Rx For Parenting Today

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.

 

Allergies in Children

There are some basic rules about allergies if  either of the parents are allergic or they come from a family with allergies. Breast feeding is best for all babies, but particularly if you are worried about allergies. Allergists I  have known suggest a breast-fed mother be careful about eating chocolate, fish, and eggs  if there is a strong family history of allergy. If a baby is bottle fed, cows' milk can be a source of trouble. I was always careful about giving my two children foods that could cause allergies because  their father had quite severe asthma on occasion and hay fever. 

When you start a new food for a little one it is wise just to try one new thing at a time. Also I would give single foods rather than mixtures. Constipation can be due to wheat intolerance and could even be a symptom of celiac disease, as can excessive diarrhea. Eczema can be an early sign of allergies and a  pediatric allergist may need to be seen to help you decide what can be done  if allergies seem to be present. Wool can cause skin problems and some children are highly allergic to dog dander. Smoking near an allergic child is not wise, even if you don't smoke in the child's room. 

If a child has multiple allergies, it is wise to keep an epipen in the house and car. One also may need to be kept at the grandparents' home and any school site. Children generally handle allergies better as they get older, but it can be a life-long struggle that an allergist can help.

Raising Teenagers You Enjoy

I've heard many parents say they can hardly wait until their teenage children go off to college. It always hurts me to hear a parent say that. I think it says a lot about the family dynamics.  Have the parents ever enjoyed their children or are the children just an accessory? Many teens have told me that they are expected to always look put together, excel in  everything they do and be perfect. Is that why the parents had them just to keep up with their friends? 

Kids are so special that no matter who they are they have wonderful traits that can be encouraged and developed. Having fun with your children at all ages is hard when you have to work full-time and have little money. The kids can be taught to help, have chores, be careful about money and play an important part in having a close, loving, warm family. Money often hurts rather than helps. When a child expects their parents to be ATM machines, don't  have chores, or make any contribution to the family, they lose out badly. I greatly missed my children when they went to college and in my book Letters Home, I included some of their special letters. When my son was in Trinity College in England there was both a mail and telephone strike. It was hard for him to get letters and his letters were only received if he had someone mail them in England.  Even though I worked full-time, had weekend and frequent night calls, the children and I had special quality times such as Saturday lunch, ice skating on their half-day off from school and entertaining their friends at our  house. I still hear from several of their friends, who said they enjoyed our house more than than own.

I wish all couples who decide to  have children realize  they are given a wonderful gift and enjoy each child for who  he or she is, not the person the  parents want them to be. 

 

 

When Children are Included with Their Parents in a Special Party

Recently, I was invited to a anniversary celebration. Several little children came with their parents and most of the parents kept close watch on their children. However, one single mother did not. I knew from a previous experience with the boy that he was a child with problems. I didn't take time to talk to many people because I  stayed with the five-year-old trying to keep him busy and occupied. He told me that he didn't like to talk to people and there was no question in my mind he had untreated ADHD, was most likely learning disabled, and was probably on the autism spectrum. One teenage boy, with wonderful doctor parents, looked bored, so I asked him if he would help me watch the little boy. He was amazing and followed the child around the rest of the  evening.  The teenager could easily have prevented an accident or even a tragedy.

I have been the pediatrician for several children who either died or became markedly delayed because of accidents or drownings. No parent should ever let a little child out of  his or her sight at a big party because serious consequent could occur. My hope for this little boy is that his school will insist on some testing and treatment. Otherwise, he could  become one of the adults we are seeing far too often now who are angry and act out with a gun or knife. If a parent or parents are in denial that there is a problem, there has to be a way to get their children help. I  have had wonderful parents ask me for help with a child in trouble and with good testing and therapy tragedies can be averted. 

Trump's Lack of Concern for Children

Not only are migrant children at the border suffering or dying, as two have done recently, but millions of children in the U.S. are hungry or lack good medical care. Food stamps are one of Trump's targets, as well as the Republicans in Congress.  Many in Congress are very wealthy and of course have excellent health benefits. A recent report showed that about three million American children live in "extreme poverty." This is happening in the richest country in the world. We should all be ashamed this is allowed to happen. Some parents skip meals so their children will have enough to eat. Food pantries help some and some churches and other organizations do what they can. It hurts me deeply to know that any child goes to bed hungry or is without good medical care. The tax bill the Republicans passed helped only the rich. Why do they need more money, more houses, or more cars when they already have more money than most people have ever seen?

At this point, 14,000 migrant children are still in federal shelters.  Medical care is minimal and some children are even housed in tents. What kind of a country is the U.S. turning into? Many of the shelters are privately owned and the owners are making millions of tax payer dollars. If the Affordable Health Care act is eliminated by the Republicans, even more children and families will be hurt. Children with disabilities and adults with pre-existing conditions will suffer terribly. I am glad I live in California where the Governor and legislators are doing what they can to fight against the terrible policies of the Trump administration. As citizens we each need to to what we can to fight their lack of concern for children and ill or disabled people. Let's hope 2019 brings us better news than 2018 has done. 

Johnson and Johnson Baby Power and Asbestos

In a recent  article in the New York Times, Roni Rabin and Tiffany Hsu reported that Johnson and Johnson as far back as 1971 were told by one of their executives that their baby power was possibly contaminated by asbestos. Other J and J executives over the years made the same comment. Yet nothing was done and the baby powder continued to sell. Now there are going to be possibly 12,000 law suits about the problems this has created. Twenty-two women who had ovarian cancer sued the company because of the connection between the powder and asbestos. They were awarded 4.69 billion dollars.

As a pediatrician, I always advised parents  to use just the Johnson and Johnson baby shampoo. I did this because I didn't feel babies needed all kinds of products on their skin and also because of the cost. I suggested cornstarch worked just as well as baby powder and was less expensive. I did not know about the asbestos problem at that time.

I was standing at a check-out line a long time ago and saw a woman buying all kinds of expensive baby products. She paid with food stamps. I wanted to suggest she spend the money on food, not baby products.  

Medical, drug, and health companies frequently make statements that are false. I often shudder when I see an ad saying a product is recommended by all pediatricians, when I know the product is not something pediatricians would recommend. 

Far too many people rely on ads to buy products. When a baby's health or body are in jeopardy some research is needed. WebMD and the Mayo Clinic are good sources for medical information. I'm not sure it is possible  to rely on all doctors because they may go along with what the drug representatives tell them. Also, far too many doctors have connections with different medical companies, which is of great concern.

Holidays and Grieving

I  have always loved the Christmas holidays with the beautiful decorations and the special times with my children and grandchildren. However, since losing a daughter to breast cancer seven years ago  because of the terrible medical care in Santa Fe, New Mexico and the recent loss of a special male friend, I find the days are a little harder to navigate. I am fortunate to have a wonderful son and soon to-be daughter-in law and my grandchildren will be home for Christmas.  Several of my single friends wish the holidays would be over quickly. One was adopted and is now a widow. She has no children, but fortunately several good friends. If we have lost a family member or special friend, I think we  must reach out to others and see if we can't put our own grief aside and see how we can bring some joy to others less fortunate. 

I love hearing from former patients and always look forward to their holiday cards and visits. How fortunate I was to find a medical profession that brought me such joy and lasting rewards. I wish the young doctors today could realize that the being a physician is not a way to make a lot of money but a way to make a difference in peoples' lives and have long-term, lasting relationships. I worry that medicine as it is being taught in far too many medical schools today is all about technology or doing research and getting a Nobel prize. No prize can ease the pain of not  having special close relationships with family, friends and former patients, particularly during the holidays.