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The passage of time
There was a family party this weekend to celebrate my niece's return from Australia, along with the birthdays of her brother and parents, and I was really struck by how different everyone looked.
By different, I mean older.
I'm talking about everybody here--kids too. There were lots of relatives there, including children who I last thought of as babies who had suddenly grown tall and become really articulate and funny. But the grownups struck me the most, because, well, I'm one of them. If they are getting older, I am too.
And yet I feel the same.
Not exactly the same, of course. I know that time is passing--I feel it in my bones, and see it in the mirror. But even though I'm approaching my 50th birthday, inside me somewhere is that fantasy you have as a kid, that "growing up" happens to kids but not parents, that life goes quickly when you are young and slows down when you get older. It's not easy to face mortality, let alone the fact that I am headed toward becoming an old lady.
Last night, as I was reading in bed I heard my 7-year-old crying. I went in to the bedroom and sat on the bottom bunk. "What's wrong?" I asked him.
"Things are changing," said Liam. "I don't like it."
Liam has had a terrible time with leaving first grade. He adores his teacher, Mrs. Forrest. He loves his classmates. He is also a creature of routine, and ever since school ended, he's been off kilter. Right before bedtime, it hit him that the fact that his sister had sewing camp in the morning meant he wouldn't be able to play with her--yet another change in his routine. I think that (along with being tired from the aforementioned family party the night before) did him in.
"I want things to stay the same," he sobbed.
No, you don't, I told him. Because if everything stayed the same, nothing would happen. You wouldn't meet any new friends--or new teachers. If everything stayed the same last year, I pointed out, you'd never have met Mrs. Forrest--who will always be your friend. Change brings us new adventures. Change brought us you: you were our surprise baby.
He nestled in to me, all warm and smelling of soap. Some things don't change, I told him. Daddy and I will always be your parents and always love you, forever. You have your family, and they will always love you too.
I kissed him good night again and thought: I should listen to myself.
Because, really, I like the passage of time. It's exciting to watch my children grow from babies into toddlers into gangly children and then awkwardly and amazingly into adults. It's fascinating to see how situations and people turn out; it's the passage of time that ultimately works things through. Even though not everything works out the way I hoped, each day is a new chance to make things right, or at least better, and to try new things. And as much as I might complain about gray hairs or the effects of gravity, I am having a wonderful time.
As for being an old lady...once, when my grandmother was 85 and I was 25, she said that she would much rather be her age than mine. She was a tremendous woman, who had lived a very full life, including raising four children, traveling, writing and living through all sorts of joy and tragedy. It was good to be through the hard years, she told me. She liked being old.
I bet I'll like it too--and I have 35 years before I get to 85. All sorts of adventures can happen in 35 years. Bring it on.
A wonderful illustration of the passage of time: my oldest two in 1992--and 2012.
Are you a parent who smokes? Read this.
Are you a parent who smokes?If you quit, you:
- Add an average of 7 years to your life
- Eliminate most of your child's exposure to tobacco
- Eliminate all the pregnancy risks associated with tobacco exposure
- Get rid of the most likely reason you'd have a fatal house fire
- Make it less likely that your child as a teen will have access to cigarettes and become a smoker
- Will have more money (cigarettes are expensive)
You also make it much more likely that you will live to see your grandchildren. One out of two smokers dies from a disease caused by their smoking. Smoking is the leading cause of preventable death in the United States, causing one out of five deaths overall.
As a pediatrician, I talk to parents a lot about smoking, because:
- Smoking during pregnancy and infancy increases the risk of SIDS (sudden infant death syndrome)
- Children whose parents smoke get sick more often than those whose parents don't--they get more pneumonia, bronchitis and ear infections
- The lungs of children whose parents smoke may not develop normally
- Exposure to cigarette smoke can trigger asthma attacks
- It can affect the future health of children: exposure to second hand smoke at home or work increases the risk of lung cancer by 20-30 percent.
A study just released in the journal Pediatrics showed that pediatricians can make a big difference when it comes to getting smoking cessation advice and information to parents. Makes sense, since we are invested in the health of our patients--and parents see us way more than they see their own doctors.
But all we can do is give advice and information. When it comes to actually quitting, well, that's up to you.
There's lots of help available. The Centers for Disease Control and Prevention (CDC) has all sorts of resources, and you can call 1-800-QUIT-NOW for assistance. Here in Massachusetts, visit the Make Smoking History website for more information and resources.
You can do it. Your life, and your child's life, depends on it. Do it for both of 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.
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Help me teach doctors to communicate!
This week I'm starting something I'm really excited about: I am going to help the resident physicians at Boston Children's learn to communicate more effectively with patients and families.
We doctors are not always great at communication, as many people like to point out. To be fair to us, though, it's not something we generally get much training in. We are trained instead in talking to each other, in a whole other jargon-filled language. In medical school, the more you use jargon, the more you speak in telegraphic, abbreviation-filled sentences, the better. So when it comes time to switch to plain English, well, it truly is like switching languages.
Plus, it's not always easy to explain complicated things in simple, understandable, thoughtful ways in situations that can be very stressful, and when time is often limited. Doing that is just plain hard.
That's why doctors need some help in learning how to communicate effectively.
As excited as I am, I'm also a bit nervous. I want to do a good job, of course. I've been doing a lot of research and reading about how to help doctors learn this stuff, and I'll be basing a lot of what I do on Kaiser Permanente's wonderful Four Habits Model. But I'm a doctor. Do I really know what patients need and want?
I have certainly been a patient myself, and I've had to take my children to doctors lots of times. But that's not the same as not being a doctor; in all of those situations, I had more knowledge than the average person, more of an ability to understand and to know what to ask or say, than someone without medical training.
So I would love your help. What do you think doctors in training should know about communication? What do you wish your doctor would do--or stop doing? What have doctors done that has been good, that has made a difference for you? What do you think are the most important lessons I could teach?
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.
Please: ask if there is a gun where your child plays
Here are some statistics all parents should know about:
- Between 33 and 40 percent of American households with children have guns.
- 42 percent of parents with guns keep at least one unlocked, 25 percent keep at least one loaded and 14 percent keep one unlocked and loaded.
- 88 percent of children who are injured or killed in unintentional shootings are shot in their own homes or in the homes or relatives or friends.
That's why the Center to Prevent Youth Violence (CPYV) reminds parents every June 21st to do something really simple: ask if there is a gun where your child plays. They call it ASK day: Asking Saves Kids.
This isn't about anybody's right to own a gun. This is about safety.
If your child is going to play or stay at someone else's house, just ask if they have a gun. If they do, ask how it is stored. The answer should be that it is kept locked, unloaded, with ammunition locked separately.
When I talk to parents about this, sometimes I hear that they feel awkward asking. Here are some conversation starters from CPYV:
- "We all know how curious kids can be..."
- "I hope you don't mind me asking a few questions about the kids' safety..."
- "I heard the most surprising fact from my pediatrician..."
- "Do you remember that tragic story about the kids who found a gun?..."
- "All of us on the PTA have committed to making sure our kids are safe..."
- "Remember what we found in our houses when we were kids!"
If you aren't comfortable with the answers to your questions, don't let your child go there. Just like you shouldn't let them play at a house with an unsecured pool or other safety hazards. Like I said, this is about safety; it's our responsibility to keep our children safe.
Here are a couple of PSA's that bring the point home (each is short, only about 30 seconds--watch both):
Things You Might Not Know About Poison Ivy
Just the other day, a mother told me that her husband took the kids for a hike--through a whole bunch of poison ivy.
"So far, no rashes," she said. "I keep checking."
And she does need to keep checking--because the rash can show a week or longer later (usually with a first exposure), something this mom knew but lots of people don't.
I've found that there are lots of other things that people don't know about poison ivy. Here are a few:
There are different kinds of poison ivy--and it can look different at different times of year. The adage "leaves of three, let them be" simply won't keep you away from everything that can give you a poison ivy rash. The plants grow all over the US, so they are hard to avoid. The Poison Ivy, Oak and Sumac Information Center has lots of pictures.
You don't have to touch it to get the rash. The toxin in the leaves, urushiol, escapes whenever the leaves are broken or bruised--and the toxin can get on things, like gloves, garden tools, and clothing. it can even get into the air if the stuff gets mowed or plowed. This is why...
You can get the rash from people or pets. If they have been the toxin on them, when you touch (or pet) them, you can get it too. Just to be clear: you can't get the rash from someone's rash--it's not contagious that way. It's the toxin from the plant that gives you the rash.
The best thing to do is to wash immediately. Take off any contaminated clothing, and wash with mild soap and water--as soon as you can. That's the best thing you can do to get at least some of the urushiol off your skin, and make a reaction less likely. Remember to clean under nails, too.
There are various different rashes you can get from poison ivy. You can get bumps, scales, and various sizes of bubbles and blisters. Often they will be in a line or streak, showing where the plant touched the skin. However the rash looks, it's usually red (although it can have black spots when the toxin stays on the skin and oxidizes)--and usually itches like crazy.
Treating the itch is all you usually need to do. Simple stuff, like oatmeal baths or cool compresses, can make a real difference. Anti-itch preparations that have menthol or phenol, like calamine, can also help--as can Burow's solution or Domeboro. Interestingly, antihistamines like Benadryl don't help all that much because of the way urushiol causes itching. Steroid creams may help if used early, but once there are any bubbles or blisters, they don't help much.
Sometimes you need to take steroids--and if you do, you need to go off them slowly. In severe cases, taking steroids by mouth is needed--but if you do take them for just a few days, like we often prescribe in asthma, the rash can come back. So the recommendation is to lower the dose bit by bit over two or three weeks.
If you're ever not sure about a rash, your doctor is your best resource. You should also call your doctor if a rash you think is poison ivy is on the face or genitals, is getting worse, gets very swollen or has pus coming out of it--and you should call if there is fever or the person with the rash seems ill.
Hope your summer is poison-ivy-free!
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.
Parents: sibling fights can lead to mental health problems
As a pediatrician, I haven't made a big deal about fights between siblings. Because of a study just released, I have decided to make a bigger deal about it.
Brothers and sisters fight--it's pretty universal. I don't think I've ever met a family with more than one kid where the kids didn't fight, sometimes a lot. So over the years, when families have told me about sibling fights, what I've done is a.make sure there wasn't serious physical, verbal or emotional stuff going on, and b.make sure the kids weren't having behavioral problems outside of the home. If neither was happening, while I always encourage intervening, I have generally let it pass.
I shouldn't have done that.
In the study, published in the journal Pediatrics, researchers interviewed more than 3500 children and their families about aggression between siblings. They asked about physical aggression, stealing, breaking things on purpose--and also about saying things to make a sibling feel bad, scared, or not wanted around. They found that even mild aggression had a negative effect on the mental health of the victim.
It makes sense, when you think about it. You can't escape your siblings--they live with you. And when someone who knows you that well, and is supposed to love you, does hurtful things to you --well, that can be more hurtful than when someone outside the family does the same thing.
I'm very happy to change my advice, because as a parent, I'm strict about fights between my kids. I'm not going to say that my kids never fight. Of course they do. But I always react--and I absolutely never tolerate anything physical or anything mean. I insist on kindness, sharing and fairness always.
Now I've got medical research to back me up. It's so cool when that happens.
So the next time your kids start fighting, don't just roll your eyes and think, "kids will be kids." Intervene. Have consequences for bad behavior. Even better, set ground rules. Make it an expectation that everyone in the family be treated well. That means no name-calling, no making fun of people or degrading people, no being rude. It means respecting privacy and property. It means sharing food, stuff and space. It means never being hurtful, either physically or emotionally.
Setting these ground rules is not only important for the mental health of your children, it teaches them an important lesson: everyone in this world is deserving of kindness. Because if you can be unkind to your brother or sister, that means that you don't always have to be kind--even to the people closest to you.
And that, I hope, isn't what you want your child to grow up believing. True kindness, after all, doesn't make exceptions.
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.
Why the end of school makes me hopeful
Officially, the year draws to a close in December. That’s when we are supposed to reflect on events and lessons learned, and make our resolutions for the coming year. But for me the year feels like it ends now, as the school year ends—and begins again in September, with the start of the new school year.
It’s September when things change, when you move out of summer clothes and into new routines, new classrooms, new teachers, new activities. It makes sense that I’d mark the year this way as a parent, but even before I was a parent the year seemed to bend in September as the seasons changed and we left the slower pace of summer. In my head the helix of years angles up in the fall.
I’ve been thinking about this a lot as my children finish up their school years, as Michaela and Zack move closer to college graduation, as Elsa finishes her sophomore year in high school, as Natasha finishes sixth grade and Liam finishes first. I’ve been thinking about how different it all seemed in September.
In September, Michaela was headed to Paris and Zack to Beijing for the semester. Elsa was starting a school year she was very worried about. Natasha was starting middle school—and Liam was out of kindergarten and starting real school. We were all nervous. The year seemed to yawn out overwhelmingly in front of us; that it was actually a finite period of time was hard to believe.
And yet here we are, in June. The expeditions abroad, both successful, seem a long time ago—and pale in comparison to planning for life after graduation. Elsa made it through the stressful year with courage and perseverance. Middle school is old hat for Tash, academically and socially. A stronger glasses prescription later Liam is finally comfortable with reading and writing, and we figured out a homework routine that worked.
See, that’s the thing: time passes, situations evolve, we find our way through. Even the most daunting obstacles get tackled, somehow, simply because they have to be. Things don’t necessarily work out perfectly, but they work out; along with the possibility of failure, there is always the possibility of success—and unexpected good luck.
Now, over the summer, we rest—well, around summer jobs and activities, we rest. We dust ourselves off. We reflect on events and lessons learned. We make our plans for next September, our resolutions to do things differently and better.
As we finish up each year, it does feel possible to do things differently and better. There is something about the passage of a school year that feels like a real accomplishment, one that makes the next challenge seem more manageable. The time period feels manageable, too: after a while, it begins to feel like you can try anything, or endure anything, for a school year. Before you know it, it will be June again, time for a rest—and another new chance.
That’s why, every June, in the midst of exhaustedly counting down the days until vacation with the kids, I feel happy and hopeful. We made it through. We learned stuff. We are wiser. We have some new muscles—and new perspectives. Although we didn’t love every moment, we definitely had some adventures—and had fun.
And as we round the bend of summer, we know that anything, really, is possible.
(Here's Liam, my almost second-grader)
Kids and concussions: is it time for some societal soul-searching?
Repeated bumps to the head are bad for children. This sounds incredibly obvious--yet as a society, we don't particularly act like we get it at all.
When the Bruins made it into the Stanley Cup finals, I thought about all the young hockey players who would be inspired to practice harder and play harder in the hope of one day doing the same. And I wondered: if they bumped their head hard enough in a practice or game to get a concussion, would they be willing to stop playing--for maybe even a year?
My colleagues at Boston Children's Hospital just published a study showing that children take longer to recover from a concussion if they've had one or more previous concussions. If they haven't had a concussion in a year or more, though, their recovery time was the same as someone who had their first concussion.
Now, this study just looked at recovery time, not long-term effects of concussion. But if it takes you longer to recover, that means that things are still healing and not back to normal. And plenty of studies suggest that repeated blows to the head do lead to permanent brain damage. We know that hockey is one of those sports that carries a higher risk of concussion than other sports. You can try to cut down the risk with safety gear and safety rules, but you can't make the risk low. So...if you send your kid back to hockey practice within a year after a concussion, you are risking brain damage.
I'm going to guess that lots of parents (perhaps most of them) wouldn't keep their kids out of hockey (or football or lacrosse or other high-risk sport) for a year after a concussion. They would take the risk. They wouldn't want their kid to miss out--for all sorts of reasons. Some of those reasons might be good ones, but some are less good--like the ones having to do with achievement, or culture. That's the conversation we need to have.
Don't get me wrong: I'm a big fan of youth sports--all of them. Sports keep kids healthy and out of trouble, and the lessons and habits learned from youth sports can help kids grow into healthy adults. I know that we can't keep kids in bubbles, and that accidents happen. But the fact that we are seeing more and more concussions in youth sports--and that we are sending kids back in to play afterward--is something that demands some soul-searching.
Youth sports should be about fun, exercise and building healthy habits for a lifetime. It should never involve knowingly risking brain damage. We owe our children more than that.
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.
Quiz: Check Your Sunscreen Smarts
It's June--the month school gets out, and the month we really get out into the sun. Which means that we really need to get out the sunscreen--and use it well.As wonderful as the sun is, too much exposure can lead to skin cancer. Experts especially warn that burns during the younger years can raise the risk of skin cancer later in life--so it's really important that parents do everything they can to prevent those sunburns. Trying to limit in-the-sun activities during the peak sun hours of 10 am to 4 pm is a good start, as is wearing hats and trying to stay covered--but on a beach day or at day camp, neither may be possible. That's where sunscreen comes in.
How smart are you about sunscreen? Try out this quiz and see:
Which of the following words shouldn't be on a sunscreen label?
a. sunblock
b. waterproof
c. both of the above
Answer: c. No sunscreen can completely block the sun--or stay on despite any sweating or swimming. That's one of the reason the FDA has changed labeling rules--so that companies will stop telling us lies.
You have some sunscreen left over from last summer. You should:
a. Use it. Why waste it?
b. Chuck it and buy new sunscreen
c. Use it if the expiration date hasn't passed
Answer: b--with one small caveat. Sunscreen is supposed to have a shelf life of 3 years so might not have an expiration date--but even if you just bought it last year, you don't know how long it was on a shelf somewhere. Theoretically you can use sunscreen that hasn't passed the expiration date on the label--but high temperatures can make sunscreen less effective. So unless that unexpired sunscreen has sat in a cool place since you bought it (the caveat), chuck it and buy new stuff.
When buying sunscreen, you should look for protection against:
a. UVA rays
b. UVB rays
c. Both--"broad spectrum"
Answer: c. While UVB rays cause most sunburns, UVA rays can too--and can cause skin cancer. Block them both.
True or false: the higher the SPF, the better.
Answer: false, at least after 30. You should buy at least SPF 30 (the Consumer Reports folks say 40 based on their tests--apparently some of the 30's aren't exactly 30), but there is just no need to buy the 50+ stuff--you really don't get more protection from it.
If the sunscreen says "water-resistant", how often should you reapply it if your kids are getting wet (or sweating)?
a. Every 2 hours
b. According to the instructions on the label
c. You don't have to reapply--it's water-resistant
Answer: b--or a. The label should tell you how often to reapply. If it doesn't, reapply at least every 2 hours (even if nobody is playing in the water!)
True or false: In order to protect against mosquitoes and ticks, it's a good idea to buy a sunscreen that has insect repellent in it too.
Answer: false. Sunscreen should be reapplied frequently; insect repellent should not.
How much sunscreen should you apply?
a. a light coating
b. as much as your kids will let you
c. an ounce (about the size of a shot glass)
Answer: c. An ounce is what you should use for the average adult or large kid. Smaller kids might use a little less, but you really want to thoroughly cover all exposed skin. While theoretically you don't need to cover areas covered by one of those swim shirts that blocks UV rays, I always do anyway--because sometimes those shirts end up coming off! Try to put on the sunscreen before you leave the house, to prevent the squirming and running away from you that often happens at the beach or park. When my kids were little, I always put it on when they were naked, before I put on their suits. That way I could be sure I didn't miss any spots!
Speaking of which, that's the problem with spray sunscreens--it's hard to know if you missed a spot. Or got enough on. And there are concerns that inhaling them by accident isn't good for you. So it's best not to use them.
True or false: there is controversy over whether some common sunscreen ingredients could be toxic.
Answer: sadly,true. There are worries that oxybenzone and retinoids, as well as nanoparticles, could possibly have health risks. The Environmental Working Group has come out against them (and has a list of sunscreens that do not contain them)--but interestingly, the American Academy of Dermatology disagrees, saying that there's no good evidence that they are dangerous. Here's what we do know: too much exposure to UV rays can cause cancer. There are risk-benefit ratios to lots of the decisions we have to make for and about our children, and this is one of them. Please, don't ever skip the sunscreen because you are worried about the ingredients.
You can find out more about sunscreens and sunscreen safety from the American Academy of Dermatology, the Environmental Working Group and the American Academy of Pediatrics--and my friends Dr. Wendy Sue Swanson and Dr. Natasha Burgert have great blogs on the topic too.
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.
Kids and Medication Safety: 6 Must-Do's for Parents
Kids get into their parents' medications.That's the bottom line of a study just released in Pediatrics, the official journal of the American Academy of Pediatrics. Researchers from Boston Children's Hospital looked at data from the National Medicare Surveys to find out which medications were most commonly prescribed to adults, and then looked at data about pediatric poisonings from the National Poison Data system. They found that as medications were prescribed more to adults, the number of poisonings from those medications went up too.
This is not exactly surprising. Every year, more than 60,000 children (most of them younger than 5 years) are evaluated in emergency departments for "unintentional medication exposures", i.e. taking medications they aren't supposed to--and of those children, 12 percent end up hospitalized. The medications are usually prescription medications, as opposed to over-the-counter ones, and usually belong to an adult relative.
But here's the thing: more adults are being prescribed medication. Between 2000 and 2008, the percentage of US adults who took at least one prescription medication went up 10 percent. Given the epidemic of obesity, that number is only going to go up. Three of the most commonly prescribed medications, antihyperlipidemics (cholesterol drugs), antidiabetic drugs and beta-blockers (for high blood pressure) are used to treat complications of obesity.
So we really need to take medication safety seriously.
The Centers for Disease Control and Prevention (CDC), in partnership with PROTECT, has an Up and Away campaign to help prevent these poisonings. Here are the 6 things they say all parents should do:
1. Pick a place your children can't reach. Literally. Preferably somewhere a little kid can't reach standing on a chair, either (some kids' vitamins taste yummy enough to make it worth the effort--and curiosity is a great motivator). Like the top of the refrigerator, or a really high cabinet. This can be a particular challenge when you are away from home; keep all your medication together in one bag, and as soon as you get to your destination, find a safe place to put that bag.
2. Put medicines away every time. It can be so tempting to leave it out for convenience--like when your child has a high fever and you're pretty sure the acetaminophen will be needed again in four hours, or when you are taking pain meds for an injury that makes it hard to move around. But convenience simply isn't a good enough reason to risk a poisoning.
3. Make sure the safety cap is locked. Take the extra few seconds to push it down and twist and be sure it clicks into place. Not that safety caps guarantee a child won't get into them (sometimes I think they keep adults out more than kids)--so a safety cap isn't a reason to leave a medication within reach.
4. Teach your children about medication safety. Make sure they understand that while medications can help people, they can also be dangerous--so they should never, ever take them by themselves. As hard as it can be to get a kid to take their medicine, resist the temptation to call it "candy"--that's something you could seriously end up regretting.
5. Tell guests about medication safety. It might feel a bit socially awkward, but it is absolutely fine--necessary, really--to ask your house guests to keep any medication they are taking out of reach. Don't wait until you find it on the bathroom sink or bedside table; make the conversation part of the settling in, here's-your-bed-and-your-towels process.
6. Be prepared in case of an emergency. This is easy: all you need to know is the Poison Help Center number, which is 1-800-222-1222. Keep it by your house phone, program it into your cell phone--and call it immediately if you think your child might have taken something. It's helpful if you have whatever it is they took in your hand when you call--and also helpful if you know what your child weighs (an estimate is fine).
Check out the Up and Away website for all sorts of great information and downloadable materials.
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.
6 Things I Wish All Parents Knew About Sleep
According to a study just released, the number of hours kids sleep at night is more affected by genetics than by bedtime or how quiet or dark it is. While daytime naps can be affected and changed by messing with the environment, nighttime sleep is a more wired thing.This doesn’t surprise me at all, actually. For years I’ve been hearing from parents about how much their children sleep, and there is remarkable variation. Some kids sleep a lot at night and a lot during the day too, while others truly barely sleep at all—and yet, for the most part, they seem to get the sleep they need. It’s hard to explain this variation to parents, who understandably think that all kids of a certain age must need roughly the same amount of sleep.
- The safest place for a baby to sleep is in the parents' room, but in their own sleep space.
- The safest position for a baby to sleep is on his or her back (we used to say back or side, but now we say just back).
- Mattresses should be firm. No waterbeds or featherbeds, and sleeping on a couch is a bad idea too.
- Bedding should be kept to a minimum. Cooler is better for preventing SIDS, and babies can smother or get tangled in extra bedding.
- There should be nothing extra in the sleep space--no crib bumpers, pillows or stuffed animals.
Snoring is bad. A little bit here and there with a cold or when the child is really tired is probably okay, but any regular snoring should be reported to your doctor--especially if the child seems to have trouble breathing. It can lead to health, behavioral and learning problems.
I don't really mind having these conversations again and again with families. After all, sleep is important for health, and my job as a doctor is to keep my patients healthy. So talk to your doctor if you have any questions about sleep; we are here to help.
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.
Could your child have a motor delay? How to help your doctor find out.
As a pediatrician, I always want to find developmental problems earlier rather than later. When I do, I can get children and families the help they need earlier, which can make a big difference--especially if the developmental problem is caused by something that needs medical treatment.The problem that I--and all doctors--face is that it's not always as easy as you might think to pick up on problems. Babies and toddlers aren't always happy to come to the doctor, and don't necessarily, um, cooperate--or show me everything they can do. So sometimes I'm not sure if what I'm dealing with is a problem--or a scared or furious kid.
And while parents are the experts on their kids and usually do know when there is something going on, that doesn't always get communicated as well as it could. Sometimes parents, especially first-time parents, aren't sure about their concerns and decide not to say anything. Sometimes denial plays into it, sometimes parents get intimidated, sometimes doctors don't ask the right questions and sometimes we plain old run out of time at a visit.
This week, the American Academy of Pediatrics (AAP) published some guidelines to help pediatricians pick up on motor delays--that's when there's a problem with how children use their muscles, especially their arms, hands, legs and feet.
The clinical report, entitled "Motor Delays: Early Identification and Evaluation," lays out a whole process for doctors to use. The well child visits they want doctors to especially concentrate on are the 9 month, 18 month, 30 month and 48 month visits.
At the last two, the 30 month and 48 month visits, doctors are mostly supposed to be looking for anything they might have missed earlier--and assessing for school readiness at the latter visit. But at the 9 month and 18 month visits there are very specific things they are supposed to look for--and parents can look for them too.
At 9 months, babies should be able to:
- Roll to both sides
- Sit well without support
- Use both arms, hands and legs equally (without preferring one side)
- Grasp objects and transfer them from hand to hand
At 18 months, toddlers should be able to:
- Sit, stand and walk independently
- Grasp and manipulate (play with, pick up, move around, etc) small objects
If your child can't do any of these, talk to your doctor. Make sure that he or she listens, and that you have a plan for not only figuring out why (if you don't know already) but for getting your child help.
There are also four questions that doctors are encouraged to ask parents--and that parents can also ask themselves:
- Is there anything your child is not doing that you think he or she should be able to do?
- Is there anything your child is doing that you are concerned about?
- Is there anything your child used to be able to do that he or she can no longer do?
- Is there anything other children your child's age can do that are difficult for your child?
Think about these questions. If the answer to any of them is yes, talk to your doctor. Again, make sure that he or she listens--and that you have a plan for figuring out and helping if after talking about the questions there does seem to be a problem.
Children under the age of 3 years with developmental delays may qualify for services and support through a program called Early Intervention. What many people don't know is that parents can call Early Intervention themselves and ask for an evaluation; a doctor doesn't need to do it. You can find listings of programs here in Massachusetts at the Family Ties of Massachusetts website.
You can also find more information about developmental milestones at the website of the Centers for Disease Control and Prevention.
Get informed, and speak up. That's what I always want the families of my patients to do--because it helps me be a better doctor to them.
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.
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 joint--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.
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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.
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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.
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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
- 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.
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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!
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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.
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
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- Vector: Children's Hospital Boston's science and clinical innovation blog
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