Rx For Parenting Today

When Children are Included in an Adult Party or Visit to Friends

I am often amazed when small children are included at an adult party or visit to friends that their parents often don't bring toys or special foods for them. I guess they expect the hosts or friends  to have things for the children. I have spent a great deal of time at different events watching out for little children to be sure they didn't get into any harm. It is so easy for a child to slip away and get into serious trouble. This is particularly true of children on the autism spectrum.

I have had to care for little children who almost drowned, were injured or tried to slip away and almost were injured. I always took special toys or snacks when I was traveling with my children, when they were small. I never expected the families we visited or the parties I attended with the  children to expect someone else to care for them.

Now that the holidays are approaching, if you want to enjoy yourself, it would be wise to hire a teenager, you can trust, to go with you and watch out for the children. A teenage boy made a real difference in a child's life at a wedding recently when the single mother paid absolutely no attention to her autistic son. This was in a large house and yard  where he easily could have come to serious harm. He also could have ruined the wedding. Thinking ahead and being aware of potential problems with small children always pays off. Happy Holidays!

Skateboard and Scooter Injuries and Deaths

I went out into my front yard this morning to pick up the paper and saw a teenager riding a skateboard down the middle of the street. No, he was not wearing a helmet which is required in California for those under 18 years of age.  I checked my computer to see how many deaths and injuries are occurring because of skate  boards. Thousands are injured every year and at least 30 have been killed in the last year or so.  Of course, those are the ones that have been reported.

Then I started thinking about all the kids and adults riding scooters that I see all over my small town, In checking the statistics, I discovered that in the last year there have been 1500 injuries and at least eleven deaths. I have never seen a scooter rider wearing a helmet. I remember one time I was standing next to a teenager at a stop light. He was holding his bicycle and a helmet was in the basket. I wondered if he wore the helmet when he left the house and then took it off. Many kids think they are invincible. If they have ever spent time in an ER, as I did as a medical student, they might think differently. 

Of course, now we have kids coming to ERs because of gun shots wounds. If you ever saw a child die from a gun shot wound as I did in an ER as a medical student you would fight hard against the gun lobby and the NRA.  I know many schools have gun drills but perhaps they need some ER doctors to talk also about skateboard and scooter injuries.  I had a classroom added to my pediatric office and had ER doctors and other medical professionals give talks. Several parents told me how important these talks were to them. I wonder if any pediatrician still does something like that. I believe we should educate parents  in our practices, as much as we can. Parenting was always hard word, but it seems to get harder and harder. 

 

Finding a Good Pediatrician

I am often asked how to find a good pediatrician. This may be from parents about to have their first child or parents new to an area. My advice is first for the parents to network with friends and neighbors to see who they suggest. When the parents get one or more names I  then advise they check the Internet to see where the doctor graduated, what training he or she has had, is he or she board certified and how many years the doctor has been in practice. In general, I  would want an older, experienced pediatrician.  If there are any malpractice suits filed against the doctor this is important to note, although the  suits  may have no merit. 

The next thing I would do is make an appointment with one or more doctors to see how you  are treated by the office staff and if you feel comfortable with the doctor.  If the parents already have children I would want them to meet the doctor to see how they are treated.  The questions I would ask the doctor are if he or she takes care of his or her own patients in a hospital or if they  leave the care to a pediatric hospitalist. Also will the doctor meet the parents in an ER or leave the child to the care of an ER physician. Unless there has been an injury, I would not want an ER doctor to see a child. The pediatric training many ER doctors get is often minimal. I would also want to know if the doctor does see all of the office patients or leaves a nurse practitioner or physician assistant to take care of some. That to me is unacceptable. You also want to know which hospitals the doctor has staff privileges and does his or her office take the insurance you have.  With what doctors does the doctor trade night and weekend calls and finally are antibiotics ever prescribed over the phone without a child being seen? That is just bad medicine and can lead to some tragic results.

Children and Immunizations

I was asked to reply to a doctors' group yesterday about what I would do if a parent refused immunizations for a child. For me that was a simple answer. Having seen the tragic effects of polio, measles, mumps, and chicken pox, I said I would tell the parent he or she would need to find another pediatrician. Then I would follow-up with a certified letter. 

I agree that children are receiving what seems like too many immunizations these days, but the experts say these are needed. Now that we are seeing over a thousand cases of measles in the U.S. it is even more important that children be immunized. 

I was an interne in the final year of the polio epidemic. We had an entire floor at Children's Hospital in San Francisco of post-polio children. It was heart-breaking to see the children with bodies, or arms and legs that were useless. I also was in the acute polio ward for over a month and had to make the decision when and if a patient should be put into an iron lung. If I waited too long, the patient could die and and if I put a patient in too soon, it could cause problems. I had a resident who should have made the decisions, but he was often not there. That was a very scary experience. 

When I was in practice before we had all the immunizations, I had a youth with limb-girdle dystrophy who was  deaf from mumps. I also had a teenager with encephalitis from chicken pox and numerous other problems because of childhood diseases.

I am puzzled why some parents think they have the right to deny their children protection from diseases when they can have such bad side effects. Dr. Andrew Wakefield did a terrible disservice to children when he published FALSE information that autism was caused by immunizations. Several studies have proved his research was false and yet many parents still believe it. 

Air Travel and Medical Problems

Every time I get on an airplane I offer a silent prayer that there will not be a passenger needing a doctor. I have had to help passengers several times on flights and on one trip had to have the plane land in Detroit because there was no medication available I could use to  treat a man  who was having seizures.

On a recent flight to New York City, I ask ask a flight attendant what medications they carried on their flights. The woman kindly gave me a list of things in their medical kit. They did have epinephrine, which can be life-saving, but there was nothing like Valium or anything to treat seizures. I was glad to see they had gloves and both adult and pediatric airways. The attendant said they were required to to a yearly CPR course and had to also be able to use a defibrillator. 

A recent article in the New York Times discussed chronic drug shortages on airlines. It said the the FDA granted airlines exemptions if the airlines said they could not replenish certain drugs. That is ridiculous and of course is because of the cost of epinephrine and other important drugs.  The article stated that "There are no data on how many airplanes may be flying at a given time without drugs." If you are someone who might have medical problems on an airplane or have an allergic child, it would be wise to carry any drugs that might be needed. I would also be very vocal about asking an airlines what drugs would be on a plane if you have a child with medical problems or are traveling with an adult with known problems. Being prepared before you board is wise if any medical problems  could be possible.

What are We Doing to our American Kids?

I have been reading through several articles I have saved about parenting and they are depressing. The U.S. is ranked 37th in the well-being of children. Yet we are the richest nation in the world. What are we doing wrong? Europe is the top in the world. I have worked in England and visited France many times and been impressed with the concern parents have about their children. Family is very important to them and Sunday meals are a must in many of the families. That means meals without the TV on and no cell phones at the table. How many American families have these rules?

In the U.S., American infants are 76% more likely to die in their first year than in other advanced countries. Part of this may be that 425,000 kids are uninsured in the U.S. That is criminal.  Also 1/2 million kids suffer from lead poisoning and youth suicide in the U.S. is at the highest level on record.  25 % of  shooters have mental illness, yet many of these  have  identifiable signs of problems that are not treated. 

Now we are seeing a problem with vaping in teenagers and vaping appears to be targeting kids.  Six deaths have occurred and vaping is causing lung damage. Where are these children's parents? Do the parents have any idea what their children are doing? Yes, many of the parents are working two jobs to keep their family afloat and all Trump and his group can think of is getting a second term and taking care of themselves. It is embarrassing to be an American these days. My friends overseas can't understand what is happening to our country. Money and position have become all important and for many kids their goal is to find a way to  make a lot of money when they are adults. Instead of finding a job they love and are passionate about, money is the overriding goal. What a tragedy. 

 

 

Parenting Children of Affluence

It is hard work to be a parent but it can be  even harder if you live in a town where parenting is left to nannies or housekeepers. I was in pediatric practice in a town where many parents were extremely wealthy and was impressed with those who insisted their children have chores, did not have their own credit cards, and knew their parents were not ATM machines. I recently met a woman from an  affluent community who told me how hard it was to parent when many of the parents of her children's friends left the parenting to live-in help or let the children grow up without rules or much parental involvement. She had a friend who worked for a big law firm who said so many of the young women lawyers did not want to work more than a few hours a day and took time off when they pleased. The older partners did not know what to do with these young women. I told her that medical schools are encountering the same problems. Many of the young women medical students, interns, and residents don't understand why they can't take time off to have children and then they expect all kinds of adjustments to their schedules if they have children doing their training. 

I was in the office one day, a lot of years ago, of the chairman of the pediatric department at Stanford when his phone rang. He motioned for me to say seated and answered the call. I watched as his face got redder and redder. When the call ended, he slammed it down and said " I wish I never had to hire another woman resident." The caller was to start her residency in a month but said she was having a baby and would not be able to start for four months. He was wondering who he would be able to find to replace her at such a late date. When I was a Stanford medical student, we would have been told we  could either come by the expected date or not come at all. 

Teens and Toxic Cosmetics

In the last American Academy of Pediatrics newsletter there was an  important article about some of the cosmetics teens use that contain toxic ingredients. The FDA does not test cosmetics before they are put on the market. The article stated that arsenic, cadmium, lead and mercury have been found in cosmetics and these are toxic. The ingredients  have to be listed on a cosmetic label in English. If they are in another language this could be a product sold illegally. 

The other thing the article noted was that sometimes the ingredients might be listed under another name. For example, lead could be sited as "kohl, kajai or surma." Also it was mentioned that talc "is a powdery mineral that forms in the ground near asbestos, which can cause cancer and mesothelioma." Asbestos has been found in eye shadow and powder in a compact. It was advised that teens not share cosmetics with friends and store their makeup in an cool place. Washing their hands before using and after putting on cosmetics is advised  and also washing them off a night. Good advice! 

Concerns about College Medical Care

Now that many students are headed off to college, parents need to be aware that the medical care in many colleges is not adequate. I  have always suggested parents find an outside internist or family medicine doctor who could be called if a child has a medical problem. I did that for my own children and grandchildren and it paid off many times. I have also done that for children I cared for when I was in private practice. The problem with many student health services is that they do not have doctors but use nurse practitioners. These individuals do not have the training to examine and prescribe medicine. Several of the Eastern colleges have had major lawsuits because a student died from the inadequate care they received from nurse practitioners. 

When my grandson started New York University, my son arranged for me to visit to be sure he had enough warm clothes and other things. Alexander took me on a tour of his dorm and the campus and showed me the beautiful library.  It had five balconies around a central courtyard. I was startled when he said that several students had committed suicide by jumping from the top balcony. As the rate of suicides has increased among teens this is a real worry if a student is under great pressure and does not think there is another answer.

Not only is it important to find an outside doctor in the U.S. but I have also done this for my granddaughter who is getting a Master's degree in Switzerland. A good friend in England knew just the right person for Heather to call when a problem developed .You can never be too careful when medical care if needed for a child or anyone else. 

The Deterioration of Hospital Nursing and Medical Care

A good medical friend recently had a 24 hour stay in her local, formerly excellent hospital. She told me what a bad experience it was  compared with her previous 7 day stay after a major operation. The medical care was left largely up to residents and hospitalists who seemed interested just in leaving as quickly as they could. The nursing care, except for three nurses was robotic and truly bad. My friend did not feel any concern or compassion for her. If the nurses did not have a protocol, they  did not seem to  think or  function on their own. My friend said she asked a nurse friend why there was such a difference and the answer was surprising. Apparently about 20 years ago there were so many deaths from medical errors that strict procedures were established. That meant that the nurses could not use their common sense but had to follow a strict protocol. That meant that caring and compassion went out the window. 

My advice to anyone who has to  have a  medical or surgical procedure in a hospital is to  have a family  member or someone who can be an advocate always with you.