Tagged Children and Childhood

The Merits of Reading Real Books to Your Children

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Credit Getty Images

A new Harry Potter book and a new round of stories about midnight book release parties reminded me of the persistent power of words printed on a page to shape children’s lives.

How do we think about a distinct role for paper, for “book-books” in children’s lives? My own pediatric cause is literacy promotion for young children. I am the national medical director of the program Reach Out and Read, which follows a model of talking with the parents of babies, toddlers and preschoolers about the importance of reading aloud, and giving away a developmentally appropriate children’s book at every checkup.

We are talking about very young children here, and we begin by giving out board books which are designed to be chewed and drooled on by babies who are still exploring the world orally, or thrown down (repeatedly) off the high chair by young children who are just figuring out object permanence and experimenting with ways to train their parents to fetch and retrieve. But the most essential attribute of those board books, beyond their durability, is that they pull in the parent, not only to pick them up, but to ask and answer questions, name the pictures, make the animal noises.

I love book-books. I cannot imagine living in a house without them, or putting a child to bed in a room that doesn’t have shelves of books, some tattered and beloved, some new and waiting for their moment. It’s what I wanted for my own children, and what I want for my patients; I think it is part of what every child needs. There’s plenty that I read on the screen, from journal articles to breaking news, but I don’t want books to go away.

I would never argue that the child who loves to read is worse off because those “Harry Potter” chapters turn up on the screen of an ebook reader rather than in those matched sets of thick volumes that occupy my own children’s shelves. (Although I think there’s something wonderful about looking at the seven books of the series and remembering a midnight party in a bookstore or two, and sometimes coming home from high school or college and taking one — or all seven — to bed with you.)

But what about the younger children, the ones who are working to master spoken language while taking the early steps in their relationships with books and stories? There’s a lot of interest right now in pediatrics in figuring out how electronic media affect children’s brains and children’s learning styles and children’s habits.

In a 2014 review of studies on electronic storybooks, researchers outlined some of the ways that such stories could help young children learn, and some of the ways that they could hurt. They pointed out that especially for children with language delays, certain features of electronic books that reinforce the connection between image and word (for example, animated pictures) may help children integrate information, but that distracting features and games may cause “cognitive overload,” which gets in the way of learning. And they worried, of course, that screen time might displace parent-child time.

Dr. Jenny Radesky, a developmental behavioral pediatrician and assistant professor of pediatrics at the University of Michigan at Ann Arbor, is one of the authors of the coming American Academy of Pediatrics policy statement on media use for children from birth to age 5. “Preschool children learn better when there’s an adult involved,” she said. “They learn better when there are not distracting digital elements, especially when those elements are not relevant to the story line or the learning purpose.”

In a small study published in February in JAMA Pediatrics, researchers looked at the interactions between parents and their children, ages 10 to 16 months, and found that when they were playing with electronic toys, both parents and children used fewer words or vocalizations than they did with traditional toys. And picture books evoked even more language than traditional toys.

Words and pictures can do many things for the reader’s brain, as we know from the long and glorious and even occasionally inglorious history of the printed word. They can take you into someone else’s life and someone else’s adventure, stir your blood in any number of ways, arouse your outrage, your empathy, your sense of humor, your sense of suspense. But your brain has to take those words and run with them, in all those different directions. Brain imaging has suggested that hearing stories evokes visual images in children’s brains, and more strongly if those children are accustomed to being read to.

And a parent can offer questions and interpretations that take the experience beyond bells and whistles. “A parent can ask, ‘Oh, remember that duck we saw at the pond?’,” Dr. Radesky said. “When a parent relates what’s on the page to the child’s experience, the child will have a richer understanding.”

Story time can also be good for the grown-ups. “Parents have said to me, ‘I need that 30 minutes of reading, it’s the only time my child snuggles with me,’ ” Dr. Radesky said. “We shouldn’t only think about what the child is getting from it.”

Part of what makes paper a brilliant technology may be, in fact, that it offers us so much and no more. A small child cannot tap the duck and elicit a quack; for that, the child needs to turn to a parent. And when you cannot tap the picture of the horse and watch it gallop across the page, you learn that your brain can make the horse move as fast as you want it to, just as later on it will show you the young wizards on their broomsticks, and perhaps even sneak you in among them.

Reading and being read to open unlimited stories; worlds can be described and created for you, right there on the page, or yes, on the screen, if that is where you do your later reading. But as those early paper books offer you those unlimited stories, the pictures will move if you imagine the movement; the duck will quack if you know how to work your parent. It’s all about pushing the right buttons.

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My Brother, the Hospice Graduate

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Credit Giselle Potter

When I was a college sophomore living in a sorority house at the University of California at Santa Barbara, my parents called to tell me that my baby brother, Gavin, was dying. He had been given a diagnosis of a very rare disease, Aicardi–Goutieres Syndrome.

The doctors immediately placed him in hospice care.

He was 4 months old.

I hung up the phone and rode my red beach cruiser to class, trying to pretend that it was like any other day. I sat through Spanish class, but stared off into the distance, numb to what was happening. When I emerged, the sun seemed too bright. People were laughing, talking on their phones, surfing waves at sunset and meeting up with dates at coffee shops.

I thought back to Gavin’s birth in June. He looked like the rest of the babies in our family, with a thick pad of blond hair. A happy baby. Then at 6 weeks old he started having fevers of 104. They turned into weeklong affairs. And no one knew why.

My parents and Gavin’s doctors tried, for the next few months, to solve a seemingly unsolvable case. We just wanted to know what was wrong. But when we finally had the right diagnosis, it was awful. His disease had triggered brain calcifications, causing permanent brain damage. He was going to lose his motor skills and be unable to eat, so he would eventually die, we were told.

At first, I wanted to avoid dealing with the situation. The playground feeling of my oceanfront college campus was in stark contrast to the atmosphere at home, where my devastated family waited, heartbroken. My impulse was to stay away. I didn’t want to be crushed by the grief that was promised to me.

But I also knew I couldn’t live with myself if I never tried to face it. So I dropped out of college and spent every day with him and the rest of my family, including my sisters, who were 9 and 14 at the time.

Gavin’s disease showed up like Louisiana rainstorms — quick, strong and mean. Sometimes he was the handsome baby who smiled at me with his innocent blue eyes. Then, it was as if he was gone. Possessed. His fevers were now paired with jitters and vomiting. Gavin would shriek uncontrollably, turn a pasty gray and roll his eyes in different directions.

Mom called these visits from the Monster.

The hospice nurses stopped by every week to check Gavin’s temperature and weigh him. There was no handbook on learning to love your dying baby brother, but eventually, I did. Instead of hiding from the Monster — when his body shook, his lips turned jelly purple, and drool spilled from his mouth — I looked at him and said: You are worth it.

With his impending death sentence, Gavin was baptized in an oversize white gown. Mom wanted his soul to be protected.

After the ceremony, we played a slideshow of his short life. I saw a picture of me holding him and thought to myself, how could I not love you? We all loved him, the best way we knew how.

My parents did not give up on him, even though he was on hospice. A major change came when a friend of my mom’s who was an occupational therapist suggested the Haberman bottle, a baby bottle with an elongated nipple for children with special needs. Part of the reason Gavin was in hospice care was that he could no longer breast-feed and it was hard to get him nutrients. But he took pumped breast milk through that bottle.

And somehow his demise never came.

On Gavin’s first birthday he was taken off hospice: a hospice graduate.

The journey shifted. Instead of waiting for a baby to die, we were learning to love and live with a handicapped boy.

Now, Gavin is 9 years old. He is a quadriplegic; he cannot walk, talk or eat solid foods, but he is a survivor. He is joy.

That doesn’t mean his life is easy – for him or for the rest of the family.

Every morning one of my parents carries him downstairs around 7 a.m. They sit him in an egg-shape chair in front of the TV to watch cartoons, usually “SpongeBob” (he’s graduated from “Sesame Street”). His breakfast usually involves bran cereal for digestion, a fried egg, a couple of blueberries, maybe a waffle, sometimes crispy pork sausage. All of that is put into a coffee cup with whole milk and butter, and puréed with an immersion blender.

Gavin’s three epilepsy medications get pulled into plastic syringes. Then the hero of the morning carries a tray, with a handful of towels and a water cup, along with the delicious breakfast surprise and medicine into the TV room, and the real work begins.

Feeding Gavin can take up to an hour. And it can be messy. Sometimes he spits up his food, other times he is just not feeling well and he lets it roll down his chin, onto his neck.

Gavin’s life includes physical therapy, occupational therapy and speech therapy. But it also includes floating in the pool in a life vest, going to school and even gleefully crossing the finish line in a marathon – with my husband pushing him in a stroller.

Instead of dismantling our family, he has brought us closer together. We treasure Gavin’s small accomplishments, whether that is running down the driveway in his special gait-training walker or using an eye-gaze communication device or nodding to let us know that he wants to use the bathroom, play with his sister or bounce on the trampoline.

We don’t know what his future looks like. But we don’t know what the future looks like for any of us. The mystery of his life is no different from any of ours.

Courtney Lund is working on a memoir about her brother.


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Attention, Teenagers: Nobody Really Looks Like That

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Credit Anna Parini

The universal truth of puberty and adolescence is body change, and relatively rapid body change. Teenagers have to cope with all kinds of comparisons, with their peers, with the childhood bodies they leave behind, and with the altered images used in advertising and in the self-advertising on social media.

It may be that the rapid way the body changes during these years can help adolescents believe in other kinds of change, including the false promises that various products can significantly modify their size and shape. A study published last month in the journal Pediatrics looked at two kinds of risky behavior that are increasingly common over adolescence: the use of laxatives for weight loss and the use of muscle-building products.

It used data from an ongoing study of more than 13,000 American children, the Growing Up Today Study (GUTS). The participants’ mothers took part in the Nurses’ Health Study II, and the children were recruited in 1996, when they were 9 to 14 years old, and surveyed about a variety of topics as they grew up.

By age 23 to 25, 10.5 percent of the women in this large sample reported using laxatives in the past year to lose weight; the practice increased over adolescence in the girls, but was virtually absent among the boys. Conversely, by young adulthood, about 12 percent of the men reported use of a muscle-building product in the past year, and again, this increased during adolescence.

So a lot of young women are taking laxatives to try to become very thin, and a lot of young men are using products to help them bulk up and become more muscular. The researchers were interested in how these practices were associated with traditional ideas of masculinity and femininity. They found that, regardless of sexual orientation, kids who described themselves as more gender conforming were more likely to use laxatives (the girls) or muscle-building products (the boys).

“The link is the perception that they are going to alter your weight, shape, appearance,” said Rachel Rodgers, a counseling psychology researcher who studies body image and eating concerns and is an associate professor of applied psychology at Northeastern University.

“The representations of ideal appearance in society are very restrictive and very unrealistic both for men and for women,” she said. “They portray bodies that are unattainable by healthy means.”

Jerel Calzo, a developmental psychologist who is an assistant professor at Harvard Medical School, and the lead author on the study, said that one important aspect of this research was the way it highlighted the vulnerability of those who identify with traditional gender ideals.

“Usually in research we tend to focus on youth who are nonconforming, who we might focus on as more at risk for negative health outcomes, depression, who might be ostracized or victimized,” he said. But there are risks as well for those who are trying to measure up to what they see as the conventional standard.

The GUTS participants were asked to describe themselves as children in terms of the games they liked and the movie and TV characters they imitated, and this was used to score them as more or less “gender conforming.”

The early patterns of gender conformity were significant, Dr. Calzo said, because they were linked to behaviors that lasted through adolescence and into young adulthood. “Laxative use increases with age, muscle-building product use increases with age,” he said. “There is a need for early intervention.”

Chronic use of laxatives can affect the motility of the bowel so that it can be hard to do without them, and overdoses can alter the body’s balance of electrolytes, to a really dangerous extent.

“There’s a lot of shame and guilt for laxative abuse,” said Sara Forman, an adolescent medicine specialist who is the director of the outpatient eating disorders program at Boston Children’s Hospital. And many products marketed as cleanses or herbal teas are not labeled as laxatives, though they contain strong laxative ingredients.

The muscle-building products in the study included steroids, creatine and several others. The risks of steroids are well known, from hormonal imbalances and shrinking testicles to acne and aggression. With other commercial muscle-building products, the risks may have more to do with the lack of regulation, Dr. Calzo said. The products can contain banned substances or analogues of banned substances, like the amphetamine analogue found in popular diet and workout supplements last year.

And of course, the muscle-building products won’t reshape you into the photoshopped model any more than the laxatives will.

As Dr. Calzo says, we need to worry about the vulnerabilities of children who are growing up with issues of gender identity and sexuality. But don’t assume that more “mainstream” or “conforming” kids have it easy when it comes to body image. Parents can help by keeping the lines of communication open and starting these conversations when children are young. We should be talking about the images that our children see, about how real people look and how images are altered.

And that conversation should extend to social media as well; in a review by Dr. Rodgers, increased social media use was correlated with body image worries. “Teenagers are looking at their friends on social media and seeing photos that have been modified and viewing them as something real.”

The other message for parents is about helping to model healthy eating, family meals, realistic moderation around eating and exercising, and to refrain from any kind of negative comments or teasing about a child’s body. “Research has shown people who have more body satisfaction actually take care of themselves better, which suggests that the approach of making them feel bad is actually not helpful,” Dr. Rodgers said.

Every adolescent, across gender, gender identity, gender conformity, and sexuality, lives with a changing body and the need to navigate body image and identity. There are a lot of unrealistic images out there to measure yourself against, and a lot of false promises about how you might get there.

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Why I Decided to Stop Writing About My Children

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Credit Giselle Potter

There is a hunger in our culture for true stories from the parenting trenches where life is lived mud-flecked and raw. I’ve written extensively, intimately, damningly, about my children for seven years without once thinking about it from the point of view of their feelings and their privacy. A few months ago I stopped.

I wish I could say that I deeply reflected on the ethics of writing about my children and heroically pivoted myself out of a concern for my character, but here’s what really happened: My father called.

He called me after reading a blog post I had written about my son’s first signs of puberty. It seems an obvious line-crossing that I wrote about such an intimate detail, but I did. At the time I didn’t pause for a split second; I was more than willing to go there. I had been writing and reading extensively about parenting tweens. I knew people might be mildly shocked, but mostly interested.

We live in a break-the-internet arms race of oversharing. And adolescent sexuality is an emergent, fascinating topic, especially for parents who are figuring out how to address difficult questions with their children. For example: I ate up Peggy Orenstein’s marvelous new book, “Girls & Sex,” with a spoon, shocked and upset the whole way through.

But when my dad said, “Elizabeth, are you pausing to deeply consider what you’re writing about?” I wanted to get defensive. I said, “Uh. I kinda perceive myself as a confessional poet, Dad,” I said, “Heir to Plath, Sexton and Sharon Olds. And the photographer Sally Mann, if I’m honest, Dad.”

But he said, “I’m not talking about art. I’m talking about my grandson.”

He was a lion for his grandson. I listened. I heard him. His words went to my heart, my maternal heart, which is in equal parts steel and cornmeal mush. I thanked him honestly for his feedback, got off the phone, and cried into my daughter’s stuffed animals, which are very soft and plush and forgiving.

So began my wrestling with my relationship with the Nora Ephron line, “Everything is copy.” Until now it has been my battle cry and artistic excuse for printing whatever I wanted whenever I wanted with very blinkered vision. Maybe, in fact, not everything is copy. Maybe it’s people’s lives, and we should be considerate and loving and respectful of their privacy. It’s a new point of view for me in our clickbait culture of confessionalism and parading nakedness.

When I started blogging, my kids were babes in arms, hardly people; they were creatures, mewling, milk-drunk, with eyes so deeply slate they were alien-denim blue.

I used the blog as a live journal to get me through postpartum depression and “the lost years” for me that were “the magic years” for them, when I felt overwhelmed by washing out sippy cups, lurking at the edges of the mommy wars, and co-sleeping and diapering.

Writing made the joys and the hardship of parenting into stories. Stories I could tell. Stories that I considered as one considers a diorama.

I was always the narrator, the main character, even if I was also the storm-tossed heroine, the hot mess in mom jeans who couldn’t get the overalls on her 2-year-old. Or figure out fourth-grade fractions homework. I was working out my issues. My kids were always satellites to the big round-faced moon of me.

I’ve shamed their eating habits in chat rooms. I have Facebooked the things they’ve said. I have skewered them horribly, but also with great interest and affection, as a collector might do to some butterflies.

I think Sally Mann’s photographs of her kids are luminous and transcendent, while others accuse her of child pornography. The lines between art and privacy are blurry. You have to consider what you are doing carefully. And previously I wasn’t.

Sally Mann and I don’t belong in the same sentence. I’ve been a Baltimore mommy-blogger writing about things like head lice. She is a world-class artist. But she and I have done the same thing: publicly disrobed our children.

My children didn’t give me their permission to tell their stories, or strike poses in a waterfall, naked, gorgeous as all get out, and human, with lives ahead of them, as Sally Mann posed hers. And now that I see that, I don’t want to mar my children’s glory and subvert their beginnings for my so-called art.

If I’m going to continue writing, I realize I need to find some new material, and for that I’m going to have to look more deeply within myself or entirely outside. For inspiration I have turned to writing about nature. The environment. The sea. Things that are bigger than me. I’ve been reading John Muir. I’ve been reading “Braiding Sweetgrass.” Nature is for all to see. Nurture is between me and my kids, off the record.


Elizabeth Bastos lives in Baltimore and writes about urban nature. Follow her at thenaturehood.blogspot.com and on Twitter @elizabethbastos.

Summer Challenge No. 6: Kids’ Choice

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A group of Pennsylvania teenagers made beaded friendship bracelets as one of the many activities they came up with to spend 24 hours outdoors.

A group of Pennsylvania teenagers made beaded friendship bracelets as one of the many activities they came up with to spend 24 hours outdoors.Credit Kelly Kopera

Challenge No. 6: Let the kids take over.

So far, the Well Family Intentional Summer challenge has been led by the grown-ups. We’ve taught our children street games, encouraged them to try wild flavors of ice cream and walked or biked with them instead of driving. This week, we invite you to shake up that family dynamic and let your children make the call: What do they want to do (within reason) to make the most of this summer?

Research shows we gain more happiness from doing something than buying something, and like adults, children and teenagers get much of their pleasure from the planning process. Being a part of making something happen makes us value it even more.

And children have their own ideas about what makes for a perfect summer day.

Their choice might be fairly simple (my youngest son asked that we play mini-golf) or far more elaborate, like the plans of 17-year-old Kelly Kopera of Phoenixville, Pa. She wrote:

For the past four years, our neighborhood group of friends has set aside a day for the ultimate “intentional summer challenge” — staying outside all day.

It all started one night early in the summer of 2013. My brother, Tim, and I were out in the driveway enjoying the first of many summer nights to come, and we didn’t want to go inside. One of us said to the other: wouldn’t it be fun to spend a whole day outside?

A few weeks later, we did it — we stayed outside from 11 a.m. to 11 p.m., accompanied by some friends and neighbors here and there, and time allotted for bathroom breaks. The day, which we dubbed “11 to 11,” became a tradition in our family and neighborhood.

The next year’s 11 to 11 was successful, with growing participation and commitment. Since our kitchen was undergoing renovations, we had a Porta-Potty in our yard, and didn’t even have to go inside to use the bathroom! The following year, however, we wanted to take it a step further. With a core group established — my brothers Tim (now 16) and Kyle (14), along with our friends since grade school, Kimmy (16), Keli (16) and Matt (15) — we stayed outside from 11 a.m. to 11 p.m., and then slept in a tent in our backyard before going back inside at 11 the next morning. We also declared it a “tech-free day” — no one was allowed to look at their phones for the entire time we were outside, enjoying summer and each other’s company.

Last year’s “11 to 11 to 11″ featured “extreme hopscotch” extending all the way down our block, a water balloon fight, a trip to our local pool, backyard croquet, a scavenger hunt and a bonfire. This year we’ll be going to the pool and a nearby creek to keep cool; playing “glowquet” (croquet after dark with glow sticks on the wickets), card and board games, and classic summer games like manhunt; and capping off the night with some stargazing before we get into the tent for the final 12 hours. It’s a summer tradition that we all look forward to every year, and we’ve been planning this one for a long time to make it the best one yet!

Last week, we challenged you to learn the name of a wildflower, tree or something else you find outside — and we offered a quiz to test your plant knowledge. Some of you complained that the quiz was too easy; about a third of you got all the answers right.

Anne, a reader from Rome, asked for the names in Latin, too. “That way people all over the world will know what you are writing about. Gratias vobis ago.”

But BusyLizzieBe wrote: “Youngsters’ disconnect from the natural world is deeper than I ever imagined and deeply disconcerting. In a volunteer situation, I have even encountered children who have never seen a caterpillar or a butterfly.”

Sue Peterson of California sent an email: “This past weekend, we went camping with friends, and there was quite a bit of concern about being able to identify poison oak. It was funny, because everyone had a slightly different identifying factor (rounded leaves, how many leaves on a stem, spots on the plant, etc.) and no plant we found seemed to have them ALL, but they would always have a few.”

She and others suggested using Google’s image recognition feature. “They are not exact, but it was fun to see the other plants that look so much like the plant I had found, but were slightly different, and learning the technical names and nicknames of different plants was fun.”

This week’s challenge: Whether it’s a full 24 hours outside or 18 holes of windmills and dinosaurs, why not let your children pick a summer moment? Tell us what they chose, and how it goes (and don’t forget to ask them what they thought, too), by commenting here or emailing us at wellfamily@nytimes.com before next Tuesday, Aug. 2. Were they more creative than you expected, or did they suggest an idea from summers past that you’d forgotten?

Be sure to sign up here for the Well Family email so you don’t miss anything.

We’ll share reader stories and post next week’s challenge on Thursday, Aug. 4. The real goal, as always: to savor the summer all season long.

Helping Our School-Age Children Sleep Better

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Credit Getty Images

Everyone knows that getting a baby to sleep through the night can be a big challenge for parents. But sleep problems are common among preschool and school-age children, too. As we ask children to function in school, academically and socially, fatigue can affect their achievement and behavior.

Australian research on sleep problems in children has included work aimed at the “school transition” year in which children adjust to a school schedule. In a study of 4,460 children, 22.6 percent had sleep problems, according to their parents, at that transition age of 6 to 7 years. “We were surprised, we thought it was all baby sleep” that was the problem, said Dr. Harriet Hiscock, a pediatrician who is a senior research fellow at the Murdoch Childrens Research Institute at the Royal Children’s Hospital in Melbourne who was one of the authors of the study.

Those results led to a randomized controlled trial of a brief intervention for children in their first year of school. A group of 108 parents who felt their children had sleep problems was divided into two groups. One group got a consultation at school, with a program of strategies tailored to the child’s sleep issues, and a follow-up phone consultation; the other group got no special intervention and served as controls. Parents in the intervention group were counseled about a range of possible measures to improve sleep, from consistent bedtimes and bedtime routines to relaxation strategies for anxiety that might be contributing to insomnia. The children in the intervention group resolved their varying sleep problems more quickly, though sleep problems got better over time in both groups. The interventions also produced positive effects on the child’s psychosocial function and parents’ mental health.

The most common sleep issues for children around the age of school entry, Dr. Hiscock said, definitely include limit-setting issues — that is, some of them need their parents to make the rules and routines clear. But there are also children with what sleep specialists call “sleep onset association disorder,” in which a child has become habituated to falling asleep only in a certain context, requiring the presence of a parent, or needing to have the TV on, to cite two common examples. Very anxious children are also often problem sleepers. And then there are children beset by nightmares, night terrors and early morning waking.

Screen use is a major issue in childhood sleep, and more generally in childhood these days. The first recommendation is always to get the screens out of the bedroom, the same recommendation made for improving adolescent sleep, and for adults in the current best-selling book by Ariana Huffington. All of us, old and young, are vulnerable here, but it’s a good place for parents to draw the line for their children, even when they can’t quite manage it for themselves.

Reut Gruber, a psychologist who is an associate professor in the department of psychiatry at McGill University, where she is director of the Attention Behavior and Sleep Lab, said that there is a close association between sleep and a wide range of cognitive functions, including attention, executive function and memory. When children go to school, “they need to pay attention and plan and follow instructions, all of which fall under executive function, which is very much affected by sleep,” she said.

Many parts of the brain work less well when children are tired. “The prefrontal cortex is very sensitive to sleep deprivation, and it is key to the brain mechanisms which underlie executive function and some of the attentional processes,” she said. “The amygdala is affected by sleep deprivation and is essential for emotional processes.”

These different but connected brain pathways led her to be interested in the way that sleep affects many different aspects of academic performance. In an experimental study of a small group of 7- to 11-year-olds who did not have sleep, behavior or academic problems, the children were asked to change their sleep patterns, so that they were sleeping an hour less per night, or an hour more. After five days with less sleep, she said, there was measurable deterioration in alertness and emotional regulation, and after five days with more sleep, there were gains in these areas.

For the past several years, Dr. Gruber and her colleagues have worked with a school board in Montreal to develop a school-based sleep promotion program that was piloted in three elementary schools; results were published in May in the journal Sleep Medicine. The intervention involved a six-week sleep curriculum for the children, to teach them about healthy sleep habits, and materials designed to involve parents, teachers, and school principals, who were asked to consider the sleep ramifications of school schedules, extracurricular activities and homework demands.

The children in the intervention group extended their sleep by an average of 18.2 minutes a night, and also reduced the length of time it took them to fall asleep by 2.3 minutes. These relatively modest changes correlated with improved report card grades in English and math; the control group children’s sleep duration did not change, and their grades did not improve.

The goal of the intervention was to help families make sleep a priority.

“How do you make changes in your priorities, find the way as a family, as a school, as an individual, to reshuffle things, no matter how much homework, no matter how many aunts and uncles coming for a visit, that bedtime will still be respected?” Dr. Gruber asked. “We all agree in principle, but how do we actually incorporate it into daily life?”

The American Academy of Pediatrics recently endorsed the 2016 guidelines issued by the American Academy of Sleep Medicine, that 3- to 5-year-olds need 10 to 13 hours of sleep per day (including naps), while 6- to 12-year-olds need nine to 12 hours for optimal health and well-being.

Dr. Gruber advised that a child should wake up naturally, without requiring energetic parental encouragement. If after nine or 10 hours of sleep, a child still seems very tired, parents might wonder about whether a sleep disorder is affecting the quality of the child’s sleep, she said.

But for most school-age children, it’s an issue of habits and routines, screen time and setting limits. Many of us know, as adults, that we don’t get as much sleep as we should, or that we don’t practice very good “sleep hygiene,” as the experts would say when they advise us to get the screens out of our bedrooms, create regular routines and avoid caffeine too close to bedtime. Making school-age sleep a family priority is a good way to get everyone focused on what really matters: waking up rested and ready to function well, in body and mind.

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My Autistic Son’s Lesson: No One Is Broken

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Credit Giselle Potter

My youngest son, Sawyer, used to spend far more time relating to his imagination than he did to the world around him. He would run back and forth humming, flapping his hands and thumping on his chest. By the time he was in first grade, attempts to draw him out of his pretend world to join his classmates or do some class work led to explosions and timeouts. At 7 he was given a diagnosis of being on the autism spectrum.

That was when my wife, Jen, learned about the practice called joining. The idea behind it, which she discovered in Barry Neil Kaufman’s book “Son-Rise,” is brilliant in its simplicity. We wanted Sawyer to be with us. We did not want him to live in this bubble of his own creation. And so, instead of telling him to stop pretending and join us, we started pretending and joined him. The first time Jen joined him, the first time she ran beside him humming and thumping her chest, he stopped running, stopped thumping, stopped humming and, without a single word from us, turned to her and said, “What are you doing?”

“Learning what it’s like to be you.”

We took turns joining him every day, and a week later we got an email from his special education teacher telling us to keep doing whatever we were doing. He’d gone from five timeouts a day to one in a week.

The classroom was the same, the work was the same – all that was different was that we had found a way to say to him in a language he could understand, “You’re not wrong.” Emboldened by our success, we set about becoming more fluent in this language. For the next couple of years we taught ourselves to join him constantly. This meant that whatever we were doing had to stop whenever we heard him running back and forth and humming. But we could not join him simply to get him to stop running and thumping and humming. We had to join him without any judgment or impatience.

That was the trickiest part. The desire to fix him was great. I had come to believe that there were broken people in need of fixing. Sometimes, I looked like one of those people. I was a 40-year-old unpublished writer working as a waiter. My life reeked of failure. Many days I looked in the mirror and asked, “What is wrong with me?”

The only way to believe that Sawyer wasn’t broken was if no one was broken – not anyone anywhere ever.

I was used to seeing good people and bad people, smart people and stupid people, talented people and untalented people. I had to break that habit. I did this through a trick of perception. If someone was flapping and humming, or insulting you or saying something cruel about a whole group of people, I taught myself to pay attention to the person beneath the behavior, to the one who was scared or confused, who felt unlucky or undeserving or inadequate.

I did this, ostensibly, so that I could be Sawyer’s dad and help him flourish in the world. And by and by he began emerging from his bubble, began talking about wanting friends, began talking about his future. Now, 10 years later, at the end of our classes (we home-school him) every day he asks, “Dad, can we hang out today?” Had this been all that had come of joining Sawyer and learning to see a world without broken people, I suppose it would have been enough.

But 10 years later the writer who couldn’t get published, who felt like failure, now finds himself talking to groups and even crowds of people, telling them, in so many words, “Everything is O.K. even though it looks like everything is not O.K.!” I would never have talked to these people, nor published the essays that inspired these talks, if Jen and I had not joined Sawyer.

Yet the moment I really understood the power of joining came long before any of this. I was having an argument with my wife. I consider ours a good relationship, by which I mean it is the relationship against which I measure all my other relationships. But on this evening we were in the thick of a particularly nasty back and forth. It started small, as they all do. We each felt wronged by the other. The more we talked, the more we tried to “clear things up,” the worse it got. We raised our voices though we live in a small house and our boys would hear us. As the argument grew more heated, as Jen’s voice grew louder and sharper, she shifted before my eyes. I wasn’t seeing my best friend and lover anymore; I was seeing an enemy. Her words, it seemed to me from the opposite end of the couch, were daggers aimed squarely at my worthiness. I had to defend myself.

It was just as I was preparing my next attack that I remembered Sawyer and our practice. I took a beat, and even though Jen still looked like an enemy, even though she still sounded like an enemy, and even though I had learned over the years to protect myself against enemies, I asked myself this question: “What if she’s not your enemy? What if she still loves you? Then what are you looking at?”

This is often how I’d practice with Sawyer or myself or strangers on the street. If any of us looked broken, I’d ask, “But what if no one is broken? Then what are you seeing?” So that’s what I did with Jen. And as I asked this question, she changed again. Now I saw a woman who was as upset as I was, who wanted to be in agreement as badly as I did, who didn’t understand why we couldn’t reach an agreement. In that instant my war was over. Soon, the argument was over as well. As always, it had just been a misunderstanding. We still loved each other after all.

Joining Sawyer taught me that unconditional love is not some point on the map. It is a path that leads me where I want to go – to the world I want to live in, rather than the one I’m seeing.

William Kenower is a writer and the editor of Author magazine.

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An Early Bedtime for Kids May Fight Weight Gain

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Preschool children who are in bed by 8 p.m. are far less likely to be obese during adolescence than children who stay up late, a study has found. Their risk of teenage obesity is half the risk faced by preschoolers who stay up past 9 p.m.

The research analyzed data gathered on nearly 1,000 children born in 1991 whose bedtimes were recorded when they were 4½ years old, and whose height and weight were recorded at age 15. The children were part of the Study of Early Child Care and Youth Development, done under the auspices of the National Institute of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Among the children who were in bed by 8 p.m., 10 percent were obese as teens, compared to 16 percent of those who went to bed between 8 and 9 and 23 percent of those who went to bed after 9, according to the study, published in The Journal of Pediatrics.

The researchers adjusted for such factors as socioeconomic status, maternal obesity and parenting style and still found that the children who went to bed by 8 p.m. were at less than half the risk of teenage obesity as those who were up past 9, said Sarah E. Anderson, the paper’s lead author and an associate professor of epidemiology at the Ohio State University College of Public Health in Columbus.

Although the study does not prove that early bedtimes protect against obesity, Dr. Anderson said, “there is a great deal of evidence linking poor sleep, and particularly short sleep duration, to obesity, and it’s possible the timing of sleep may be important, above and beyond the duration of sleep.”

“This provides more evidence that having an early regular bedtime and bedtime routine for young children is helpful,” she said.

Talking to Kids About Racial Violence

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The daughter of Diamond Reynolds, whose boyfriend, Philando Castile, was shot by the police in Minnesota last week.

The daughter of Diamond Reynolds, whose boyfriend, Philando Castile, was shot by the police in Minnesota last week.Credit Eric Miller/Reuters

My husband is white; as an Armenian man, I am a hue darker, and our 10-year-old daughter is biracial, with brown skin. We’ve tried to shield her from some of the recent painful news stories related to bias. But after last week’s killings of two African-American men by police officers, and then the killings of five Dallas police officers, we need to be ready to talk with her about the terrors of prejudice.

I reached out to some experts who help teenagers and parents make sense of violent racism, and work toward something better. Here is some of the wisdom they offered:

  1. Don’t avoid it. “As moms and dads, we can be scared to talk about something so raw, and ugly,” said Tamara Buckley, an associate professor of counseling and psychology at Hunter College and the co-author of “The Color Bind: Talking (and Not Talking) About Race at Work.” “But not bringing it up doesn’t protect your family. It only puts the conversation in others’ hands.”
  2. All kids — not just minorities — need to talk. “Every youth needs to be nurtured to practice empathy, not judgment,” said Renée Watson, who has worked with high school students struggling to process the Black Lives Matter movement and whose work includes the young adult novel “This Side of Home.” “It’s time for us to get out of our own worlds. To be critical thinkers, young people must be exposed to news about every demographic.”
  3. It’s O.K. not to have answers. “Don’t be afraid to be vulnerable in front of your child,” said Ms. Watson. “Even as a teacher I don’t know everything. It’s not about me trying to get students to think how I do, but to create room for dialogue.”
  4. Ask open-ended questions. Buckley suggested asking: “How are you feeling about what you’re seeing in the news? What are your friends saying? What bothers you the most?”
  5. Notice changes in behavior. “Your son might answer, ‘It’s not bothering me,’” Dr. Buckley said. “Some young people may be in such shock they can’t take in the news. Keep a close eye on them. Do they seem stressed? Isolated? Watch for changes in demeanor, which can suggest they’re upset even if they’re telling you otherwise.”
  6. Turn to art. “If things get tense, music, painting, and dance are great ways to express yourself,” said Ms. Watson, who was a 2013 NAACP Image Award nominee. She said multicultural publishers like Lee & Low “know we need a mix of ‘mirror’ books — in which we see ourselves reflected — and ‘window’ books — in which we see others.” She offered a checklist to measure the diversity in your home library: Do all the titles featuring black characters focus only on slavery? Do all the ones about Latinos emphasize immigration? Are all your L.G.B.T.Q. books coming out stories? If so, you could consider books that examine broader issues in these communities.
  7. Educate yourself about social justice. “Know the difference between equality and equity,” said Shuber Naranjo, a diversity educator at Bank Street School for Children in Manhattan. “It’s like in a Broadway theater, there are the same number of stalls in the women’s and men’s bathrooms. It’s equal, but not equitable, because you see a longer line for women.”
  8. Don’t go it alone. Racism is a tough subject for one person to tackle. “Seek out other dads and moms,” Dr. Buckley suggested, “and find ways to support one another. I’ve noticed all this racial violence has been a real point of connection between black and white parents.”


How do you talk to your kids about race, policing and violence? Join six New York Times journalists for a live chat at 2 p.m. Eastern time, Tuesday, July 12.

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Pokémon Has Children on the Move

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The author’s son and daughter, both 10, sneak up on a virtual Pokémon.

The author’s son and daughter, both 10, sneak up on a virtual Pokémon.Credit

Parents looking for a way to get children moving and off the couch this summer have found a surprising new ally: Pokémon.

Unlike most video and smartphone games, the phenomenally popular Pokémon Go, which has been downloaded by millions in the past week, requires the player to be active. The game uses map technology and local landmarks to make it seem as if mythical cartoon creatures are lurking in the real world all around you.

As my two 10-year-olds and I quickly found, playing Pokémon Go is not sedentary. Pokémon “trainers” must search for the virtual creatures; finding more of them requires getting up and heading outside.

Other parents are reporting a similar effect.

“My 18-year-old and his friends walked and biked 25 plus miles in two days, outside, in the heat and rain,” said Lisa Romeo, a mother of two who lives in Cedar Grove, N.J.

Phil LeClare of Salem, Mass., said that after three days of Pokémon Go while on vacation in Maine, his 11-year-old son proudly said that he’d walked 30 miles.

Along with the stories of calories burned come the benefits of unexpected family time. The real-world component of walking and hunting for the creatures seems to make playing Pokémon Go alone unappealing. Instead, even teenagers are inviting siblings and parents along. Add in the likelihood of meeting other players at Poké-stops, and the game begins to feel like a social event.

“Event” is a good characterization, said Jeffrey Rohrs, a father of two and the chief marketing officer of Yext, a location data management platform. The app, he said, appears to have struck a perfect chord in our culture, making fresh use of smartphone technology while offering a way around our collective fears that smartphones make us more sedentary and connect us better to the cloud than to one another. “There’s just this euphoria around it,” he said. “It’s unique.”

But for families that have been pleasantly surprised by the action and interaction of Pokémon Go, the game has created a quandary: Do our usual screen time limits apply? Do miles logged and family togetherness really make Pokémon Go different from other screen-based distractions?

The average American child already spends more time consuming media via a screen than at school. Adults aren’t doing much better. Many of us say we spend too much time on our smartphones and the internet, and our kids think so too: In one study, about 70 percent of children under 18 said their parents spent too much time glued to the phone.

“I’m wary of promises that more technology is the answer to problems caused by the overuse of technology,” said Richard Freed, a psychologist and author of “Wired Child: Reclaiming Childhood in a Digital Age.” We’ve been hopeful in the past that certain games, like the Wii system, would promote family time or get kids moving, he said, but those games ultimately failed to live up to the hype.

When it comes to Pokémon Go, Dr. Freed says he is in “wait and see” mode, but dubious. His family loves to walk together outdoors. “Now you add this new wrinkle,” in the form of a game that may be more compelling than the conversation that forges bonds among them. “You have to ask,” said Dr. Freed, “will this facilitate that connection?”

As a replacement for other forms of gaming, Pokémon Go offers plenty of advantages. My two 10-year-olds and I did enjoy connecting while roaming the streets in search of creatures — but part of the pleasure, for me, was that I’d lured them away from their usual Sunday afternoon game-fest with the Wii.

For some families, the hunt has already begun to take over their travels — encouraging kids to walk and hike further, yes, but will they remember seeing the White House, or the Pokémon at its gates? On a positive note, Mr. Rohrs sees a future where the technology could be used to enhance our destinations “It’s easy to imagine a hunt for the great authors of London,” he said, rather than Pokémon.

But for now, it’s even easier to imagine getting just a little tired of children who’d rather hunt Zubats than enjoy a zoo.

Which can only mean one thing. “Part of parenting is establishing boundaries,” said Mr. Rohrs, who spent his weekend exploring New York City with his wife, two children and Pokémon Go. Although he was mostly enthusiastic about the unexpected places the game led them, “We quickly realized we needed to declare some ‘phone in pocket’ time.”

For now, many parents seem to be relishing the good in Pokémon Go, while recognizing that they will need to create limits. For some of us, Pokémon Go brings up unexpected summer memories of twilight freeze-tag and hide-and-seek. Laurel Snyder had to set a curfew for her kids, ages 9 and 10, who spent the day wandering their neighborhood in Atlanta.

“I told them they had to be home by 8, and they dashed in sweaty-faced at 7:53. It really felt more like my own childhood experience than I’d have imagined,“ she said. That early hour might even relax a little, with so much community to be found in the initial excitement surrounding the game. It’s likely that for many children, and adults too, the summer of 2016 just became the summer of Pokémon.

To Stem Obesity, Start Before Birth

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Credit Paul Rogers

To stem the current epidemic of obesity, there’s no arguing with the adage that an ounce of prevention is worth a pound of cure. As every overweight adult knows too well, shedding excess pounds and keeping them off is far harder than putting them on in the first place.

But assuring a leaner, healthier younger generation may often require starting even before a baby is born.

The overwhelming majority of babies are lean at birth, but by the time they reach kindergarten, many have acquired excess body fat that sets the stage for a lifelong weight problem.

Recent studies indicate that the reason so many American children become overweight is far more complicated than consuming more calories than they burn, although this is certainly an important factor. Rather, preventing children from acquiring excess body fat may have to start even before their mothers become pregnant.

Researchers are tracing the origins of being overweight and obese as far back as the pre-pregnancy weight of a child’s mother and father, and their explanations go beyond simple genetic inheritance. Twenty-three genes are known to increase the risk of becoming obese. These genes can act very early in development to accelerate weight gain in infancy and during middle childhood.

In the usual weight trajectory, children are born lean, get chubby during infancy, then become lean again as toddlers when they grow taller and become more active. Then, at or before age 10 or so, body fat increases in preparation for puberty – a phenomenon called adiposity rebound.

In children with obesity genes, “adiposity rebound occurs earlier and higher,” said Dr. Daniel W. Belsky, an epidemiologist at Duke University School of Medicine. “They stop getting leaner sooner and start putting on fat earlier and put on more of it.”

Still, twin and family studies have shown that many children with these genes remain lean. Furthermore, these same genes were undoubtedly around in the 1960s and 1970s when the obesity rate in children was a fraction of what it is today.

So what is different about the 2000s? Children today are surrounded by a surfeit of unwholesome, easy-to-consume calorie-dense foods and snacks accompanied by a deficit of opportunities to expend those extra calories through regular physical activity. And countering a calorie-rich, sedentary environment is now harder than it should be, with the current heavy emphasis on academics, parental reluctance to let children play outside unattended, and intense competition from electronics. All these circumstances may give obesity genes a greater chance to express themselves.

“There is no going back to a world in which calories are scarce and obtaining them is physically demanding,” Dr. Belsky wrote in an editorial in JAMA Pediatrics. “And governments and their publics have shown little enthusiasm for regulations restricting access to palatable, calorie-dense foods.”

Curbing consumption of sugar-sweetened beverages and keeping calorie-dense junk food out of the house and other settings where young children spend time is crucial. This is especially important for infants and children with large appetites that are not easily satisfied.

It’s also essential that parents model good eating habits, experts agree. “If you do it, they’ll do it,” David S. Ludwig, an obesity specialist at Children’s Hospital Boston, said. “Young children are like ducklings, they want to do what their mothers do.”

Equally important, Dr. Belsky said, is “allowing children in institutional settings – in day care, preschool and elementary school – to be as active as they choose to be rather than forcing them to sit quietly in chairs most of the day. Being physically active encourages a healthy metabolism. Active children are not constantly hungry.”

He added, “In the face of the obesity epidemic, eliminating the handful of opportunities for kids to be active during the day is a shame. Sedentary behavior becomes a life pattern.”

Another critical issue is the vicious cycle of overweight that starts with future mothers and fathers who are overweight or obese. “If we want healthy kids, we need healthy moms before pregnancy and during pregnancy,” Dr. Belsky said. “There are multiple pathways by which unhealthy levels of weight before and during pregnancy can influence a child’s weight going forward.”

As Dr. Ludwig explained, “Although genes are not modifiable, the weight of the mother before and during pregnancy is. Excessive weight gain during pregnancy predicts not just the baby’s birth weight but also the likelihood of obesity in middle childhood.”

The father’s weight is also turning out to be important, Dr. Ludwig said. “Acquired factors influence gene expression,” he said. “Being heavy alters DNA in the father’s sperm that changes gene expression and can be passed down to the next generation.”

Most, though not all, studies have linked a longer duration of breast-feeding to a reduced risk of overweight in children. Although Dr. Ludwig said that the effect “is not dramatic,” a more important benefit of breast-feeding may be “exposing the baby to a wider range of tastes based on what a mother is eating. If a breast-feeding mom eats a large variety of nutritious foods, the child is more likely to like them.”

Antibiotics given early in life, however, may counter any potential benefits of breast-feeding for weight gain, a new study found. Researchers at the University of Helsinki in Finland reported that when breast-fed infants are treated with antibiotics, the antibiotics kill off health-promoting bacteria that live in the gut. “The protective effects of breast-feeding against infections and overweight were weakened or completely eliminated by early-life antibiotic use,” the team wrote in JAMA Pediatrics last month.

Even if children have already started on a path of poor eating habits and excess weight gain, Dr. Ludwig said it is not too late to make healthful changes. As founder of the Optimal Weight for Life program and author of “Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World,” he advocates an authoritative, but not an authoritarian, parenting style that eliminates stress and conflict over what and when a child eats.

“Never force food on a child,” he insists. “Stand your ground in a gentle but firm way and be prepared to do a little negotiating. When a child refuses to eat the dinner that’s served, put it away in the fridge to be eaten later. If the child says ‘I’m not going to eat it,’ the response should be, ‘Fine, just go to bed,’ not ‘O.K., I’ll make you mac and cheese.’

“Children should be allowed to control their bodies, but parents have to provide the guidance and control the environment,” Dr. Ludwig said.

This is the second of two columns on childhood obesity. Read the first: “The Urgency in Fighting Childhood Obesity.”

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Thumb Suckers and Nail Biters May Develop Fewer Allergies

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Credit Getty Images

Babies have been seen sucking on their fingers in utero weeks before birth. But the sight of an older child with his fingers constantly in his mouth, sucking her thumb, biting his nails, can drive parents crazy, bringing up fears about everything from social stigma to germs.

A new study suggests that those habits in children ages 5 to 11 may indeed increase exposure to microbes, but that that may not be all bad.

When a pediatrician discusses thumb-sucking, it’s usually because a parent is worried. The thumb is in the mouth so constantly that there’s a worry about speech or about whether the teeth may be affected. It’s gone on too long, and an older child is being teased about it. And in those situations, especially when a child is over 4, we work with parents and children on how to break the habit.

Nail biting worries parents for similar reasons, and we often end up giving similar advice: Don’t make negative comments; look for the situations that bring on the behavior and find alternate strategies; praise and reward the child for not doing it; put a glove or a bandage on the hand to remind the child.

In a study published Monday in the journal Pediatrics, researchers drew evidence from an ongoing study of New Zealand children to show those whose parents described them as thumb-suckers and nail-biters were less likely to have positive allergic skin tests later in life.

The children were in the Dunedin Multidisciplinary Health and Development Study, in which 1,037 children born in 1972-73 in Dunedin, a coastal city in New Zealand, were assessed and tested as they grew up, with the most recent assessment done at age 38. Stephanie Lynch, a student at Dunedin School of Medicine and the first author of the paper, had the idea of using the data to look at a possible relationship between children who tend to have their fingers in their mouths and allergic sensitization.

The question of such a connection arose because of the so-called hygiene hypothesis, an idea originally formulated in 1989, that there may be a link between atopic disease — the revved-up action of the immune system responsible for eczema, asthma and allergy — and a lack of exposure to various microbes early in life. Some exposure to germs, the argument goes, may help program a child’s immune system to fight disease, rather than develop allergies.

In the study, parents were asked about their children’s nail-biting and thumb-sucking habits when the children were 5, 7, 9 and 11 years old. Skin testing for allergic sensitization to a range of common allergens including dust mites, grass, cats, dogs, horses and common molds was done when the children were 13 years old, and then later when they were 32. Thirty-one percent of the children were described as “frequent” nail biters or thumb suckers (or both) at one or more of those ages.

The study found that children who frequently sucked a thumb or bit their nails were significantly less likely to have positive allergic skin tests both at 13 and again at 32. Children with both habits were even less likely to have a positive skin test than those with only one of the habits.

These differences could not be explained by other factors that are associated with allergic risk. The researchers controlled for pets, parents with allergies, breast-feeding, socioeconomic status and more. But though the former thumb-suckers and nail-biters were less likely to show allergic sensitization, there was no significant difference in their likelihood of having asthma or hay fever.

Robert J. Hancox, one of the authors of the study, is an associate professor in the Department of Preventive and Social Medicine at Dunedin School of Medicine, a department that is particularly oriented toward the study of diseases’ causes and risk factors. He said in an email, “The hygiene hypothesis is interesting because it suggests that lifestyle factors may be responsible for the rise in allergic diseases in recent decades. Obviously hygiene has very many benefits, but perhaps this is a downside. The hygiene hypothesis is still unproven and controversial, but this is another piece of evidence that it could be true.”

Malcolm Sears, one of the authors of the paper, a professor of medicine at McMaster University in Hamilton, Ontario, who was the original leader for the asthma allergy component of the New Zealand study, said, “Early exposure in many areas is looking as if it’s more protective than hazardous, and I think we’ve just added one more interesting piece to that information.”

Dr. Hancox pointed out that the study does not show any mechanism to account for the association. “Even if we assume that the protective effect is due to exposure to microbial organisms, we don’t know which organisms are beneficial or how they actually influence immune function in this way.”

Thumb sucking, especially in an older child, can still be a problem if it interferes with the teeth, or causes infections on the fingers, or gets a child teased. Lynn Davidson, a developmental pediatrician who is an attending physician at the Children’s Hospital at Montefiore in the Bronx, and the author of a review article on thumb sucking, said she tends to be “very low-key” about thumb sucking, since children often stop on their own as they grow.

With older children, Dr. Davidson suggests that parents, if they are worried, should try to analyze when and why the child resorts to thumb sucking or nail biting, and then try behavioral techniques, like offering a child a foam ball to hold and squeeze at those moments. “In an older child you can use their input, ask, what would you do with your hands instead of putting them in your mouth,” she said.

Dr. Sears said, “My excitement is not so much that sucking your thumb is good as that it shows the power of a longitudinal study.” (A longitudinal study is one that gathers data from the same subjects repeatedly over a period of time.) And in fact, as researchers tease out the complex ramifications of childhood exposures, it’s intriguing to look at long-term associations between childhood behavior and adult immune function, by watching what happens over decades.

So perhaps the results of this study help us look at these habits with slightly different eyes, as pieces of a complicated lifelong relationship between children and the environments they sample as they grow, which shape their health and their physiology in lasting ways.

10 Children’s Apps for Summer Road Trips

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Credit iStock

The car is packed, the pets have sitters and the GPS is programmed. But have you properly prepped your children’s devices?

While there are many apps that can keep a child busy, the best are those designed to promote active, engaged, meaningful and social learning, researchers say.

Here are some recent apps for the job. Most work without a Wi-Fi tether, are free or very affordable and are rich in bite-size bits of interaction, making them easy to pass around the car. Platform and price information change frequently, so check your favorite app store for the latest information.

FOR YOUNGER CHILDREN (ages 3 to 7)

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Chomp by Christoph Niemann, Fox and Sheep GmbH ($2.99 on iOS, Android), is a powerful, easy-to-use video creativity experience that combines hand-drawn animations with real-time video. You’ll find your face inside 52 spring-loaded gags that you can try out simply by looking into the camera, and swiping. Pass this app around and give everyone a chance — except the driver.

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HangArt: Play Hangman, Draw Pictures, Tell Stories by Literary Safari ($1.99 on iOS, Android) brings the age-old game of hangman to your road trip, using words straight out of a school reading curriculum. The two-player mode can promote cooperative play.

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Heads Up! Kids by Warner Bros. Interactive Entertainment (99 cents with in-app purchases, on iOS and Android) is another fun, social word game that is a simplified version of the Ellen DeGeneres game, in which you hold your device up to your forehead and ask someone else for a clue. The initial download contains six decks of virtual cards on topics like animals; extras cost a dollar each.

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Moonbeeps: Gizmo by Moonbot Studios ($1.99 on iPad, iPhone) turns your tablet into a pretend dashboard full of dials and switches that are perfect for imaginary play, say, for turning your minivan into a submarine.

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Sago Mini Robot Party ($2.99 on iPad, iPhone) contains a set of rubbery robot parts that can be mixed and matched. We like how easy it is to be silly with this app. You can use the sock for a head, for example, or put two heads on the feet and flip the robot upside down.

FOR OLDER CHILDREN (ages 8 and up)

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MSQRD — Live Filters & Face Swap for Video Selfies by Masquerade Technologies (free on iPad, Android) is like sticking your head inside a magical mirror where you can try on some glow-in-the-dark face paint, or do a face swap with the person sitting next to you — and you can post it on Facebook. Keep this one far away from the driver.

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Thinkrolls 2 by Avokiddo ($2.99 on iPad, Android, Kindle) lets you swipe your way through a series of increasingly challenging mazes. This is the second app in the series, and it’s well named because it gently introduces properties of matter and physics. You discover that things do more than “roll.” They can also float, glide and teleport through the 270 levels.

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Stack the States 2 by Freecloud Design ($2.99 on iPad, iPhone) for ages 7 and up is a great app for learning about the United States while you drive through it. The app quizzes you on the capital, shape and location of each state. You can now zoom in for a 3-D view of the details on key cities and landmarks.

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Toca Life: Vacation by Toca Boca ($2.99 on iPad, iPhone) transforms your back seat into a tropical resort, with its own airport, hotel and island. There’s no way to fail with this free-play app, and there’s room for plenty of cooperative play.

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Finding Dory: Just Keep Swimming by Disney ($3.99 on iPad, Android, Kindle) delivers plenty of well-illustrated, slippery fun in this maze game. There are 13 levels, each inspired by the movie, and it’s easy to revisit an already mastered level, so a little brother or sister can have a turn. Make sure children know that they can pause the game at any point.

FOR THE WHOLE FAMILY

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Traveling at night? Turn your vehicle into a rolling planetarium with Star Walk HD ($2.99 for iPad, Android). You’ll be able to predict when and where the moon will come up, or confirm if the bright star is actually Saturn.

Google Maps is a wonderful family resource. You can install a second version on your child’s Android or Apple device, saving on data costs by using the “offline map feature.” As you drive, your child can view the scrolling maps, and help you find landmarks or navigation, dropping pins on favorite places along the way. Show your child how to toggle between satellite, topographic and regular map modes, and use the Street View feature to follow your car.

Finally, Siri loves geography facts. Besides knowing “how many people live in Detroit,” she can tell you current altitude, or where the closest rest area might be. She’ll also have the exact answer, in miles, to that age-old back-seat question, “Are we there yet?”

When a Child Thinks Life is Unfair, Use Game Theory

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Credit iStock

As soon as Kristina Dooley’s 5-year-old triplets see an elevator, they race to be the one who gets there first.

“When they get to the buttons, elbows start flying,” she says. Almost immediately, she hears the complaint “That’s not fair!” from the child who doesn’t get to hit a button.

A child’s list of things that are “not fair” is seemingly endless. Whether it’s elevator buttons, equal piles of goldfish crackers, who gets the first bedtime kiss or who gets to use the precious purple cup, children demand precision equality that seems impossible to achieve most of the time.

But research suggests that humans evolved to want fair treatment — an expectation that other social animals share. In a now famous study, a capuchin monkey rewarded for a task with a piece of tasty cucumber was pleased, until she saw one of her peers rewarded for the same task with a tasty grape. The reaction may be familiar to parents. The monkey throws the cucumber at her handler and rattles the cage in anger.

In humans, the desire to be treated fairly starts early. Researchers have found that children as young as 19 months seem to understand the concept of fairness, and appear surprised by scenes of blatant favoritism – such as when one puppet is given toys and another puppet goes without. By age 7, some children will choose to forgo candy rather than get a significantly larger share than others.

“The question of jealousy is easy — in any kind of group living, you have to be careful that somebody else isn’t getting more than you,” said Paul Raeburn, a co-author of “The Game Theorist’s Guide to Parenting.”

The desire not to have more than others can also be explained. In a hunter-gatherer society where conditions of scarcity arise frequently, sharing food when you have more increases the likelihood that others will share when you have less. “The presumption is that it gave some ancestor an evolutionary advantage,” he said.

Given that a child’s desire for life to be fair seems to be hard wired, it’s better not to fight it, says Mr. Raeburn. Instead, he suggests applying classic game theory strategies to help children make “fair” decisions and stop the squabbling. They include:

I Cut, You Pick: This classic strategy for dividing simple things, like cake, allows each child to make a choice: One divides the desired good, and the other chooses. I Cut, You Pick has limits, says Mr. Raeburn, if the thing to be divided has a different value to each child, or if there are more than two children with an interest. But if nothing else, it works well for cake.

Tit for Tat:When children are faced with the job of cleaning up a joint mess, suggest “you pick up one, then he picks up one,” said Mr. Raeburn. “We had mixed results with Tit for Tat,” he admits. His 9-year-old son was able to manipulate his 6-year-old brother into doing more. “This probably works better with children who are closer in age, or at least both over 7.”

Random Dictator: In Random Dictator, a family faced with a choice that affects every family member (what movie to watch, what cereal to buy, which restaurant to go to) has each family member write down a selection, then draws a single one from a hat. One person ultimately chooses — but who “wins” is random.

Auction: How to decide who chooses the one show that will be watched tonight or gets first play on the iPad on a road trip? Try auctioning the desired reward to the highest bidder, using chores, other privileges or even Halloween candy as currency. “This involves some learning,” said Mr. Raeburn. “It’s easy for a child to overvalue something in the moment and get stuck doing way too many chores.” At first, he says, parents might have to monitor the fairness of the auction process itself — but children who like it may end up running auctions on their own.

Even if you adopt these strategies, chances are that some things will always feel “not fair” to kids.

“Don’t react defensively,” says Laura Markham, author of “Peaceful Parent, Happy Siblings.” Parents have to recognize that sometimes, no matter how logical the division of everything from elevator buttons to our time and attention seems to us, one child feels less loved. Even grown-ups know it’s hard when someone else gets a gift you wanted, or more ice cream on their cone. Find words that acknowledge the child’s perspective.

“Try focusing on whether you’re meeting their individual needs instead of worrying whether each one is getting the exact same thing at the exact same time,” Dr. Markham said. “When we’re always busy with the baby, or something like that, it really rankles.”

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The Urgency in Fighting Childhood Obesity

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Credit Paul Rogers

Life-threatening ailments like heart disease, cancer, stroke and Type 2 diabetes most often afflict adults. But they are often consequences of childhood obesity.

Two new studies, conducted among more than half a million children in Denmark who were followed for many years, linked a high body mass index in children to an increased risk of developing colon cancer and suffering an early stroke as adults. The studies, presented at the European Obesity Summit in Gothenburg, Sweden, this spring, underscore the importance of preventing and reversing undue weight gain in young children and teenagers.

One study, of more than 257,623 people, by Dr. Britt Wang Jensen and colleagues at the Institute of Preventive Medicine, in Bispebjerg, Denmark, and Frederiksberg Hospital in Copenhagen, grouped children according to standard deviations from a mean B.M.I., adjusted for a child’s age and sex.

They found that each unit of increase in being overweight at age 13, generally corresponding to a two- to three-point increase in B.M.I., increased the risk of developing colon cancer by 9 percent and rectal cancer by 11 percent.

The second study, involving 307,677 Danish people born from 1930 to 1987, used a similar grouping of B.M.I. The risk of developing a clot-related stroke in early adult life increased by 26 percent in women and 21 percent in men for each unit of increase in being overweight at all stages of childhood, but especially at age 13.

Although neither study proves that excess weight in childhood itself, as opposed to being overweight as an adult, is responsible for the higher rates of cancer and stroke, overweight children are much more likely to become overweight adults — unless they adopt and maintain healthier patterns of eating and exercise.

According to the American Academy of Child and Adolescent Psychiatry, obesity most often develops from ages 5 to 6 or during the teen years, and “studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.”

In a study published in 2014 in The New England Journal of Medicine, Solveig A. Cunningham and colleagues at Emory University found that “overweight 5-year-olds were four times as likely as normal-weight children to become obese by age 14.” The study, which involved a representative sample of 7,738 kindergartners, found that the risk of becoming obese did not differ by socioeconomic status, race or ethnic group, or birth weight. Rather, it showed that excess weight gain early in life is a risk factor for obesity later in childhood across the entire population.

Children are generally considered obese when their B.M.I. is at or above the 95th percentile for others of the same age and sex. Currently, about one-third of American children are overweight or obese. By 2012, the Centers for Disease Control and Prevention reports, 18 percent of children and 21 percent of adolescents were obese.

The adverse effects of excess weight in childhood and adolescence don’t necessarily wait to show up later in life. In a review of complications resulting from youthful obesity, Dr. Stephen R. Daniels, a pediatrician at the University of Colorado School of Medicine and the Children’s Hospital in Denver, found that problems in many organ systems were often apparent long before adulthood. They include high blood pressure; insulin resistance and Type 2 diabetes; high blood levels of heart-damaging triglycerides and low levels of protective high-density lipoprotein (HDL) cholesterol; nonalcoholic fatty liver disease; obstructive sleep apnea; asthma; and excess stress on the musculoskeletal system resulting in abnormal bone development, knee and hip pain, and difficulty walking.

Problems of youthful obesity go beyond physical ones. Obese adolescents have higher rates of depression, which in itself may foster poor eating and exercise patterns that add to their weight problem and result in a poor quality of life that persists into adulthood.

In a study conducted in Singapore, researchers reported that “individuals who were obese in childhood are more likely to have poor body image and low self-esteem and confidence, even more so than those with adult onset obesity.”

Another study by Dr. Jeffrey B. Schwimmer of the University of California, San Diego, and colleagues found that obese children and adolescents reported a diminished quality of life that was comparable to that of children with cancer.

Taken together, the data speak to the critical importance of preventing undue weight gain in young children, a task that depends largely on parents, who are responsible for what and how much children eat and how much physical activity they engage in. As researchers from the University Medical Center Groningen in the Netherlands put it, “Early recognition of overweight or obesity in children by their parents is of utmost importance, allowing interventions to start at a young age.” Yet, they found in a study of the parents of 2,203 5-year-olds, “parents underestimated their overweight child in 85 percent of the cases.”

Though it seems logical that parents who think their children are overweight would make a special effort to assure they would “grow into” their weight as they get older, research has shown the opposite. Such children tend to get even fatter, according to findings from the Longitudinal Study of Australian Children reported in April in the journal Pediatrics by Eric Robinson of the University of Liverpool and Angelina R. Sutin of Florida State University College of Medicine.

Even being labeled overweight can itself be damaging and make it harder for children to avoid bad habits, the authors suggested. A 2014 study of girls aged 10 to 19 found that “regardless of actual weight, adolescents who reported having been labeled ‘too fat’ by a family member or peer were more likely to become obese nearly a decade later.”

“I encourage parents to change the environment at home,” Dr. Daniels of the University of Colorado said in an interview. “Without being authoritarian, they should limit high-calorie-dense foods, keep sugar-sweetened beverages out of the house and assure that kids eat the right amount of fruits and vegetables and fewer calorie-dense snacks. Parents also need to be tuned into opportunities for physical activity and set hard-and-fast rules about television and time spent on electronics.”

Following the “5210” daily program endorsed by the American Academy of Pediatrics can help: Aim for five fruits and vegetables a day; keep recreational screen time to two hours or less; include at least one hour of active play: and skip sugar-sweetened beverages and drink water.

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Sunscreen and Bug Spray: Children’s Summer Skin Care

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Credit Getty Images

Summer is here, and we know we’re supposed to shield children from the sun. There’s strong evidence that early sun exposure can increase children’s risk of later skin cancer, and that’s true also for darker-skinned children who are less likely to burn. Boston and Miami Beach are providing free sunscreen in public places, and now New York is talking about it, too.

Parents have certainly gotten much more aware about sun protection, though they sometimes feel a little overwhelmed by the variety of products and by the job of keeping up with the imperatives for proper use.

And with old worries about ticks and new worries about mosquito-borne viruses, parents wonder if they should also be coating a child’s exposed skin with bug repellent.

But babies’ delicate skin is more permeable than adults’, so any chemicals we apply may be more likely to be absorbed, and their immature organs may be less able to handle those chemicals. What stays on the skin may be absorbed; but what doesn’t stay on the skin doesn’t shield. Dermatological toxicology involves considering the balance between “wash in,” the risk of absorbing potentially toxic substances through the skin, and “wash out,” the loss of protection as substances are lost by sweating or water exposure or rubbing. Both are highly complex processes, with many variables, and not necessarily well studied in young children.

With little babies, the advice is always to rely on reducing exposure, on shade and clothing for sun, and on adding screens and netting to keep the bugs off. Both the Food and Drug Administration and the American Academy of Pediatrics emphasize that babies under 6 months should be kept out of direct sunlight, protected with shade, shielded with sunhats and protective clothing when they do have to be out, rather than relying on sunscreen.

Babies’ skin surface is large in proportion to their body volume and their internal fluids, putting them at high risk for heat and dehydration. So make sure they are drinking and wetting their diapers regularly.

Adults and children alike are advised to avoid the hours of maximum exposure — to stay out of the sun between 10 and 2, and to avoid going outside at dusk in areas with lots of mosquitoes. But of course, that isn’t necessarily easy.

Sun hats and protective clothing are important for older babies and toddlers, and so is avoiding those peak hours. For children under 2, “the rule of thumb in this age group is clothing first,” said Jacqueline Thomas, an assistant professor of dermatology and surgery at Nova Southeastern University in Fort Lauderdale, who is the senior author on a commentary reviewing pediatric sunscreen and sun safety guidelines published last year in the journal Clinical Pediatrics. Dark colors and more tightly woven fabrics are more effective.

As to sunscreen, experts say not to choose by what is marketed for children or babies, and to read the label carefully. In 2011, the F.D.A. required much more information to be standardized on sunscreen labels; parents should look for products with an SPF of 30 or higher, advises the American Academy of Dermatology, and make sure they are labeled as “water resistant” (lasts 40 minutes in the water) or “very water resistant” (80 minutes), and as “broad spectrum,” meaning that they block both UVA and UVB rays, both of which do damage. There is no such thing as waterproof sunscreen.

The active agents in sunscreen can be either chemical blockers or physical blockers, and the physical blockers are safer for children because they are much less likely to be absorbed. For children ages 2 to 12, look for products with titanium or zinc as their active ingredients, rather than chemical agents, which really haven’t been studied in children.

The recommended amount for an adult-size body is variously described as a shot glass and a golf ball for the trunk and extremities; for under 12, some authorities suggest using the amount that would fill a child’s cupped hand as a rough guide. It needs to be reapplied after two hours, because the efficacy is gone, even if you can still feel the lotion on your skin, and sunscreens with higher SPFs don’t last any longer than those with lower SPFs (in fact, there is no evidence that SPFs over 50 are more protective).

Although spray-on sunscreens are popular, their efficacy has not been studied,, and there’s concern about children inhaling them. The F.D.A. has asked for more data.

What about insects? Mosquito repellents generally contain either DEET, picaridin or one of several essential plant oils, most commonly oil of lemon eucalyptus, as an active ingredient; permethrin, which is meant to be applied to clothing (or sometimes already applied by manufacturers) works to repel ticks.

There has been concern in the past about DEET toxicity, and the recommendation is to avoid DEET and picaridin for babies younger than 2 months, and to avoid oil of lemon eucalyptus for children under 3. But most pediatricians would recommend being very sparing with all of these substances on babies and young children, applying them only to exposed skin, right before going outside, and washing them off when you come back in. Don’t let young children apply the stuff themselves, and keep it away from their eyes and their mouths, and their hands if they tend to put those in their mouths. If possible, put the repellent on the clothing, or on the tent; there are also clip-on devices that can be attached to strollers.

Dr. Adelaide A. Hebert, a professor of dermatology and pediatrics at McGovern Medical School at the University of Texas Health Science Center at Houston, said she tends to recommend picaridin-based insect repellents such as Cutter Advanced and Off Clean Feel for children over those that contain DEET. “I like picaridin. I feel there’s less concern for parents using it with regard to toxicity,” she said. The strength of these insect repellents can vary as well, so again, it’s important to read the label. “We don’t recommend DEET strength above 20 percent because of concern about toxicity,” Dr. Hebert said.

Combination products are another problem, though the idea of a single lotion that protects against both sun and insects is very appealing. “I never recommend combination products,” said Dr. Hebert. “We don’t want to reapply the insect repellent as often as we may need to reapply the sunscreen.” Further, there’s evidence that the mixture may make the sunscreen less effective, and the chemicals more likely to be absorbed.

So keep babies out of the sun, be scrupulous about sun hats and protective clothing, about screens and mosquito netting. As children grow, don’t forget about protecting the eyes; think about broad-brimmed hats and sunglasses. If you need protection against insects, apply insect repellent over sunscreen, and reapply the sunscreen after two hours, on top of the insect repellent, which does not have to be reapplied so frequently.

The skin is the largest organ of the body, proportionally larger in the smallest children, and protecting it properly needs our care and attention.

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The ‘Intentional Summer’ Challenge: Play an Outdoor Game

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Credit Maren Hilton

Don’t let summer slip away! Challenge No. 2: Play (and teach your kids) a classic outdoor game, like Capture the Flag.

It’s week two of Well Family’s Intentional Summer, where — to quote an email from Pete Jameson of Ligonier, Pa. — we are making sure to enjoy “the gift that is summer.”

Why be intentional about this most relaxed of times? Summer goes by so fast. One minute, it’s June, and we have all the time in the world for ice cream, drive-in movies and bike rides. The next, it’s August, and too often, we’re left wondering where it went. We want to avoid regrets over missed opportunities. Every week, we’ll offer research-based suggestions for ways to set this season apart from the rest of the year.

Last week, we suggested walking or biking to somewhere you’d usually drive. In our family, a walk to a doctor’s appointment ended in a memorable excursion through a construction zone and under a parking garage — and my 10-year-old was delighted by our “adventure.” Readers tried it too, and reported back: Sam (age 7) and Elisabeth (4) of St. Paul, Minn., (pictured) biked to the library. Anne walked to yoga and back (bonus exercise!). Myriam let our challenge inspire her to start biking to work again after the birth of her baby five months ago: “It was rather hard, my bike is in need of some tuning, I am still sleepy from being up feeding baby at night, but my lungs are so happy and the view of the ocean on the way in was breathtaking.”

On this Fourth of July weekend, many American readers will be joining friends and family at picnics and barbecues. Our second challenge lends itself to a big gathering, though it works well for smaller groups too: Play a classic outdoor game you played in your youth, and teach your kids. If you remember late suburban nights playing flashlight tag or Ghost in the Graveyard under the streetlights, or Capture the Flag in your backyard, this one’s for you.

Anecdotally, parents know our kids spend less time playing outside than we did, and research bears that out. When mothers were questioned about the differences between their childhood experiences and those of their children, 70 percent described playing outdoors daily as children, many for more than three hours at a stretch. By contrast, less than a third of their children played outside every day, and most for far shorter periods — and while most of the mothers said they played street games, only about a fifth of the children ever had. That’s a shame: Outdoor games encourage self-reliance and independence along with an appreciation for just being outside.

“Kids who are used to more structured activities may not know how to create these things on their own,” said Kristen Race, a psychologist and the author of “Mindful Parenting.” With no set number of players and played outdoors, such games encourage a loose creativity (and camaraderie) to develop quickly. “If adults get things started, children will quickly take over,” she said. She suggests pulling aside an older child or two to get things organized. Then, after the adults race around for a bit, sit off to the side and watch the children create their own memories.

We’ve found the rules for some old favorites for you: Ghost in the Graveyard or flashlight tag for evening gatherings that stretch into twilight, or Capture the Flag and Kick the Can for anytime play — but we want to hear about your games, too. If you remember epic nights playing TV tag, tell us how to play and how you recreate them in your yard or local park.

Tell us about all your adventures by commenting here or emailing us at wellfamily@nytimes.com by next Tuesday, July 5. You can also share on Twitter, Instagram or Facebook (#intentionalsummer).

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We’ll share reader stories and post next week’s challenge on Thursday, July 7. The real goal: to savor the summer all season long.

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When It’s Not Just a Boo-Boo: The Push to Treat Children’s Pain

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Credit Sally Deng

It began with a roller-skating accident three years ago. Taylor Aschenbrenner, then 8 years old, lost her balance amid a jumble of classmates, tumbled to the floor and felt someone else’s skate roll over her left foot. The searing pain hit her immediately.

The diagnosis, however, would take much longer. An X-ray, M.R.I.s, a CT scan and blood tests over several months revealed no evidence of a break, sprain or other significant problem. Taylor’s primary symptom was pain — so severe that she could not put weight on the foot.

“Our family doctor first told us to give it some time,” said Taylor’s mother, Jodi Aschenbrenner, of Hudson, Wis.

But time didn’t heal the pain. After about a month, an orthopedist recommended physical therapy. That didn’t end the problem, either. “I couldn’t walk or play outside or do anything,” Taylor said.

After she had spent a year and a half on crutches, her orthopedist suggested she see Stefan Friedrichsdorf, the medical director of pain medicine, palliative care and integrative medicine at Children’s Hospitals and Clinics of Minnesota. He and his team promptly recognized Taylor’s condition as complex regional pain syndrome, a misfiring within the peripheral and central nervous systems that causes pain signals to go into overdrive and stay turned on even after an initial injury or trauma has healed.

He came up with a treatment plan for Taylor that included cognitive behavioral therapy, physical therapy, mind-body techniques, stress-reduction strategies, topical pain-relief patches and a focus on returning to her normal life and sleep routine.

“That turned things around so fast, if I didn’t see it myself, I wouldn’t have believed it,” Mrs. Aschenbrenner said. “I thought, ‘finally, someone understands what this is, has experience with it, and knows how to fix it!’”

But why did it take so long for a child in unbearable pain to find relief? Experts say children’s pain is, for the most part, grossly underrecognized and undertreated.

“Unfortunately, in 2016 pain management in the United States and all Western countries is still abysmal,” said Dr. Friedrichsdorf, who noted that pediatric pain receives the least attention. “Data shows that adults with the same underlying condition will get two to three times as many pain medication doses as children.”

There are effective treatments. But pediatricians, specialists and even parents have been slow to turn to them because pain in children has long been misunderstood and medical training in pain management is scant. Veterinary schools require “at least five times more education on how to handle pain” than medical schools, Nora D. Volkow, the director of the National Institute on Drug Abuse, said..

As recently as the 1980s, babies would routinely undergo invasive medical procedures, including open-heart surgery, without anesthesia or analgesics because physicians believed that infants’ brains were not developed enough to feel the pain. And it was thought that even if babies did feel pain, it wouldn’t ultimately matter because they wouldn’t remember it later on.

The emphasis in Western medicine has traditionally been on “saving lives and executing medical procedures effectively, while pain has been pushed way down on the priority list,” said Christine Chambers, a professor of pediatrics, psychology, neuroscience and pain management at Dalhousie University in Halifax, Nova Scotia.

Many doctors and parents also fear that pain medications will have dangerous side effects, like developmental problems and addiction. But current scientific evidence supports a different conclusion.

“Research shows that poorly managed pain exposures early in life can actually change the wiring in the brain and prime children to be more sensitive to it later on, putting them at risk for developing chronic pain in childhood and adulthood,” said Anna C. Wilson, a child psychologist and assistant professor of anesthesiology at the Pediatric Pain Management Center at Oregon Health & Science University. And while babies or young children may not consciously remember it, their nervous systems will.

There is, however, reason for optimism. Contrary to previous conventional thinking, the effective use of pain medication for children does not hinder brain development, according to several studies.

Research has also shown that the appropriate medical use of prescription pain medications, such as opioids, when properly monitored, does not lead to addiction in young children and adolescents, Dr. Friedrichsdorf said.

A host of other behavioral interventions have been shown to prevent and treat pain as well. Pain experts say these can and should be used even during seemingly minor medical procedures, such as vaccinations. Parents can hold their children during the procedure, breast-feed or give them a sweet solution to suck on, distract them with a song or breathing exercises, and use a topical numbing cream.

One recent study also found that a parent’s behavior and approach to their children’s vaccinations can affect a child’s response to needles.

“That vaccination at age 5 might not seem like a big deal to you, but if it goes wrong and causes a lot of pain, then the child becomes fearful,” Dr. Chambers said, which can perpetuate a cycle of fear and pain over medical care.

“One of the best ways to address the epidemic of chronic pain in this country is to stop it before it starts,” Dr. Wilson at Oregon Health & Science University said.

“If we could reduce painful experiences and problems in childhood, we might be able to reduce chronic pain in the next generation.”

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Disney Princesses Do Change Girls — and Boys, Too

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Credit Chang W. Lee/The New York Times

When you’re a parent of children of a certain age, the Disney princesses seem to be everywhere. For years, parents have been questioning how princess culture might influence little girls, particularly those who seem besotted with their images and their stories. A new study offers some surprising insights, finding that the princesses did make a difference in the behavior of girls — and that they influenced boys as well.

Researchers looked at the rates of engagement with Disney princess media in 198 5- and 6-year-olds, and found that for both boys and girls, higher princess involvement (through toys, products and media consumption) over the course of a year was associated with higher levels of female gender-stereotypical behavior at the end of the study — even after the researchers controlled for other variables.

“It’s not just that girly-girls like princesses,” said Sarah Coyne, a professor of family life at Brigham Young University and lead author of the study, which was published in the journal Child Development. “We were able to completely take that out of the equation, and look at whether there is really long-term growth” in female stereotypical behaviors in children with high levels of princess engagement.

“We found that there was,” she said, and that the media was really “driving” that association “as opposed to the other way around.” That growth in female stereotypical behaviors (like quiet play, pretend cooking and cleaning, and avoiding risks, getting dirty or trying new things), was also observed, to a lesser but still significant degree, in boys with higher Disney princess engagement.

How concerned parents will be about that connection depends on how we perceive those behaviors — and possibly on which gender child we’re thinking about. When it comes to girls, the link between princess involvement and stereotypically female behavior is certainly no surprise, said Rebecca Hains, media studies professor at Salem State University and author of “The Princess Problem.” “It supports what cultural studies critics have been saying for years.” Fear of how the princess narrative influences girls in a culture that often puts more emphasis on how a girl looks and behaves than on how she acts and thinks is nothing new, and Dr. Hains is pleased to see quantitative research backing up the qualitative argument that Disney, as a primary purveyor of all things princess, is contributing to that influence.

But when it comes to boys, Dr. Coyne and her fellow researchers described the increase in stereotypically female behavior as meaning something very different. In girls, they saw an increase in those behaviors as “potentially problematic,” while in boys, the increase in androgyny that the stereotypically female behaviors reflected could, they wrote, have “benefits for development throughout the life span.” That preference for shifting girls away from more traditionally female behaviors while encouraging them in boys is reflected in some popular culture as well, such as commercials for GoldieBlox toys in which girls destroy princess toys and new products designed to encourage doll play among boys.

Why is what’s good for boys bad for girls in this case? It’s all about the starting point, Dr. Hains said. “If girls are already tending in this direction, then increasingly exaggerating the feminine is becoming extreme. For boys, who are already immersed in a hyper-masculine culture, becoming more feminine is becoming more well-rounded.”

As appealing as that desire for the well-rounded boy may sound, Catherine Connors, founder of Demeter Media and the former head of content at Disney Interactive for Women and Family, suggests that the reality is more complicated. “We really get our hackles up at the idea of femininity being encouraged in girls,” she said, and that reaction itself is, she argued, “a manifestation of institutional and cultural sexism.” A former academic, she said her daughter pushed her to rethink her own fears about princesses.

“She asked for a Disney princess snowsuit,” Ms. Connors said. “It was pink, it was sparkly, it was like the platonic ideal of princess merchandise.” (This was before her employment with Disney.) “We’d just bought Spiderman snow boots, which I was happy about, but when I balked at the snowsuit, she just looked at me, and she said ‘Mommy, why don’t you think this is cool?’”

Put on the spot, Ms. Connors bought the snowsuit — and started to rethink the princesses. We’re so worried about the passive, waiting-for-rescue narrative, she said, that we don’t see the positive in even the older stories. “Snow White and Cinderella are active,” she said. “They’re just not necessarily active in masculine ways. We see Cinderella being kind as somehow less noble than going out after a dragon.” Snow White, she said, is “about creating your own community, imagining a life for yourself beyond your situation.”

“There are absolutely things about the princesses that should be looked at with a careful and critical eye,” she said, noting the tendency of the products to depict the active princesses of the movies in pretty but passive (and often sexualized) poses. “We also need to look at the rich legacy of these stories.”

That’s where parents come in. “Our goal is not to kill princess culture,” Dr. Coyne said. “It’s a magical part of childhood that I enjoyed with my own daughter. But we can talk about the characteristics of the princesses — the great things they do, as opposed to what they look like, or what girls look like when they dress up like them.”

Dr. Hains agreed. “Call out the good things,” she said. “She’s pretty and she’s so smart. Belle always has a book in her hands. Anna is really a problem solver. Identify the things that are important to your family.” Focus on the princesses’ qualities that support your values. For parents who want to encourage children to think beyond the Cinderella story, Mulan and Merida (of “Brave”) offer alternative models. Both defy expected gender roles, speak their minds and challenge the traditional expectations for princesses and the princes they supposedly seek. Anna and Elsa of “Frozen” do the same.

Still, there’s no need to go overboard in our explanations, Ms. Connors said. “We wring our hands about girls being snookered by the princess narrative, but we don’t worry about boys being confused about their future as superheroes.”


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The Connections Between Spanking and Aggression

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Credit iStock

In the 1990s, in my first month in practice as a pediatrician, I asked the mother of a 4-year-old about discipline and she told me that her son was often out of line and wild, and spanking was the only thing that worked, though she was sure I was going to tell her not to, just as her previous pediatrician had done. Around the same time, my colleague in the same clinic walked into an exam room to find a cranky toddler who was acting out, and a frustrated father who was taking off his belt and threatening punishment. In each case, and in many others, we had to decide how to talk to the parents, and whether to bring up the issue of child abuse — which is definitely an issue when a child is being struck, or threatened, with a belt.

Corporal punishment, also known as “physical discipline,” has become illegal in recent decades in many countries, starting with Sweden in 1979. The United States is not one of those countries, and pediatricians regularly find ourselves talking with parents about why hitting children is a bad idea. The American Academy of Pediatrics officially recommends against physical discipline, saying that evidence shows it is ineffective and puts children at risk for abuse; pediatricians are mandated reporters, responsible for notifying the authorities if we think there is a possibility of abuse, though the boundaries are not clearly defined by law.

But many parents continue to spank, even when they don’t think it does much good. In a recent report by the nonprofit organization Zero to Three of a national sample of 2,200 parents of children birth to age 5, parents were asked which discipline strategies they used a few times a week or more. Twenty-six percent said they “pop or swat” their child, 21 percent spank, and 17 percent reported hitting with an object like a belt or a wooden spoon. (Parents could respond that they used more than one strategy.) Zero to Three reported that even those who used these strategies frequently did not rate them as effective, and 30 percent agreed with the statement, “I spank even though I don’t feel O.K. about it.”

One reason the A.A.P. opposes spanking is because of evidence that it is associated with aggressive behavior in children. But does that mean that hitting children produces aggressive behavior, or that aggressive behavior in children elicits more and sterner parental measures?

Michael MacKenzie, an associate professor of social work and pediatrics at Rutgers, called the association “bidirectional and transactional.” How you discipline your child shapes your child, but also shapes you as a parent. But if you control for the child’s behavior, comparing more aggressive young children with other children who behave in the same ways, those who are frequently hit or spanked are more likely to show aggressive behavior and rule-breaking later on.

In a study published last year, he and his colleagues looked at these bidirectional effects. Children who were spanked were more likely to show disruptive, aggressive behaviors later on. Those behaviors, in turn, made it more likely that those children would be spanked more in the future.

“It mattered for everybody, but it mattered more for these kids in riskier contexts, the families facing more stress,” Dr. MacKenzie said. Other research showed that spanking was associated with poorer cognitive outcomes for children, even when the researchers controlled for factors such as maternal intelligence, maternal depression and cognitive stimulation in the home.

Dr. MacKenzie suggested that some families get caught in a “feedback loop,” in which children who are spanked respond more aggressively, and become even more challenging, reinforcing parents’ sense that only harsh discipline will work, so parents find themselves escalating the discipline, which in turn evokes more intense behavior.

“We want to think about these cycles and how they amplify,” he said, and to think as well about how to support families early on so that they set up different patterns. “We’ve sort of suggested the removal of a tool that many parents use, most parents use, without discussion of what the alternatives might be.”

Michael Lorber, a research scientist in the Family Translational Research Group at New York University, has found that parents who interpret their children’s behavior more negatively than an objective observer tend to use more harsh discipline. These patterns begin younger than we think, he told me, with parents in their studies clearly identifying children as young as 8 months old as difficult and aggressive.

“We think the infancy period is probably the time when parents begin to develop their disciplinary practices,” Dr. Lorber said. “Call it difficult temperament or incipient externalizing behaviors or contentiousness, it’s definitely the case that infants’ behaviors influence their parents, including physical discipline.”

One complicated question that researchers raise about physically aggressive children and their physically aggressive parents is whether there may be a genetic component to this behavior, which would be shared across the generations.

Leslie Leve, a professor of counseling psychology and human services at the University of Oregon College of Education, said that it was possible there were genetic predispositions toward aggressive behavior, which might affect both parents and children. “There is a common misperception that when people think of a behavior as ‘genetic’ that it’s not changeable, and that is not true,” Dr. Leve said. “With A.D.H.D. or aggression we know there is a genetic component, but there is a lot we can do in a family or educational environment. Genetics does not mean immutable.”

Dr. Leve has participated in studies of adopted infants, which can help tease out these effects, but which also show how complex the interactions are, with harsh parental responses affected by the child’s characteristics but also by factors in their own temperaments and their marriage.

Zero to Three reported that 69 percent of the parents said that “if they knew more positive parenting strategies they would use them.” Pediatricians try to help parents develop such strategies, discussing what behavior is developmentally realistic for young children; helping them interpret behavior without regarding it as defiant; counseling them about setting limits; and helping them find positive behaviors to praise and enjoy.

Disciplinary choices reflect parental stress, family circumstances and the whole complex cocktail of emotion and personal history and daily life at home. What parents do affects their children — their brains and their behavior — and the ways that children behave affects their parents. And the cycle of spanking and aggressive behavior seems to leave everyone worse off.

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A Poster Family for Diversity

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Credit Giselle Potter

Clicking through the new website of the private school my three children attend, I landed on a close-up photo of my oldest child’s smiling face. I shouldn’t have felt jarred, but I did. The picture, accompanied by a short interview highlighting everything she loves about the school, had been posted on the admissions page. Born in India and adopted by my husband and me, who are white, she’s a minority student at a majority white school that’s striving to become more diverse. Her interview was one of many, but for me, her mother, it generated a spotlight’s heat.

My older daughter is 14. Our son and younger daughter, siblings born in Ethiopia, are 13 and 12. When the children were small, strangers often mistook them for adorable, boisterous triplets. The kids’ friendly smiles and our family’s multicultural makeup ensured that we attracted attention everywhere we went. More than once, professional photographers stopped us on the street to propose a photo shoot. Religious strangers felt compelled to thank my husband and me for “loving the Lord and loving orphans.” Shoppers in the grocery store flagged me down to gush, “Your family is beautiful.”

The idea of us made a lot of people feel good, hopeful even, but I quickly grasped that we could also be perceived by some as a kind of entertaining novelty. For years, another mom at our elementary school referred to me, in public and private, as “Angelina Jolie.” I did my best to shield the kids, and myself, from the attention, so that our family could be just that — a family, not a symbol of post-racial equality or evidence of a supposed Hollywood trend, a trend some critics characterized as white celebrities adopting black babies as fashion accessories.

By virtue of their white parents, transracial adoptees often move in majority white spaces, inadvertently providing diversity for others. Although I’ve always tried to place my kids in environments where they encounter peers and role models of the same race, they inevitably end up in the minority at school, at camps, in enrichment classes and on sports teams.

Early on I noticed how schools and kids’ programs love to feature children of color in their marketing materials to highlight their commitment to diversity, just as the big corporations do. As much as I wanted pictures of my three to entice more minority children to join my children in their activities, I couldn’t bring myself to sign the blanket photo releases that came with every registration packet. I didn’t want my children being used to promote an ideal of diversity that didn’t exist in reality.

But complications arose. Without my release, my son’s fourth-grade teacher couldn’t post group pictures to her classroom website, an inconvenience that didn’t seem fair to her. Then a photo of my daughter, taken without my knowledge at our town’s Christmas parade, popped up in a catalog for the recreation department. A picture of all three kids appeared in a brochure for their favorite summer camp, even though I’d specified no photos. Complaining after the fact felt petty and pointless when I couldn’t identify any tangible harm done.

And then there was the problem of my work as a writer. Frequently when I published a parenting essay, the editor would want to run a family photo. For years I resisted, putting myself at a distinct disadvantage in the world of mommy blogs and image-centric parenting websites. As the kids matured, I discussed the pros and cons of every photo request with the whole family. The kids voted to publish the photo every time, and sometimes I did. Although I’ve been careful to never include their real names in my work to guard their privacy, there’s no question that using my children’s photos on occasion has helped my professional career, a reality I’m conflicted about, even if my kids are not.

And so I gave up. These days I sign all the photo releases for schools and camps and teams because this is the way the world works. All I can do as a parent is maintain an ongoing dialogue with my children about the hidden messages in advertising, about the ways minorities are portrayed in the media, and about why I feel so protective of their likenesses.

Sometimes, when I find a picture of my daughter playing bass guitar on the girls’ rock camp Facebook page or discover a video of my son’s deft footwork being tweeted by his soccer club, I’m thrilled. To see my kids promoted for what they do, not what they look like, feels good. Finding them featured in a camp catalog or a school brochure doing nothing but looking “ethnic” alongside their white peers brings up less positive emotions.

The photo and interview on the school admissions page felt like a “do nothing” at first, even though the school does a good job representing students of all backgrounds in its marketing as a whole. The post also felt like an intrusion. I’d never signed a release for an interview, and nobody had warned me it was coming, let alone sought my permission.

“Did you know they were going to put this interview with you on the website?” I asked my daughter.

“Of course,” she said.

“And you’re O.K. with it?”

“Obviously.”

She’d made her decision. With my children approaching adulthood in the age of the selfie, they’ll be making decisions daily about how to use and distribute their own images, with their status as members of minority groups an added twist. As a mom who shies away from the camera, I hope I’ve given them the tools to figure it out.

Sharon Van Epps is a freelance writer.

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Is Selfie Culture Making Our Kids Selfish?

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Michele Borba

Michele BorbaCredit

The psychologist and parenting expert Michele Borba says society’s fixation with the selfie is having some unintended consequences. She sees children mimicking not-so-nice behavior in adults and fewer grown-ups calling them out.

In “UnSelfie: Why Empathic Kids Succeed in Our All-About-Me World,” her 23rd book, Dr. Borba combines scientific research with tales from real-world families and offers concrete tips on how to cultivate kindness.

We talked recently about “selfie syndrome,” ways to flip the focus away from the self and specific activities to build empathy in our children. Here is an edited excerpt of our conversation.

Q.

You suggest in the book that technology disrupts kids’ emotional lives. How?

A.

You have to have face-to-face connection in order to read emotional cues and experience where the other person is coming from. If the average kid is plugged in – let’s just say what Common Sense Media says is 7.5 hours a day – you’re not having the opportunities to look face-to-face. You can do that in FaceTime. You can do that in Skype. It’s not like you’re throwing the entire thing out. It’s finding ways to make sure there are opportunities where your child won’t lose the critical core skills of not only empathy but connection and social skills. We’ve failed to realize that all of those social skills are learned and they need practice. What we’re not doing is helping our kids practice.

Q.

Your book talks about kids and their often-inflated egos. Is this a repercussion of the 1980s self-esteem movement?

A.

Yes. Unfortunately, we misinterpreted self-esteem. I wrote five books on self-esteem, but my whole concept of self-esteem was it was layered. Real self-esteem is a balance between two things. One part is feeling worthy and likable. The other part is being capable to handle life – having the skills and competence.

What we did on the self-esteem bandwagon is we did the whole thing of helping the child feel worthy but without the competence; it backfires. Our praise, if we keep focusing on you, after a while, the kid begins to forget there’s others in the world. And the other thing is they become more and more dependent upon us. We kind of bubble-wrapped the child. We helicoptered them and we didn’t teach them the skills to be able to cope. We’re going to have to re-tilt the balance.

Q.

Let’s talk discipline. You cite a lot of problems with approaches like spanking and yelling, which are known as detrimental. But what’s wrong with time outs?

A.

Time out works if you do it the right way. It’s impossible to discipline wisely or well if you’re in distress or your kid is in distress. It’s better to say, “Let’s separate from each other and let’s calm ourselves down.”

But just sitting alone doesn’t help the kid think through the impact of his actions on others. When your kid comes back out, you need to say, “I’m disappointed in you. I expected better of you because I see you as a caring person. How would you feel if that were you? What are you going to do differently next time?” That’s the piece that research says we may be missing.

Q.

Just what is “selfie syndrome?”

A.

Self-absorption kills empathy. Narcissism is “it’s all me.” Empathy is feeling with someone. Empathy is always “we, it’s not me.” The problem is kids are tuning into themselves, and what we need to do is flip the lens and start looking at others. We started to emphasize one side of the report card and we forgot the other side, which is “You’re also a caring human being.” Let’s redefine success so it’s not just a GPA, but it’s also a kid who has heart.

Q.

You suggest that some activities, such as chess, reading, watching movies and recess, boost not only academic achievement but increase empathy. Why?

A.

Chess is about perspective taking. Kid are not thinking of themselves. They start thinking of others. New research on reading shows that emotionally charged literary fiction like “Charlotte’s Web” or “To Kill a Mockingbird,” where the kid can catch the feelings of the character, makes the child not only smart but nice. Chapter books (such as the “Frog and Toad” series) are short and easy, and more parents are skipping literary fiction in favor of a chapter book because they think it will boost their kid’s vocabulary and reading comprehension. What they’re missing is the rich moral dilemma. Movies and literature are the same. Think of the kind of movie that stirs your heart, like “Dumbo.”

Following are some of Dr. Borba’s tips for how to flip the focus and cultivate kindness.

  1. When your children walk out the door, remind them to do one or two kind things each day.
  2. Show that you value kindness. Do not just ask, “What you get on your test today?” but, “What kind thing did you do?”
  3. Praise your kids for being kind in the moment – when they have earned it: “That was being kind because you offered your toy to your friend.”
  4. Make kindness a regular happening. Put a box by your front door for gently used items and when it fills up, drop it off together for a needy family.

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Living with a Teenage Data Hog

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Credit iStock

After children reach a certain age, most parents give in to their desire for a mobile phone. We like being able to find them at any moment, and they risk being left out if their friends can’t ping them. A Pew Research Center report from last year found that 88 percent of American teenagers now have phones.

But today’s smartphones have earned that name because of their ability to suck in and spit out data at ever-faster rates. That gets expensive, quickly, and figuring out who should pay for the data, how much, and according to what rules, can be a giant headache.

So first, an opening proposition: The ability to access the internet via a cellular signal, in those passing moments when Wi-Fi is not available, is a want and not a need for most teenagers. And if they want it, they should pay for it themselves.

But when I share that assertion with many parents I know, they often respond by patting me on the head and telling me to get back to them when my 10-year-old has a phone and all her friends do, too. To those parents, a data plan is no indulgence. Their kids are busy — constantly on the way to an athletic event or rehearsal. They don’t want to deprive their kids of the ability to stream music or stay connected with their friends on data-draining apps like Snapchat. So a data plan is a given, and the parents are willing to pay.

But just how high a bill is reasonable? I suggest the budgeting approach: Parents pay for a certain amount of data each month, the children track how much they’ve used, and then they pay for anything beyond that allotted amount.

It’s simple enough in theory. Carriers lets customers check to see how much data each person in a family plan has used so far during the month, and the privilege of having a phone should come with the responsibility of keeping track.

That approach does, however, require you to sit down with your teenager and identify the sources of data drain and perhaps set rules for when those apps ought to go off. The Times’s Wired Well columnist, Jennifer Jolly, lives with a data-draining teenager. She suggests turning off any features on a teen’s phone that drain data automatically in the background. Also, track the apps that use the most data and limit data hogs like Spotify or Snapchat to times when the teenager has Wi-Fi access. One additional hint: The more video an app records, transmits and receives, the higher the data bill is likely to be. Call your carrier or consult online forums if you need more help.

In an ideal world, this approach teaches patience, self-control and restraint. Your kids can always watch a video a little later over Wi-Fi, after all. And many messages – most, even – can wait a bit.

But in a less than ideal world, teenagers tend to go over their caps, especially if their friends send lots of videos back and forth via Snapchat. Some parents have enough money to simply pay for the overages. But discussions about those bills are useful. If we don’t set limits, after all, who will? And isn’t our job to get our kids ready for the moment when they really will be paying their own bills?

A few years ago, I wrote about the Russell Plan, named after Mary Kay Russell, a mother of four sons in Naperville, Ill. She added her sons to the family’s cellphone plan when they were ready for their first phones, and the cheap devices they received came with unlimited calls and texting. The boys were welcome to burn data to their hearts’ content on an upgraded phone, but if they wanted to do that, they would have to pay for the device and prepay $360 for a year’s worth of data. The oldest waited until age 21 to get his first fancy phone.

Perhaps his response to the family’s strategy was not such a big surprise. The cost of a smartphone plus data is a big pile of cash to a middle school student who may not have many ways to earn money. Parents who can afford it might consider raising a child’s allowance some to put the decision just within their reach – and make the possibility of waiting on an upgraded phone more enticing.

How much more allowance might they get? It depends on whether you’re asking them to use allowance to cover lunch, snacks, transportation and clothing, too. But you could increase the allowance enough to pay for 50 or 75 percent of a basic data plan, so that the choice to purchase it would involve some sacrifices elsewhere.

Yes, you’re technically “paying” for the data plan in this instance, but that’s true with allowance in general. Once your children have it, the money will feel like it’s their own, and the trade-off will feel real, too.

The Russell children could have asked for upgraded mobile devices and money toward data for birthdays or Christmas, but they often had other priorities. Which is great: We want our children making financial trade-offs, since that is what they’ll have to do as grownups just about every day of their adult lives.

Ron Lieber is the Your Money columnist for The New York Times and the author of “The Opposite of Spoiled,” about parenting, money and values.

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The Intentional Summer

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Summer officially starts today, brimming with delicious potential. You may think you don’t need to schedule summer fun — it just happens, right? Well yes, sometimes, but research shows it helps to plan for it.

Well Family is declaring this the Intentional Summer, and we’re here to help you avoid regrets over missed opportunities. Every week, we’ll offer research-based suggestions for ways to set this season apart from the rest of the year.

The sense that summer fun slips through our fingers is real, and it’s reflected in how people report feelings of health and well-being over the course of a 24-day vacation: Our positive feelings increase quickly at the outset, peak about one-third of the way through and then start a downward slide toward our baseline happiness — and sadly, leave us back there about a week after we return to work.

Jessica de Bloom, the researcher on that and other studies on vacation and happiness, suggested that we take time to consider how we can maximize our summer pleasure, even when we’re not on vacation. A sense of autonomy — of making active decisions about how we spend our time — is one of the elements that helps us enjoy our free time.

“Make ordinary evenings and weekends more memorable,” she said. Do the things you normally do “a little bit differently. Take a bike instead of the bus” or car. Research also suggests that people appreciate their leisure most when it includes elements of challenge, connects us with the people we care about, or helps us to feel a sense of purpose, she said.

To add some or all of those elements to these few weeks of summer, planning is essential. As a bonus, planning and anticipating something new can boost our happiness. Once we’re carrying out our plans, said Dr. de Bloom, we need to detach from our usual roles (and our gadgets), relax and savor the experience.

Join us! Every week for the next two months, we’ll propose a simple challenge to help connect you to the season and to the people you love. We’ll be listening to your feedback. Expect fresh ways to get outdoors, get moving (and slow down) and flavor your summer.

Having started with the solstice, we’ll end with another astronomically notable event: the annual Perseid meteor showers, which occur every August and peak this year around the 12th of the month (start thinking now about where you can find some dark sky to watch those “shooting stars”).

This week’s challenge: Walk or bike to somewhere you would normally drive or reach via public transportation. Pick a short distance that might turn into a summer ritual (a bike ride to the library, for example) or a longer trek.

A friend and I once took an entire summer day to walk from his apartment on the Upper East Side of Manhattan down to Battery Park City, something I still remember over a decade later. And that’s exactly the point, said Gretchen Rubin, the author of “Better Than Before” and host of the “Happier” podcast. “Life feels richer when some parts of it are different.” Routine days run together into a single memory, while special things stand out.

If you’re walking with children, let them help pick a destination, mode of transport and route. Leave enough time to enjoy unexpected discoveries along the way, whether it’s a street fair or a turtle living in the run-off ditch by the side of the road.

Let us know how you do by commenting here or emailing us at wellfamily@nytimes.com before next Tuesday, June 28. Was it more fun than you expected, or did things go wrong? Would you do it again? Did you make a day your family will remember? You can also share on Twitter, Instagram or Facebook (#intentionalsummer).

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We’ll share reader stories and post next week’s challenge on Thursday, June 30. The real goal: to savor the summer all season long.