Rx For Parenting Today

Children and Viruses

Now that we are all seeing the terrible effects of the cororna virus, I hope parents who have not allowed their children to receive vaccinations will think differently when we get a vaccine against the corona virus. If a parent had seen, as I have, a teenager almost die from chickenpox encephalitis and a youth become deaf from mumps, they will change their minds.  I do not understand any parent refusing protection for their children against diseases. 

Dr. Andrew Wakefield did a terrible thing when he connected autism to vaccinations. His medical license was taken away from him in England and so he moved to Texas. Why he met with Trump in the Oval office bothers me greatly. He continues to defend his unscientific  beliefs that there is a connection between immunizations and autism, although many excellent studies have repeatedly shown this not to be true.

I spent the first two months of my pediatric internship at Children's Hospital in San Francisco.  Ir was the last year of the polio epidemic and having to put patients in iron lungs, when my resident was absent, was a frightening experience. We had an entire floor of the large hospital with beds filled with post-polio children.  Many never walked again.  

Teenagers and the Virus Crisis

Now that schools are closed, I am told that most teenagers these days are spending their time on Social Media. I was delighted to have an e-mail from a neighbor I do not know. The the e-mail was sent to all the neighbors in the area where I live. The woman said her two 15-year-old twin girls wanted to help anyone who needed groceries. It said they would leave a list in the mailboxes and neighbors could check off what they needed. No contact would be  necessary because the groceries could be left by the front door and an invoice  put in the neighbor's mailbox. I sent back an e-mail saying how delighted I was by the offer, although I was O.K. for groceries. I added that the mother and her husband must have done a great job of raising the twins. 

I worry a lot these days about what is happening with so many of our teens. Many feel so entitled that they seem to grow up expecting the same treatment when they go to college or become doctors, lawyers etc. 

I have heard far too many stories of professionals who feel entitled to make all kinds of demands. If whose of us, who are older and professionals, had made those kinds of demands in college or professional schools we would have been quickly asked to leave. One woman medical resident demanded that she have a refrigerator to store her breast milk and be given special times off to nurse her new baby. I was amazed. I remembered when I was engaged during in my first year as a Stanford medical student  Our physiology professor saw my engagement ring  and tapped his fingers against it saying "If you had had that when you applied to  medical school, you would not have been accepted." I laugh now when I  realize that I probably practiced longer and saw more patients than most of my 62 classmates. 

My hope is that there are many parents like my good neighbor, who sent the e-mail, and are raising their children to do more than watch social media and feel entitled. 

 

 

Infant Steps of Development

Parenting is not easy particularly in times of crisis, as we now have with the corona virus. Having a grandmother or grandfather close by is great but at this time it is a problem because of social distancing. Some pediatricians are very good about helping parents handle newborn anxiety, but some have not had children of their own, so have no concept of parents' concerns if their baby is developing as he or she should.

It is important to remember that every baby and child will develop at his or her own speed. Some even in the hospital nursery look as if they cannot wait to get up and get going. Others are fat and placid and will do things in their own time and way. No child should be pushed to walk or crawl. Premature babies take longer to develop and large babies are usually slower to develop. If a baby does not respond to your voice or sound, I would  make an appointment for a hearing test in a reputable hearing center. The baby's hearing should have been checked in the hospital, but there can always be mistakes.

If an infant seems floppy or has low muscle tone, a neuromuscular specialist should be seen. Sadly, I have found that most neurologists have not had adequate training about neuromuscular diseases. Now that I no longer see patients I send all children with questionable muscle disorders to Dr. Selcen at the Mayo Clinic in Minnesota. I have seen far too many mistakes in diagnosis by doctors who have not had neuromuscular training. Babies can have spinal muscular atrophy, a congentital myopathy, or congenital muscular dystrophy. Infantile myositis is rare, but does occur and is treatable. There are drugs now for infantile spinal atrophy that appear to be helping. The term, congenital hypotonia, is still found in textbooks but is not a diagnosis.

Finding a good Doctor for a Teenager

I was talking with a young mother the other day about her teenager daughter. I asked about the girl's pediatrician and the mother said, "I think he is great." When I asked if he did a complete physical examination yearly, she said "He has never looked below her waist!" I told her of some of the problems I  had found in both teenage girls and boys and she was astounded. Boys can have hernias or other problems that need to be watched and girls can also have several problems that you can not find unless you look  for them.

One of the most surprising cases I had was a teen patient who had not menstruated, but never felt well. When I examined her I  saw a bulge when I separated the labia and on doing a rectal examination, I felt an enormous mass. The girl had an intact hymen, so the blood when she menstruated could not come out. I  have taken foreign objects from the vagina in girls and from the rectum in both sexes. Sadly, many medical schools are not teaching their students the importance of doing a rectal examination, so a lot of things can be missed. I think a rectal examination should be part of a complete physical for both kids and adults. Otherwise you can miss something that could make a difference in their lives.

Keeping Children Busy when Schools Close

It is hard to keep children happy and busy when they have to out of school for long periods. I learned a lot about this when we lived in Rochester, New York for three snowy, cold  years. In one of my latest books, Your Personal Parenting Guide, I devote almost two pages to activities that kids can do, plus a section for kids with disabilities. I always kept things like blocks, play dough, paint and similar things on hand for days when the children had to be at home. You can actually make your own play dough,  create a puppet stage out of a cardboard box and make your own puppets. There a some other  books that can also help. One is 365 TV-Free Activities by Steve and Ruth Bennett. Another is the Preschooler's Busy Book by Trish Kuffner.

You can do a lot with a roll of white shelf paper. Kids can make murals and they can create an outline of their bodies by lying down on the paper and having someone drawing around them.  I still have my grandchildren's dress up box and advise all parents to have one. Kids can be very creative with plays, fashion shows, and similar activities. Cardboard blocks are great for building villages, roads, and many other things. You will be surprised about how creative your children can be if given a chance. 

Preparing High School Seniors for College Life and Being an Adult

I have been worried recently about all the high school seniors who will be off to college in the fall or start jobs and have no idea about how they to take care of themselves. I noted in a recent magazine article that colleges are giving courses for their students about how they should do basic things like caring for their clothes etc. That is amazing. 

I always taught parents that their children needed to learn the steps of Independence, so they could take care of themselves as adults. I was talking to my 29 year-old grandson about this and he told me an amazing account of his freshman year at New York University. He said his 3 suite mates had no idea how to care for their clothes, cook, or many other things. One of the students put the contents of macaroni and cheese box into a dish in the microwave without reading the directions and not adding any water. It made a terrible smell and mess.

My two children learned early on about how to iron, wash clothes and cook simple dishes. They both said they had to help friends learn to do these things when they started college. I certainly did as a Stanford undergraduate.  Even though I was working many hours a day as a pediatrician we had two wonderful housekeepers who also taught Jennifer and Geoffrey basic things. I have always been very grateful to them. 

 

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Feeding Picky Eaters

Feeding small children who are picky eaters can be a challenge, but sometimes there is a reason they are picky. An older woman told me of the problems she has had with getting  the right food in a senior home complex because she has documented celiac disease.  No  diagnosis of the disorder was made until she was in graduate school. She told me that when she was an infant her mother nursed her for many months. Then when she was put on solid food she began losing weight and soon lost ten pounds. In those days there was not knowledge about celiac disease, so her mother did the best she could. She soon discovered that mashed bananas did not cause any problems so with trial and error, several foods were found that the child could eat. The woman told me that she always ate the inside of a sandwich but never the bread. Even ice cream can have wheat in it, so  celiacs can have a great problem often in finding foods that don't  cause diarrhea and abdominal pain.  Now the disorder can be diagnosed with a intestinal biopsy. Much information is available at www.celiac.org. So if your infant or small child is unusually picky, I would look at this website and also talk with your child's doctor.

Safety Precautions for Children

I have always been amazed at the precautions parents need to take to keep their children safe. For small children, it is important that all of their toys are checked to be sure there are not magnets that can be swallowed.The magnets in toys today are quite numerous and once one is swallowed, it can burn the feeding tube or esophagus.  Small pieces like button eyes in toys should be checked to be sure they can not be pulled off. 

If an older woman  comes to visit or baby sit, I would be sure her purse is put up high because it could contain medication. Medicine chests or bedside tables should not have medications that can be reached and swallowed. 

Wall heaters can be a problem and can be made safe by putting a wire barrier or screen around them. We did that in a  house that we rented when our first child was small. Playpens can save a child's life when a parent is busy. Garages can be dangerous if a child is not supervised.

Outlet covers for electrical outlets are wise and I always had them in my office. Open wires, frayed cords can be dangerous, as can coins, scissors, and pins that can be swallowed.

Health Concerns in Children

I am sure parents are greatly concerned about their children's health these days with all the worries about the coronavirus. The most any parent can do,  particularly if the schools have to be closed is to keep in touch with their doctors and be sure basic medical care is given.. Children should have a  daily multi-vitamin and never be given herbal medicines. Deaths have occurred from these in children. Kids are not good about drinking enough water usually and drinking juice or soft drinks does not take the place of water. Kids should also do better about washing their hands, particularly after playing with pets. If you have a health concern about a child, you want to talk to the child's doctor not the receptionist or nurse. Retail clinics should not be used for children and urgent care clinics may also not be staffed by a physician.

If a child has a fever and is not eating it would be important to check in with the child's doctor. ER doctors would not be the ones you want to see your child, but a family doctor or pediatrician. you may have to be fairly assertive to get the medical care your child needs.  

Handling a Childhood Emergency

Few children get through childhood without some kind of an accident or emergency. That is why it is wise to think about and know what to do if one occurs. I would suggest having the number of your child's doctor posted where a baby sitter or relative could easily find it. Adding the number of the poison center is also a good idea. As a parent if you know how to do CPR on a child, this should give you a feeling of comfort. Little children  often stick foreign bodies in different parts of their bodies. I  have taken them out of the nose, the ear canal, the rectum and the vagina. 

If a child is allergic to bees, particular foods or something else it is a good idea to  have an epi-pen on hand. I will never forget the mother  of a child who was quite allergic to bee stings. I had my nurse show her how to inject a syringe and  had her practice on a grapefruit. I also insisted she carry an epi-pen with her. However, when a bee sting occurred, she drove the child to my office for the nurse to give the epinephrine, Fortunately, she got to the office before there was a serious reaction. 

If a small child has a fever over 101 or 102, a doctor should be  called or the child seen. Remember that many ER doctors have little pediatric training. Also, urgent clinics and store clinics may be staffed by nurse practitioners who may also have had little  pediatric training. Eye injuries should be immediately seen, as should a child who has had a severe burn, a convulsion, or a head injury. Difficulty breathing, severe croup, severe abdominal pain, and a broken bone are all emergencies. If you are new to an area, it is wise to find out about the nearest hospital and be sure it is equipped to handle childhood emergencies. If a child needs surgery, it is important that a pediatric anesthesiologist be available. Hopefully, as a parent your child will sail through childhood without any serious problems, but it is a good idea to be prepared.