Rx For Parenting Today

The Challenge of Feeding Some Children

Some children right from birth are a challenge to feed. Other children will eat whatever you give them. I had one of each kind. My picky eater grew up to be an excellent cook and always enjoyed most foods. Peas were her downfall. I never understood where that came from.

If you  have a picky eater, try to present small amounts of colorful foods and don't insist  everything be eaten. Giving snacks between meals or milk can greatly decrease a child's appetite. I had a teenage patient whose mother was an M.D. and the boy would only eat french fried, bananas, and ice cream. It took a long time to get him to eat a wider variety of foods and some psychiatric help was needed. I had another patient who would  have a temper tantrum if he wasn't given the foods he liked. My suggestion to the mother was to serve him whatever the family were eating and just  give him have juice between meals. She called me daily and I said as long as he was getting enough fluids and sleeping O.K. just to hang on. On the third day she called me and said the boy was eating them out of house and home!

Children usually like single foods, not casseroles. Graham crackers contain a lot of sugar and should just be given as a treat. If a child refuses to eat a particular food, such as fish, he or she could be allergic to it. For allergic children, starting one new food at a time for a few days is the best plan. Pre-packaged foods can contain a lot of calories and with obesity in children on the rise, I would avoid these. Vegetarian diets can lack greatly in protein unless great care is taken. 

Geneticists and Neuromuscular Disorders

I am finding more and more medical reports and patients' case histories listing muscular dystrophy as a possible diagnosis because of a moderately elevated CPK. This can cause terrible anguish to parents. Geneticists now are faced with an ever expanding field of genes and disorders, but sadly most of them  have had little or no contact with patients who have muscle disorders. I wish all geneticists had to spend some time in a clinic or program that treats patients with muscle diseases. It certainly would save parents and those of us who have had many years years of experience treating patients with muscle disorders a great deal of grief. 

My advice to parents, if a geneticist or neurologist makes the diagnosis of muscular dystrophy or a muscle disorder, is to seek a second opinion in a well recognized center that treats patients, both children and adults, with neuromuscular disorders. Because I am no longer seeing patients, I refer parents and patients only to Dr. Selcen at the Mayo Clinic.  She was trained by Dr. Andrew Engel who is one of the greats in the muscle world. 

An elevated CPK can occur for many reasons. If blood is taken from a screaming child or an adult has had some recent strenuous exercise, the CPK can be elevated. There are other reasons also. A lab test must go along with a good physical examination, a family history and personal history.  A complete workup would save a great deal of grief for parents and patients.     

Mothers and Mother's Day

I think family celebrations and tradition are important. I talked with two mothers yesterday and was sad that neither mother thought they would hear from their children on Mother's Day. I have thought a lot about why that could be. One mother was in her seventies and the other in her early forties. Both had worked hard in their different careers and I wondered if their jobs had come before their children or what had happened?  I also remembered  a minister friend who gave a most uninspiring sermon on Mother's Day. In the past, his sermons had been excellent. I asked him about it later and he said he didn't think it was appropriate to be depressing on Mother's Day. I argued that there were probably some in his large congregational who had had mothers who were less than great. I'm sure some were controlling, distant, alcoholics or had other problems. I have known mothers of all kinds.  My best advice for mothers is to help their children follow their own paths, to be supportive and loving, but insist on respect, kindness and that the children follow the rules and contribute to the work of the family. I  have always urged mothers to be their own persons, to take adequate time for themselves and their own needs. A mother who is completely unselfish and never has time for herself is not doing what is best for the children.   A mother who is completely self-absorbed can do great damage to the children. I have seen that also. 

So to all mothers and grandmothers, I hope tomorrow will be a special day and you will be honored and loved.

Guns, Guns, and More Guns

How many more students and others have to be killed before members of Congress have the courage to defy the NRA? How can parents send their children to  public schools in the United States and be sure they will ever see them alive again? I am horrified that the Governor of Florida just signed a bill allowing teachers and others in Florida schools to have guns?  Even with the 133 hours of training the bill suggests, a gun in a classroom is a very dangerous thing. I certainly would never send a child to a school where guns were allowed. It is a known fact that a gun in a house means it is more likely that a death or injury will occur to a member of the household rather than to an intruder. 

Rather than spend the money on guns and training, schools need more counselors, social workers, and nurses to identify at risk kids  and find help for them. Every school shooter has been an at-risk kid. Instead of getting help for them, they are generally expelled with no follow-up. I have a long list of these. Since 1970, 1.45 million Americans  have  died from guns. These include suicides, murders, and accidents. (New York Times 5/9/19). There are more guns in the U.S. than there are individuals. That is shocking!

If you have ever watched a child die from a gun shot wound, as I did as a Stanford medical student, you would fight for gun control as hard as you can. 

Teaching Children the Steps of Independence

 I have always thought an important part of parenting is teaching children how to become independent adults. This means they need to learn what I call the "Steps of Independence" I once asked a mother who feared letting her son out of her sight what he  did for himself. I was startled by her response. "Well", she said, "he takes his own shower!" I tried on every  visit to my office to help her see how much the youth needed to grow up and learn to take care of himself. As it turned out, he got away from his overbearing mother, found a girlfriend and moved in with her. The mother was devastated.

Both girls and boys need to learn how to cook, clean, shop, wash their clothes and make basic decisions about their lives. We cannot, as parents, do everything for our children and expect them to become independent adults. I think some children of the rich have a harder time that most because maids and housekeepers do everything for them. They are lost when they  have to shop for food and do everyday tasks. When I was a Stanford undergraduate, I often showed a wealthy friend how to wash and iron a blouse or skirt for a date. Many did not  have the slightest idea how to do anything for themselves. They sent their dirty clothes home every weekend for the maids to take care of their clothes. 

Not only do kids need to learn how to take care of themselves, but they also need to learn how to handle money and make decisions. Many children of the affluent look for a partner to take care of them and end up being unhappy. Learning the tools of independence helps young people feel good about  themselves. Always being dependent on a boyfriend or  parents does not do anything for a young person's self-esteem.

Supporting Older Children in Their Choices

I was talking to the mother of four sons the other day and was interested in what she was saying about her youngest son. He was about to graduate from college where he had majored in finance. His father, grandfathers and brothers had all chosen this field and made quite a lot of money. The mother told me her youngest son had decided he wanted to pursue a career in music which had always been his love. His mother said she and her husband had to think a lot about this but realized the son was an adult and had to make his own choices. What a fortunate young man. I  have seen far too many parents push their children into not only specific careers but also the choice of partners. One professional woman said her father  pushed her into marrying a man she did not love. Incredible!

I  recalled a physician who had several sons and convinced them all to become doctors. The youngest son tried to follow his father's wishes but ended up committing suicide. I don't understand how any parent  thinks he or she should make  the decision about what kind of work a child should do or whom to marry. What gives a parent that right? Young people can ask for guidance, but for parents to insist on certain choices often ends up with everyone being unhappy and even tragic outcomes can result. Sadly, many bright young people in major colleges and universities these days are committing suicide or suffering from depression. We are particularly seeing this in women medical students. Many young people need time to decide on their future choices and may even change one or more times. I think the British system of a gap year before college makes a lot of sense. 

 

Another Dangerous Object Children are Swallowing

When Children Swallow Foreign Objects

A recent pediatric report stated that there has been a marked increase in ER visits for children who have swallowed foreign objects. Boys are being seen more often than girls.  When I had my pedaitric practice, I was amazed at what some of  the things my patients swallowed. One child swallowed a razor blade, another swallowed a safety pin that ended up in his trachea. A doctor friend's little grandchild swallowed a piece of raw carrot. (The mother didn't like to cook  and often gave the little boy chunks of raw carrot.) He had to be rushed to the hospital to have the chunk removed from his lung. Unbelievable. A child on an airplane tried to swallow a peanut which fortunately I was able to remove. Not only do children swallow common foods or objects, but toys and other things that contain magnets are causing terrible damage when a child swallows the magnets. One patient of mine swallowed dishwasher detergent and had to  have  part of his feeding tube or esophagus replaced.  Another child saw an open coke bottle in a neighbor's yard and swallowed some of the liquid. It was a caustic liquid to use in the garden. This child, too, had to have major surgery. 

There is a museum in Boston, I  have been told that contains objects children have swallowed. Medications found in bedside tables, medicine cabinets, or visitor's purses have and can cause a lot of problems.  I think the answer for parents is to teach their children that putting things in their mouths other than food the parents can supervise may lead to a lot of trouble. My children heard countless tales from me about the children whose stomachs I had to pump out because they had swallowed harmful substances. They both learned that was not something they ever wanted to happen to them!

Manners, Morals and Ethics

It must be hard these days to know how to raise a child who has good manners, moral, and ethical values.  Children usually mimic what their parents do. If they see their parents being rude to a sales clerk or someone else, they suppose that is O.K.  If parents are unkind to someone, that too is noticed by their children. I was in a store one early morning when one of the workers told me how she  had been treated by a father the day before. This particular woman was a temporary employee because she was waiting to move to  another city where her husband had been sent. I had been impressed by the  woman when she told me she had a master's degree and written two novels. Apparently, this father was taking his child to school, but had stopped at the store to get something. He said to his daughter, "See that woman behind the counter, that  is why you have to get good grades so you don't have to do what she is doing." I was appalled and wished I had been there to tell the father what I thought. How rude can someone be? 

I have had several parents of children with disabilities tell me about some of the things said to them. One lovely mother and her daughter were leaving church when a woman came up to her and said " You have offended God because you have a disabled child."  Unbelievable when the woman had also  just come from the church. One of my favorite teenagers told me that he would love to have a girl friend but he had heard  one girl tell another  one that " He is probably funny in the head since he has to walk with crutches."  

Kids also copy the way  parents obey the law. If you never stop at stop signs, cheat in other ways and assume the law does not apply to you, how do your children learn what is right and what is wrong? My father was not a warm,  hugging man but he certainly taught us what was right and what was wrong.  As a college professor, I am sure his students quickly learned that cheating was unacceptable. He would  have been appalled at the college admissions scandal we are seeing today. What were these  parents thinking?

 

 

 

Measles and Other Immunizations

It must be hard to be a parent these days and have concerns about all the immunizations  your children need to have. This is particularly true if you have friends who are refusing to  have their children immunized. Some states and cities are  not allowing children to attend school unless they are up to date with their immunizations. With several quite large measles epidemics recently in the U.S., I would certainly prefer to live in a state where children cannot go to school if the parents don't allow immunizations.

I took two weeks off from work when my daughter had measles. This was before there was an immunization for measles, as well as other bad communicable diseases. Measles can be very serious with bad complications, as can chicken pox, mumps, German measles etc.  Instead of worrying about all the shots a child has to be given, I wish parents could have  seen some of the children I had to care for when I had my pediatric training and in my early days of practice. Watching a child suffer, when he or she could  have been given a shot to prevent a disease, is very painful. I cared for one boy who had muscular dystrophy and then mumps that left him deaf. Not only did he have one serious disorder, but being deaf in addition was a terrible burden. I wonder how you could be the doctor for a child whose parents refuse immunizations. I hope these doctors will take time to explain some of the terrible problems that can occur with polio, measles, whooping cough etc. If you are a young doctor and being trained in a medical program that relies much on computer training, I'm not sure he or she will realize how important immunizations are for kdis.