Teens and Stress: Who Has Time For It?

What is stress?
Stress is what you feel when you react to pressure, either from the outside world (school, work, after-school activities, family, friends) or from inside yourself (wanting to do well in school, wanting to fit in). Stress is a normal reaction for people of all ages. It's caused by your body's instinct to protect itself from emotional or physical pressure or, in extreme situations, from danger.
Is stress always bad?
No. In fact, a little bit of stress is good. Most of us couldn't push ourselves to do well at things – sports, music, dance, work, school – without feeling the pressure of wanting to do well. Without the stress caused by a deadline, most of us also wouldn't be able to finish projects or get to work or school on time.
If stress is so normal, why do I feel so bad?
With all the things that happen at your age, it's easy to feel overwhelmed. Things that you can't control are often the most frustrating. Maybe your parents are fighting, or your social life is a mess. You can also feel bad when you put pressure on yourself – like pressure to get good grades or to get promoted at your part-time job. A common reaction to stress is to criticize yourself. You may even get so upset that things don't seem fun anymore and life looks pretty grim. When this happens, it's easy to think there's nothing you can do to change things. But you can! See the tips below.

• Signs you're stressed out
• Feeling depressed, edgy, guilty, tired
• Having headaches, stomachaches, trouble sleeping
• Laughing or crying for no reason
• Blaming other people for bad things that happen to you
• Only seeing the down side of a situation
• Feeling like things that you used to enjoy aren't fun or are a burden
• Resenting other people or your responsibilities
• Things that help fight stress
• Eating well-balanced meals on a regular basis
• Drinking less caffeine
• Getting enough sleep
• Exercising on a regular basis

How can I deal with stress?
Although you can't always control the things that are stressing you out, you can control how you react to them. The way you feel about things results from the way you think about things. If you change how you think, you can change the way you feel. Try some of these tips to cope with your stress:
Make a list of the things that are causing your stress. Think about your friends, family, school and other activities. Accept that you can't control everything on your list.
Take control of what you can. For example, if you're working too many hours and you don't have time to study enough, you may need to cut back your work hours.
Give yourself a break. Remember that you can't make everyone in your life happy all the time. And it's okay to make mistakes now and then.
Don't commit yourself to things you can't do or don't want to do. If you're already too busy, don't promise to decorate for the school dance. If you're tired and don't want to go out, tell your friends you'll go another night.
Find someone to talk to. Talking to your friends or family can help because it gives you a chance to express your feelings. However, problems in your social life or family can be the hardest to talk about. If you feel like you can't talk to your family or a friend, talk to someone outside the situation. This could be your priest or minister, a school counselor or your family doctor.
What are some things that don't help you deal with stress?
There are safe and unsafe ways to deal with stress. It's dangerous to try to escape your problems by using drugs and alcohol. Both can be very tempting, and your friends may offer them to you. Drugs and alcohol may seem like easy answers, but they're not. Using drugs and alcohol to deal with stress just adds new problems, such as addiction, or family and health problems.
I've tried dealing with my stress, but I just feel like giving up.
This is a danger sign. Stress can become too much to deal with. It can lead to such awful feelings that you may think about hurting – or even killing – yourself. When you feel like giving up, it may seem like things will never get better. Talk to someone right away. Talking about your feelings is the first step in learning to deal with them and starting to feel better.

Understanding Your Teenager's Emotional Health

What should I know about my teenager's emotional health?
The teenage years are a time of transition from childhood into adulthood. Teens often struggle with being dependent on their parents while having a strong desire to be independent. They may also feel overwhelmed by the emotional and physical changes they are going through.
At the same time, teens may be facing a number of pressures – from friends to fit in and from parents and other adults to do well in school or activities like sports or part-time jobs. The teenage years are important as your child asserts his or her individuality.
What can I do to help my teen?
Communicating your love for your child is the single most important thing you can do. Children decide how they feel about themselves in large part by how their parents react to them. For this reason, it's important for parents to help their children feel good about themselves. It is also important to communicate your values and to set expectations and limits, such as insisting on honesty, self-control and respect for others, while still allowing teenagers to have their own space.
Parents of teens often find themselves noticing only the problems, and they may get in the habit of giving mostly negative feedback and criticism. Although teens need feedback, they respond better to positive feedback. Remember to praise appropriate behavior in order to help your teen feel a sense of accomplishment and reinforce your family's values.
Establishing a loving relationship from the start will help you and your child through the teenage years.
The American Academy of Child and Adolescent Psychiatry (AACAP) suggests the following ways for parents to prepare for their child's teenage years:

• Provide a safe and loving home environment.
• Create an atmosphere of honesty, trust and respect.
• Allow age-appropriate independence and assertiveness.
• Develop a relationship that encourages your teen to talk to you when he or she is upset.
• Teach responsibility for your teen's belongings and yours.
• Teach basic responsibility for household chores.
• Teach the importance of accepting limits.

What warning signs should I look for?
Remember that your teen may experiment with his or her values, ideas, hairstyles and clothing in order to define him- or herself. This is typically normal behavior and you shouldn't be concerned. However, inappropriate or destructive behavior can be a sign of a problem.
Teens, especially those with low self-esteem or with family problems, are at risk for a number of self-destructive behaviors such as using drugs or alcohol or having unprotected sex. Depression and eating disorders are common health issues that teens face. The following may be warning signs that your child is having a problem:

• Agitated or restless behavior
• Weight loss or gain
• A drop in grades
• Trouble concentrating
• Ongoing feelings of sadness
• Not caring about people and things
• Lack of motivation
• Fatigue, loss of energy and lack of interest in activities
• Low self-esteem
• Trouble falling asleep
• Run-ins with the law

What should I do if there is a problem?
Work together to maintain open communication. If you suspect there is a problem, ask your teen about what is bothering him or her. Don't ignore a problem in the hopes that it will go away. It is easier to cope with problems when they are small. This also gives you and your teen the opportunity to learn how to work through problems together. Don't be afraid to ask for help with dealing with your teen. Many resources, including your family doctor, are available.

Dental Hygiene: How to Care for Your Child's Teeth

How can I best care for my child's teeth?
Good dental hygiene habits should begin before your child's first tooth comes in. Wiping your baby's gums with a soft damp cloth after feedings helps to prevent the buildup of bacteria. When teeth appear, start using a soft children's toothbrush twice a day.

Once your child is preschool-age, start using fluoride toothpaste. Don't cover the brush with toothpaste; a pea-sized amount is just right (see picture above). Young children tend to swallow most of the toothpaste, and swallowing too much fluoride toothpaste can cause permanent stains on their teeth.

What about using fluoride tablets?
Fluoride helps make teeth strong by hardening the tooth enamel. Many cities are required to add fluoride to tap water. If you live in an area where the tap water doesn't contain fluoride, your doctor may prescribe daily fluoride tablets when your child is about 6 months old. Fluoride is an important part of your child's dental health, but don't give him or her more than the directions call for. If you miss a dose, don't give your child extra fluoride to make up. Just as with swallowed toothpaste, too much oral fluoride can cause stains on your child's teeth.

What are cavities?
Cavities are holes that are formed when bacteria (germs) in your mouth use the sugar in food to make acid. This acid eats away at the teeth. Cavities are common in children. Good tooth care can keep cavities from happening in your child

Is my child at risk for cavities?
Your child might be at risk for cavities if he or she eats a lot of sugary foods (such as raisins, cookies and candy) and drinks a lot of sweet liquids (such as fruit juice and punch, soda and sweetened drinks). Your child also might be at risk if he or she has any of the following risk factors:

· Was born early (prematurely) or weighed very little at birth (low birth weight)
· Has ongoing special health care needs
· Has white spots or brown areas on any teeth
· Does not go to the dentist very often

How can I help stop cavities?
Everyone in your family should take good care of their teeth. Family members with lots of cavities can pass the cavity-causing bacteria to babies and children.

Teeth should be brushed at least twice a day and adults should floss once a day. Everyone should see the dentist twice a year. Have your doctor or dentist show you the right way to brush your child's teeth.

Does diet affect my child's teeth?
Yes. Avoiding sweets, sticky foods and between-meal snacks is good advice. To avoid cavities, limit sweet snacks and drinks between meals. Have meals and snacks at regular times. Teeth-friendly snacks include fresh fruits and vegetables, and cheese and crackers.

Baby bottles can create additional problems with your child's dental health. When liquid from a bottle--like milk and juice--stays in contact with the teeth for a long time, the sugars cause tooth decay. This can create a condition called bottle mouth. Your baby's teeth can develop cavities and become pitted or discolored. Never put a baby to bed with a bottle. Don't let your child walk around during the day with a bottle, and teach your child to use a drinking cup around his or her first birthday.

Is thumb-sucking bad for my child?
It's normal for children to suck their thumbs, their fingers or a pacifier. Most children give up this habit on their own by age 4, with no harm done to their teeth. If your child still has a sucking habit after age 4, tell your dentist. Your dentist can watch carefully for any problems as the teeth develop. In most children there is no reason to worry about a sucking habit until around age 6, when the permanent front teeth come in.

When should I start taking my child to the dentist?
The American Dental Association recommends that parents take their child to a dentist no later than his or her first birthday. This gives the dentist a chance to look for early problems with your child's teeth. Pediatric dentists specialize in treating children's dental health. You and your child's dentist should review important information about diet, bottles, tooth brushing and fluoride use. Visiting the dentist from a young age will help your child become comfortable with his or her dentist. It also establishes the good habit of regular dental check-ups.

Personal Safety: Helping Children Deal With Their Feelings

Children are not blind to the world around them. They see the news. They hear what adults are talking about. Yet children can't sort out what is really a threat. They need help from parents and other caring adults to cope with their fears. This information is intended to help you recognize when children are upset, and gives suggestions on how to talk with them about their fears.

How can I tell if my child is worried?
Here are a few things to look for that might mean your child is fearful:
· Loss of interest in normal activities
· Change in appetite or sleep habits
· Tearfulness
· Return to earlier habits such as bedwetting, thumb sucking or difficulty sharing with other children
· Unwillingness to leave parents

What can I do to help my child?
Create a safe environment for your child at home where it is okay to ask questions. By listening carefully to what your child says, you can reassure him or her and explain any misconceptions. Make it clear to your child that he or she is safe and keep daily activities as close to normal as possible. Pay attention to how much television your child is watching. You may want to turn off the television or at least watch it together and talk about what you see.

What else can I do?
Show your child that you aren't overly concerned. Remember that children often pick up cues from the adults around them. Even if you've worked hard to protect your child from fear, he or she may sense your fears or those of other adults or relatives. Often, children think discomfort is a sign that they shouldn't ask questions or talk about their worries. It can even seem to children that they've done something wrong. Give your child plenty of chances to ask questions and express his or her feelings. Sometimes it can be easier to ask about how other children are reacting as a way to begin the conversation

How much information should I give my child?
The amount and type of information you give your child depends on many things. This includes the child's age, past experiences and stage of development. Begin with basic facts and then ask questions to check your child's understanding. Remember that graphic details are not necessary.

What if I need more help?
If you are unable to talk with your child about his or her fears or need more advice, talk to your family doctor.

Help Your Child Develop Good Judgment

Many adults are crippled with indecision when faced with difficult choices.  Others, worse yet, make self-destructive choices and repeatedly demonstrate poor judgment.  But no one is born with good judgment and the ability to make wise decisions.  Good judgment and decision-making skills develop from experience combined with reflection.  As one sage noted, "Judgment develops from experience.  Good judgment develops from bad experience."
Your goal is to give your child experience in making decisions, and make sure she has the opportunity to reflect on them and learn.  You also want to raise a child who feels good about herself, so that she takes pleasure in making good decisions, rather than bad ones.  Research shows that kids who've been treated less than kindly get used to feeling bad, so as teens and adults they make decisions that make them feel bad.
How can you help your child develop good judgment?1.Practice makes perfect.  Give your child practice making choices even before she begins talking and she'll never have a problem making decisions.  (Who cares if the stripes and flowers clash?  She thinks she looks like a rainbow.  And if other people can’t figure out that she dressed herself, you don’t really care about their opinion of your parenting, do you?)
2.Be clear about his span of control.  Emphasize what he has the right to make decisions about, and what areas you as the parent retain the right to exert control over.
With toddlers: “Yes, I guess you may wear your superman outfit again, although you’ve worn it every day this week.  You’re in charge of your own clothes.  But you’ll need to change before we go to services, because there we dress up to show respect.  And you’ll need to brush your teeth. Do you want to do it now or before we leave the house?”
With preteens: "You can invite your friends for Friday night dinner if you want, but you're expected to have dinner with the family on Friday night as usual.  You can either go to the movies with your friends after dinner on Friday, or on Saturday."
3. Consciously help your child develop good judgment. Many people never develop good judgment because their experience isn't accompanied by reflection.  Help him to make decisions consciously (“How will you decide what piece to play for the recital?”) and to think through the possible repercussions of various choices before he makes them (“I wonder if you’ll feel too pressured about getting your homework done if you add another after-school activity.”)
Just as important, offer her the opportunity to reflect on how her decisions worked out (“I know you were worried about having a threesome this afternoon.  Are you glad you invited Clarisse to join you and Ellie for the playdate?”)  
4. Model decision making.  Share how and why you make decisions from the time your child is tiny. ("I think I'll bring an umbrella on our walk. It looks like rain." "I’m going to try the salmon; it's really good for you."  “I’d like our family to help with the drive for school supplies; all children deserve a good education, and this is one way to help.")
5. Know that it's ok for your child to make bad decisions. He's still learning about himself as well as about life. It's just more opportunity for reflection and the development of good judgment, as long as you help him consider afterwards how things could have been different if he had made different choices. Teens have more decision making latitude, and they're bound to make some bad decisions.  Just try to resist the universal impulse to say “I told you so,” and they'll learn from them.
6. Give your children control of their own decision-making as it becomes age appropriate.  What's age appropriate?  The list below will give you a frame of reference, but obviously, you'll need to adapt this chart to your own child and your family circumstances.  Remember to slowly build the degree of freedom and responsibility you offer your child, giving them as much help as they need to handle each level until they master it comfortably.
Each section covers a number of years; children in the lowest ages of that range are just beginning to handle the listed items.

Responsibilities Toddlers can be in charge of:

1. Their own bodies, within the limits of safety and decency.
2. Cleaning up their own messes. (“That’s ok. Get the paper towels off the counter and let’s clean that milk up.  We always clean up our own messes.”)
3. What to wear (within the limits of appropriate season, safety, and decency.)
4. Amount of food to eat  (You provide the selection. They decide how much.)
5. Getting the food into their mouths. (Unless they want help.)
6. What book to read, even if you're reading to them.
7. What toys to play with.
8. What toys to share (others get put away before friends arrive)
9. When to use the potty. (You offer: “Do you need to use the potty before we leave the house?”  But they need to check in with their own body and get to know its signals.  Unless you want to be in charge of their toileting for years to come?)

Responsibilities Preschoolers (3-5) can be in charge of:
All of the above, plus:

1. Their own clothes (Choosing them, within your parameters. Maintaining them, by keeping them in reasonably neat piles by category.)
2. Their own rooms (within reasonable neatness parameters. They decide what they want on the walls, within reasonable limits.  Parents will need to help them organize their stuff and teach them how to clean up.)
3. How much to eat.
4. What to eat (within appropriate nutritional guidelines. This only works if you limit accessibility of junk food.  It does mean you have to decide what to do when they don't like what you've fixed for dinner. In our house, they have to try one bite, then they can get a yogurt if they want. Yogurts rarely win out.)
5. Who to play with and when.
6. Whether to attend social events to which she is invited (excluding mandatory family events.)
7. Who is allowed in his room.

Responsibilities School-Age Children (6 to 9) can be in charge of:
All of the above, plus:

1. How to wear their hair (within appropriate grooming standards).
2. Clearing their place from the table.
3. Simple chores around the house
4. How to spend their allowance
5. Completing their homework
6. Getting their school backpack ready the night before
7. How to spend their time (after basic responsibilities like homework are accomplished.)
8. Whether to play an instrument or take a class.
9. What sport or physical activity to engage in (Given the research on this, physical activity in our house is non-negotiable, but they get to choose the type.)
10. Fixing simple food for themselves for snacks and lunch.

Responsibilities Preteens & Tweens (10-12) can be in charge of:
All of the above, plus:

1. Packing their school lunch
2. Self-grooming: nails, hair, etc.
3. Make (or help make) the family contributions for the class bake sale and other events.
4. Walk with a friend from one point to another within the neighborhood as long as a parent always knows where they are. (We live in New York, and bought our kids cell phones at this age.  Their early usage was mostly limited to calling parents.)
5. Staying alone in the house, with certain rules about who can be with them.

Responsibilities Early Adolescents (13-15) can be in charge of:
All of the above, plus:

1. Getting themselves up in the morning (you may need to be the backup plan.)
2. Doing their own laundry (eliminates you feeling like the maid when they suddenly need a certain item.)
3. Temporary changes in appearance (i.e., permanent tattoos are out in my family till they’re eighteen, but temporary ones are their choice. Piercings are discussed on an as-requested basis, and are discouraged because of the risk of infection and permanent scarring.)
4. Riding the bus and subway (some families require that this be with a friend.)
5. Going to movies with friends.
6. Earning spending money by babysitting or other jobs.
7. Budgeting their own spending.

10 Tips to Help Your Child Overcome Shyness

Were you shy as a child?  Half of all adults think of themselves as shy, and many more say that they were shy as children. 
But shy kids are at a disadvantage in our outgoing, busy culture, because they have a harder time relaxing and connecting with others.  Shyness can keep kids from learning the social skills that let them be part of a group, and it can compromise their school performance by making them anxious about asking questions.  Worst of all, shy kids can begin a pattern of isolation that keeps them from meeting others, beginning friendships and romances, and simply connecting with other human beings.  Scientists now think that social contact is one of our most important human needs, positively impacting our emotional and physical health on every level throughout our lives.
The good news is that shy kids can learn to manage shyness.  They just need a little extra support.  So what’s the best way to help your child overcome shyness?
1. Nurture your child by noticing her needs and responding to them. Shy baby chimps given to extremely nurturing mothers became leaders in their group, while their shy siblings raised by average mothers remained shy and fearful throughout life.  Responsive mothering helps shy little ones learn to calm themselves and manage their reactions.  That allows their heightened sensitivity to become an asset, because it makes them more responsive to the needs of their peers and better at negotiating group situations. 
 2. Empathize with your child’s shyness and avoid shaming him.  Acknowledging what he feels, without negative judgment, helps him to feel good about himself.   Giving him the impression that there is something wrong with him will just make him feel worse about himself, and therefore more insecure and shy.  Empathizing with your child will also help him develop empathy, which will enhance his social skills and keep him connected to others.
3. Model confident behavior with other people.  Kids learn from watching us.  That means being friendly to strangers, offering help to others, and modeling a relaxed attitude about social interactions of all kinds.
4. Teach your child basic social skills.  Kids often need to be taught to make eye contact, shake hands, smile, and respond to polite chit-chat appropriately.  Role play with them how to join a game at the playground, introduce themselves to another child at a party, or initiate a playdate. Kids who are successful in joining groups of kids usually observe first, and find a way to fit into the group, rather than just barging in.  Make games out of social skills and practice at home.
5. Help your child learn how to make friends.  Most kids need to learn social skills, and benefit from a little extra help.  I particularly recommend Lonnie Michelle's How Kids Make Friends: Secrets for Making Lots of Friends, No Matter How Shy You Are
6. Coach your child to handle teasing and bullying by role playing and encouraging her to stand up for herself.  A terrific book to help you help your child, offering scripts and strategies, is Scott Cooper's Sticks and Stones: 7 Ways Your Child Can Deal with Teasing, Conflict, and Other Hard Times
7.  Don’t label your child as shy.  Instead, acknowledge his feelings and point out that he can overcome his fears.  For instance, “Sometimes it takes you awhile to warm up in a new situation.  Remember Billy’s birthday party, how you held my hand all through the games?  But by the end, you were having lots of fun with the other kids.”
8. Teach your child effective strategies for dealing with shyness.  The general rule of thumb is to accept the nervousness that comes up as a part of normal life that affects most people, reassure yourself that you’re ok anyway, and focus on others rather than yourself.  For instance, remind your child that she doesn’t have to be interesting, just interested, and teach her to ask other kids questions and listen to their answers. Brainstorm with her how she might handle a situation that makes her nervous: “If you feel nervous at the party today, what could you do to make yourself more comfortable?  Could you hang out with one of the kids you know from school? Could you offer to help serve the refreshments?  What do you think you might talk with the other kids about?”
9. Provide your child with daily opportunities to interact with others.   Shy kids need downtime, of course, but they also need plenty of opportunities to practice their social skills. And remember that empathizing doesn’t mean being over-protective. Applaud every little step he takes on his own.
10. Don’t create social anxiety by teaching young children to be afraid of strangers.  Instead, teach your child that he or she should always be with you, or with a teacher or babysitter.  If her special adult is with her, your child doesn’t need to be afraid of strangers.  Once she’s old enough to begin walking home from school by herself, you can begin discussing how to keep herself safe.

Cholesterol and Your Child

Why should I be worried about my child’s cholesterol levels? Cholesterol is only a problem for adults, right?
Many people don’t realize that problems with high cholesterol levels can begin in childhood. High cholesterol levels are likely to continue to rise as a child grows into a teen and adult. High cholesterol levels increase your child’s risk for cholesterol-related health problems.


What are the risks of high blood cholesterol?
Your child’s body needs some cholesterol to protect nerves, make cell tissues and produce certain hormones. But too much cholesterol damages blood vessels by building up along blood vessel walls and forming sticky, fatty-like deposits known as plaque. Studies show that plaque can begin to form in childhood and is more likely to form when a child’s cholesterol levels are high.
High cholesterol levels increase the risk of heart disease and stroke. Heart disease is the leading cause of death in the United States. The risk is higher in people who have a family history of heart disease, have diabetes, are overweight or obese, have unhealthy eating habits, are inactive, or who smoke. Talk with your doctor about whether your child or teen needs to be screened for high cholesterol.


Where does cholesterol come from?
Your body’s liver makes all the cholesterol your body needs. However, you can also get cholesterol from the foods you eat, including animal products such as eggs, meats and dairy products.


What is the difference between LDL and HDL levels?
Cholesterol travels through the blood in different types of bundles, called lipoproteins.
Low-density lipoproteins (LDL) deliver cholesterol to the body. That’s why it’s often thought of as the “bad” cholesterol. Some people’s bodies make too much LDL cholesterol. LDL levels also are increased by eating foods high in saturated fat, trans fats and dietary cholesterol.
High-density lipoproteins (HDL) remove cholesterol from the blood. HDL is known as the “good” cholesterol for this reason. A healthy level of HDL may help protect against heart disease. Exercise can increase the amount of HDL the body produces. Avoiding trans fats and following a healthy diet also can increase HDL levels.
This explains why too much LDL cholesterol is bad for the body, and why a high level of HDL is good. The balance between the types of cholesterol tells you what the total cholesterol level really means. For example, if the total cholesterol level is high because of a high LDL level, the risk for heart disease or stroke is higher. But if the total level is high because of a high HDL level, the risk probably is not increased.


How does the doctor know that my child has high cholesterol?
To test for high cholesterol, your doctor can do a blood test called a lipid panel. However, screening is usually not done unless there is a family history of high cholesterol or the child or teen has diabetes.


What should my child’s cholesterol levels be?
If your doctor recommends a lipid panel, talk to him or her about what levels are right for your child’s age and development. The American Academy of Pediatrics generally recommends the following levels for children and teens 2 to 19 years of age:
Total cholesterol (mg/dL)
Acceptable — less than 170
Borderline — 170-199
High — 200 or greater
LDL cholesterol (mg/dL)
Acceptable — less than 110
Borderline — 110-129
High — 130 or greater


What can I do to help prevent my child from having high blood cholesterol levels?
Help your child maintain a healthy weight by teaching him or her to make good choices about diet and exercise.
Offer your child at least 5 servings of fruits and vegetables a day, and other foods low in saturated fat and cholesterol, such as whole grains and fish. Encourage your child to avoid saturated and trans fats, which can raise cholesterol levels. Also limit overall cholesterol intake. More information about nutrition is available in our handout about how to make healthier food choices and also in Nutrition: Healthy Eating for Kids.
You also can help your child form healthy habits regarding exercise and activity. Encourage your child to choose activities he or she enjoys. Involve the whole family in active time, such as walking, bike riding, bowling and more. Limit screen time (the time your child spends watching TV, or playing video or computer games). See more information about exercise in children in Keeping Your Child Active.


Will my child need medicine to lower his or her cholesterol?
If your child or teen’s cholesterol levels are high and healthy eating and exercise don't lower them, especially if he or she has diabetes or is overweight or obese, your family doctor may consider prescribing a cholesterol-lowering medicine. Not all medicines are safe for use in children so do not offer your child cholesterol-lowering medicine that isn’t specifically prescribed to him or her.