Listen up parents and grandparents! Here are four alerts from the pediatric literature.

First, all babies 6 months and older should have a flu shot as should their parents and grandparents. According to the American Academy of Pediatrics, flu sent thousands of children to the hospital last year, 179 died and 80 percent of the dead children had not received a flu shot.

What dreadful odds. When I was a resident, iron lungs lined hospital corridors. Polio was eliminated in the U.S. in 1979 though it still kills and cripples children elsewhere. Polio and influenza can both kill an unvaccinated child.

Second, a warning about young babies in infant car seats. Babies can suffer from reduced oxygen levels while strapped in car seats. Babies under one month should not be kept in a car seat for a long trip. More than half an hour? Stop the car and take baby out of the car seat for a rest.

No baby should ever sleep in a car seat that is not in the car. Car seats are mandatory when driving but at home or in grandma’s house take your sleeping baby out of the car seat and hold in an upright position.

Third, the Food and Drug Administration announced that teen use of electronic cigarettes has become an epidemic. Over 2 million middle and high school students regularly use them and sales of flavored e-cigarettes rose from 2.4 percent of all e-cigarette sales in 2012 to 19.8 percent in 2016. The FDA has given five manufacturers 60 days to prove they can keep their attractive products away from minors. Warning letters were also sent to major retailers warning them about the illegality of selling to minors. And the FDA is launching a huge marketing campaign to educate teens about the danger of e-cigarettes.

The biggest and most successful manufacturer of β€œvaping” devices controlling 72 percent of the market is Juul Labs. Their product looks like a flash drive and has eight flavors from mango to menthol. Yummy and cutesy but it contains enough nicotine to hook teens and pre-teens. The CDC says nicotine dependence is the most common addiction in the US. Getting kids hooked on vaping early means lots of future sales of the product.

Smoking tobacco is lethal and cigarettes still kill almost 500, 000 people a year in the US. E-cigs lack the toxic chemicals that come from inhaling burning tobacco but they are still not safe. A vaping teen inhales lots of nicotine and young brains are vulnerable to addiction.

What to do? Don’t smoke or allow smoking in the house. Talk to children and teens about the dangers of vaping. Confiscate vaping devices as I once confiscated my son’s pack of cigarettes leaving pictures of normal and diseased lungs in its place. Support federal agencies that are looking after children rather than corporations.

Fourth, a clinical report of the AAP urges pediatricians to counsel all parents about providing children with a free, safe, and non-prescription wonder β€œdrug” called play. And further recommends that play be reinstated in schools.

Parents and grandparents give children many educational toys. Parents worry about which afterschool programs to choose. But simply letting kids play fosters and ensures healthy cognitive development.

What happened to play? Studies show that the time children engage in free play at home has declined 25 percent and schools, preparing children for standardized testing, have cut deeply into recess and other free time.

The loss of play in kindergartens that focus on learning may be counterproductive. One study showed that children in play-based kindergartens learned to read as well as those in learning-based schools and were better-adjusted. No play is especially hard on the one out of five children living in poverty. Streets and playgrounds in disadvantaged neighborhoods may not be safe and parents working two jobs may lack time and energy to encourage play.

What else has robbed kids of playtime? You guessed it. Play time has been stolen by screen time. The digital age has changed all of us, parents and kids alike. Seventy-five percent of toddlers between 6 months and 3 years use a touchscreen on a daily basis and nearly 75 percent of teenagers and virtually all parents have smartphones.

AAP recommendations for children: Under 18 months, no screens except video-chats with grandparents (Yay!). Ages 18 to 24 months, choose high-quality programming, and watch with your children. Ages 2 to 5 years, allow one hour per day of high-quality programs. Six and older set consistent limits on media time. Also designate media-free times together and no screens in bedrooms, especially at night.

What is play and why is it so vital to the developing child? All mammals play and species that need to learn a lot like higher primates and humans play the most. Play aids physical development, enhances cognitive, social and emotional development, enculturates children so they adapt to their world, and helps integrate new members of a culture into the group.

Play starts with eye contact and peek-a-boo. It continues with rolling a ball from parent to child and building blocks. But children need to play together and need to play their own games, not have it always structured by parent or teacher. Free play is just that. Children play by themselves without coaching, suggestions, or hovering.

What about toys? I hate all flashing, noisy toys especially those that talk to kids. Children need toys that foster creative play so their imagination creates the game.

Grandparents can play a crucial role here. We are pre- Toys R Us and have lived to see its demise. I had few toys β€” only one doll (gasp!) β€” and I survived. My children had many more toys and I helped them create their own. An upside down plastic laundry basket became a garage with a cookie ramp.

My twin grandchildren had lots of toys because twins get two of everything including presents. But parents and grandparents showed them how to use foot long cloth blocks and houses with regular blocks. My toddler twins built a whole town.

My singleton grandchild was given a motorized toy truck one Christmas. His parents were up all night putting it together. Adam drove it up and down the driveway a few times and then deserted it. Grandpa cut a door and windows in the huge carton the truck came in and grandson crawled in and out all day. It became a space ship for action figures, a zoo for stuffed animals, etc.

We grandparents have the power to help give play back to children. Let’s use it. And parents, remember, free play helps your children develop better than all those extracurricular sessions do and it’s free. All you need to do is make sure your children are safe inside the house or outdoors and keep an eye on them.


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Dr. Heins is a pediatrician, parent, grandparent, great-step grandparent, and the founder and CEO of ParentKidsRight.com. She welcomes your questions about parenting throughout the life cycle, from birth to great-grandparenthood! Email info@ParentKidsRight.com.