Rx For Parenting Today

When Parents are Considering Adoption

Parenting is special if you can find a way to still have a life for yourself and your partner. I am seeing far too many parents using their children to improve their image. The kids have to do what the parents want and not follow their own dreams. Helicopter parenting in the U.S,. is very prevalent in many affluent families. The  kids get excellent educations, have lessons of all kinds and are expected to excel at everything.

If you are deciding to adopt, it should be because you love children, not becasue you think it is something you must do to prove you can be a  parent.  I was talking to a young woman one day who was deciding to get married. Her own hesitation was that her husband wanted children and she didn't really want any. I suggested she spend a weekend with friends who had children to see how it went. She said "Well, I love cats, so I am sure it will be fine!" I felt great fears for any children who were born.

If an adoption is private, be sure you  have a lawyer who does adoptions on a regular basis. If it is an overseas adoption, you want to be sure the child has a complete physician examination, is up to date on immunizations and has had a complete blood count and urinalysis. A tuberculin test is a must. 

It is important that a child be told early on that he or she was adopted. A good friend was adopted by a warm, loving couple, but later found out  her birth mother had another child after she was given to the adopting parents. She has always felt abandoned even though she had had a good marriage and a loving partner. She never had children.

 

The Importance of Fathers

Happy Father's Day to all grandfathers and fathers. How lucky children are to have warm, caring men in their lives. Uncles, too can play an important role. I  have friends who had abusive fathers  and these men changed their daughters' lives. Many years of psychiatric help has helped, but the pain is always  there. How any man can be abusive to a child is beyond my understanding. I remember one father telling me that you never wanted to get near his father's big hands. The man was bright and successful, but the problem with his father and teenage mother made a tremendous difference in his life. It was hard for him to trust or get close to people.

If a mother is widowed or decides to be a single mother, I hope she will find male friends  to  help fill the role a father should play. A male role model is important. My son's father was  a good provider, but his great love of orthopedic surgery and his adoring patients meant he gave both of these more time than his children. I suspect that is one reason my son is such a great father. 

Fathers do need time for themselves and also time for their partners or wives. A weekly date is something I have always stressed to keep a relationship going. Having a good buddy to talk to is important and for new fathers, a fathers' support group can be very valuable. Fathers are often much more relaxed with a new baby than the mothers. They can be great about helping out and take pride in doing so. I've seen some wonderful fathers  and know what a difference they  have made in their children's  lives.

Stress in Children and Teens

Stress in children and teens is increasing almost daily. This can be partly documented by the number of children being put on medications to modify their behavior or to increase their ability to focus, but also by the increasing number of teenage suicides. As parents, particularly affluent ones, enroll their children in more and more activities, the kids have almost no time to themselves to do what they want. Maybe they would like to lie in the sun or read a novel. Instead, they are signed up for karate or dance lessons, have tutoring or are involved in some other time consuming activity. The choice is often not theirs.

Schools are also to blame because the nonsense of giving even small children homework assignments started quite a few years ago. If a child has ADHD or is learning disabled, this can put a great deal of stress on them. Physicians may also be the ones to blame because it is  easier to write out a prescription for a medication than to do a complete physical examination, order lab tests. or make a referral to a psychologist for testing. The ten minutes often allotted for an office visit is ridiculous. I would never tolerated that. If money is the primary concern  for a physician, he or she certainly picked the wrong field if  they have chosen pediatrics or family practice. 

As a parent, if your child's physician does not take time to do a complete physical examination once a year and order a basic blood count and urinalysis, I hope you will look for another  doctor. There are still some who practice old-fashioned caring medicine. 

Information for Child Care People or Baby Sitters

With weddings, graduations and other festivities now going on, parents need lots of help with their children. One of the most important things  I always stress is that a baby sitter   must  be able to communicate with others in case there is a need for medical help or household help. In one of my parenting books, I give a list of other things to be considered. For example, do you leave the names and telephone numbers of people like plumbers or handymen, neighbors who might be at home, the  family doctor or pediatrician,  and the nearest hospital? The number of the National Poison Center needs to be posted by the telephone or refrigerator. Having grandparents nearby is great if they can help out, but they need these numbers also. 

A child's routine  needs to be discussed with the childcare person, as well as any allergies to foods or particular problems. Children with autism are very good about finding ways to escape, so locks should be on windows and doors and these should be carefully monitored.

The location of the fire extinguisher and first aid kit are important to note. If there is a pet in the house, their needs should also be mentioned, as well as their routines. Making a list of important telephone numbers and other important items can prevent problems from arising and parents can leave without worrying.   

Are Today's Parents in Charge or are Their Children in Charge?

I talked recently to a young woman who was house sitting for a friend and in charge of the 16 year-old daughter. The 16 year-old had gone to her boyfriend's senior prom and  instead of  returning home after the prom was "hanging out with friends." I expressed concern and the friend said not to worry that there were just different parenting styles today. I wished the house sitter could have seen the results of this kind of parenting when I was in pedaitric practice in a small affluent town. I had girls who became pregnant, were injured in car accidents because of drinking, developed venereal diseases or pelvic inflammatory disease. The  kids who had rules and boundaries fared much better, were more mature, and when they had children parented like their parents had parented. I still hear from many of these  patients and their parents. 

Children and teenagers want and need rules and boundaries. That way they feel safe and know what to expect from their parents. If there are no rules, anxiety can and does usually result. I  have seen this far too many times. Somehow in the last few years, many parents' ability to say "no" or establish boundaries and rules has changed.  They want to be loved and liked by their children and think giving them money, cars, and freedom will accomplish this. Instead, it can cause lots of trouble and problems. I wish pediatricians and family doctors would have parenting classes as I did when I was in practice, Instead, it seems money and time to play have become much more important to many doctors. I fear for this generation of children. The old rules of parenting still work and the kids do far better. 

The Importance of Grandparents

Grandparents can be a wonderful source of love and help if both parents get along with them. Even if there is a problem between a grandparent and one of the parents, the best thing that can be done is try and still be pleasant with each other. Sadly, few states have laws that give grandparents any rights unless a single parent is abusing a child or the grandparents  have proof that something is not right in the  parents' household. 

I receive frequent calls from two grandparents who have not been permitted to see their grandchildren. I have spoken with a family attorney about what can be done and she agrees that unless there are strict state laws to help a grandparent, nothing can be done.

I put grandparents' rights into Google and was surprised to see that it lists their rights state by state. So that is a good resource. I had a mother-in-law who disliked me intensely. I was always pleasant to her and even thought she was quite abusive,  mostly by ignoring I existed, my daughter was her favorite grandchild. Fortunately, we didn't  have to see her too often, so I was able to keep the peace. She would stand or sit right in front of me at family gatherings and still would not speak to me or look at me. The rest of the family and many friends knew this, so always tried to shield me. I suspect she was angry that I did not come from a wealthy family and I had taken her son away from her control. She did not  have a college education and because I had an M.D. that could have  been  part of the problem. She was a bright and capable woman and I loved my father-in-law.

I remember seeing my one grandmother  when I was about four because she lived far away. I wish I had had a loving grandparent but was fortunate to have  some other older relatives and older friends. There is a lot the older generation can teach us and our children, particularity now in these turbulent times.

 

The Challenge of Feeding Some Children

Some children right from birth are a challenge to feed. Other children will eat whatever you give them. I had one of each kind. My picky eater grew up to be an excellent cook and always enjoyed most foods. Peas were her downfall. I never understood where that came from.

If you  have a picky eater, try to present small amounts of colorful foods and don't insist  everything be eaten. Giving snacks between meals or milk can greatly decrease a child's appetite. I had a teenage patient whose mother was an M.D. and the boy would only eat french fried, bananas, and ice cream. It took a long time to get him to eat a wider variety of foods and some psychiatric help was needed. I had another patient who would  have a temper tantrum if he wasn't given the foods he liked. My suggestion to the mother was to serve him whatever the family were eating and just  give him have juice between meals. She called me daily and I said as long as he was getting enough fluids and sleeping O.K. just to hang on. On the third day she called me and said the boy was eating them out of house and home!

Children usually like single foods, not casseroles. Graham crackers contain a lot of sugar and should just be given as a treat. If a child refuses to eat a particular food, such as fish, he or she could be allergic to it. For allergic children, starting one new food at a time for a few days is the best plan. Pre-packaged foods can contain a lot of calories and with obesity in children on the rise, I would avoid these. Vegetarian diets can lack greatly in protein unless great care is taken. 

Geneticists and Neuromuscular Disorders

I am finding more and more medical reports and patients' case histories listing muscular dystrophy as a possible diagnosis because of a moderately elevated CPK. This can cause terrible anguish to parents. Geneticists now are faced with an ever expanding field of genes and disorders, but sadly most of them  have had little or no contact with patients who have muscle disorders. I wish all geneticists had to spend some time in a clinic or program that treats patients with muscle diseases. It certainly would save parents and those of us who have had many years years of experience treating patients with muscle disorders a great deal of grief. 

My advice to parents, if a geneticist or neurologist makes the diagnosis of muscular dystrophy or a muscle disorder, is to seek a second opinion in a well recognized center that treats patients, both children and adults, with neuromuscular disorders. Because I am no longer seeing patients, I refer parents and patients only to Dr. Selcen at the Mayo Clinic.  She was trained by Dr. Andrew Engel who is one of the greats in the muscle world. 

An elevated CPK can occur for many reasons. If blood is taken from a screaming child or an adult has had some recent strenuous exercise, the CPK can be elevated. There are other reasons also. A lab test must go along with a good physical examination, a family history and personal history.  A complete workup would save a great deal of grief for parents and patients.     

Mothers and Mother's Day

I think family celebrations and tradition are important. I talked with two mothers yesterday and was sad that neither mother thought they would hear from their children on Mother's Day. I have thought a lot about why that could be. One mother was in her seventies and the other in her early forties. Both had worked hard in their different careers and I wondered if their jobs had come before their children or what had happened?  I also remembered  a minister friend who gave a most uninspiring sermon on Mother's Day. In the past, his sermons had been excellent. I asked him about it later and he said he didn't think it was appropriate to be depressing on Mother's Day. I argued that there were probably some in his large congregational who had had mothers who were less than great. I'm sure some were controlling, distant, alcoholics or had other problems. I have known mothers of all kinds.  My best advice for mothers is to help their children follow their own paths, to be supportive and loving, but insist on respect, kindness and that the children follow the rules and contribute to the work of the family. I  have always urged mothers to be their own persons, to take adequate time for themselves and their own needs. A mother who is completely unselfish and never has time for herself is not doing what is best for the children.   A mother who is completely self-absorbed can do great damage to the children. I have seen that also. 

So to all mothers and grandmothers, I hope tomorrow will be a special day and you will be honored and loved.

Guns, Guns, and More Guns

How many more students and others have to be killed before members of Congress have the courage to defy the NRA? How can parents send their children to  public schools in the United States and be sure they will ever see them alive again? I am horrified that the Governor of Florida just signed a bill allowing teachers and others in Florida schools to have guns?  Even with the 133 hours of training the bill suggests, a gun in a classroom is a very dangerous thing. I certainly would never send a child to a school where guns were allowed. It is a known fact that a gun in a house means it is more likely that a death or injury will occur to a member of the household rather than to an intruder. 

Rather than spend the money on guns and training, schools need more counselors, social workers, and nurses to identify at risk kids  and find help for them. Every school shooter has been an at-risk kid. Instead of getting help for them, they are generally expelled with no follow-up. I have a long list of these. Since 1970, 1.45 million Americans  have  died from guns. These include suicides, murders, and accidents. (New York Times 5/9/19). There are more guns in the U.S. than there are individuals. That is shocking!

If you have ever watched a child die from a gun shot wound, as I did as a Stanford medical student, you would fight for gun control as hard as you can.