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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
- 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. So talk to your doctor if you have any worries at all. The Audiology department at Boston Children's offers hearing tests in Boston and Waltham--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.
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.
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.
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.
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.
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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How about explaining THESE toys?
Last week I read about how Mattel (the toy company) flew in some "influential mommy bloggers" to talk to them about toy cars. Apparently sales are down--and since moms buy toys, they figured they should talk directly to them--especially since moms, being girls and all, might not "get" the whole playing with cars thing. So they talked to them about just how cool cars are, and about how playing with Hot Wheels can improve hand-eye coordination.
Really?
The Mouthy Housewives had an absolutely hilarious response (don't read it somewhere you have to be quiet--I laughed out loud), explaining to moms how to play with other Boy Toys such as balls, sticks, Thomas trains, action figures and play tools. But as I thought about it, I think that Mattel's approach has some merit.
I'm good with cars. I like little toy cars. Rewarding my son Liam with them is what clinched potty training for him. We have hundreds of them. Well, maybe not hundreds, although it seems that way sometimes when we are cleaning the toy room. We have a mat that has roads on it and it's fun to play with the cars on that, or on racetracks (although we always seem to lose pieces crucial to holding the tracks together).
I am, however, fuzzy on the value of certain other toys--and I bet some of you guys are too. There have been so many times that I've wondered what exactly the manufacturer was thinking; wouldn't it be great to have the chance to ask? I could write for pages about toys that puzzle me. But in the interest of (your) time, I'll just give three examples:
What's up with the Lego kits? Whatever happened to, I don't know, using your imagination and building things? And why do the kits have to be so complicated? My son got two for Christmas, and we got in a collective family bad mood trying to keep all the bags properly sorted and follow the directions. - And those stuffed animals that walk or bark or do whatever--huh? Again, what happened to using your imagination? They always seem so cool, and my kids have asked for them over the years, but it turns out that not only are they boring (the one or two things they do get old pretty quickly) but the hardware that makes them do stuff ensures that they are Really Not Snuggly.
- And (sorry, as a pediatrician, have to get this one in): why do so many video games have to be violent? Even many rated "Everyone" (okay, that's 10+, but the reality is lots of younger kids play them) like Lego Lord of the Rings are reasonably violent. "They are not actually people," my first-grader likes to point out. "They don't die--they can be put back together." This is true, but why do we have to encourage play violence? Wouldn't it be great if the games discouraged violence?
I'm likely not influential enough, but I would love to be flown in by toy manufacturers and fed brunch and have this stuff explained to me. What about you? Which toys would you like explained?
It's of course possible that I'm missing the boat, or just getting old. When I asked my two youngest children (they are 12 and 7) if there were any toys they thought were bad or didn't make sense, their response was quick and simple: "No."
tags Claire McCarthy, parenting, toys, value of toys
FAQ: when should I start my baby on solids?
It's a milestone that parents get both excited and scared about: starting solids. Making that transition from breast milk or formula (or both) to stuff that requires spoons is something that many parents in my practice have lots of questions about.
It's not always easy to answer those questions, because the science behind the answers isn't always clear--and is still evolving. Plus, different doctors often have different opinions on the subject.
That said, here's what I'm telling my patients:
- Babies should start solids between 4 and 6 months.
- They shouldn't start before they are ready to take the food off a spoon (don't mix it in the bottle, please!). If Baby pushes his tongue back or otherwise doesn't seem to know what to do with the spoon, put it away and try again in a week or two.
- While exclusively breastfed babies really don't need solids before 6 months, recent research suggests that adding other foods improves iron levels (although breastfeeding alone doesn't leave babies without enough iron)
- A study just out suggests that starting cereals before 5.5 months (and fish before 9 months and egg before 11 months) can decrease the risk of asthma and allergies.
- No matter what anybody tells you, there is no Best First Food. Cereal (but not rice cereal, because of arsenic) mixed with breast milk or formula, or a pureed fruit or vegetable, is usually what I recommend. If you buy it, get a single ingredient food (the ones marketed for starting out); if you make it, make sure there are no lumps and don't add any salt or sugar or anything else.
- Give each new food a few days (at least three) before adding a new one. That makes it easier to pick up on any signs of an allergy or other problem (like diarrhea or constipation).
If you are breastfeeding, just because your baby has started solids doesn't mean you are okay to stop--the longer you keep at it, the better for your baby (but at least once they are on solids, you get a little bit of a break).
My friend Dr. Wendy Sue Swanson wrote a great blog on this that is full of useful links--check it out.
Starting solids is the next step in teaching your child healthy eating habits for life. So make sure your child gets lots of fruits and vegetables--and use this time, before they are really watching what you eat, to make your own diet better. As your child grows, be a good role model!
Amy Nobile and I were on NECN recently talking about ways to get kids to eat healthy:
The effects of ADHD can last a lifetime--what parents need to do
ADHD isn't just a kids' problem. It's a grownup problem too--and there's more bad news.
In a study just released in the journal Pediatrics, nearly a third of a group of adults who had ADHD (Attention Deficit Hyperactivity Disorder) in childhood still had it as adults. A third. That's a lot of people to still be struggling with concentration and learning, still have trouble with impulse control, still have problems interacting with others--while they are trying to make a living, and possibly raising a family too.
But here's where it gets worse. The majority (56.9 percent) of the adults who had ADHD as children, whether or not they still had it, had at least one psychiatric diagnosis. The most common one was alcohol dependence or abuse, which was followed by antisocial personality disorder, other substance abuse disorders, hypomania, anxiety and depression.
And there was more: compared with the control group in the study, adults who had childhood ADHD were twice as likely to have considered or attempted suicide by age 21.
Considering that ADHD is the most common neurodevelopmental disorder of childhood, affecting at least 3 to 7 percent of school-age children in the United States, this is scary stuff.
The authors of the study (including Dr. Barbaresi from Boston Children's Hospital, where I work) say that we need to stop thinking of ADHD as just a childhood learning and behavior problem, and start thinking of it as a chronic disease. They are right; like diabetes, ADHD clearly has effects that can be very serious--and last a lifetime.
It's going to take a while for the medical profession to wrap their minds around this, I think. I mean, it's not that hard to understand intellectually--but putting the needed evaluations, supports and treatments into place will be harder. Not impossible--and actually, thinking of it as a chronic disease helps, because it gives us models to follow--but harder.
In the meantime, I think it's going to be up to the parents--and doctors and teachers and counselors--of kids with ADHD to really advocate for them. Every kid with ADHD should have:
- Regular contact with a mental health professional. This might be every week for some children. For other children it might be much less frequent--but all children should have it. It's not okay to just get a prescription for ADHD medication--good mental health care is way more than that.
- The school program they need. Each child is different, but kids with ADHD have different learning styles and needs than kids who don't have it. Far too many of them end up feeling stupid, or doing poorly when a different program could have helped them to succeed--and both have lifelong consequences, whether or not the ADHD hangs around. Know your child's rights--and fight for them. Ask for help if you need it--from your doctor, your teacher, an educational advocate.
- A doctor who is aware of, and screening for, ongoing ADHD and other mental health problems that may come with it. As teens become young adults and enter the adult health care system, it's especially important that they keep this in mind.
To learn more, check out the CDC's ADHD page, or the website of CHADD, Children and Adults with Attention Deficit Disorder.
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When (and how) to talk to your daughter about periods
In that list of awkward-parenting-moments-we-wish-we-could-avoid-but-can't, talking to daughters about periods is way up there. It's just hard to talk about. It's hard to know what to say, and it's tough because it has to do with sex--my experience is that most parents get a bit squirmy talking to their kids about anything related to sex.
So when a reader asked if I would write about this, I thought: what a great idea.
Here's some advice from both my experience as a pediatrician and as a mom who has talked about periods with three daughters...
When to Talk
When you start talking is going to depend a lot on your child and the culture of your family. But at some point you really have to--and in figuring that out, there are three things to consider:
1. When she is going to get her period. There's really no way to know exactly, but when your daughter has both breasts and pubic hair (not just a couple of wisps of hair, but a reasonable amount), you need to get talking if you haven't already.
2. When someone else is going to tell her about it. My opinion is that she should hear it first from you, not the health teacher or her best friend. Most schools do have some education about puberty; find out when (in our district, it's the end of fifth grade), so you can plan (and have some time to get up your nerve).
3. When she starts asking questions. That's what happened with my eldest: when she was 10 she noticed the tampon dispenser in a public bathroom and would not give up until I explained what they were for.
What to Say
Give the actual facts. I remember that all my mother said was something along the lines of "You're a woman now." Which was remarkably unhelpful. And really made being a woman seem uncomfortable and unfair.
You should explain why girls have periods and what is going on. You can figure out what explanation works best for you. In case it's useful, here's what I do in the office when I'm explaining it to girls (when their parents want me to):
I draw a picture of two ovaries connected to the uterus, with a vagina below (very abstractly, no artistic ability required). I explain that the ovaries have eggs, and that in women who have their periods, once a month one of the ovaries sends an egg down toward the uterus. I say that it to make a baby, the egg has to meet up with a sperm. How you want to handle the issue of how the sperm gets there is up to you--I talk with parents ahead of time about what they want me to say (I recommend giving the facts there too, but it's important to imbue those facts with values, advice, and an open door for further communication). When I'm giving this talk, I always say that for a while, the egg isn't going to be meeting any sperm.
I explain that babies need a sort of nest in the uterus to grow (the top layer of the endometrium). I scribble some lines on the inside of the uterus to look like a nest. I say that every month the uterus makes a nest just in case. But when the egg doesn't find a sperm and make a baby, the nest comes out because it isn't needed--and that nest coming out is the period. That's why, I explain, women who are pregnant don't get their period: the nest is being used.
How to say it
Refrain from using words like "curse." Please don't be negative about something your daughter is likely already a bit nervous about--and that is inevitable. Actually, for the first couple of years she's unlikely to have any cramping, so it shouldn't hurt. Be positive. It's part of womanhood and motherhood, and these are both good things.
Allay any fears you can. I reassure girls that it isn't likely to come gushing out the first time, that some toilet paper in the underwear can temporize until they can get a pad. Talk together about packing some pads for her school backpack. Have her practice putting one in her underwear.
A note about tampons: I have found this to be a very sensitive topic in some families. It doesn't take a girl's virginity away to use one, and if your daughter swims regularly or needs to wear a tight leotard for dance or sports, tampons can be helpful. There are some very slender ones with applicators that are easy to use--talk to your doctor if you have any questions.
Sometimes we all need help with figuring out what to say. The Center for Young Women's Health has good information about menstruation. There are lots of great books out there, too. The Care and Keeping of You series by the American Girl company is very nice, and now has books for both younger and older girls. I also like Growing Up--It's a Girl Thing by Mavis Jukes. But there truly are so many. I recommend going to a bookstore without your daughter and looking at the various choices--and choosing one (or more than one--I bought three!) that fits with your daughter, your family and your values.
Because talking about periods isn't just making sure your daughter has the facts she needs; it's also about encouraging and empowering her to make the best choices for her health and her life.
That's our job as parents, after all.
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FAQ: should kids have nutritional supplement drinks?
Here's a question more and more parents seem to be asking themselves: should I buy a nutritional supplement drink for my child?
I am seeing it often in my practice: concerned because a child isn't eating as well as they think he should, parents are buying nutritional supplement drinks like Pediasure or Boost.
I wish they would ask me instead of themselves. Chances are, I'd tell them not to do it.
I totally get why they do it. It's one of our most primal needs as parents to be sure that our children are getting enough nutrition. And the ads for these products are really effective: they market themselves as the solution for the picky eater problem.
The problem is, they can make the picky eater problem worse.
Think about it. What would you rather have: a plate of chicken, whole grain pasta and broccoli, or a chocolate milkshake? Because that's what these things taste like: milkshakes. They are thick and really sweet. And if not eating dinner meant you'd get one of those yummy drinks, well, there's an incentive to refuse dinner if ever there was one. The drinks are very filling, too (and full of calories)--so once you've had one, you really don't feel like eating.
Now, I definitely have patients who need these drinks to improve or maintain their weight, often because of medical problems. But those patients are relatively rare.
So, please--before you throw that pack of chocolate nutritional supplement drinks into your grocery cart, give your doctor a call. Talk about why you are thinking of doing it--and talk together about whether it's the best idea.
There may be other, healthier ideas.
What your doctor is supposed to do for your child's earache
Your child has an earache. You are worried it is an ear infection. You call the doctor and make an appointment. After all, he needs antibiotics, right?
Maybe not.
We have a real problem of antibiotic overuse in our country--and because we are overusing our antibiotics, many bacteria are getting smarter and stronger. Because ear infections is the diagnosis that kids in the United States are most commonly prescribed antibiotics for, the American Academy of Pediatrics (AAP) tried in 2004 to encourage doctors to rethink their prescribing habits.
The thing is, it turns out that ear infections don't necessarily need antibiotics. Many are caused by viruses. Many will get better by themselves.And not only does overuse of antibiotics cause resistance, antibiotics can have side effects. The guidelines were supposed to help doctors make better decisions--the problem is, many doctors don't follow them. So the AAP is trying again; they have reissued guidelines, with some clarifications and additions.
Here is what your doctor is supposed to do when you bring your child in with that earache:
Check to see if it's really an infection. Not only can the common cold or tooth problems cause earaches, you can also get pain from having fluid in the middle ear, something called Otitis Media with Effusion (OME). OME can look like an infection, but it's not--so it doesn't need antibiotics. Your doctor is supposed to look for the signs of a true infection: ear pain that comes on suddenly and persists, and an eardrum that is full or bulging with pus behind it, one that doesn't move when you blow air into it--or an eardrum that is draining pus.
Ask about and treat pain. This sounds obvious, but sometimes we doctors get so caught up in the diagnosing and antibiotic stuff that we forget to really talk about pain--and it's pain that brings parents in the first place. Whether or not there is an infection that needs antibiotics, there is an earache that needs soothing--so your doctor should be talking to you about how you can help your child's pain.
If there really is an infection, figure out if it's severe. Again, sounds obvious--but it's important for deciding if antibiotics are needed. A severe infection is one where there is a lot of pain, the child seems ill, or there is a fever of 39 degrees Celsius (102.2 degrees Fahrenheit) or higher.
Decide if antibiotics are necessary. Here is who should definitely get antibiotics:
- Anybody with a severe infection
- Anybody with other health problems that put them at risk of complications
- Children under 6 months old
- Children 6-23 months who have infections in both ears
If antibiotics aren't definitely needed, talk with parents about waiting and watching for 48-72 hours. I do this a lot. I give parents a prescription, but I tell them not to fill it unless the child either gets worse or doesn't get better in 2-3 days. In my experience, most don't need to fill the prescription. Pain medication and some patience very often do the trick.
To make this work, parents need to understand exactly what they are looking for, need to be able to get the prescription if needed, need to be able to reach the doctor easily if they have any questions--and the doctor needs to be able to reach them easily to check on the child. These are not gimmes in life sometimes--sometimes, to be on the safe side, we need to just go ahead and give antibiotics. But when we can wait, we should wait.
If an antibiotic is prescribed, it should be Amoxicillin. To fight antibiotic resistance, it's important to use just the right antibiotic--the one that will kill only the bacteria likely to cause the infection. For ear infections, that's Amoxicillin, unless the child's allergic, just had Amoxicillin in the past month (which might mean Amoxicillin isn't strong enough), has conjunctivitis too (which can be a sign of bacteria that Amoxicillin doesn't kill), or doesn't get better in 48-72 hours. The guidelines tell doctors what to do in those situations.
There are a few more things in the guidelines, such as discouraging prescribing antibiotics for prevention of infections in kids who get them a lot, and advice as to when it's a good idea to send kids to get ear tubes. To prevent ear infections from happening in the first place, the AAP suggests immunizing kids against pneumococcus and influenza, encouraging breastfeeding for the first six months of life, and keeping kids away from tobacco smoke.
So...the next time your child has an earache, check to see if your doctor does these things--if not, ask why. And--this is just as important--if your doctor suggests waiting instead of giving antibiotics, don't freak out. It may really be the better choice.
To read more about the right way to treat ear infections, check out the article I wrote for Parents magazine on this topic.
Why Snapchat is dangerous (it's not just because of sexting)
We've all been hearing about the cool app Snapchat, which allows people to send pictures and videos that only last a few seconds before disappearing. Because of the disappearing thing, the worry that I keep reading about is that teens will use it for sexting, figuring that it's no problem if they take sexy pictures or videos, because they won't last.
Now I worry about sexting as much as anybody else (although a 2011 study suggests that not that many teenagers actually do it). Sexting can glamorize and normalize sex in a way that might cause some teenagers to start having sex earlier, or in unhealthy ways. And legally, sexting can possibly be considered sexual harassment--or worse, distributing pornography.
But that's not my biggest worry about Snapchat.
Here's the thing: the pictures and videos don't necessarily disappear. The way the app is set up, someone can take a screen shot. While theoretically the sender should be notified if a screen shot gets taken, it only took me a couple of minutes on Google to find hacks that would allow me to take screen shots or save video without the sender knowing.
I worry about Snapchat because it creates the illusion that something can disappear from social media--and that is really dangerous. The biggest two lessons that youth need to learn--actually, that everybody needs to learn--about social media are: 1. Nothing is private and 2. Anything you do on social media can last forever.
We keep hearing about people losing their chances at jobs or school admission because their prospective employers or admissions officers go online and check them out. They look at publicly available stuff--tweets, Facebook posts, etc--and they don't like what they find. We are all doing it, actually: making judgments about people based on what they post.
The other day, my 15-year-old daughter got mad that I looked at her blog. She saw it as an invasion of her privacy. Um...sweetie? The entire world can look at it. But I'm asking you not to, she said. It doesn't work that way, hon. You don't pick who looks at what you put online.
We just don't think about this stuff as we are posting and tweeting and sending photos and texts. A couple of days ago my 20-year-old son took a screen shot of a text conversation we'd had and posted it on Facebook. I didn't really mind, but it was definitely one of those note-to-self moments. Anything we email or post or text or send can go anywhere. Literally.
This is a really important, and yet really hard, lesson to learn. And apps like Snapchat make it harder by making it seem like it's possible that social media could actually be ephemeral or private.
I love social media, and think that it has tremendous potential to help us in so many ways. But it isn't ephemeral or private. At all. The sooner everyone learns and lives that, the better.
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
- Was your child near the marathon bombings? He might need his ears checked.
- FAQ: What causes warts--and what can you do about them?
- The Slacker's Guide to Screen-Free Week
- Finding autism early: 6 important questions about your toddler
- Watching for stress: suggestions and resources for parents this week
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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