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FAQ: the color of baby poop

Posted by Dr. Claire McCarthy January 31, 2013 08:01 AM

I hear it all the time: "My baby's poop is (insert color here). Is that okay?"

It's very true that the color of baby poop can be startling--and changeable. Usually the color of poop is affected by what babies eat and drink--makes sense, as what goes in, um, eventually comes out. For breastfed babies, sometimes it's what the mother ate or drank that affects the color. Sometimes it's illness that changes the color--but sometimes, truly, the color is different for reasons that are completely unclear.
 
So here's what I say when I am asked this question (I got asked it twice last week alone):
There are only three poop colors I worry about:
  1. Red. That can be blood. Although not always--I've had patients with red poop from drinking red juice or eating red foods. But I want to know about any red poop--we can do a quick test to see if it's actually blood. It's not necessarily a serious thing if it is blood--sometimes something as minor as a little cut on the anus can do it--but I want to see those babies.
  2. Black. That can be blood too--that's the color it can turn as it passes through the intestine. Again, it might not be blood, and I'm talking real black here, not dark brown. But those are babies I want to come in and get checked out too.
  3. White. That can be a sign of a problem with the system that produces bile, an important chemical that your body uses in digestion. It's rare that this happens--and I do mean white, not light brown or light yellow--but when it does, we need to hear about it.
Other than that, I don't worry about any color of a poop. I'm good with any shade of green (I think I've seen just about every shade there is), yellow or brown. Most weird colors, like blue or orange (I've seen those too) come from blue or orange foods. 
 
Obviously, call your doctor if something worries you, especially if your baby is constipated or having diarrhea or seems uncomfortable--you should always do that. But if your baby seems fine, and the poop is the normal consistency for your baby and isn't red, black or white, chances are all is absolutely fine.

 
I will be doing more of these FAQ's--questions I hear again and again in my practice. If you have one for me, send me a message on my Facebook page.

My 100th post! Would love input for future posts.

Posted by Dr. Claire McCarthy January 29, 2013 10:52 AM
This is my 100th MD Mama post!

I don't actually count everything I write. But the "backstage" area of boston.com keeps track of it for me, and it's been fun to be approaching 100. I've been having a great time since starting the MD Mama blog this past March; I am thankful to all who have read them and to those who have left comments. Even when the comments aren't positive, I appreciate when people take the time to let me know what they think.

Speaking of which...if anybody has anything they would like me to write about, I'd love to hear from you. I can't give specific medical advice, of course--I can't do that without being able to do a full history and physical examination. But maybe there are topics you've been wondering about, or general questions that you either keep forgetting to ask the doctor about or feel silly asking the doctor about.

Along those lines...I'll be starting to do some "FAQ's", short blogs answering questions I hear again and again in my practice. This week I'll talk about when to worry (or, more importantly, not worry) about the color of your baby's poop--I have been asked about that countless times (twice last week!). 

So let me know! You can post things here in the comment section, or send me a message on my Dr.Claire Facebook page (where I post everything I write, not only from boston.com but Boston Children's Thriving blog and Huffington Post too--if you "like" me, you can get updates). 

Any topic is fair game--health (staying healthy, conditions, treatments) parenting, health policy, societal issues, media issues, you name it. All of it affects us as parents, right?  If I don't know about it, I'll learn about it or find somebody who does know about it to help me; at Boston Children's, there are some pretty amazing people--the depth of expertise is incredible.

I look forward to hearing from you.

Did you know ibuprofen can cause kidney damage?

Posted by Dr. Claire McCarthy January 28, 2013 08:00 AM
One of the most common medications parents in my practice give is ibuprofen. Known also by its brand names Advil and Motrin, it does a great job of bringing down high fevers and can be really helpful with pain, too. It's so helpful, in fact, that it's easy to think of it as completely safe.

It's not.

Now, no medication is completely safe. All medications can have side effects, and any medication can possibly cause an allergic reaction. And since acetaminophen (the other medication parents give for fever and pain) can cause serious liver damage if too much is given, it's easy to think that ibuprofen is the safer choice. 

But there is a difference between "safer" and "safe". That's what a study just out in the Journal of Pediatrics reminds us of. Researchers from Riley Hospital for Children in Indianapolis looked at medical records of children admitted to the hospital, and found that of those who had kidney damage, a significant number had been taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen (Aleve). Some of the kidney damage was serious.

This isn't news to doctors; we've known that along with possible bleeding problems, NSAIDs can damage kidneys. But we think of it as rare and we don't always mention it to parents. Which is our bad. But since medications like ibuprofen and naproxen are readily available without a prescription, we don't always get a chance to talk with parents about it either.

So here's what you need to know: while it's not common, NSAIDs can hurt the kidneys. It's more likely to happen when there is dehydration, as this concentrates the medication in the blood and the kidneys are already a bit stressed out dealing with the dehydration. 

What this means in practical terms:
  • Think twice before giving your child any over-the-counter medication. This is a good general rule of thumb. Ask yourself: is this really necessary?
  • Don't freak out over fevers. Fever is one of the ways the body fights infection, as germs don't like high temperatures. If your child has a fever but is basically comfortable and drinking, leave the fever alone. You'll avoid the risk of side effects from medication--and your child might even get better faster.
  • Don't give ibuprofen or other medications "just in case," to prevent a fever. I actually see this often; parents give it when their child has a cold, whether or not there actually is a fever. This is rarely a good plan--better to save the medication for when your child really needs it.
  • The other reason that parents give these medicines is for pain. While I am certainly not saying that you should let your child be in pain, if the pain is mild it's always good to think about other remedies, like massage or rest, and only give medications if they don't work.
  • Since dehydration can make NSAIDs more dangerous, don't give them if your child isn't drinking well. If they are drinking fine and you give them, make sure they keep up with the fluids.
  • If ever you're thinking about giving an over-the-counter medication and you aren't sure if it's a good idea, call your doctor. That's what we are here for!
At your next visit with your doctor, talk about over-the-counter medications such as ibuprofen. Get their opinion on which you should give, how much and when--and talk with them about what circumstances warrant a call. As I've said lots of times in other blogs, medicine works best when parents and doctors work as a team--it's the best way to keep children safe and healthy.


Three things parents can do to keep their child safe from child abuse

Posted by Dr. Claire McCarthy January 23, 2013 11:25 AM
The news of the Cambridge toddler that recently died from injuries has parents terrified.

While this is really understandable, I think that instead of just being terrified we should use this as a moment to really think about what we can do to keep children safe from child abuse. While nothing can prevent all abuse, there are things that parents can do. Here are three: 

Never shake a baby. Shaken Baby Syndrome (SBS), which is when children are shaken hard enough to cause brain damage, is the leading cause of child abuse death in the United States. The most common reason SBS happens? Inconsolable crying. When you mix a baby that won't stop screaming with a stressed-out, overwhelmed caregiver, bad things can and do happen.

If you've got a baby that screams a lot, check in with your doctor--but often it's just normal crying. And in those cases, you need to take care of not just your baby but yourself. Sometimes the best way to care for both of you is to put the baby in a safe place, like his crib, and take a moment to calm down. Here in Massachusetts, you can call the Parental Stress Hotline at 800-632-8188. 

Make sure that everyone who cares for your child knows the dangers of shaking. To learn more about SBS and how to prevent it, visit the CDC's Heads Up: Prevent Shaken Baby Syndrome website.

Know the signs of child abuse. It's not always obvious. The Department of Health and Human Services has a fact sheet that has all sorts of information about recognizing abuse and neglect, but here are some of the signs that parents and caregivers should watch for:
  • Any unexplained bruise or other injury (or an explanation for one that doesn't make sense)
  • Frequent bruises or injuries, even if an explanation is given
  • Changes in behavior, such as acting withdrawn, sad, angry or afraid. An occasional off day is usually normal, but if the changes are persistent or recurrent it could be a sign of a problem.
  • Changes in appetite or sleep (including trouble falling asleep, nightmares, or bedwetting). Again, only worrisome if persistent--and there can be lots of other explanations.
  • Behaviors or statements from children that are odd or not normal for their age (like talking about sex)
  • Negative comments about the child from the parent or caregiver--and/or lack of nurturing/happy interactions with child
  • The child expresses fear or dislike of the parent/caregiver
Remember--these are just a few of the signs, and could have other explanations. But if you see them, let someone know--like your doctor, or the Department of Children and Families.

Check out all your child's caregivers thoroughly. If you use a daycare center or family daycare, be sure that they are licensed--and check with your local licensing board to find out if there have ever been any concerns or complaints. If you use a nanny or babysitter, do background checks--including in other states the person has lived. Since most child abuse happens when a child is left alone with a caregiver, doing your homework is really important. Get plenty of references. Ask lots of questions--and be sure you communicate with them regularly about your child's behavior and needs. Ask friends and neighbors who might interact with the nanny or babysitter to keep an eye out and let you know if anything concerns them--and make surprise visits regularly. 

It's impossible to know everything about anybody, no matter how well you do your homework--that's what so scary about this. Keeping your antennae up can help; if for any reason something about a caregiver doesn't feel quite right to you, listen to that feeling. Don't ignore it. It's always better to be safe--after all, nothing will ever be more important than your child.

For more about how all of us can help to prevent child abuse, visit the website of Prevent Child Abuse America.


Help Governor Patrick get our children off to a good start

Posted by Dr. Claire McCarthy January 21, 2013 07:00 AM
Here's a sad fact: since 2001, Massachusetts funding for early childhood education and care has gone down 25 percent. Doesn't say much about how we care for our kids, does it?

Governor Patrick wants to change this. And he will need our--your--help.

The budget proposal outlined last week by the governor calls for $131 million more for early education and care in fiscal year 2014--which sounds like a lot, but would get us to just under where we were in 2001. Over the next three years, he would add $350 million more. There are 30,000 infants, toddlers and preschoolers whose families are eligible for help paying for daycare or preschool that are on a waiting list--this funding would get them off that list and into programs. It would also help improve the quality and availability of programs for the very young--and help support families.

Investing in our children is investing in our future. Sometimes sayings are so trite that we forget that they are true. This one really, really is.

There's tons of evidence that getting an early, strong start on education makes all the difference for children. Kids do best when they are nurtured as infants and toddlers--when their caregivers talk to them, hold them, sing to them, play with them, read to them. They do best when they go to good preschool programs that teach them not just the alphabet but how to take turns and pay attention. I've been a pediatrician for more than twenty years, long enough to watch a lot of children grow up--and it's the ones who get that strong start, and support along the way, that do well in school, stay out of trouble and go to college.

But that strong start and support aren't so easy to come by for many families. Many of my patients come from families that don't have much money. Some don't have much money despite working long hours, sometimes at more than one job. Many of the parents whose children I care for never went to college; some don't speak English. For them, finding good day care and good preschools that they can afford can be very hard. And when they don't, the odds are immediately against their kids.

Over the years, I've watched this play out. I've watched bright kids struggle in school because they didn't have the skills and knowledge other kids have. I've watched them get left back, lose their confidence, and give up. They go from wanting to be doctors to barely graduating, if they do at all. College doesn't happen; they end up in minimum-wage jobs. It's heartbreaking--and really unfair. 

If the fairness argument doesn't work for you, how about the economic one? Kids who get a good education are more likely to get a job with a higher income--and contribute more in taxes (and contribute more generally to society). They are less likely to need government assistance and less likely to end up in jail. Education strengthens our economy.

That's the thing: funding education, especially early childhood education, makes both moral sense and financial sense. You don't often get that combo.

But even still, there are going to be people who object, who think it's too much money or who want to use the money for something else. That's where you come in. Call your legislators. Tell them you think giving more money to daycare and education is a really good idea.

It's the right thing to do. Let's do it.




When should you keep your child home from school?

Posted by Dr. Claire McCarthy January 18, 2013 07:30 AM

These days, with all the sickness going around, and with all the fright about the flu, it's a question parents are facing regularly: when should your keep your child home?

It's not usually a straightforward question, either. For most families (mine included), keeping a kid home means missing work--and although our families are of course our first priority, missing work can be hard. Missing school isn't great for kids' learning, either.

What makes the keeping-home decision even more complicated is the fact that it's not just about your kid--it's about other kids too. Children are really, really good at spreading germs.

I talk about this a lot with parents. For me, there are some clear-cut guidelines--and some judgment calls. First, the clear-cut ones:

If they've got any symptom you'd want to take them to the doctor urgently for, they shouldn't go to school. Like any trouble breathing, or bad pain, or a new limp. Sometimes people send them and then call the doctor, figuring they'll pick them up or take them after school. Please don't.

Fever. You can't send your kid to school with a fever. Not only will they feel miserable, but people are usually at their most infectious when they are febrile. The definition of a fever is 100.4, but chances are the school nurse will call for 100 or higher--and your kid will feel yucky at that temperature too. Besides, a temp of 100 often has a way of going up in an hour or two.

Please--resist the temptation to give acetaminophen or ibuprofen, send them off, and cross your fingers. You might decrease their fever, but you wont decrease their contagiousness--and the stuff wears off.

Vomiting or diarrhea. Reasonably obvious. Mean to send a kid with either one, although I've seen it happen. Usually it's a hopeful parent who thinks that just because the kid feels better after vomiting, they are better. Unless they've gone many hours without vomiting, they aren't better--and really, with vomiting, diarrhea and fever you should wait until your child has gone 24 hours (or pretty close to that) without symptoms.

Okay--now for the judgment call ones:

Cough and runny nose. If we kept kids home for every cough and runny nose all winter, they'd hardly ever go to school. And usually, if they don't have a fever and don't have trouble breathing, they can go. However, if they are really hacking away, or completely covered in snots, keep them home for a day or so. It's kinder to your child--and to everyone at school.

Headache and other pains (assuming they aren't severe). Take their temperature, ask about any other signs of illness, ask about injury, look them over (do your Dr. Mom exam). If you don't find anything, ask yourself: how uncomfortable are they? If they really seem uncomfortable, keep them home--and check in with the doctor. If they don't seem so bad, try some acetaminophen or ibuprofen--and tell them to go to the nurse (or let the teacher know) if they get any worse. Which means you need to make some work contingency plans.

"I don't feel so good." We all hear this from our kids some mornings--usually mornings when we've got an important meeting at work or they've got a test or something else is going on that makes missing school suboptimal. My advice for this one is the same as the above: check 'em out, and if you don't find anything and they seem basically okay, send them with instructions to call if they need you. I've also found that reminding them that if they are sick they need to stay in bed all day and not watch TV sometimes makes them suddenly feel a bit better. 

Remember, too, that you don't have to be the only one making the decision. Even if your doctor's office isn't open yet, there should be someone on call that can help you figure out the best thing to do.

Here's my interview about this on Fox 25:

Boston News, Weather, Sports | FOX 25 | MyFoxBoston

For the sake of our children, it's time to say: enough.

Posted by Dr. Claire McCarthy January 16, 2013 01:07 PM
Our first task as a country, said President Obama today, is "keeping our children safe."

"This is how we will be judged," he said. I couldn't agree more.

They say that nations are judged by how they treat their most vulnerable. Twenty of our most vulnerable were shot dead a month ago, in their first grade classroom. If this is how we are to be judged, we aren't doing so well.

It's not just Aurora or Sandy Hook. The president said that in the month since those beautiful children died, 900 people have died because of guns. Homicide is the second leading cause of death for 12 to 19-year-olds--and guns are a big part of that. We may have the right to bear arms--but at the same time, as Obama said, with rights come responsibilities. And our greatest responsibility is to our children. We need to make changes that keep our children and youth safe from guns.

But it's not just the guns. There is a culture of violence and disconnection these days that worries me so much as a parent and pediatrician. There are so many reasons--violent video games are certainly part of it, and I was heartened to hear the president say he wants the Centers for Disease Control to study this--but it's more than that. It's bullying and cyberbullying; it's the way we are often more involved with our smartphones than the person next to us. It's the ways we are often so isolated, even when we are surrounded by people--and this is affecting our children. We seem to have forgotten that, as Obama said today, "we are responsible for each other." Somehow, we need to change our culture so that it nurtures our children.

It's not just the violence and disconnection, either. Our children are less healthy. There is more obesity, more asthma, more autism and more of other health problems. Some reasons are clear--like the super-size portions, sweetened beverages and sedentary lifestyle that lead to obesity, or the pollution and infestations that make the asthma of inner-city children worse. But some reasons, like those for autism, are less clear. We need to understand all the reasons our children are less healthy--and make real changes.

And it's not just the health of our children: it's the health of the world we are leaving them. Air pollution, mercury in fish, global warming, polluted soil, polluted water...what kind of future does this give the generations to come?

In his speech today, Obama said that we need to say: Enough. He was talking about guns and violence, and I agree with him, but while we're at it, let's say "Enough!" to so much more.

If our first task as a country is to keep our children safe, if that is how we will be judged, we have work to do.

Let's do some thinking--and roll up our sleeves. Each and every one of us can do something that makes a difference in the life of at least one child. 

Try it. Get someone else to join you. Throw out a violent video game. Support sensible gun control legislation. Invite the shy kid for a playdate. Stop buying plastic water bottles. Go for a walk. Shut off your phone for a bit each day. Talk to your congressmen--ask them what they are doing to help keep children safe and healthy.

"The only way we can change," Obama said, "is if the American people demand it."

Let's start demanding.






Want to get your kid to bed? Shut off the TV.

Posted by Dr. Claire McCarthy January 14, 2013 07:56 AM
If you want your child to get to bed earlier and easier, don't watch TV (or play video games) at night.

We pediatricians have thought and said this for a while, but a study just released in the journal Pediatrics backs us up. Researchers in New Zealand studied two thousand kids between the ages of five and eighteen to find out everything they did in the ninety minutes before bedtime. By everything I mean everything, including not just watching TV or playing video games but doing homework, brushing their teeth or going to the bathroom. They also looked at when the kids fell asleep. 

The kids that had screen time (especially those who watched more) fell asleep later.

There are three ways screen time does this:
  • Screen time often pushes bedtime later ("Mom, can I just see the end of this show?" "I'm almost done with this level!"). When there is a TV in the bedroom, this can be an even bigger problem.
  • The "blue light" emitted from the screens lowers melatonin level and so messes up the circadian rhythms that help kids fall asleep. So when they say they aren't sleepy, they mean it.
  • Scary or exciting shows or video games have a way of making you, well, scared or excited. It's not easy to fall asleep when you feel that way.
In the study, the kids who went to sleep earlier were ones who spend those ninety minutes doing sedentary non-screen activities (like reading--sadly, only nine percent of kids did that before bed) and self-care activities (like taking a bath).

I have to admit that in our house, TV is often a part of our evenings. We are a big and busy family, and curling up together on our big old couch and watching TV (although, one or more of us might be reading at the same time) together before starting the various bedtimes is something we enjoy.

However, I have to admit that getting our 7-year-old to fall asleep is hard. He has to be dragged away from the television if his older siblings (with later bedtimes) are still watching it, and after being tucked in to bed he frequently either calls us up to his room or traipses down the stairs to tell us that he can't sleep or that there might be a spider or that a noise has worried him.

So this study makes real sense to me not just as a pediatrician but a parent. I think that turning off the TV and spending the family time together doing something else--like reading, or playing a game, or just talking--would be a really good idea.

It's going to be a bit of a tough sell (including to my husband), but I'm willing to give it a try. What do you say--will you do it with me?

It's time to take the flu seriously

Posted by Dr. Claire McCarthy January 10, 2013 07:42 AM
Okay, guys, it's time to take this flu stuff seriously.

According to the CDC, influenza cases are reaching what were peak levels during moderately severe seasons in the past. And just this week, Mayor Menino declared a flu emergency here in Boston, as the number of flu cases hit 700--which is ten times the total cases last year.

If you are one of those people who think that the flu is no big deal, you should know that 18 children have died from the flu so far this season. And there's a lot of flu season left. 
 
So here's what you need to do, if you haven't already, to help prevent the flu:
 
Become a compulsive hand-washer. Carry hand sanitizer with you, and use it regularly. You'd be amazed how effective hand-washing can be when it comes to preventing infections, especially influenza.

If you have a baby or toddler, you should be aware that the majority of hand sanitizers contain alcohol and aren't meant to be, um, eaten. Given that kids put their hand in their mouth a lot, you might be better off carrying hand wipes with you--and using every sink you can to wash your hands with soap and water. Remember that to really be effective you should wash your hands (using soap) for 20 seconds--which is more or less singing "Happy Birthday" twice or the ABC's once.

Get a flu shot! Please. I get so sad and frustrated when parents say to me, "We don't do flu shots." The flu shot can't give you the flu--and while side effects are always possible, they are usually mild and brief--much milder and briefer than the symptoms of the flu, that's for sure. To all those people who say that they got sick after getting the flu shot, I want to be sure you know that it can take a couple of weeks for the flu shot to really take effect--and since we give the flu shot during flu season, it's always possible that you could catch the flu during those two weeks. This does not mean that the flu shot gave you the flu or made you really sick. It's a coincidence.

Boston is holding free flu clinics this weekend; to find out more, call the Mayor's Health Line at 617-534-5050 from 9 am to 5 pm Monday through Friday, or the Mayor's 24-hour Hotline at 617-635-4500 after hours. You can also visit the online calendar of clinics.

Keep your distance from sick people. This isn't always easy to do, but do your best. In situations like these, it's really okay to ask about the health of everyone in the house before you  accept an invitation for a play date--or change your seat at the movies or in church if someone starts coughing. Smile and apologize as you do it, and white lies can help ("So sorry, but my son has a weakened immune system, we have to be extra careful, hope you feel better soon").

There is a flip side to this: if you don't feel well, or your child is sick, stay home. Don't expose people to whatever you have. If you or someone in your family has some combination of cold symptoms, sore throat, muscle aches, headaches or fever, it could be the flu. If this happens, call your doctor for advice--and to see if treatment is a good idea.

For everything you need to know about the flu, visit the flu website of the Centers for Disease Control.


Parents: do you know the biggest risk factor for underage drinking?

Posted by Dr. Claire McCarthy January 8, 2013 12:30 PM
Do you know what the biggest risk factor for underage drinking is?

It's having a best friend who drinks.

I read an interesting article in Pediatrics, the official journal of the American Academy of Pediatrics, about ways to predict when an adolescent will have their first drink of alcohol. It was mostly about screening tools that doctors might use, and was heavy on statistics, but there was information in it that parents should know.

First of all, it turns out that kids who have their first whole drink (whole drink--not just sips) before the age of 15 have a four times higher risk of developing alcoholism. Four times. That's huge. Given how alcoholism can devastate not only the life of the alcoholic but the lives around them, it's really important that parents know the risk factors.

Like I said, the biggest risk factor is having a best friend who drinks. Which makes sense; peer pressure is huge for adolescents. There's also the matter of availability: you have to be able to get the alcohol to drink it, and having friends who drink makes that more likely.

What this means for parents is that you need to know who your kids hang out with. Really know them. Now, it's not always possible to know everything about your kids' friends (my parents didn't know everything about mine), but you can ask questions. You can try to make your house kid (teen)-friendly so that they hang out there and you can get to know them. You can get to know their parents (not in a creepy way--but introduce yourself at school gatherings or when you drop off or pick up your kid). The point is: who your kid hangs out with matters. 

You can't dictate your child's friendships, of course (you can try, but you will likely not be very successful). But you can certainly try to steer them toward activities, like sports and clubs, where they will meet motivated kids with interests who are less likely to drink. Not that kids in sports don't drink (our town had an issue with the football team), but getting kids involved generally helps protect them against alcohol use, as does helping them succeed in school.

There were two other big risk factors for having that first whole drink early:

Having a family member with high-risk drinking behavior. That doesn't necessarily mean alcoholism, although alcoholism does run in families. It means any unhealthy or risky drinking. Families need to be willing to take a long, hard, honest look at themselves.

Having a conduct problem. This means things like being defiant, lying, stealing, skipping school, using drugs and otherwise getting into trouble. This means that parents really need to take these kind of behaviors seriously, and not just write it off as a phase. 

What the authors of the article were trying to do is find ways to pick out the kids who most need help and get them help. That's exactly what parents should do if they think their child could be at risk for underage drinking: get help. Talk to your doctor about resources in your community to support your child--and you.

For more information on how you can talk to your child about alcohol and prevent drinking problems, check out "Make a Difference: Talk to Your Child About Alcohol" from the National Institute on Alcoholism and Alcohol Abuse.

And remember that what makes the biggest difference is you. Your relationship with your child can go a really long way toward helping them not just now, but in giving them the best future possible.

Having all my children home

Posted by Dr. Claire McCarthy January 6, 2013 09:15 AM
My house looks ransacked. All the time. 

It doesn't matter how much I try to pick it up, or how many dishes I collect and put in the dishwasher, or how many times I beg, plead or yell. With all five children home, the place is just a mess.

My oldest two children were abroad for the semester, so they were really not home. It was most noticeable with Michaela, my eldest, who goes to college in Boston and tends to come home often to sleep in relative quiet, get her laundry done, and have someone else pay for food. 

Turns out there are definite upsides to having only three children at home. There is less noise, fewer chores, fewer boxes on the to-do list and manageable grocery bills. There are fewer fights (doesn't seem to matter how much siblings love each other, they still fight). Life is just, well, easier.

When they all came home, all of that changed. Besides the mess, the grocery bill skyrocketed (Zack had been in China, and was particularly exuberant about his return to American food) and even still, we couldn't keep the house stocked with milk, toilet paper, American cheese, eggs or paper towels. I could never be sure that I'd have the car when I wanted it. And somehow, the children seemed to inhabit all the spaces in the house. My 15-year-old, who had been using Zack's room to study because of its desk, took over my little office. Even going to the bathroom gets complicated with seven people in the house.
 
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But despite the ambient craziness, from the moment we finally had everyone home, I felt a calm I hadn't felt in months. My babies were home. I knew exactly where they were and what they were doing. I could reach out and hold them; I could hear their voices and know that they were okay.

And that means everything. Because as much as my children make me crazy sometimes (well, okay, often), they are as much a part of me as my feet and fingers. It's really hard to be missing parts. I muddle through and get used to it, but the feeling of completeness when they are near is unmistakable--and beautiful.

My daughter moved back into her apartment in Boston yesterday (taking her socially inept cat with her, thankfully--we'll all have fewer scratches now), and Zack leaves a week from tomorrow to go back to Virginia. It will be quieter and the house won't always look like someone tore it apart looking for valuables (not that we can afford valuables with five kids).

But I will feel incomplete and wistful. I will hold the ones that remain even closer--and count my blessings, every day.


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Should the government pay for our bad food choices?

Posted by Dr. Claire McCarthy January 2, 2013 11:04 AM
We don't have to buy healthy foods if we don't want to. We can go to the store and fill our cart with soda and chips if we feel like it.

But should the government have to pay for our bad food choices?

No, says a commentary in the Journal of the American Medical Association (JAMA) written by David Ludwig MD, the head of the New Balance Foundation Obesity Prevention Center at Boston Children's, along with Susan Blumenthal MD and Walter Willett MD

They point out that the highest rates of obesity are found in people with the lowest incomes. And the Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps, is part of the problem.

When it comes to fighting hunger, it's not just about getting enough calories--getting good calories matters. Not all calories are created equal; some simply offer better nutrition, and keep us full longer. As the authors write:

Research suggests that if a child consumes 20 oz (600 mL) of a sugary drink, she will become hungrier more quickly than if she ate a large apple and a heaping tablespoon of peanut butter, even though both have about the same number of calories. Thus, the present lack of focus on food quality in SNAP may simultaneously exacerbate hunger and promote obesity.

See, you can buy any food or beverage you want with food stamps--except alcohol, tobacco, vitamins or hot prepared items (not sure I get the last two, but whatever). You truly could fill your shopping cart with soda and chips. 

Now, I am all for personal choice. Being poor is hard enough without the government telling you what you can and can't eat, right? Right...except that empty calories can leave you hungry, and the point of SNAP is to fight hunger. Actually, empty calories make you not just hungry but fat, the weird paradox of all this. And if the government is going to be paying for your health care, I think it's fair that they have some say in your diet. As it says in the commentary:

The public pays for sugary drinks, candy and other junk foods included in SNAP benefits twice: once at the time of purchase, and later for the treatment of diet-induced disease through Medicaid and Medicare. 

It's not like there isn't precedent for regulating what foods the government pays for. The WIC program (Special Supplemental Nutrition Program for Women, Infants and Children) only pays for a defined and healthy food package, and in 2010 legislation was passed to improve the quality of school breakfasts and lunches (we could argue that they haven't improved it much, but at least they are trying).

I was surprised to read in the commentary that half of the population will be enrolled in SNAP at some time by age 19 years. As a pediatrician, that really makes me want the program to only cover healthy foods. It's one thing if you're a grownup making bad choices for yourself. It's entirely another thing to make bad choices for children--choices that could doom them to lifelong poor health.

After the government fixes SNAP, they need to fix the agricultural subsidies. Because they, too, are contributing to our obesity epidemic. 

Taxpayer money should go toward making us healthy, not unhealthy. It's that simple.

About MD Mama

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 »

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