Rx For Parenting Today

Why are Youth Suicides increasing?

A good article in the 12/3/19 New York Times stressed the importance of doing something about the marked increase in youth suicides. It stressed that from 2000 to 2007 the suicide rate of youths from ten years to twenty-four increased by 56 percent. That is startling. It is the second leading cause of death in this age group next to car accidents.  It also stated that "since 2011, there's been nearly a 400 percent increase nationally in suicide attempts by self-poisoning." 

What is going on? Are parents getting so busy that they are not recognizing a child in trouble? Perhaps they are in denial or just not paying attention to their children. School, too, are to blame when individuals in trouble are expelled rather than identified and helped. I've seen several articles about schools that send troubled kids to charter schools so their graduation rate stays high, rather than helping the students in trouble.  The charter schools don't seem to be helping these students either because many students do their school work online and no one pays much attention to them. 

Social media is terrible for the many students who spend a great deal of time online and their smartphones are their connection with the outside world. I would not allow any child of mine to constantly be on a smartphone. What about talking to your children, having family dinners, what about chores or doing things together? Has parenting turned into just feeding and clothing children? When I was in private pediatric practice, many kids would pretend to be ill just so they could come and talk to me. I still hear from patients I took care of many years ago. They are desperate for real communication and knowing an adult who cares. One of the reasons I sold my practice was I was either going to open a group home for the many lost kids I saw almost daily, adopt a bunch of them, or find an answer to their loneliness. 

Medical Care for College Students

Many parents have real concerns about letting their child or children go away to college. One of their fears is if the student becomes ill who will look after them. This is a very real concern, but there are ways to ensure your child will be safe. One way is to find an outside physician in the local community.The other is to teach your child what is acceptable and what is not acceptable in college medical care. When my daughter went to University of Colorado, I checked on the credentials of the health service doctors. I also found an outside internist she could see. She needed some medical advice, so made an appointment with the one doctor I  thought was the best. When she went for her appointment, she was told she would see a nurse practitioner. "No", Jennifer said, "My parents are both doctors and they researched Dr,. X. That is the doctor I want to see." Yes, she was taken to see Dr. X. 

One thing that is important to do when a child goes away to college is to check if he or she will be covered by your insurance. Some colleges require you have insurance under their specific health insurance. 

The child of a local doctor called me one day in San Francisco and told his daughter was very ill in Berkeley. She had seen someone at the local student health service who diagnosed tonsillitis and gave the girl antibiotics. She was alone in her dorm on a Friday night and was having a hard time swallowing. I got in my car and drove to the dorm in Berkeley. The girl had enormous tonsils and signs of infectious mononucleosis. I called an ambulance and arranged for her to be admitted to the local hospital. My diagnosis was correct and with good medical care the girl survived the night. Her big tonsils could have created a serious problem.

If a student has a chronic problem, such as asthma or diabetes, the health service should be  notified of this. An outside specialist would be particularly important  in this situation. 

Colleges and Students' Mental Health

I was delighted to see an article in today's New York Times  saying several colleges, including UCLA, are adding personnel to care for their students' mental health problems. This is long overdue. I hope some of the prestigious Eastern colleges will follow suit. Many parents these days are putting so much emphasis on their children going to prestigious colleges that I worry. I remember in my Stanford medical school class of 62 students that two of our class committed suicide. This is becoming more and more common in both undergraduate and medical school classes. What a tragedy to see the life  of bright, capable students end when mental health counselors should have been available. Sadly, as in the New York University case of suicide, the student was seen by a nurse practitioner in the health service and given medicine, but not referred to a physician, a psychologist, or a psychiatrist. 

Public schools in the past had a nurse on staff and some even had social workers. Now when a student is having  or creating problems, many schools simply get rid of the  student with no follow-up and no help. This is unforgivable. Several of the recent school and college  shootings have been by former students expelled from school with no help for their mental health problems. I have a long list of these. I wish we could  have an R.N. and social worker in every school, including charter and private schools. I think we would save many lives.

Holiday Care in Emergency Rooms

Now that many doctors do not see patients on holidays, it is important for parents, and others, to know how to get the best medical care in an emergency room. ER doctors are trained  to take care of trauma patients, not everyday medical problems. I remember seeing a child in an ER on a holiday when the ER secretary was frantically trying to find an eye doctor for a patient with an eye injury. Every eye doctor who was called was not available. I knew a wonderful ophthalmologist, who had seen many patients for me, so I called him at home. He was  excellent.  He asked the patient's family to meet him in his office and took care of the problem. I was his children's pediatrician and knew he would respond to my call if he was in town. 

Holidays are generally very busy in ERs and should not be used for general medical care and certainly not for children with problems, unless it is trauma.  Now that we have networks and HMOs, a surgeon who is called to take care of a patient who needs stitches may not be on the patient's networks or HMO list. There have been incredible accounts of surgeons who charged outlandish fees for putting a few stitches in a patient. I worry about how money has become so important to so many doctors. 

ER doctors should not try to handle problems  for which they do not have adequate training. If a small child has severe croup, a pediatrician or pediatric anesthesiologist should be called. Many hospitals do not have these doctors on call and also do not have the necessary pediatric equipment to handle problems needing for example a tube for inserting in a child's windpipe or trachea. Before I started my own practice and took other doctors' practices for short periods, I always carried a big black bag with a lot of equipment, including pediatric endotracheal tubes. Fortunately I never had to use one. If you have to take a child to an ER and get to feel uncomfortable about what the ER doctor is telling you, I would find another hospital. 

Facts Parents Need to Know about their Children's Doctor or a New Doctor

I am frequently amazed at how little some parents know about the qualifications of their children's doctor. Questions I would want to have answers to are: Is the doctor an M.D. or a  D.O. Also is the individual a nurse practitioner with a doctor of nursing degree?  Many states now are allowing these individuals to practice without being supervised by an M.D. That to me is very scary. They simply do not have the necessary training to do this.

Once you have decided on a doctor you can get some answers to my questions by checking the individual out on the Internet or calling the Board of Medical Examiners in your state if the individual is an M.D. My next  question is if the M.D. is Board Certified or Board qualified. Anyone can call themselves a pediatrician but that does not  mean they have the necessary training. Where they went to medical school is also  good to know. 

Once you have chosen a specific doctor you need to ask if he or she will meet you in the ER in an emergency or if they just refer you to the ER doctor. Most E.R. doctors do not have the necessary pediatric training to take care of anything except trauma. If a child has to be hospitalized does the doctor come to the hospital daily to see the child or twice daily as I  did or  is the care left to a pediatric hospitalist. That is very scary to me and something I would never have done.

Also does the doctor answer his or her own calls after hours or leave that to a nurse or non-medical person. The answers to these questions could mean a child's life or serious problems. Children can become ill very quickly and need the best care possible. They are  precious and our future. 

Medical Care for Children with Special Needs

Because medical schools often do not include subjects about caring for children with special needs, pediatricians and family doctors are often at a loss about what to do with a child who has cerebral palsy, spina bifida or other disorders. Thus parents  usually have  to be the ones to find the medical care their child or children need. Each state has a special program for these children. Special services are provided, such as physical and occupational therapy, some equipment and clinics. This does vary from state to state. In my first book, Raising a Handicapped  Child, I give the number for each state office that a parent can call for information. I also give this list in my book for  children with neuromuscular disorders.   If you know an older parent who has a child with a disability this individual can often be your guide to getting help. Community clinics or those run by different organizations may or may not provide good care. Many do have social workers who can be very helpful. Agencies associated with different disorders may be helpful with referrals  but I would always check out these referrals carefully.  

There are two good agencies that can help. One is the Patient Advocate Foundation at 1-800-532-5274 and the other is Family Voices at 1-888-835-5669. If there are any legal problems the Protection and Avocation organization is excellent. Their number is 1-888-835-5669. They have lawyers on staff who can be very helpful. 

The Internet can be a good resource for information but I would be very careful about some of the information that is given. It is always wise to check and double check both on doctors, their credentials, different agencies and treatments.  

When Children are Included in an Adult Party or Visit to Friends

I am often amazed when small children are included at an adult party or visit to friends that their parents often don't bring toys or special foods for them. I guess they expect the hosts or friends  to have things for the children. I have spent a great deal of time at different events watching out for little children to be sure they didn't get into any harm. It is so easy for a child to slip away and get into serious trouble. This is particularly true of children on the autism spectrum.

I have had to care for little children who almost drowned, were injured or tried to slip away and almost were injured. I always took special toys or snacks when I was traveling with my children, when they were small. I never expected the families we visited or the parties I attended with the  children to expect someone else to care for them.

Now that the holidays are approaching, if you want to enjoy yourself, it would be wise to hire a teenager, you can trust, to go with you and watch out for the children. A teenage boy made a real difference in a child's life at a wedding recently when the single mother paid absolutely no attention to her autistic son. This was in a large house and yard  where he easily could have come to serious harm. He also could have ruined the wedding. Thinking ahead and being aware of potential problems with small children always pays off. Happy Holidays!

Skateboard and Scooter Injuries and Deaths

I went out into my front yard this morning to pick up the paper and saw a teenager riding a skateboard down the middle of the street. No, he was not wearing a helmet which is required in California for those under 18 years of age.  I checked my computer to see how many deaths and injuries are occurring because of skate  boards. Thousands are injured every year and at least 30 have been killed in the last year or so.  Of course, those are the ones that have been reported.

Then I started thinking about all the kids and adults riding scooters that I see all over my small town, In checking the statistics, I discovered that in the last year there have been 1500 injuries and at least eleven deaths. I have never seen a scooter rider wearing a helmet. I remember one time I was standing next to a teenager at a stop light. He was holding his bicycle and a helmet was in the basket. I wondered if he wore the helmet when he left the house and then took it off. Many kids think they are invincible. If they have ever spent time in an ER, as I did as a medical student, they might think differently. 

Of course, now we have kids coming to ERs because of gun shots wounds. If you ever saw a child die from a gun shot wound as I did in an ER as a medical student you would fight hard against the gun lobby and the NRA.  I know many schools have gun drills but perhaps they need some ER doctors to talk also about skateboard and scooter injuries.  I had a classroom added to my pediatric office and had ER doctors and other medical professionals give talks. Several parents told me how important these talks were to them. I wonder if any pediatrician still does something like that. I believe we should educate parents  in our practices, as much as we can. Parenting was always hard word, but it seems to get harder and harder. 

 

Finding a Good Pediatrician

I am often asked how to find a good pediatrician. This may be from parents about to have their first child or parents new to an area. My advice is first for the parents to network with friends and neighbors to see who they suggest. When the parents get one or more names I  then advise they check the Internet to see where the doctor graduated, what training he or she has had, is he or she board certified and how many years the doctor has been in practice. In general, I  would want an older, experienced pediatrician.  If there are any malpractice suits filed against the doctor this is important to note, although the  suits  may have no merit. 

The next thing I would do is make an appointment with one or more doctors to see how you  are treated by the office staff and if you feel comfortable with the doctor.  If the parents already have children I would want them to meet the doctor to see how they are treated.  The questions I would ask the doctor are if he or she takes care of his or her own patients in a hospital or if they  leave the care to a pediatric hospitalist. Also will the doctor meet the parents in an ER or leave the child to the care of an ER physician. Unless there has been an injury, I would not want an ER doctor to see a child. The pediatric training many ER doctors get is often minimal. I would also want to know if the doctor does see all of the office patients or leaves a nurse practitioner or physician assistant to take care of some. That to me is unacceptable. You also want to know which hospitals the doctor has staff privileges and does his or her office take the insurance you have.  With what doctors does the doctor trade night and weekend calls and finally are antibiotics ever prescribed over the phone without a child being seen? That is just bad medicine and can lead to some tragic results.

Children and Immunizations

I was asked to reply to a doctors' group yesterday about what I would do if a parent refused immunizations for a child. For me that was a simple answer. Having seen the tragic effects of polio, measles, mumps, and chicken pox, I said I would tell the parent he or she would need to find another pediatrician. Then I would follow-up with a certified letter. 

I agree that children are receiving what seems like too many immunizations these days, but the experts say these are needed. Now that we are seeing over a thousand cases of measles in the U.S. it is even more important that children be immunized. 

I was an interne in the final year of the polio epidemic. We had an entire floor at Children's Hospital in San Francisco of post-polio children. It was heart-breaking to see the children with bodies, or arms and legs that were useless. I also was in the acute polio ward for over a month and had to make the decision when and if a patient should be put into an iron lung. If I waited too long, the patient could die and and if I put a patient in too soon, it could cause problems. I had a resident who should have made the decisions, but he was often not there. That was a very scary experience. 

When I was in practice before we had all the immunizations, I had a youth with limb-girdle dystrophy who was  deaf from mumps. I also had a teenager with encephalitis from chicken pox and numerous other problems because of childhood diseases.

I am puzzled why some parents think they have the right to deny their children protection from diseases when they can have such bad side effects. Dr. Andrew Wakefield did a terrible disservice to children when he published FALSE information that autism was caused by immunizations. Several studies have proved his research was false and yet many parents still believe it.