Rx For Parenting Today

Helping Obese Children

I was eating with friends in an Italian restaurant the other night when in walked a mother and father with a little girl who was probably about six or seven. The mother was short and greatly overweight. The little girl was also morbidly obese. I thought about her on the way home and wondered what could be done if I were her pediatrician. I saw a very unhappy future  for  the child. I suspect her diet was a lot of pasta and many carbohydrates. Even if   the girl  was able to go to a camp where weight loss was encouraged, she would most likely revert to her former weight when she was back home because of the family diet.  Children can be very cruel and I can see a great deal of taunting, teasing and name calling in her future. That could be very painful.

I wonder if the parents have any idea what they  are doing to the child. She was a cute little girl and that is probably all they saw. With over 200,00 cases of childhood or Type I diabetes, some bad medical problems could be ahead. I wonder if the child had a family doctor or pediatrician and if he or she had tried to do anything about the child's obesity. I  have been told by many medical students and house staff that I am the only doctor they have ever heard take a diet history. That has always been part of any physical examination I do.

Diabetes is not a benign disorder in a child. There can be visual and other problems and later on even more medical problems. I think parents need to  offer a healthy diet, but they also have to be careful that food does not become an issue, so a child develops anorexia. I had one professional parent who insisted on weighting his daughter every morning. It didn't take a lot of imagination to wonder why the girl developed  anorexia.  I have cared for many of these girls and so too much emphasis on food can become a real problem. Good dietitians are available at most hospitals, so there is help if you need it.  Too much stress on it, however, can create even more problems.

Eye Problems to Watch For in Children

Parents can make a big difference in their children's vision if they watch for some simple things. For babies and little children, you want to be sure you don't see one eye that seems to stray. I find that with the few minutes allotted to office visits these days, strabismus or cross eyes are often missed. If strabismus is not picked up and treated before a child is five or six, the child can end up with a blind eye. It is very simple to pick up an eye in trouble if the doctor does a quick cover test. Even having a child read an eye chart seems to be missing from many physical examinations. If a small baby has a teary eye, there could be an obstructed tear duct.  If you rub the corner of the affected eye very gently, the duct can often be opened without surgery. I talked to a father one day who was worried about the surgery his daughter was to have for an obstructed tear duct. The pediatrician had not suggested that firm pressure in the corner of the affected eye near the nose and warm compresses could cause the duct to open. The parents did this and surgery was not needed. Simple things can often make a big difference.

Children with diabetes should have frequent eye checks and every child with multiple disabilities should have their vision checked regularly. Children with rheumatoid arthritis  must have regular eye check-ups. They, too,can have major visual problems. I will never  forget the girl I saw in a clinic for patients with RA. She was blind because she had not had regular slit-lamp eye examinations. 

Children and Pets

Pets are special and can be good companions, as well as offering comfort. If little children  have pets, medical problems can develop. If a small child plays with a pet and then  puts his or her fingers in the mouth, this can be a source of parasitic infection. Some pets carry tapeworms and hookworms. In general, it is advised by experts that children under five years of age not have pets. Any child who has a pet should be carefully supervised and taught to wash their hands after playing with their pet.   They also should not be left alone with a pet

    An interesting and scary statistic is that puppies can shed more than 100,000 per gram of parasitic eggs in their feces. Vets advise that regular deworming if pets is important to avoid problems. Also, teaching children to wash their hands after playing with  pets is a good idea. Pets can teach responsibility and are particularly comforting to children with chronic illnesses or disabilities. 

If you ever see a child hurt a pet this should cause a red flag to wave in front of your face. Children who later show mental problems often hurt pets or other children.  If this early sign is ignored, serious problems could be ahead. I would want a child psychologist to see the child and do some testing to see what is going on. Picking up problems early is the best way to later avoid some of the terrible gun and other tragedies we are seeing almost daily in this country. Yes, a  pet can add new problems for parents, but some good oversight and basic rules can help you, your children and any pets have fun and companionship.

Summer Car Safety for Little Children

Now that we are having excessive heat due to climate change, parents need to be more aware of having any little children in  their car.  Far too often we hear of a child's death because he or she was left in a closed car on a hot day. If you ever see a little child alone in a closed car on a hot day, I  hope you will call 911. The parent or  caretaker could be upset with you, but the law will support you and you could save a child's life. 

A former  patient, who had two little children, had to go to court because her five year old said  Daddy often left her and her little brother alone in the car when he ran into get  coffee or do an errand. He now is not allowed to take the two children without another adult  along. So many parents, particularly single presents  have a hard time doing an outside job, getting  groceries, and doing other errands. Without a baby sitter it is always tempting to take the kids along and let them stay in the car while you run errands and grocery shop or go to various stores. 

In a recent Pediatric newsletter, a small box was included that showed the outside temperature and what the inside temperature in a car would become after 60 minutes. For example if it is 84 degrees outside on a sunny day, the temperature in a closed car after 60 minutes can become 125 degrees. No little child will survive that for very long. 

I've often suggested to  parents that many colleges  have employment offices where you can hire a college student for a fairly small amount of money. Some parents find that  having a live-in student often works for them, also. 

How Can Children Learn the Difference Between Right and Wrong?

We are living in such divisive times that I wonder how children today can learn the difference between right and wrong. I am seeing a lot of what is called situational ethics. This means that people do what is appropriate for them at the time, not what is moral or right. Our  leaders seem to be doing a lot of that right no just to ensure  their own positions and to keep their power, health care, and pensions. When children see this, how do they know what is right? I was very fortunate growing up that my college professor father made it clear that there was  a definite red line between right and wrong. He had no problem letting us know if he felt we were headed in  the wrong direction.I greatly appreciate that   and I think children want and need that. Otherwise they are left flying in the wind and don't  truly know how to lead their lives. I think drugs, alcohol and other teenage problems are a result of a lot of that. 

Sitting around the dining room table and talking about what is going on and teaching children your values is important. As parents rush around trying to perfect parents, talking to their children doesn't  occur often enough . Driving a child to a lesson, a medical appointment or something else is a good time to  talk. Having a child engrossed in his or her cell phone often prevents conversation. At the dining room,table,cell phones need to be left somewhere else. Conversation with parents is an important part of parenting.

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.