Rx For Parenting Today

Corona Virus Cases in Children

There have been 180,000 cases of this terrible virus in children since last month. Children are not immune despite the lies the administration is putting out. 338,000 children have become infected and can infect their parents, family members, teachers, and others. I would be very hesitant to send a child back to school at this point unless I could be sure many safety precautions were taken. No child is going to stay away from friends, wear a mask all day, and keep 6 feet away from their friends. 

There was an interesting article in yesterday's New York Times by Joanna Schroeder. She stated that for some children learning at home  or on-line has been a blessing. These are children with ADHD, children who are constantly being bullied, some children with disabilities who find it  hard to keep up with their peers  and very shy children. There are also children for whom the noise of classmates and the need to do things slowly and with lots of time find school a problem. Also teens who need lots of sleep are happy if they can start the day later, go slowly and even take a nap if they need to. Perhaps schools are going to have to re-think how they are educating some children when this pandemic is finally over.  Perhaps a few good things have come out of this awful time. 

An Amazing Fifteen-year-old

It was wonderful to see a fifteen-year-old Georgia girl say why she took the picture of the crowded hallway  in her school. She said "She felt it was the right thing to do."  Her parents must be very proud. The girl knew she would probably be suspended and she was. The suspension was later removed because of public outcry. I predict a bright future for this teenager and hope many others will follow in her footsteps. I see far too many teens in the affluent town where I now live whose only concern is their clothes, having a boyfriend, and social media. I asked one teenager at the beginning of the summer if she was going to look for a summer job. She said she had one for a few days, but the hours were not right. When you have a car, a boyfriend and a credit card, no job is going to seem right.

I knew I needed summer and other jobs to buy my clothes for college. My friends were mostly professors' daughters, as I was, but money was tight for all of us. We did not have cars and certainly not credit cards.  I learned a lot by waiting table in high school and in college. Many people who have always had money have no idea how the real world works. I feel sad for them as I did for my many Stanford wealthy classmates. Good parenting means teaching children about real life and making a difference. I was asked at a book reception what I felt my greatest accomplishment was. They thought I would probably say my M.D. or my ten successfully published non-fiction books. They were surprised and pleased when I said "My two children." 

Lets hope more teenagers follow Hannah Watters and her bravely speaking out and doing what she felt was right. 

When a Baby has Sleeping Problems

A friend told me of her concern that her brother and his wife had their young baby sleeping with them. She knew that many babies die when they sleep with their parents. She really wanted to call their pediatrician but felt she should not. I wondered if the pediatrician was aware of the sleeping problem and the danger the parents were placing the baby in. 

When a young couple has a new baby, lack of sleep because the baby will not  settle down can be very difficult. There are several things that can be done. Babies like to be fed and then put to bed. They should sleep on their back and on a firm mattress. No pillows, toys or anything soft should be left in the bed. Trying to to sleep in a big crib is hard for a little one. They like to be snug in a small bassinet and warmly wrapped unless the room is hot. A pacifier can help a baby sleep and helps cut down on the possibility of a death from SIDS. A smoke-free room also decreases the  possibility of SIDS. If an infant is old enough to sleep in a crib, it is important to check that the slats are no more than 2-3/8 inches apart. Otherwise, an infant can get caught between the slats. Old cribs painted with lead paint should not be used and cut-outs at the ends of the crib can cause problems.  If an infant won' settle  down, check for a burp, a soiled or wet diaper or a hungry baby. A music box playing nearby can often sooth a restless infant. A rocking chair is a must in a baby's room. The infant will often  fall asleep in a parent's arms while being rocked.

Anorexia and Other Eating Disorders

There was an interesting article by Jane Brody in the 7/28/20 new York Times about Eating Disorders. She brought up some interesting points but did not address two important subjects. As a practicing pediatrician I treated many girls with anorexia and bulimia. I was fortunate to have a wonderful woman psychiatrist to help with the girls and as I remember we  did not have to hospitalize a single one. What we both found was with eating disorders there were things going in the patient's family and social life that were contributing  to the problems. Now with social media, there is an even greater problem. Also with the focus on both female and male beauty , we are seeing even more teens with major eating problems. 

The one major fact that Jane Brody overlooked or doesn't know is that nutrition is seldom or never taught in medical schools. I don't remember any mention of nutrition  when I was a Stanford medical student or pediatric intern and resident. I learned about nutrition on my own  and from feeding my own children. I have had many medical students and house staff  tell me that I am the only physician they have ever heard take a diet history. That has always been part of my physician examination. Now that doctors often limit time with patients to ten to fifteen minutes there is just no way an eating disorder can be discovered unless that is the subject of the examination or a teen is obviously gaunt. 

Males can have eating disorders, as well as females. Sometimes their disorders are more about wanting to build body mass and not to look skinny. They may eat a lot of supplements or even take something like steroids. Those can be very harmful if not well regulated or prescribed for something like polymyositis. Parents, too, can be in denial or insist that their children look perfect. 

Finding Services for Children with Disabilities During this Pandemic

It must be especially hard for parents who have a child with a disability to get the services their son or daughter needs during this awful pandemic. I received the PACER newsletter today that is about kids who need special help. There is an excellent quote by Rachel Pearson " We don't know the magnitude of the skills that students with disabilities have lost, so it's hard to fully realize the colossal work that families and school districts will face in the future to help students with disabilities recover those skills."

A good resource for parents of special kids is the telephone number 1-952-838-9000 and their email is PACER@ PACER.ORG. They offer support and advice and have several pamphlets, as well as workshops online. These can be found at PACER.org/workshops.

I have always found their newsletter informative and would suggest any parent who has questions about how to handle their child's special needs during this difficult time to give them a call.

All parenting is hard work with many worrisome times, but I have found working with these special parents to be rewarding and inspiring and have met some amazing parents.

 

Medical Concerns and Tips about Infants

If you are a new parent, it is important to know the signs to recognize that the baby should be seen by a pediatrician or family doctor. Hopefully, you will have a baby scale, so you can check for weight gain or loss. If an infant is not interested in nursing or a bottle, I would be concerned. A poor suck can be a problem, although it might just be that the nipple of a bottle is not right or some help is needed with breast feeding.

If an infant seems listless or is not moving very much that is a real cause of concern. Breathing problems or a yellow color to the baby's skin are signs medical advice is needed. Oozing around the navel should be investigated, as  should pus oozing from one or both eyes. If you are hearing a high-pitched cry or non-stop crying something is definitely not right. Diarrhea or an elevated rectal temperature means a doctor should be seen. 

I remember being called to a hospital nursery one day by the doctor in charge. He was sure an infant had a tumor surrounding the penis. I asked one of the medical students or residents to bring me a gauze and gently teased back the foreskin.  A substance called smega had collected which I removed. The resident and medical student were appalled since the doctor in charge had said the baby had a tumor. I was never that doctor's favorite consultant after that!  Little girl babies  may also have a cheesy-like substance around the labia. 

If an infant has an obstructed tear duct, some doctors advise a surgical procedure. This can usually be avoided if you try  massage at the corner of the eye for several days and warm compresses. 

Emergency room doctors are not the ones to see because many of them have had little pediatric training. I would also not want a nurse practitioner to be seen because they also may not have had training in problems like these. 

Questions to Ask Before Children Return Safely to School

I have  a list of 14 questions to ask schools before allowing a child to return to school. 

1. Will the kids have daily temperatures taken?
2.  If a child's temperature is elevated and the parents can not be found what will be done with the child?
3. Will a nurse be present each day at the school?
4. How many children will be in each school room and will the desks be separated by six feet?
5. How will the children be kept apart on the playground?
6. Will school be a full day or just a few hours?
7. Will staff wear protective masks?
8. Will the staff have virus checks before they return and how often will they be checked?
9. What protections will there be on buses and how often will buses be cleaned?
10. Will there be daily cleaning of classrooms, bathrooms, door handles and desktops?
11. Will the children have to wear masks before they enter school?
12. How will lunchtime be done safely?
13. Will box lunches be served at the children's desks?
14. Will special ed students still receive, P.T., O.T. speech therapy etc, as mandated by their IEPs?

A Controlling Parent Can Have a Life-time Impact on a Child

As a practicing pediatrician, I saw wonderful parenting and some that was truly terrible. I think the hardest thing was seeing parents who wanted to control everything their children did, said, and how they looked. I have long-term follow-up of many of the children and know what damage was done to the children.  Far too often the parents who came to the  parenting classes I held were not the parents who truly needed them. Perhaps I persuaded some parents to change but it always was an up-hill battle.  One father insisted on weighing his teenage daughter every morning. When she developed anorexia, I was not surprised. 

One parent was abusive and his son paid for this by becoming very closed and unwilling to trust. His relationships were not happy ones. Another parent was very strict and always wanted a male child. Instead he had five girls. One of the girls was accepted by a medical school, probably to impress her doctor father, but she committed suicide her second year. What a tragedy. 

Parenting is hard work and means a lot of worrisome times, but the joys far outweigh the problems if the kids become well-rounded, loving adults. They should be allowed to make their own choices when they become adults and their talents should be encouraged not controlled. 

How Foster Children are Treated in the U.S.

I  wonder if people who are against abortions have any idea of what happens to the mothers who cannot get an abortion and have to give up their children because they can not feed and clothe them. To be a foster child in the United States can be good or terrible. We now have 400,000 foster children in the U.S. and twenty-two babies are left each year at hospitals.

I have a long-time friend who was given up for adoption and spent many years in foster care. Social workers tell me many children go from foster home to foster home in what they call foster home drift. How can you have any sense of being valued or wanted if you know your mother gave you up and often continued having children? Some foster parents are great and I have met several. One wonderful foster mother adopted two of the children after her own daughter was killed in an accident. 

Some foster children are abused, some run away because they are being used as a way for a parent to make extra money.  Many are treated like servants and forced to work very hard. We don't have enough social workers to regularly check on foster children and so many of those who are abused have no recourse but to run away. Then they often become homeless or some turn to working for drug dealers.

In this rich country where some CEOs are paid as much or more as 25 million a year it is embarrassing to be an American. Poor people have little power and yet perhaps with the new marches about black lives and poverty we hopefully will see some changes in this country. However, if Trump gets his way in appointing more conservative judges we will have more homeless and foster children. Something has to change!

How Can Schools Open Safely?

The mother of two middle school children asked me if I felt it was safe for her kids to go back to school in September. She lives in one of the best school districts in San Diego and they are asking for thoughts from parents. I sent her a list of my questions and told her I would be glad to talk to  her about them some more. She was a favorite patient of mine, as were her sisters and we have kept in touch for many years.

In thinking about the problems parents are having in deciding whether they were willing to put their children at risk if they go back to school I thought about how I would feel if I had small children.The American Academy of Pediatrics, of which I am a fellow, has said children should back to school. However, they give no specifics about what the schools should do, nor does Trump. Children certainly need socialization with their peers and online school is just not the same. I do not understand why any parent would either home school or allow a child to have schooling entirely on-line if they had a choice. I don't think either are healthy for children or teens. A particular problem with online or home schooling is for children with special needs. P.T., O.T., speech therapy, and other things specified in an IEP would not be available.

I think I would find a way for small children to have lots of books and other learning tools and not  allow them to go back to school if I was not satisfied with good answers to my 14 questions. If any parent would like a copy of my questions, you can e-mail me at cetmd@earthlink.net and I will be glad to send them to you.