Rx For Parenting Today

When a Child Becomes Violent or Out of Control

In watching the  violence at the Capital on the sixth, I wondered  about the participants who joined the violent mob.  I remembered two patients I had seen and knew violence and out of control behavior can begin early in life. One particular patient I thought about was a small boy who was new to me. I am not sure how his mother got him to my office or who referred him. The child was almost dragged  into my examining room and immediately started pushing the music boxes that were on a low shelf on to the floor.  His mother was desperate and said "Do what ever you have to, I can 't control him any more." I had read somewhere that if you have a patient like this, control can be obtained by getting the child onto the floor and literally sitting on him or her. So that is what I did. If he had been a big child, I would not been able to control him. I talked very quietly to the child and the boy soon calmed down. Thus I was able to get some history from the mother and also to ask my secretary to call an ambulance, the police, and my favorite child psychiatrist at at St. Mary's Hospital. Sadly, his special unit was closed several years ago. Now the pediatric patients have to go to  UC San Francisco Medical Center. I don't remember  being when told the child started becoming violent. Usually, you can pick up  problems early on if you take a good history and do a good physical examination. The child's severe problems should have been addressed and treated long before I saw him. Unfortunately, the five to ten minute examinations now dictated in some HMOs do not allow a child like this to get adequate care. If any parent reading this  has concerns about their child, an appointment with a good child psychologist or psychiatrist is the place to start. Any delay can make the condition worse and a child's life and the life of others may be affected.

When Children Bully, Tease, or Hurt Other Children

I have often been asked by parents what they should do when they discover or are told by school personnel that a child of theirs has hurt another child, lied or been a bully.  The first thing I always did was to ask that I do a physical examination. Sometimes I could find neurological signs that were troubling and often just talking with a child I could get an idea of what was going wrong in their lives. Often a child feels others are picking on him or her and he or she just wants to fight back. Often there is a deeper problem and for that I needed the help of a  child psychologist or psychiatrist. It always surprised me at some of the things that were found. Sometimes a marked learning disability was found or the child was being bullied by a sibling or someone at their school. In rare cases it was a deep psychiatric problem. Medication was usually not needed, but was in some cases. Ongoing counseling was  often a must. It  can be hard to find just the right specialist to test or counsel a child and I was fortunate to have several professionals I could call on. 

Children who stutter, have a physical disability, or other problems have told me how they were often bullied, called "crip" or their speech mimicked. Some administrators tell teachers they should not make more than two or three referrals for children in trouble because of budget considerations. I have had to fight with several principals in order to get help for patients. Frequently, I used my Center's grant dollars to pay for testing or treatment. If a child is in trouble a way must be found to get the child the help they need. Otherwise there could be long-term consequences.

Parenting the Siblings of a Child with a Disability

When a child has a disability, many parents find their days filled with trips to doctors, PTs, and other specialists. Sadly, if there are other children in the family they often get much less attention from their parents. In caring for children with disabilities for many years, I often held groups for the siblings of the children.  The groups taught me a great deal and also gave the boys and girls the chance to realize they all had similar problems. Even though you may love your siblings and want the best for them, it is hard to watch them get more attention from your parents than you do. The groups I held gave the siblings a chance to talk about the problems they were encountering and to say things they did not feel they could say to their  parents. Some children with disabilities become very manipulative and find ways to always make themselves the center of attention. 

I am the sibling of a girl with a disability and I do not remember my mother ever asking her to perform a chore, while my brother and I were given frequent jobs.  My sister became very spoiled and my brother and I both chose jobs in the medical profession. He became a hospital administrator and I became a pediatrician with special neuromuscular training. I still help parents around the world with questions about their children with special problems. 

If you are the parent of a child with a disability, I hope you will think about how you are parenting and if you are giving each of your children the same attention. It will make a great difference.

Hospital Care for Children

These are scary times for children with the Corona Virus infecting both children and adults across the world. Care in the United States is particularly worrisome when so many pediatricians are not seeing their patients but are leaving the care to Urgent Clinics, ERs, and hospitalists if a child has to be in a hospital. I could not do that if I was still in private practice. Children and teens want to see a familiar face, as do their parents. 

Even in this terrible time, you want to be sure if your insurance needs a prior authorization for the admission of your child to a hospital. Also you want to be sure there is an available bed. A parent, relative, or child should always stay with a child. Children also need to take a favorite stuffed animal or blanket  and don't  let any staff member intimidate you. There are some wonderful nurses and doctors in hospitals but some can be scary. I remember a nurse who left an empty syringe on the bed of one of my patients. 

Insist that your doctor or the hospitalist speak to you daily.  I also would keep a written record including the names of those caring for your child.  You may later need to file a complaint. If you are not happy about the care your child is getting,  talk to the head doctor or the CEO. The squeaky wheel does get attention. If the care is really bad, I would try to transfer to another hospital. You can also always seek a second opinion if you have concerns.  It is not a good idea to overwhelm your child with gifts or toys. 

After you leave the hospital, do check your bill carefully.  Many mistakes are possible. Let's hope this is a better year for everyone and we all avoid hospitals!

 

Emotional Responses During this Awful Pandemic

It is difficult to be a parent even during normal times. Now with the holidays and the raging pandemic, parents have to be very creative not only for their children, but also for themselves. Holidays should be a time for fun, joy, and connections with others. Now that stay-at-home orders are in place in so many states, how do parents and children survive?  If your children are little, it is important to still have a routine with regular hours, rules about what is and what is not acceptable and ways for children to connect with their friends and family members. Having the ability to see friends or relatives using Zoom or  using other ways to connect on the internet can make a difference.  No small child will be content to watch others on Zoom for very long but you could do it for short periods during a day.  You  could set up Zoom dates with other families. One of the most special things my son did this Christmas was to set a time when we could open packages by Zoom with my granddaughter and her male friend in Switzerland. That was wonderful! 

One of the hardest things to handle during this pandemic is not being able to have your usual holiday customs. Each culture has  many wonderful and fun  events that are now lost. Even the loss of a special event can cause a feeling of grief and loss.  Holidays  are also  a time when the loss of a child,  a relative, or special friend  can be  particularly painful. Grieving is different for each person and the saying that a loss gets easier as time goes by is not true for everyone. I miss my daughter daily and yet she died of breast cancer nine years ago. What I do is try to stay connected with many friends and particularly widows who are friends. That way I help them and myself. We will all get through this terrible time and hopefully have more tolerance of others, as well as more compassion. 

 

When Children are Left Home Alone

 With the increased violence we are seeing under the Trump administration and  threats on legislators and government officials, I fear for the safety of their children. Even before the Trump administration, I have always been opposed to children being left home alone.  I know of far too many teenage girls who became pregnant in their own homes when they were home alone with a boy friend. Kids who were left home alone have told me they always hid in a closet until a parent arrived, fearing someone would come and hurt them. There have been children injured or killed when no adult was present and they were playing with a gun found in the home. All guns must be put up and away where a child cannot find them.

One boy was playing cops and robbers with a friend and since he was the bad guy, he pretended he was being hung. The rope slipped and his mother found him dead when she returned home.

The answer to the  problem can be an older person hired to watch after a child or children if parents have to be gone. Ideally, there is a grandparent or relative who can help out. When schools were open and there was after-school playtime, the problem was not so acute. Now with many playgrounds and schools closed the problem has become even more severe. Some parents  have found that  trading with other parents for childcare can be the answer if they have to be gone. There still can be masks and social distancing this way. 

Knowing an adult will be present gives a child a feeling of safety. How nice to know an adult will be home to give you a snack and even some homemade cookies. It was easier to  have children when guns were not such a problem and divorce was less prevalent so there were fewer single, working parents. 

 

Safety Tips for Children during the Holidays and the Pandemic

This is a very difficult time to have a toddler or a small child. With the holidays fast approaching most parents are busier than ever. If as a parent you feel overwhelmed, it would be a good idea to hire a friend's teenage daughter or son to help with your child or children. Yes, they need to wear masks and you want to be sure they have been tested recently for the corona virus. 

If you are ordering or buying toys to give to your children, you want to check that they don't have buttons that can be pulled off, removable eyes, magnets, or any other removeable parts. Children will swallow just about anything small. I had one little patient who swallowed a razor blade and I use his x-ray to teach medical students. There is a museum in the east that exhibits the many objects that have been removed from little stomachs and bowels.  

All medicines, cleaning supplies, and dishwasher products should be put up out of reach. I would also check to be sure your house has adequate smoke and carbon monoxide detectors. A wall furnace and fireplaces need to have good screens around them.  Open wires or frayed cords can be dangerous and should be removed.  Plastic bags should never be within a child's reach. Matches, alcohol, and cigarettes should also be put out of reach. One of the things I always did at night before I went to bed was to walk around the house to be sure neither of my children could get into anything if they were up before I was. Jennifer, even as a toddler, was very adept at climbing out of her crib and later her bed. 

Why Children Get Upset or Irritable

It must be very hard in these long days of staying inside because of the terrible virus to keep small children and toddlers happy. In my parenting book,  Prescription (Rx)for Parenting, I give lots of examples why children get upset and ways to keep them happy.  One problem, which is easy to solve, is that a hungry child can be an irritable child. Also if a child is allergic and given food or milk that does not agree with him or her, that can be a cause of irritability. A tired child or one in a in a position or situation that is uncomfortable may become irritable or upset. If a  child is overstimulated he or she will let you know by crying or throwing something. A little one who is dressed too warmly,  is cold, or has dirty diapers will also let you know by crying or being upset. 

A reaction to medicine, feeling lonely and needing a hug can be a reason for  crying  and needing attention. It is important that little ones have regular bedtimes, know the rules, and don' t have to try to sleep when there is a noisy radio or TV on in the house or people making a lot of noise.  Some children need a lot quiet and don't react well to loud noises. If parents argue or are in the middle of a divorce, a child may sense something is very wrong and react to it. If  there is  something like  an emotional problem, some medical help may be needed.  A bored child will let you know and some fun games or other activities will be needed. 

Special Thoughts for Parents

I was going through some old parenting information and found one of my favorite pages. It is by Marion Kinneman. I will give just a few of her sayings. The first is "Blessed are the parents who make peace with spilled milk and mud."  Then "Blessed is the parent who engages not in comparison of his (or her) child with others: for precious unto each is the rhythm of his or (her) own growth." Then "Blessed and mature are those parents who without anger can say no, for comforting to the child is the security of firm decisions." "Blessed is the gift of consistency, for it is heart's ease in childhood." Blessed are they who accept the awkwardness of growth."

In this very difficult time when we cannot even have large family Thanksgivings because of the corona virus, it must be  so hard to have children  and teenagers. Being a parent in normal things and doing a good job is not easy  but between the terrible administration we have right now and the virus, my heart goes out to all parents and grandparents. 

I am sure we will all get through this, but how glad I am that my grandchildren are not little ones and are both busy and happy, Yes, they do wear masks and are very careful about social distancing and crowds. I worry when I see groups of teens all together with no masks and older people in groups also without masks. What are they thinking? Their lack of caring for themselves and others appalls me. 

 

Online Learning can Create Long-Term Problems

I agree with Dr. Fauci that we need to get kids back in school as soon as we can be sure they will be safe. A child from an affluent home who has a computer and parents who can help if there is a problem are much better off than those in poor homes with no computer and parents lining up at food banks or trying to get to their jobs. 

Even children from affluent homes are at a disadvantage if all their school work is done on a computer. Several studies have been published showing that  children need to learn cursive or how to write by hand. Writing cursive helps children retain facts better than if they just see them on a computer. One study showed that children "with fine-motor  writing skills early on did better later on". Another study showed that kids retain information much better if they have to take notes or  write down information. I always took a lot of notes when I was in school, college, or medical school. I often just studied the notes when I needed to prepare for a test. I still take notes about things I want to remember and use a computer only for e-mails, book chapters, Google etc.

If I had children at home now I would insist on as little computer time as possible. If a child had to do on-line learning, I would be sure a lot of time was not being spent on social media sites, sexting, and e-mailing friends. Some children are having headaches, eye strain and other medical problems from overusing their computers.