Rx For Parenting Today

Problems with Vegetarian Diets for Kids

If a child always has to eat vegetarian meals, problems can develop. Vitamin B12, for example, is just found in foods of animal origin. This means: meat, liver, kidneys, most cheeses and fish and shellfish. If one parent insists on a vegetarian diet and other parent becomes concerned, I would suggest a two week diet history is kept and the results discussed with a dietitian. These trained individuals can generally be found in children's hospitals and general hospitals. A daily multivitamin is important for children, but that alone is not the answer. According to the physician, Dr. Henry Legere " a child would need to eat anywhere from three to seven times as much non-meat protein to get the amount of protein found in a single serving of meat or cheese." Most little children  can not eat that amount of food at a meal. 

One of the things I always did as part of my general routine physical examination was to take a diet history. I  have been told by many medical students and residents that I am the only doctor they ever heard do that. I have been amazed at the  meals some children eat each day. I believe I was able to cure a lot of irritability and other problems by  asking about diets. I often had to suggest ways that children could be given better meals by outlining how meal plans could be made on weekends and the shopping done  to get all the necessary items. "I agree with the old statement, "We are what we eat."  Fast foods can be easy, but can also be harmful if that is all kids eat. School lunches should be nutritious but I am not sure they always are. Budgets can play a large part in what children receive, so as a parent I would want to find out what the children are given if they eat lunch at school. 

When Child Has to be Hospitalized.

This is a scary time for anyone to be in a hospital. However, if a child has an accident, a bad case of  croup, or the need for emergency surgery, there are some things that parents can do that will help. 

The most important thing is to be sure your nearest hospital is equipped to care for children. I have two favorite hospital: Los Angeles Children's and Cincinnati Children's. I also know several I would not want a child to be in. One of the newest problems is that now many pediatricians do not go to the hospital to see their patients, but leave the care to a pediatric hospitalist. I have had bad experiences with these individuals in adults and cannot imagine letting one care for a little patient of mine. Not only the child, but also the parents need to see a familiar face that they know and trust. 

My most important tip for parents is always have a parent, relative, or good friend stay with the child. That way if anything  seems wrong it can be questioned. If a second  opinion is needed, I would request it. If you are having problems with any of the staff or treatment, I would urge you to call your child' s pediatrician or make an appointment with the hospital CEO. I f necessary, I would transfer your child to another hospital. 

A small child needs a favorite toy or stuffed animal to have in the hospital. But I would not overwhelm a child with lots of gifts or toys. If an adult is anxious, this can make the child anxious also. It is important to get to know the nurses, doctors, etc. and call them by name. That way you will be ensured of better care. Keeping notes of what is going on is a good idea, particularly if you are not pleased with the care. The squeaky wheel  does get the grease. Also, always check the hospital billc arefully, and if you needed to get previous authorization form an HMO or insurance  company, be sure you have the necessary papers to prove this was done. 

Safety at Childcare Centers

Now that many childcare centers are opening, so parents can go back to work, there are some safety features to watch for. The most important thing is if the adults coming and going or staying are wearing masks. Are temperatures being taken on children and adults? Is a sick child sent home or just isolated at the center?  Do the children have naps and how is the food prepared? When are meals served and are there snacks? Do they know  if a child has allergies?

One little patient of mine wandered into  the kitchen at a childcare center and got into  detergent under the sink. She had to have surgery  on her esophagus or feeding tube because of severe scarring. No poisonous substances should ever be where a child can get into them. Is the center clean and is it licensed? It should not be in someone's home. Does it smell clean and do the children have plenty of room to play and also play outside? 

If your child is unhappy at the center is bullying going on? Can you just drop in and see what is going on or do you have to make an appointment?  Have the caretakers had recent medical examinations including a chest X-ray and TB skin test? How many adults are there per child? Have the adults had CPR training? How close is the nearest hospital and is there a pediatrician or GP on call?  It would be good also to talk to some  of the parents who have had experience with the center personnel. You can never be too careful, particularly at a time like this. 

Spoiling a Child Could Have Long-Term Consequences

As parents, it is far easier to let a little child have or do everything he or she wants, but several years later when school or the real world intrudes, the child can be badly surprised and hurt. Teachers have told me how hard it is to have a child start school and expect to be the center of attention and never be told "No".  The child can be attention-seeking, have temper tantrums and not be able to sit still or listen to the teacher. Other children will soon find it is best to stay away because the child wants what he or she wants and wants it now.  Knowing how to make friends, share, and be a part of a group may be something the child does not know how to do. If the boy or girl has no siblings, this can be even harder. Siblings can teach each other how to play fairly and share toys.

All kids need to have some wishes unfulfilled. If they have to wait for a birthday or earn some money by doing chores, those are important lessons. Earning treats make them more valuable. A child who has chores to do gives  a feeling of being grown-up and important to the family. Discipline is love and spoiling is not love. 

One teenage patient of mine was told he could not have the car keys because he needed to so some chores and homework. He grabbed them and had a serious accident. That was a hard lesson for him to learn and for the parents also.  I once asked my two children when they were adults what the best  form of discipline  I used. They both immediately said "Just your voice, Mother."  They knew if I said "No"  I meant it and there was no argument.  They both raised their children the way they were raised with  excellent  results.

The Importance of Grandparents and the Corona Virus

Now that there is a question of schools not opening soon because of the corona virus and some parents going back to work, healthy grandparents  could be a great resource. Unfortunately, because older individuals are at greater risk for contacting the virus, this creates a dilemma. Ideally, if there was a fast way to tell if a grandparent had no evidence of the virus, they could help with childcare if they tested negative.  However, because some of the rapid virus tests are reported to have as many 15% false negative what can parents do?

I think the answer is to talk to your child's pediatrician. Ideally, we would have testing for everyone who wanted it, as Trump  promised.That does not seem to be happening, even though it is happening in the White House.  If the grandparents were willing to babysit and they could have daily tests that could be the answer. Nursery schools and schools do not appear to be opening soon, which means someone needs to care for the children. Even if a stay-at-home parent was willing to care for her children and yours, how do you know the kids would be safe? Once again it all depends on testing. Even if a parent has had the virus and recovered, he or she may not feel up to having extra children to care for.  Some creative ways will have to develop so parents can work and the children will have someone to care for them. One answer might be a college student who is not able to go back to college because their college was not open.  However, testing would still be important. Children and adults ideally would be able to be tested, so parents would know how to proceed. I think we all have to speak out and demand adequate testing from our state and federal people in charge. 

Celebrating Mothers and Mother's Day

Happy Mother's Day to all mothers and grandmothers. If you have raised or are raising children who have respect and concern for others I send my congratulations. Being a parent and especially a single, divorced or widowed parent is very difficult. I know because I have been one of those.

One of the most important things I have always told the parents of the children I cared for as a pediatrician was not to lose yourself, but still try to be who you are. Many of us, when were we are married, tried to fulfill our partner's needs, while putting our own needs aside. I think I finally became who I really was when I sold my practice and moved to my beloved Bay area. There I was seeing consultations of children and teens with disabilities and neuromuscular disorders and not taking any night calls.  I was able to attend neuromuscular meetings in other countries and also spent considerable time working  in the neuromuscular unit at  Hammersmith Hospital in London. That was special. 

If you are a new mother, it is important that you establish a strong network of friends of all ages. Often an older woman can help you through difficult days and give you some perspective about child raising. I find many mothers today find it hard to say "No" to their children but want to be their friends. That does not work and both the children and you will pay a big price for that in the long run. Grandparents, too, need to set limits because the kids want and need them. 

Handling Anger in Children

Handling anger in children can be a real problem if it occurs frequently. Sometimes a parent also has trouble with anger. If the anger occurs just now and then, that is one thing, but if it is a frequent occurrence then professional help may be needed. Teachers and babysitters can sometimes give parents insight into why it happens. Is it jealousy, selfishness or is there a medical or psychological reason the anger occurs. Exercise can often defuse or lessen anger, as can art and sometimes music. When a parent asks me what to do when the anger becomes a real problem, I ask my favorite child psychologist do some testing. Sometimes the cause  is found to be a learning disability, other times ADHD or even autism.   A child may have  a condition called Oppositional Defiant Disorder which is a true psychiatric diagnosis. Psychiatric help is needed and medication may  help. 

If the anger is intermittent, talking to the child could help, as can having the child draw the anger. Art therapy can often help greatly. Children want and need firm guidelines and boundaries. If parents are unable to do this then some family counseling could be in order. I find many parents these days find saying "no" to their children difficult, so the children don't know how to act and try to  push the limits as far as they can go. No matter the cause, help is available and it should be given early in childhood, so as a teenager, the individual does not use guns or other weapons to express the anger.

 

Safety Tips for Babies' Safe Sleeping

Having your first baby is a hard time unless you have been around little babies. When I was  a young intern, I loved spending time in the newborn nursery. However, when I had my first baby I had now idea about practical things.  Fortunately, our family G.P. recommended an old nurse to come and help. I called her "Minnie the Angel. She taught me to be sure Jennifer was in a small, snug bed with no soft toys, a firm mattress and no soft pillows or quilts. Babies must sleep on their backs and having a baby sleep in bed with  you is a recipe for disaster. The use of a pacifier and a smoke-free room also reduce the number of infant deaths. If or when a baby is put in a crib, it is important to check that the crib slats are no more than 3/8 inches apart. A warm bath before bedtime can be very soothing. Also, a music box placed near the crib can help a baby relax  and get sleepy. If a baby won't settle down sitting in a rocking chair while nursing can help. When a child is not dressed warmly enough or is in too many clothes, both will make a baby fussy. Anxious parents can make an anxious baby. Letting a infant fuss a little is usually a good idea. Most parents can soon distinguish between a hurt cry, the need for a diaper change or burping and just fussiness. When I was baby sitting for my first grandchild, Heather started crying la, la. I let her fuss for a few minutes and she soon quieted herself. Babies do have that ability and picking up an infant at their first cry does not give the baby the chance to calm down. 

Parenting the Siblings of a Child with a Disability

As a pediatrician with neuromuscular training, I have cared for countless children and teens with disabilities. I know the toll it takes on parents. It also can take a toll on the siblings. So much time and effort has to be given to the child with a disability that there may just not be enough time and attention left to give to any other children. I learned a great deal about this when I held special groups for the siblings of my patients.They felt a lot of compassion for their sibling, but also a sense of loss for the parenting they missed. I also held groups for the parents and I think it helped the  siblings a little by talking about how much time and attention many felt they were missing.

Many children with disabilities have learned how to manipulate the adults around them to get the most attention they can. I remember a patient with spinal atrophy, who while in the hospital would yell down the hall that she wanted various things. When I didn't immediately run down to her room, she finally learned  I was one adult she could not manipulate. She was bright and attractive and a great actress. When parents have one or more children with disabilities, a sibling who does not  have any medical problems, often gets completely left out. I had to hospitalize one boy in a psychiatric ward because he had 3 brothers with Duchenne muscular dystrophy and got minimal parenting. 

I asked one of my favorite mothers how she raised such an outstanding son.  Kenny had muscular dystrophy and the other  boy had no medical problems. Her reply was that she expected Kenny to do chores and other things just like his brother. Kenny was a wonderful teen and it was a great loss when he died at 21. 

When there are no Special Education Services with Schools Closed

Special Education services are so important for children with disabilities that when schools are closed parents need to take over. There is a lot that can be done at home with the guidance of the special ed professionals. If a child has something such as Duchenne muscular dystrophy or other forms of dystrophy, muscle stretching is important. Tightness of  the heel cords is a common problem and a therapist has probably shown you how to do the stretching. Many therapists are still available by telephone and can help you do a lot of what is needed. Having a boy stand in a stand table or in his AFO's or braces can be very helpful to keep his legs working. Putting his arms and legs through a range of motion can help also. 

I had one patient whose physical therapist kept him out of a wheel chair after a heel cord lengthening. The orthopedist did a good job surgically but did not arrange for any physical therapy afterwards, which was a glaring error. The boy's physical therapist called the parents and arranged to go to their house daily . She kept  the youth moving and also kept him from having to spend the rest of his days in a wheelchair. Occupational therapists, speech therapists, and learning disability specialists are key to the progress and development of many children. They can teach parents many things that can be done at home. Yes, it takes a lot of time, but with businesses and many other things now closed because of the corona virus  parents may have time on their hands. Once a child is allowed to slide back in learning, reading, walking, or speaking, it is hard to regain what is lost. Often parents can help each other by sending pictures of what to do or just by being supportive. We all have to help each other to get through this pandemic without losing a lot of ground.