More Common Than You Think: Encopresis

How many children do you know with Attention Deficit Disorder? 

Probably several, at least. 

How many children do you know who suffer from Encopresis, otherwise known as childhood soiling?  You might have observed a much smaller number of children in this latter category.  Nationally, only about 4-5% of children are known to have Attention Deficit Disorder, while up to 6% of elementary school children struggle with Encopresis.

Encopresis is an unpleasant problem for the child, his or her family, classmates, and friends.  And yet it is easily treated and resolved.  In most situations, this condition begins as a simple, physical problem.  Due to a combination of embarrassment and misinformation, parents are reluctant to seek help – even from a pediatrician whom they trust.  Delayed treatment results in family and social problems, which compound the problem and add to the child’s increasingly poor self-esteem.  Left untreated, children may experience a sense of alienation or develop behavior problems.

According to the Mayo Clinic’s website, symptoms of encopresis include:

  • Leakage of stool or liquid stool on underwear, which can be mistaken for diarrhea
  • Constipation with dry, hard stool
  • Passage of large stool that clogs or almost clogs the toilet
  • Avoidance of bowel movements
  • Long periods of time between bowel movements
  • Lack of appetite
  • Abdominal pain
  • Problems with daytime wetting or bedwetting (enuresis)
  • Repeated bladder infections, typically in girls

Early intervention is essential for positive outcomes.  Treatment for Encopresis includes consulting with a psychotherapist who not only can help alleviate the soiling behavior, but also will assist with problems related to this disorder.  Most importantly, remember to show compassion to your child as they deal with this uncomfortable situation.

Joan T. Magill, Psy.D., is a licensed psychologist and licensed marriage and family therapist at Therapeutic Oasis of the Palm Beaches.  She has been helping children and families with Encopresis for over thirty years.

Tech Presents for Kids: Tips for Establishing Healthy Boundaries

Stephanie Burstein, MS, LMFT

The holidays are here and shopping has begun. At the top of everyone’s holiday wish list are electronics. Even our littlest loved ones are enamored with the latest and greatest gadgets. Who could blame them? Our world runs on technology and our kids are part of that world. Whether they are using electronics for school or entertainment, the demand exists. And as every parent knows, finding the right balance for electronics is tricky. How do you give the gift of technology to your child without them turning into zombies?

The most effective step to take when giving your child a phone, iPad or other gadget is to set limits immediately. Yes, that even means the first night they have their new toy!

Here are a few other guidelines to follow:

1. Set time limits. The American Academy of Pediatrics recommends one hour of screen time for children ages 2-5 years old. Consistent time limits should be in place for children over the age of 6. An example would be allowing kids access to their electronic device for 10-15 minutes immediately after school. You can then block out another 10-15 minutes after homework or other school activities are completed. As children grow older, their access to technology will vary based on appropriate behaviors and responsibility.

2. Specify charging areas. Have a designated charging station in your bedroom, not your kid’s bedroom. By limiting where electronics are charged, you will help establish boundaries and reinforce time limits.

3. Establish electronic free zones. Create electronic free times for everyone. Ideas include electronic free meal times, family movie nights, and family outings that are focused on relationship building.

4. Monitor online activity. Remember, it’s not just your child interacting with the Internet. The Internet is also interacting with your child. Keep track of passwords to all electronic devices, social media accounts, game apps, and other online activities. Start device checks when you kids are young. As your kids turn into teens, routine checks will be something that they are already used to. Check with your mobile provider for monitoring tools, or visit for helpful time management and monitoring suggestions.

5. Keep activity age appropriate. Be aware of the latest games, social media, and online trends. A quick Google search can give you insight about the apps your kids are using. It’s also helpful for parents to have their own accounts on popular sites (Instagram, Snapchat, etc), which will help you monitor and understand how the technology is used. Research which apps are appropriate for your child’s current age range.

6. Modeling is key! Children are watching your every move and learning from the example you provide. If you are constantly plugged in, your kids will believe that is the norm. Model moderation and keep the conversation open about technology.

 When it comes to gifting technology, keep Dr. Seuss’ the Grinch in mind:

“Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store. What if Christmas, perhaps, means a little bit more.”

The best gift you can give is your presence. Let us all remember to put down our electronics and spend time together with our families. Happy holidays!

Contributor: Stephanie Burstein, MS, LMFT, Licensed Marriage & Family Therapist


Students Receive Tips on Fueling Their Creative Selves

Students in grades 3-12 gathered in West Palm Beach on Saturday, October 24, participating in the year-round enrichment programs offered through the Kravis Center.   Underwritten by the Lawrence J. and Florence A. De George Charitable Trust, the De George Academy for Performing Arts provides instruction and coaching to economically disadvantaged youth interested in the performing arts.  Through these ongoing programs, students learn necessary tools and strategies that enrich their creative lives.

Christie Caggiani, RDN, LDN, CEDRD, understands how good nutrition helps students achieve goals.  Christie’s presentation, “Fueling Your Creative Self: Simple Strategies for Super Students”, emphasized the connection between regular, balanced meals fueling creative endeavors.  Children eagerly listened on as Christie shared important tips that included:

  • Always eat breakfast!
  • Don’t skip meals. 
  • • Have grains, protein, and color at all meals.
  • • Eat when you’re hungry, stop when just right.
  • • Have Growing Foods (whole grains, fruits & veggies, dairy, nuts, protein) for a sharp brain & body, and include Sometimes Foods (candy, desserts, sweets)
  • Enjoy your food and let creativity shine!

Wishing the best to these budding super stars!

Introducing CALM: Stress Reduction & Mindfulness for Teens

Shutt Fav Headshot (1)Modern life has many amenitites that simplify and automate our lives; however, daily demands continue to grow rapidly.  Technological advances streamline tasks while simultaneously keep us connected to social media, news, and email.  We have at our fingertips the ability to reap the benefits of a less stressful lifestyle, but we often pursue the path of more rather than less.  Besides the obvious negative impact on our own health, modeling this more and more lifestyle has consquenses for our children as well.  (Don’t worry! Nonjudgment…I’ve made many of these choices too.) Recognizing stress motivates us parents to incorporate stress reduction practices into our own lives.  How do we then identify and incorporate stress reduction into the lives of our children?

Some stress is part of everday living.  In teenagers, many stressful life expereinces are often part of the norm.  Mild stress can be helpful to motivate one to complete difficult taks and reach important goals.  However, excessive and/or chronic stress in teens may result in a downward spiral of emotional and physical problems.  Common signs of stress in teens include:

Difficulty sleeping

Changes in appetite (too much or too little)

Excessive worry thoughts

Avoidance of social situations and activities

Frequent illness

Headaches and stomachaches

Extreme anger or sadness (reacts or overreacts)

Substance abuse

Parents who have identified stress related symptoms, anxiety, or depression in their child or adolescent might have already sought psychotherapy treatment. In addition to therapy, research has demonstrated that mindfulness is an effective tool for reducing stress, offering teens a way out of suffering and reducing risk to complications that arise from untreated anxiety and depression (including dropping out of school, addiction, and suicide).  Mindfulness can also help with the everyday challenges of being a teen, such as college testing and applications, homework, extracurricular activities and social relationships.  Offering teens an alternative way of building stress resiliency before they breakdown can be an excellent preventative medicine tool.  Some tips to incorporate mindfulness into your teen’s life include:

1. Disconnect!  Even if it is only for 20 minutes, remind your teen that downtime is important.  Turn off the technology and focus on breathing.  Breathe in a full breath (fuller than usual) and very slowly exhale, feeling the sensations of letting go.  With each exhale, there is a softening of the body.  Repeat.

2. Naming. When you are stressed, take time to pause, identify and name your emotions and thoughts.  Ask yourself, “Is this really true?”  Check the facts and see if there are any exaggeration of thoughts or catastrophic beliefs.  What can you realistically do about it now?  If nothing else, practice letting go.  Reframe by thinking, “I am feeling stressed about _____ and I intend to do _______ about it, or I am going to let this go for now.

3. If your mind is racing and overwhelmed with too many thoughts, STOP.  Stop everying.  Take a deep breath, Observe your breath, Proceed mindfully with just one thought.

Utilizing these easy tools now will provide teens with a lifetime of healthy coping mechanisms.  To advance your teen’s mindfulness knowledge even further, learn more about CALM: Teen Mindfulness Workshop at Sacred Treehouse.  This workshop will teach teens techniques to help cultivate acceptance and live mindfully.  Classes will include gentle yoga and stretching, mindful meditation, group discussion, and self-reflection activities. 

Wishing you and your children health, joy, and peace. 

– Dr. Patty Shutt

CALM: Teen Mindfulness Workshop will begin on Saturday, October 24th, 3:30-5:00 p.m.  For more information, please call 561-278-6033.

Snacking Sense: Tips for Healthy Kids

Christie Caggiani, RDN, LDN, CEDRD

Since all foods can be part of a balanced eating relationship, I tend to recommend buying full-sized bags of products (chips, crackers, cookies), rather than 100-calorie individual versions.  Not only does this save you some money, it most importantly avoids all of the subtle messages that we give our kids by placing “calories” as part of a food decision.  Have you ever had a 100-calorie bag of anything?  Were you completely and utterly satisfied after finishing it?  If you wanted another one, did you feel like you “shouldn’t”?  In my experience, they leave us hanging, wishing we had more. There is nothing magical about that number “100”, except that it’s an effective marketing strategy.  By focusing on the number, we have a much harder time listening to our tummies and the signals that tell us if we are still hungry or comfortably satisfied.  Instead, present these foods on a plate or in a serving bowl, allowing kids to fill their own plate and gauge the food amounts to their hunger levels.  For snacks you need to pack, keep some reusable snack containers on hand and make certain to include enough so that they can eat sufficiently.  Happy Snacking!


Snacking Sense

By Christie Caggiani, RDN, LDN, CEDRD

If you’ve ever tried to have a clear and concise conversation with your child after school, you might find it a daunting and nearly impossible task.  Typically, you will find their attention, energy and desire to recount the day stretched thin, and much of that is simply because their bodies have run out of fuel. If it’s been at least 3 hours since their last meal or snack, or their previous amount of food was small, rest assured it is time for them to eat. They need a snack.

As Ellyn Satter so beautifully explains in her Division of Responsibility, one of the parental roles in the feeding relationship is to “provide regular meals and snacks”.  This provides stability and the reassurance that food will always be available, thereby allowing children to develop a regular rhythm of hunger and fullness signals which will serve them well throughout their life.  As they trust that we will provide food in a regular and timely manner, they can best develop a sense of trusting themselves and their internal signals.

Snacks, however, have many stigmas and much confusion abounds as we try to determine the “best way” to provide them to our kids.  Here are some suggestions that may answer a few of your questions:

  • Snacks are typically best thought of as little meals, not a single stand-alone item. Our culture has branded certain categories as “snack foods”, however anything you would serve at a meal could feasibly be a snack and will undoubtedly be more satisfying than a single-serve package of baked crackers!  How about a slice of leftover veggie pizza and some grapes?
  • Include two or three foods from amongst:  whole grains, protein, dairy, fruits, vegetables, and fats.  Make certain to also offer some ‘fun foods’, and pair them with foods that have a little staying power, such as chocolate chip cookies and a glass of milk.  Having foods with a higher fat content will hold them longer, and create greater satisfaction.
  • Since all foods can be part of a balanced eating relationship, I tend to recommend buying full-sized bags of products (chips, crackers, cookies), rather than 100-calorie individual versions.  Not only does this save you some money, it most importantly avoids all of the subtle messages that we give our kids by placing “calories” as part of a food decision.  Have you ever had a 100-calorie bag of anything?  Were you completely and utterly satisfied after finishing it?  If you wanted another one, did you feel like you “shouldn’t”?  In my experience, they leave us hanging, wishing we had more. There is nothing magical about that number “100”, except that it’s an effective marketing strategy.  By focusing on the number, we have a much harder time listening to our tummies and the signals that tell us if we are still hungry or comfortably satisfied.  Instead, present these foods on a plate or in a serving bowl, allowing kids to fill their own plate and gauge the food amounts to their hunger levels.  For snacks you need to pack, keep some reusable snack containers on hand and make certain to include enough so that they can eat sufficiently.
  • A snack is not a treat, not a reward, not withheld in a punishing manner, not conditional.  It’s simply a consistent part of a normal day between meals.  It is just food.
  • Have your kids sit at a table for snacks (without TV, Instagram, or homework!), allowing them to better listen to their bodies and know when they’re satisfied, (not to mention the fact that running around the house is dangerous and messy if done while eating!).  If your child needs to go straight from school to a practice, event or appointment, make certain to have packed a few snack options, and give him time to fully taste and enjoy before running out of the car.
  • Sit down and keep your child company, listening to your own body’s signals of hunger or thirst.  Snack time is designed to relax and regroup.  Take a quick minute to breathe, stretch and transition from the busy day.  Don’t create a stressful conversation about the hours of homework they have yet to face!  Our children are watching us always, and modeling consistent snack and re-charge time is helpful for their development, as we as for our energy and patience.
  • Try to give at least two hours and not longer than 3½ -4 hours between a snack and the next meal.  For example, if dinner is at 6:00, aim to have snack time completed by 4:00, in time for your child to get hungry again by the meal.  In the meantime, make certain your little one has caught up on their water intake, adding in some fresh fruit, ice cubes or cucumbers for a little flavor and fun.
  • If your child is truly not hungry, they won’t eat.  They can then eat at the upcoming meal –  no grazing later on as the meal approaches.
  • When your kids are older, they can begin to make some choices about snacks, within the guidelines that you’ve demonstrated.  Remember to keep them planning and eating at a generally consistent time.

If you maintain the reliable consistency of meals and snacks, including a variety of foods, your child will regulate and be able to trust their body’s signals of hunger and fullness.  Happy snacking!


Ellyn Satter, Child of Mine: Feeding with Love and Good Sense (n.p.: Bull, 2000),“Ellyn Satter’s Division of Responsibility in Feeding,” Ellyn Satter Institute, 2014,


Metabolism: A Neutral, Natural Process

by Kristina Bergman

Everybody, regardless of color, shape, or size is born with a metabolism.  It breaks things down—so we may have the energy to do the things we love—and it also builds things up—so our cuts may heal fast and our hearts may beat strong.  Certainly, the unseen reactions that compose our metabolic pathways are fundamental to our very existence.  However intricate and complex, this innate system of “breaking down” and “building up” only requires one conscious effort from each of us: to consume the nutrients it requires to keep the system running.  All three of the macronutrients play countless essential roles: protein is converted into the enzymes that metabolize carbohydrates into usable energy and fats/lipids into the compounds that create our hormones and strengthen our minds.  Our bodies are made of countless interconnected, interdependent systems, each relying on an adequate intake of protein, carbohydrate and fat.  Our metabolism knows it needs these things to keep us going.  So, in the midst of continuous, devoted effort, it speaks to us.  When it needs fuel, it tell us to be hungry—so that we may seek its nutrients—and when it has all it needs, it tells us to feel satiated—so that it can work its scientific magic.  Our brilliant metabolism naturally tells us what to do; all we have to do…is listen.

 By Kr

Beat The Heat

by Kristina Bergman 

As a South Floridian in the summertime, you know this all too well: whether you’re taking the dog out for a walk, or just trying to get from the front door to the car, it’s nearly impossible to be outside without breaking a sweat!  Sweating out water and other nutrients can leave us feeling tired and dehydrated, which can ruin our summer fun.  Thankfully, Mother Nature doesn’t want us to melt!  To help endure the grueling heat, we’re offered an abundance of the perfect thing to keep us hydrated and full of energy: fruit!  Full of water, vitamins and even fiber, fruit can help us beat the heat and enjoy the summery flavors we love. Cherries, nectarines, berries, honeydew, peaches and plums are all in season.  You can always enjoy fruit on its own or incorporated into your favorite dishes to give them a summer twist: try topping your oatmeal or cereal with berries or slicing up pears or mangos for a salad.  So if you’re feeling the heat this summer, “Don’t sweat it!”  Remember that fruit is a nice refresher.


What is a Registered Dietitian Nutritionist?

The Institute of Medicine identifies registered dietitians as qualified professionals for nutrition therapy. According to IOM, “the registered dietitian is currently the single identifiable group of health-care professionals with standardized education, clinical training, continuing education and national credentialing requirements necessary to be directly reimbursed as a provider of nutrition therapy.”

A Registered Dietitian Nutritionist (RD or RDN – these credentials can be used interchangeably) is a food and nutrition expert who has at least a Bachelor Degree in Nutrition and has completed a rigorous training with supervised practice in a variety of clinical settings.  The majority of Registered Dietitians work in the treatment and prevention of disease (administering medical nutrition therapy, often part of a multi-disciplinary team), in private practice, hospitals, other health-care facilities, as well as research, business and sports nutrition. All Registered Dietitians are nutritionists, however not all nutritionists are Registered Dietitians.

The following criteria have to be met to earn the RD or RDN credential:

  • Completion of a ACED (American Council for Education in Nutrition and Dietetics)-accredited supervised pre-professional experience program including practicing at a variety of settings such as healthcare facilities, community agencies, and foodservice institutions.
  • Passing an extensive national Registration Examination for Dietitians administered by the Commission on Dietetic Registration (CDR).
  • Completion of continuing professional educational requirements to maintain registration.

Additionally, nearly all states have their own licensure requirements which further helps regulate standards within which the dietitians must practice.

How does a Registered Dietitian differ from a Health Coach, Health Counselor, Nutrition Coach or Holistic Wellness Provider?

As people have become more interested in nutrition and overall health, there has been a rise in programs and services disseminating nutrition information.  Additionally, online nutrition schools are emerging, many of which have no prerequisite to enter.  They usually do not require or produce a Bachelor’s degree and can be finished in less than a year online.  There is typically not a licensure governing the practices of Health Coaching or Nutrition Coaching, and they are not reimbursable by insurance plans.  Registered Dietitians have a minimum Baccalaureate degree granted by a U.S. regionally accredited college or university, or foreign equivalent.  There are a variety of specialty certifications available within the field, including sports nutrition, eating disorders, pediatrics and diabetes to name a few.  Many RDs practicing in outpatient or private practice settings employ a therapeutic approach as a Nutrition Therapist, guiding their clients toward balanced and normalized eating patterns.

Christie Caggiani, RD, LDN, CEDRD is Co-Founder of Therapeutic Oasis of the Palm Beaches in Delray Beach, Florida. Christie is a Registered Dietitian within the State of Florida and is certified as an Eating Disorder Registered Dietitian from the International Association of Eating Disorders Professionals (IAEDP).

Handling a Hurricane – Tips for Parents

With numerous activities involved in preparing for hurricane season, don’t neglect to spend a few minutes safeguarding your most important asset- your children. The “unknown” can create stress for families both before and after the storm. Taking the time to prepare you young ones for the hazardous weather can save you from unwanted meltdowns.  Children who have been prepared, and whose parents handle the disaster well, have a greater ability to cope with the stress. The following are some tips to help you teach, prepare, and play-out the storm.

Teach: Talking with your children prior to the hurricane can help to alleviate their fears. Be sure to explain why people board up their homes, what goes on outside during the storm, the sounds they will hear, and the likelihood of loosing power. The Internet has many resources that can help you teach basic concepts about the weather and its effects in terms kids can understand. Try

Prepare: Make preparations for hurricane season, just as you would for a house fire or other family disaster. Create a family plan that includes home safety, your family’s needs, and emergency actions. Allow children to participate in family preparations so they may feel less vulnerable. Simple tasks for children may include checking the yard for loose material, shopping for provisions, preparing a “safe place” with supplies, cleaning perishables items from the refrigerator, assembling an activity box for the storm, and being in charge of their own flashlight. Keep your family informed of evacuations, open shelters, government aide, and storm updates.

Play-out: In addition to a little wind and raid a hurricane brings time.. and lots of it! Schools and businesses can remain closed for days after the storm as they deal with unexpected repairs. This gives you plenty of time to be at home with each other so make it a fun memorable experience by thinking outside of the box! Keep to routines as much as possible and incorporate fun activities for the downtime. Here are some ideas to start you on your way:

  • Safe Camp: To make bunkering down even more fun, allow your children to set up a tent in your safe place.
  • Activity Kit: Gather family games, art supplies, and your child’s favorite toys together for easy access during the storm.
  • Entertainment: Have your children develop imaginary products that would be useful in the storm and the act out silly commercials.
  • Daylight Advantage: Let’s face it, there is more for children to do during daylight hours. Avoid sleeping-in and mid-day napping! Have your children go to bed early and rise early so that they do not find themselves restless and bored during the evening without power.
  • Driveway Movies: If you happen to have a laptop adaptor( or built in DVD player) for the car, you can go to the movies in your driveway.
  • Fondue Fun: Think of ways to make dinner a fun experience. Fondue, s’mores over candles, and grilled fruit can be sweet dinner adventures.
  • Explore: Take advantage of those bicycles or roller-skates you have always been meaning to use.
  • Volunteer: Encourage your children to help neighbors clear their yards and make repairs. Keep track of their unpaid volunteer hours during the storm. Many schools have volunteer coordinators who keep record of your child’s hours for future scholarship requirements.

Clara Bossie, M.S., B.Ed., LMFT, is a licensed marriage and family therapist at Therapeutic Oasis of the Palm Beaches in Delray Beach Florida.  She works with children and teens both individually and in groups, including DBT Skills Group for Teens and Pre-teens.