“Use your head!!” yell some parents from the sidelines. Our coach winces at my son’s high kick to bring down the soccer ball – he shouts at my 11 year old son and motions to his head, an instruction for my son to use his head the next time. My son glances at me from across the field.
What the other parents and my son’s coach don’t know is that my son is not allowed to do headers in soccer. That’s our deal. If he wants to continue playing the game, he’s not to use his head; otherwise, I won’t let him play anymore. You might say if I wasn’t going to let him play the game fully, why did I ever get him into the sport in the first place? Well, prior to letting him start, I was pretty ignorant about the sport and its physical nature. Another one of those things I wish I knew before. . .
Unfortunately, with World Cup 2022 mania sweeping the globe and my household, I can see that headers are still very much a part of the game. Will disallowing headers ever be possible? Would it “ruin” the sport? Soccer is a highly physical contact sport and headers are certainly not the only source of major injury, but header rules are perhaps the most straightforward thing to change about the sport to reduce the risks of head injury and long term brain damage.
Mom, what a buzzkill, right? Seriously, first, no screen time, and now, we can’t even play soccer like we’re supposed to? And, like with the France vs. Argentina final coming up, nobody wants to hear about that now! Surprisingly, I did find some recent research and media commentary suggesting that a ban on headers may be in the future.
What’s the Danger of Headers in Soccer?
First, there is increasing evidence to support my anxiety. Cognitive impairment can result from just a single training session involving the practice of headers. Whether that impairment is just short term or long term is yet unknown (but we could take an educated guess on what the research will likely find). Plus, do any of us knowingly want that impairment even if it’s just for a day? Don’t practice headers before your math test?
Long term, it’s suspected that soccer players may eventually suffer from CTE (chronic traumatic encephalopathy – a degenerative brain disease) as has been the case with MLS players, Scott Vermillon (confirmed CTE), Bruce Murray (suspected CTE, early dementia in his 50’s), former England international, Jeff Astle (confirmed CTE), and many players in American football. CTE is caused not only by repeated concussions, but it’s also suspected that small, repetitive hits to the head have the same damaging effects.
Will Headers Ever Be Banned from Soccer?
Soccer organizations in England and Scotland have already responded to the growing research on the dangers of headers by putting guidelines on heading practice in adult games. In both the US and England, soccer authorities have delayed the introduction of headers in youth soccer.
With the World Cup in Qatar going on, I’ve caught a few articles covering soccer that discussed the end of headers, including a New York Times piece projecting that with increasing evidence, it’s just a matter of “when,” and not “if” headers will eventually be banned.
The more studies that come out to show the risks of headers and the more educated parents become on the dangers of letting their kids beat their heads with a high velocity ball, the harder it will be to knowingly endanger the long term health and safety of all the athletes and our kids.
A sampling of the media attention to the dangers of headers and the possibility of ending them:
There have been a few standout audiobooks that my kids have really enjoyed so far over their elementary and early middle school years. For the most part, the books themselves are well known and already wonderful, but the particular readers have made these audiobook stories even better! The way these narrators know how to perform the dialogue, pausing, enunciating, emphasizing, applying different tones and voices, can really transform the story experience.
You can find these audiobooks free at the library and at many of the audiobook apps such as Hoopla, Overdrive, and the like. I hope you enjoy these as much as we did!
Here is the list of what we have loved so far:
Roald Dahl Books
In the Roald Dahl audiobook collections, look for these versions:
by Beverly Clearly, read by actor and Broadway star Neil Patrick Harris – tales of trivial everyday childhood experiences that Clearly writes with such hilarious insight and Harris reads with such perfection.
by actor Tony Shalhoub, famous, I believe, from the TV show, Monk, and The Marvelous Miss Maisel – a heartwarming story of a special little cricket and his animal friends.
A Series of Unfortunate Events (Books 1-13)
by Lemony Snicket and narrated by Lemony Snicket (the author himself) or Britsh actor, Tim Curry – this series about unfortunate orphans trying to escape a terrible villain had us both laughing and sitting at the edge of our seats in suspense. The readers really made the characters come alive.
by J.L. Esplin, narrated by Robbie Daymond – Two brothers must travel 96 miles through the hot Nevada roads without barely any food or water. This book may be more interesting for ages 9 and up. The narrator really makes this story worth listening. He reads the entire book with such emotion, possibly surpassing the imagination that would have come with silent reading.
Have you heard some superbly narrated audiobooks for kids? I would love to hear about them! Please share below or email me at email@example.com
The standard fit of soccer cleats doesn’t make any orthopedic sense (see this article on podiatrists whose patients play soccer) and yet, it’s the norm. If you play soccer in cleats, you probably know they can be pretty uncomfortable. However, when I was a new soccer mom, the first time I went shopping for cleats for my kids, I was stunned by the stiffness and narrow shape of the shoe. The uppers were stiff, synthetic leather and the sole plate was hard plastic with a thin, flat insole. I sucked it up and after twisting many a pair, I settled on some Nike cleats that I generally find are the least stiff of all the brands. Fast forward through 5 years of soccer playing, and my kids started complaining of knee and heel pain, enough to knock them out of sports for weeks at a time.
I wish I had paid more attention to the cleat fit issue from the beginning because now I realize what I shouldhave done from the start to help the cleats fit better. It should be standard soccer education along with “what is a shin guard?” Here is a list of the things I learned to do to help the cleat fit as much as possible:
Replace Insoles with OTC Orthotic Inserts
Far and away, the best thing you can do to make your cleats fit more comfortably is to replace the soccer cleat insoles with orthotics. Out of the box insoles on cleats are minimal drop with minimal padding. If you follow some principles behind minimalist footwear, it would seem like this is a good thing. However, the stiffness of the shoe and rigidity of the soleplate probably negates this.
Instead, the insole should provide some of the shock absorption and protection that you will need from both the impacts and the rigidity of the cleat. There are a couple of OTC orthotic inserts that are often mentioned as fitting well in cleats: Currex CleatPros and Superfeet Carbon. We tried a couple of different Superfeet and found the Everyday Superfeet Insole (Green) to have the deepest heel cup and the most cushion for shock absorption.
Tip #1: Orthotics and insoles are FSA/HSA eligible. (They can feel expensive, but then again, the visits to the orthopedists or podiatrists cost even more. We’re skipping those type of doctor visits in the future. Plus, they will just tell you to buy orthotics, too!)
Tip #2: When selecting orthotics, pay attention to:
the level of arch support,
depth of heel cup, and
the thickness of the insole to determine if it’s the right orthotic for you.
Tip #3: it’s easier to try orthotics in your cleats if it comes with a removable insole. However, it’s also possible to scrape out any glued on, out of the box insoles and slide in your orthotic inserts. See pic below.
Stretch and Soften the Uppers
Stuff a compression or regular tennis ball or shoe-tree as far into the shoe as it can go. We were able to get into the lower toe area and leave it in for awhile. This can help resolve the squished pinky toe feeling to some degree and give a little more room in the toe box. This is player preference, but there’s a balance to be had between ball feel and painful toes.
Add Heel Lift or Heel Cup
Sometimes the orthotic insert isn’t enough shock absorption particularly on the heel. You can add a gel heel lift which increases the drop on the cleat, which is usually zero drop (i.e. completely flat). Sever’s and plantar fasciitis are common heel injuries that occur with cleat-wearing athletes. In both diagnoses, contributing factors include tight calf muscles, irritated heel pad, or muscles that just haven’t caught up in growth with the bones. A heel lift reduces the stretch on the calf muscle and heel cups can provide more shock absorption and support for the heel strike during activity. We ended up with the heel lift which I stuck to the shoe underneath the insert. Heel cups can sometimes be hard to get used to – my kids kept feeling like the cup was going to come out of the shoe, but they are also a popular option.
Wear Cushioned Soccer Socks
Some soccer socks don’t come with extra cushioning, but many do. Cushioned socks just add that one more layer of shock absorption and some protection against blistering in cleats.
Twist Before First Wear
I’m sure the boot guy does it for the pros. By that I mean, break in soccer shoes for fit and comfort. On an episode of Amazon’s All or Nothing: Manchester United, the camera shows the boot room for the team and there’s an equipment guy giving all kinds of TLC to each of the players’ cleats. Wow, until my son turns pro, it’ll have to be his poor mom. Wring the cleat multiple times and knead the uppers until the shoes feel like they give more easily. Yeah, you could also let your kid break them in on the field, but then they may have a blister or two – depends on how much of a helicopter parent you are!
Podiatrists weigh in on the problem with soccer cleats and offer advice:
When I saw the title, “How to Be a Happier Parent” at my local library, I was curious. It certainly wouldn’t hurt to be happier! Written by KJ Dell’Antonia who is a former editor of a New York Times parenting column, the book has chapters on dealing with pain points, called: Mornings, Chores, Siblings, Sports and Activities, Homework, Screentime, Discipline, etc.
Even though it’s not the main or only message of the book, my biggest takeaway from this book is that taking care of myself will make me a happier parent. I used to poo-poo this idea when my children were younger, and in road warrior-fashion, I made sure that my kids should always come first. However, I’m a little older now, worse for wear, panting to keep up with the kids, and finally starting to realize that even if I want to put my kids first all the time – that actually means that I need to be my best self – first. So, how to do this?
Duh. Getting enough sleep seems like a no-brainer, but I don’t think sleep makes it to many parents’ priority list as much as it should, mine included. Dell’Antonia brings sleep up in relation to mornings which are rushed and chaotic because so much can be out of our control at that time. However, she declares that there’s one thing that for many people is more controllable about those mornings – and that’s SLEEP. (Incidentally, I struggle with RBP, revenge bedtime procrastination. If you’ve never heard of RBP, but you often stay up later than you should, check to see if you have RBP too!)
But sleep is critical to more than just the morning. I find that being a better and therefore, happier parent, HINGES ALMOST ENTIRELY on getting enough sleep! If I just wasn’t so sleep-deprived and tired all the time, then I would have more energy to do all the hard things like setting limits, following up on chores, and disciplining consistently. Everything is so much easier to handle when you’re not sleep-deprived and not dragging every afternoon.
Find Your Own Thing
In the book’s chapter on Sports and Activities, I also particularly valued the author’s idea of “finding your own thing.” It’s tempting to lose myself in doing everything in the name of my children’s advancement. But one day, they’ll look at me, and wonder, why should I listen to her? What does Mom do for her own improvement?
More loosely, finding your own thing is really about having time to do your own thing or to develop yourself. This can seem like a luxury – but I think we can try to more consciously incorporate this into our lives by using time differently:
Think about your work differently and ways you can gain more skills or knowledge at your job, no matter how small the activity – while you are at work
Work on a skill or activity during your kids’ activities – if you have just an hour to kill, use some of the time to exercise, read, or practice, etc.
If you’re with the kids, try to learn whatever it is that they’re learning – the exercise of pushing your own cognitive development is important
When you have child-free time, try to avoid household chores, administrative tasks, and family errands. Use most of that time for self-improvement and self-care.
While reflecting on “finding your own thing,” I concluded that I have to protect and value my own learning and growth as a person – whether for my career or personal development. This serves multiple purposes:
I improve as a person.
I teach my children that they are not the center of the universe.
I model for them how a person can continually learn and try to better themselves. They can learn from seeing how I practice and put hard work into what I’m interested in doing.
The better I feel about how my own life and interests are progressing, the more patience, strength, and energy I will have in helping my children with their challenges.
Of course, my willpower and ability to do any of this is greatly enhanced by getting enough SLEEP. See how everything spawns from sleep? Since reading this book, I’ve been working deliberately on both sleep and self-development and I’d like to say that I’ve been calmer, more productive, and more purposeful. . . maybe even happier.
Bryan reminds us about keeping it fun and using games or related fun activities to cultivate interest or passion in a child. This is pretty common knowledge. It was his idea that less is more that was intriguing to me. Bryan suggests spending just enough time on an activity that leaves them wanting more. For example, he would stop tennis practice early for his kids, leaving them hungry for more opportunities to play another time.
It’s not intuitive, yet I think it works to some degree, even when they don’t have that intrinsic interest. Sometimes, there’s a subject matter or skill that you might feel is valuable for your child to learn, but they’re not interested. I only “let” my kids practice piano for 15 minutes a day (they don’t love the piano), but it seems to keep them from being over saturated with it. For the kids who do have a passion, a tempered approach would help to keep them from mentally or physically burning out early.
2) Hold Your Ground as a Parent
Bryan has a story about how his twins wanted to play video games like their friends so badly that they proposed a one year plan of doing daily chores in return for getting to play video games for 1 hour every Friday night. He was against the idea of any easily accessible video games or TV, but incredibly, the kids accomplished their one year goal and Bryan got them a game. Behind their father’s back, they broke their 1 hour/week promise within the month and started to prioritize game playing over sports, academics, and music. When Bryan realized, he got rid of the games forever. Sounds a bit extreme on both ends, but when I feel badgered and too tired to hold out on my kids’ constant requests, I actually think of his story to help me dig my heels in and say no to the kids. (I feel comforted that I’m not the only parent to hold off screen time and video games, ha.) For us right now, it’s NO to new toys, extra snacks, video games, more screen time, etc. I’m sure there’s a plethora of other things on which I’ll need to stand my ground as the kids get older.
3) Nurture a Second Passion
Being intentional with fostering a second passion wasn’t something that I had really thought about, but Bryan writes that it can be very valuable to a child’s development. Kids can be interested in a lot of different things and so while we may support them in all of these interests, it may actually be even better if we consciously help them to build a second passion as well (more than just an interest).
Bryan views this second passion as something a person can fall back to when things aren’t working out well in their first passion – a second passion is something that counterbalances the first passion, and maybe strengthens the other side of their brain. When his twins had a tough time with tennis, they could go to their music. He writes that the famous actress, Kaley Cuoco (known for The Big Bang Theory) would fall back to competitive tennis during difficult periods in her early acting career.
While I’m not raising any elite athletes, I definitely see the benefits of how being skilled or knowledgeable in more than one thing supports my children’s self-confidence and takes the edge off of disappointments or injuries in other sports and activities.
All in all, I’ve got these takeaways in mind as we emerge from the pandemic and are faced again with modern day’s multitude of activities to choose for the kids. It’s an opportunity to rethink as well as become more intentional with my choices and my parenting.
Feeding our children in this day and age is challenging – unhealthy food is too readily available and social norms of accommodating children can cultivate picky eaters. As parents, we’re met with a plethora of feedback from grandparents, pediatricians, parenting books, media, peers, societal norms, and social pressures and expectations.
My kids, ages and 7 and 9, are good eaters, in the sense that they eat a wide variety of foods (meats, vegetables, grains), and will try new foods. Some of this may be luck, but it’s also due to habits. There are constant “turning points” in their eating career, and we can’t take their eating habits for granted at all. Their tastes and behavior continue to evolve and I’ve sometimes had to double down on some habits that wane easily. Below are our top 10 habits (10+ actually) to raising healthy eaters.
#1 Limit Snacks
Start with limiting snacks in quantity and frequency. This is very subjective – we’ve had friends who say they are limiting snacks but I see that their “limits” are quite different than ours. The basic idea though is that snacks, whether in the morning or afternoon, reduced my kids’ appetites for regular meals.
Not over-snacking is fundamentally important to being a good eater at mealtime. It’s totally fine and good for kids to be a little hungry or thirsty. The effectiveness of any other tactics that we use at mealtimes is very dependent on this habit of limiting snacks. I have seen a friend give his child a cupcake 30 minutes before dinner, and then fight with his son to have him finish a pasta dish. My friend didn’t realize that he himself had sabotaged his son’s appetite for that dinner.
#2 Eat Only in Designated Areas
We only allow eating in the kitchen and dining room, never in any other area of the house. First, it reduces ant and sticky toy problems. Secondly, it takes away the temptation to extend snacking and meal times and distract from the eating process itself – eating is not to be multi-tasked. Originally, we started this habit from when they were mobile because we didn’t want to be chasing them, or cleaning up after them all over the house. Then, I saw other kids running around their homes after taking a few bites, and coming back to the table for now cold food, and fighting with their parents about finishing their food. I realized we had conveniently sidestepped this battle.
#3 Try Everything At Least 10 Times (not during the same meal)
I once read from one of those child nutritionist guides that people need to try something at least ten times to determine if they like that particular food or taste. Whether this is true or not, I have actually used that rule of thumb to great success. My children have expressed dislike for a lot of foods at one point or another. I tell them the rule and continue to put the foods that they dislike on their plates. My only requirement is that they have at least one bite of the food that they dislike and they can discard the rest. Over time, they surprisingly just started eating more of that food.
One of my kids hated mushrooms with a passion. Over the course of a year of seeing them on his plate regularly, he suddenly started eating them. So don’t give up. Keep making the food a part of their meals whether they eat it or not. Foods come in and out of “favor,” especially the vegetables, so if I remove them from the lineup altogether, I’ll never know when they’re coming back into favor!
# 4 Don’t Offer Alternative Foods During a Struggle
There have been times when my kids didn’t like the meal we had prepared for them, and basically looked like they were going to be missing a meal. Their grandparents have then suggested that I heat up some leftover pasta or other food that they knew the children liked. First, missing a meal here and there is okay. Second, try not to give in during those moments. All it takes is your doing this a few times, for your child to see your potential as a short order cook.
#5 Prepare a “Reliable” Food
I might sound like a mean mom, but I don’t like my kids to go hungry either. To be proactive about avoiding a struggle, try to always have one aspect of the meal that is “reliable.” Reliable as in reliably eaten. That could be something as basic as rice, pasta or bread. If you’re introducing a new grain, then try to make sure either the meat or vegetable portion is “reliable.” That way, even if they’re not fully satisfied, they won’t “starve.” Or I might even heat up the “backup leftover food” and offer it as a side dish in advance, so long as they don’t think I got up specifically to go make a special dish that only they like to eat.
# 6 Offer Yucky Foods in a Variety of Ways
We prepare the “yucky” foods in different ways: different shapes, different spices, and different sizes. Our kids hated red bell peppers. Then I chopped them up and put them in chili (which has a pretty overwhelming flavor on it’s own). They noticed them, but couldn’t taste them. Gradually, I put the chopped bell peppers in less overwhelming dishes and before I knew it, they were eating large pieces without complaint (although still without love).
#7 Have One Bite and Don’t Force Finish
We have a one bite rule. It doesn’t matter if they spit it out. The important thing is that they put it in their mouth. And the important thing is that they try it every time it’s offered.
On the flip side, we never encourage the kids to finish their meal either. We encourage them to stop eating when they feel full even if it means leaving a lot of food on the plate. We don’t say just “a few more bites.” However, we also have limited snacks and don’t prepare special meals outside of meal times (unless someone is sick), so there’s no gaming the system for extra snack food.
#8 Offer a Variety of Foods Early On and Repeatedly
It’s now commonly encouraged for parents to introduce babies to a diverse diet as a way of limiting the likelihood of developing allergies. However, this advice has multiple benefits. It helps develop a diverse palate early on. The ability to eat a variety of foods early on makes it easier for kids to get the different vitamins and minerals that their growing bodies need. To avoid FOMO, even junk food, snacks, and desserts are all sampled – just in limited quantities! The important thing is to keep offering the variety even as it is rejected. . . possibly over and over again.
#9 Control Meal Portions
Controlling how much food your children eat is contrary to most of the advice I found in baby-led weaning books, parenting books, and from our own pediatrician. All these sources advised that babies and young children know how to self-regulate and will stop eating when full. This ranks among some of the most incorrect advice I ever heard from “official” sources. Maybe this was true for breast-feeding, but absolutely wrong for milk and solids. Or perhaps this may have been true for humans prior to a world of processed foods, fiber-free food where eating bite after bite was not so easy.
Yet given the ubiquitous advice, I tried this many times, and watched as my babies, and later, children absolutely did not know their limits over and over again when eating a food they liked (usually something fried, sweet, or a processed snack). In fact, adults often don’t know their limits either when it comes to snacking or foods they like in particular, and we somehow expect children to? Allowing kids to stretch their stomachs too much on a regular basis sets them up for a cycle of overeating and getting more than their bodies need. Try to limit meals to reasonable quantities until you’ve taught your kids to reliably know how to stop eating.
#10 Educate About the Foods They’re Eating
Don’t underestimate the ability of your children to want to do right by their bodies. In past societies, food education may not have been so important, but with all the choices of foods these days, teaching kids how to navigate the food world is just as important as teaching them how to navigate cyberspace.
I wasn’t very aware about food growing up, but the trends towards understanding what we put in our bodies and our babies has really heightened my awareness around food and its impact on our health. Talk to them often about what your family is eating and why it’s good for you. Or when you’re having junk food, talk about why it’s not good for you and why you shouldn’t eat too much of it. Talk about cultural differences in foods and diets and the relative healthiness of each. Talk about the evolution of food. Talk about it all repeatedly. Eventually, it will resonate.
When we joined the food world through organized sports and school, our kids became inundated with birthday party pizza and cake, sport practices that included brown bags filled with a variety of processed/healthy/sugary snacks, and classmates who got to eat candies and chocolate milk regularly at school lunchtime. We had to teach our kids about how food and snacks are thought about differently by each family and why they might not get to eat as much of the snacks and sweets as their friends. Holding off the peer pressure to eat like their friends can be one of the toughest things to do, but it gets easier the longer you do it.
#12 Model Food Behavior
Finally, what if you’re a junk food junkie and / or a picky eater yourself? It’s extra, extra tough to raise your kids to eat differently than you do, so I had to model the food behavior I wanted them to have.
I found myself learning to be a better eater by following the habits that I was trying to model for my kids. Interestingly, my appetite for junk (formerly quite strong), waned when I removed a lot of the items from my shopping list. After I learned to pay attention to labels and ingredients, the rational side of me was put off by many of the ingredients in a lot of packaged foods that I used to eat.
Similarly, I hated lamb meat, eggplant, and brussel sprouts growing up, but in an effort to diversify and follow the behavior I was trying to encourage in my kids, we introduced it in meals periodically. Roasted brussel sprouts and spicy garlic eggplant are now in my list of favorite vegetable dishes. I’m still working on the lamb meat, one bite per meal. . .
It may be too late for my children in some respect, but it seems there are more things that we now know about how food allergies develop that would have COMPLETELY changed the way we approached our kids’ diets at birth. If you’re concerned about your baby or child possibly developing allergies, below are some things you should absolutely consider. Actually, there are an increasing number of individuals who are developing allergies as adults, so it’s worth taking a read below even if you’re no spring chicken.
Food Allergy Epidemic
First, some statistics that I came across recently – according to Dr. Kari Nadeau, who is well-known in the food allergy treatment world:
1 in 12 children in the US, Europe, China, Korea, and Japan have food allergies
1 in 10 children in Australia
1 in 10 adults had food allergies according to a recent survey of 40,000 adults. 50% weren’t aware of the allergies until they were adults.
I don’t have food allergies yet, but I’ve developed some environmental allergies as an adult. . . are food allergies on the way? Below are three food allergy prevention strategies that every one should know.
Food Allergy Prevention Strategy #1: Avoid Antibiotics and Heartburn Medications
Avoid antibiotics and heartburn medications if at all possible – they cause changes to your gut flora, which in turn, affects the way your body responds to food.For all ages, studies have come out showing a link between the increased likelihood of food allergy and the use of antibiotics or heartburn medications. While the studies have shown correlation and not necessarily causation, it’s suspect enough to reconsider your next antibiotic or heartburn medication RX. If there are alternatives, why risk it? Until recently, I didn’t realize that there are a lot of things to try before resorting to antibiotics or heartburn medications, so do your research on alternatives. Your doctor may or may not be aware of this information, let alone warn you of the possible issues when prescribing these medications. For further understanding:
These writings discuss the impact of antibiotics and heartburn medications on babies and children:
Food Allergy Prevention Strategy #2: Introduce Potential Food Allergens Early – Don’t Avoid Them
Neither my husband nor I have any food allergies – just hay fever, so I didn’t consider that my kids were at high risk for food allergies. Yet both kids ended up with nut allergies (and underwent oral immunotherapy). We followed the accepted approach at the time of avoiding nut introduction until age 1.
Alas, it’s also clear that there is still confusion and the guidance you receive will depend on your pediatrician. This study by Contemporary Pediatrics found that pediatricians today are still not necessarily recommending the current guidelines. Regardless of what your doctors say, do your own research too, especially given the inconsistencies across medical professionals, and come to your own conclusion about what you want to do. If you do introduce potential allergens early, do it with the support of a doctor because the risk levels vary by family.
Food Allergy Prevention Strategy #3: Control Eczema
For babies and children (and who knows, perhaps adults, too?), it appears particularly important to try and control eczema as best that you can to avoid the risk of further allergy development. This includes finding and avoiding the triggers for eczema as well as treating it topically.
Since I started trying to reverse my myopia and control my child’s myopia progression, I’ve found eye charts to be handy. During the pandemic with distance learning and increase in computer use, I have used eye charts as a way to check my kids’ vision regularly. However, I’ve also found that those sneaky kids have memorized the eye charts so it’s harder for me to check their vision accurately! So below I’ve included links to the best free printable eye charts that I found online as well as links to some eye charts that I can customize.
Standard charts typically come in two formats, one designed for 10 feet viewing distance and one for 20 feet (6 meters) viewing distance. The 10 feet (3 meters) chart is useful when you don’t have enough space for a 20 feet check.
Best, free standard eye charts
These were the best, free eye charts that I could find online:
I also made my own, so I could occasionally change the lettering. To customize either of the charts below, log in to your Google account while you are accessing the Google document. Select “make a copy” and modify the letters and spacing however you want in your copy. (Be sure to print them on default settings and not “custom scale” or “fit to page,” etc. as it will throw off the size of the printed letters.)
Since the pandemic began, I’ve been supplementing home learning for the kids here and there. I’ve found a few free printables that we really like – because they print well, and have an interface that is easy to use.
Here’s a running list in the various categories of what I’ve found and used:
Favorite Free Math Printables
Both of the math sites listed here provide a lot of different printable worksheets that go up to at least 5th grade. I see calculus topics on Math Aids, and if I remember correctly – that would be high school!
https://www.math-aids.com/ – I use Math Aids quite a lot to give my kids the practice with basic addition, subtraction, multiplication, and division that they don’t get with common core at school. I think it helps them to understand the common core approaches better. There are a wide range of math topics on the site though that we haven’t reached at my kids’ age.
https://www.math-salamanders.com/– I’ve used Math Salamanders less than Math Aids but I liked the mental math problems and it has a similar interface to Math Aids. A large variety of worksheets in a large range of math topics are available.
https://online.seterra.com/ – We just started some geography and I found this awesome site calledSeterra, for free, professional-looking blank maps for the seven continents to teach the kids all the countries of the world. The printables were just a minor part of the site. The site is an extensive free resource of games and resources on world geography.
http://chineseworksheetgenerator.org/ – I love, love, love this Chinese Worksheet Generator. You input any characters that you want and it will generate great looking practice worksheets, along with options for stroke order, etc.. This is especially useful for us because it’s curriculum agnostic and allows us to customize the worksheets for our kids to suit whatever we are learning or need to practice more.
I found this site to have a lot of free teaching printables to help supplement home learning. It’s regularly updated by different sources, so it provides a bit of inspiration even if you don’t find exactly what you’re looking for. It’s UK-based, but many materials are still applicable for us. I’m sure there’s a US equivalent, but I just haven’t come across it yet.
Maybe Zyrtec doesn’t work for you lately or perhaps you don’t like its side effects. Personally, I fear that we don’t know much about the long-term use of these “safe” OTC antihistamines for allergy relief. Instead, I’m hoping to treat my sneezing family as naturally as possible. Below are some of the things that I’ve been reading about (and in some cases, trying out):
1. Avoid Antibiotics as Much as Possible
Scientists are increasingly looking at an imbalance in the microbiome as the root cause of many of the problems we have with our immune systems not working properly. These problems include both food and environmental allergies, asthma, and dermatitis.
It’s not too far of a stretch to see the problem with taking antibiotics, since antibiotics essentially kill all the bacteria you have, both the good and the bad.
For children, I’ve been looking for ways to address what seems to be cough-variant asthma in one of my kids. A TCM practitioner recommended a combination of liquid extract formulas from “Gentle Warriors”, a line of children’s herbal formulas. The formulas were selected based on my child’s constitution and the presenting symptoms. I’m skeptical, but also hopeful. We’re trying it out for 1-2 months and I’ll be sure to update this post with our results.
Update as of 1/6/2021: After we tried these formulas last year, my child’s cough-variant asthma seems to have disappeared! After having this asthma cough for over 1 year, it’s now been gone for 5 months! We’ve managed to keep off of Qvar and Singulair, oral steroids that had bad side effects for us.
3. Eat a Diet Rich in Natural Antihistamines
If you’re in the midst of having allergic symptoms, this approach isn’t going to help you right away. However, over a couple weeks, it sounds like a person with mild allergies could benefit. Common foods with natural antihistamines include: bell peppers, citrus fruits, pineapples, broccoli, cauliflower, berries, apples, tomatoes, black/green tea, ginger.
My family has pretty good eating habits and many foods on this list are already a regular part of the diet. Yet we still have allergic symptoms so I’ll have to say this doesn’t get rid of all your allergies, although I guess they could always be worse. Anecdotally, as a data point, I’ve noticed that my two kids who rate equally on the allergy scale, have different levels of allergic symptoms. The one who happens to eat a lot more fruits (2-3x more than the normal serving that everyone else eats), also happens to experience less allergic symptoms. Then I read this study about how a Mediterranean diet rich in fruit and vegetables was found to be associated with less allergy symptoms, which further boosted my small finding.
4. Take Natural Supplements to Boost the Immune System
The amount of natural antihistamines found in foods may not be enough for some allergies. Higher dosages in capsule or powder form enable higher intake to replicate the dosages given in scientific studies. These supplements include:
Vitamin C – I found Vitamin C at the top of many lists. Apparently, vitamin C both inhibits the release of histamine from anti-inflammatory cells as well as helps to break down histamine after it has been released. However, the current recommended daily allowances (RDAs) for children (25mg-45mg) and adults (65mg-90mg) may be too low to create the expected allergic relief. The current RDAs were in fact calculated as the amount needed to prevent scurvy and not other ailments. According to the ODS, the highest daily intake likely to pose no risks is:
400 mg for infants aged 1–3 years
650 mg for children aged 4–8 years
1,200 mg for children aged 9–13 years
1,800 mg for teenagers aged 14–18 years
1,800 mg in pregnant or breastfeeding teenagers aged 14–18 years
2000 mg for adults
For my kids, I decided to trial 400-500mg dose. We are only 1 week into it, so I will have to update this post when I have more observations.
Quercetin – this is an antioxidant also regularly included in everyone’s list. It’s high in leafy greens, apples, grapes, and onions to name a few. I saw a range of dosage recommendations for taking it as a supplement. For adults, I saw a range from 500mg daily to 1000mg 2x/day. For children, Dr. Weil says 200mg daily 2x/day for hay fever.
N-acetyl-cysteine (NAC) – this is an antioxidant that some websites report is stronger than Vitamin C. It’s touted as being able to break down mucous, and reduce allergy symptoms. While it can be found naturally in protein-rich foods that you might eat, like turkey, eggs, etc., a much higher dose is needed for therapeutic effect. I read that NAC caused stomach pain in high doses for some users, so I would proceed with caution. I saw recommended dosages of 300mg 2-3x daily.
Probiotics – Probiotics are the supplements that contain the good bacteria that your gut needs for a healthy immune response. Whether probiotics are effective in putting the good bacteria in your gut is still being studied. However, this doesn’t stop a lot of people from trying. There have been quite a few studies that suggest taking probiotics may result in less hay fever symptoms.
What has worked for you? If there is something that has really worked for you, I would love to know about it!
During this time of “shelter in place,” I’m tempted to give myself a bigger break than usual when it comes to parenting. Then I remember two things: one, we don’t know how long we’re going to be dealing with this, if this is, in fact, the “new normal,” and two, if I relax my parenting now, I might be giving myself more work for later to fix habits I’ve undone in a couple of weeks (screen time, anyone?).
The best thing about her book is that it’s practical and usefully laid out. For each “thing” that mentally strong parents shouldn’t do, she lists examples of ways we actually do what we shouldn’t do – without even realizing it. You will almost always find yourself in some of her examples. She shares a detailed story highlighting that “thing” parents shouldn’t do and then provides a variety of tips and guidance for what you should do instead. First, if you just want to read her list, see below. But the list doesn’t mean much without the context she provides in each of the chapters. She really brings each of these “Don’t Do’s” to life with lots of example situations and personal experience.
13 Things Mentally Strong Parents Don’t Do, according to Amy Morin:
They don’t condone a victim mentality
They don’t parent out of guilt
They don’t make their child the center of the universe
They don’t allow fear to dictate their choices
They don’t give their child power over them
They don’t expect perfection
They don’t let their child avoid responsibility
They don’t shield their child from pain
They don’t feel responsible for their child’s emotions
They don’t prevent their child from making mistakes
They don’t confuse discipline with punishment
They don’t take shortcuts to avoid discomfort
They don’t lose sight of their values
I’m dissecting my own behavior around this list as a form of parenting self-analysis. Starting with the #1 Thing that I should try not to do too often. . .
#1 They Don’t Condone a Victim Mentality
My kids will moan and complain that it’s their worst day ever. That it’s everyone else’s fault but their own that they weren’t focused during a basketball game. That their math book is stupid and that’s why they’re frustrated. Or they’ll let their sibling push their buttons until they explode while their sibling sits smugly and happily in the other room.
Morin calls a victim mentality a learned behavior that can be learned from parents unfortunately. Some things that I’ve been guilty of as a parent:
Making excuses for my kids’ failures or shortcomings (yes, I’ve blamed their terrible tempers on their father and their negativity on genes from my pessimistic mom)
Thinking that my children are helpless sometimes
Instead of giving time to these thoughts, I should be helping my child focus on what he can control in his life. For example, being trapped more or less in our home now, I’m trying to empower them with how not to be fearful of coronavirus. I’m telling them that we have to train ourselves to wash hands automatically, not touch our faces, and to be mindful of space and contact with others at all times. If the kids get into fights with each other, I can ask them to think of what they can do to make themselves feel better and not expect me to solve it or punish the other child.
I’ve had lots of opportunity to work on my parenting these last few days, and without getting too ahead of myself, I want to say that I’ve noticed more independent behavior. I’ll be sure to have another post on “#2 They don’t parent out of guilt” which I already know will give me some cringe-worthy self-reflection. . .
I’m home with my family this morning, following guidelines for self-isolation and social distancing. It is so surreal, but here are the actionable items that I’ve learned so far from living in the time of coronavirus. Most of us will survive the coronavirus, and this is why these learnings are important to me.
#1 Respond at the first hint of trouble, not at panic time
Determining what constitutes as “the first hint of trouble” is open to debate, but I will say that I responded somewhere in the middle between “the first hint of trouble” and “panic time.”
I went to Costco two weeks ago and decided to purchase some stocking supplies. It was more crowded than usual and I could see a number of carts filled with an irregular amount of certain supplies. However, it was still a manageable crowd. I should have thought of precautionary preparation when the first case of coronavirus was diagnosed, rather than when I actually did. After all, there’s no downside to acting earlier.
A few days ago, I went back to Costco for some allergy medicine and it was panic time. The parking lot was almost full before the store even opened. The allergy medicine I wanted was out of stock, as were all of the panic items (paper towels, toilet paper, rice, pasta, disinfecting wipes, rubbing alcohol). Shoppers were elbow to elbow (great for our minimum 6ft social distancing requirement) and I am now hearing online reports from our neighbors of the continual crowds at all the local grocery stores.
#2 Always have 3 months worth on hand
Why 3 months worth? Well, I’m not sure that’s the correct number, but basically you want to be self-sufficient for some period in the event that you become isolated (due to say coronavirus, store closures, insufficient stock, or a major disaster renders everything unavailable to you except for your home (don’t forget to pack your emergency bag for when your home isn’t an option either).
Here’s what I should have had 3 months worth of:
Food (that we would actually eat – not random cheap stuff for emergencies)
Household supplies (paper products, cleaning, and disinfecting supplies)
Toiletries (soap, shampoo, toothpaste, etc.)
Medications (common OTC items like cold and allergy medicines and prescriptions)
I wasn’t able to get some of these items during the current panic time. What I should have done is just gradually amassed 3 months worth of the above items like a regular consumer in the months/years prior and thereafter, just replenish stress-free any items that dipped below the 3-month threshold.
If you don’t have enough room where you live, stockpile whatever amount is realistically maintainable in your available space. If organized purchasing is not your strong suit, use an inventory list – there are many online options to help.
#3 Don’t rely on doctors or the government
. . . ever. Assess your own risk.
My elderly mom lives with us. One of my kids has asthma, as does their father. Initial government and public health/medical guidance was not enough for us. After a few days of discussion and wondering what we were waiting for, we pulled our kids out of public school. The next day, the public schools announced a 4 week closure. Given our high risk family members, I have already decided we will not go back in just 4 weeks even if that date holds true.
If we don’t get the coronavirus soon (assuming my kids didn’t just contract it at school last Thursday), I will consider ourselves lucky this time. I already know a couple of families with members who have COVID-19-like symptoms. We were late to make the right decision for ourselves. Next time, I will trust my gut and not be afraid to seem overly cautious.
This is not likely going to be the last time that we or our children will experience pandemics or global crises in our lifetimes. I won’t miss this opportunity to make lasting changes to my own lifestyle and habits and to truly instill the same into my children so they won’t even have to think about these habits when they’re older. It will serve them well throughout their lives in any context.
Not to touch your face. I’ve toyed with the idea of wearing gloves or taping a Kleenex to my face to make me realize when I’m touching my face. Send me your suggestions!
Take Chinese herbs that strengthen the immune system and respiratory system – again, I know this can be controversial, but if you happen to believe that TCM works, then look into the variety of herbs that can help, like reishi for allergies, or ASHMI for asthma (which has been studied by Western medicine).
Recognize how decisions and actions you think that you are making for just yourself actually affects other people. This applies to so many things in our lives. The earlier our children learn this, and to act on this, the better our world will be.
There’s nothing groundbreaking here, but at my age, I’ve developed some unhelpful habits and sustaining change isn’t easy. But perhaps the threat of coronavirus to those I love can give me the motivation to sustain change. Plus, I’m not elderly now, but I most certainly will be someday. Hopefully, we’ll be better prepared then to handle anything life gives us.
We have stopped oral immunotherapy updosing, after having reached a dose of 1 whole nut for each child (see why in the section below, “New information since we started OIT”). So now we are entering maintenance phase at a daily peanut for one child and a daily cashew for the other. Our allergist said that after about 3 months on the 1 nut dose, they would be protected from accidental ingestion of up to 2-3 times their dose – which would be about 2-3 nuts.
It took us 7 months, updosing on a schedule target of every 2 weeks, to go from roughly 2.5mg of nut flour to 1 of an actual, decent-sized nut. We had a few updoses with 2.5 to 3 weeks in between due to illness, scheduling availability, and travel.
We’re only 30 minutes away from our food allergist. Each appointment was 1.5 hours long. I got used to measuring out the nut flours everyday. All in all, in retrospect (now that it’s over!), the time invested didn’t seem so bad.
Reactions during updosing
Overall, we had a pretty smooth experience with updosing. We did not have any anaphylactic reactions. We followed most of the guidelines:
We usually dosed in the evenings around 7 to 7:30pm. Our kids go to bed around 9pm. We did occasionally dose late around 8pm.
We skipped dosing on particularly hectic/exciting days like Halloween.
We did shower after the dose a few times, but we kept it particularly short and not too hot and did not have reactions.
We dosed with Zyrtec on updose days and for 2-3 days after based on initial recommendations of our allergist.
Both my kids had occasional tummy aches, but I could never be certain if it was related to dosing. I suspect that some were and some weren’t.
Twice, one child had the feeling of something in the throat. Both resolved with Zyrtec.
My peanut-allergic child had coughing reactions on 5-6 occasions within the two hour window of dosing that were resolved with Zyrtec.
Our allergist basically recommended that we stop at 1 nut. This is a change in thinking since the time we began OIT last year. Originally, our provider thought that OIT would continue up to about 3-4 nuts. Here are the recent learnings that resulted in the change of their decision:
Clinically, our provider saw that patients in maintenance were having more reactions at 3-4 nuts versus patients who were doing very well on just 1 nut, while conferring a strong level of protection of up to 3 nuts. (Incidentally, for what it’s worth, I learned that a maintenance dose of 8-10 nuts is around the level of what is considered “free eating.”)
This supported my own anxiety-inducing findings on Facebook OIT groups where it seemed that many parents shared that their kids were having reactions, even anaphylactic ones on maintenance doses of 3-4 nuts or more.
Palforzia, the “drug” containing pre-measured doses of peanut flour will also only go up to 300mg (1 peanut), so this falls in line with what is now considered “safe” and FDA-approved.
I also came across this 2018 Palforzia aka AR101 study that showed only 67.2% of patients who had been on a maintenance dose of 300mg peanut flour were able to pass an exit challenge of 600mg without dose-limiting symptoms. This made me less comfortable about the 2-3 nut protection level mentioned by our allergist. If you’re data-inclined, here’s the appendix for even more details (including the OIT dose schedule, patient characteristics, etc.) on the study.
All in all, our provider suggested that we stop at one nut for now and reassess in 3 months whether we would like to continue, given the recent findings and after we see how our kids fare on their 1 nut maintenance. Our provider also said that we would need to be completely reaction-free for the next 3 months to even consider updosing to reach 3-4 nuts (which is about 3-4 more updose appointments).
Our peanut-allergic child with suspected underlying asthma conditions would not be recommended to continue past 1 nut due to the risk associated with the conditions, unless we resumed asthma control medications. We’ll have to think hard about that one because the behavioral changes were very unsettling.
Our other cashew/pistachio-allergic child could be allowed to continue if there are zero reactions in the next 3 months. However, in that case, we would do a pistachio challenge of some sort. When we began OIT, we were told that desensitizing to cashew results in desensitizing to pistachio (due to the cross-reactivity) in about 80% of the cases. Our allergist now says that this is actually the case in 90%+ of the allergies, and after 3 months on the 1 cashew maintenance dose, they would recommend a challenge of eating 3 pistachios in the clinic to see if my child has desensitized to the pistachio as well (1 cashew = 2.5 pistachios).
I’d been sniffing the hair on my children’s heads – yes, moms do that. And found that they smell very different. I can’t even describe the smell though – one like vanilla soup and the other like citrus tea. That got me wondering what they might smell like as teenagers and then adults. Would my deliciously smelling kids become stinky people with various body odors? Would I need to arm them with deodorants? Was I going to need to do a 3 week research project on finding the best, non-toxic deodorants?
I’ve noticed that men and women and folks of different ethnicities also seem to have different body odors. I’m of Asian descent and have never used deodorant in my life and have probably rarely needed it (although I suppose I should get some second opinions about that). My husband of European descent can have more distinctive scent, but many of my male Asian friends have claimed that showering after the gym is utterly unnecessary from a body odor standpoint.
I got searching. Researching trivial things is a guilty pleasure of mine.
The answer first
Here’s the bottom line on whether you and/or your child will be stinky:
A mutated, non-functioning ABCC11 which results in lower secretion of MRP8 has been found in approximately 80-95% of East Asians (Chinese, Korean, Japanese, etc.)
In the rest of the world, this gene mutation exists in only 0-3% of people of European and African ancestry, and 30-50% of people from South Asia, the Pacific Islands, Central Asia, and indigenous Americans. Those with a mutated ABCC11 aren’t completely immune from body odor, just that they will probably have a lot less of it and maybe indetectably so.
This gene incidentally also determines the type of earwax you have. A non-functioning ABCC11 gene results in dry ear wax, whereas a normal expression of the ABCC11 gene results in wet ear wax. Therefore, the type of earwax you have (at any age) can help determine your levels of body odor.
What makes the actual body odor?
The main source of our body odor comes from our body’s sweat glands in combination with the bacteria on our skin. At birth we have eccrine sweat glands all over our body which excrete water and salt mostly, but at puberty we develop apocrine sweat glands in the armpit and groin regions. Apocrine sweat glands secrete proteins (including the odor causing MRP8 protein) and lipids and when they mix with the bacteria on your skin, body odor is created.
What’s the connection to ear wax?
The ABCC11 gene that determines your body odor also determines your ear wax type. It’s expressed in humans as two alleles resulting in either sticky brown cerumen also known as “wet ear wax” or dry flaky cerumen aka “dry ear wax.”
The dominant allele, let’s call it “W,” produces wet ear wax and body odor. The recessive allele , say “D” (also referred to as the mutated version of the gene) results in dry ear wax and less of the odor causing protein. If you have two recessive alleles, DD, then you have dry ear wax. If you have wet ear wax then you either have WW or WD. For a refresher on genetic traits and to see how this will be passed down in your family, see here and here.
Check your ears and your child’s ears if you’re curious. For evolutionary reasons still unclear, dry ear wax is found predominately in East Asian populations (as mentioned above).
Things in your diet such as spicy, pungent foods in high quantities can come through your skin. Stress can increase the production of your apocrine sweat glands, and the breathability of your clothes can either trap in your sweat or allow it to evaporate. How often and when you shower (like post-workout) can also determine how much bacteria is on your skin and available to turn sweat into odor.
Bacteria and surroundings nothwithstanding, your scent may also change with age due to a couple major factors. Babies and pre-teens don’t have the apocrine sweat glands that produce the odor-causing proteins. For older people, scientists have discovered that people over the age of 40 emit an odor compound called 2-nonenal that occurs when chemicals breakdown in our bodies as we age. It appears to be linked to the muskier smell that people associate with older people.
So I checked the type of earwax in my kiddos and I’ve got one wet and one dry. Looks like I might have some future Google research on deodorants after all.
This is a niche post for those of us trying to explore the causes and cures for myopia. Since the causes of myopia are not fully understood, the treatments are still under discovery and experimentation. If you search online, you probably won’t find much evidence that the axial length of the human eye can be reduced – this is a key measurement that folks are using as an objective way to determine if axial length myopia can be reversed. However, I suspect that there exists some evidence – it just hasn’t reached Google’s top search results. I discovered that the axial length of my child’s eye was reduced over a 3 month period, leading me to think some researchers out there may have similar data on children.
So my current answer to “can the axial length of an eye be reduced?” Yes, based purely on numbers and measurements for a single child data point – more on this below, along with the caveats. All in all, it’s still encouraging information. (Update as of 11/17/22: In absence of a new post on axial length, I wanted to share that our optometrist once described a case of one teenage patient whose axial length dropped significantly for an unknown reason and the patient’s RX correspondingly dropped about 2 diopters! So YES, axial length absolutely can change, but IF and HOW it will happen is not understood.)
Here are the axial length measurements on my 8 yr old child who has an RX of OD: plano, OS: -1.25:
20-20-20 near work rule, outdoor time ~1.5-2 hrs/day, “active focus” 2-3x/wk for a few minutes at a time
OD: 24.37mm OS: 24.65mm
End of June 2019
20-20-20 near work rule, outdoor time ~2-3 hrs/day, “active focus” 2-3x/wk for a few minutes at a time
OD: 24.36mm OS: 24.66mm
End of August 2019
20-20-20 near work rule, outdoor time ~3-4 hrs/day, “active focus” 2-3x/wk for a few minutes at a time, plus lenses when reading
OD: 24.43mm OS: 24.75mm
Beginning of Dec 2019
20-20-20 near work rule, outdoor time ~1.5-2 hrs/day, “active focus” 1-2x/wk for a few minutes at a time, regular wear of multifocal soft contact lenses
OD: 24.38mm OS: 24.67mm
Things to note on the data
In a 3 month period, there was a .05mm reduction in the right eye and a .07mm reduction in the left eye. The practitioner wasn’t surprised by the positive change and said this was known to happen with the initial wearing of multifocal soft contact lenses, from which I inferred that more reduction isn’t to be expected.
.07mm is estimated to be the equivalent of 0.25 diopters, according to our optometrist.
.12mm is the average growth/year in the axial length of non-myopic children, according to our optometrist.
Although we incorporated many good vision habits, the reduction in axial length did not occur until my child was able to wear multifocal soft contact lenses.
Even though the right eye is not myopic, we decided to wear multifocals in both eyes to try and help prevent the right eye from becoming myopic. After one eye becomes myopic, it is common for the other eye to become myopic as well.
The increase in axial length came during the summer at a time when we were able to spend a lot of time outdoors in a lot of sunshine, we no longer had school (less near work time), and when we had added the use of plus lenses for reading.
I checked my child’s vision with an eye chart a few times a week, and it seemed to me like his eyes were getting better during the 3 months that there was an increase in the axial length.
Our attempts at “active focus” were so few per week that it’s not a significant factor for consideration.
My child gets almost zero screen time. He reads books a lot but will only occasionally read as much as 45 minute blocks which are then peppered with a 20-20-20 rule.
Thoughts on the effect of the multifocal soft contact lenses
Multifocal soft contact lenses and “active focus” – Since seeing that the contact lenses seemed to make the most difference in my child’s axial length, I’ve been thinking about how they work and how it might compare to the concept of active focus which I read about on endmyopia.org. According to endmyopia, active focus is the activity you need to do to stimulate your vision to improve – you look at something that’s just very slightly blurry and then focus on it to see if you can clear the blur. When you wear multifocals, your eyes also have to do something similar on a constant basis. Because there are patches of less clear vision, your eyes have to learn to adapt to pick out the parts that are clear to create the focused image that you finally see. I could be totally off-track, but just throwing it out there. Thoughts, anyone?
If you have any axial length measurements or similar experiences, please do share! Anyway, we’ll be measuring axial length again in another few months. Stay tuned.
This is a very helpful post in providing more numbers for understanding axial length, and understanding of possible ethnic differences, and growth differences in myopic and non-myopic children:
If you’ve been reading about the latest findings on why we’re all becoming so nearsighted, then you know that researchers have found a strong link between myopia and outdoor light. They think that outdoor light (possibly even more so than near work) may have the strongest impact on protecting against myopia. However, the simple recommendation of spending more time outdoors is a little ambiguous and not enough information to decide whether following this recommendation was feasible or worthwhile. As much as I would like to spend my entire day at the beach, in a time-constrained world, I wondered how much and what kind of outdoor light do we need for it to make a difference?
Why outdoor light matters
Why outdoor light matters is still unclear to researchers. There are a few candidate theories, but if the reason is unclear, that means the kind of outdoor light you need is, well, unfortunately, another educated guess. Here are the theories so far:
The dopamine theory: Outdoor light triggers retinal dopamine. Animal studies show that when the eye has low levels of dopamine, its’ axial length increases.
UV exposure: Being exposed to UV light in the range of 360 nm to 400 nm light may be the part that helps control myopia
More distance viewing: Being outside causes more frequent distance viewing, as opposed to near work and the closer viewing environment that we have when indoors.
Brighter, outdoor light: The higher light levels that are outside are thought to be key – this doesn’t necessarily negate the other theories above.
How much light and how bright?
Based on the theories above, here are the study recommendations:
There was a range of “how much light” recommendations from the studies. On the lower end, I saw that 14 hours outdoors/week could lower the chances of myopia by ⅓. On the higher end, Dr. Ian Morgan, a researcher who specializes in myopia and the environment, has concluded that children need to spend at least 3 hours/day in light levels of at least 10,000 lux to be protected.
10,000 lux is described as “the level experienced by someone under a shady tree, wearing sunglasses, on a bright summer day.” For comparison, average indoor lighting is about 500 lux. Consequently, sitting by the window with natural outdoor lighting is probably more protective than being indoors without natural light.
Despite the fact that the UV exposure may play a role against myopia, it is still recommended that we wear UV protective eyewear and clothing. Since it’s unclear if and how much UV exposure is needed, doctors still recommend protecting against the damaging effects of UV light. However, since many contacts and glasses nowadays include UV protection, they are continuing to investigate the possibility that a different balance may be needed between UV protection and myopia protection.
To get adequate levels of vitamin D (30 ng/mL or more), some experts recommend about 10-15 minutes of sun exposure on your arms and legs without sunscreen between 10a-3pm each day. However, you need to tailor this recommendation for yourself by factoring in sunscreen (which blocks UVB), your skin pigmentation (darker skin needs longer exposure), and where you live in the world. For example, if you live at latitudes 37 degrees north of the equator, there is less UVB exposure resulting in less if any vitamin D production. You may also look into adding more vitamin D rich foods or supplements to your diet.
Most of this research is around outdoor light and its impact on children’s myopia, but it’s probably meaningful to adults who have progressing myopia, too. All in all, 2-3 hours outdoors daily can be a tall order for over-scheduled, over-worked lives – both kids and adults, especially in winter!
The pediatric allergists who we’ve seen have said that all the allergy medications being used to treat children’s allergies are “very safe these days.” However, I like to double-check everything, including what the doctors say. Plus, to me, there’s a range of “safe” which I like to call risk reduction. Here’s what I found: there are in fact, nuances to the common allergy medications that are prescribed like Zyrtec and Benadryl, that are worth considering when deciding which to use and when. (If you want to try and reduce allergies without medications, see my posts on physically reducing allergens in your environment and also natural ways to minimize or treat your allergies.)
Best anti-histamine for kids: Zyrtec
For regular environmental allergies, Zyrtec seems to be the anti-histamine of choice. It’s the second fastest-acting (20 minutes – 1 hour) and lasts 24 hours. Benadryl apparently works the fastest, but its main ingredient has been linked to increasing risk of dementia. Many allergists no longer recommend Benadryl for kids at all. The Stanford clinical trials on OIT for peanut allergies used to require children to dose daily with Benadryl. When the studies came out about its link to dementia risk, they switched over to Zyrtec immediately.
Claritin takes longer to work (3 hours). Allegra, another popular choice, is shorter-acting and apparently less effective.
Anecdotally, on a Facebook group for children with allergies, some parents noted increased aggressive behavior and acting out during their child’s regular use of Zyrtec. They felt that symptoms resolved with the use of Allegra. I searched this briefly and found that allergy meds are sometimes linked to negative effect on behavior, although no one particular anti-histamine is blamed. It appears to depend on the child.
Our own pediatric allergist also recommended Zyrtec during our food allergy treatment, but did not have any particular reason for not recommending the others. If you’re looking for the quickest relief possible (and for one-off use) such as reaction to a food allergen, etc. then Benadryl might be your top choice. Also, according to our pediatric allergists, if you need the medication to get into your system faster, then choose liquid over tablet form. However, if your child needs the medication daily, then Zyrtec sounds like a safer choice.
Best nasal spray for kids: Flonase Children’s Sensimist
Two of our pediatric allergists recommended Children’s Flonase Sensimist (different formulation from the adult version). One pediatric allergist called it “super safe.” It appears to have the least amount of systemic absorption – which is what you want since you are mainly trying to treat nasal symptoms and want the drug to work locally. We were also warned to be sure and spray away from the nasal septum as spraying directly can damage the septum and cause nosebleeds.
Even with Flonase, it seems that the less you need to use it, the better. Studies have found that inhaled corticosteroids, like Flonase, can stunt a child’s growth.
One pediatric allergist’s ranking of allergy meds for children
My child sprained an ankle and immediately, every well-meaning person around us kept at us with ice, and more ice. The day after the injury, our sporty, super-fit friends quizzed me, double-checking that we were continuing to ice the ankle. All this emphasis on ice gave me pause, because in traditional Chinese medicine (whose philosophy I have followed growing up), ice is never used for an injury. These opposing views sent me running to Google.
It turns out that recent research suggests icing an injury may not be the best way to heal an injury. In fact, a new March 2021 study found that ice may be more than just unhelpful, but may actually slow healing!
The bullet points below summarize the basic arguments against using ice:
For years, ice has been widely practiced as the standard treatment for sprains and sore muscles. However, recent research has determined that both ice and too much rest may actually delay healing. In fact, Dr. Gabe Mirkin, the doctor who coined the term RICE, Rest, Ice, Compression, and Elevate in 1978, wrote an article in 2015 stating that he now believed this method actually delayed, rather than helped healing.
A review of 22 research papers found little evidence that ice and compression helped healing over the use of compression alone, so there is actually scant scientific proof that ice helps
Controlled blood flow and inflammation is needed for the body part to heal and ice (as well as anti-inflammatories like ibuprofen, and other pain reducers) work against them, by shutting or slowing down blood flow to the area and turning off your body’s natural immune response of inflammation
If ice is used at all, it should just be used briefly and is only for the benefit of pain relief. You should use ice in those instances, but be aware that it may slow your recovery.
Instead of ice and rest, do movements (gently as needed) but as soon as possible. According to renowned physical therapists, Dr. Jim and Phil Wharton, “inactivity shuts the muscle down. Blood flow is restricted and tissue atrophy follows. In contrast, activity improves blood flow, which brings oxygen and removes metabolic waste.”
Icing may slow healing. It may be disrupting the body’s natural cell process in a way that actually delays muscle recovery according to a March 2021 study done on mice. Apparently, there are enough similarities between animal and human muscle to suggest that the body’s muscles may know how to heal itself better without the ice.
Ice vs. no ice is still widely debated and you will find professional, medical voices on both sides. However, if you do a search, you will find most articles by orthopedists, physical therapists, physicians alike advising you to use ice. It seems the idea of ice not always being helpful or necessary is either not well-known or perhaps not acceptable to most people in this field where the idea of using ice for injuries has been ingrained for some time. I found that our own orthopedist at a well-known sports medicine clinic prescribes ice.
This turned out to be a much more controversial topic that I expected it to be. It definitely reinforced my propensity to question conventional medical wisdom (5 Reasons Not to Rely on Doctors). Arguably, I found the evidence to back my personal bias towards traditional Chinese medicine (of not using ice). I saw arguments ranging from ice is harmful, to neutral, to helpful. I think at the very least, I saw that ice is not necessarily helpful nor necessary, (and I won’t have to feel like I wronged my child by not giving ice).
In another post, I wrote about how I decided to lean towards minimalist footwear for my kids and for myself. Well, I didn’t realize that finding children’s minimalist, athletic footwear (and there are definitely degrees of minimalism here) would be so difficult! In fact, most popular brands had very thick soles and were heavy. Others were too rigid and narrow, particularly in the toebox, and even others also had positive inclines, so much that I was effectively putting my child in a slight heel. None of those made any sense to me and yet those were the majority that I found.
Below is what I eventually found (some of which I ended up buying, others which I considered). Zappos and Amazon are my go to sites for buying shoes due to their easy buy and return policy. Buying shoes isn’t like buying t-shirts – easy return policies are so key!
Tsukihoshi Mako – These are my personal favorite. They’re flexible, some sole, zero drop heel, very washable. Lots of color options (compared to some others) and athletic-looking enough that my kids didn’t feel too different from their Adidas, Under Armor-clad peers. Velcro closure for fast in and out! Plus, this model has been around for many seasons. Around $55 & up.
Tsukihoshi Kaz – These are another favorite, but don’t come in some of the larger “Little Kid” sizes. Same pros and cons as the Tsukihoshi Mako. Around $50 & up.
Merrell Kids Trail Glove – I just noticed these recently (2021) on Zappos and will have my boys try them out. They’re very lightweight and have a barefoot feel. The sole is minimal with very light cushion, but it’s still sturdy with with a lot of traction on the bottom. The toe box is pretty wide, but doesn’t seem quite as wide as I’ve seen on Vivo, Xero, or Altra models. Advertised as being good for cross-training, available in sizes for toddlers through big kids. Listed at $50.
Altra Kids’ Athletic Shoes – Altra’s running shoes for kids have a large toebox for toe splay. Last I checked, there were two models, Kokiri and Lone Peak – my kids found both models to be comfortable. They are flexible and lightweight. They are zero drop, and though the soles look thick, they are actually much less cushioned than your typical running shoe. We love these shoes, but we did find that the traction on both models wore down pretty quickly. $60-$70.
Prio – I’ve been eyeing this model for my kids to try maybe in the future. They’re not available on Zappos or Amazon, so ordering is a little more “work.” Also on the pricier side, $70. Check their website for more info and pics.
Nike Free RN (pictured below, left) and Nike Flex (pictured below, right)for kids – some of the versions of the Flex and Free RN are pretty lightweight and very flexible. They tend to have thick, wide soles. Maybe that’s for stability? At any rate, I couldn’t discern much of any incline despite the thick sole on some of these models. Look carefully for what’s important to you though because there’s variation even within the models and from season to season. My kids found them super comfortable in general and said they felt like slippers. $40 – $70, depending on the model – plus these go on sale frequently when the newer versions come out.
PLAE – I don’t have a particular model in mind and we don’t own any of this brand, but almost all their shoes seemed to be zero-drop. We’ve definitely tried some of their models on a couple of times, too, but I find them a bit stiff and heavy though for a minimalist shoe. They look like a good fit for wider feet and toebox and the bottoms feel robust, for those wanting a sturdier sole. $50 & up.
Martial arts and wrestling shoes – Most shoes used in these sports tend to be zero-drop. Their flexibility varies. Asics makes a wrestling/martial arts shoe, so it is a high cut shoe, but aside from the ankle support, the rest of the shoe is very flexible, zero drop, with varying degrees of width. Puma, Adidas, Asics also have martial arts shoes that are zero drop, somewhat flexible, but sometimes a bit narrow in the toebox, and the leather (faux?) can make the shoe a little stiffer to begin with.
Indoor soccer shoes (not the grass cleats!) – Indoor soccer shoes are typically zero drop, so we got that requirement out of the way quickly. They also have the “cool” factor, so my kids are always excited to see these. After that, you have to sift through the brands and models for the ones that suit your child’s feet. Nike has the most models that felt flexible and lightweight. Alot of them look good, but have rigid soles and for whatever reason, soccer shoes tend to run narrow though, and are all lace-ups. Around $35 & up.
In my quest to quell my child’s myopia, I discovered the myopia reversal community online. It seems there are many adults who are trying to improve their vision naturally. Yet while the medical eyecare community has not reached the point where they will even consider that myopia reversal is possible, myopia control for children is a growing sub-specialty and reaching mainstream eyecare practices in the US. In Asian countries where myopia is unusually high, myopia control is already a common practice. Considering that myopia control didn’t exist when I was growing up, (and yet here it is), I’m wary of dismissing the possibility of myopia reversal too quickly.
Researching and comparing these two “fields” was helpful for me in deciding how to manage my child’s myopia and also in convincing me that it was worth trying to reverse some of my own myopia. Below are some of the similar ideas that I found between the two areas .
Single vision lenses (SVL) will likely progress your myopia – This is not yet a commonly known fact, especially among adults. On the plus side, as I mentioned earlier, myopia control is definitely a growing sub-specialty and I think it’s only a matter of time before it will become common practice:
Myopia control view: Optometrists who provide myopia control options to children know that the traditional single vision glass lenses or contact lenses will mostly likely cause your prescription to get worse and worse. (Yes, that’s the lenses that you and I grew up wearing.) The current thought is that myopia stabilizes in adulthood, but the eye is particularly susceptible to growth in childhood and teenage years since those are “growing” years for the body. SVL are known to cause peripheral light to focus behind the retina, which is thought to stimulate the axial growth of the eye and therefore increase myopia.
Myopia reversal view: In the philosophy of two popular myopia reversal methods, Jake Steiner’s endmyopia.org and Todd Becker’s gettingstronger.com, it is also believed that the cycle of progressively stronger RXes are due to wearing SVL that perfectly correct or overcorrect your vision. If your myopia is worsening as an adult, it seems that perfectly corrected or overcorrected SVL could also be a contributing factor. They call it “lens-induced” myopia
Reducing near work strain is important in treating myopia – Giving your eyes a break from reading a book or the computer screen is common wisdom (that many of us probably have trouble following). However, myopia treatment takes this a step further.
Myopia control view – Multifocal or bifocal glasses and multifocals contacts give the child different corrections for distance viewing and near viewing. The theory here is that the near viewing through an add power reduces the strain of close work. Although studies haven’t found much clinical benefit from bifocal glasses as from the multifocal contacts, researchers think it may be due to children not being able to use the bifocal lenses correctly (looking thru the right part for the particular activity at hand).
Myopia reversal view – Similarly, many myopia reversal methods also include wearing either a reduced RX or plus lenses for near work to reduce strain.
Outdoor time affects myopia – Spending time outdoors is believed to play a central role in vision.
Myopia control view – Research in myopia control is full of studies on the possible link between myopia and time spent outdoors. It is believed that spending more time outdoors (3 hours/day) can help prevent myopia in children (although studies find that it’s not helpful once myopia has begun). Although there are many theories (i.e., the eye needs vitamin D, outdoor time replaces screen/reading time, being outdoors skews the eyes towards using distance vision, etc.), it’s also not clear why the outdoor time may prevent the eye from growing too much.
Myopia reversal view – Jake Steiner’s endmyopia.org frequently posts about the importance of incorporating outdoor time into part of the rehabilitation. While myopia control researchers still don’t feel that they have found the reason that outdoor time is beneficial, Mr. Steiner believes that outdoor time spent actively trying to see things more clearly is the reason that outdoor time can improve vision.
The effects of both treatments are variable in individuals – both research and anecdotal evidence show that neither myopia control nor reversal methods are guaranteed to work. Researchers don’t know why myopia control works for some children but not so much in others. I haven’t found any formal myopia reversal studies on adults – perhaps I just haven’t logged enough hours in the search. Nevertheless, the treatments do seem to work for many adults anecdotally and definitely for many children.
This Medium post by an Australian optometrist describes how the traditional approach of glasses for children is becoming outdated and that myopia is becoming recognized as a condition that can be treated: