All posts by Iris Farrou

Importance of Prenatal Care

Finding out you are pregnant is often very exciting, and it may come with a ton of questions as to what happens next, how you should take care of your body and your baby, how to prepare for their arrival, and all the combinations of both nervousness and excitement! Taking care of your baby begins the moment you find out you are pregnant, and seeking professional prenatal care early is key to a healthy pregnancy and successful delivery. 

What Do I Do?

Very good question! Most mothers have asked the same, so here is a basic checklist:

  • If you suspect you are pregnant, make an appointment with your OBGYN as soon as possible. If you don’t have a regular OBGYN, call your insurance and see which experts in your area accept your insurance. If you don’t have insurance, before you look into applying, contact family planning clinics and community health centers close to you–those do provide basic prenatal care either free of charge or at a low cost. 
  • Your first prenatal appointment usually happens when you are 8 weeks pregnant, when a review of your medical history will take place and possibly a urine and blood test as well. 
  • For uncomplicated pregnancies, expect to see your prenatal healthcare provider once a month up until the 28th week, twice a month for weeks 28-36, and weekly from week 36 until delivery. 

How Does this Help my Baby? 

During your prenatal visits your doctor or nurse will check both your health and the health of your baby: your blood pressure and weight need to be monitored, measuring your abdomen to determine your baby’s growth is important, and your baby’s heart rate will also be checked at every visit. 

Studies have shown that babies of mothers who receive no form of prenatal care whatsoever are three times more likely to have birth complications or low birth weight. It is understandable that if your insurance doesn’t cover the cost of all suggested prenatal exams and tests, you may not be able to afford them all. Some tests are screening tests, meaning that they detect risks of possible health problems; based on their results, your doctor may suggest diagnostic tests to get more accurate results. 

What are some of the tests?

First and foremost your doctor needs to know your blood type and Rh factor, as well as any STIs, infections, or HIV. Genetic testing may be suggested to diagnose birth defects or possible genetic conditions, tests for chromosomal abnormalities, gestational diabetes test, glucose tolerance test, as well as regular urine tests and ultrasounds.



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Allergies in Babies

We all know babies are fragile, and none other than parents of a newborn are more aware of this–and worried! Newborn babies can’t tell you what’s wrong with them, so the guessing game is nonstop, and the more you see your baby in distress, the more your worry skyrockets. Although parental anxiety may suspect the worst case scenario, sneezing and a runny nose, red eyes and itchiness could also just be signs of your baby experiencing allergies. 

Environmental and Seasonal Allergies 

In fact, even very young kids can be allergic to pollen, dust, pet dander, and mold. Babies are more likely to experience allergies to foods and eczema–especially if you have a family history of those, as well as asthma. No region is safe from allergy triggers, but if you live in nature, are in close proximity to more allergens, have indoor pets, and generally enjoy the outdoors your baby may be exposed to more allergens. If they do have seasonal allergies, then the symptoms will begin. 

  • Itchiness and tendency to rub the eyes, ears and nose, as well as puffy or watery eyes
  • Sneezing, wheezing, and frequent mouth breathing
  • Dry cough with clear mucus, and possible shortness of breath
  • Irritability or excessive fatigue 

Food and Medicine Allergies 

Food and medicine allergies have different symptoms, which are usually seen immediately after consumption of the offensive food or medication, within a few minutes or an hour or two later at most. If your baby is allergic to medication and their reaction is hives or a rash, that may take a few days to develop. However, immediate reactions may include hives, itching, shortness of breath, vomiting, nausea, or abdominal pain. Good news is that even if other symptoms are present, anaphylaxis is rare in babies. 

Treating Allergies in Babies 

Even though as adults we’d rush to take an antihistamine for our allergies, this is not recommended for babies under the age of 2. The safest treatment is to reduce your baby’s exposure to the allergen: if it’s pet dander you may want to limit the time spent with pets and close off certain areas in the house; for environmental allergies you may have to keep your windows closed and invest in an air purifier; food allergies will mean eliminating the foods with allergens and possibly consider w hether allergens may transfer to your baby through breastfeeding. You should consult with your pediatrician before administering any medication, even topical skin medications such as hydrocortisone cream. 

Diagnosis 

The good news is that even though your baby may not be able to articulate what’s going on, your pediatrician can perform a skin test to determine possible allergies– a test usually safe on anyone over 6 months of age. A blood test could also be done for younger babies, though it is not as sensitive as a skin test. Food allergens are usually determined by process of elimination, which can be a long process as you take out the allergens from your baby’s diet one by one every week. However, at the very least when you see a difference you will know what not to feed your baby! 



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DEXA Scan and Osteoporosis

If you have a family history of osteoporosis or are postmenopausal and suspect osteoporosis will affect your quality of life, then it may be time to take a closer look at what this “silent disease” i, how you can prevent it from taking control of your life, and the medical technology available to help you know your body. 

Very simply, osteoporosis means that your bone mass and mineral density have decreased, thus diminishing the strength of your bones and increasing the risk of fractures. Although many believe only women are at risk for osteoporosis, that is not true: this disease affects men as well, and all genders as we get older. The first step to determining whether you have osteoporosis is a physical exam: 

  • Loss of height and weight may be signs of osteoporosis, as well as changes in posture
  • If you’ve had a fracture that has not healed this is also a big sign of osteoporosis
  • Balance and the way you walk can be affected by osteoporosis too

If the physical exam, along with your medical history and age, determines you may have osteoporosis then your doctor will order an exam to measure your bone density. This is where DEXA tests come in, which measure the mineral content of your bones, focusing on certain areas of your skeleton. DEXA stands for “dual-energy X-ray absorptiometry” and it is a medical imaging test; it uses very low levels of x-ray to determine how dense your bones may be (or not be). 

What does the test involve?

Although it is a test you may not want to pass, medical professionals consider DEXA scans to be one of the most effective, quick and painless, as well as useful ways to diagnose osteoporosis. 

  • You will lie on the special DEXA x-ray table and the technologists will help you hold the desired position by using positioning devices. 
  • The arm of the DEXA machine will pass over your body, and two different x-ray beams with miniscule radiation distinguish bone from other tissue. 
  • The scanner gathers the data and translates the bone density information into pictures and graphs. 
  • A radiologist or other physician that has been trained in DEXA interpretation reviews and interprets the results of the scan. The expert sends a report to your primary doctor, who in turn discusses the results with you and determines the appropriate treatment. 

Why is DEXA more effective than other methods?

As you may know, there are other body imaging methods that medical providers use: if you have a broken bone, you will most likely get an X-ray done, while if you experience constant headaches your doctor may order an MRI. DEXA very specifically measures bone density, and it also measures bone density in each specific area of the body. A common misconception is that our bone density is the same throughout our skeletal system, but DEXA is able to determine lean skeletal, fat, and bone masses in various spots in our body. 



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Amniocentesis

The majority of expectant parents want to ensure their baby is as healthy as possible. Along with pre-genetic tests that determine certain genetic traits or risks parents may pass to their offspring, prenatal testings are quite common. These help you carry a healthy pregnancy to term, and check in on the baby’s health. Amniocentesis is one of these prenatal tests: it diagnoses genetic disorders and other health issues in a fetus:

  • Fetal infection can be determined through amniocentesis, along with other illnesses 
  • Fetal lung testing is rarely done, but if a delivery is planned to happen sooner than 39 weeks amniotic fluid helps see if a baby’s lungs are mature enough for birth
  • Sometimes there is an amniotic fluid build-up in the uterus–polyhydramnios–and it is drained through amniocentesis

What is the procedure?

It is normal to be nervous about any medical procedure, much more so if you are pregnant! The goal of amniocentesis is to extract amniotic fluid from your uterus, and most procedures happen between 15-20 weeks of gestation. Here’s what you should expect on the day of your appointment:

  1. You will lie on your back, just like you would prepare for a routine ultrasound. That’s the first step, as the ultrasound will show where your baby is in your uterus that particular day and time. 
  2. The ultrasound will remain on screen as your healthcare provider inserts a very thin needle through your stomach wall and into the uterus. The needle is removed swiftly as amniotic fluid is drawn into the syringe. 
  3. There is no sedation or numbing used, and it is important that you stay still. Even after the needle is removed, the ultrasound will remain in use to monitor your baby’s heart rate. 
  4. You may experience mild cramping during the procedure, and/or shortly after, but you should be able to resume your normal activities after the test. 

When is it necessary?

As one of many prenatal testings, amniocentesis provides details on certain genetic conditions and issues that other procedures may not fully address. It can detect chromosomal, genetic disorders, or congenital disabilities such as down syndrome, Tay-Sachs disease, neural tube defects, and Rh disease. 

If the results of a routine prenatal screening test are worrisome, your doctor may suggest amniocentesis to rule out another diagnosis. If you’ve had a pregnancy with a genetic condition, amniocentesis will look for that condition in your current pregnancy. If the parents are carriers of a genetic condition, or have a family history, amniocentesis shows whether your baby is affected by it. Unusual ultrasound findings are another reason for further testing. Babies born to people over 35 have a higher risk of chromosomal conditions, so if you’ve had a prenatal cell-free DNA screening that came back positive, amniocentesis will shed light into possible conditions. 

Even if your doctor suggests amniocentesis, and explains why, the final decision is up to you; as with any healthcare issue, you always have the right to seek out other professional opinions! 



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Breast Reconstruction Options

The conversation around breast reconstruction surgeries focuses on women who have had either a mastectomy or a lumpectomy done and wish to reconstruct their breasts once they are cancer free. This is a wonderful opportunity for women who are cancer survivors, and of course, a very body-affirming procedure as well! According to 2020 data from the American Society of Plastic Surgeons, breast augmentation surgery has been in the top 5 cosmetic surgeries since 2006, followed by breast implant removals, lifts, and reductions. The highest demographic for breast procedures are women ages 40-54. Sometimes, breast reconstruction surgeries get categorized alongside cosmetic breast procedures. Though there is definitely an overlap, these are the most common breast surgeries:

  • Breast augmentation that increases the size of the breasts and may affect the shape and cleavage as well. 
  • Breast lift, which tightens the existing tissue for a more refined breast shape. 
  • A combination of breast augmentation with lift, for a one-time makeover. 
  • Breast revision: patients update their existing implants, can change the size or shape of their breasts, or completely remove the implants. 
  • Breast reduction for women with excessively large breasts that affect either their body image, create physical problems, or both. 
  • Male breast reduction for men with excess fat and glandular tissue on their breasts.    

All of these procedures reconstruct the breasts in one way or another, and the reasons are often both cosmetic and medical, as well as mental health reasons. A prime example of this is gender affirming top surgery for trans people: either chest feminization or chest masculinization. For chest feminization, surgeons will usually recommend breast augmentation with implants or fat grafting, or a combination. When it comes to chest masculinization, surgeons perform a type of mastectomy that removes breast tissue, eliminates the crease on the bottom of the breast, and reconstructs the nipples according to the patient’s preferences. 

Women who have undergone double or partial mastectomy, or a lumpectomy, may choose to have breast reconstruction surgery. Patients whose breast cancer can be removed with surgery  have more options on the type of surgery they get done–and can usually have immediate reconstruction surgery right after their breast cancer surgery. However, for medical and/or personal reasons, women can also choose to have delayed reconstruction surgery: months or even years later. There are two main types of post-cancer breast reconstruction surgery: 

  1. Flap Reconstruction: this surgery uses tissue from your own body to form one or both breasts. There are several types of flaps, and the choice is made on a case by case basis. Your surgeon will consider which type is appropriate for you, and whether you safely qualify for this type. 
  2. Implant Reconstruction: much like the cosmetic procedure, silicone or saline implants are used to reconstruct the breast tissue. Your surgeon will either lift the chest muscle and place the implant underneath, or they may place the implant above the chest muscle if they can. 

Since every body and case is different, not all options may be available. Whether for medical or cosmetic reasons, consult with your surgeon about your breast surgery options, get several opinions if you can, and see if you are eligible for insurance coverage. Keep in mind some procedures may take a long time to be completed, may need to successfully happen over a period of months, or be regularly maintained to ensure your health and safety. 

 

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Worried about Low Libido?

This may be a touchy subject for many women, as on the one hand a lot of us experience low sex drive, but on the other hand we don’t talk about it! The issue becomes more complicated when healthcare providers don’t even ask us about our libido, yet hypoactive sexual desire disorder (HSDD) is quite a common issue women deal with. Additionally, many psychologists, primary healthcare providers and OBGYNs are trained to care for and treat HSDD. HSDD is defined as the absence of desire for sexual activity and/or sexual fantasies– we most often just refer to it as “low libido,” and like anything else, it can have its ebbs and flows. Lack of sex drive can be frustrating in a relationship, but it is a normal thing to be experiencing, it can be traced back to causes, and it doesn’t mean that it’s permanent or that you do not love or are attracted to your partner. 

What Causes It?

Especially in women, low libido can be attributed to hormonal changes or imbalances: this can be during the menstrual cycle as estrogen and progesterone levels rise and lower, during menopause when our estrogen levels dramatically drop, in the case of a total hysterectomy, during pregnancy, or if you have PCOS–just to name a few examples. 

Another common reason for low libido in women are mental health issues, as well as medications. Depression and anxiety, PTSD, and past sexual trauma can negatively affect a woman’s desire for sex. Many times, the medications used to treat mental health issues can worsen an already low libido. This does not mean an important medication should be stopped, but you can–and should–bring it up with your therapist or mental healthcare professional. 

Life stressors, chronic stress, and fatigue can minimize the body’s natural sexual urges. This is even more prevalent in new mothers, or families with young kids: the everyday exhaustion, lack of sleep, and constant worry simply leave no room for sexual intimacy, or desire thereof.  

What Can We Do?

If one partner has low or no interest in sex while in a healthy relationship, remember it is a team effort: it is not up to the partner who has low libido to “solve” the issue and magically become better. 

  • The first thing to consider and talk about, even if it’s uncomfortable, is relationship issues. Your partner’s desire for sex, or how safe they feel, may be affected by something in the relationship neither of you knew was an issue until you really examined it and talked about it. 
  • If you and/or your partner face mental health issues, it is important to carefully consider how those may be affecting your sex life. Especially if you take any medications, look into the side effects and talk with your therapists about how they could be affecting your sex drive, and solutions to balance that out. 
  • Redefine intimacy in ways that work for you, and where sex is not the goal or the starting point. You may plan a romantic date, do small daily things to lessen stress, or start with small affectionate gestures to help strengthen your romantic bond. 

If you feel that your lack of interest in sex is related to a more serious health issue, either physical or mental, or to a serious issue in your relationship that you have not communicated about, it may be a good idea to seek out professional help and support. HSDD is not uncommon, and many medical professionals can assist you with it; you know your body and life circumstances best, and with a bit of assistance you will be able to get to the root of the issue much more effectively.



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Coming Out to your Doctor

If you belong in the LGBTQ community, you probably know that coming out is constant and not a “rip off the bandaid processm,” as it happens every time you meet someone new. Seeking a medical provider, and specifically an OBGYN, as a queer person can be challenging; if you already have a provider but have not discussed your sexual orientation or gender identity with them, it may be time to prepare for a coming out discussion. 

Why does it matter?

It’s understandable you may want to avoid another discussion about your sexual orientation and/or gender identity, but when it comes to healthcare this is vital information so you can get the best possible healthcare. A queer ally doctor would be knowledgeable on the health risks a queer person faces. If you are seeing an OBGYN, being open with them about your sexual orientation is important in getting the care you deserve: proper exams and vaccinations, contraceptive methods (if needed), safe sex and risk factors education, and other preventative care. For example, if you are a lesbian couple trying to conceive, your OBGYN should be your strongest advocate in this process. If you are transitioning, your OBGYN should oversee your hormone intake and be there for you through your hormone replacement therapy, helping you remain healthy both physically and mentally. 

How to Find a Queer-Friendly Provider

Whether you are considering coming out to your current doctor or looking for one, it’s good to look for queer friendly signs in a practice: you can inquire whether they have LGBTQ+ patients, or if there are doctors who focus on queer health and are more knowledgeable and experienced. You can also ask for referrals through your community: especially when it comes to finding an OBGYN, word of mouth and personal credibility go a long way. If you are nervous about your initial appointment you can ask a friend or trusted family member to come with you. Sometimes you can also authorize your partner or spouse to speak with your doctor on your behalf about certain matters–should you feel comfortable doing so–or be with you during the appointments. 

What Should Providers Do?

Don’t think this should be a one-way street: not all falls on you when you want to ensure a practice is queer friendly. Providers can specifically showcase they are LGBTQ friendly, and a safe space, by doing some of the following: 

  • Displaying equality symbols in their office and/ or website
  • Specifically stating they are knowledgeable about the LGBTQ community and are allies 
  • Have a visible non-discrimination statement 
  • Customize their patient intake forms to be appropriately inclusive 

Meet the Standards of Practice: a set of recommendations created by the Massachusetts Department of Public Health to improve LGBTQ access to quality care

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Sexual Intimacy after Pregnancy

When we become pregnant, we anticipate changes in our bodies. We may also have worries about how we will look and feel different after giving birth. Many women are concerned about the changes delivery and a newborn baby creates in their intimate relationships– and who wouldn’t worry about such a profound issue? A baby changes everything, bedroom adventures included! 

Medical professionals recommend that you allow your body approximately 4-6 weeks to heal after giving birth: if you have had a C-section, the area will need extra care, so sex may prove a little challenging. During delivery, it is also possible you have had a vaginal tear that needs to heal, or have received an incision to enlarge the vaginal opening. Give your body the time it needs to heal; there is no need to rush. 

New mothers experience their body differently after giving birth. Some women feel like their libido may never come back, while others find themselves aroused– a lot of hormones and the release of oxytocin make for a variety of responses to sexual desire; any way you feel is completely normal. There is no right or wrong way to feel or not feel sexual desire and no right or wrong way to listen to your body. To ensure your safety, note that the risk for postpartum complications is highest two weeks after giving birth, regardless of the delivery method. You may also have vaginal discharge during this time, vaginal dryness, general discomfort, or even pain. Fatigue, exhaustion, and lack of sleep are also very common and it is understandable that you may have zero interest in sex while trying to recover and care for your newborn baby. 

If and when you and your partner decide to have sex make sure you are completely comfortable and not just trying to get things “back to normal.” Couples go through several changes when their baby is born, and nobody is under any obligation to put their health on the line—especially not a new mother. So, when the time is right for you, keep in mind you may experience some pain during vaginal sex.

Since sex after delivery is guaranteed to be different, consider the following as ways to rebuild your intimacy with your partner and be safe: 

  • Sex is the end point, not the start. Start small, like hand holding or cuddling.
  • Be comfortable: you may want to take a painkiller to help your body relax and ease some of the discomfort. You can ask your partner to give you a massage, or take a hot bath together.
  • Set time aside to be intimate. You will need time to relax, get in the moment, pay attention to your body, and to reconnect with your partner. 
  • Discuss alternatives to vaginal intercourse and use this opportunity to experiment with your partner.
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Pelvic Floor Physical Therapy

When we hear about pelvic floor exercises, we often associate them with either older women, or pregnant women/women who have just given birth. This is a common misconception–older women and new mothers may see immediate benefits when engaging in pelvic floor PT, but everyone can benefit from it. 

No matter your age or overall physical health, if you were assigned female at birth, knowledge is power when it comes to knowing what your pelvic floor looks like, and what it does: 

  • Imagine your pelvic floor as a hammock of support consisting of muscles, tendons, ligaments, nerves, and connective tissue. This hammock is between the tailbone and the pubic bone.  
  • First and foremost, your pelvic floor supports the bowels, bladder, uterus, and vagina; there are also muscular bands that pass through the pelvic floor that encircle the urethra, vagina and anus.
  • All this, when it functions properly, plays a key role in bowel and bladder control. Your pelvic floor also helps you stabilize your pelvis and your spine, and assists with sexual function. 

Who is at risk of Pelvic Floor Dysfunction? 

Remember that the pelvic floor is mostly made up of muscles, and like any muscles in our body those–too–can weaken or suffer damage and lead to pelvic floor dysfunction. People who have experienced pregnancy, childbirth, chronic constipation, or obesity may be at higher risk as their pelvic floor has, and does, work harder to support their normal bodily functions and the bowels/bladder. 

Some of the symptoms of pelvic floor dysfunction may include pain during intercourse, bladder pain, bowel or urinary incontinence, frequent urination, persisting pubic, tailbone, or lower abdominal pain, and constipation–to name a few. More serious issues may include pelvic organ prolapse: bowel prolapse, prolapsed uterus, and even endometriosis. 

How can Physical Therapy Help?

Physical therapists are not just experts who help you walk better after an injury, they are medical experts in the functions of muscles, joints, and nerves, and have an in-depth and holistic understanding of human health. Just like any medical field, PTs have areas of expertise and you may want to work with someone who is trained on pelvic floor functions. 

A PT will assess your whole body after consulting with you, not just the problem or painful areas. Your medical history, symptoms, and needs will of course be taken into account to create an individualized plan for your pelvic floor health. The exercises will, and should, be done with the physical therapist–unless they assign you specific exercises to do at home. Since our pelvic floor is basically holding everything in our body together, the center so to speak, don’t be surprised if some exercises are not directly working on the pelvic area; ask your PT to explain why they are assigning you an exercise, and how it will help you. Some soreness or aches are normal after your PT sessions, but this is not a “no pain, no gain” situation: at no point during PT should you feel acute pain or strain on your muscles/ligaments.  

And for this subject, the saying “the sooner, the better” cannot be emphasized enough: do not wait until you’re older, pregnant, or have any painful symptoms to get started on strengthening your pelvic floor.



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Adjusting for School

With Fall just around the corner, you know that back-to-school– or first-grade–season is upon us! Getting ready for the school year is always an adjustment for families, even more so if your first-born is about to join the first grade. There may be a lot of excitement, as well as nervousness, around the situation. How can you help your child, or children, and the whole family be better prepared for the school year?

Stress and Anxiety

It’s not unusual for first-graders to experience anxiety that takes the form of tummy aches or headaches, especially on Monday mornings or Sunday nights. Sometimes, you may even get a call from the school that your child is feeling unwell. These are not lies, nor are children faking discomfort in order to stay home. They are experiencing discomfort due to the anxiety of being away from home. 

  • Establish a morning routine that makes your family feel more connected; you can spend some extra snuggle time with your child, especially on Monday mornings, and allow enough time to have a good breakfast as a family. 
  • Especially in the first few weeks of school, you may want to get there early to cement the goodbye-routine: reassure your child that you are always available during the day if they need you, and remind them that they are safe. Remember that this can feel very daunting for a child, as they are spending a lot of time away from home–which they know as a safe place–and they are surrounded by new people in a new environment. 
  • Share your own stories from school, and bond over those memories with your child. It will make them feel much more comfortable to hear that their role model was also nervous going to school, or had the same issues as them. Sharing stories and experiences openly will not only enhance your child’s trust towards you, but it will reassure them that what they are feeling is normal. 
  • Be early for pickup time; your child’s separation anxiety is volatile until they fully adjust to school, and they are really looking forward to seeing you and feeling safe that they are going home. As the school day reaches its end, their expectation and nervousness heighterns: it is of immense importance that they see you waiting for them during pick up time, and are not left wondering or feeling abandoned. 

Familiarity and Safe Spaces

Even if your child has attended pre-school, going to grade school is another can of worms… in addition, it is a new school and they don’t know what it looks like or what to expect. How can you help them feel secure about this change? 

  1. Visit the school with them, walk through the campus and be present in this new space where they will be spending a lot of time without you. Trivial as it may sound, it will help your child tremendously to know what their future classroom will be like, where they will be sitting, where the restrooms are, the cafeteria, exit and pickup point, main office, etc. 
  2. Meet the teachers if you can, as essentially they will be the “replacement” caretakers and safe people for your child while they are at school. If you can facilitate building trust and rapport with your child’s teachers before the school year begins, then your child will feel more comfortable in their expectations. 
  3. Talk through the curriculum with your child, and explain what expectations come with grade school. It’s a new structure, so the more you can explain to them what their day will look like, what they will be doing at this new school, and what they will be doing at home as a learner, the better prepared they will be when they hear “homework” is expected to be completed. 

As much as we would like to keep our children in a bubble, we all know that this is not possible. However, there is nothing more important than preparing for the school year as a family and validating your child’s anxiety–both before the school year starts and during the school year. Fingers crossed, this new school year will be filled with excitement and happiness! Remember that you and your child are a team in this, and you should always be able to reach out to the school for support if need be. 

https://www.wikihow.com/Adjust-to-a-New-School 

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/back-to-school-tips-to-help-students-adjust 

https://www.ahaparenting.com/read/Help-kids-adjust-school



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