Kids and Alcohol

As much as parents may not like to think about it, the truth is that many kids and teens try alcohol during their high school and college years, long before it's legal for them to drink it. Research has shown that nearly 80% of high school kids have tried alcohol.

Although experimentation with alcohol may be common among kids, it's not safe or legal. So it's important to start discussing alcohol use and abuse with your kids at an early age and keep talking about it as they grow up.

The Effects of Alcohol Abuse

Alcohol interferes with a person's perception of reality and ability to make good decisions. This can be particularly hazardous for kids and teens who have less problem-solving and decision-making experience.

Short-term effects of drinking include:

• distorted vision, hearing, and coordination
• altered perceptions and emotions
• impaired judgment, which can lead to accidents, drowning, and other risky behaviors like unsafe sex and drug use
• bad breath
• hangovers

Long-term effects include:

• cirrhosis and cancer of the liver
• loss of appetite
• serious vitamin deficiencies
• stomach ailments
• heart and central nervous system damage
• memory loss
• an increased risk of impotence
• high risk for overdosing

Talking to Kids About Alcohol

Long before your kids are presented with a chance to drink alcohol, you can increase the chances that they'll just say "no."

Childhood is a time of learning and discovery, so it's important to encourage kids to ask questions, even ones that might be hard to answer. Open, honest, age-appropriate communication now sets the stage for your kids to come to you later with other difficult topics or problems.

Preschoolers

Although 3- and 4-year-olds aren't ready to learn the facts about alcohol or other drugs, they start to develop the decision-making and problem-solving skills they will need later on. You can help them develop those skills in some simple ways.
For instance, let toddlers choose their own clothing and don't worry if the choices don't match. This lets them know you think they're capable of making good decisions. Assign simple tasks and let kids know what a big help they are.
And set a good example of the behavior that you want your kids to demonstrate. This is especially true in the preschool years when kids tend to imitate adults' actions as a way of learning. So, by being active, eating healthy, and drinking responsibly, parents teach their kids important lessons early on.

Ages 4 to 7

Kids this age still think and learn mostly by experience and don't have a good understanding of things that will happen in the future. So keep discussions about alcohol in the present tense and relate them to things that kids know and understand. For example, watching TV with your child can provide a chance to talk about advertising messages. Ask about the ads you see and encourage kids to ask questions too.
Kids are interested in how their bodies work, so this is a good time to talk about maintaining good health and avoiding substances that might harm the body. Talk about how alcohol hurts a person's ability to see, hear, and walk without tripping; it alters the way people feel; and it makes it hard to judge things like whether the water is too deep or if there's a car coming too close. And it gives people bad breath and a headache!

Ages 8 to 11

The later elementary school years are a crucial time in which you can influence your child's decisions about alcohol use. Kids at this age tend to love to learn facts, especially strange ones, and are eager to learn how things work and what sources of information are available to them.
So it's a good time to openly discuss facts about alcohol: its long- and short-term effects and consequences, its physical effects, and why it's especially dangerous for growing bodies.
Kids also can be heavily influenced by friends now. Their interests may be determined by what their peers think. So teach your child to say "no" to peer pressure, and discuss the importance of thinking and acting as an individual.

Casual discussions about alcohol and friends can take place at the dinner table as part of your normal conversation: "I've been reading about young kids using alcohol. Do you ever hear about kids using alcohol or other drugs in your school?"

Ages 12 to 17

By the teen years, your kids should know the facts about alcohol and your attitudes and beliefs about substance abuse. So use this time to reinforce what you've already taught them and focus on keeping the lines of communication open.
Teens are more likely to engage in risky behaviors, and their increasing need for independence may make them want to defy their parents' wishes or instructions. But if you make your teen feel accepted and respected as an individual, you increase the chances that your child will try to be open with you.
Kids want to be liked and accepted by their peers, and they need a certain degree of privacy and trust. Avoid excessive preaching and threats, and instead, emphasize your love and concern. Even when they're annoyed by parental interest and questions, teens still recognize that it comes with the territory.

Teaching Kids to Say "No"

Teach kids a variety of approaches to deal with offers of alcohol:

• Encourage them to ask questions. If a drink of any kind is offered, they should ask, "What is it?" and "Where did you get it?"
• Teach them to say "no, thanks" when the drink offered is an alcoholic one.
• Remind them to leave any uncomfortable situation. Make sure they have money for transportation or a phone number where you or another responsible adult can be reached.
• Teach kids never to accept a ride from someone who has been drinking. Some parents find that offering to pick up their kids from an uncomfortable situation — no questions asked — helps encourage kids to be honest and call when they need help.

Risk Factors

Times of transition, such as the onset of puberty or a parents' divorce, can lead kids to alcohol use. So teach your kids that even when life is upsetting or stressful, drinking alcohol as an escape can make a bad situation much worse.

Kids who have problems with self-control or low self-esteem are more likely to abuse alcohol. They may not believe that they can handle their problems and frustrations without using something to make them feel better.
Kids without a sense of connectedness with their families or who feel different in some way (appearance, economic circumstances, etc.) may also be at risk. Those who find it hard to believe in themselves desperately need the love and support of parents or other family members.
In fact, not wanting to harm the relationships between themselves and the adults who care about them is the most common reason that young people give for not using alcohol and other drugs.

General Tips

Fortunately, parents can do much to protect their kids from using and abusing alcohol:

• Be a good role model. Consider how your use of alcohol or medications may influence your kids. Consider offering only nonalcoholic beverages at parties and other social events to show your kids that you don't need to drink to have fun.
• Educate yourself about alcohol so you can be a better teacher. Read and collect information that you can share with kids and other parents.
• Try to be conscious of how you can help build your child's self-esteem. For example, kids are more likely to feel good about themselves if you emphasize their strengths and positively reinforce healthy behaviors.
• Teach kids to manage stress in healthy ways, such as by seeking help from a trusted adult or engaging in a favorite activity.

Recognizing the Signs

Despite your efforts, your child may still use — and abuse — alcohol. How can you tell? Here are some common warning signs:

• the odor of alcohol
• sudden change in mood or attitude
• change in attendance or performance at school
• loss of interest in school, sports, or other activities
• discipline problems at school
• withdrawal from family and friends
• secrecy
• association with a new group of friends and reluctance to introduce them to you
• alcohol disappearing from your home
• depression and developmental difficulties

It's important not to jump to conclusions based on only one or two signs. Adolescence is a time of change — physically, socially, emotionally, and intellectually. This can lead to erratic behavior and mood swings as kids try to cope with all of these changes.
If your child is using alcohol, there will usually be a cluster of these signs, like changes in friends, behavior, dress, attitude, mood, and grades. If you see a number of changes, look for all explanations by talking to your kids, but don't overlook substance abuse as a possibility.
Other tips to try:

• Keep tabs on where your kids go.
• Know the parents of your child's friends.
• Always make sure you have a phone number where you can reach your child.
• Have kids check in regularly when they're away from home.
• When spending an extended length of time away from you, your child should check in periodically with a phone call, e-mail, or visit home.

For teens, especially those old enough to drive, consider negotiating and signing a behavioral contract. This contract should spell out the way you expect your child to behave and state the consequences if your teen drives under the influence. Follow through and take the keys away, if necessary.

Make part of the deal with your teen that you and the rest of your family also agree never to drink and drive.
Also encourage responsible behaviors, such as planning for a designated driver or calling an adult for help rather than driving under the influence.

It's important to keep communication open and expectations reasonable. Tying responsible actions to freedoms such as a later curfew or a driver's license can be a powerful motivator. Teach your kids that freedom only comes with responsibility — a lesson that should last a lifetime.

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Fetal alcohol spectrum disorders (FASDs)

 

Facts about FASDs

Fetal alcohol spectrum

disorders (FASDs) are a 

group of conditions that

can occur in a person

whose mother drank

alcohol during pregnancy. 

These effects can include 

physical problems and 

problems with behavior

and learning. Often, a person

with an FASD has a mix of

these problems.

Cause and Prevention

FASDs are caused by a woman drinking alcohol during pregnancy. There is no known amount of alcohol that is safe to drink while pregnant. There is also no safe time to drink during pregnancy and no safe kind of alcohol to drink while pregnant.

To prevent FASDs, a woman should not drink alcohol while she is pregnant, or even when she might get pregnant. This is because a woman could get pregnant and not know for several weeks or more.  In the United States, half of pregnancies are unplanned.

Signs and Symptoms

FASDs refer to the whole range of effects that can happen to a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways, and can range from mild to severe.

A person with an FASD might have:

• Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
• Small head size
• Shorter-than-average height
• Low body weight
• Poor coordination
• Hyperactive behavior
• Difficulty paying attention
• Poor memory
• Difficulty in school (especially with math)
• Learning disabilities
• Speech and language delays
• Intellectual disability or low IQ
• Poor reasoning and judgment skills
• Sleep and sucking problems as a baby
• Vision or hearing problems
• Problems with the heart, kidneys, or bones 

Types of FASDs

Different terms are used to describe FASDs, depending on the type of symptoms.

• Fetal Alcohol Syndrome (FAS): FAS represents the severe end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others.
  
  
• Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.
  
  
• Alcohol-Related Birth Defects (ARBD):  People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.

The term fetal alcohol effects (FAE) was previously used to describe intellectual disabilities and problems with behavior and learning in a person whose mother drank alcohol during pregnancy. In 1996, the Institute of Medicine (IOM) replaced FAE with the terms alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD).

Diagnosis

The term FASDs is not meant for use as a clinical diagnosis. CDC worked with a group of experts and organizations to review the research and develop guidelines for diagnosing FAS. The guidelines were developed for FAS only. CDC and its partners are working to put together diagnostic criteria for other FASDs, such as ARND. Clinical and scientific research on these conditions is going on now.
Diagnosing FAS can be hard because there is no medical test, like a blood test, for it.  And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS.

To diagnose FAS, doctors look for:

• Abnormal facial features (e.g., smooth ridge between nose and upper lip)
• Lower-than-average height, weight, or both
• Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination)
• Prenatal alcohol exposure; although confirmation is not required to make a diagnosis

Treatment

 FASDs last a lifetime. There is no cure for FASDs, but research shows that early intervention treatment services can improve a child’s development. 

There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches.  No one treatment is right for every child.
Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.
Also, “protective factors” can help reduce the effects of FASDs and help people with these conditions reach their full potential.

Protective factors include:

• Diagnosis before 6 years of age
• Loving, nurturing, and stable home environment during the school years
• Absence of violence
• Involvement in special education and social services
  

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Club Foot

The Facts on Club Foot

Congenital talipes equinovarus, commonly known as club foot, is a foot deformity in which the foot is twisted inward with the toes pointing down. 

It affects approximately 1 in every 1,000 newborns in the US each year. It is more common in males. Club foot may affect one or both feet. In 30% to 50% of affected children, it involves both feet.

This condition sometimes runs in families. If one child in the family has club foot, the likelihood of another child having this condition increases to 10%.

Causes of Club Foot

The exact cause of club foot is not known. An abnormality of the tendons and ligaments in the foot causes an abnormal structure and position of the foot. In some children, bones may also be abnormal in terms of shape, size, or position. There may be a link to maternal smoking during pregnancy.

If the foot is abnormally positioned in the uterus during pregnancy, it may not grow into a normal shape, but this is not usually considered a "true" club foot.

Club foot may, in rare instances, be associated with spinal deformities such as spina bifida or other neuromuscular diseases; however, in these cases, the foot is usually more deformed.

Symptoms and Complications of Club Foot

Club foot is easy to recognize. The key identifying features are:

• tightening of the Achilles tendon (heel cord)
• inward turning of the front of the foot
• downward-pointing toes
• resting of the foot on its outer border
• abnormal shape of the foot
• rigidity and other changes in the movements of the foot

In some children, the foot may have a higher-than-normal arch. The foot and calf on the affected side are smaller than normal.

It is important to remember that although it is a painless condition at birth, club foot can worsen with time. If left untreated, the child may begin walking on the outer surface of the foot and the toes. This abnormal walking pattern causes hardening of the skin and development of corns and ulcers over the outer border of the foot. Wearing shoes is difficult, and over time it may become a crippling and unsightly condition.

Diagnosing Club Foot

Club foot is diagnosed at birth and may be diagnosed earlier, during pregnancy, or through ultrasound.

Although club foot may be diagnosed on the basis of physical examination alone, your doctor may also order X-rays of the foot in order to assess the position of the bones and to determine if there are any abnormalities in the bone. A complete physical examination is performed to rule out other spinal and muscular diseases.

Treating and Preventing Club Foot

The goal of treatment is to make a club foot functional, painless, and stable, especially for walking. A pediatric orthopedic surgeon experienced in this condition will normally be the best person to treat it. The earlier the treatment starts, the better the results.

Non-surgical treatment includes manipulating the foot into a corrected position and then holding it in position with a cast or splint with tapes. This is usually done 2 to 3 days after birth. The cast is applied from the toes to just above or below the knee and is changed every week until the infant is 3 to 6 months old. Your doctor will make regular assessments of this treatment. In most cases, it is apparent within 6 weeks whether the treatment is successful. An X-ray can also confirm this.

This treatment, if done by a trained doctor, is successful in about 50% of children with club foot. Special footwear or braces may be required to ensure that the muscles do not pull the foot back into the clubbed position. These may be used until the child is 2 or 3 years old.

Surgery may be performed to correct the abnormal tendons, ligaments, and joints. This may also include moving tendons into better positions for the best function. The surgery requires a hospital stay of 2 to 3 days. After surgery, a cast is applied to maintain the foot in the corrected position for 10 to 12 weeks. After the cast, a splint is used throughout the day. Once the child starts walking, the use of splint is gradually reduced.

There is no clear consensus regarding when to operate and which surgery to perform. Most orthopedic surgeons prefer to operate when the child is 6 months old, though some prefer to wait until 9 to 12 months of age.

If there are persistent bone abnormalities, surgery may be required when the child is older. An osteotomy (cutting the bone) can be performed when the child is at least 5 years old, or arthrodesis (fusing and stabilizing the bones) may be performed when the child is at least 10 years old. Not all children require more than one operation.

Physiotherapy is always an important part of the treatment. It may begin once the child is 3 months old. The therapist manipulates the affected foot and may also tape it. This alone may be successful in milder cases. Parents can learn these techniques and continue the treatment at home.

A chiropodist may need to be consulted for the treatment of corns and for custom insoles and shoes for the affected foot.

Most children do well with treatment when it is started early. If treatment is delayed, non-surgical treatment will not be effective and surgery will be more difficult and less successful. Some degree of deformity could persist. The foot and the calf on the affected side may remain smaller than normal.

Since the exact cause of club foot is not understood, there is no specific prevention. However, regular monitoring is recommended until the person reaches adulthood. Approximately 20% of affected children experience a recurrence of the club foot, usually in the first 2 to 3 years of life. The recurrence is more difficult to correct, and surgery is less successful in such cases. Your doctor may also advise using corrective shoes and splints until the child matures. But when treatment is started early, most children are able to enjoy full and active lives.

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