Rx For Parenting Today

Children with Eating Problems

Some babies, children, and teens will eat anything and never cause problems. Other babies are picky right from the start, so it is important to be sure a baby is not lactose intolerant or does not have celiac disease.

Now that many parents think any form of discipline is wrong they can end up with difficult eating problems. I don't think any child should be required to eat everything on their plate. However, if you start catering to their various whims about food, you can end up with some major difficulties. I had one teenage boy who  had a doctor parent, yet his diet consisted of three things. The family could not go out to dinner unless they were sure the restaurant would have the three things he would eat. I found a counselor for him and also asked the mother to serve him  the same meal the rest of the family were eating.  I knew he wasn't allergic because he had seen a good allergist.  I also asked the mother not to  offer milk or snacks between meals. It took about a week, but then he ate what the rest of the family had. 

If a teen has anorexia, that is a different problem. I have had many anorexic girls as patients and was fortunate to work with an excellent psychiatrist. I don't ever remember having to hospitalize a teen, but was frequently amazed at some of the family problems we had to address. 

Guns and Children

When I was a second-year medical student at Stanford, I was on a week's duty in the Emergency room at San Francisco General Hospital. It was a hard week, but the worst thing that week was seeing a child brought in with a gun shot wound. He had been playing Cops and Robbers in an alley with a friend. This boy had found a loaded gun in his house and shot my patient. Several of us tried very hard to save the boy's life but to no avail. I had never seen a child die before and it left a terrible memory. Now we are seeing children and adults die every  day from guns. Four teens died from guns in Tennessee between January 15th and March 10th.  How can parents, grandparents and families tolerate this? I cannot imagine  having children put at daily risk from guns. There should be a national uproar and yet the killings go on. Do your know if there are available guns in a neighbor's house where your children play? Have you talked with your children and teens about guns?  Also have you contacted your state and local representatives about how you feel about guns?  My father was always kept a  small pistol in the top drawer of his dresser, but it would never have occurred to me or my siblings to enter his room and take the gun.  We can and must talk to children  about guns and what harm they can do. The NRA wants to sell more and more guns and during this pandemic guns sales are getting higher and higher. This puts more and more children and teens at risk. 

Children and Anger

Most people feel anger now and then but if a child always seems angry then something needs to be done. There is a specific psychiatric term for children who always seem angry and it is Oppositional Defiant Syndrome. I was fortunate to  have a wonderful resource in San Francisco where I could get help for these children.  I had one little boy the parents brought to me who literally burned their house down. He was seen by good psychiatrists at St. Mary's Hospital and later was place in a special home for children who needed help. Sadly, we don't  have a lot of facilities for children who need help or doctors trained to help the children. The boy's  parents were wonderful and did everything they were asked to by the doctors. When I was in private practice I had a teenager lunge at his mother with a big knife. I  had a very good psychiatrist to help and he was hospitalized in a unit at San Diego Mercy Hospital. Fortunately, the boy's mother was tall and strong and was able to to deflect the knife. 

I have a long list over many years where angry kids found a gun and used it to kill one or more children or adults. I don't understand why the parents or the child's doctor didn't seek help for these kids. If we had better gun safety measures a lot of the killings could be eliminated. Also if we picked up kids in trouble early on and found help for them a lot of tragedies could be avoided. Sadly, I find that many medical schools are teaching with computers rather than how to take a good family history and how to get to know their patients. I loved making house calls and could learn more about a family in one visit  than in several  office visits. 

Now that family doctors and pediatricians are limited by the  Covd 19 virus from actually examining children, many angry children will be missed.  With the pandemic, gun owners and buyers need to be very  careful about where their guns are stored and who has access to them.  One angry, mentally unstable person with a gun can do a lot of damage, as we are seeing. There has to be a better answer to all the tragedies we are seeing. 

When Parents Try to Dictate a Child's Future

I think a good statement for all parents to remember is that a happy child is one whose parents give them "Roots and Wings." If you try to dictate what you want your child to do or be as an adult you may be in for some big surprises. Some teens even run away from home if they know they will never be able to live the life they want. This may be particularly hard for affluent families who have always been involved in law, medicine or other professions. I know of one very successful lawyer father who insisted his son go to law school. The young man did do that, but as soon as his father died he resigned from his father's law firm.  He ended up in real estate, but never made much of a living because what he really wanted to do was teach gymnastics. He had won several awards in this sport as a teenager.  

Another man told me that he and his wife took their three -year-old son several miles each day to a university pre-school. He was intent on the child becoming a doctor or lawyer. When I asked him what if the boy wanted to do something else the father's  answer was  "Well, that is just not possible." I am afraid he was in for some difficult surprises. I don't have any follow-up on the child but I have seen a great deal of unhappiness in families when parent's decide they  have the right to make a plan for a child's future.

My favorite cousin who died many years ago wanted to marry a divorced man. Her father was a minister and said he would not allow that. She spent many years working overseas and then after 12 years went to New York and became a well known children's author. She was a lovely person and I feel sad that she was never able to marry and have children of her own when she obviously cared a great deal for children. 

 

 

Where are the Parents of the Miami Beach Kids?

I watched in horror, as I am sure many others did, at the hoards of college students  on the beaches in Miami. The news  reported these were college students on spring break.

I cannot remember ever doing anything but working during spring break and I also  never traveled home. Where did the kids get the money to go to Miami and party? What kind of parenting did they have that they wore no masks on, there was no social distancing and they did not seem to  have a care in the world? I am assuming they each had credit cards and never listened to world news. What kind of young people are we raising? I know there are some wonderful thoughtful kids in the US but the Miami beach group certainly showed how we are spoiling some of our  kids. Yet some of these are going to be future parents, medical students, law students, legislators and on and on. 

I imagine what a college student who has to work to make ends meet would feel looking at the pictures  they saw on the news. Yes, many of these young people   will be accepted to medical schools, law schools, and  expect their parents to be their personal ATM machines. I imagine people in other countries, who saw these images, did not think too highly of our country during this awful pandemic and the loss of so many people.

 

Teenagers and Suicide during the Pandemic

There was a troubling article about teenagers and suicide in the March 16, 21021 New York Times by Benedict Carey.  The article talked about how so many teens were depressed and even tried suicide because they missed school, their friends, and their normal activities.  Several parents were quoted who said they took their sons to hospital emergency rooms and received no help. This is not surprising because that is not where you would go to get help. What was surprising to me was that there seems to be no interaction with the child's doctor or pediatrician. ER doctors are great for accidents, trauma and similar problems, but mental health and the care of  kids in despair is not something they are trained to handle. 

I cannot imagine any of my parents taking a child to an ER without calling me first. I had a few teen age patients who threatened suicide, but by working with a good psychiatrist and the parents I was able to make a difference. I don't understand why pediatricians or family doctors were not contacted. That makes no sense. 

I made a list of what I would do if I were a parent of a child in despair. The first thing I would do is talk to a good psychologist or psychiatrist. Once contact and an appointment was scheduled I would look at what the child was doing all day and work out a plan with him or her about how to keep the despair at bay. Does the child get an exercise, does he or she have any household chores? What about getting the teen involved in something such as cooking, art, music or if there is  man or father who can help, what about a project such as woodworking, car repair etc? Certainly a good friend could come to your house with a mask on and the teens could throw a ball around, go for a bike ride, or hit some tennis balls.

A statistic was given in the article that ER visits for anxiety and panic were up by 24% in young children and 31% for teens compared with the previous year. 

I believe that a close connection with your family doctor or pediatrician is  essential, not visits to the ER for panic or depression. That is not where you will get the help that is needed in most cases.

Children of Poverty and the Rescue Bill

President Biden's just signed his Rescue bill that will lift one-half million U.S. children out of poverty. For the richest nation in the world, we  have done little before this to help poor, underprivileged children. We have the highest rate of childhood poverty of any industrialized nation. That is disgraceful. The child tax credit enclosed in the bill will help families feed and clothe their children.  I hope it will give these children a chance to strive for a good education and make something of their lives. If a child spends his or her entire life hungry and poor what chance is there of ever having anything more?

Many children who are born into low income families have a disability. I have spent many years caring for disabled  children, as a  pediatrician, and know  of their pain and that of their families. I hope this new bill will help both able and  disabled children.  This pandemic has been particularly hard on poor children and their parents. No Republican voted for the Rescue bill which I find appalling. I wonder if any of these men and women have ever known or worked with poor families or with children who have disabilities?

Feeding Children

The is a hard time to feed children when even going to a store can be risky.  I go at seven a.m. with a mask on and plastic gloves. Most doctors are taught little about diet and nutrition. I don't remember anyone talking about it at Stanford when I was in medical school there and my son agrees that he had no nutrition teaching at Washington University Medical School. 

There is an excellent book by Dr. Henry Legere entitled, Raising Healthy Eaters. He makes some good points and it is easy reading. I particularly like his discussion of vegetarian diets for kids. He notes that this type of diet can cause real problems unless parents understand how little protein such a diet can give a child.

I have great concerns about the advice some doctors are giving parents about feeding even little children  allergen foods, such as peanuts, eggs, fish, citrus, and  chocolate. There was an excellent allergist when I was on the staff at University of Rochester and he cautioned parents about these foods. I had married a man who had strong allergies in his family and was very careful about not  feeding allergenic foods to my two children. It certainly paid off.  Some children are very allergic to cows milk and when mothers can breast feed, that is much safer. Milk between meals for older children will decrease their appetite for regular meals, as will snacks, such graham crackers etc. If a particular food is disliked by a child, he or she could be allergic to it. No child should ever be forced to eat everything on their plate. Also children should not be catered to as to what  foods they will and will not eat. Fast foods and pre-packages foods may not be the best for children, except now and then. We are what we eat is still a wise saying. 

Thoughts about Charter Schools and the Pros and Cons

Our educational system in the United States leaves a lot to be desired, particularly in low income areas. There was an interesting  article recently in the New York Times by Eve Ewing. She is a former teacher and has interviewed and researched charter schools. I like one paragraph  where she notes that  "Although  charter schools  have  improved, they are "less effective than their non-charter peers". However, she says they are "more effective for low-income students and students of color than for white and affluent students."

I was raised in a college town that should  have had good public schools. However, when I went to Stanford the professors would said, "Oh you would  have had that in high school." They were not talking about the high  school I attended!

One of the smartest things I did when my two children were growing up was insist they go to private school. Our San Diego public schools were not good and certainly do not seem to have improved. Both children received wonderful educations for which I am very grateful. We did not have the money to send them to private school and were living in a small rented house , as we were both just  starting to practice medicine. 

I worry greatly about the education many students are receiving. I think we can see that in many kids need for constant entertainment, social media, and the lack of inner resources so evident during this pandemic. Kids knowledge of other countries, other cultures, and even the history of this country seems to be greatly lacking. 

I hope the Biden administration will push our schools to do a better job and all  children will get a good education, as kids seem to in Europe.

 

Pregant Teenagers

I worry about many of the teenage girls today. So many seem focused on dating, clothes, and their appearance. I was fortunate growing up in a town with several colleges and a college professor father. My main concern was to get out of high school and go away to college. The boys in our class were pleasant, but seemed more interested in sports than dating, although we did have class parties and I always had a date.

I had a good friend, who is no longer living, who told me her mother was 15 when she was born and that you never wanted to get near her father's right hand. She didn't ever talk about her family, but from just those two remarks and her adult life, it was not hard to figure out what her family life must have been like. She had two bad marriages, several pregnancies, and multiple affairs. Even with good friends, she was very closed and did not want to talk about her family life. 

As a pediatrician, I have cared for several teenage girls who became pregnant and all but one were able to get abortions. One mother insisted her daughter carry the baby to term because  she wanted a baby to raise. I don't have a follow-up on either the girl or her baby, but have a lot of concern about both of  them. Having a baby as a teenager will change a girl's life forever. I do not understand the stance many people take  against abortions. If they could see the tragedies I have seen in the girls' and their babies' lives, I hope they would re-think their stance against abortions. The say it is a religious stance, but I don't think any religion would want to inflict the pain I have seen in pregnant girls. We now have 450,000 foster children in the U.S. Many of the kids come from homes where they were not wanted or the parent or parents could not afford to care for them. I hope we can do a much better job of caring for our children in the future than we are doing now.