Tips for Coping With Child Anxieties: For Back-to-School and Beyond

For many kids, the back-to-school season stirs up nervous feelings.

“It’s normal for anxiety to gear up before kids go back to school. Some are able to adapt, and that anxiety soon fades away. But others continue to experience heightened stress and worry,” says Saniya Tabani, PhD, Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai and a licensed clinical psychologist at The Mount Sinai Hospital.

Whether a child is experiencing short-term back-to-school jitters or something more long lasting, parents and caregivers can do a lot to support them.

“It’s common for kids and teens to experience anxiety. But we’ve also seen great strides in our understanding of anxiety, and there are resources in place to help them,” Dr. Tabani says.

Some nerves are normal when kids are starting a new school year, taking a big test, or trying out for a sports team. But anxiety can show up in different ways.

“There’s a spectrum of typical responses,” Dr. Tabani says. Those can range from healthier coping strategies—like eagerly laying out back-to-school outfit days in advance—to less-healthy strategies, like procrastinating on a summer reading assignment that’s due on the first day of school.

In general, there are two signs that suggest school-related anxiety might be cause for concern, Dr. Tabani says. The first is mood changes, such as increased worry, irritability, sadness, or withdrawing from social situations. The second is physical changes like headaches, upset stomach, or sleeping more or less than normal.

Saniya Tabani, PhD

“If you notice these types of symptoms, it’s a sign that the child’s anxiety is becoming more significant,” she says.

Anxiety can derail kids, interfering with their school success and social life. Yet anxiety is often predictable. By planning ahead, you can help your child work out what Dr. Tabani calls a “cope-ahead plan.”

The plan draws on a skill taught in dialectical behavior therapy, which teaches people how to increase their tolerance for distress. “It’s hard to think about how to react to a stressful situation when you’re in a tornado of emotions,” she explains.

By following these eight steps, caregivers can help kids and teens plan for the situations that make them worry.

Identify the challenge: What, specifically, is your child worried about? Are they concerned they won’t be liked by peers? Afraid they’ll get lost in their new school? Nervous about getting good grades in a tough course? “Have a conversation with your child or teen to better understand where their anxiety is coming from,” Dr. Tabani says.

Name emotions, thoughts, and actions: You’ve identified the challenging situation that makes your child feel anxious. Help them practice naming the specific emotions they may be feeling. Also guide them to identify worry thoughts connected to these feelings. Next, help them consider how their feelings about it and thoughts affect their behavior. If a child isn’t feeling smart enough for their honors class, what does that make them do? Do they not want to go to school? Avoid studying? Run to the bathroom if there’s a chance they might get called on?

Check facts: Nervous thoughts can quickly spiral. Stress about a test can turn into “I’m not smart enough for this class and if I don’t get an A I’ll never get into college.” Validate your child by acknowledging their fears, Dr. Tabani says. Then help them step back to consider whether the facts match their feelings, or if they might be falling into a “thinking trap” (a mistake in the way we think about things, such as assuming the worst-case scenario is also the most likely scenario). “Encourage them to look at whether their thoughts actually fit with the evidence,” she says. “Gently push back to help them see things rationally.”

Choose a coping strategy: “Different situations call for different ways of coping,” Dr. Tabani says. If a child gets anxious taking tests, for instance, they might try deep breathing exercises as the teacher hands out the exams. If a teen is worried about losing their temper or crying in public, they might work with a therapist to practice distress tolerance skills.

Imagine: The next step is to picture the stressful situation as vividly as possible. Help your child picture the situation in detail. Where are they sitting? Who is around them? How are they feeling? Then help them picture their coping strategy in action. If they’re concerned about getting teased by bullies, they can imagine how they’d look to a friend for support or turn to a trusted teacher. “Imagining a situation is a good way to work out the kinks,” she says.

Rehearse: Now it’s time to practice. Caregivers or friends can help a child act out the stressful situation and practice using their coping methods. Families can do this by helping the child visualize the situation or roleplaying at home. A parent can pretend to be a teacher or classmate, for example.

Envision coping with your biggest fear: While you don’t want to focus on the negative, it can be helpful to have a child rehearse how they might respond to their worst-case scenario. Chances are, their biggest fear won’t come to pass. And even if it does, they’ll feel more in control if they have imagined—and practiced—how they would respond.

Practice relaxation: Just imagining the things you’re afraid of can set your nerves on edge. As you work through these steps with your child, help them learn relaxation strategies like deep breathing, progressive muscle relaxation, or engaging in sensory exercises like smelling a calming scent or cuddling a pet or favorite plush. “When kids are feeling more relaxed about their fears and anxieties, these coping strategies feel more achievable,” Dr. Tabani says.

Parents and caregivers have an important role to play in helping kids learn to manage their anxiety. But you can’t solve all of their problems for them—nor should you try, Dr. Tabani says.

“It’s a delicate balance between providing structure and support, and not fragilizing children,” she says. That means you should help them develop a coping plan to manage their test anxiety—but you shouldn’t let them stay home from school on test day to avoid the stressful scenario altogether.

“Families may have the urge to treat kids as less capable of coping with these things than they actually are. Remember that kids today are incredibly smart and sophisticated—and resilient,” she says.

Still, many young people need support to put coping skills in place. If you notice that anxiety or depression is getting in the way of your child’s everyday activities, reach out to a mental health professional.

“They can tailor these coping strategies to a child’s individual needs,” Dr. Tabani says. “And if you notice any signs of self-harm or suicidal thoughts, or have any concerns about safety, refer to a mental health professional right away.”

Pumpkin Can Be a Healthy Treat


From jack-o’-lanterns to pumpkin pies and pumpkin spice lattes, there is no question that pumpkins are a fall favorite. But you might not realize that pumpkins and other squashes are also a fruit loaded with nutrients that have a number of benefits for your health.

Taylor Stein, RD

In this Q&A, Taylor Stein, MS, RD, CDN, Associate Researcher and Registered Dietitian at The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, explains why you should be eating pumpkin and suggests some easy ways to incorporate it into your diet.

What are the health benefits of pumpkin?

Pumpkins are a squash that are high in beta-carotene, which gives them their bright orange color. Your body converts beta-carotene into vitamin A, a fat-soluble vitamin essential to immune system health, vision, reproductive health, growth and development for children, and healthy skin function. Eating high amounts of vitamin A is associated with reduced risks for some types of cancers because it has a role in cell growth. Generally, it’s important to have adequate or even higher intakes of vitamin A. Pumpkin and other squashes are also a good source of fiber and are low in carbohydrates. Categorized as a starch, squashes are similar to sweet potatoes, but contain about one third of the amount of carbohydrates, and contain other benefits, including vitamin C and potassium. Pumpkin seeds contain high levels of magnesium and other nutrients that are good for your immune system, heart, bones, muscles, nerves, and blood sugar.

What are the benefits of canned pumpkin versus whole pumpkin?

Canned pumpkin does not come from the same pumpkins used to make jack-o’-lanterns. Carving pumpkins are bred for their appearance and are not very flavorful. Canned pumpkin is a more flavorful puree intended for cooking and baking, and is not strictly made from pumpkin. Rather, it is a blend of different types of pumpkins and squashes that are more flavorful and have a creamier texture (for example, Dickinson pumpkin and some butternut squashes, depending on the brand). While the texture and taste are different from whole pumpkin, the nutritional value remains similar. In fact, canned pumpkin is even higher in fiber than whole pumpkin because much of the water has been removed.

What are some easy ways to incorporate pumpkin into my diet?

You can easily blend canned pumpkin into soups, dips, and sauces. Since it has a creamy texture, it can be a healthy substitute for ingredients in baking recipes, such as heavy cream. However, just because you add pumpkin doesn’t make it healthy if the recipe is high in sugar and fat, so be mindful of other ingredients you are using.

Whole pumpkins and other fresh squashes can be prepared similarly to sweet potatoes and make a delicious and healthy side dish, salad add on, or breakfast hash. You can eat carving pumpkins. But “baking pumpkins” (also known as “pie pumpkins” as they can be used to make pumpkin pies) and other squashes sold at most grocery stores and famers markets in the fall have better texture and flavor.

The easiest way to prepare pumpkins is to roast them. Don’t be afraid to try different types of squash, even if they are oddly shaped or colored. The skins are the one characteristic that tends to vary, and some skins may be too tough to eat, but the taste and nutritional value of the flesh are similar.

How to roast pumpkins and other squash:

  • Cut into pieces, either small or large, depending on how you plan to use it.
  • Drizzle with olive oil and season how you prefer. For a more savory dish, use salt and pepper and/or other seasoning (popular ones include garlic powder, chili powder, smoked paprika, cumin, or cayenne); for a sweeter dish, sprinkle with cinnamon or other spices (popular ones include nutmeg, ginger, and cloves). If you want the dish even sweeter, add a little brown sugar.
  • Spread the pieces evenly onto a baking sheet and roast for about 30 minutes at 425 degrees (baking temperature and time may vary depending on the size of the pieces and how soft you want them).
  • Separately, clean the seeds, spread them onto a baking sheet with parchment paper, drizzle with olive oil, add your seasoning of choice, and bake at about 300 degrees for about 30 to 45 minutes, depending on how brown you want the seeds.

How long do pumpkins last, and when are they unsafe to eat?

September through November is when squash are generally sold, but they can last a long time if you store them well in a cool, dark space—about 50 to 60 degrees. Do not eat pumpkins you have carved, especially if they have been sitting out, or any squash that show signs of mold or rot.

Ditch the Itch: Avoiding Skin Reactions to Halloween Costumes and Make Up

Halloween treats, costumes, and decorations are exciting for parents and children alike, but these holiday staples may be associated with unpleasant reactions, such as contact dermatitis or urticaria (hives).

As Halloween approaches and you are choosing your child’s costume, here are some helpful tips from Justine Fenner, MD, Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, on how to protect your child’s skin.

Know the signs of a reaction

 Justine Fenner, MD

Your child may be experiencing an adverse skin reaction if redness, itching, dryness, or blistering of the skin develops. If you notice these signs, immediately wash off any make-up/body paint and remove their costume and accessories. For some children, the rash may improve with removal of the offending agent, but others may require topical corticosteroids or oral antihistamines.

It is important to note that not all reactions develop equally. Conditions such as contact urticaria are more likely to develop immediately following an exposure. Irritant contact dermatitis may develop after a couple of hours or days, and allergic contact dermatitis may not be seen until two to three days following exposure.

Continue to watch for skin reactions even in the days following Halloween. Keep an eye on any reactions, and contact your doctor if your child isn’t improving with at-home treatments.

Do a spot check before applying face paint and makeup

Face paint and make-ups may contain preservatives such as methylchloroisothiazolinone/methylisothiazolinone, dyes, or fragrances that can be irritating to the skin. Be sure to test the face paint or makeup on a small area of your child’s skin, such as a spot on the inner wrist, for at least a week prior to full application on Halloween, to make sure your child does not develop a reaction.

Avoid false eyelashes and nails

Fake eyelashes are held in place with glues, and acrylic nails contain potential contact allergens such as cyanoacrylates, latex, and formaldehyde. Furthermore, these products may damage your child’s nails and eyelashes over time.

Beware of hidden nickel  

Costume jewelry and accessories, such as belts, can also cause skin reactions as they commonly contain metals such as nickel, which is one of the most common causes of allergic contact dermatitis.

Opt for a natural, breathable fabric

When choosing a costume for your child, 100 percent cotton fabric is recommended. Other materials, such as wool and polyester, may be irritating to the skin. Irritation is especially likely if your child has a history of sensitive skin or eczema. Looser fitting, breathable fabrics also decrease the incidence of skin issues.

Most importantly, have fun and Happy Halloween! 

The Facts About Male Infertility

Infertility affects many couples, and while discussions often focus on female fertility, male infertility can be equally significant.

In this Q&A, Alan Copperman, MD, Director of the Division of Reproductive Endocrinology and Infertility and Vice Chair of the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Mount Sinai Health System, explains male infertility and discusses when to see a medical specialist.

Alan Copperman, MD

“Understanding male infertility and its implications is crucial for couples navigating fertility challenges,” says Dr. Copperman, who is also Managing Director and Chief Executive Officer of RMA of New York. “By addressing these common questions and seeking appropriate medical guidance, men can take proactive steps towards achieving their family planning goals.”

 How common is male infertility?

Male infertility contributes to nearly half of infertility cases. There can be structural, hormonal, genetic, and even environmental drivers of male infertility.

What does a semen analysis look at?

A semen analysis is a critical diagnostic tool used to assess various parameters of semen quality. It evaluates aspects such as sperm count, motility (movement), morphology (shape), and other factors that affect fertility such as the presence of infection.

When should I consider making an appointment with a male reproductive specialist or urologist?

If a couple has been trying to conceive for six months without success, it may be advisable for the male partner to be tested, and potentially referred to a reproductive urologist. Additionally, men with specific health conditions or lifestyle factors that could affect fertility should consider seeking expert advice.

Contact RMA of New York at 212-756-5777 or email info@rmany.com to schedule a consultation.

What can I expect during an initial meeting with a male reproductive specialist?

During the first appointment, the specialist will typically review your medical history, discuss lifestyle factors, and may recommend further diagnostic tests, including a physical examination and possibly additional semen analyses, hormone tests, and an ultrasound.

Are there lifestyle considerations men should consider to optimize their sperm health?

Several lifestyle factors can affect your sperm health. These include your diet, how much you exercise, your use of tobacco and alcohol, managing stress, and avoiding exposure to environmental toxins. Making positive lifestyle changes can potentially improve sperm quality and overall fertility.

How to Make the Most of Your Visit to an Orthopedic Surgeon

Orthopedic surgeons specifically manage issues related to your musculoskeletal system—the system that provides form, support, stability, and movement for your body.  While the main components—muscle and bones—are fairly obvious, this system also includes cartilage, tendons, ligaments, joints, and connective tissue.

Your visit to an orthopedic surgeon might be for a chronic issue like carpal tunnel syndrome or for an acute injury like a torn meniscus, the thin fibrous cartilage in the knee.  Like most office visits, your initial visit with your orthopedic surgeon involves diagnosis and the development of a treatment plan. And it can set the stage for a life-changing procedure.

Edward Yang, MD

“I went into medicine and specialized in orthopedics because of my love of fixing things with my hands,” says Edward Yang, MD, a board certified orthopedic surgeon and Chief of Orthopedic Surgery at Mount Sinai Queens. “This combined with my passion for helping people led me to surgery and the specialty of Orthopedics. The surgery we do can truly change our patient’s life.”

And the right surgeon can make a big difference. “I provide my patients with a written diagnosis, and treatment plan. In addition, I often video a short exercise program for them to do at home. If my diagnosis and your symptoms are severe enough to warrant surgery, I provide written pamphlets on the surgery that is being planned,” he says. “Make sure your surgeon also discusses the risks, benefits, and alternatives to treatment when discussing surgery. “

In this Q&A, Dr. Yang offers some suggestions for how you can prepare for a visit with an orthopedic surgeon and for orthopedic surgery.

Prepare for the visit: Communication and planning in advance for the visit are key. Research shows the more involved you are in your care, the better the results.   The first steps are the same as for any doctor visit:  compile the information you need to give your orthopedic surgeon a good medical history, including any other conditions or past surgeries, and all of the medications you are taking.

Write it down: Write down the reason for your visit; this one step provides tremendous clarity for both you and your doctor.  It is important to focus, as much as possible, on the reason for your visit: When did the pain start? Where is the pain? What makes it hurt?  What helps? Have you had this problem before?  What is the quality of the pain?  Try not to volunteer unnecessary information. Be prepared with a written list of questions, and plan to take notes during the visit.

Bring your images: A great tip for saving time and money is to bring copies of any scans or X-rays related to the reason for your visit. Most images are available in digital format and are easily transported to your doctor’s office on a disk or USB flash drive. Don’t forget the accompanying report from the radiologist.

The physical exam: Dress comfortably in clothes that are easy to change into and out of. This is the time to ask your questions and be clear about next steps. The next steps often utilize the diagnostic tools in the orthopedic surgeon’s toolbox.

Are Women Who Drink More at Risk Than Men?

There are many areas where women and men face different health and medical issues. Now there is evidence that one area where they may differ is in a key part of our culture: how they respond to consuming alcoholic beverages.

For example, according to a recent study published in JAMA Health Forum, alcohol-related health issues rose faster among women than men during the pandemic. And surprisingly, women ages 40 to 64 experienced the fastest rate of increase. Another recent study found that women who binge drink are more likely to develop heart disease.

Timothy Brennan, MD, MPH

In this Q&A, Timothy Brennan, MD, MPH, Chief of Clinical Services for the Addiction Institute of Mount Sinai, discusses some of the ways alcohol can be harmful, including how alcohol can affect women differently than men and what you can do if you think you may have a drinking problem.

Why do women and men respond differently to alcohol?

People born biologically female or born with two X chromosomes, have a higher percentage of body fat and a lower percentage of water on average compared to men of the same weight. Alcohol is water soluble. So, if you’ve got a lower percentage of water, the alcohol concentration in a woman is higher after consumption of the same quantity of alcohol.

Here’s a scenario to illustrate: a biological XX person and biological XY person who have the same weight each consume three 12-ounce beers. The biological XX person will have a higher blood alcohol concentration compared to the other person and is therefore more impaired.

There’s also a difference in the way that women process alcohol. There’s an enzyme in our livers called alcohol dehydrogenase (ADH), that’s responsible for metabolizing alcohol in our bodies. Women have lower levels of ADH, meaning they have less ability to metabolize that alcohol. So bottom line, the alcohol hangs around longer and exerts more of an effect on women.

What amount is considered safe for a woman to drink?

Our understanding is evolving quickly, but what we now know is, no alcohol is best. Alcohol simply does not appear to convey any health benefit, whatsoever. There used to be some belief that drinking certain types of alcohol, red wine, for example, might lower your risk of cardiovascular disease. That doesn’t seem to be the case anymore. Different countries have looked at this question differently. The Canadian government has been much more emphatic than the United States that no alcohol is best.

However, if we’re defining “safe” as not being at risk to develop an alcohol use disorder, then we can look to the National Institute on Alcohol Abuse and Alcoholism for some general guidelines. They recommend that women have no more than seven drinks per week and no more than three drinks on any one day. By comparison, their recommendation for men is no more than 14 drinks per week and no more than four drinks on a single day. That means no more than a drink a day for a woman, which might strike the lay person as pretty low.

Isn’t it hard to limit drinks when we regard alcohol as a social lubricant and ingrained in our society?

Alcohol is pervasive in our cultures and in our social interactions. It’s ritualized across a variety of our holidays and traditions. It’s part of our everyday vernacular. It’s hard to even ask someone to do something in the evening without drinking being implied. Happy hour is a big component of our recreation.

But alcohol is technically a neurotoxin, which means that it is destructive to nerve tissue. I heard someone suggest that instead of using the term “alcohol,” we should use the term “neurotoxin.” It’s a provocative thought, but imagine someone saying, “Hey, would you like to get a couple neurotoxic beverages after work?” The response would most likely be, “Not really.” Just the way we talk about alcohol is very interesting.

A recent study found that women ages 40 to 64 were the fastest growing segment of people with alcohol related health problems during the pandemic. Why is that?

Most likely a lot of factors are involved. First, there’s the anxiety of society as a whole with the pandemic, so people turn to what they think are anxiety relieving products. However, the anxiety-relieving effects of alcohol diminish over time and actually promote anxiety. Someone may say, “Well, my wine is the only thing that helps,” and it becomes the thing that hurts the most with their anxiety in the long run. But on top of that, women tend to be responsible for the family, have the increased stress of children at home, and are managing an entirely new routine.

Plus, our social norms are that you really couldn’t drink on the job for the most part. But if you’re suddenly working at home, how would the boss know if you grab that glass of wine at 3 pm versus 6 pm? Nobody has any idea what you’re doing. And the normalization of drinking at home has been promoted with the advent of Zoom happy hours and social media memes.

Why is it important to discuss the health effects of alcohol?

It’s hard to find an organ system that’s not affected by alcohol. Classic examples that we talk about start off with the liver and liver damage. Types of liver damage can vary from what is called a fatty liver and advance to alcoholic hepatitis or alcoholic fibrosis. It can progress all the way to cirrhosis and liver failure, when the person will need a transplant.

Cardiovascular issues are pervasive among people who are heavy drinkers. Not only does it promote hypertension and high blood pressure, but heavy drinking also weakens the heart muscle and promotes arrhythmia, or irregular heartbeat, and stroke.

The gastrointestinal system or GI system can be irritated and develop ulcers or GI bleeds. The pancreas can frequently be acutely inflamed with alcohol and oftentimes people can develop pancreatitis. Alcohol is not safe for our brain, and long-term alcohol use can lead to cognitive impairment. It affects our psychiatric health and emotional health in many ways. Heavy alcohol use can interrupt our ability to metabolize certain vitamins and minerals such that people can develop chronic dementia. And alcohol can promote a variety of cancers. The way alcohol affects our body is very profound.

What is the difference between a heavy drinker and an alcoholic?

When we talk about alcoholism, the clinical term we use is alcohol use disorder. That’s a disease that’s been codified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5. Alcohol use disorder is diagnosed by 11 different criteria. It’s not something you can diagnose with a blood test. If you’ve got two to three criteria, it’s mild. If you’ve got four to five, it’s moderate. If you’ve got more than five, that’s considered a severe alcohol use disorder. Heavy drinking is not defined in the DSM-5. But the guidelines from the National Institute on Alcohol Abuse and Alcoholism we discussed earlier define low risk drinking to high-risk drinking based on the number of drinks consumed in a week. Let’s say for example, a biological female has more than seven drinks per week. But a clinician goes through that DSM-5 criteria with them, and they have none of criteria. You can’t diagnose them with an alcohol use disorder. You wouldn’t call them an alcoholic, but technically, they’re a high-risk drinker. And I think it’s reasonable to classify high risk and heavy drinkers in the same way.

Now that the pandemic is over, would you expect less drinking-related health concerns?

It’s well established in our field that once a substance use disorder takes hold, it does not go away by simply changing one factor in our environment. Alcohol hijacks the reward pathway in our central nervous system. It’s very hard to break that cycle, without any treatment and without any actual abstinence.

What should people do if they think they have a problem with alcohol?

First, there are some patient-facing websites that allow a person to quantify their alcohol use and explore it. The National Institute of Alcohol Abuse and Alcoholism has a lot of great information and interactive tools. I also encourage people to talk to their doctor. Often, people don’t realize the damage alcohol is doing to their body. And they may be self-medicating because of some other issue, like struggling with sleep or anxiety. And revealing that to their doctor can address the primary issue.

If you think you have an alcohol use disorder, I encourage people to check out a meeting of Alcoholics Anonymous. You don’t need to be an alcoholic to go to an AA meeting—there are Open Meetings where anyone can attend. And if you determine that you do have an alcohol use disorder, I always recommend that people get formal addiction treatment. And by that, I mean finding someone who is board-certified in addiction medicine. I trained in pediatrics, and then followed that with an addiction medicine fellowship. Unlike addiction psychiatry, addiction medicine is a multi-specialty subspecialty so there are a lot of different paths into it. Mine was pediatrics, but others might be internal medicine or family medicine. The good news is, there is a lot of help and resources for people seeking help.

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