your growing and changing family.

Children Get Headaches, Too

By: Mary B. Hammock, MSN, CPNP

Children Get Headaches, Too

Many parents worry that headaches in children are signs of brain tumors or other serious medical conditions. However, headaches in children are common and frequently are attributed to acute illness and infection, including sinus, throat, and ear infections, and often accompany fever. Children also suffer from headaches attributed to high levels of stress or anxiety, just like their parents. Good health is the best method of prevention.

Migraines In Children

It is estimated that 25% of adult migraine suffers started with migraines before their fifth birthday. It is also known that children exhibiting car or motion sickness, with a family history of migraines, will often develop migraine headaches later. Adult’s migraines usually start in the early morning, whereas a child’s may develop in late afternoon. In general, a child’s migraine occurs on both sides of the head instead of just one side in adults. Also, an adult’s migraine usually lasts at least four hours but a child’s may last less than four hours. In general, migraines can cause nausea, vomiting, abdominal pain, sensitivity to light and sound, throbbing or pounding pain and pain that worsens with exertion. Even small children may get migraines, resulting in unexplained crying or holding their head.

Tension Headaches In Children

Tension headaches are the most common headache in children, not associated with illness. Emotional factors are the most common cause of tension headaches. Stressful situations at school, competition, family or friend friction or excessive demands placed by the child or the parent can induce the diffuse pain described as a tight band squeezing the head. Tension headaches can last from 30 minutes to several days. These headaches are usually not associated with nausea or vomiting and do not worsen with exertion. Younger children may withdraw from play or want to sleep more.

Cluster Headaches In Children

Cluster headaches are not common in children under 12 years old. These headaches can occur in five or more episodes, ranging from one headache every other day to many headaches in a day. Sharp, stabbing pain on one side of the head lasting fifteen minutes to three hours is the hallmark of cluster headaches. These headaches are often accompanied by tearing, nasal congestion, restlessness or agitation.

Headache Breakdown

Most headaches aren’t serious but certain symptoms warrant further investigation. Any headache that wakes one from sleep, change’s one’s personality, includes vomiting more than once, follows a head injury, or is accompanied by fever and neck stiffness require immediate medical attention.

More typical headaches require individualized treatment, depending on the age and weight of the child and the frequency and severity of the pain. Reassuring the child that the headaches are the result of no serious abnormality generally reduces the number and severity of attacks. Regular sleep and eating habits do a lot to stave off headaches. Be sure your child stays well hydrated, especially in hot and humid weather. Caffeine and simple sugar intake should be restricted and monitor the time spent in front of a screen, whether it be a TV, computer or tablet.

Understanding Triggers

It is important to identify triggers of headaches and record them in a headache diary. The diary should include what took place or what was eaten at the time of the headache and what made the headache better or worse. Avoiding triggers is an important step in successfully treating headaches. Identifying stressors that trigger headaches and teaching coping skills are successful ways to treat tension headaches. OTC ibuprofen and acetaminophen can be used to provide relief and should be taken at the first sign of a headache. If headaches come monthly, are concerning or particularly distressing, or cause missed school days, seek guidance from your healthcare provider to determine if preventative therapy or counseling is necessary.

Like so many other conditions, practicing healthy behaviors, reducing stress and avoiding triggers are the best prevention for headaches. Healthy Steps Pediatrics is helping to grow healthy children one step at a time. If your child suffers with headaches that need further evaluation, call 678-384-3480.

A Child’s Anxiety

By: Mary B. Hammock, MSN, CPNP

A Child’s Anxiety

Anxiety is a normal part of life, even for children.  Stress and mild anxiety are motivating.  It helps one to meet deadlines, study for exams, and make goals.  Anxiety comes in phases and the phases are generally temporary and harmless.   Children who struggle with significant anxiety may experience fear, nervousness, or extreme shyness and may start to avoid people, places or activities.   There are multiple types of anxiety disorders.  If anxiety begins to take over your child, there are several strategies that can help improve their quality of life.

Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is described as a condition of excessive worry about a large variety of things, such as grades, family issues, relationships, and performance in sports and /or extracurricular activities. A perfectionist, type A personality, someone that is his or her own worst critic, is most likely to experience GAD.

Panic Disorder

Another form of anxiety that can be frightening and severe is called a Panic Disorder. A panic episode is sudden in onset and unexpected and involves symptoms of panic, difficulty breathing, feelings of dread or even demise. Two episodes must occur to be diagnosed with panic disorder and every episode is usually followed by an intense fear over having another attack or losing control.

Separation Anxiety Disorder

Separation Anxiety Disorder is defined as excessive anxiety when away from home or when separated from caregivers. Separation anxiety is common and normal between 9 months of age and three years of age. Separation Anxiety Disorder generally affects children ages 7-9 years of age and about 4% of the pediatric population.

Social Anxiety Disorder

An intense fear of social and performance situations, such as public speaking or being called on in class, is called Social Anxiety Disorder. This type of anxiety can interfere with your child’s attendance at school or sabotage his or her ability to develop and maintain personal relationships.

Selective Mutism

Children who refuse to speak in social situations where talking is expected or necessary may suffer from Selective Mutism. These children are typically 5 years old and may turn his or her head, avoid eye contact, chew or twirl hair, or withdraw into corner to avoid talking.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is described as unwanted and intrusive thoughts and the feeling that one must repeatedly perform rituals and routines in an attempt to ease anxiety, such as turning the lights on and off 3 times or stepping over every 6th tile. OCD can show itself in children as young as 2 years of age with most children suffering diagnosed around 10 years of age.

Post Traumatic Stress Disorder

Those who directly witness a traumatic event, suffered mental health issues prior to the traumatic event, and those who lack a strong support system are at risk for Post Traumatic Stress Disorder (PTSD). Those who suffer PTSD may have intense fear and anxiety, may become easily irritable, or avoid places, people, or certain activities.

Strategy For Help

There are many strategies to help manage anxiety. For children, it is extremely important to maintain a schedule and routine. Wake them, feed them, bathe them and put them to bed on a regular schedule. Keeping a calendar on the refrigerator listing the day’s activities should be helpful in communicating and reducing the anxiety of simply not knowing what comes next. Other tips to teach your children to reduce anxiety include:

  • Eating a well-balanced meal: Keep healthful, energy-boosting snacks on hand and don’t allow your child to skip meals.
  • Limit caffeine: Caffeine can aggravate anxiety and trigger panic attacks.
  • Get enough sleep: When stressed, one’s body needs additional sleep and rest.
  • Exercise daily: For best benefits, alternate moderate and vigorous-intensity exercises at least every other day.
  • Take a time-out: Learn relaxation techniques and step back from the problem to clear one’s mind.
  • Take deep breaths and count to 10: Inhale and exhale slowly and count slowly. Repeat as necessary.
  • Do your best and maintain a positive attitude: Instead of aiming for perfection, which isn’t possible, be proud of who and what you have.
  • Try to accept that you cannot control everything: Put your life and stresses in perspective: Is it really as bad as you think?
  • Learn what your triggers are: Sometimes it is obvious and other times, it is not so obvious. Keep a journal and write when feelings of stress and anxiety arise and look for a pattern in your writing.
  • Talk to someone: Tell friends and family how you are feeling. Let them know when and how they can help you. It may be necessary to talk to a healthcare provider and/or a therapist for professional help.

Mild anxiety can be helpful, while moderate to severe anxiety can be detrimental to one’s health, well-being and relationships. The first goal is to recognize anxiety and the second goal is to overcome the anxiety to lead a confident and rewarding lifestyle. If you have concerns about your child’s anxiety, please call 678-384-3480 for an appointment. Healthy Steps Pediatrics is helping to GROW healthy children one step at a time.


            Life, in general, is full of advice.  When you are pregnant, the advice is voluminous.  Advice comes from pregnancy and childbirth magazines, books, family, friends and your obstetrician’s office.  Not all advice is good advice and weeding through it all can be overwhelming. 


            So here’s more advice from a busy pediatric practice about your beautiful bundle of joy.  First, breast is best.  According to the American Academy of Pediatrics and the United States Surgeon General, breast milk is the best nutrition for your baby.  That said, breastfeeding is not an easy task.  Like everything in life, practice makes perfect.  New mothers need plenty of rest, good nutrition and water, as well as emotional support while learning to breastfeed.  It takes approximately 6 weeks for mom and baby to find their rhythm. Mom will have good milk supply, the soreness should have diminished and mom will be better able to enjoy nursing her baby.  The baby will become an efficient feeder in less time.  Breast milk’s benefits for the baby include easier digestion, fewer allergy risks, less constipation, less obesity, less diaper rash, improved immunity and a stronger mother-baby relationship.  The benefits for mother include lower cost, greater convenience, faster recovery, less post-partum depression, reduced risk for breast cancer and higher satisfaction.  Don’t hesitate to ask for assistance from your pediatrician or a lactation consultant.

            Breastfeeding is not the best situation for everybody and there should be no guilt in bottle-feeding.  Babies thrive with commercially made formulas.  Cow’s milk, soy, lactose-free and specialty formulas are available.  Consult your pediatrician to find what formula works best for your little one.  No matter the nutrition source, watch the baby for sucking on hands, rooting or crying to indicate readiness to feed and the relaxation that occurs with a full tummy.

Illness Prevention

            Secondly, illness prevention is a must.  In Kindergarten, we learned to wash our hands after using the restroom and before eating.  In the daily care of a newborn, we should always wash our hands before handling them, feeding them and after changing them.  Anyone who comes to visit must wash their hands before coming in contact with the baby.  If they are sick with a fever or cough, they should not enter the home until they have been free of illness for at least 24 hours.  Due to the lack of immunity, a fever and illness is a big concern in a newborn.  If the baby feels warm, take a rectal temperature.  It is the most accurate.  If the temperature is above 100.4, the baby must be seen immediately at the pediatrician’s office or emergency care.


            Finally, a baby should be put on their back to sleep.   Since the American Academy of Pediatrics instituted the “Back to Sleep” program, there has been a significant decrease in the incidence of Sudden Infant Death Syndrome (SIDS).  Babies should sleep on a firm, well-fitted mattress with no pillow or fluffy stuffed animals in the crib.  Co-sleeping is not recommended because of the fear of suffocation from being trapped in bedding or under a parent.

Newborns frequently have their days and nights mixed up.  Caring for a newborn is exhausting.  Arrange your day around your newborn’s sleep schedule and nap when he or she naps.  The laundry and dishes will wait.  As early as 2 months of age, sleeping patterns start to regulate.  Feeding frequently during the day makes for a better sleeper at night.

            Healthy Steps Pediatrics is helping to grow healthy children one step at a time.  We look forward to helping you raise a healthy newborn.  678-384-3480