Rx For Parenting Today

What to do about Anger in Small Children

The mother of a three-year-old came to see me about her little boy. She said he always seemed angry and she didn't know what to do. I had never seen the child and said the first step would be for me to examine him. Anger can have many causes but three-year-olds are usually wonderful little people, one of my favorite ages. When the child came for an examination, there was no question that he seemed angry. He didn't want to play with any of the toys in my office or listen to any of my many music boxes. It took a while to examine him but first I gave him a crayon and paper.  He took the crayon and made deep, long lines. Then by having him sit on his mother's lap, I was able to do a fair examination. I knew my next step would be to get a blood count and urinalysis and then refer him to my favorite child psychologist. It took a while for her to finish testing him, but the report did not surprise me. The little boy was on the autism spectrum. I also had his hearing tested which showed he had a considerable hearing loss. This is not unusual for a child with autism and  a hearing test should always be done. 

We referred the little boy to the Regional Center where they have some good programs for children on the autism spectrum. They also usually have good social workers who work with the parents and make any needed referrals. A good social worker knows local resources and can be very helpful. Fortunately, the parents wanted to do everything possible to help the little boy. If one or both parents  deny a problem exists then the schools often have to be the ones to insist something be done. I  have seen this occur several times. Sometimes the parents resist but if they want their child in school, they usually decide to do what  the school personnel require.  

 

Raising Children in this Money/Celebrity Culture

It must be very difficult to raise children in these days when money and celebrities seem to rule. Now that we  have a TV celebrity president and billionaires running the country, how do  parents who care about raising caring, moral children make it from day to day? I was amazed and appalled at the accounts of parents who paid thousands of dollars to ensure their children were admitted to so-called elite colleges.

There is a wonderful non-profit in San Diego, A Bridge for Kids, that helps low income children with tutoring, computers, and even college tours to get into college. These are students that would never have a chance of going to college without this help. Just think of how many low-income students could have been helped with the thousands of dollars spent by parents on bribes to get their children into these rich, celebrity colleges. The daughter of one celebrity, whose parents paid an  enormous amount of money in  bribes for her to get into USC, said partying at college was her focus. Unbelievable! 

When I applied to Stanford it didn't occur to me that money would play such an important part for  so many of the students. I had worked as a waitress after school and weekends all through high school. I didn't  think about how I was going to pay the tuition at Stanford, but fortunately my college professor father had a colleague at Scripps College who started a scholarship for me and other women students who wanted to go to medical school. The Mary B Eyre scholarship is still active at Stanford. When I started Stanford I found I could wait on tables in the dining room of my dorm and I also worked in a small dorm store. In addition, I worked in the summers. I felt a strong disconnect between those of us who were "hashers" and the affluent women students we served. Most were there to find a rich husband, I heard.  I had never been exposed to wealth, being raised in a small college town where  most of my  friends were professors' children. 

I believe parents  do great harm to their children if money and only associating with rich  people is what they are taught.

The Devastating Effects of Measles

The New York Times on 2/12/19 had an excellent editorial on measles. They noted that the U.S. was measles free in 2000. Then Dr. Andrew Wakefield in England came up with the false claim that autism could result from vaccinations. He subsequently had his British license revoked and is now in Texas. He  met with Trump after the election.

Because so many parents have decided to not vaccinate their children, we now have had several new outbreaks of measles. So far 500 children have died from this disease. Many more have had bad problems with it. I do not understand how any parents could allow their children to possibly have measles encephalitis or other serious complications. When my daughter was in kindergarten in Rochester, New York, before we had a measles vaccine, a doctor's wife brought her ill son to Jennifer's classroom.  Of the 22 children in the class, only two escaped being infected by the virus he carried. Jennifer had a very bad time and I stayed with her the many days she was ill. The virus is very infectious and can cause great damage to a child. It  must be hard for a doctor to have parents who will not vaccinate their children. I would not be able to take care of children like this were I still in private  pediatric practice. Not only can measles cause great damage, but so can mumps, whooping cough, and other childhood diseases. One of my muscular dystrophy patients became deaf from mumps. It was before the vaccine was available and I know his parents would have had him vaccinated had the vaccine  been available. Polio still is found in a few countries and it hurts me terribly to know that polio could happen to U.S. children with  the rapid airplane travel from these countries and the decrease of immunizations in the U.S.

Teens Concern About Depression and Anxiety

I worry that so many parents these days seem more concerned about how their kids perform and look rather than about how the young people are feeling. There was a startling article by Karen Zraick in the 2/26/19 New York Times. She discusses a survey from the Pew Research Center finding that 70% of teenagers were concerned about mental health issues. These included depression and anxiety. The article noted that social media, academic pressure, terror attacks, and school shootings were causing  a lot of anxiety. An important statement in the article was that "A study in 2017 found admissions for children and teens to hospitals for suicide and self-harm had more than doubled from 2008 to 2015." This is frightening. So what can  parents do to watch out for their teens and make a difference in their lives?

I  found in my many years of practicing pediatrics that teens need someone they can talk to who really listens. I had many patients who pretended to have a sore throat or not feel well come to my office, They just wanted and needed an adult to  talk to who listened and was not judgmental. They also want guidelines and advice about how to handle problems they were facing. I still hear from quite a few of these teenagers and am always glad to know what is going on in their lives.  It was a compliment that many of my two children's friends liked coming to our house rather than going home to their often quite elegant, affluent homes.  Children of the wealthy face a lot of burdens and often find the pressure is just too much. I was fortunate to be able to have both a good psychologist and a good psychiatrist to help with some of the most desperate kids. I felt the best gift I could give my children was to let them be the person they wanted to be, support their various activities and  establish boundaries. I was able to say "No" when it was needed and loved having them. 

 

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 psychologis, 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.

Toys for Children with Special Needs

In a recent pediatric newsletter I found an article about buying toys for children with special needs. I was puzzled by one statement that said " Parents should chose toys that they can use to play together with their child". I disagree with that statement  because caring for a child with special needs often doesn't leave a lot of time to "play." Also, many parents don't enjoy games.  My first child loved big wood puzzles and I don't see how my helping her would have been  much fun for either of us. I  never enjoyed playing  games with my two children, but did when I could make the time. My granddaughter liked to play store and I did this occasionally, but I would have enjoyed reading to her much more. Children need  time to play on their own, be creative, and a parent's involvement may not make this possible. 

Some good points the article made were to "Choose toys for the child's developmental, not chronological age." It was also mentioned that the toy should be adjusted to fit the child.  Electronic toys can interfere with a child's creativity and traditional toys are the best. 

One of the most important points made in the article was that all toys should be checked for parts that could be removed  and put in the mouth. Little children will try to swallow unbelievable things and choking can be a hazard. So if you enjoy games and have the time to play with your little children, that is great.  I raised two very creative children, so I don't think either of them suffered by my not being a game-playing mother!

School Avoidance

I found an interesting article in the Minnesota newsletter sent by Pacesetter. The article discussed what parents should do if a child or teenager starts refusing to go to school. They note that: complaining about feeling sick, crying or being sad, becoming easily frustrated or quick to anger and refusing to leave home, get on the bus or leaving school are all warning signs. I agree with all of these  but would make some important additions.  

The article rightly states that the child's doctor should be consulted as the first step, but did not mention that a complete physical examination should be done and a blood panel, urinalysis, and thyroid tests ordered. The next step, that the article did not mention, which to me may be  the most important, is to have testing done by a qualified and experienced psychologist. An experienced psychologist can pick up a learning disability, the possibility of being on the autism spectrum, bullying, and many other things. When I saw patients with school problems, wanting to stay home etc. I was amazed at what a complete physical examination and testing by a child psychologist could pick up. Once we had a definite diagnosis, we could get the child or teenager the needed help, medication, or therapy. Sadly, with the rush to see lots of patients a day, many doctors don't do complete examinations, order blood tests, a urinalysis or get to know their patients and families. Then if only a nurse practitioner is seen, as now happens in some colleges, there can be bad and even tragic outcomes. Sometimes the answer is simple. I often mention my grandson, who when he was a four- year- old in a private pre-school program started acting out. When his parents ask for advice. I suggested testing by my favorite child psychologist. It didn't take long for her to get an answer. Alexander was bored with what they were doing in his pre-school class and just wanted to read. Once he could do that, he was well-behaved and after that was always an A student. 

When a Child Has To Be in the Hospital

Hospital care for children has changed drastically with the addition of pediatric hospitalists. I would never let another doctor take care of a child I had to hospitalize unless he or she was a specialist I had requested. I am puzzled how this specialty came about. Was it because doctors were getting too tired to see many patients in their offices and didn't have the time or energy to go to the hospital?  No matter how it happened, it certainly is something parents need to know about. I am sure there are some fine doctors who are hospitalists, but my experience with adult hospitalists has been so bad that I worry.

I think an adult family member or good friend should always be in the room with a child. How frightening it must be for a child to be in a strange place with people poking at him or her if a familiar face is not there. If you are not happy with the care your child is receiving talk to the child's doctor and if necessary go to the CEO of the hospital. I would not overwhelm your child with toys or gifts.Your presence is the best gift possible. A favorite blanket is a good idea. Always get a second opinion from another doctor if you are not happy with the care. If necessary take your child to another hospital. Don't ever let a doctor, a nurse or anyone in the hospital intimidate you. They are there to provide the best possible care for your child. 

I would keep notes of what goes on in the hospital and the names of the individuals caring for your child. Always check your hospital bill when your child is discharged. 

Saying "NO" to Children

I had an upsetting conversation with a long-time friend the other day. She is a teacher in a private school and told me something truly unbelievable.  It was about a spoiled little girl who was misbehaving. My friend,who has been a teacher for many years, started to insist the child behave when another teacher whispered "Be careful, you know we are not allowed to say "no"" to the children". Not only  were they not allowed to say "No" but any form of discipline, such as a time-out, was not allowed. My friend is going to stick it out until the end of the year and then retire.

What are we doing to children if they are given no limits, no discipline and no guidelines. Many of my pedaitric patients told me  they wished their parents would lay down the rules. That way they knew what was expected and the boundaries. No wonder so many children seem lost and at loose-ends. If they don't know what is right and what is wrong and how far they can go, they are in big trouble. Drugs, alcohol and acting out may be just a cry for some guidelines. 

When I helped my divorced son raise his children, I often said "This is just the way it is. I am not here to be your friend, but to keep you safe, feed you, and get you to and from school." Now my granddaughter and I laugh about this. Both grandchildren have become wonderful caring adults. Their father has always parented the way I parented, as did my daughter with her two step-children.

I do not know when parents decided they could not longer say "No" to their children, but it is causing great harm. The parents who can say "no" and set limits are fighting against the current trend, but their children are very fortunate to have parents who act like parents, not good friends.

Constipation and Urinary Infections in Toddlers, Children and Teens

I am constantly amazed at how few ER doctors, family doctors, and pediatricians do either routine yearly urinalyses or check the urine when a child has a fever or the cause of not feeling well has not been found. A yearly urinalysis on a child can pick up both infection and chronic urinary problems. If a child is constipated and ill or has a fever, a urinalysis MUST be done.

Recently, I was told of a baby less than a year old who had quite severe constipation for  which no treatment seemed to be working and then suddenly had a seizure. A small fever was noted but the ER doctor did not do a urinalysis. Now the child  has been found to have  urinary tract infection. I would have ordered a urinalysis in the ER. I also would  have asked if a previous urine had ever been checked. I suspect it had not been checked. It is simple to get a urine for examination on an infant or small child. There are little pediatric bags that fit right over the penis or vulva in a little one. 

As parents, I think you  have to insist that a urinalysis is done yearly and always checked if there is constipation or a fever of unknown origin. I  have picked up many urinary problems simply because checking urines was something I routinely did. I also looked at the urines myself and then sent them to  the lab if I suspected infection.  Old fashioned thorough medicine still pays off. 

I have picked up problems with congenital abnormalities in the kidneys, pyelonephritis, and glomerulonephritis by always insisting a urinalysis is done. Sometimes I  have even found that checking urines a couple of days in a row has paid off. The first urine might be clear but on the second day a problem can be obvious. If a doctor does not look at the urine, problems can be missed.