Rx For Parenting Today

Finding a New Pediatrician

A young mother was moving with her husband to a different state and asked me how to find a good pediatrician. I suggested she check with parents in the new town, but reminded her that the most popular pediatrician was not always the best. There are doctors who have great personalities but their training and care may not be good. My parents had a doctor like that, who they loved, but he was very inadequate. 

Once the woman was given one or two names, I suggested she look on the state medical board website to check on the doctor's training, if he or she was board certified and any comments about the doctor. Then I suggested making an appointment without her child to see  how she felt about the  office staff  and the doctor.  When she found a doctor she liked who was board certified, I would  make an appointment for her child. If the doctor answered her questions, did a thorough examination and took a good family and medical history then she had made a good choice. However, if her child was not asked to be undressed and given a gown, the doctor did not sit down to answer questions and take a good history, that was not an adequate examination. One mother of a teenage girl told me the child's  pediatrician had never looked below the girl's waist. I was amazed, thinking of all the problems I had found by checking patients all over. My grandson said he had a pediatrician who had never asked him to undress below the waist. 

The other questions the woman needed to ask was if she could call the doctor if she had a question or did someone in the office answer parent' questions. One nurse in an East coast office told a new mother that " the  doctor won't tell you anything that I can not tell you." The woman's child had had a small seizure  and should  have been seen right away. The mother was a former patient of mine who had moved to the east coast. She called her mother and I immediately called the doctor. The child was seen within the hour. 

A little Child's Life Can Be in Danger if a Parent or Caretaker is Otherwise Busy

I was driving slowly on a busy beach-front street today when I saw two little children being completely ignored by their parent or caretaker. One little child was trying to catch up to the adult who was busy on her iphone. Another child was in a stroller trying to get out when the parent or caretaker was looking away and busy talking on a phone. It just takes a minute for an accident to happen. I know of two adults who lost a younger sibling because the parent was engrossed in something else and had no idea where the child was. A child can slip away quickly, particularly if the child is on the autism spectrum. Windows and doors must have locks up high and never be left open. Neighbors and the police should also be notified that the child has a habit of trying to run away. If you are having a party or entertaining that is a time when a little child can easily slip away.     Two parents, who were both M.Ds, lost a two-year-old that way because the child slipped outside and drowned in the fish pond. If you are entertaining, it is a good idea to hire someone to keep a constant eye on a little one. Some children love to climb and can be quite adept at doing so. I know because I had a child like that when she was little. I can remember some scary episodes and tried to never let her out of my sight. As a college student she took a rock climbing course with a poor instructor and had a  narrow escape. I think that put an end to  her climbing days, because of the fall she almost had. 

Summer Safety for Children

It must be very hard to be a parent or parents of active children during this time of the corona virus. Now that summer is coming with some hot days, parents will have to be very creative to keep their children busy. Because of social distancing, swimming pools, the beach and other summer activities may not be a good idea. I now live in a beach town and am amazed to see young people, some with children in groups, with no masks and no social distancing. I am often the only one wearing a mask, as I stop to get my mail or do a quick errand. 

If you are determined to travel there are some safety issues to consider. Some motels and hotels are lax about being sure their windows can be securely shut. I was in a hotel several years ago and noted that even on the fifth floor where my room was, the windows had no screens and were difficult to close. I sent a letter to the CEO of the big chain of hotels and expressed my concern about this. After several follow-up calls, I finally received a letter saying he had issued an order that all their hotels should have screens on the windows that could not be removed. Children have been lost from climbing out of hotel windows that were high up and had no screens.

Children have skin that can burn easily from hot sun, so if you are outside  even for a walk, little ones over six months of age should have sunscreen put on. 

Remember also that their clothing should should be appropriate for the temperature outside. I have seen babies dressed too warmly in summer and with too little clothing on cold winter days. Indoor games can be fun, puzzles can also be fun even for little ones if they have large pieces or are made of wood. 

Older children can put on plays and even fashion shows. Keeping them away from the TV can be hard and should be allowed only for short periods of time. 

Single Parenting

The problems of being a single parent are different whether you are divorced, widowed, or a single parent by choice. One of the pluses of being a single parent is that the way you parent is up to you and you don't have to discuss your choices with a partner. However, the downside is that you have the total responsibility of how the kids are raised. It can get very lonely and you need a  great support system. I always felt like a single parent, even though I was married for seventeen years. My husband was a Navy flight surgeon and in Okinawa for six months. After he he came home, we set out for Rochester, New York where he was known as the best orthopedic resident they ever had. He was a marvelous orthopedic surgeon, but the only way I knew he had been home was there were dirty clothes and the peanut butter jar was left open on the counter. It didn't get easier when he was in private practice in California with a group. I was also working,in pediatric private practice and directing 3 neuromuscular clinics. 

I had great support  from friends and housekeepers and the children were wonderful. They had chores and were very aware of how hard I had to work. I involved them in many of my activities and they got to know quite a few of my neuromuscular patients and often helped in my office. Support groups can be very helpful and you need to take good care of yourself by getting exercise and eating in a healthy way. Trying to be a super parent  does not work and allowing your children to get by without helping in every way they can will create later problems.  You need to give the children specific guidelines. Trying to be your children's friend and not their parent is a serious mistake and this is something kids have told me they do not want.

The Importance of Fathers

It is a lucky child who has a warm, loving father. Now that so many parents are divorced or are single parents, both boys and girl can miss this special relationship. When a father is a bully or abusive, a child pays for this for a lifetime. I have two friends who were emotionally or physically abused as children and it changed their lives. Both are accomplished professionals but each day can be a struggle. Many years ago fathers were usually strict and very much in control of their family but they did teach their children what was moral and what was not. Honestly was taught and those of us who are older profited greatly from this. We may not have had the hugs that many children get today but we knew our fathers  were always there for us. 

I know of families were the mother was completely into her own needs and the fathers had to be both mothers and fathers. How lucky those children were to have a father who took charge. I do not understand how any mother can put her own needs before those of her children but I have certainly seen a lot of this. I knew one wonderful doctor who wanted to be a family doctor but because his wife was in a surgical residency he became a pathologist with regular hours. He  planned the birthday parties and essentially did everything else. I doubt that the marriage lasted for too many years. The mother's loss would be great. 

Fathers still have to take time for themselves and having a good buddy to talk to is very important. Fathers' groups can also be helpful.

HAPPY FATHER'S  DAY!

 

Medical Care for College Students

The medical care for college students can be good if a physician is in charge, but these days many colleges use nurse practitioners with no doctor in charge. There could be a doctor available if the nurse calls him or her but one may only be available if the nurse requests a consultation.   

When my daughter was to start as a freshman at University of Colorado, I did some research to see who was available for care at the student health service. One doctor had good training and experience, so when Jennifer had some medical questions she made an appointment to see her. When her name was called she was told she would see a nurse practitioner. "No", Jennifer said, "my parents are both doctors and I have an appointment with  Dr. X."   I think they did not expect a young freshman to say this and yes she saw Dr. X. 

When my grandson started as a freshman at an Eastern college, I  did research on the doctors in the town. I knew the student health service had had had a major lawsuit because a student had died when the nurse practitioner did not recognize the young man was in serious trouble and needed to see a psychiatrist.  The student committed suicide without  being given adequate medical care. 

If a student has a chronic illness such as kidney disease or something else, it is important that he or she knows who to call outside the student health service. I have done research for many patients who are off to college and found names of private physicians for them. 

Parents also need to check if their family insurance will cover the college student or if they need to pay for the health insurance that the college uses. Relying on the college health service for a new student could lead to serious problems, so please do some investigating. Your child's doctor may know someone to call in the town where the college is located. 

What ER Doctors Can and Cannot Do

ER doctors are great for real emergencies, such as severe bleeding from a wound, car accidents or other similar problems. However, if as a parent you are unable to reach your child's doctor, an ER doctor or Urgent Care clinics are not usually staffed by physicians with pediatric training. Now many urgent care clinics are staffed just by nurse practitioners. They do not have the training to take care of an ill child. 

 A patient with a known cardiac problem, who is not in immediate danger, should be referred to a cardiologist. A child with symptoms of an appendicitis should be seen by a general surgeon. If there are symptoms of a kidney stone, a urologist should be called by the ER doctor. 

If an ER doctor is not comfortable making a diagnosis, a specialist should be called. If an X-ray is ordered, both the ER doctor and a radiologist should read the film. 

If you need to go to an emergency room, be sure to take any insurance information with you. If a child has swallowed a poisonous substance, eaten a poisonous plant, or ingested a household product, take the medicine bottles or the household item along with you. Having the number of the Poison Center posted in your house is always a good idea.

Eye injuries should always be seen immediately by an eye surgeon or ophthalmologist. Major face wounds should be cared for by a plastic surgeon. 

Emergency rooms are not the place for routine care. Sometimes their bills can be excessive if the ER is not connected with your medical insurance. 

Medical Care for Special Needs Children

Each state in the U.S. has special programs for children with problems. If a child has a medical problem found at birth the child's doctor should immediately contact the state program.because  they usually will assume a great deal of the cost, if not all. Sadly, many doctors, even pediatricians,are not aware of this or don't want to be bothered to make the call. Thus parents need to be  know this should happen. CCS, in California also pays for PT, O.T. and equipment when there are monthly clinics held in schools. A physician needs to order what is needed and social workers in the clinics can be very helpful. It is important that parents register with the office of special needs at their child's school, so their name can be on the list for the clinics.

Parents can receive a lot of help from most of the agencies that cover their child's particular need. Advocates can be found through the Patient Advocate Foundation and their number is  1-800-532-5274. Family Voices can also be a valuable resource. Their number is 1-888-835-5669. If there are legal problems connected to the child's disability, there is a wonderful organization called Protection and Advocacy. They have lawyers who will help at no charge.  Their website is www.protectionandadvocacy.com.

There are agencies for almost every disorder. For example there is the a United Cerebral Palsy agency in almost every state. I have found some of the agencies to be helpful and some not, so you have to do a lot of research in your particular state.  In my book, Raising a Handicapped  Child, I list many resources in each state. I do this also in Raising a Child with a Neuromuscular Disorder. Both books are still available after many years from Oxford University Press, Amazon or on order at bookstores. 

Help with Childen's Sleeping Problems

With all the anxiety about the Corona virus now, sleeping for both adults and children may be difficult. None of us  are likely getting the exercise we formally did because of the "Stay at Home" curfews. However, if your child or children have had  sleeping problems for a long time, some new solutions need to be thought about. I was lucky to have one child who never had problems sleeping, as long as he had plenty to eat. He is still a very good sleeper, he says.

Little children do best with a routine. This means a specific time for bed, with usually a bath first, then a drink, a story, and toileting. Protein at dinner makes a child sleep better. The size and kind of bed needs to fit the child's age and they should NEVER sleep with their parents. Deaths have occurred for far too many children who slept with their parents. Soft music or a  parent's voice coming from a tape recorder can help a child sleep. Be sure your child is not too  warmly or cooly dressed and the room is not too hot or too cold. Pajamas should fit the time of the year and a night-light can help a child get to sleep. Glowing stars on the ceiling are fun, as is a dream -catcher with a story about how it catches the bad dreams. A rocking chair is good for a child's room where a father or mother can sit with the child to tell a bed-time story. A noisy TV or radio outside the child's room can keep a child awake. Cokes or drinks containing caffeine can keep a child awake.  If a child is frequently having bad dreams or nightmares, these should be investigated by a physician or children's therapist. 

Information to Leave for People Caring for Your Children

There may be times when you will have others caring for your children. I had parents in my practice who left on a trip. They did leave the number where they would be and a cellphone number. Unfortunately, they changed hotels and their cellphones were not working. Their little three-year-old became quite ill, so the woman caring for him called me in distress. I quickly left the office and found the boy in trouble. The hospital was not far away, so  off we went and I immediately admitted him. A chest X-ray showed pneumonia. The parents did not return for several days and I had the child home before they returned. It is important to  leave not only the child's doctor's name and number, but also that of close relatives or friends, dentist, and any specialists that are seen. 

Leave a list of your child's daily routine, allergies, any medications taken and when they should be given. Also where the medications are stored, the location of fire extinguishers, instructions as to wall heaters or thermostats and where a first-aid kit is kept. Some emergency money is also a good idea. 

If you restrict TV viewing or have other things you want a childcare  person to know, leave those  instructions also.