“Which food should I start with?”

“Does everything need to be puréed?”

“When can I give egg, fish or nuts?”

“How much should she eat?”

“And what if he doesn’t want to eat?”

Introducing solid foods, or more correctly starting complementary feeding, does not mean that milk stops and is suddenly replaced by food. It is a gradual transition during which the baby discovers new flavours and textures, learns to chew and swallow different foods and slowly begins to join the family table.

And as with many things in development, not all babies follow exactly the same schedule.

When do we start solid foods?

For most healthy infants, solid foods are introduced
at around 6 months of age. At this age breast milk or infant formula alone is no longer enough to meet all of the baby’s nutritional needs, and other foods need to be added.

But we don’t only look at the calendar.

The baby must have reached the necessary developmental readiness: good head control, the ability to sit steadily with support or on their own, interest in food and the ability to move food back and swallow it rather than constantly pushing it out with the tongue.

Introducing complementary foods before 4 months is not recommended. CDC

Which food should we start with?

There is no compulsory first food and no specific order that all babies must follow.

We can start with suitably prepared vegetables, fruit, cereals, meat or other nutritious foods, depending on the family’s habits and diet. Current guidelines do not require fruit or vegetables to come first, nor a particular food “protocol” to be followed.

From early on it is important to offer a variety of flavours and foods rather than sticking for weeks to fruit purées or cereal porridges.

At first, the baby is learning — not being tested

The first days are not about replacing a whole milk feed.

We start with small amounts and increase them gradually, watching the baby. One or two spoonfuls may be enough at first. CDC

Some babies are enthusiastic from day one. Others pull faces, spit the food out or need many repeated tastes of a new flavour before they accept it.

This does not necessarily mean “they don’t like it”.

Getting used to food is a learning process.

Milk is still important

Starting solid foods does not mean stopping breastfeeding.

Breastfeeding can continue alongside complementary foods for as long as mother and child wish. The WHO recommends continuing breastfeeding up to 2 years or beyond.

For babies who are not breastfed, the appropriate infant formula remains an important part of their diet during the first year of life. Between 6 and 12 months, breast milk or formula still provides a significant part of nutritional needs, while solid foods gradually take on a bigger role.

Fresh cow’s or goat’s milk should not be used as the main drink before 12 months. This doesn’t mean all dairy products are forbidden — pasteurised yoghurt without added sugar and suitable cheeses can be included in complementary feeding earlier.

Pay special attention to iron

After the first months of life, the baby’s needs for certain nutrients increase, and iron is particularly important.

That is why complementary feeding should not consist only of fruit and vegetables.

It needs to include age-appropriate iron-rich foods, such as meat, pulses and iron-fortified infant cereals, as well as other protein sources. ESPGHAN also stresses that all infants should receive iron-rich complementary foods.

Puréed or lumps?

There is no reason for a baby to stay on completely smooth purées for many months.

At first they may need soft, puréed or mashed food. But as their skills develop, we gradually move on to
thicker, lumpier and eventually soft solid textures.

Exposure to different textures is part of learning to eat.

What about baby-led weaning?

Baby-led weaning (BLW) is a way of introducing foods in which the baby feeds themselves suitably soft pieces of food instead of being fed only puréed food from a spoon.

We don’t need to pick a “side”.

A family can use a spoon, finger foods or
a combination of the two, depending on the child’s developmental readiness and the preferences of the child and the family. The NHS points out that there is no single right method; variety and adequate nutrient intake matter more.

Whichever method is chosen, safety from choking is non-negotiable.

What about allergenic foods?

Older ideas have changed quite a lot here.

We no longer recommend delaying, without reason, the introduction of foods such as well-cooked egg, nuts, fish, wheat and other potentially allergenic foods.

They can be introduced along with other complementary foods, in an age-appropriate form.

Peanuts in particular are never given whole. They can be offered in a safe form, for example as a smooth paste suitably thinned or mixed with another food.

In babies with severe eczema, an already known food allergy or other significant risk factors, how and when to introduce certain allergenic foods should first be discussed with the pediatrician.

Does every new food need to wait three days?

The old practice of introducing one new food and waiting several days before the next was mainly intended to make it easier to identify which food caused a possible reaction.

The CDC still suggests, in the initial phase, introducing single-ingredient foods and waiting 3–5 days between new foods to watch for possible allergic reactions.

In practice, however, the schedule should be individualised.

How will I know she’s full?

One of the most important things we can teach from the start is a healthy relationship with food.

The parent decides what, when and where food is offered. The baby shows us whether and how much they want to eat.

When they open their mouth, turn towards the food or show interest, they may want more. When they close their mouth, turn their head away, push the spoon away or lose interest, they may be telling us they are full.

The WHO recommends recognising and responding to the child’s hunger and fullness cues — responsive feeding.

There’s no need for “one more spoonful for mummy”.

An empty plate is not the goal.

Water, juices and other drinks

From the start of complementary feeding we can offer small amounts of water. The CDC mentions about 120–240 ml of water a day for ages 6–12 months, without this being an amount the baby should be pushed to drink.

Juices are not needed before the first birthday, even if they are 100% natural. Whole fruit is preferable.

Soft drinks, sugary drinks and other drinks with added sugar have no place in an infant’s diet.

Which foods do we avoid in the first year?

There are some important safety rules:

• No honey before 15 months of age, because of the risk of infant botulism.

• No fresh cow’s milk as the main drink before 12 months.

• Avoid unpasteurised milk and unpasteurised dairy products.

• Don’t add salt or sugar to the baby’s food.

• Avoid juices and sugary drinks.

• Don’t give whole nuts or other foods whose shape, size or hardness could cause choking.

Particular care is also needed with safe food preparation and storage.

Choking and gagging are not the same

When a baby starts learning new textures, they may
gag — making strong movements as if trying to push the food out of the mouth. This is a protective reflex and is not the same as a real blockage of the airway.

Choking, on the other hand, is an emergency.

For this reason the baby should always eat sitting upright in a stable position and under constant adult supervision. They should not eat lying down, walking around or playing, and should never be left alone with food.

Foods should always be of a suitable size, shape and texture for their developmental stage. Avoid foods which, because of their hardness, shape or size, could cause choking, such as whole nuts, raw carrot and hard pieces of apple.

“He didn’t like the broccoli”

Maybe. Or maybe he just doesn’t know it yet.

Babies are born with no experience of most flavours and need time to get used to them.

If they reject a food, there is no need for pressure. Calmly take it away and offer it again another day.

Variety is particularly important. ESPGHAN recommends exposure to different flavours and textures, including less sweet and more bitter flavours such as those of green vegetables.

So there is no need to “hide” every vegetable in sweet fruit for the baby to accept it.

How many meals does a baby need?

At first the amounts are small and increase gradually.

The WHO generally suggests 2–3 meals of complementary foods a day at 6–8 months and gradually 3–4 meals from 9 months, always according to the child’s needs and alongside milk.

But there is no need to turn these recommendations into a rigid timetable.

One baby will progress faster and another more slowly. What matters is the gradual progress in amount, variety and textures, and the child’s normal growth.

First foods are about more than calories

Complementary feeding is not simply the moment we add “solids” to milk.

It is a period during which the child learns to recognise flavours, handle different textures, chew, use their hands, drink from a cup, sense their hunger and fullness and gradually take part in family meals.

It doesn’t need to be perfect.

The baby doesn’t need to eat a specific amount at every meal, and parents don’t need to follow a complicated schedule to the exact day.

What is needed is safe foods, variety, gradual progression of textures, respect for hunger and fullness cues and time to explore.

The goal is not simply for the baby to learn to eat. It is to start building, from the very first bites, a healthy and enjoyable relationship with food.

For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.

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“My friend’s child walked earlier. Should I be worried?”

“She understands what I say but doesn’t talk much. Is that normal?”

A child’s development is a fascinating process — but it is often also a source of worry for parents.

From the first smile and babbling to the first steps, words and pretend play, every new skill is part of a complex developmental journey.

But children do not all develop at exactly the same pace.

That is why developmental milestones are valuable as reference points, but should not be treated as a strict “timetable” every child must follow.

What are developmental milestones?

Developmental milestones are skills and behaviours that usually appear at certain periods of childhood.

They are not only about speech or walking. We monitor development across different areas:

• movement and motor skills
• language and communication
• thinking, learning and problem-solving
• social and emotional development
• play and interaction with others

The CDC defines milestones as skills that most children — about 75% or more — can do by a certain age. Milestone checklists help monitor development, but do not replace developmental assessment with validated tools when there is a concern.

Around 12 months

By the first birthday, impressive changes have already taken place.

Most babies start to join in simple social games such as peek-a-boo, use gestures such as waving “bye-bye”, understand a simple “no” and call a parent “mama”, “dada” or another special name.

They also look for an object they saw being hidden, pick up small objects between thumb and index finger, pull up to stand while holding on to something, and many start to move around holding on to furniture. CDC

What matters especially is not only how many words the child says, but the overall way they communicate: whether they make eye contact, use sounds and gestures, share their attention with the parent and show interest in interacting.

Around 18 months

At 18 months communication becomes more complex.

Most children point to something interesting to share it with the parent, look at a few pages of a book together with them, and move away to explore while checking that the parent is still nearby.

In speech, they usually try to use three or more words besides “mama” and “dada” and can follow a simple one-step instruction without the adult having to accompany it with a gesture.

In terms of movement, most children now walk without support, try to use a spoon and can climb on and off a low sofa or chair without help.

Around 2 years

By the second birthday, language and play take another important step forward.

Many children now use several dozen words and start to combine two or more words, such as “want water” or “mummy come”. Between 19 and 24 months, children usually use and understand at least 50 different words and begin to combine them.

Pronunciation does not yet need to be clear. At two years it is completely expected that many words are not pronounced the way an adult would say them.

At the same time, the child understands more and more, follows simple instructions and uses play, gestures and words to communicate their wishes and interests.

We don’t just count words

This is perhaps one of the most important messages for parents.

Language development is not assessed simply by counting how many words a child says.

We are also interested in whether they understand speech, respond to sounds and to their name, use gestures, point to ask for things but also to share something interesting, seek communication, and whether their skills are progressing over time.

A child who says few words but understands well, uses gestures and tries hard to communicate shows a different developmental picture from a child who struggles with expression as well as understanding or social communication.

That is why the assessment must always look at the child’s whole developmental profile.

“His dad was a late talker too.” Should we wait?

Some children start talking later and then catch up. But there are also children in whom a language delay is the first sign that they need more support.

A delay may be related to different factors, such as a hearing problem, developmental language disorder, broader developmental delay or autism spectrum disorder.

That is why the approach “let’s wait until he’s three and he’ll talk” is not always appropriate.

When there is a real concern, assessment does not harm a child who turns out to be developing normally. On the contrary, it can significantly help a child who really does need intervention.

When is it worth talking to the pediatrician?

Parents don’t need to try to decide on their own whether a behaviour is a “red flag”.

There are, however, some situations in which we should not simply wait. Talk to the pediatrician early when the child is not reaching several of the expected milestones for their age, does not respond consistently to sounds or there are doubts about their hearing, has significant difficulties with communication or social interaction, or when something about their development worries those who care for them.

Loss of skills is particularly important. If a child stops using words, gestures, social or motor skills they had already mastered, this should be discussed with the pediatrician without delay. Prompt assessment is recommended when a child loses skills they had previously acquired.

If speech is delayed, should hearing be checked too?

Usually, yes.

Hearing is fundamental to the development of speech and language. A child may react to some sounds and yet have a hearing problem that affects how they take in speech.

So when there is a significant speech delay or a suspicion that the child does not hear as expected, a hearing assessment is an important part of the investigation.

Do two languages at home cause speech delay?

No.

A child growing up in a bilingual or multilingual environment may spread their vocabulary across the different languages, but
exposure to more than one language does not in itself cause a speech or language disorder.

Parents can speak to the child in the languages they know best. Families are encouraged to communicate with their child in the languages they feel most comfortable with.

What can parents do at home?

Special “exercises” are not needed for every healthy child.

Everyday life offers plenty of opportunities for development. Talk to your child about what you see and do, read books together, sing, play, name the things that interest them and give them time to answer.

When they say a word, you can expand on it. If they say “dog”, you can reply “Yes, a big dog!”. If they point at something, follow their interest and talk about it.

Monitoring doesn’t just mean “waiting”

Development is a core part of preventive pediatric care.

The pediatrician doesn’t just check whether the child walks or how many words they say. They follow progress over time, taking into account the history, the clinical picture and all areas of development.

Developmental surveillance, carried out at every visit, is different from standardised developmental screening with appropriate tools. American Academy of Pediatrics recommendations, as summarised by the CDC, provide for standardised developmental screening at 9, 18 and 30 months and specific autism screening at 18 and 24 months, as well as whenever a parent or health professional has a concern.

When there are indications, a hearing assessment or referral to a developmental pediatrician, speech and language therapist, pediatric neurologist or other appropriate professional may be needed, depending on the type of difficulty.

Don’t compare children — follow your own child’s progress

Development is not a race, and reaching a milestone a few weeks earlier does not mean a child is “smarter” or will do better.

There is normal variation in when many skills are acquired.

On the other hand, “every child has their own pace”
should not be used to ignore a real developmental difficulty.

Parents know their child better than anyone. When they feel that something in their communication, movement, play or social responsiveness is not progressing as they expected, it is worth discussing.

There is no need to panic, but there is also no need to wait without an assessment.

Recognising a difficulty early can lead to the right support at a time when the child is developing extremely fast.

And very often, the assessment simply leads to something equally important: reassuring parents that their child’s development is following its own normal course.

For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.

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Annual flu vaccination is the main measure for preventing flu and especially its serious complications.

For the 2026–2027 season, flu vaccination has already started in Greece. Ministry of Health

Which children should be vaccinated?

According to the National Immunisation Programme, flu vaccination is recommended for children with a relevant indication based on their age or health condition. The current 2026 National Immunisation Programme for Children and Adolescents has been published by the Ministry of Health. Ministry of Health

Recommended vaccination of infants and children aged 6 months to 5 years is particularly important, as well as of older children and teenagers who have a chronic illness or another factor that increases the risk of flu complications.

These groups include children with chronic respiratory conditions such as asthma, heart disease, diabetes, chronic kidney or liver disease, neurological or neuromuscular conditions, immunosuppression and certain other risk factors.

The pediatrician can review the child’s history and let the family know whether vaccination is indicated.

One dose or two?

This is a point that often causes confusion.

Children aged 6 months to 8 years who have not previously been adequately vaccinated need two doses of flu vaccine, at least 4 weeks apart.

So the simple question “has my child ever had a flu jab?” is not always enough. The number of doses should be determined by the pediatrician based on the child’s age and previous doses received.

Older children over nine and those who have already been adequately vaccinated in previous years need one dose for the current flu season.

When is the right time for the vaccine?

Flu vaccination is given every year, because protection wanes over time and the composition of the vaccines is updated according to the virus strains expected to circulate.

Autumn is the right time to arrange vaccination, so that there is time to build immune protection before flu viruses circulate widely.

Especially when a young child needs two doses, it helps to schedule vaccination early, as the two doses must be at least four weeks apart.

However, if vaccination is not done on time in the autumn,
it does not mean “the chance has been missed”. It may still be worthwhile as long as flu viruses are circulating in the community.

Can the flu vaccine give you flu?

No. Injectable flu vaccines cannot cause flu.

After vaccination there may be mild, short-lived reactions such as pain or redness at the injection site, tiredness, muscle aches or a low-grade fever.

These reactions are usually mild and settle quickly.

“My child had the vaccine and still got sick”

The flu vaccine protects against flu, not against all the respiratory viruses that circulate in winter.

So a vaccinated child may still get a runny nose, cough or fever from RSV, rhinoviruses, adenoviruses or other infections.

In addition, no vaccine gives absolute protection. Flu vaccination is particularly valuable, however, because it helps reduce the risk of severe illness and complications from flu. For the 2026–2027 season the Ministry of Health again emphasises the importance of timely vaccination, especially for vulnerable groups. Ministry of Health

What if my child has a cold?

A simple cold without a significant effect on the child’s general condition
is not necessarily a reason to postpone vaccination.

However, when there is an acute illness with fever or the child is unwell, the pediatrician will judge whether it is better to postpone the vaccination.

So parents don’t need to cancel the appointment themselves just because a mild runny nose or slight cough has appeared.

A small act of prevention every autumn

Flu comes back every year, and with it the need to protect children at greater risk of serious illness.

Flu vaccination is an annual act of prevention, which should be tailored to each child’s age, medical history and previous vaccination history.

Talk to your pediatrician about whether your child belongs to the groups for whom this year’s flu vaccination is recommended, how many doses they need and when is the right time to give them.

For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.

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The best known is strep throat (streptococcal pharyngitis), while the same bacterium can cause scarlet fever and certain skin infections, such as impetigo. In the vast majority of cases the infections are treated effectively. Much more rarely, streptococcus can cause a serious, invasive infection. National Public Health Organization (EODY)

For parents, then, the important thing is not to fear every sore throat, but to know when a child needs to be examined and when their general condition requires urgent assessment.

What symptoms can it cause?

Strep throat may present with a sudden sore throat, pain on swallowing, fever, swollen lymph nodes in the neck and redness or exudate on the tonsils.

Some children also have a headache, abdominal pain, nausea or vomiting.

When the infection is accompanied by the characteristic fine, sandpaper-like rash, it may be scarlet fever.

In contrast, symptoms such as cough, runny nose, hoarseness or conjunctivitis point more towards a viral infection than typical strep throat. CDC

Is every sore throat strep?

No. In fact, many sore throats in children are caused by viruses and do not need an antibiotic.

When there are no clear symptoms of a viral infection, the clinical picture alone is not always enough to distinguish viral from streptococcal pharyngitis with certainty. Depending on the child’s age and symptoms, the pediatrician may decide that a
rapid strep test or throat culture is needed.
CDC

Especially in children and teenagers, when a rapid test is negative but clinical suspicion remains, confirmation with a culture may be needed. CDC

When is an antibiotic needed?

When strep throat is confirmed, appropriate antibiotic treatment is given.

Treatment shortens the duration of symptoms, limits the spread of the bacterium and reduces the risk of certain complications. It is important that the antibiotic is taken at the right dose and for as long as the doctor has recommended. CDC

On the other hand, antibiotics should not be given “preventively” to every child with a sore throat, nor because another child in the class was diagnosed with strep.

Using antibiotics properly protects both the individual child and public health.

How does it spread?

Group A streptococcus spreads mainly from person to person through respiratory droplets and direct contact with secretions. It can also spread through contact with infected skin sores. CDC

Close contact makes transmission easier, which is why infections are more common in settings where many children are together, such as schools and nurseries. CDC

Simple measures can limit the spread: good handwashing, covering coughs and sneezes, and not sharing cups, cutlery and food with someone who is ill.
CDC

When can my child return to school?

Once appropriate antibiotic treatment has started, contagiousness drops considerably.

Current CDC guidance states that a child with strep throat can return to school or nursery when they
have no fever and at least 12–24 hours have passed since starting appropriate antibiotic treatment. The child should, of course, feel well enough to take part in their activities. CDC

The pediatrician can give more specific advice depending on the clinical picture and the circumstances at the school or nursery.

Do other family members need antibiotics?

Usually not.

Close contacts of a child with an ordinary strep infection do not, as a rule, receive preventive antibiotics simply because they were exposed to streptococcus. If they develop symptoms, they need to be assessed. CDC

Different management may be needed in special cases of severe invasive disease, or when there are people with specific high-risk factors in the close environment. In these cases, advice is given individually by the treating doctors and the relevant public health services. CDC

What is invasive strep (iGAS)?

Very rarely, group A streptococcus can reach parts of the body where bacteria are not normally present and cause
invasive infection (invasive Group A Streptococcal disease – iGAS).

This is a different condition from ordinary strep throat. It can present as serious infections such as bacteraemia/sepsis, pneumonia, necrotising soft-tissue infection or streptococcal toxic shock syndrome. These conditions are
rare but serious and require urgent hospital treatment. CDC

The fact that a child has ordinary strep throat
does not mean they are going to develop invasive disease.

Which symptoms should worry parents?

More than a specific temperature reading, what matters is the
child’s overall condition.

Urgent medical assessment is needed when a child shows a significant deterioration in their general condition, difficulty breathing, unusual sleepiness or difficulty waking, inability to take fluids, severe or rapidly worsening pain, or rapid worsening of a skin infection.

Also, if a child taking antibiotics for confirmed strep infection does not improve or gets worse, contact the pediatrician again. The CDC recommends contacting a healthcare professional if the child does not feel better after 48 hours of antibiotic treatment. CDC

Is there a vaccine against strep?

Currently there is no approved vaccine available against group A streptococcus. Vaccine development is an active field of research, and the World Health Organization has made the development of GAS vaccines one of its related research priorities. World Health Organization

Until an effective vaccine is available, prevention relies mainly on good hygiene, early recognition of symptoms and correct diagnosis and treatment of streptococcal infections. CDC

What parents should remember

Strep is common in children and in most cases is treated effectively. Not every sore throat needs an antibiotic, and not every contact with a case should cause worry or lead to preventive treatment.

What matters is a proper assessment of the child, confirming the diagnosis when appropriate and prompt treatment when it really is a streptococcal infection.

But when a child seems much more unwell than we would expect from an ordinary infection, or their condition worsens quickly, we don’t wait — we seek medical assessment straight away.

For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.

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“Is an examination by the pediatrician enough, or do we also need to see a cardiologist?”

These are questions parents often ask, especially at the start of the school year or when a child begins an organised sports activity.

The Student Individual Health Record (ADYM) and the
Athlete Health Card (KYA) are not the same document and do not serve the same purpose.

The first mainly concerns the child’s participation in school life and Physical Education. The second is linked to participation in organised sport under the applicable legal framework.

Let’s look at the main differences.

Student Individual Health Record (ADYM)

The ADYM is an official document used at school in Greece and serves as a certificate of the student’s health monitoring.

It is not simply a “note saying the child can exercise”. It is completed after a preventive medical examination, which includes taking a medical history and a physical examination of the child. Further specialised testing is carried out when there is a relevant medical indication.

The ADYM is required for the student to take part in Physical Education and other school sports activities, in accordance with the applicable regulations.

It is submitted at specific stages of schooling, including at enrolment in kindergarten and the 1st grade of primary school, at the start of the 4th grade of primary school, and after enrolment in the 1st year of lower secondary school (Gymnasio) and upper secondary school (Lykeio).

What does the pediatrician check for the ADYM?

The ADYM visit is a good opportunity for a
comprehensive preventive check-up.

The pediatrician reviews the personal and family history and carries out a clinical examination. Depending on the child’s age and history, the assessment may include growth, the cardiovascular and respiratory systems, blood pressure, the musculoskeletal system, vision and hearing, the progress of puberty and other aspects of physical and developmental health.

It is also an opportunity to check vaccination status and to discuss nutrition, sleep, physical activity and, for older children and teenagers, psychosocial health.

The official ADYM form states that additional specialist testing is requested when there are specific medical indications.

Who can complete the ADYM?

The legal framework provides that the ADYM may be completed and signed by a pediatrician or general practitioner and, in special cases, by an internist, with exceptions for areas where access to these specialties is difficult.

For a child or teenager, an examination by the pediatrician has the advantage that it can be part of their overall preventive care rather than being limited to issuing a certificate.

In other words, the ADYM can be the occasion for a real check-up of the child.

And what is the Athlete Health Card?

The Athlete Health Card serves a different purpose. It is linked to
organised sports activity and registered athlete status and is not replaced by the ADYM.

Likewise, the ADYM is not replaced by the Athlete Health Card when the school asks for it.

So a child who goes to school and is also officially registered with a sports club may, depending on the case, need both documents.

Why does pre-participation cardiac screening matter?

Sport has huge benefits for children’s physical and mental health and should be encouraged.

Pre-participation screening is not meant to keep children away from sport. Its aim is to identify those rare cases where there is a health problem that needs further investigation or specific advice before taking part in intense exercise.

The personal and family cardiac history is especially important.

Symptoms such as fainting or near-fainting during exercise, chest pain related to exertion, unexplained breathlessness, a sensation of strong palpitations or markedly reduced exercise tolerance need assessment.

It is equally important for the doctor to know whether there is a family history of sudden or unexplained death at a young age, cardiomyopathy, serious arrhythmias or a known inherited heart condition.

Does every child need an ECG and a heart ultrasound?

Generalisations should be avoided here.

The cardiac assessment of a young athlete is not simply “an echo just to be sure”. Different heart conditions are detected in different ways, and no single test rules out every possible condition.

In fact, in 2026 a specific European consensus on the cardiac evaluation of pediatric athletes was published. It proposes that cardiovascular pre-participation screening should include personal and family history, clinical examination and a resting 12-lead ECG, starting at the latest at age 12.

A heart ultrasound (echocardiogram) can be useful in selected cases, and the same European document states that a transthoracic echocardiogram may be appropriate for detecting certain structural conditions not seen on the ECG. This does not mean, however, that
every healthy child must have an annual heart echo.

When something suspicious emerges from the history, clinical examination or ECG, the assessment is individualised and further tests by a cardiologist may be needed.

So, pediatrician or cardiologist?

The right answer is not “one or the other”, because the two specialties have different and complementary roles.

The pediatrician assesses the child’s overall health, development and history. They can recognise symptoms or risk factors that need further investigation and refer to the appropriate specialist.

The cardiologist carries out the specialised cardiac assessment when it is needed and interprets cardiac findings in the appropriate clinical context.

For children and teenagers who play sport regularly, good cooperation between pediatrician and cardiologist is often far more meaningful than the question of which specialty “takes precedence”.

ADYM and Athlete Health Card at a glance

ADYM: concerns school and participation in school Physical Education. It is based on a preventive medical examination and, when there are indications, leads to further specialist testing.

Athlete Health Card: concerns organised sports activity within the framework set by sports legislation and has a different purpose from the ADYM.

The two documents should not be confused and, when a child falls into both categories, they may need both.

The signature is not the most important thing

Whether it is the ADYM or pre-participation screening, the goal should not simply be to fill in yet another form.

It is an opportunity to pause for a moment on the health of a growing child: to listen to their history, examine their development, look for symptoms that may not have been discussed before and decide whether any more specialised testing is needed.

Sport is valuable for children. Proper preventive screening is not meant to frighten them away from it or limit it, but to help every child take part in sport as safely as possible.

For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.

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“Am I being too strict?”

“Why does he keep reacting even though I explain?”

These questions are very common in parents’ everyday lives. Raising a child involves constant small decisions, and the balance between understanding and boundaries is not always easy.

Today we know how important it is to listen to children, acknowledge their feelings and respect their needs.

This, however, does not mean doing away with boundaries.

Children need care and guidance at the same time. They need space to express themselves, but also a stable framework in which they can feel safe and gradually learn to manage their behaviour.

Why do children need boundaries?

Boundaries help children understand what is allowed, what is not and what others expect of them.

In fact, a stable and predictable environment can provide security. When basic rules keep changing depending on mood or circumstances, it is harder for a young child to understand what is expected of them.

As they grow, through boundaries and everyday guidance they can gradually learn to wait, cope with frustration, take other people’s needs into account and take on age-appropriate responsibilities.

The goal is not obedience “at any cost”.

The goal is to help the child gradually acquire the skills that will one day allow them to regulate their own behaviour.

Acknowledging the feeling without removing the boundary

One of the hardest things for parents is seeing their child angry, disappointed or upset because they heard a “no”.

It is important to remember that acknowledging a feeling does not mean agreeing with every behaviour.

We can, for example, recognise that a child is angry because they have to stop playing, without necessarily changing the decision that it is bedtime.

We can accept their anger without accepting hitting.

We can understand their disappointment without meeting every demand.

In this way, the child receives two important messages at once:

“What you feel matters” and
“there are limits to behaviour”.

Boundaries don’t need to be harsh to be firm

Consistency does not mean strictness.

Shouting, threats or punishment are not needed to make a boundary clear. Often a short, calm phrase is more effective than a long explanation when the child is already upset.

Boundaries work best when they are few, understandable, age-appropriate and applied fairly consistently.

And “consistency” does not mean that a parent will never change their mind. There are times when an exception makes sense, or when a rule needs to change as the child grows.

It mainly means that the child can understand the basic framework within which the family operates.

When the child tests the boundaries

Children test boundaries. That is expected.

A young child may repeat a behaviour many times even though we have already said “no”. This does not necessarily mean they are ignoring us or “manipulating” us.

The ability to control an impulse, wait or manage a strong emotion develops gradually.

That is why parents often need to repeat the same message again and again.

A child does not learn a boundary because they heard it once. They learn it through repetition, experience and the consistent response of the adults around them.

And when the tantrum comes?

Intense outbursts, especially in younger children, are often part of development.

During a big outburst of anger, a child is usually not able to listen to long explanations or have a calm discussion.

The priority is to keep the child and those around them safe, and for the adult, as far as possible, to remain a calm presence.

The discussion can happen later, once the tension has eased.

Sometimes the best guidance at that moment is not more words, but fewer words and more steadiness.

Consequences are more valuable when they make sense

As the child grows, the consequences of a behaviour can become part of learning.

It is usually more helpful for them to be logically connected to what happened, rather than imposing unrelated or excessive punishments.

If, for example, a toy is being used in a way that could cause injury, it can be put away temporarily. If something was deliberately spilled or messed up, the child — depending on their age — can help tidy it up.

The aim is not to make them “pay” for the mistake.

It is for them to start understanding that our choices have consequences and that we can put right, as far as possible, what we did.

We don’t need to win every conflict

Not everything is equally important.

Safety, respect for others and certain basic family rules need clear boundaries. On other matters, however, we can offer choices and more autonomy.

A young child may not get to decide whether to sit in the car seat, but can choose which toy to take along.

An older child can take a bigger part in shaping the rules of their daily life.

As they grow, parental guidance needs to evolve:
less direct control and more gradual taking on of responsibility.

What happens when parents disagree?

It is normal for two parents not to always share the same view on boundaries.

One may be more flexible and the other stricter. They don’t need to react in exactly the same way in every situation.

It helps, however, if they agree on certain basic rules and, above all, avoid systematically overruling each other in front of the child.

Consistency does not require two identical parents. It requires a basic framework the child can understand.

Parents make mistakes too

There will be days when a parent shouts more than they would like. Gives in after deciding to stand firm. Reacts out of tiredness, or handles a situation in a way they later wish they had avoided.

This does not cancel the relationship.

On the contrary, the moment after a conflict can also become part of parenting. A parent can acknowledge that they reacted badly, apologise when needed and restore the boundary in a calmer way.

In this way the child learns something equally important: relationships can withstand mistakes and can be repaired.

When do difficulties need more support?

Every family goes through periods with more conflict, and every child may show difficult behaviour from time to time.

There are cases, however, where a behaviour is worth discussing further: when it is very intense or persistent for the child’s age, when it significantly affects daily life at home or at school, when there is marked aggression, or when parents feel they have exhausted the strategies they know.

A family asking for help is not a failure of parenting. It may be the best way to understand what is happening and what this particular child needs.

The pediatrician as a partner for the family

Pediatric care is not only about weight, height, infections and vaccines.

A child’s behaviour, sleep, development, relationships and adjustment are also part of their overall health.

Knowing the child’s developmental path, the pediatrician can help parents understand which behaviours are expected for the age, discuss practical ways of managing them and recognise when further assessment or specialist support is needed.

Care and boundaries are not opposites

Parenting does not require us to choose between tenderness and consistency.

A child can hear “no” and at the same time feel loved. They can be angry about a rule without that meaning the rule is wrong. And they can learn that all feelings are acceptable, without all behaviours being acceptable.

Parents don’t need to be perfect or to handle every difficult moment in the ideal way.

What they need is, as far as they can, to offer the child something far more essential:

consistency without harshness, understanding without an absence of boundaries, and love that does not depend on whether the child behaved “well”.

Because ultimately, boundaries do not exist to control the child. They exist to give them security, guidance and room to grow.

For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.

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They watch faces, recognise familiar voices and react to touch, sounds and the expressions of the people around them. Long before they can talk, they communicate: with their gaze, movements, facial expressions, sounds and, of course, crying.

Every time a parent looks at their baby, talks to them, cuddles them or responds to what they are trying to express, something much more than a simple moment of care is happening.

The baby is learning.

And perhaps most importantly, parents don’t need special toys, complicated techniques or a “training” programme to support their development.

The most important stimuli are already there in their everyday relationship.

Development begins through the relationship

A baby’s brain develops at an impressive pace in the first years of life. Genetic information determines a significant part of this process, but the child’s experiences and relationships with the people who care for them also play an essential role in their development.

When the baby cries and someone responds, when they smile and the parent smiles back, when they make a sound and someone answers, an early form of “conversation” is created.

Through these repeated interactions, the baby gradually begins to learn that the people around them respond to their needs and that the world can be a safe and predictable place.

Your face is one of the best “toys”

Babies are especially drawn to human faces and voices.

Look at your baby up close. Talk to them. Smile. Sing, even if you think you don’t have a good voice. Change your facial expressions and watch how they react.

As they grow, games like peek-a-boo, simple sounds and funny faces can become a source of great fun.

Constant stimulation is not needed. A few minutes of real interaction are worth more than a non-stop effort to keep the baby busy.

Talk to them — even if they can’t answer

Language development starts long before the first word is heard.

Simply describe what you are doing together: “Now we’re changing your nappy”, “Here’s your sock”, “Can you hear the doggy?”.

When the baby makes a sound, wait a little and answer. When they smile, smile back. When they try to get your attention, look at what they are looking at.

This back-and-forth — the baby does something, the adult responds and the baby answers again — is one of the first foundations of communication.

Repetition isn’t boring for a baby

We adults usually look for something new. Babies, on the other hand, learn a lot through repetition.

The same song, the same game, the same little story can be repeated many times and still be interesting.

Through repetition, the baby begins to recognise patterns, predict what will happen next and gradually understand the world around them better.

That is why there is no need for a new “educational activity” every day. Simple things are very valuable.

Read together from very early on

We don’t need to wait until the child starts talking to open a book together.

In the early stages, the baby doesn’t follow the story the way an older child does. But they hear the parent’s voice, look at the pictures and enjoy the closeness and the repetition.

Choose simple books with clear pictures, point to objects, name them and let the baby — when their age allows — touch and explore the book.

It doesn’t matter whether you get to the last page.

The goal is not to “finish the book”. The goal is the shared moment.

Follow your baby’s lead

Not all babies are the same.

Some seek more stimulation and social contact. Others tire more easily from loud sounds, lots of faces or long play sessions. Some are more expressive, while others watch quietly.

These differences are part of each child’s temperament.

By watching their baby, parents gradually learn their signals: when they want to keep playing and when they need a break, a cuddle or sleep.

A baby who is tired may look away, become more restless, fuss, yawn or rub their eyes.

At that point they don’t need more “learning”.

They need calm and rest.

Play doesn’t need to fill the whole day

Development doesn’t progress because the baby is constantly in front of new stimuli.

Sleep and periods of calm are essential for their health and development. Likewise, an environment with too much noise, constant toys and a continuous effort to keep them busy can tire a young baby.

Leave room for quiet moments too.

Sometimes the baby simply needs to be in your arms, watch your face or look around.

Does a baby need “educational” toys?

Suitable toys can certainly offer opportunities to explore as the baby grows. But they don’t need to be complicated or expensive.

A safe object they can look at and later grasp, a book, a song, play on the floor and, above all, interaction with a person offer plenty of learning opportunities.

Of course, toys must always be age-appropriate and safe, without small parts or other features that could cause choking or injury.

Other people in the baby’s life

A baby can form secure and meaningful relationships with more than one person.

The other parent, grandparents, relatives or regular carers can be an important part of their world.

When the baby needs to stay with another carer, it helps to have as much stability and predictability as possible. A person who responds consistently, with care and tenderness, can become another important secure relationship for the child.

As they grow, the baby may go through periods when they react more strongly to the parent leaving or to strangers. This is often a normal part of development and does not mean we have “spoiled” the child.

Don’t forget to look after yourself too

The first months with a baby are beautiful, but they can also be exhausting.

Lack of sleep, constant care and a changed daily routine demand a lot of physical and mental energy.

Parents don’t need to be constantly happy, available or creative to give their child a good start.

They also need rest, support and time for their own basic needs. Ask for help from people you trust and share the care whenever possible.

When should we discuss development with the pediatrician?

Every child develops at their own pace, and there is normal variation in when many skills are acquired.

Development, however, is a core part of preventive pediatric care.

At regular visits the pediatrician follows the child’s motor, language, social and cognitive progress and discusses with parents what they notice in everyday life.

If something about your baby’s communication, movement, response to sounds or faces, or development in general worries you,
don’t just wait for them to “grow out of it” before discussing it.

An early conversation with the pediatrician can either reassure the family or, when needed, lead in good time to a more specific assessment.

A strong start doesn’t need to be perfect

Impressive changes happen in the first year of life. The baby learns to communicate, move, explore and gradually understand more and more of the world around them.

Parents don’t need to know special techniques to “develop their child’s brain”, nor to turn every moment into an educational activity.

What is needed is something much simpler and much more essential:

to look at them, talk to them, play with them, respond to their signals and offer them a safe environment to explore.

For a baby, the everyday relationship with the people who love and care for them is in itself an extremely rich learning experience.

Because a baby’s first and most important “toy” is not on a shelf. It is the relationship with the people around them.

For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.

The post Babies are amazing: how a baby learns through everyday life appeared first on Γιάννης Ρίτσας.

Despite the appearance of the rash, which sometimes worries parents, in most cases it is a mild illness that clears up on its own within 7–10 days. CDC

What causes it?

The disease is caused by various enteroviruses, most often Coxsackie viruses. Coxsackie A16 is a common cause, while Coxsackie A6 can cause a more extensive rash. Enterovirus A71 has, more rarely, been associated with more serious complications. CDC

In everyday clinical practice, however, we usually don’t need to know exactly which virus caused the infection. The diagnosis is generally made from the child’s age and clinical picture, that is, the symptoms and the characteristic appearance of the rash. CDC

What are the symptoms?

The illness may start with fever, a sore throat, reduced appetite and feeling unwell.

Then characteristic painful small sores or blisters inside the mouth appear, and a rash may develop on the palms and soles. Spots may also appear on the buttocks, legs or arms. CDC

Not all children have exactly the same picture. In some the rash is limited, while in others it can be quite extensive.

How long does it last?

In most children the illness resolves without specific treatment within
7 to 10 days. CDC

The problem that most often needs attention is not the rash itself but the pain from the mouth sores. Because of the pain, a young child may refuse to drink and so be at risk of
dehydration. CDC

What can we do at home?

There is no specific treatment for the virus, and antibiotics have no place in treating uncomplicated hand, foot and mouth disease.

Treatment aims to make the child feel better until the infection passes.

Offer fluids often. Cool drinks may be easier to tolerate when the mouth hurts. Acidic drinks, such as some juices, are best avoided if they irritate the sores.

Choose soft, cool foods, such as yoghurt or other foods the child can swallow without much discomfort. There is no need to push them to eat. For a few days, getting enough fluids matters more than the amount of solid food.

For fever or pain,
paracetamol or ibuprofen can be used, at the right dose for the child and according to the pediatrician’s instructions.
Aspirin is not given to children. CDC

Blisters should not be popped. Keep the skin clean and let the sores heal on their own. CDC

How does it spread?

Hand, foot and mouth disease is highly contagious.

The virus can spread through droplets and secretions from the nose and mouth, close contact, fluid from the blisters, contaminated surfaces and objects, and also through stools. CDC

Children are most contagious during the first week of illness, but the virus can continue to be shed for days or even weeks after symptoms have gone. CDC

That is why good handwashing is particularly important — especially after nappy changes or using the toilet — as well as cleaning toys and frequently touched surfaces. Sharing cups, cutlery and towels should also be avoided. CDC

When can my child go back to nursery or school?

There is no need to wait for all the skin spots to disappear.

According to CDC guidance, a child can usually return when they have no fever, feel well enough to take part in activities and do not have uncontrolled drooling because of mouth sores. The school or local health authorities may also have more specific instructions, especially during an outbreak. CDC

Staying at home until the very last blister has gone usually offers little real benefit in limiting spread, as the virus can be shed for quite a long time. nhs.uk

Can peeling skin or nail changes occur?

After recovery, some children may develop
peeling skin on the hands or feet.

Nail changes, or even temporary loss of nails a few weeks after the illness, have also been reported rarely. Nails usually grow back normally. The CDC notes, however, that it has not been definitively proven that the disease itself causes the nail loss. CDC

When should you contact the pediatrician?

In most cases the illness runs a smooth course. However, medical assessment is needed when the child cannot drink enough or shows signs of dehydration, has a fever lasting more than three days, has severe symptoms or does not improve within about 10 days. The threshold for contacting a doctor should be lower for very young infants and children with a weakened immune system.
CDC

Urgent medical assessment is needed if the child shows unusual sleepiness or difficulty waking, seizures, difficulty breathing, a severe headache with a stiff neck, or any significant change in their general condition. Serious neurological complications are very rare but require immediate assessment. CDC

The most important things to remember

Hand, foot and mouth disease can look dramatic, but in the vast majority of children it is mild and self-limiting.

During the illness we focus on hydration, pain relief, hand hygiene and monitoring the child’s general condition.

And, as always, when your child’s condition worries you or does not progress as expected, contact your pediatrician.

For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.

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Heredity describes the passing of genetic information from parents to their children. Genetic information influences many characteristics of the human body — from blood group and certain features of appearance to a predisposition to specific conditions.

Reality, however, is more complex than “she got it from mum” or “he inherited it from dad”.

A child’s development and health are the result of a continuous interaction between their genes and the environment in which they grow up.

DNA, genes and chromosomes: in simple terms

Almost every cell in the human body contains our genetic material, DNA.

We can imagine DNA as a huge set of biological instructions. Sections of DNA make up the genes, which contain information involved in the functioning and development of the body.

DNA is organised into structures called
chromosomes.

Most human cells have 46 chromosomes, arranged in 23 pairs. In each pair, as a rule, one chromosome comes from the mother and the other from the father.

So from the moment of fertilisation, the child acquires a unique combination of genetic material.

Genes and environment: which matters more?

There is no simple answer.

For some characteristics the genetic influence is very strong. Others are significantly affected by the environment, while most complex human traits result from the
interaction of many genes with each other and with many environmental factors.

Nutrition, physical activity, sleep, infections, exposure to substances, social circumstances and many other experiences can interact with a child’s biological predisposition.

This becomes especially important when we talk about development.

A child is not simply the “sum of their parents’ genes”. Their physical growth, learning, behaviour and health are shaped through a much more complex process.

What are genotype and phenotype?

The term genotype refers to a person’s genetic make-up.

The phenotype is their observable characteristics — not only outward appearance, but also many biological and functional traits.

The phenotype is not always a simple “copy” of the genotype. In many cases it is shaped by the interaction of genetic information with the environment.

Is “genetic” the same as “hereditary”?

No — and this is an important distinction.

A genetic disease is a disease associated with changes in the genetic material.

A hereditary disease is a genetic disease whose underlying genetic change can be passed from a parent to a child.

Therefore, all hereditary diseases are genetic, but not all genetic diseases are hereditary.

Some genetic changes may appear for the first time in the child, without having been inherited from either parent.

How are genetic diseases inherited?

There is no single mode of inheritance.

Depending on the gene and the condition, there are different inheritance patterns.

Autosomal dominant inheritance

In some diseases, a pathogenic variant in one of the two copies of a particular gene may be enough for the condition to appear.

When a parent carries such a variant, in a typical autosomal dominant pattern each of their children has a 50% chance of inheriting it.

The probability applies to each pregnancy separately. The outcome of a previous pregnancy does not change the probability for the next one.

A well-known example is familial hypercholesterolaemia, which can cause very high LDL cholesterol levels from childhood.

Autosomal recessive inheritance

In other diseases, for the condition to appear the child needs to inherit a pathogenic variant in both copies of a particular gene.

The parents may be completely healthy
carriers.

When both parents carry pathogenic variants of the same gene, in a typical autosomal recessive pattern each pregnancy has:

a 25% chance that the child will have the condition,
a 50% chance that the child will be a carrier like the parents, and
a 25% chance that the child will not inherit either of the two variants.

Here too, the probabilities repeat with every new pregnancy.

A classic example is beta-thalassaemia (Mediterranean anaemia).

X-linked inheritance

Some conditions are associated with genes located on the X chromosome.

In the more common X-linked recessive diseases, boys are usually more likely to develop the condition when they carry the relevant pathogenic variant, because they have only one X chromosome.

A typical example is haemophilia A.

However, X-linked inheritance is more complex than the old rule “the mother is a carrier and the boys are affected”. Girls or women who carry a pathogenic variant may, depending on the disease and the biological mechanisms, also have symptoms.

What are chromosomal disorders?

Not all genetic diseases are caused by a change in a single specific gene.

Sometimes there is a different number or structure of chromosomes. A well-known example is Down syndrome (trisomy 21), in which there is an extra copy of the genetic material of chromosome 21.

Most cases of Down syndrome are not caused by inheriting an “abnormal gene” from a parent, but result from a chromosomal event during the formation of reproductive cells. There are, however, rarer forms in which the mechanism and the risk of recurrence are different.

This shows why genetic counselling must be based on the
specific diagnosis and not on general rules.

What does “I have a hereditary predisposition” mean?

A genetic predisposition does not always mean certainty that someone will develop a condition.

For many common health problems — such as obesity, diabetes, high blood pressure and several other conditions — there is usually no single “disease gene”.

Many genetic variants, combined with environmental factors and lifestyle, may influence the overall risk.

That is why saying “there is an increased predisposition” is different from saying “the child will develop the disease”.

Why does the pediatrician care about family history?

Family history remains one of the most useful tools in medicine.

The presence of specific diseases in parents, siblings or other close relatives can help the pediatrician decide whether a child needs earlier or different preventive screening.

For example, very high cholesterol or early cardiovascular disease in the family, certain blood disorders, unexplained pregnancy losses, congenital anomalies or a known genetic diagnosis may be important information.

That is why parents should inform the pediatrician about significant changes or new diagnoses in the family history.

When might genetic testing be needed?

Not every child needs genetic tests.

Genetic testing may be considered when there are, among other things, specific clinical findings, congenital anomalies, developmental difficulties with features that need investigation, a strong family history or a known genetic disease in the family.

The decision to carry out a genetic test is best made with a specific clinical question in mind.

A genetic test can provide valuable information, but it may also reveal findings of uncertain significance or information that concerns other family members. That is why interpreting the result is as important as the test itself.

What is genetic counselling?

Genetic counselling helps an individual or family understand a genetic diagnosis, how it may be inherited, the chances of it occurring or recurring and the testing options available.

Its purpose is not to decide on the family’s behalf.

The aim is to provide clear, evidence-based information, so that those involved can make their own decisions according to their needs and values.

Prenatal screening and prenatal diagnosis

When there is an increased likelihood of a specific genetic or chromosomal condition, testing options before or during pregnancy may be discussed.

An important distinction is needed here:

Prenatal screening estimates the probability that a specific condition is present, but usually does not by itself give a definitive diagnosis.

Diagnostic tests, such as chorionic villus sampling or amniocentesis in appropriately selected cases, can be used for a more definitive genetic or chromosomal investigation.

The available methods have advanced considerably, and the choice depends on the history, the stage of pregnancy and the specific question. The decision is made together with the obstetrician and, where appropriate, a clinical geneticist or genetic counsellor.

Heredity is not destiny

Modern genetics has helped us understand how important the genetic material we inherit is. At the same time, it has shown us that biology is far more complex than the idea that “one gene determines our life”.

For some genetic diseases the link between a genetic change and the disease is very strong. For many other traits and conditions, however, the outcome depends on many genes, the environment and their interaction throughout life.

For parents, the most important thing is to know their family history and discuss it with the pediatrician.

When there is a real indication, appropriate genetic investigation and counselling can provide answers, guide follow-up and help the family make informed decisions.

Our genes are an important part of our biological story — but in most cases, they are not the whole story.

For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.

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Taking some risks can be part of this developmental journey. However, when
repeated aggressive, dangerous or delinquent behaviours appear, we need to look for what may lie behind them, rather than simply labelling the teenager as “difficult” or “delinquent”.

Adolescent delinquency is a complex phenomenon. It has no single cause and is rarely explained by one factor alone. Individual characteristics, family and social circumstances, school difficulties, peer relationships, experiences of violence or bullying, substance use and mental health problems can all interact.

That is why effective management starts with
understanding and prevention rather than assigning blame.

The family: presence, communication and boundaries

In adolescence, the parent–child relationship changes. Teenagers need more personal space and autonomy, but this does not mean they stop needing their parents’ presence.

Positive parental involvement does not mean constant control. It means that parents know what is happening in their child’s life, take an interest in their friends and activities, notice changes in behaviour and remain available to talk.

At the same time, teenagers still need clear and consistent boundaries. Boundaries work best when they are understandable, age-appropriate, applied fairly consistently and gradually leave more room for responsibility and independence.

The goal is not a teenager who obeys everything. It is a young person who gradually learns to make choices, anticipate consequences and take responsibility for their actions.

Listen before judging

Communicating with a teenager is not always easy. They may answer in single words, withdraw, get angry or reject adults’ advice.

This does not mean parents should stop trying.

Often, listening needs to come before advice. Questions such as “What happened?”, “How do you see it?” or “Is anything bothering you lately?” can open a dialogue far more than an interrogation or a lecture.

Teenagers don’t need their parents to agree with every choice they make. But they do need to know that they can come back to them even when they have made a mistake.

This does not cancel the consequences of a behaviour. But it creates the conditions for the family to deal with it.

The role of the school

School is one of the most important settings in a teenager’s daily life. An environment where students feel they belong, are treated with respect and can turn to an adult when they are struggling has significant protective value.

At the same time, changes such as a sudden drop in school performance, frequent absences, isolation, repeated conflicts or marked aggression may indicate that a teenager needs more attention.

None of these behaviours on its own means a child will become delinquent. But it can be a reason for
early assessment and support.

When does a change in behaviour need closer attention?

Changes in mood and behaviour are common in adolescence. What matters most is their intensity, their duration and how far they affect the functioning and safety of the teenager or the people around them.

Particular attention is needed when there is persistent aggression or violent behaviour, repeated risky acts, significant withdrawal from school or family, substance use, serious changes in sleep or mood, or behaviours that put the teenager or others at risk.

Behind a difficult behaviour there may be an equally difficult emotion or a situation the teenager does not know how to handle.

So the question is not only “How do we stop this behaviour?” but also “What is this behaviour trying to tell us?”

The pediatrician and the adolescent’s psychosocial health

Pediatric care in adolescence is not only about height, weight, vaccines or physical symptoms.

The primary care pediatrician can follow the child’s development as a whole and discuss issues such as mood, school, relationships, sleep, substance use, sexual health, the internet, bullying and behaviours that may put the teenager at risk.

It is especially important to make room for the teenager themselves to speak and feel heard.

The pediatrician does not replace a mental health specialist. But they can be an important first point of recognition and support, assess whether further evaluation is needed and, when necessary, refer to a child psychiatrist, psychologist or other appropriate service.

In more complex cases, cooperation between the family, the pediatrician, the school and mental health professionals can be decisive.

Positive parental involvement: neither absence nor suffocating control

Being a positive presence in a teenager’s life can mean something very simple:

Showing interest without interrogating. Listening without always rushing to offer a solution. Knowing where your child is and who they spend time with, in an age-appropriate way. Setting boundaries and explaining why they exist. Recognising effort and not only results. Leaving room for independence while remaining available when the teenager needs you.

And perhaps the hardest of all: keeping the relationship going even when you need to disagree with the behaviour.

We are not looking for “someone to blame” — we are looking for what the teenager needs

A teenager’s delinquent behaviour should not automatically become their identity.

A teenager who breaks a rule, gets involved in a conflict or makes a seriously wrong choice is not necessarily a “delinquent teenager”. We need to assess the behaviour, the context in which it occurred, whether it is repeated, its consequences and the factors that may be feeding it.

The family, the school and health professionals have different but complementary roles. Early communication between them can help a difficulty to be recognised before it develops into a bigger problem.

Standing firmly by the teenager

Adolescence requires a delicate balance: freedom and boundaries, trust and supervision, independence and presence.

Parents don’t need to be perfect, and teenagers don’t need to be cooperative all the time.

But there needs to be a relationship secure enough to withstand disagreements, mistakes and difficult periods.

Because prevention does not start when delinquency appears. It starts much earlier — with relationship, communication, consistent boundaries and early recognition when a teenager is struggling.

For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.

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