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FAQ: when should my child be potty trained?

Posted by Dr. Claire McCarthy March 29, 2013 07:38 AM
potty training.jpgIt's a moment most parents can't wait for: the moment they no longer have to change diapers. 

But when, many parents ask me, is that supposed to happen?

Like so much else in medicine and parenthood, the answer is: it depends on your kid--and you.

Most kids in the US are potty trained by between 24-48 months, although needing a diaper at night for longer is common. However, there is a really big variation in when children achieve this (wonderful) milestone. Here are some of the factors that influence it:

Cultural factors. Some cultures simply start earlier than ours. I take care of a lot of patients from the Dominican Republic, for example, and I've noticed that many of those parents start actively working on getting their children to use the potty before they are 2, which is about when most US parents start thinking about it. Which leads me to the second factor...

Parental motivation. Some parents are just more anxious to move the process along than others. Everybody is different.

Child motivation. Some children are just more anxious to move the process along than others. Everybody is different.

Logistical factors. If you want to do it, but your child care provider doesn't, or vice versa--that makes it more complicated. Or sometimes, things like a new baby or a move make parents want to put it off--or speed it up, which is often the case when the beginning of preschool looms.

Developmental challenges. Children who are delayed in speech, in using their hands and arms and legs, or in other ways, may take longer to potty train.

Bottom line: Most children are potty trained between 18 months and 4 years. If your child is older than 4 and still in diapers, you should definitely ask your doctor for help. Not that you have to wait that long--we are here to help whenever you need it.

Here are some signs of readiness to watch for:
  • Your child shows an interest (follows people into the bathroom, takes off diaper, wants to sit on the potty, etc)
  • Your child has words or some other way to communicate with you that he wants to use the potty
  • Your child can pull his pants up and down and get on and off the potty (or toilet) by himself.

For advice on potty training, read my 6 tips for potty training success.



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Starting solids too early: a communication problem?

Posted by Dr. Claire McCarthy March 26, 2013 10:32 AM

Why is it that 40 percent of mothers in a study gave solid foods to their baby before doctors say they should?


That's a lot of moms. More than a third. Headed toward half. These are not just a few moms mixing some rice cereal into formula to prevent spitting up. This is a lot of moms doing what medical professionals are really clear is a bad idea.

mom and baby.jpg
You know what I think? I think we medical professionals need to own this one. We aren't doing a very good job of communicating--or listening.

You know what the top three reasons moms gave for starting early were?
  1. "My baby was old enough." (88.9 percent)
  2. "My baby seemed hungry" (71.4 percent)
  3. "My baby wanted to eat the food I ate, or in other ways showed an interest in solid food" (66.8 percent)
These are reasons you would give if either you didn't clearly hear the doctor say no solids before 4 months--or if you did hear, but didn't agree.

It doesn't help, of course, that doctors are a bit wishy-washy and unclear when it comes to when exactly parents should start solids. The American Academy of Pediatrics says 6 months--but also say that it could be a little earlier. And there have been a couple of studies recently that suggest that starting solids before six months could actually be good for future health. 

But nobody is saying that before 4 months is okay, and that's when these moms were starting solids (the mean age was 12 weeks). Before four months, babies may not be developmentally ready to eat solids. Too many calories too early, also, raises the risk of of obesity--and studies are showing that being overweight in infancy raises the risk of future obesity. Plus, getting solids early can interfere with breastfeeding--and breastfeeding is really good for babies.

We doctors clearly need to start talking about solids early. Lots of us (including me) sometimes don't mention anything until the 4 month visit--which is obviously too late. 

But even more, I think we need to realize that we have a habit of throwing a lot of information at people. And we also have a habit of using doctor-speak, and not exactly making it easy for people to admit when they don't understand or remember everything we say. That's not good. We need to fix that. And we need to give more written materials, and tell families about good websites where they can get information in between visits.

We also need to do a better job of asking people about their own beliefs and needs--and really listening to their answers. Whether it's because they think a baby will sleep better--or because Grandma tells them it's time, parents have reasons for ignoring us. When we don't ask about those reasons or circumstances, we miss the opportunity to talk with families about other options--and help them in other ways.

And parents...please, talk to us doctors. Let us know what you are thinking and doing. Tell us if you don't agree with our advice. Give us a chance. We're on your kid's team too--let's do a better job of working together.

I joined Bridget Blythe on NECN to talk about this:


When to call the doctor

Posted by Dr. Claire McCarthy March 22, 2013 08:09 AM
4828970781[1].JPGSometimes, when a parent tells me about something that happened with their child, I think (and say, as nicely as I can): Why didn't they call right away?

And sometimes, when I'm talking to a parent or seeing their child in the office, I think (but don't say): Why did they call about this?

It can be really hard to know when to call the doctor. 

It's hard because sometimes you plain old don't know what's going on. It's hard because things have a way of evolving, and you can't always predict whether they are going to get better or worse. 

And it's hard because we don't want to think that something is really wrong with our child--and at the same time, we don't want to miss something. Most of us vacillate between denial and overreaction on a regular basis.

So, yeah, it's hard.

Some things really do warrant a call to the doctor. We've made a list (a slide show, even!) of a bunch of them. Although it's certainly not exhaustive, these are conditions that your doctor really wants to know about right away.

But memorizing a list is tough--and like I said, it's not exhaustive. So here's how I'd suggest thinking about it. Call the doctor if:

What is happening is bad. Bad anything. Bad pain. Bad trouble breathing. Bad bleeding. Bad vomiting. I know, bad is subjective. But if in your head the word "bad" seems to apply, better to get advice than wait and watch.

Whatever is happening isn't going away. Even little things can worry us doctors when they don't go away. That little limp, the pesky headaches, the rash that the cream isn't making better, the diarrhea that just doesn't stop...time to check in.

Your gut is telling you something is wrong. I can't tell you how much I've come to respect and rely on parental instinct over the years. Whenever I hear that from a parent, I want to see that child--and I check them out incredibly carefully. The parents are nearly always right.

You can't say: I know what to do and really mean it. This takes stopping for a moment and not only really thinking, but really being honest with yourself. Which lots of us don't do anywhere near as much as we should (both thinking and being honest with ourselves).

None of us knows what to do all the time. That's true in all spheres of our lives, and parenthood is no exception. We all get stumped and scared; we are all lifelong learners, and that's okay. 

That's why even though I might wonder why a parent called about something, I wouldn't dream of chiding them. Instead, I use it as a time to listen, to understand, and to educate. Next time, they'll know what to do and they won't need to call.

So read the list--but if what's going on isn't on the list and you're worried, call.
 
 
 
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Same-sex marriage: why supporting it is good for children

Posted by Dr. Claire McCarthy March 21, 2013 05:05 AM
Having married parents is good for children. That's why the American Academy of Pediatrics (AAP) thinks that same-sex couples should be able to marry.

In a policy statement just issued, that's exactly what they said. It's going to put the AAP in the middle of controversy--but it was the right thing to do for children.

gay parents.jpg
There are currently almost 2 million children being raised by gay and lesbian parents in the United States. And you know what? They are fine. There is simply no evidence to suggest that it's bad for children in any way to be raised by same-sex couples. They don't have more emotional or social or any other problems than other children. For many of these couples, parenthood is something that they have chosen very deliberately and do with real commitment--and that is exactly what children need.

Whatever anyone's beliefs are about parenting and same-sex marriage, we need to pay attention to the research. And research shows that what makes a difference in the well-being of children is the quality of the relationship they have with their parents, the quality of the relationship between their parents (or the significant adults in their lives) and the availability of resources, both social and economic. 

That's what matters, according to study after study. The sexual orientation of the parents just doesn't. 

And here's the thing: marriage makes all of that more likely. As the policy statement says, marriage strengthens relationships and families. It brings 2 extended families together. Married couples have more financial and social resources. Married people tend to be healthier both physically and emotionally and less likely to do risky things. And marriage brings legal rights and responsibilities that are important--sometimes crucial, such as the right to make medical decisions.

This is about families. All children deserve to be raised in a secure, stable family that can give them the love, nurturing and resources they need. Marriage--not civil union or something else shy of marriage--helps give children all those things. Marriage supports families.

The AAP is hardly a hotbed of liberals. It is a huge organization with people from all sorts of different personal and political backgrounds. They don't make policy statements unless they are absolutely sure that the scientific evidence supports them--and they only make policy statements that they think are really important for the health and well-being of children. 

This is really important. It's important for the 2 million children being raised by gay and lesbian parents. It's important for the thousands of children in foster care who need loving families. It's important for us as a society to do everything we can to support families--not just some families, the ones that look like us or that we agree with, but all families.

Because our children live in all sorts of families. And our children are our future.


On middle school dances, parenthood--and hope

Posted by Dr. Claire McCarthy March 18, 2013 07:00 AM
My 12-year-old went to her first middle school dance on Friday. They've been having them all year, but either Natasha had a swim practice she couldn't miss, or she didn't want to go. This time she didn't have practice--and she wanted to go.

Thumbnail image for Thumbnail image for tash dance texts.jpg
She had a great time. She didn't want to leave. And it made me so happy.

My 22-year-old daughter, a student at Northeastern, came home for the evening to get some things she needed and have dinner with us. Michaela helped Natasha pick out clothes, did her hair and was with me when we dropped her off at the dance. "I wish I could be a chaperone," said Michaela. "Look at all the boys! And those girls--look at what they are wearing!" I reassured her that there were lots of chaperones. "Yeah, but they don't know the stuff I do," she said. "I've been to these dances."

We waited in the car at the curb until Natasha got inside. "She's growing up," said Michaela. "I don't like it."

I don't either--but I do, too. It's complicated.

Natasha is the fourth of my children to go through adolescence. I've been through this before. I've been through the angst. I've grieved the loss of the little kid years. I've worried, and wished I could turn back time, or at least slow it down.

But we can't. Time moves forward, no matter how we feel about it. Our children grow up. There's nothing we can do to change it.

Instead, we have to concentrate on helping them grow, on giving and teaching them what they need to manage in the world. And when they do something without us, and it goes well (and it's all legal), it's great. Because it's a good sign.

A middle school dance may not seem like such a big deal. And it isn't, really. But it's not a gimme that it will go well. The dances are loud, hot, crowded and overwhelming. There is nearly always social drama.  Navigating a middle school dance takes a certain amount of confidence and social skills--and as a pediatrician and parent, I know that neither is to be taken for granted.

That's just it: we can't take anything for granted. We don't know that our children will be confident, or have social skills, or be able to think clearly in an emergency. We don't know how they will handle responsibility--or money. We don't know if they will work hard--or look for shortcuts. We don't know how they will weather the storms of love, or betrayal. We can teach them all we want, but the truth is, we just don't know.

So every success--a good grade, an honor won, a kindness shown, a successful middle school dance--matters. Not that it promises anything; life doesn't work that way. But it gives us hope.

And hope, when it comes to those we love most in this world, is a really good thing.



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Quiz: How smart are you about salmonella?

Posted by Dr. Claire McCarthy March 14, 2013 10:12 AM
Thumbnail image for frogs.jpgJust this week a study was released in the journal Pediatrics about an outbreak of salmonella linked to African dwarf frogs--all of which were traced back to a common breeding facility. It's got me talking to people about salmonella--and I've found that many people don't know very much at all about this bacterial illness. 

To check out your salmonella smarts, try this quiz. Are these statements true or false?

Salmonella is a common illness.

True. According to the Centers for Disease Control and Prevention (CDC), every year 42,000 cases are reported--but because many cases aren't reported or even diagnosed, they estimate that the number of actual cases could be up to 29 times that much (not sure where the 29 comes from, but that's what they say). And every year, about 400 people die from the illness.

Salmonella just gives you diarrhea.

False. While the vast majority of salmonella infections stay in the intestine and give you diarrhea, the bacteria can spread into other parts of the body including the gallbladder, blood and bones, especially in people who have weakened immune systems. It can also cause a problems with the joints, eyes and with urination that can last months or years, although that's rare.

Children are most likely to get it.

True. Kids put their hands everywhere, don't always wash them, and put their hands in their mouths...and so are more likely to catch germs generally. The majority of cases are in children under the age of 4. Anyone can get it, though.

Frogs are the only pet that carry salmonella.

False. The bacteria can live in the intestines of lots of different animals, so any exposure to animal poop is risky. Turtles and baby chicks are common sources of infection, which is why these are not recommended pets if you've got a baby or little kid in the house--and why everyone should wash their hands immediately after touching these animals. Outbreaks have been linked to pet food, too. 

Pets are the most common source of infection.

False. Contaminated food is the most common source of infection, including chicken, beef, eggs and dairy (including unpasteurized milk). That's why it's really important that all food be cooked very well (the CDC recommends that if you are at a restaurant and food doesn't seem fully cooked, you should send it back!). Infected people can spread it to any food they touch, though, and it can contaminate water, which is why there have been outbreaks associated with vegetables and even baby formula.

It's really important to wash any surfaces you leave raw meat on--and wash your hands really well after handling raw foods. The CDC also warns against handling raw meat and handling a baby at the same time (e.g. don't cut up your chicken and then change a diaper without some serious hand washing in between).

If you get salmonella, you need antibiotics.

False--mostly. The vast majority of cases of diarrhea caused by salmonella go away by themselves within a week or so without antibiotics. In fact, antibiotics can actually make the bacteria hang around in the intestine longer. 

However, if the bacteria travel outside the intestine, antibiotics are needed. They are also recommended in really young infants, people with weakened immune systems and people with certain other health problems.

The two best things you can do to prevent salmonella are wash your hands and make sure your food is washed well and fully cooked.

True. It won't prevent every case of salmonella, but it will prevent a lot--and it will prevent a lot of other infections, too (especially the hand washing part).

To learn more about salmonella and how to prevent it, visit the Salmonella page of the CDC website.




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How about explaining THESE toys?

Posted by Dr. Claire McCarthy March 11, 2013 10:51 AM

Last week I read about how Mattel (the toy company) flew in some "influential mommy bloggers" to talk to them about toy cars. Apparently sales are down--and since moms buy toys, they figured they should talk directly to them--especially since moms, being girls and all, might not "get" the whole playing with cars thing. So they talked to them about just how cool cars are, and about how playing with Hot Wheels can improve hand-eye coordination.

Really?

The Mouthy Housewives had an absolutely hilarious response (don't read it somewhere you have to be quiet--I laughed out loud), explaining to moms how to play with other Boy Toys such as balls, sticks, Thomas trains, action figures and play tools. But as I thought about it, I think that Mattel's approach has some merit.

I'm good with cars. I like little toy cars. Rewarding my son Liam with them is what clinched potty training for him. We have hundreds of them. Well, maybe not hundreds, although it seems that way sometimes when we are cleaning the toy room. We have a mat that has roads on it and it's fun to play with the cars on that, or on racetracks (although we always seem to lose pieces crucial to holding the tracks together).

I am, however, fuzzy on the value of certain other toys--and I bet some of you guys are too. There have been so many times that I've wondered what exactly the manufacturer was thinking; wouldn't it be great to have the chance to ask? I could write for pages about toys that puzzle me. But in the interest of (your) time, I'll just give three examples:

  • legos2.jpgWhat's up with the Lego kits? Whatever happened to, I don't know, using your imagination and building things? And why do the kits have to be so complicated? My son got two for Christmas, and we got in a collective family bad mood trying to keep all the bags properly sorted and follow the directions.
  • And those stuffed animals that walk or bark or do whatever--huh? Again, what happened to using your imagination? They always seem so cool, and my kids have asked for them over the years, but it turns out that not only are they boring (the one or two things they do get old pretty quickly) but the hardware that makes them do stuff ensures that they are Really Not Snuggly.
  • And (sorry, as a pediatrician, have to get this one in): why do so many video games have to be violent? Even many rated "Everyone" (okay, that's 10+, but the reality is lots of younger kids play them) like Lego Lord of the Rings are reasonably violent. "They are not actually people," my first-grader likes to point out. "They don't die--they can be put back together." This is true, but why do we have to encourage play violence? Wouldn't it be great if the games discouraged violence?

I'm likely not influential enough, but I would love to be flown in by toy manufacturers and fed brunch and have this stuff explained to me. What about you? Which toys would you like explained?

It's of course possible that I'm missing the boat, or just getting old. When I asked my two youngest children (they are 12 and 7) if there were any toys they thought were bad or didn't make sense, their response was quick and simple: "No."

FAQ: when should I start my baby on solids?

Posted by Dr. Claire McCarthy March 7, 2013 08:12 AM
baby eating.jpg

It's a milestone that parents get both excited and scared about: starting solids. Making that transition from breast milk or formula (or both) to stuff that requires spoons is something that many parents in my practice have lots of questions about.

It's not always easy to answer those questions, because the science behind the answers isn't always clear--and is still evolving. Plus, different doctors often have different opinions on the subject.

That said, here's what I'm telling my patients:
  • Babies should start solids between 4 and 6 months. 
  • They shouldn't start before they are ready to take the food off a spoon (don't mix it in the bottle, please!). If Baby pushes his tongue back or otherwise doesn't seem to know what to do with the spoon, put it away and try again in a week or two.
  • While exclusively breastfed babies really don't need solids before 6 months, recent research suggests that adding other foods improves iron levels (although breastfeeding alone doesn't leave babies without enough iron)
  • A study just out suggests that  starting cereals before 5.5 months (and fish before 9 months and egg before 11 months) can decrease the risk of asthma and allergies.
  • No matter what anybody tells you, there is no Best First Food. Cereal (but not rice cereal, because of arsenic) mixed with breast milk or formula, or a pureed fruit or vegetable, is usually what I recommend. If you buy it, get a single ingredient food (the ones marketed for starting out); if you make it, make sure there are no lumps and don't add any salt or sugar or anything else.
  • Give each new food a few days (at least three) before adding a new one. That makes it easier to pick up on any signs of an allergy or other problem (like diarrhea or constipation).
If you are breastfeeding, just because your baby has started solids doesn't mean you are okay to stop--the longer you keep at it, the better for your baby (but at least once they are on solids, you get a little bit of a break). 

My friend Dr. Wendy Sue Swanson wrote a great blog on this that is full of useful links--check it out.

Starting solids is the next step in teaching your child healthy eating habits for life. So make sure your child gets lots of fruits and vegetables--and use this time, before they are really watching what you eat, to make your own diet better. As your child grows, be a good role model!

Amy Nobile and I were on NECN recently talking about ways to get kids to eat healthy:

The effects of ADHD can last a lifetime--what parents need to do

Posted by Dr. Claire McCarthy March 4, 2013 08:10 AM
ADHD isn't just a kids' problem. It's a grownup problem too--and there's more bad news.

In a study just released in the journal Pediatrics, nearly a third of a group of adults who had ADHD (Attention Deficit Hyperactivity Disorder) in childhood still had it as adults. A third. That's a lot of people to still be struggling with concentration and learning, still have trouble with impulse control, still have problems interacting with others--while they are trying to make a living, and possibly raising a family too.

But here's where it gets worse. The majority (56.9 percent) of the adults who had ADHD as children, whether or not they still had it, had at least one psychiatric diagnosis. The most common one was alcohol dependence or abuse, which was followed by antisocial personality disorder, other substance abuse disorders, hypomania, anxiety and depression. 

And there was more: compared with the control group in the study, adults who had childhood ADHD were twice as likely to have considered or attempted suicide by age 21. 

Considering that ADHD is the most common neurodevelopmental disorder of childhood, affecting at least 3 to 7 percent of school-age children in the United States, this is scary stuff. 

The authors of the study (including Dr. Barbaresi from Boston Children's Hospital, where I work) say that we need to stop thinking of ADHD as just a childhood learning and behavior problem, and start thinking of it as a chronic disease. They are right; like diabetes, ADHD clearly has effects that can be very serious--and last a lifetime.

It's going to take a while for the medical profession to wrap their minds around this, I think. I mean, it's not that hard to understand intellectually--but putting the needed evaluations, supports and treatments into place will be harder. Not impossible--and actually, thinking of it as a chronic disease helps, because it gives us models to follow--but harder.

In the meantime, I think it's going to be up to the parents--and doctors and teachers and counselors--of kids with ADHD to really advocate for them. Every kid with ADHD should have:
  • Regular contact with a mental health professional. This might be every week for some children. For other children it might be much less frequent--but all children should have it. It's not okay to just get a prescription for ADHD medication--good mental health care is way more than that.
  • The school program they need. Each child is different, but kids with ADHD have different learning styles and needs than kids who don't have it. Far too many of them end up feeling stupid, or doing poorly when a different program could have helped them to succeed--and both have lifelong consequences, whether or not the ADHD hangs around. Know your child's rights--and fight for them. Ask for help if you need it--from your doctor, your teacher, an educational advocate. 
  • A doctor who is aware of, and screening for, ongoing ADHD and other mental health problems that may come with it. As teens become young adults and enter the adult health care system, it's especially important that they keep this in mind.
To learn more, check out the CDC's ADHD page, or the website of CHADD, Children and Adults with Attention Deficit Disorder.


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When (and how) to talk to your daughter about periods

Posted by Dr. Claire McCarthy March 1, 2013 09:16 AM

talking w tash.jpgIn that list of awkward-parenting-moments-we-wish-we-could-avoid-but-can't, talking to daughters about periods is way up there. It's just hard to talk about. It's hard to know what to say, and it's tough because it has to do with sex--my experience is that most parents get a bit squirmy talking to their kids about anything related to sex.  

So when a reader asked if I would write about this, I thought: what a great idea.
  
Here's some advice from both my experience as a pediatrician and as a mom who has talked about periods with three daughters...
 
When to Talk
When you start talking is going to depend a lot on your child and the culture of your family. But at some point you really have to--and in figuring that out, there are three things to consider:
1. When she is going to get her period. There's really no way to know exactly, but when your daughter has both breasts and pubic hair (not just a couple of wisps of hair, but a reasonable amount), you need to get talking if you haven't already.
2. When someone else is going to tell her about it. My opinion is that she should hear it first from you, not the health teacher or her best friend. Most schools do have some education about puberty; find out when (in our district, it's the end of fifth grade), so you can plan (and have some time to get up your nerve).
3. When she starts asking questions. That's what happened with my eldest: when she was 10 she noticed the tampon dispenser in a public bathroom and would not give up until I explained what they were for.
 
What to Say
Give the actual facts. I remember that all my mother said was something along the lines of "You're a woman now." Which was remarkably unhelpful. And really made being a woman seem uncomfortable and unfair. 
 
You should explain why girls have periods and what is going on. You can figure out what explanation works best for you. In case it's useful, here's what I do in the office when I'm explaining it to girls (when their parents want me to):
 
I draw a picture of two ovaries connected to the uterus, with a vagina below (very abstractly, no artistic ability required). I explain that the ovaries have eggs, and that in women who have their periods, once a month one of the ovaries sends an egg down toward the uterus. I say that it to make a baby, the egg has to meet up with a sperm. How you want to handle the issue of how the sperm gets there is up to you--I talk with parents ahead of time about what they want me to say (I recommend giving the facts there too, but it's important to imbue those facts with values, advice, and an open door for further communication). When I'm giving this talk, I always say that for a while, the egg isn't going to be meeting any sperm. 
 
I explain that babies need a sort of nest in the uterus to grow (the top layer of the endometrium). I scribble some lines on the inside of the uterus to look like a nest. I say that every month the uterus makes a nest just in case. But when the egg doesn't find a sperm and make a baby, the nest comes out because it isn't needed--and that nest coming out is the period. That's why, I explain, women who are pregnant don't get their period: the nest is being used.
 
How to say it
Refrain from using words like "curse." Please don't be negative about something your daughter is likely already a bit nervous about--and that is inevitable. Actually, for the first couple of years she's unlikely to have any cramping, so it shouldn't hurt. Be positive. It's part of womanhood and motherhood, and these are both good things.
 
Allay any fears you can. I reassure girls that it isn't likely to come gushing out the first time, that some toilet paper in the underwear can temporize until they can get a pad. Talk together about packing some pads for her school backpack. Have her practice putting one in her underwear.
 
A note about tampons: I have found this to be a very sensitive topic in some families. It doesn't take a girl's virginity away to use one, and if your daughter swims regularly or needs to wear a tight leotard for dance or sports, tampons can be helpful. There are some very slender ones with applicators that are easy to use--talk to your doctor if you have any questions.
  
Sometimes we all need help with figuring out what to say. The Center for Young Women's Health has good information about menstruation. There are lots of great books out there, too. The Care and Keeping of You series by the American Girl company is very nice, and now has books for both younger and older girls. I also like Growing Up--It's a Girl Thing by Mavis Jukes. But there truly are so many. I recommend going to a bookstore without your daughter and looking at the various choices--and choosing one (or more than one--I bought three!) that fits with your daughter, your family and your values. 
 
Because talking about periods isn't just making sure your daughter has the facts she needs; it's also about encouraging and empowering her to make the best choices for her health and her life.  
 
That's our job as parents, after all. 


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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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