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Approximately 1 in 9 women in the United States experiences symptoms of postpartum depression, according to the Centers for Disease Control and Prevention. Now, the Food and Drug Administration (FDA) has approved brexanolone, an analog of the endogenous human hormone allopregnanolone and the first drug specifically designed to treat postpartum depression.

Some psychiatric drugs owe their discovery to chance — serendipitous observations of clinical benefit — or a process of incremental improvement based on drugs previously discovered by chance. Not so with brexanolone, which has a truly novel mechanism of action and was developed by design, thanks to a series of basic and translational neuroscience studies. FDA approval represents the final phase of a bench-to-bedside journey for this drug — a journey that began in the NIMH Intramural Research Program (IRP).

In the 1980s, NIMH IRP researchers discovered that metabolites (products formed when the body breaks down or “metabolizes” other substances) of the steroid hormones progesterone and deoxycorticosterone bound to and acted upon receptors for gamma-aminobutyric acid (GABA) — a major inhibitory neurotransmitter in the brain. These steroids were found to amplify GABA-activated chloride ion currents, thereby impacting the excitability of neurons.

This finding led to a series of studies, completed by researchers in the NIMH IRP and by researchers at institutions funded by NIMH, that clarified how these metabolites fluctuate during times of stress and during the estrous cycle in rats and the menstrual cycle in humans. Research indicated that the concentration of one of these metabolites (allopregnanolone) increases during pregnancy, but then drops after birth. In some women, this drop triggers the development of depression and anxiety.

A biopharmaceutical company utilized these basic research findings to develop brexanolone, a drug that can be used to treat postpartum depression by restoring levels of this metabolite. Successful clinical trials have led to FDA approval of an injectable version of this drug.

Want to learn more about this story? NIMH experts are available to provide information on postpartum depression and the importance of, and the science underlying, brexanolone.

Who:

• Joshua Gordon, M.D., Ph.D., NIMH Director
• Peter Schmidt, M.D., Chief of the Behavioral Endocrinology Branch, part of NIMH IRP
• Mi Hillefors, M.D., Ph.D., Chief of the Translational Therapeutics Program, Division of Translational Research

For interviews, photos, or additional background information, please contact the NIMH Press Office at 301-443-4536 or NIMHpress@nih.gov.

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

NIH…Turning Discovery Into Health^®

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When Therapy Doesn’t Work

What to do next

Joel L. Young, M.D.

For many people, therapy is a treatment of last resort. A depressed person, for instance, might delay therapy for months or even years, only to give in when his symptoms become so terrible that anything seems preferable to living another day with depression.  Because therapy patients often view therapy as a panacea—and one which they’ll only try when life gets impossible—the disappointment you feel when therapy doesn’t work can be deep, cutting, and profoundly demoralizing.

Mental illness is just like any other health condition, though. Whether it’s difficulty coping with stress or something more serious, such as post-traumatic stress disorder, the first treatment doesn’t always work. If you had heart disease, you wouldn’t throw up your hands and give up if your first medication didn’t yield results, so don’t do the same with therapy! If therapy has failed you, you still have plenty of options for feeling better.

Ask Your Therapist About Next Steps

If therapy isn’t working, the first person you should talk to is your therapist. She may opt to change her approach to treatment, pursue more “homework” options for you, or even refer you to another therapist.

Be sure to ask the following questions:

• How long should it take for me to see results?
• What treatment method are we using, and is it too early to try a different approach?
• Is there anything I can do to increase the efficacy of therapy?
• Could medication help? What about lifestyle changes?

Pursue Lifestyle Changes

Therapy is just one step in your treatment journey, not the whole journey. One of the greatest benefits of therapy is that your therapist can give you the confidence and strength you need to pursue lifestyle treatments. A good therapist can also recommend changes you can make that might improve your prognosis. Every person is different, and every mental health condition demands slightly different treatment. Generally speaking, though, the following lifestyle changes can often help you combat mental illnesses:

• Developing a regular schedule and taking time each day to plan your day. Remember, time is exactly like money, and by budgeting your time, you may find you have more of it—not to mention less stress.
• Take steps to ensure your lifestyle and environment are healthy. If you are in an abusive relationship, leave. If conflict with loved ones is an ongoing problem, work to resolve these conflicts.
• Eat a balanced, healthy diet rich in lean proteins, fruits, and veggies.
• Get at least 150 minutes of cardiovascular activity each week.
• Commit to a regular sleep schedule, getting up and going to bed at the same time each night. Aim for seven to eight hours of sleep.
• Start meditating. If meditation is not your style, try another activity that forces you to slow down and focus on your breathing, such as yoga or mindfulness-based cognitive therapy.

Do Your Homework

Therapy isn’t brain magic. There’s nothing your therapist can say that will mysteriously re-scramble things in your brain, immediately making your life better. Instead, therapy is hard work. Just as you’ll never learn algebra if you don’t do your math homework, you’ll never learn to better manage your emotions and life if you don’t do your therapy homework. By following your therapist’s assignments, you enable yourself to adopt new coping mechanisms and move beyond the struggles of the past.

But what if your therapist doesn’t give you homework? Homework doesn’t have to be specific or involve paper. Instead, it’s simply a matter of doing the things your therapist suggests with an open mind. If he asks you to focus on saying no less, give it a shot before rejecting it out of hand. And if your therapist doesn’t give you homework, it’s time to start asking for some—or begin working with a therapist who is a bit more proactive.

Try a New Therapist

The single best predictor of whether therapy will work is whether you and your therapist is a good fit. A therapist who accepts your values, understands your emotions, and who makes you feel accepted and heard is key to therapy. If your therapist isn’t offering you this, it’s time to try someone else.

What if you like your therapist but therapy’s just not going where you want it? It’s not enough to like your therapist, and there’s huge differences in competence from therapist to therapist. If therapy’s not working, consider whether your therapist is the right one for you. If your therapist hasn’t done at least the following, it’s time to move on:

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• Talked with you about treatment options and advised on what you can do to increase the effectiveness of therapy.
• Set specific treatment goals and given you a timetable for when you can see results
• Talked to you about medication for your mental health condition.
• Given you a diagnosis or a clear picture of what you’re in therapy to work on.
• Given you clear, specific recommendations for homework and other activities you can do to build upon what you’re learning in therapy.

Talk to Your Doctor

Research suggests that, for many mental health conditions, combining therapy with medication is the single most effective way to see results. If therapy’s not working, it’s time to consider taking medication. But medication is not the only thing your doctor can help you with. Health problems can interfere with your progress, and some physical health problems masquerade as mental health problems. The sluggishness some people experience with hypothyroidism, for example, can mimic common symptoms of depression. It could be that you’re struggling with an easily treated health problem, so ask for blood work and give your doctor a specific, detailed list of your symptoms and health history.

It can be deeply frustrating when therapy doesn’t work, but this is just the beginning of the journey, not the end. If you’re willing to research your condition, be a good advocate for yourself, and keep trying until something works, you can feel better sooner than you expect.

Discipline Basics
Often parents wonder how they can create an environment in their homes and in their relationships with their children that will nurture their children’s ability to meet the challenges they will confront as they grow and move out into the world. The kind of discipline you use can have a big influence on this.
There are three main parenting styles that are most commonly used.

• What distinguishes one from the other is the amount and kind of structure that the family has in place and the kind of discipline it imposes.
• These different approaches exist on the arc of a pendulum from the loosest organization to the most rigid.
• Most families are blends of all three strategies, usually with one approach being dominant.

The Three Parenting Styles
These three styles are called the Permissive style, the Aggressive style, and the Assertive style.

Let’s take a look at three different ways a parent might handle the same situation: an eight-year-old leaves his things all over the family room floor even after being asked numerous times to pick up after himself.

Permissive Style
“Oh Honey, I see your stuff is still left out. I guess you were too busy to clean up. I’ll clean-up for you so you can find everything next time you want to play with them.”

This parent demonstrates what is called the Permissive style that relies most heavily on the nurture role, but without offering enough structure.

This parent does not hold the child accountable for cleaning up his items and does not show herself to be the authority figure in the home.

Clues that you are using the Permissive Style
• Evading discipline issues
• Begging for cooperation
• Acting flustered
• Being unclear or indirect in your requests
• Being a martyr versus asking for what you need
• Worrying about being “liked” by your child
• Fearing that you may upset your child
• Blaming yourself and taking all the responsibility when problems arise
• Being inconsistent with expectations

Results of Using the Permissive Style
• Your child does not learn to respect you.
• He is not held accountable for his behavior.
• Proper limits are not set.
• Your child has too much power in the house.
• He does not learn to be responsible to fulfill obligations.
• He is not encouraged to learn the tasks of everyday living that he will need as an adult.

As a result, your child will not build healthy self-esteem. It also damages the relationship between you and your child.

When you use a permissive style of parenting, you do not show yourself to be “in-charge,” and as a result, your child will be less likely to turn to you for guidance in other situations in his life.

Aggressive Style
“I’m sick and tired of seeing your things all over the room. Why are you such an irresponsible slob? That’s it for you – you are grounded for a week and I’m throwing out all your things.”

This parent demonstrates the other end of the discipline pendulum, which is called the Aggressive style of parenting. It relies most heavily on the structure role, while not including enough caring and nurture.

A parent using this style refuses to listen to the child’s point of view at all and is typically harsh, angry, and cold.

Clues that you are using the Aggressive Style
• Having many power struggles
• Accusing your child of having bad intentions
• Discrediting your child’s ideas
• Tricking, teasing, humiliating your child
• Doling out harsh punishments
• Rigidly enforcing rules
• Withholding information about expectations
• Having a litany of strict rules

Results of Using the Aggressive Style
• The self-esteem of your child is damaged because he does not feel understood or supported.
• The parent-child relationship is weakened as your child would not feel that you are someone he could turn to if he had a problem.
• Children from these families often become either overly submissive or rebellious.

Assertive Style
“Jon, I see your games are still not put away as I asked you to do. It is really bothering me that I can’t count on you to take care of your things and I can’t stand seeing the family room be such a mess. We need to come up with a plan for you to put your things away. Until we can agree upon a plan, there are no electronics for you.”
This parent demonstrates the third style of discipline which falls in between the two extremes and is called the Assertive approach to parenting.
Parents using this approach are willing to listen and yet still hold firm so that the parent’s and the child’s needs are both basically met.
When setting limits, the parent does not get sidetracked, can provide choices, and allows the child an opportunity to participate in finding a solution.

Clues that you are using the Assertive Style
• Persisting until your requests are followed
• Listening to your child’s point of view
• Giving brief reasons
• Revealing honest feelings
• Politely refusing
• Empathizing
• Setting reasonable consequences
• Accepting your need to be “in-charge”
• Not blaming your child
• Making clear, direct requests
• Having rules that are flexible

Results of Using the Assertive Style
This style:
• Is most successful because it uses a healthy balance of both nurture and structure.
• Raises your child’s self-esteem because you communicate that your child is lovable and loved and worthy of respect.
• Communicates that your child is capable of meeting the demands that life places on him – he can tolerate some frustration and he can contribute to solving the problems he encounters.

• Builds a strong parent-child relationship, as your child realizes that he can depend on you to both understand his struggles and provide guidance and support. When you use an Assertive style of parenting, your child is more likely to come to you for direction in the future as issues arise in his life.

Benefits to Children
They:
• See you as a source of support.
• Have a sense of safety because rules are in place.
• Feel lovable and worthy of being cared for.
• Feel listened to and understood.
• Develop basic feelings of trust in relationships.
• Learn to be kind to other people.
• Consider another person’s point of view.
• Learn to tolerate frustration and disappointment.
• Learn to be responsible and to make decisions.
• Learn that they are capable of doing things.
• Become more independent.
• Learn they can tackle difficult situations.

Tips for Using an Assertive Parenting Style
Your children see you modeling assertiveness as you take care of and respect yourself and others. To use an Assertive approach:

• LISTEN
When your children talk about things that may bother them, acknowledge their feelings and let them know you have heard them.
• Be respectful
When you discipline, you can set limits without blaming or shaming your children.
• Model
Exhibit the behavior you would like your children to exhibit.
• Give children choices
When possible give your kids opportunities to make decisions on issues that effect them. This is respectful, encourages independence, and shows you have trust in them.
Your children are more likely to cooperate when they have had a say in the decision-making.
• Send clear messages about your expectations
• Establish clear rules
Know that it is in your children’s best interest to have clear rules that are consistently enforced with persistence, love, and warmth.
• Use praise
Praise your children for positive behavior that you would like to see repeated: “Catch them being good.”
• Plan ahead
To avoid problems, anticipate situations that might be difficult for your children. Prepare them for such times.
• Follow through with discipline and consequences
• Be consistent
Also allow for sufficient flexibility to accommodate specific situations and your unique child.

Summary of Three Parenting Styles

BY ANDREA ROMANO

If you’re feeling down or burnt out, it might be time to get back into nature.

According to Niels Eék, psychologist and co-founder of mental wellbeing and self-development platform Remente, spending time in nature may be the key to good mental health.

“Several researchers have looked into the health benefits connected to spending time out in nature. One study specifically, which was recently published in BioScience Journal, found that daily exposure to nature can, among other things, help reduce feelings of stress and even improve your self-esteem, for up to seven hours. Reconnecting with nature can also help you become more mindful and present in the moment,” Eék said in a statement.

Moreover, a study from the University of Michigan suggests that being in nature not only improves your mood for the time, but also has positive long-term effects when it comes to depression and memory, as well as decreasing the risk of certain cancers and high blood pressure.

So what should you do to boost your mental health effectively in nature? Well, there is always camping, biking and hiking, but some experts believe the best way to take care of your mind is to go on a fishing trip.

An Australian survey funded by the Recreational Fishing Initiatives Scheme reports relaxation and stress relief are the main benefits people get from recreational fishing, according to reps for Fishbrain, a mobile app and social network for people who love to fish.

The free app has attracted millions of users who have discovered fishing as their newfound self-care hobby. The app uses an interactive map to allow users to find the best places to fish, as well as record their catches, plan trips, share tips and techniques, and purchase the latest gear.

“Fishing is one of the most popular sports in the world and one of only a few truly global hobbies,” Johan Attby, CEO and founder of Fishbrain, said in a statement “With data and sophisticated technology at its core, and an engaged community as its heart, Fishbrain has become a social network that both inspires and equips users across the globe to have more fun by fishing smarter, not harder.”

So it’s easier than ever to go fishing, even if you’re a newbie, without the added stress of not catching anything.

Fishbrain’s users can attest to the mental health benefits of fishing. “Fishing has become critical to my mental health. My job as a sales/production manager can be quite stressful at times, and nothing relieves stress and centers me like fishing,” said Gabe Beaudry of Central Oregon.

“Going fishing outdoors increases your vitamin D, which helps regulate the amount of calcium and phosphate in your body, keeping your bones and teeth healthy. It boosts your immune system and has been linked to fighting depression,” added Chasten Whitfield of Cortez, Florida.

As a parent, you may have wondered how best to help your children learn to make positive choices. One way to set your children up for success is to establish strong boundaries in your home.

It’s essential to begin instructing your children about boundaries between themselves and others very early on in their childhood. A child who grows up in a home where healthy limits are well established will learn to apply such boundaries in his or her own life, thus developing better self-control and the capacity to make positive choices.

What Does “Boundary” mean?

A boundary signifies a limit that a person has for themselves. Limits that people set can be physical or emotional boundaries.

1. Physical boundaries. This limit can be physical and tangible, such as one’s own body parts. This involves explaining to a child that his body belongs only to himself and that nobody else teaches him to develop a sense of his physical self. Explaining, “Daddy’s body belongs to him” and “Your body belongs to you” is a good place to start.

2. Emotional boundaries. Another type of boundary is more emotional than physical. Teaching children that it’s not okay to say hurtful things to others is an example of an emotional boundary. Teasing would be another way of crossing a person’s emotional boundaries.

In a sense, boundaries are rules that you live by. Living with boundaries basically means, “I won’t do anything to harm you” and “I expect you not to do anything to harm me, but if you do, I’ll let you know.”

Teaching Boundaries:
When you’re raising kids to have healthy boundaries, it’s important to allow your children to have and express their own feelings. This one can be pretty tough as it isn’t unusual for some parents to try to suppress a child’s healthy behavioral expression.
For example, if a 4-year-old starts crying and stomps her feet, what would you do as a parent? One healthy strategy to ensure your 4-year-old develops healthy boundaries is to help her label her feelings. Say something like, “I see that you’re frustrated that you can’t have the candy right now. Maybe you can have some candy after dinner.” Then, move on with life.

You helped her to label her emotions. You chose not to punish her or demand that she stop crying or “Straighten up right now.” As a parent, you just showed acceptance of your child’s feelings. Each time you behave this way as a parent, you’re reinforcing your child’s natural sense of self and boundaries.

Another example is a two or three-year who throws a toy at their sibling. Again, tell your child that it’s okay to have and express angry feelings, but it’s not okay to throw a toy at others. During the episode, show no feelings. When you’re establishing boundaries, it’s time to be diplomatic. Be firm, but not frustrated or angry.

Simply state, “It’s not okay to throw a toy at your brother. When you throw a toy, you have to sit in a chair,” and say nothing more until the minutes have passed. Have your child sit in a chair for the number of minutes that matches their age (if they’re two years old, they sit for 2 minutes; 3 years old, 3 minutes).

After the time is up, thank your child for sitting in the chair and go on with your day. Hopefully, your child will not throw a toy again. Instead, he or she will see that you allowed them to have and show feelings without negative consequences, as long as they stayed within your boundary.

Expect your children to occasionally “test the limit,” or challenge your boundary–this is completely normal. When these testing behaviors occur, think of each situation as an opportunity to show your kids the consequences of crossing the line.

Sometimes, there will be situations when you find it prudent to explain some boundary situations or “rules” to your child. For example, telling your child that no one but a doctor when Mom or Dad is also present should touch your child where their bathing suit fits is an effective way to teach limits and boundaries related to his or her own body.

Modeling Boundaries

Ultimately, the single best way to teach children healthy boundaries is for parents to have healthy boundaries themselves and to model them in the home.

Showing respect for each person in the house, ensuring everyone has rights to their feelings and appropriate expressions of them, as well as talking openly and honestly about any challenging issues demonstrate healthy boundaries for children.

From the time your children are born, you’re charged to teach them many things so they’ll grow up to make positive choices in life. Help create happier, healthier lives for your kids by teaching your children about limits and boundaries.

Parents who ensure their kids grow up learning about limits and boundaries provide a solid foundation for their children’s futures. Apply some of these methods in your home to teach your kids about having and maintaining healthy limits and boundaries, and your kids will thrive.

Preschoolers (3-5 years of age)
Developmental Milestones
Skills such as naming colors, showing affection, and hopping on one foot are called developmental milestones. Developmental milestones are things most children can do by a certain age. Children reach milestones in how they play, learn, speak, behave, and move (like crawling, walking, or jumping).

As children grow into early childhood, their world will begin to open up. They will become more independent and begin to focus more on adults and children outside of the family. They will want to explore and ask about the things around them even more. Their interactions with family and those around them will help to shape their personality and their own ways of thinking and moving. During this stage, children should be able to ride a tricycle, use safety scissors, notice a difference between girls and boys, help to dress and undress themselves, play with other children, recall part of a story, and sing a song.

For more details on developmental milestones, warning signs of possible developmental delays, and information on how to help your child’s development, visit the “Learn the Signs. Act Early.” campaign website. http://www.cdc.gov/ncbddd/actearly/index.html

Positive Parenting Tips

Following are some things you, as a parent, can do to help your preschooler during this time:

• Continue to read to your child. Nurture her love for books by taking her to the library or bookstore.
• Let your child help with simple chores.
• Encourage your child to play with other children. This helps him to learn the value of sharing and friendship.
• Be clear and consistent when disciplining your child. Explain and show the behavior that you expect from her. Whenever you tell her no, follow up with what he should be doing instead.
• Help your child develop good language skills by speaking to him in complete sentences and using “grown up” words. Help him to use the correct words and phrases.
• Help your child through the steps to solve problems when she is upset.
• Give your child a limited number of simple choices (for example, deciding what to wear, when to play, and what to eat for snack).

Child Safety First
As your child becomes more independent and spends more time in the outside world, it is important that you and your
child are aware of ways to stay safe. Here are a few tips to protect your child:

• Tell your child why it is important to stay out of traffic. Tell him not to play in the street or run after stray balls.
• Be cautious when letting your child ride her tricycle. Keep her on the sidewalk and away from the street and always have her wear a helmet.
• Check outdoor playground equipment. Make sure there are no loose parts or sharp edges.
• Watch your child at all times, especially when he is playing outside.
• Be safe in the water. Teach your child to swim, but watch her at all times when she is in or around any body of water (this includes kiddie pools).
• Teach your child how to be safe around strangers.
• Keep your child in a forward-facing car seat with a harness until he reaches the top height or weight limit allowed by the car seat’s manufacturer. Once your child outgrows the forward-facing car seat with a harness, it will be time for him to travel in a booster seat, but still in the back seat of the vehicle. The National Highway Traffic Safety Administration has information on how to keep your child safe while riding in a vehicle.

Healthy Bodies

• Eat meals with your child whenever possible. Let your child see you enjoying fruits, vegetables, and whole grains at meals and snacks. Your child should eat and drink only a limited amount of food and beverages that contain added sugars, solid fats, or salt.
• Limit screen time for your child to no more than 1 to 2 hours per day of quality programming, at home, school, or child care.
• Provide your child with age-appropriate play equipment, like balls and plastic bats, but let your preschooler choose what to play. This makes moving and being active fun for your preschooler.

A pdf of this document for reprinting is available free of charge from
http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/preschoolers.html

Additional Information:
http://www.cdc.gov/childdevelopment
1-800-CDC-INFO (800-232-4636) http://www.cdc.gov/info

Middle Childhood (6-8 years of age)
Developmental Milestones
Middle childhood brings many changes in a child’s life. By this time, children can dress themselves, catch a ball more easily using only their hands, and tie their shoes. Having independence from family becomes more important now. Events such as starting school bring children this age into regular contact with the larger world. Friendships become more and more important. Physical, social, and mental skills develop quickly at this time. This is a critical time for children to develop confidence in all areas of life, such as through friends, schoolwork, and sports.

Here is some information on how children develop during middle childhood:

Emotional/Social Changes
Children in this age group might:

• Show more independence from parents and family.
• Start to think about the future
• Understand more about his or her place in the world.
• Pay more attention to friendships and teamwork.
• Want to be liked and accepted by friends.

Thinking and Learning

• Children in this age group might.
• Show rapid development of mental skills.
• Learn better ways to describe experiences and talk about thoughts and feelings.
• Have less focus on one’s self and more concern for others.

Positive Parenting Tips
Following are some things you, as a parent, can do to help your child during this time:

• Show affection for your child. Recognize her accomplishments.
• Help your child develop a sense of responsibility—ask him to help with household tasks, such as setting the table.
• Talk with your child about school, friends, and things she looks forward to in the future.
• Talk with your child about respecting others. Encourage him to help people in need.
• Help your child set her own achievable goals—she’ll learn to take pride in herself and rely less on approval or reward from others.
• Help your child learn patience by letting others go first or by finishing a task before going out to play. Encourage him to think about possible consequences before acting.
• Make clear rules and stick to them, such as how long your child can watch TV or when she has to go to bed. Be clear about what behavior is okay and what is not okay.\
• Do fun things together as a family, such as playing games, reading, and going to events in your community. Positive Parenting Tips for Healthy Child Development
• Get involved with your child’s school. Meet the teachers and staff and get to understand their learning goals and how you and the school can work together to help your child do well.
• Continue reading to your child. As your child learns to read, take turns reading to each other.
• Use discipline to guide and protect your child, rather than punishment to make him feel bad about himself. Follow up any discussion about what not to do with a discussion of what to do instead.
• Praise your child for good behavior. It’s best to focus praise more on what your child does (“you worked hard to figure this out”) than on traits she can’t change (“you are smart”).
• Support your child in taking on new challenges. Encourage her to solve problems, such as a disagreement with another child, on her own.
• Encourage your child to join school and community groups, such as a team sports, or to take advantage of volunteer opportunities.

Child Safety First
More physical ability and more independence can put children at risk for injuries from falls and other accidents. Motor vehicle crashes are the most common cause of death from unintentional injury among children this age.

• Protect your child properly in the car. For detailed information, see the American Academy of Pediatrics’ Car Safety Seats: A Guide for Families.
• Teach your child to watch out for traffic and how to be safe when walking to school, riding a bike, and playing outside.
• Make sure your child understands water safety, and always supervise her when she’s swimming or playing near water.
• Supervise your child when he’s engaged in risky activities, such as climbing.
• Talk with your child about how to ask for help when she needs it.
• Keep potentially harmful household products, tools, equipment, and firearms out of your child’s reach.

Healthy Bodies

• Parents can help make schools healthier. Work with your child’s school to limit access to foods and drinks with added sugar, solid fat, and salt that can be purchased outside the school lunch program.
• Make sure your child has 1 hour or more of physical activity each day.
• Limit screen time for your child to no more than 1 to 2 hours per day of quality programming, at home, school, or afterschool care.
• Practice healthy eating habits and physical activity early. Encourage active play, and be a role model by eating healthy at family mealtimes and having an active lifestyle.

A pdf of this document for reprinting is available free of charge from
http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle.html

Additional Information:
http://www.cdc.gov/childdevelopment
1-800-CDC-INFO (800-232-4636) http://www.cdc.gov/info

Middle Childhood (9-11 years of age)

Developmental Milestones
Your child’s growing independence from the family and interest in friends might be obvious by now. Healthy friendships are very important to your child’s development, but peer pressure can become strong during this time. Children who feel good about themselves are more able to resist negative peer pressure and make better choices for themselves. This is an important time for children to gain a sense of responsibility along with their growing independence. Also, physical changes of puberty might be showing by now, especially for girls. Another big change children need to prepare for during this time is starting middle or junior high school.

Here is some information on how children develop during middle childhood:

Emotional/Social Changes
Children in this age group might:

• Start to form stronger, more complex friendships and peer relationships. It becomes more emotionally important to have friends, especially of the same sex.
• Experience more peer pressure.
• Become more aware of his or her body as puberty approaches. Body image and eating problems sometimes start around this age.

Thinking and Learning
Children in this age group might:

• Face more academic challenges at school.
• Become more independent from the family.
• Begin to see the point of view of others more clearly.
• Have an increased attention span.

Positive Parenting Tips
Following are some things you, as a parent, can do to help your child during this time:

• Spend time with your child. Talk with her about her friends, her accomplishments, and what challenges she will face.
• Be involved with your child’s school. Go to school events; meet your child’s teachers.
• Encourage your child to join school and community groups, such as a sports team, or to be a volunteer for a charity.
• Help your child develop his own sense of right and wrong. Talk with him about risky things friends might pressure him to do, like smoking or dangerous physical dares.
• Help your child develop a sense of responsibility—involve your child in household tasks like cleaning and cooking. Talk with your child about saving and spending money wisely.
• Meet the families of your child’s friends.
• Talk with your child about respecting others. Encourage her to help people in need. Talk with her about what to do when others are not kind or are disrespectful. Positive Parenting Tips for Healthy Child Development
• Help your child set his own goals. Encourage him to think about skills and abilities he would like to have and about how to develop them.
• Make clear rules and stick to them. Talk with your child about what you expect from her (behavior) when no adults are present. If you provide reasons for rules, it will help her to know what to do in most situations.
• Use discipline to guide and protect your child, instead of punishment to make him feel badly about himself.
• When using praise, help your child think about her own accomplishments. Saying “you must be proud of yourself” rather than simply “I’m proud of you” can encourage your child to make good choices when nobody is around to praise her.
• Talk with your child about the normal physical and emotional changes of puberty.
• Encourage your child to read every day. Talk with him about his homework.
• Be affectionate and honest with your child, and do things together as a family.

Child Safety First
More independence and less adult supervision can put children at risk for injuries from falls and other accidents. Here
are a few tips to help protect your child:

• Protect your child in the car. The National Highway Traffic Safety Administration recommends that you keep your child in a booster seat until he is big enough to fit in a seat belt properly. Remember: your child should still ride in the back seat until he or she is 12 years of age because it’s safer there. Motor vehicle crashes are the most common cause of death from unintentional injury among children of this age.
• Know where your child is and whether a responsible adult is present. Make plans with your child for when he will call you, where you can find him, and what time you expect him home.
• Make sure your child wears a helmet when riding a bike or a skateboard or using inline skates; riding on a motorcycle, snowmobile, or all-terrain vehicle; or playing contact sports.
• Many children get home from school before their parents get home from work. It is important to have clear rules and plans for your child when she is home alone.

Healthy Bodies

• Provide plenty of fruits and vegetables; limit foods high in solid fats, added sugars, or salt, and prepare healthier foods for family meals.
• Keep television sets out of your child’s bedroom. Limit screen time, including computers and video games, to no more than 1 to 2 hours.
• Encourage your child to participate in an hour a day of physical activities that are age appropriate and enjoyable and that offer variety! Just make sure your child is doing three types of activity: aerobic activity like running, muscle strengthening like climbing, and bone strengthening – like jumping rope – at least three days per week.

A pdf of this document for reprinting is available free of charge from
http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle2.html
Additional Information:
http://www.cdc.gov/childdevelopment
1-800-CDC-INFO (800-232-4636) http://www.cdc.gov/inf

Young Teens (12-14 years of age)
Developmental Milestones

This is a time of many physical, mental, emotional, and social changes. Hormones change as puberty begins. Most boys
grow facial and pubic hair and their voices deepen. Most girls grow pubic hair and breasts, and start their period. They
might be worried about these changes and how they are looked at by others. This also will be a time when your teen
might face peer pressure to use alcohol, tobacco products, and drugs, and to have sex. Other challenges can be eating
disorders, depression, and family problems. At this age, teens make more of their own choices about friends, sports,
studying, and school. They become more independent, with their own personality and interests, although parents are
still very important.
Here is some information on how young teens develop:

Emotional/Social Changes
Children in this age group might:

• Show more concern about body image, looks, and clothes.
• Focus on themselves; going back and forth between high expectations and lack of confidence.
• Experience more moodiness.
• Show more interest in and influence by peer group.
• Express less affection toward parents; sometimes might seem rude or short-tempered.
• Feel stress from more challenging school work.
• Develop eating problems.
• Feel a lot of sadness or depression, which can lead to poor grades at school, alcohol or drug use, unsafe sex, and other problems.

Thinking and Learning
Children in this age group might:

• Have more ability for complex thought.
• Be better able to express feelings through talking.
• Develop a stronger sense of right and wrong.

Positive Parenting Tips
Following are some things you, as a parent, can do to help your child during this time:

• Be honest and direct with your teen when talking about sensitive subjects such as drugs, drinking, smoking, and sex.
• Meet and get to know your teen’s friends.\
• Show an interest in your teen’s school life.
• Help your teen make healthy choices while encouraging him to make his own decisions.
• Respect your teen’s opinions and take into account her thoughts and feelings. It is important that she knows you are listening to her.
• When there is a conflict, be clear about goals and expectations (like getting good grades, keeping things clean, and showing respect), but allow your teen input on how to reach those goals (like when and how to study or clean).

Child Safety First
You play an important role in keeping your child safe―no matter how old he or she is. Here are a few tips to help
protect your child:

• Make sure your teen knows about the importance of wearing seatbelts. Motor vehicle crashes are the leading cause of death among 12- to 14-year-olds.
• Encourage your teen to wear a helmet when riding a bike or a skateboard or using inline skates; riding on a motorcycle, snowmobile, or all-terrain vehicle; or playing contact sports. Injuries from sports and other activities are common.
• Talk with your teen about the dangers of drugs, drinking, smoking, and risky sexual activity. Ask him what he knows and thinks about these issues, and share your thoughts and feelings with him. Listen to what she says and answer her questions honestly and directly.
• Talk with your teen about the importance of having friends who are interested in positive activities. Encourage her to avoid peers who pressure her to make unhealthy choices.
• Know where your teen is and whether an adult is present. Make plans with him for when he will call you, where you can find him, and what time you expect him home.
• Set clear rules for your teen when she is home alone. Talk about such issues as having friends at the house, how to handle situations that can be dangerous (emergencies, fire, drugs, sex, etc.), and completing homework or household tasks.

Healthy Bodies

• Encourage your teen to be physically active. She might join a team sport or take up an individual sport. Helping with household tasks such as mowing the lawn, walking the dog, or washing the car also will keep your teen active.
• Meal time is very important for families. Eating together helps teens make better choices about the foods they eat, promotes healthy weight, and gives your family members time to talk with each other.
• Limit screen time for your child to no more than 1 to 2 hours per day of quality programming, at home, school, or afterschool care.

A pdf of this document for reprinting is available free of charge from
http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/adolescence.html

Additional Information:
http://www.cdc.gov/childdevelopment
1-800-CDC-INFO (800-232-4636) http://www.cdc.gov/info

Teenagers (15-17 years of age)
Developmental Milestones
This is a time of changes for how teenagers think, feel, and interact with others, and how their bodies grow. Most girls will be physically mature by now, and most will have completed puberty. Boys might still be maturing physically during this time. Your teen might have concerns about her body size, shape, or weight. Eating disorders also can be common, especially among girls. During this time, your teen is developing his unique personality and opinions. Relationships with friends are still important, yet your teen will have other interests as he develops a more clear sense of who he is. This is also an important time to prepare for more independence and responsibility; many teenagers start working, and many will be leaving home soon after high school.

Here is some information on how teens develop:

Emotional/Social Changes
Children in this age group might:

• Have more interest in romantic relationships and sexuality.
• Go through less conflict with parents.
• Show more independence from parents.
• Have a deeper capacity for caring and sharing and for developing more intimate relationships.
• Spend less time with parents and more time with friends.
• Feel a lot of sadness or depression, which can lead to poor grades at school, alcohol or drug use, unsafe sex, and other problems.

Thinking and Learning
Children in this age group might:

• Learn more defined work habits.
• Show more concern about future school and work plans.
• Be better able to give reasons for their own choices, including about what is right or wrong.

Positive Parenting Tips
Following are some things you, as a parent, can do to help your teen during this time:

• Talk with your teen about her concerns and pay attention to any changes in her behavior. Ask her if she has had suicidal thoughts, particularly if she seems sad or depressed. Asking about suicidal thoughts will not cause her to have these thoughts, but it will let her know that you care about how she feels. Seek professional help if necessary.
• Show interest in your teen’s school and extracurricular interests and activities and encourage him to become involved in activities such as sports, music, theater, and art.
• Encourage your teen to volunteer and become involved in civic activities in her community.
• Compliment your teen and celebrate his efforts and accomplishments.
• Show affection for your teen. Spend time together doing things you enjoy.
• Respect your teen’s opinion. Listen to her without playing down her concerns.
• Encourage your teen to develop solutions to problems or conflicts. Help your teenager learn to make good decisions. Create opportunities for him to use his own judgment, and be available for advice and support.
• If your teen engages in interactive internet media such as games, chat rooms, and instant messaging, encourage her to make good decisions about what she posts and the amount of time she spends on these activities.
• If your teen works, use the opportunity to talk about expectations, responsibilities, and other ways of behaving respectfully in a public setting.
• Talk with your teen and help him plan ahead for difficult or uncomfortable situations. Discuss what he can do if he is in a group and someone is using drugs or under pressure to have sex, or is offered a ride by someone who has been drinking.
• Respect your teen’s need for privacy.
• Encourage your teen to get enough sleep and exercise, and to eat healthy, balanced meals.
• Encourage your teen to have meals with the family. Eating together will help your teen make better choices about the foods she eats, promote healthy weight, and give family members time to talk with each other. In addition, a teen who eats meals with the family is more likely to have better grades and less likely to smoke, drink, or use drugs. She is also less likely to get into fights, think about suicide, or engage in sexual activity.

Child Safety First
You play an important role in keeping your child safe―no matter how old he or she is. Here are a few tips to help protect your child:

• Talk with your teen about the dangers of driving and how to be safe on the road. You can steer your teen in the right direction. CDC’s “Parents Are the Key” campaign has steps that can help. Motor vehicle crashes are the leading cause of death from unintentional injury among teens, yet few teens take measures to reduce their risk of injury.
• Remind your teen to wear a helmet when riding a bike, motorcycle, or all-terrain vehicle. Unintentional injuries resulting from participation in sports and other activities are common.
• Talk with your teen about suicide and pay attention to warning signs. Suicide is the third leading cause of death among youth 15 through 24 years of age.
• Talk with your teen about the dangers of drugs, drinking, smoking, and risky sexual activity. Ask him what he knows and thinks about these issues, and share your feelings with him. Listen to what he says and answer his questions honestly and directly.
• Discuss with your teen the importance of choosing friends who do not act in dangerous or unhealthy ways.
• Know where your teen is and whether a responsible adult is present. Make plans with her for when she will call you, where you can find her, and what time you expect her home.

A pdf of this document for reprinting is available free of charge from
http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/adolescence2.html

Additional Information:
http://www.cdc.gov/childdevelopment
1-800-CDC-INFO (800-232-4636) http://www.cdc.gov/info