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8 Ways to Give Your Child a Safer Diet
Food: It's supposed to keep us healthy. But these days, sometimes our food makes us sick.
I'm not just talking about bad potato salad. I'm talking about more insidious risks, the kind that build up, and cause problems down the line--such as cancer. That's what makes these hard: you feel fine after eating or drinking this stuff.
As parents, it's particularly important that we make our children's diet is as safe as possible. Not only are we responsible for their well-being, but the fact that they have so many years ahead of them means that toxins have many years to build up in their bodies.
It's nearly impossible to avoid all toxins these days--they are truly everywhere. But here are 8 things parents can do to at least make their child's diet safer (not necessarily in the order of importance):
1. Limit processed foods. Yes, processed foods make life simpler. But they simply aren't as healthy as food you make or cook yourself. As much as you can, buy whole grains and fresh produce and fresh meats. Make big batches of recipes and freeze some. MyPlate has a great Pinterest board with tons of healthy, easy recipes.
2. Buy organic--wisely. The pesticides many farmers use can be poisonous and increase the risk of various diseases. However, it's not absolutely necessary to go totally organic. Some foods just have more pesticides than others. The Environmental Working Group has two great lists: The Dirty Dozen and The Clean Fifteen. Check them out--there's even an app you can use while you shop.
3. Wash your produce. Really well. All the time. You lower all sorts of risks that way. Originally in this post I said to wash meat, but I was appropriately corrected; the USDA says not to do that, because of the possibility of cross-contamination.
4. Be aware of mercury. Mercury can harm the developing brains and nervous systems of unborn babies and children--and there's mercury in a lot of seafood these days. Thick fish like tuna and swordfish (my favorites, sigh) have particularly high levels. To find out exactly what is safe (and what isn't) for children and pregnant women, check out the Fish Consumption Advisories page of the website of the Environmental Protection Agency.
5. Limit rice and rice products. Turns out that the rice plant is really good at sucking things out of the ground--like arsenic. The Consumer Products Safety Commission published a scary report last year that suggested we should all be cutting back on the amount of rice and rice products we ingest (I summarized it in a blog I wrote last fall). Rice isn't the only food with arsenic in it--a recent report found it in chicken, too--but it's important to know about.
6. Watch out for BPA. BPA, bisphenol-A, is another ubiquitous chemical, found in all sorts of plastics, the linings of cans, and even cash register receipts. It can affect the reproductive system, may affect behavior and can increase the risk of cancer. To limit exposure, use fewer canned goods (I've been using dried beans more--takes advanced planning but worth it) and don't serve or eat foods in or on plastics with the numbers 3 or 7 on them (limiting plastics in general is a good idea). You can read more at the National Institute for Environmental Health website.
7. Keep to real colors. This is part of #1, really, but if the color of the macaroni or the drink you are giving your chid is, well, not a color you've ever seen in a food (or in nature), that's not a good sign. Not that all food coloring is toxic. But some of it isn't good for you--and chances are that the food or drink isn't healthy for some other reason. Speaking of drinks...
8. Keep drinks to the healthy three. Kids really should be drinking milk (or a healthy alterna-milk--my friend Dr. Natasha Burgert has a great post about those), water or 100 percent juice (although, keep juice to no more than a cup a day or so). Nothing else.
If I'm forgetting something, please chime in!
It's really important, too, to stay informed. Talk to your doctor. The various websites I've linked to have lots of great information, as does the American Academy of Pediatrics website for parents and families. We learn new things every day, so check in frequently to learn the best ways to keep your family healthy.
Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.
New report says 1 out of 5 children has a mental disorder
In your average classroom of 20 children, four of them have a mental disorder.That's the finding of a report published by the Centers for Disease Control and Prevention (CDC). It's the first report to describe the number of U.S. children aged 3 to 17 years who have specific mental disorders. Using information from various different sources covering the period 2005 to 2011, they came up with estimates for what percentage of children currently have mental disorders. The "currently" part is important: when they say that up to 1 in 5 children have a mental disorder, they mean that up to 1 in 5 have it--and need help--now.
The report is sobering. Here are the top five:
- ADHD: 6.8 percent, or 1 in 14
- Behavioral or conduct problem: 3.5 percent, or 1 in 28
- Anxiety: 3.0 percent, or 1 in 33
- Depression: 2.1 percent, or 1 in 50
- Autism spectrum disorders: 1.1 percent, or 1 in 100
You child knows these children. You child may be one of them.
The report also had numbers for the percentage of adolescents with substance use disorders or cigarette dependence in the past year. These aren't the kids who occasionally get drunk or smoke a cigarette or a join--these are the kids who use them enough to have a real problem:
- Illicit drug use disorder: 4.7 percent, or 1 in 20
- Alcohol use disorder: 4.2 percent, or 1 in 25
- Cigarette dependence: 2.8 percent, or 1 in 36
Again: your teen knows these kids. Your teen may be one of them.
And the report found that in 2010, suicide was the second leading cause of death among youth ages 12 to 17. You really don't want your teen to know one of those--or be one of them.
That's the thing: this does, or could, touch all of us. And not only are many mental disorders chronic diseases that children will battle for a lifetime, when they start in childhood they often bring family problems, school problems and social problems that can shape a child's life forever. This isn't just about children; this is about tomorrow's adults. This is about who we will be as a society.
It's also about what we will pay as a society. The report estimates that $247 billion is spent each year on childhood mental disorders. Add to that the costs of caring for them as adults, and lost productivity, and this becomes an extremely expensive problem.
So what can we do? The good news is that many childhood mental health problems can be prevented, or at least improved, by giving children the support and nurturing they need--and acting early and quickly if there is a sign of a problem. As a country, we need to be sure that there are enough mental health resources, and that everyone can afford them. But there are also things that each one of us can do.
Parents: It's really important to be aware of the signs of possible mental health problems--and to ask for help if you see them. It's also a really good idea to learn as much as you can about positive parenting; being a parent is really hard, and we all have something to learn.
Teachers, coaches, and others who work with youth: Learn the signs too. Speak up. Reach out. Work with families and mental health care professionals--do everything you can to help kids get what they need.
Health care professionals: Never dismiss a parent's concern--and always act on any concerns you might have about a child. Sometimes parents just don't realize what is going on--or are waiting for you, or anyone, to say something and help.
Teens: if you are feeling angry, sad, anxious or some other feeling that feels bad or hard, let someone know. You don't have to handle it alone.
The CDC's Mental Health page has more information and lots of links. Check it out; find out what you need to know--and what you can do.
Here's an infographic from the CDC:
One way you can--and should--spy on your teen driver
I'm not big on spying on teens generally. I think that privacy is important. And by the time they are teens, in most cases we need to trust that at least some of the stuff we've said for years has stuck--and we need to let them learn to be independent and make choices without us.
That said, if you have a teen who drives, there's some spying I suggest, assuming you pay for your teen's cell phone (if you don't, I'm really jealous): check to see when your teen is texting. More specifically: check to see if he's doing it while he's driving.
I have Verizon, and it's really easy. With our online account, I can see every call or text anybody makes. I can't see the text itself (or, if I can, I haven't figured out how), but I can see when they do it. It's not even so much spying, because really, you own that information.
Now, you may not know exactly when your teen is driving. This is not a perfect system. But you might catch something--and the fact that you are checking might be enough to make your teen think twice before texting behind the wheel.
A new study in the journal Pediatrics says that half of US teens 16 years and older report texting while driving in the past 30 days. To be fair to teens, we adults aren't setting much of an example: according to the Centers for Disease Control and Prevention, a third of adults text while they drive.
We all know it's dangerous...but some of us do it anyway, perhaps thinking that disaster will happen to someone else. And that's just the thing about teens: they are wired to think that disaster will happen to someone else. Their brains are still developing, and the last part to mature is the frontal lobe, the part of the brain that controls our impulses and gives us some common sense. From an evolutionary standpoint, it's good that adolescents are willing to take risks; as you start out in life, it's good not to be afraid of your shadow. But that risk-taking can sometimes play out badly--and often does, when they text and drive.
The same study showed that teens who text while driving are also more likely to do other risky things while driving--like skip the seat belts, drive with someone who has been drinking alcohol or drive while drunk themselves. There's probably technology to figure that out, too, but it's not quite as easy as checking your cell phone bill.
If you do discover that your teen has been texting when driving, there should be consequences. At a minimum, there should be a loss of driving privileges. Driving truly should be a privilege, not a right--teens need to understand really clearly how their lives, and the lives of those around them, can be on the line every time they drive.
So set rules for safe driving--and enforce them. And while you are at it, follow them too. Please, don't text and drive.
This UK PSA from 2009 is very graphic (it's four minutes long but feels like an eternity, it's so hard to watch) but it really, really drives the point home. If you watch it with your teen, neither of you will ever think that it's no big deal to text and drive.
Parents: Let's Keep Some Perspective About Youth Sports
At my son's soccer game the other day, a parent kept yelling very loudly at one of the players on the other team, giving various directions as to what the player should and shouldn't do. When I say "very loudly", I mean so loud--and harsh--that it startled me each time.The kids were first graders.
The mother of one of my son's teammates (who was wincing along with me) told me how at her daughter's soccer game earlier that day, the coach of the other team was berating the players, telling them what a terrible job they were doing and calling them names.
Those kids were sixth graders.
Really?
Now, I get that these are extremes. But with five kids, I've been to a lot of sporting events, and have listened to a lot of parents and coaches pushing--in good ways and bad ways--kids to achieve. And while achievement is generally a worthy goal, I'm not sure it's the best goal for youth sports.
Often, when I talk to other parents, I hear stuff about hoping for athletic scholarships. I've got two kids in college now, and so know first-hand how outrageously expensive it is and how every little bit helps. But only about 2 percent of high school athletes get athletic scholarships to college--and very few of them are full rides. The chances of "going pro" are even smaller: about 0.03 percent for basketball, 0.08 percent for football, for example. Basically, unless your kid is extremely gifted and extremely lucky, he's not getting any money out of sports.
Here's what your kid can get out of youth sports:
- Exercise. With a third of US kids overweight or obese, we need to get more kids moving. Not only does exercise help kids now, it builds healthy habits for a lifetime.
- Friendships. Sports can be a great way to build relationships and social skills.
- Positive self-image. Feeling strong and learning skills can make a kid feel really good about herself.
- Involvement in positive activities. Sports are a way better way to spend your time than video games or hanging out on the streets; for many kids, sports are what keep them on a good life path.
- Time management skills. Athletes, especially high school athletes, need to learn to get homework and other things done around practice.
- Fun! With the right approach and attitude from the athlete and the coach, sports can be a lot of fun.
They are, however, not fun when you are being yelled at--or pushed all the time to achieve. Which is probably why the majority of kids drop out of sports before high school--and miss out on all the benefits entirely.
So, parents, let's keep some perspective. When you are at the sidelines, let the coach do the coaching--if you are going to yell anything, make it encouragement. If you see coaches treating kids badly, speak up--and find a different team if it continues. Don't push your kids to achieve--we should always try to do our best, but it's not always the point of everything. It's certainly not the point of youth sports.
Sometimes it's good enough--better, even--to show up, play the game and have fun.
Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.
For the Women Who Dread Mother's Day
Everywhere you look--or listen--there's something about Mother's Day. There are ads for gifts, reminders to buy flowers, sentimental blogs, stores stocked with cards. It's all so lovely and sweet...unless you really don't like Mother's Day.
There are lots of good reasons to not like Mother's Day--the mere fact of how commercial it has become is probably enough. But for some of us, the reasons are, well, harder.
For me, Mother's Day is hard because I am the mother of a child who died. It's not that there aren't good things about Mother's Day, but it's definitely a trap-door day for me and all the mothers who have lost children, including children who had yet to be born.
It's a hard day for those who have lost mothers.
It can be a bitterly sad day for those struggling with infertility, or those who for other reasons don't have the children they hoped for.
Mother's Day can be painful, too, for those who are estranged from, or have difficult relationships with, their mothers or their children. It's a day when it's hard to escape or ignore that your relationship isn't what you what you want it to be.
And it's not always easy for the mothers of disabled children, the mothers who aren't going to get those homemade cards, or ever hear "Happy Mother's Day" from their child. Again--it's a day that so idealizes the mother-child relationship that anything less, or different, feels not good enough--even though these women are among the heroes of motherhood.
We are a sisterhood, all of us who just want the day to pass. We are a sisterhood of women who have learned so much the hard way, who know that life doesn't hold guarantees, who in our better moments understand that love isn't about what you get, but what you give.
There's no way to make the day go away. It hurts, no matter what. But for me, part of what helps is acknowledging that it will hurt--and planning for it. I run in a Mother's Day race that I really enjoy. I spend time with people I love. I eat food I like. I take care of myself.
That is what I hope for each of you in the sisterhood with me: that you take care of yourself. Do something self-indulgent. Eat only ice cream all day if you feel like it. Buy yourself a gift. Spend at least a few minutes of the day being beholden to nobody but you.
And--any of you who know one of us, reach out. Let us know you are thinking of us--it helps. Give us a call, or a hug. Send a text. We'll need them.
Sisters, you aren't alone. There are vast numbers of us. Maybe that's what we can do, too: reach out our hands to each other--in real ways, in cyber-ways, in any way--and say: I understand. I stand with you. This day shall pass, life goes on, and there are always, always reasons to be grateful.
FAQ: What can I do about my teen's acne?
Acne: it's part of life for most teens. And maybe because it's so much a part of life, it's easy sometimes for parents to minimize or ignore it. After all, it's going to get better, right?
It's true that it usually does get better. But living with it is no fun. To have pimples at a time in your life when what matters most to you is what people think about you...yikes. Also--some parents don't think about this--when acne is severe, it can leave scars.
Luckily, there are some effective treatments for acne. In fact, the American Academy of Pediatrics just published recommendations. Here's what they say:
First, the lowdown on washing: acne is not a hygiene problem. Too much scrubbing, especially with harsh products, can actually make acne worse! Use a mild, soap-free cleanser. You can try toners, which may help reduce oiliness, but stop if they irritate the skin.
Most cases of acne will respond really well to some combination of:
- Benzoyl peroxide. This comes in strengths from 2.5 percent to 10 percent, without a prescription (stronger isn't necessarily better--sometimes stronger can irritate the skin and make things worse) and should be the first thing you try.
- Retinoid cream or gel (tretinoin, adapalene or tazarotene). These are only available by prescription. The best way to use them is to spread a pea-sized amount over the area with pimples, rather than trying to get it on each pimple.
- Antibiotics. While antibiotics can sometimes be helpful when put on the skin (especially if combined with benzoyl peroxide or a retinoid), they are most helpful when taken by mouth. This, too, requires a prescription.
For more severe cases, your doctor might consider:
- oral contraceptives (for girls). There are a few types that can help make acne better. Oral contraceptives can have risks and side effects, so you should discuss this carefully with your doctor.
- Isotretinoin. This is a retinoid in a pill form, and it can make a big difference. However, teens who take it need to be monitored closely for side effects and need regular blood tests. It can cause birth defects if taken while pregnant, so girls who are taking it need regular pregnancy tests. There is also a possible risk of depression, so parents need to watch their teens closely for this (but given how depressed severe acne can make a teen, this risk may not seem so bad).
The bottom line: acne doesn't have to be a necessary evil of adolescence. There's lots that you can do. Talk to your doctor.
Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.
Study: Parents Are Really Distracted Drivers
As someone who has been a parent for 22 years, I know firsthand just how hard driving kids around can be. When they are little they cry, as they get older they ask a million questions and fight with their siblings, and when they get older there's the whole issue of the radio, not to mention the chaos of friends in the car. But a study just released suggests that when it comes to parents and distracted driving, it's not just an "Are we there yet?" problem.Researchers from the University of Michigan surveyed more than 600 parents about various common driving distractions. They asked them whether, in the past month, they had talked on the phone (handheld or hands-free), done child care (fed a child or picked up a toy), done self-care (grooming, eating), gotten directions (via a navigation system or a map), fiddled with the entertainment system (changing a CD or DVD), or texting/surfing the Internet. They also asked them if they did it during less than half the trips, more than half the trips or every trip.
The results (which, sadly, probably won't surprise most parents) were worrisome. Here's the rough breakdown of how many said yes to each:
- Phone calls: 75 percent (20 percent every trip)
- Child care: 70 percent (25 percent every trip)
- Self-care: 70 percent (10 percent every trip)
- Directions: 50 percent (10 percent every trip)
- Entertainment: 50 percent (5 percent every trip)
- Texting: 15 percent (1 percent every trip)
Now, not all of this is necessarily awful. I don't know that it's that dangerous to munch on a cracker or listen to the nice GPS voice telling you to turn right in 30 yards while you drive. But some of it is dangerous; while there is a general and understandable uproar about texting and driving (thank goodness the numbers in this study were lowest for that), the truth is that anything that takes our eyes or minds off the road can lead to disaster.
And that's what the researchers found, too. Parents who used phones while driving were more than twice as likely to have had a previous motor vehicle crash. Those who did child care, self care or got directions were about twice as likely, and those who fiddled with the entertainment or texted were about one and a half times more likely.
Multitasking is an intrinsic part of parenthood. It's hard to imagine parenthood without it--I'm certainly someone who has done some pretty extreme multitasking. But I think that there are some times, and some places, when we just have to stop ourselves from multitasking. When we are driving our kids somewhere, well, that's one of those times.
Try pulling over to make phone calls (and certainly to text or use the Internet). Eat before you go--or stop and eat if it's a long ride. Make sure there are plenty of toys within reach for long car rides. Know where you are going before you leave. If they don't like the music or the movie, tough--unless you have someone with you who can change it, or until you can pull over. Try setting car rules and creating a culture of safety; it will lessen the arguments.
When we drive our children, let's treat them like the precious cargo they are.
Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.
Was your child near the marathon bombings? He might need his ears checked.
We've been reading in the news about all the people who have had hearing loss from the bombs at the Boston Marathon. Some of them didn't go to the doctor until days later, when they realized that they just weren't hearing right.
The thing is, kids might not realize that.
That's what the ear specialists at Boston Children's Hospital, where I work, are worried about. Children, especially small children, may not understand what's going on when they lose hearing. And they may not be able to explain what it is they are experiencing.
So--if your child was within about 300 feet of either blast (especially if not shielded by a building), if your child was with you and either of you needed any medical care afterward or if your child has any signs of a hearing problem, talk to your doctor about getting an ear and hearing check.
Signs of a problem could include:
- Ear pain (and obviously any bleeding or fluid coming out of the ear)
- Ringing in the ears (a younger child may complain of hearing something)
- Not responding normally when spoken to
- Not paying attention
- Asking people to repeat what they say
- Turning up the volume on things like the TV
Really young children might be more clingy or irritable than usual, and be less interactive.
Some ear problems from the blast may get better by themselves--but some may need treatment, and if there is a permanent hearing loss, the sooner you know, the better--hearing loss can cause lots of problems for children. So talk to your doctor if you have any worries at all. The Audiology department at Boston Children's offers hearing tests in various locations in the Boston area--you can call 617-355-6461 for more information.
Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.
FAQ: What causes warts--and what can you do about them?
There is something about warts that makes them seem icky and embarrassing, although I'm not sure why; I think we have some odd associations with them (like with frogs and witches) that these skin growths, which aren't dangerous, don't deserve. They are incredibly common--up to a third of school-age children may have them--which means I have a lot of conversations with worried parents about warts.
Here's what people ask--and what I tell them.
What causes warts?
Warts are caused by viruses in the human papilloma virus (HPV) family. These are incredibly common viruses that can be easily passed between people (which is why warts are so common). They can also spread around the body.
Pools (and the showers associated with them) have traditionally been associated with warts, but a recent study suggests they've been getting a bad rap for no good reason--kids are much more likely to get them from family members and school friends. They grow really slowly, so it can be hard to figure out where you got them from.
I thought warts stuck out of the skin--how can those flat things on the bottom of my feet be warts?
Warts on the bottom of the feet are called plantar warts, and they do appear flat--but they can grow inward (or get pushed inward when you walk) and be painful.
How can we make warts go away?
This is what people most want to know--and they want to know how to make warts go away quickly. That's hard, because, well, warts don't go away quickly. Patience is key. And actually, patience alone can sometimes do the trick; most warts will go away by themselves, if given enough time.
But if you'd like to hurry them along, there are some things you can do:
- Salicylic acid. This is the most common treatment, and it's widely available in different forms (liquid, discs or a solid stick like a glue stick) without a prescription. I suggest to parents that they rub the wart gently with a nail file before using the medication (soaking it in warm water can help too). It still can take weeks or months for them to go away--like I said, these things don't go away quickly.
- Freezing. Warts don't like being frozen, and this can help them go away a bit sooner (again, not quickly). There are freezing treatments you can buy without a prescription, and they are certainly worth a shot--but for more effective freezing treatments, you'll need to see your doctor or a dermatologist.
- Duct tape. If you stick the tape over the wart and change it every few days, it may help by taking off the top layer of the wart. The cool colors of duct tape now available may make this a more appealing option to kids--and not only does it cover it from view (although they may have to explain why they have duct tape on them), by covering it, you can help prevent the spread.
- Other home remedies. I've heard about people using all sorts of stuff on warts, like garlic, vitamin E, aloe and even carrots. I don't think there are any good studies to know if any of these actually work--I would try the other remedies first--but I don't think they can hurt.
There are other treatments such as cantharadin that can be done in a doctor's office--and in rare cases, sometimes we even do surgery to remove them. If the wart isn't going away, or if you aren't entirely sure that what you are dealing with is a wart, call your doctor.
How can we prevent warts?
The people who can do the most to prevent warts are the people who have them: when warts are covered, they are far less likely to spread. So if your child has one, keep it covered! Washing your hands regularly is always a good idea to prevent all sorts of infections, not just warts. The HPV vaccine can help prevent genital warts, but it doesn't prevent all warts.
Bottom line: they aren't dangerous, you can't really prevent them--and they will go away. Which, compared to lots of other health problems, makes warts something parents really shouldn't worry about.
Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.
The Slacker's Guide to Screen-Free Week
Okay, guys: it's Screen-Free Week. From April 29th to May 5th, we are supposed to shut them off--TV's, computers, video games, iPads. We're allowed to use them for work or homework (I think), but that's it.I don't think I can make that happen in my house.
Don't get me wrong. I think that we have way too much screen time in our lives, especially kids. And it's not good for us. Being in front of screens for hours each day increases the risk of obesity, as well as the risk of attentional problems, aggression and other behavioral problems. We don't want this for our kids--nobody does.
But in my family, screens are so much part of our lives that shutting them off completely would cause more unhappiness than I am willing to manage. I am, though, willing to cut back for a week--and use this as an opportunity to remind my family that there is more to life than screens. It's a slacker approach, I know, but for my family it might just be more effective.
So here are some suggestions for those times when you or your kids might gravitate toward a screen. If you're going to be a slacker like me, you don't have to try all of them...just try what works for you.
Mornings. Whether it's the morning news or SpongeBob, television is often part of the morning routine. On weekday mornings, shutting it off can be helpful--if it's on I come down from the shower ready to put everyone in the car only to find my youngest two half-dressed with their hair and teeth unbrushed. So keep it off, and linger over breakfast instead. Read the funnies. Play music really loud and dance while you get dressed.
On weekend mornings, try snuggling. Hanging out in bed together in the morning can be really nice. Cook breakfast--or go out for breakfast. Read not just the funnies but the whole paper together, and talk about it; it may lead to some really interesting conversations.
Afternoons. This is when my 7-year-old really clamors for the Wii or iPad. Distraction is key. Now that the weather is better, try staying outside, whether it's at the playground after school or the park on weekends. Kick a soccer ball around, play catch or Red Light Green Light or some other game you used to play as a kid. Go to a craft or school supply store and get paper and paints and play Picasso--or use what you have around the house to make things like play-dough or leaf rubbings. Go to the library, and curl up and read when you get home. If none of that works, bake cookies. That always works in our house. And rather than using screens to occupy the kids while you cook dinner, have them cook with you!
You might want to try a visit to the zoo or to a museum, too. There's some really cool stuff to do in Boston--we are loving the Planetarium recently (the kids can find Orion's belt and some other constellations now) and if you haven't taken your kids to the MFA, you should--it's way more kid-friendly than you might think.
Evenings. Try reading books out loud--either short picture books, or longer ones like the Harry Potter or Chronicles of Narnia series (EB White and Roald Dahl books are great for reading aloud too). Play board games--they can be really fun. Apples to Apples (or the Junior version) is one that everybody in my family (my kids range from 22 to 7) can play together and have a good time--as are Wits and Wagers and Quirkle. But old standards, like Monopoly and Life and Scrabble, are great too. Make popcorn, spread out on the floor, maybe play in your jammies. You may just end up making it a habit even when Screen-Free week is over.
I guess that's the point: you might just find that some of this stuff is more fun, and makes you happier, than screens. That's why it's worth a try, even if you take the slacker approach and only do some days or parts of days. And actually, the slacker approach makes it more of a choice and less of a mandate--which might make folks a bit more positive about making sustained changes as opposed to toughing it out for a week and then going back to their old habits.
Let me know how it works out--and pass on any ideas you might have. I'd love to hear from you!
Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.
Finding autism early: 6 important questions about your toddler
April is Autism Awareness Month--and if there's anything that we need when it comes to autism, it's awareness. We need people to be aware of this condition that affects a staggering 1 in 50 children, so that we can understand what causes it, and find ways to prevent it. And we need people to be aware of the signs of autism--because getting help early can make a real difference.
Many children aren't diagnosed with autism until they get to preschool, or sometimes even later--and that means important time is lost. The signs of autism can be present in toddlers--and when we find it then, we can get help to those children and their families right away. The trick is in asking the right questions--and acting on the answers.
In the practice where I work, as in many other practices, we ask parents to fill out questionnaires about the behavior and development of their children. At the 18 month and 24 month visits, we ask parents to fill out one called the MCHAT (Modified Checklist for Autism in Toddlers)--that's the tool we've chosen to help us look for autism. It's a list of questions that parents answer yes or no to, questions about how their child acts, plays and interacts with other people.
While all the questions on the MCHAT are important, there are six that are most important:
- Does your child take an interest in other children?
- Does your child ever use his finger to point at or ask for something?
- Does your child ever bring objects over to you to show you something?
- Does your child imitate you?
- Does your child respond to his name when you call?
- If you point at a toy across the room, does your child look at it?
If parents answer no to these questions, that's when we get most worried that the child might have autism.
Now, there can be other reasons why the answer might be no, like hearing loss, vision problems or learning problems. We would never make a diagnosis just based on a questionnaire. We would ask many more questions, do a careful examination of the child and make an appointment for the child and family to be seen by someone who specializes in autism, like a neurologist, psychologist or developmental pediatrician.
The Centers for Disease Control and Prevention (CDC) has some great resources to help families and caregivers pick up on early signs of autism. Their Learn the Signs, Act Early campaign has lists of milestones for children 2 months to 5 years, so that parents can track their child's development--and know when there might be a problem.
That's what it's all about, really: being watchful, and asking for help.
So ask those questions about your toddler. If the answer to any of them is no, talk to your doctor. It may be nothing--and if it's nothing, you and your doctor will figure that out. But if it's something...the earlier you speak up, the earlier your child will get the help he needs.
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Watching for stress: suggestions and resources for parents this week
It's a new week, bringing with it relief, now that the suspects are no longer out there, and yet still sadness--because catching the suspects doesn't make all those people any less dead or injured. It's going to take a while before life feels normal again, if it ever does.School vacation week is also over. This is good, because kids can really get back to their routines, and this helps. But it's also bad, or at least possibly bad. For some children, being away from their family will be hard. And any hope that parents might have had of controlling the messaging about the bombing with their young children, well, that's gone.
This may lead to new questions and new conversations, some of which may be hard. It also may be a week when children start to show signs of stress if they haven't already. Here are some suggestions for parents:
- Be watchful of, and patient with, your child's behavior. Stress could play out as worry and clinginess, but it could also show up as irritability or defiance. Children may seem sad for no reason, have difficulty concentrating, not want to be alone or even regress. This is all normal after a traumatic event--but it's not normal if it's really interfering with daily life, if you think your child may hurt himself, or if the changes last more than a week or two. Call your doctor if you have any concerns.
- Be more proactive about conversations. Just because your child hasn't told you that she heard something at school that upset her doesn't mean she hasn't. Ask questions. Make yourself available to your child--try to have some undivided attention time, some hanging out time, so that your child can talk to you. Answer your child's questions simply and honestly.
- Keep in touch with the school. If your child is having a tough time, let the teacher know. Even if your child seems okay, it's a good idea to talk to the teacher and principal about what is happening at school--in the classroom and on the playground. Working together is always best.
- Continue to reassure your child that you, and many other people, are working hard to keep them safe. The fact that the suspects were caught in four days is a good example. Talk about that, and about the firefighters and the police and other people whose job it is to help us be safe, as well as about all the people who care about them and watch out for them every single day.
- Keep hugging them. I just can't say that enough, I think.
Here are some resources that might be helpful:
How to Talk to Your Child After a Scary Event, a very helpful handout from Boston Children's Hospital
After the Trauma: Helping My Child Cope, a nice handout from the National Child Traumatic Stress Network, which also has a list of resources to help children after terrorism.
Talking to Children About Disasters, from the American Academy of Pediatrics. The page has additional resources as well.
Helping Children Cope With Disasters, from FEMA and the American Red Cross.
Moving forward after the Boston Marathon bombings: advice for parents
A few days have passed since the Boston Marathon bombings. We are all still stunned, but the initial shock is wearing off. The news is moving from the horrors of the moment to stories about the investigation--and heartbreaking details about the victims.The conversations that parents have with their children need to change, too. Before, it was telling them what happened, and hugging them and reassuring them. Now, we need to find a way to move forward.
Every family will do that in a different way. But as families find their way, here is some advice:
Hug your kids. I said this before when I was talking about what parents should do first; there's nothing like an event like this to remind us how vulnerable we and everyone we love are, and we should use that reminder wisely. Well, keep hugging. Once the moment passes, we have a way of getting back into our old ways and habits, but don't let it happen with this. Strive to make your loved ones feel loved on a regular basis. Set up some new rituals of togetherness and connection. It will help you and your children in the days and weeks (and years) to come, and it's a good way to...
Honor the victims. I think it's important to do this. It's natural to want to shelter your children and so to not talk about the fact that there were people killed and maimed by the explosions. You don't need to talk about the gory details--it's better not to, with young children. But I do think it's good to teach children to show solidarity with and compassion for those who are hurt. Maybe it's a donation. Maybe it's going to a vigil. Maybe it's planting flowers, or a tree, in their honor. The idea is to teach your children that we are all connected, and that what hurts one of us hurts all of us.
Keep the lines of communication open. We all are going to need time to process what happened. New feelings will arise as we hear news updates. We will feel anxious, whether it's when we are at a crowded event, or when we hear a loud noise--or sometimes for no clear reason at all. Same goes for our children. So be ready and willing to talk, to hug, to sort through and cope with the questions and feelings that may arise.
It's normal for your child to be cranky, clingy or anxious after events like these. I know I'm feeling that way. But if your child is having a lot of trouble, if they don't start to get back to themselves after a few days or if you just aren't sure how to handle things, talk to your doctor.
Think about safety. The sad reality is that we live in a time when anything can happen. You don't want to freak your kids out, but at the same time, it's a good idea to make, or review, some safety rules for your family. It doesn't all have to be related to terrorism--every family should have a fire evacuation plan, for example, and even little kids can be taught to dial 911. But it's good to talk about staying together in crowds, and about what to do if you get separated and who you can go to for help.
With older children, set clear rules about always letting a parent know where they are. Talk about being watchful when they are out in the world, about being careful around things like stray bags or people who are acting oddly. There's no way to prevent someone you love from being at the wrong place at the wrong time, but you can teach your children to be more aware of their environment.
Find the helpers, and teach your child to be one. Many people who were at the scene have spoken about how while lots of people were running away (as the police were telling them to do), there were also lots of people who were running to help. The fact that only three people died at the scene of those horrible explosions is a testament to those helpers, those people who put pressure on bleeding wounds and got people into ambulances and otherwise made all the difference in those crucial first minutes. Some of them had medical training, but many of them were ordinary people who leapt into action--and saved lives.
There's a quote from Fred Rogers that's been in the media a lot this week:
"When I was a boy and I would see scary things in the news, my mother would say to me, 'Look for the helpers. You will always find people who are helping.' To this day, especially in times of disaster, I remember my mother's words and I am always comforted by realizing that there are still so many helpers--so many caring people in this world."
Talk about those helpers, those people who ran to the scene. Or the people who opened up their homes, the restaurants who fed people or the doctors and nurses who rushed to their hospitals to help. Talk about how all of us can be helpers to each other, in little ways as well as big ways. Model being a helper: offer to help carry groceries for someone, cook a meal (or make a get-well-soon card) for a sick neighbor, volunteer for a playground clean up, bring food to a food pantry. Even simple things, like holding the door for someone or asking if you can help someone who looks lost or upset, are important.
Teach your children that not only can they always help somehow--but they always should. Yes, you need to teach them to be careful of their own safety (sometimes the best way a child can help is by alerting an adult), but you also need to teach them that we need to take care of each other. As G.K. Chesterton wrote, "We are all in the same boat, in a stormy sea, and we owe each other a terrible loyalty."
By teaching them to help, you'll not just be teaching them compassion but empowering them. You will be teaching them that terrorism can't defeat the human spirit. The human spirit, and the connections between us, will always prevail.
After the Boston Marathon explosions, what parents should do first
I haven't quite stopped shaking yet, but I want to put up a post.
I found out about the Boston Marathon explosions when my daughter called me as she was running from them. She was at the Prudential Center on Boylston, just a block or two from the scene, close enough to see the explosions. "Turn on the TV," she said to me as she and her friends ran. "There's something happening here. Tell me what's happening."
So I turned on the TV, and, well, there are no words. And the fact that my child was so close to it...makes it even harder to find words. Crying would be much easier than talking right now.
But words have to be said to children; as parents, we don't get the luxury of processing and dealing separately from our children. So here are some suggestions as we all do that processing and dealing, as we all try to be sure that our loved ones and friends are okay...
First of all, give your kids a hug. And your partner. Call your mother. Honest to God, call anyone and everyone you love and make sure they know you love them. Don't wait another second. The world is a tenuous place, and those we love are more important than anything.
Second, shut off the television. It's hard not to stay glued to the television, especially since we are waiting for answers and are wondering how this will affect our lives in the days to come. But shut it off--it's too much, and too disturbing, for young eyes. Get your information from your laptop and smart phone instead.
Tell your children what happened. They need to hear it from you. Keep it big picture; no need for gory details.
Answer their questions honestly. Again, skip the gory details.
Reassure children that terrible things like this are very rare. Usually, Copley Square and other public places and events are safe.
Talk about all the ways that you and other people work to keep them safe. These conversations might just help you, too.
Talk about the heroes. There will be more stories in the days to come, but I heard on Twitter about runners who kept on running--right to the hospitals to give blood. Those are the stories to concentrate on; it can help your children, and give them inspiring and empowering role models.
In the days to come, find ways to help. Maybe it's donating to the Red Cross. Maybe it's writing condolence letters. There will be ways to show that you care, and to make a difference...look for them.
Here are some resources that I shared on my Boston Children's Thriving blog:
From Boston Children's Hospital: Coping with Frightening Events
Talking with Kids about News, from PBS Parents. They also have tips on communication strategies.
How to Talk to Kids About Tragedies in the Media, from the Child Development Institute.
Talking to Children About Disasters, from the American Academy of Pediatrics
To all of you who were affected by the horrible events today...I don't even know what to say, except that you are in my prayers and I am thinking of you and crying for you.
If you believe in vaccines, can you speak up?
If you believe in vaccines, can you speak up?
When we are unsure about decisions, we want to know what our friends and loved ones think. This is normal and understandable; after all, these are people who are important to us, people whose opinions we value and trust.
We also turn to these people when making medical decisions--including ones about immunizations. While what the doctor says is important, what our friends and loved ones say is just as important--if not more so.
That's the message of a study just released in the journal Pediatrics, the official journal of the American Academy of Pediatrics. Researchers had parents--first-time parents of children less than 18 months old--fill out online questionnaires asking them where (and from whom) they got information about immunizations, what those sources of information told them, and how they ranked the sources in terms of importance. They also asked the parents about their vaccine beliefs and choices. They did the survey in Kings County, Washington, which has lower than average immunization rates.
Here's what they found: what made the biggest difference was whether the people the parents turned to recommended vaccination. If they did, chances are the parents immunized their children completely and according to the schedule. If they didn't, the parents were much more likely to either not immunize or immunize on a different schedule. While people talked to their doctor, and read things like books and internet sites, the opinions of their friends and loved ones won out.
Now, I absolutely respect everyone's right to make their own decisions about medical treatments, including immunizations; there are risks and side effects to everything, and we should do what we think is best for ourselves and our children. But as we make these important decisions, we want to be sure that we are getting the most accurate, complete and up-to-date information. Some friends may have that--but some might not.
Immunization is a very important decision. The risks of vaccine-preventable diseases are very real, something that sometimes gets lost in the discussion about the risks of vaccines. And it's not just the health of the unvaccinated children we worry about, but the health of the children around them. There are some children who cannot be immunized, either because they are too young or because they are on medications or have conditions that make immunizations unsafe for them; when the immunization rates drop, the chance of them catching a vaccine-preventable illness like pertussis or measles (we have seen cases of both) goes up, and the consequences can be deadly.
The people who don't immunize tend to be more vocal than those who do. There are lots of reasons for this, but I think that for parents who immunize, it doesn't seem like such a big deal. It's just what you do: you take your kids to the doctor and they get their shots. It seems very unremarkable, not worth talking about.
But, those of you who immunize your children...could you talk about it? Can you tell people why you choose to do it? Can you tell them what your doctor has told you about vaccines, and what you've learned on your own? Can you let them know how you think about the risks--and how your kids handled their vaccines? If you've ever seen a child with a vaccine-preventable illness like pertussis (whooping cough), can you talk about that too?
It may be that everyone around you feels the same way you do about vaccines (which may be part of why you give them), but you never know--maybe somebody is hesitant. Or maybe the fact that you talk about it gets somebody else talking about it, which gets somebody else talking about it...and you could start a movement.
You might not change anybody's mind. But maybe you will. Maybe you'll stop a child--or a whole bunch of children--from getting measles or pertussis or influenza, or meningitis or hepatitis or another vaccine-preventable illness.
You might just save a life.
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My Touchscreen Generation Kid
When the Easter Bunny didn't bring him an iPad (a significant disappointment), my first-grader decided to use his writing time at school for Plan B: begging me and my husband.
Dear Mom and Dad, he wrote. I want an iPad. We can bring it on trips (not that we actually go on many trips, but whatever). I will pay the cents (and we will pay the dollars?). I will charge it. It can be at home, a othr houses, in the car and othr plases. I will take good care of it. Pleeeeeeeeeeeeeees.
Fifteen e's in please--clearly, he's serious.
It's easy to roll your eyes at this kind of thing. Kids these days--they just want the latest, coolest technology. They should go outside and play instead. Or read books.
But if you watch Liam play with my iPad, it's easy to see why he loves it. He bangs out songs on drums or piano keys, does puzzles, draws pictures, plays spelling games, flies airplanes...he moves in and out of the different apps, completely captivated.
Yeah, I want him to read books and play outside--which is why I make sure he does both. But I like that he has touchscreen time. It is giving him something that my older, non-touchscreen generation kids didn't have.
For Liam, everything is 3D. Content has depth; whether it's just links, or that it can be manipulated, picked up and looked at different way, he sees the page and the word and the world in a way that is fascinating to me. Nothing is just there; there is always more you can do with it, always a different way you can think about it. I think that it makes him more creative, more willing to look at things differently, more empowered.
And for Liam, every day (sometimes every moment) is full of questions that can and should be answered. He doesn't understand why anyone would let a question linger, when there is an iPad or a smartphone nearby. "Look it up!" he'll demand, and we do--and we read and look at pictures and videos. Which inevitably leads to more questions and things to look up--and then to trips to museums and battleships and ponds. For Liam, life is about exploring and learning.
These are the gifts of growing up with the Internet and touch screens. Yes, we need to be careful and thoughtful and monitor what our kids do (the Common Sense Media website is a great resource), as we should do with all aspects of our kids' lives, not just media. But these are tremendous tools for our children, with so many possibilities.
I don't know that Liam will get an iPad just yet, though. But maybe if he asks Santa Claus instead of the Easter Bunny...
Dear Mom and Dad, he wrote. I want an iPad. We can bring it on trips (not that we actually go on many trips, but whatever). I will pay the cents (and we will pay the dollars?). I will charge it. It can be at home, a othr houses, in the car and othr plases. I will take good care of it. Pleeeeeeeeeeeeeees.Fifteen e's in please--clearly, he's serious.
It's easy to roll your eyes at this kind of thing. Kids these days--they just want the latest, coolest technology. They should go outside and play instead. Or read books.
But if you watch Liam play with my iPad, it's easy to see why he loves it. He bangs out songs on drums or piano keys, does puzzles, draws pictures, plays spelling games, flies airplanes...he moves in and out of the different apps, completely captivated.
Yeah, I want him to read books and play outside--which is why I make sure he does both. But I like that he has touchscreen time. It is giving him something that my older, non-touchscreen generation kids didn't have.
For Liam, everything is 3D. Content has depth; whether it's just links, or that it can be manipulated, picked up and looked at different way, he sees the page and the word and the world in a way that is fascinating to me. Nothing is just there; there is always more you can do with it, always a different way you can think about it. I think that it makes him more creative, more willing to look at things differently, more empowered.
And for Liam, every day (sometimes every moment) is full of questions that can and should be answered. He doesn't understand why anyone would let a question linger, when there is an iPad or a smartphone nearby. "Look it up!" he'll demand, and we do--and we read and look at pictures and videos. Which inevitably leads to more questions and things to look up--and then to trips to museums and battleships and ponds. For Liam, life is about exploring and learning.
These are the gifts of growing up with the Internet and touch screens. Yes, we need to be careful and thoughtful and monitor what our kids do (the Common Sense Media website is a great resource), as we should do with all aspects of our kids' lives, not just media. But these are tremendous tools for our children, with so many possibilities.
I don't know that Liam will get an iPad just yet, though. But maybe if he asks Santa Claus instead of the Easter Bunny...
To help prevent obesity, give your kid a smaller plate
Sometimes, the best ideas are the simplest ones.
If there's anything we need some good ideas for, it's childhood obesity. A third of US kids are overweight or obese (nearly one in five is obese), and this has huge (excuse the pun) implications for their future health. Unless we do something, they are likely to end up with heart disease, diabetes, cancer and all the other health problems (not to mention the social and emotional problems) that obesity can bring. This is the first generation that may actually die before their parents.
A study just released in the journal Pediatrics has a beautifully simple idea: give kids smaller plates.
Researchers gave adult-sized and kid-sized plates to first graders at an elementary school in Philadelphia, and let them serve themselves lunch. Guess what happened? The kids with bigger plates served themselves more--and ate more.
This has something of a "duh" feel to it--and at the same time, it's brilliant. If we want kids to eat kid-sized portions, then we might should give them kid-sized plates. This is something we could all do right this second. There are no arguments or logistics or money involved (except, perhaps, to buy smaller plates). It won't cure childhood obesity, but it's a clear, easy step in the right direction.
While we're concentrating on plates, here are two more things to think about:
Make your plate look like the plate at choosemyplate.gov: half fruits and vegetables, a quarter whole grains, and a quarter protein (like meat, fish or eggs). Those are the proportions that make up the healthiest diet.- Don't make kids finish everything on their plates. The Clean Plate Club (a phrase my parents used often) is a really bad idea. It's way better to let kids listen to their own hunger cues, and stop eating when they are full. Make sure they eat at least some of the fruits or vegetables on the plate (in our house, the rule is three bites), but if they leave food on their plate, that's fine. One big caveat, though: resist the temptation to let them raid the cupboard when they don't finish their meal. If you want to reinforce good eating habits, they should wait until the next scheduled (healthy) meal or snack.
Even if your child isn't overweight (to find out, check out this BMI calculator), using a smaller plate is a good idea. The habits learned in childhood can last a lifetime--and we want that lifetime to be a healthy one.
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It's Autism Awareness Month: how aware are you?
April is Autism Awareness Month. As a pediatrician with many patients with autism, I'm glad that we have this month--because each and every child with autism deserves the best we can offer them, and everything we do begins with awareness.
So...how aware are you? See if you know whether these statements are true or false.
According to the Centers for Disease Control, 1 in 150 children has been diagnosed with autism.
False. That's what the numbers were in 2007. The most recent data shows that a stunning 1 in 50 children has this diagnosis.
Autism is more common in boys than girls.
True. Five times more common, to be exact.
Autism is diagnosed with a blood test.
False. While there is exciting new research about the genetics of autism that may lead to blood tests in the future, the diagnosis of autism is made by taking a careful history and doing a developmental examination--i.e. testing their language, social and other skills. It's not always an easy diagnosis to make; sometimes it can be subtle, especially when children are young, and there are other conditions (such as hearing loss, or language delays) that can be confused with autism. That's why, when autism is even a possibility, it's a good idea to have an evaluation by a someone with special training in child development, such as a developmental pediatrician, a pediatric neurologist, or a child psychologist.
You can't make the diagnosis of autism until a child is in school.
False! Signs of autism can be seen as early as toddlerhood, at 18 months or even younger. Some of the common signs early signs are:
- not talking, or saying very few words
- not responding to their name by 12 months
- not making eye contact
- preferring to be alone, not wanting to be held
- getting upset with any change in routine
- not playing "pretend" with toys by 18 months
- repetitive movements, like hand-flapping or rocking
Having one or more of these doesn't necessarily mean a child has autism, but if any of these are going on, it's important that parents talk to their doctor. Which leads me to...
If parents are worried about autism, they shouldn't wait for their doctor to say something.
Really true. Parents are the ones who are with children all the time; we doctors just get little snapshots of children and their behavior. And I know I certainly don't want to go alarming parents based on little unclear snapshots. We ask lots of questions at checkups, which helps us find problems, but we can miss things--and parents don't need to wait until checkups to let us know when something doesn't seem right. The sooner we check things out, the sooner we can either reassure you--or get your child the help he needs.
Vaccines cause autism.
False. There has been lots of research on this, including a recent study showing no link between getting lots of vaccines and autism. Vaccines do not cause autism. People talk about thimerosal, a vaccine preservative--but not only have studies failed to find a link between thimerosal and autism, there hasn't been any thimerosal in the vaccines we routinely give to children 6 and under since 2001.
Children with autism are alike.
Really false. There is a really wide "spectrum" when it comes to autism (that's why we call them Autism Spectrum Disorders). While they have things in common, every single child with autism is different, with different abilities and different needs.
There is no cure for autism.
Sadly, this is true. That doesn't mean, though, that there's nothing that can be done. There are lots of different treatments that can be very helpful--especially when we start early. Applied Behavioral Analysis (ABA), a behavioral treatment that encourages positive behavior and discourages negative behavior, makes a difference for lots of kids. Having a good school program with speech and other therapies is essential, medications can be useful, and for some children, changes in diet help (parents should always talk this over with their doctor first). Support for families is really crucial, too.
It's not hard for children with autism to get the help they need.
Boy, is this false. Although children with autism are eligible for services through Early Intervention (birth to age 3) and the public schools (age 3 and older), getting the right help isn't straightforward. There are certainly some families that get it easily, but in my experience they are in the minority. It's easier if you've got lots of money and are tenacious, savvy about advocacy and know how to navigate bureaucracy, but that doesn't exactly describe most parents. It's not that people don't want to help kids with autism, it's just that there aren't enough services out there, and they are expensive--bad combo.
So families need to ask for help early and often. Your doctor can help. Advocacy organizations like Autism Speaks and local parent support groups are a good place to turn, too--they often have practical suggestions and know the best people to contact.
To learn more about autism, visit the Autism Spectrum Disorders page of the CDC website.
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Medicalizing normal: why patients (and doctors) need to ask questions
Let's say your kid is gassy. She seems okay, but you're not sure, so you decide to take her to the doctor--who, after listening to your story and doing an examination, says: "Your child is suffering from eructation and flatulence."
Well, shoot. And here you just thought she was gassy. Before the doctor said anything, your only plan was to keep the windows rolled down on the car ride home. But having heard this diagnosis, you are hoping that the doctor will do something--because some sort of test or treatment is necessary, right?
Nope. All the doctor said was that your kid is burping and farting--i.e. gassy.
We doctors do this a lot, actually, this medicalizing of things that really aren't medical conditions. We're not so much doing it to sound smart or alarm people, it's just how we talk. And sometimes, making something a condition is easier for us because then we can offer tests and medical treatments, which is what we know how to do (seeing as how we went to medical school and all). The problem is, not all of those tests and treatments are necessary.
A less silly example: baby fussiness and spitting up. Lots and lots of babies have this. With rare exceptions, it's normal and goes away by itself; parental reassurance works as well as--actually, better than--any medications or other interventions. That doesn't stop us, though, from giving it a medical name--Gastroesophageal Reflux Disease, or GERD--and prescribing medications, which mostly do nothing.
In an interesting study just published in the journal Pediatrics, researchers from the University of Michigan had parents read a clinical scenario about a fussy, spitty baby and then answer some questions. What they found was that if the fussiness and spittiness were referred to as "GERD" rather than "a problem," parents were much more interested in medication--even when they were told that the medication likely wouldn't work. It wasn't that they thought that the term "GERD" meant that it was more serious, either. It truly seemed that for the parents, once there was a medical term involved, there should be a medical treatment involved.
In this case, medical treatment isn't a good idea. But in lots of other cases, treatment or tests might be a good idea. Without a medical degree, it's hard to know what to do. Even having a medical degree doesn't guarantee you'll know, because medicine is always changing as new studies teach us new things.
To help patients and families, and to help those well-meaning, busy doctors who may not have time to read all the latest studies, the ABIM foundation has started the Choosing Wisely Initiative. They have asked specialty societies to submit lists of 5 tests or treatments that doctors and patients should question, and to date more than 35 organizations (including the American Academy of Pediatrics) have done so. They also have patient-friendly resources from the specialty societies and Consumer Reports. Check it out, and spread the word.
It's all about asking questions, really. Which is what all of us should be doing--patients and doctors alike--if we want quality health care that everyone can afford. The science and technology of medicine is amazing these days--but sometimes less, and simpler, is better.
It's definitely better for eructation and flatulence, that's for sure. Hopefully your doctor won't pull out the prescription pad if ever your child is diagnosed with those--but if he does, start asking questions.
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FAQ: when should my child be potty trained?
It's a moment most parents can't wait for: the moment they no longer have to change diapers.
But when, many parents ask me, is that supposed to happen?
Like so much else in medicine and parenthood, the answer is: it depends on your kid--and you.
Most kids in the US are potty trained by between 24-48 months, although needing a diaper at night for longer is common. However, there is a really big variation in when children achieve this (wonderful) milestone. Here are some of the factors that influence it:
Cultural factors. Some cultures simply start earlier than ours. I take care of a lot of patients from the Dominican Republic, for example, and I've noticed that many of those parents start actively working on getting their children to use the potty before they are 2, which is about when most US parents start thinking about it. Which leads me to the second factor...
Parental motivation. Some parents are just more anxious to move the process along than others. Everybody is different.
Child motivation. Some children are just more anxious to move the process along than others. Everybody is different.
Logistical factors. If you want to do it, but your child care provider doesn't, or vice versa--that makes it more complicated. Or sometimes, things like a new baby or a move make parents want to put it off--or speed it up, which is often the case when the beginning of preschool looms.
Developmental challenges. Children who are delayed in speech, in using their hands and arms and legs, or in other ways, may take longer to potty train.
Bottom line: Most children are potty trained between 18 months and 4 years. If your child is older than 4 and still in diapers, you should definitely ask your doctor for help. Not that you have to wait that long--we are here to help whenever you need it.
Here are some signs of readiness to watch for:
- Your child shows an interest (follows people into the bathroom, takes off diaper, wants to sit on the potty, etc)
- Your child has words or some other way to communicate with you that he wants to use the potty
- Your child can pull his pants up and down and get on and off the potty (or toilet) by himself.
For advice on potty training, read my 6 tips for potty training success.
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Starting solids too early: a communication problem?
Why is it that 40 percent of mothers in a study gave solid foods to their baby before doctors say they should?
That's a lot of moms. More than a third. Headed toward half. These are not just a few moms mixing some rice cereal into formula to prevent spitting up. This is a lot of moms doing what medical professionals are really clear is a bad idea.
You know what I think? I think we medical professionals need to own this one. We aren't doing a very good job of communicating--or listening.
You know what the top three reasons moms gave for starting early were?
- "My baby was old enough." (88.9 percent)
- "My baby seemed hungry" (71.4 percent)
- "My baby wanted to eat the food I ate, or in other ways showed an interest in solid food" (66.8 percent)
These are reasons you would give if either you didn't clearly hear the doctor say no solids before 4 months--or if you did hear, but didn't agree.
It doesn't help, of course, that doctors are a bit wishy-washy and unclear when it comes to when exactly parents should start solids. The American Academy of Pediatrics says 6 months--but also say that it could be a little earlier. And there have been a couple of studies recently that suggest that starting solids before six months could actually be good for future health.
But nobody is saying that before 4 months is okay, and that's when these moms were starting solids (the mean age was 12 weeks). Before four months, babies may not be developmentally ready to eat solids. Too many calories too early, also, raises the risk of of obesity--and studies are showing that being overweight in infancy raises the risk of future obesity. Plus, getting solids early can interfere with breastfeeding--and breastfeeding is really good for babies.
We doctors clearly need to start talking about solids early. Lots of us (including me) sometimes don't mention anything until the 4 month visit--which is obviously too late.
But even more, I think we need to realize that we have a habit of throwing a lot of information at people. And we also have a habit of using doctor-speak, and not exactly making it easy for people to admit when they don't understand or remember everything we say. That's not good. We need to fix that. And we need to give more written materials, and tell families about good websites where they can get information in between visits.
We also need to do a better job of asking people about their own beliefs and needs--and really listening to their answers. Whether it's because they think a baby will sleep better--or because Grandma tells them it's time, parents have reasons for ignoring us. When we don't ask about those reasons or circumstances, we miss the opportunity to talk with families about other options--and help them in other ways.
And parents...please, talk to us doctors. Let us know what you are thinking and doing. Tell us if you don't agree with our advice. Give us a chance. We're on your kid's team too--let's do a better job of working together.
I joined Bridget Blythe on NECN to talk about this:
When to call the doctor
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Sometimes, when a parent tells me about something that happened with their child, I think (and say, as nicely as I can): Why didn't they call right away?
And sometimes, when I'm talking to a parent or seeing their child in the office, I think (but don't say): Why did they call about this?
It can be really hard to know when to call the doctor.
It's hard because sometimes you plain old don't know what's going on. It's hard because things have a way of evolving, and you can't always predict whether they are going to get better or worse.
And it's hard because we don't want to think that something is really wrong with our child--and at the same time, we don't want to miss something. Most of us vacillate between denial and overreaction on a regular basis.
So, yeah, it's hard.
Some things really do warrant a call to the doctor. We've made a list (a slide show, even!) of a bunch of them. Although it's certainly not exhaustive, these are conditions that your doctor really wants to know about right away.
But memorizing a list is tough--and like I said, it's not exhaustive. So here's how I'd suggest thinking about it. Call the doctor if:
What is happening is bad. Bad anything. Bad pain. Bad trouble breathing. Bad bleeding. Bad vomiting. I know, bad is subjective. But if in your head the word "bad" seems to apply, better to get advice than wait and watch.
Whatever is happening isn't going away. Even little things can worry us doctors when they don't go away. That little limp, the pesky headaches, the rash that the cream isn't making better, the diarrhea that just doesn't stop...time to check in.
Your gut is telling you something is wrong. I can't tell you how much I've come to respect and rely on parental instinct over the years. Whenever I hear that from a parent, I want to see that child--and I check them out incredibly carefully. The parents are nearly always right.
You can't say: I know what to do and really mean it. This takes stopping for a moment and not only really thinking, but really being honest with yourself. Which lots of us don't do anywhere near as much as we should (both thinking and being honest with ourselves).
None of us knows what to do all the time. That's true in all spheres of our lives, and parenthood is no exception. We all get stumped and scared; we are all lifelong learners, and that's okay.
That's why even though I might wonder why a parent called about something, I wouldn't dream of chiding them. Instead, I use it as a time to listen, to understand, and to educate. Next time, they'll know what to do and they won't need to call.
So read the list--but if what's going on isn't on the list and you're worried, call.
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Same-sex marriage: why supporting it is good for children
Having married parents is good for children. That's why the American Academy of Pediatrics (AAP) thinks that same-sex couples should be able to marry.
In a policy statement just issued, that's exactly what they said. It's going to put the AAP in the middle of controversy--but it was the right thing to do for children.
There are currently almost 2 million children being raised by gay and lesbian parents in the United States. And you know what? They are fine. There is simply no evidence to suggest that it's bad for children in any way to be raised by same-sex couples. They don't have more emotional or social or any other problems than other children. For many of these couples, parenthood is something that they have chosen very deliberately and do with real commitment--and that is exactly what children need.
Whatever anyone's beliefs are about parenting and same-sex marriage, we need to pay attention to the research. And research shows that what makes a difference in the well-being of children is the quality of the relationship they have with their parents, the quality of the relationship between their parents (or the significant adults in their lives) and the availability of resources, both social and economic.
That's what matters, according to study after study. The sexual orientation of the parents just doesn't.
And here's the thing: marriage makes all of that more likely. As the policy statement says, marriage strengthens relationships and families. It brings 2 extended families together. Married couples have more financial and social resources. Married people tend to be healthier both physically and emotionally and less likely to do risky things. And marriage brings legal rights and responsibilities that are important--sometimes crucial, such as the right to make medical decisions.
This is about families. All children deserve to be raised in a secure, stable family that can give them the love, nurturing and resources they need. Marriage--not civil union or something else shy of marriage--helps give children all those things. Marriage supports families.
The AAP is hardly a hotbed of liberals. It is a huge organization with people from all sorts of different personal and political backgrounds. They don't make policy statements unless they are absolutely sure that the scientific evidence supports them--and they only make policy statements that they think are really important for the health and well-being of children.
This is really important. It's important for the 2 million children being raised by gay and lesbian parents. It's important for the thousands of children in foster care who need loving families. It's important for us as a society to do everything we can to support families--not just some families, the ones that look like us or that we agree with, but all families.
Because our children live in all sorts of families. And our children are our future.
On middle school dances, parenthood--and hope
My 12-year-old went to her first middle school dance on Friday. They've been having them all year, but either Natasha had a swim practice she couldn't miss, or she didn't want to go. This time she didn't have practice--and she wanted to go.
She had a great time. She didn't want to leave. And it made me so happy.
My 22-year-old daughter, a student at Northeastern, came home for the evening to get some things she needed and have dinner with us. Michaela helped Natasha pick out clothes, did her hair and was with me when we dropped her off at the dance. "I wish I could be a chaperone," said Michaela. "Look at all the boys! And those girls--look at what they are wearing!" I reassured her that there were lots of chaperones. "Yeah, but they don't know the stuff I do," she said. "I've been to these dances."
We waited in the car at the curb until Natasha got inside. "She's growing up," said Michaela. "I don't like it."
I don't either--but I do, too. It's complicated.
Natasha is the fourth of my children to go through adolescence. I've been through this before. I've been through the angst. I've grieved the loss of the little kid years. I've worried, and wished I could turn back time, or at least slow it down.
But we can't. Time moves forward, no matter how we feel about it. Our children grow up. There's nothing we can do to change it.
Instead, we have to concentrate on helping them grow, on giving and teaching them what they need to manage in the world. And when they do something without us, and it goes well (and it's all legal), it's great. Because it's a good sign.
A middle school dance may not seem like such a big deal. And it isn't, really. But it's not a gimme that it will go well. The dances are loud, hot, crowded and overwhelming. There is nearly always social drama. Navigating a middle school dance takes a certain amount of confidence and social skills--and as a pediatrician and parent, I know that neither is to be taken for granted.
That's just it: we can't take anything for granted. We don't know that our children will be confident, or have social skills, or be able to think clearly in an emergency. We don't know how they will handle responsibility--or money. We don't know if they will work hard--or look for shortcuts. We don't know how they will weather the storms of love, or betrayal. We can teach them all we want, but the truth is, we just don't know.
So every success--a good grade, an honor won, a kindness shown, a successful middle school dance--matters. Not that it promises anything; life doesn't work that way. But it gives us hope.
And hope, when it comes to those we love most in this world, is a really good thing.
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Quiz: How smart are you about salmonella?
Just this week a study was released in the journal Pediatrics about an outbreak of salmonella linked to African dwarf frogs--all of which were traced back to a common breeding facility. It's got me talking to people about salmonella--and I've found that many people don't know very much at all about this bacterial illness.
To check out your salmonella smarts, try this quiz. Are these statements true or false?
Salmonella is a common illness.
True. According to the Centers for Disease Control and Prevention (CDC), every year 42,000 cases are reported--but because many cases aren't reported or even diagnosed, they estimate that the number of actual cases could be up to 29 times that much (not sure where the 29 comes from, but that's what they say). And every year, about 400 people die from the illness.
Salmonella just gives you diarrhea.
False. While the vast majority of salmonella infections stay in the intestine and give you diarrhea, the bacteria can spread into other parts of the body including the gallbladder, blood and bones, especially in people who have weakened immune systems. It can also cause a problems with the joints, eyes and with urination that can last months or years, although that's rare.
Children are most likely to get it.
True. Kids put their hands everywhere, don't always wash them, and put their hands in their mouths...and so are more likely to catch germs generally. The majority of cases are in children under the age of 4. Anyone can get it, though.
Frogs are the only pet that carry salmonella.
False. The bacteria can live in the intestines of lots of different animals, so any exposure to animal poop is risky. Turtles and baby chicks are common sources of infection, which is why these are not recommended pets if you've got a baby or little kid in the house--and why everyone should wash their hands immediately after touching these animals. Outbreaks have been linked to pet food, too.
Pets are the most common source of infection.
False. Contaminated food is the most common source of infection, including chicken, beef, eggs and dairy (including unpasteurized milk). That's why it's really important that all food be cooked very well (the CDC recommends that if you are at a restaurant and food doesn't seem fully cooked, you should send it back!). Infected people can spread it to any food they touch, though, and it can contaminate water, which is why there have been outbreaks associated with vegetables and even baby formula.
It's really important to wash any surfaces you leave raw meat on--and wash your hands really well after handling raw foods. The CDC also warns against handling raw meat and handling a baby at the same time (e.g. don't cut up your chicken and then change a diaper without some serious hand washing in between).
If you get salmonella, you need antibiotics.
False--mostly. The vast majority of cases of diarrhea caused by salmonella go away by themselves within a week or so without antibiotics. In fact, antibiotics can actually make the bacteria hang around in the intestine longer.
However, if the bacteria travel outside the intestine, antibiotics are needed. They are also recommended in really young infants, people with weakened immune systems and people with certain other health problems.
The two best things you can do to prevent salmonella are wash your hands and make sure your food is washed well and fully cooked.
True. It won't prevent every case of salmonella, but it will prevent a lot--and it will prevent a lot of other infections, too (especially the hand washing part).
To learn more about salmonella and how to prevent it, visit the Salmonella page of the CDC website.
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About the author
Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »Recent blog posts
Blogroll
- Thriving: Children's Hospital Boston's pediatric health blog
- Huffpost parents
- Vector: Children's Hospital Boston's science and clinical innovation blog
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