Rx For Parenting Today

The Challenge of Feeding Little Children

I found a wonderful book the other day I wish I had had for my first child. Jennifer was a picky eater as a little child, unlike her younger brother, who would eat anything. The only problem I had with Geoffrey was that he was hard to fill up. He was a big baby and once he had enough to eat he was always happy. The book I found was First Meals by Annabel Karmel. It is beautifully illustrated and has lots of clever and interesting recipes. It was published in 1999, but I checked that it was still available on Amazon and it is. The author has a newer book  about feeding babies.

Some of the things I learned about feeding small children was to make the portions small, make them attractive, and offer milk after the meals, if you have a small or picky eater. Two-year-olds often prefer milk to food and this can cause a milk anemia and also constipation. If you are a vegetarian and want to give a vegetarian diet to your children, this is worrisome. According to the medical doctor, Henry Legere, a child needs to eat "anywhere from three to seven times as much nonmeat protein to get the amount of protein found in a single serving of meat or cheese." There a few little children who would be able to eat that much, so a vegetarian diet for little children is  something I have always advised against. 

Fast foods not only are often loaded with calories, but they may not have the nutrition a child needs. Whenever parents told me they had an irritable child or one who is always tired, I would not only do a good physical examination, but also check a blood count and get a three day diet history. I was often amazed at the child's diet. Often just  by working with the parents on a different diet for the child, I was told the little boy or girl became a completely different child. So an irritable, tired, or unhappy child can sometimes be "cured" by better meals, with lots of protein, fiber, fruits and vegetables. As children get older letting them help cook simple things and helping to plan the menus often makes a difference. Having them make special place mates and setting the table, so it is attractive can also  help. . As a working divorced, working M.D., I planned menus for the week and did the shopping on weekends. Both children became great cooks as adults saying because they liked delicious food that was what they had to do. We ate well, but not elegantly or with great variety.

Tips for Traveling with Children

Traveling with children can be fun or it can be a nightmare. Even with careful preparation unexpected problems can occur. I have traveled back and forth across the U.S. by both airplane and car with a tiny baby, a six-months-old, and two children, ages three and five. As a Navy wife for three years and then as the wife of a doctor-in-training, moving was part of life. I am always amazed when someone says they have been in the same house for fifty plus years!

The most important thing I have learned about traveling with children is to think through each day about what you need to pack and what you need to carry with you. Parents with small babies and little children have more to pack than I did, since special seats for the airplane and car are required. I think the most important rule is to always have twice as many supplies as you think you will use if you are traveling with small babies or little children. Having lots of things to entertain children as they get older is very important. I found that carrying a bag of surprises  to be opened when the children get restless helps a lot. Of course, now with DVDs and all kinds of technology, children are somewhat easier to entertain. However, It doesn't seem healthy to have little children constantly looking at a screen when they are  traveling. Old fashioned games such as finding out-of-state license places, special words on signs and similar games can help.

Snacks are good for older children, but be careful about hard candies or anything a child can choke on. A first aid kit is wise to carry, plus some Tylenol, band aides and antibiotic ointment. I will never forget the day, when I was about five and we stopped by the side of the road.  I think we were in Arizona or some place similar and a big cactus attached itself to my hand. it took my father considerable time to remove all the tiny thorns.  Kids can get into almost anything, so you really need eyes in the back of your head to be aware of what they are doing.  Out of state  medical care can be scary, but always keep your receipts and a copy of the medical report, so your insurance or HMO  will hopefully reimburse you. If you are not satisfied with the medical care, call your child's doctor and ask for advice. Happy traveling!

Hearing Loss in Children and Teens

For several years now hearing loss in children and teens has been steadily increasing.  There are several reasons for this and if action were taken, a lot of hearing loss could be prevented. Parents of newborns are fortunate that now most hospitals require a hearing test is done at  birth. However, as with any test, the results can be wrong and a loss not detected. Thus, if a newborn is not reacting to loud sounds or is not making sounds by three months, hearing should be rechecked in a pediatric hearing center, not in a doctor's office. There is such a thing as congenital deafness and it can run in families. I had  a new little  patient, who was not making sounds by several months. I referred her to a good pediatric hearing center and the child was found to have a total loss of hearing. Her sister was born with congenital deafness. I remember the account told me by a social worker that a ten-year-old was sent to an institution for children with developmental delay or retardation when a new staff member insisted the child's hearing be checked. The child was not delayed, but deaf!

One loss of hearing that makes me angry is when a small child has repeated ear infections and the doctor treats with multiple antibiotics and does not refer the child to a pediatric ear, nose, and throat doctor. When I was in private pediatric practice, I did countless myringotomies on children with severe otitis media or bulging ear drums. By opening the ear drum a tiny slit, pus could come out and not stay in the middle ear. When pus is not released  thickening of the ear drum can occur and if not treated, there can be hearing loss. Unfortunately, few pediatric residencies teach young residents how to do myringotomies. Many do not even teach their students or house staff how to take wax  or debris out of the ear canals, so an infected ear can be seen. One older doctor even told me he didn't clean out ear canals any more because it was too time consuming and he didn't get paid to do it! I was horrified. Often allergic children have frequent ear infections and seeing a pediatric allergist can be important. Teenagers are losing hearing with all the loud noise to which they are exposed. If we could get movie theaters and other entertainment  places to decrease the loud sound, that would be a good place to start. Turning down the volume of the music teens listen to would also help reduce some of the hearing loss that is occurring. We are fortunate that cochlear implants are helping many patients. Yes, there is a small risk of meningitis associated with these, but with good medical care, this should not be a consideration. Parents need to be aware that ear infections can occur in a child without a fever, so if a child has a cold, is miserable, and pulls at their ears or keeps their head turned to one side, please think of an ear infection.

 

Tips for Parents of Children with Special Needs

You are the expert with your child, so don't ever let any  professional make you feel you are not.

Most kids with special needs and particularly  those with physical disabilities are great at manipulation. Parents are often the easy targets.

Siblings of kids with disabilities often carry great guilt that they are O.K. They may also feel they did or said something to cause the disability, if for example a child had a serious accident.

Always seek a second opinion if your instincts tell you something or someone is not right.

You have to decide which battles you want to fight, when you have a child with special needs.

Try a little honey when you deal with difficult professionals before you put on your warrior suit.

If a doctor talks just to you and not to your child or teenager you might want to find a  different  doctor.

It can be hard to discipline a child with special needs, but then they might well become whiny and unhappy. Kids do want and need limits.

Take daily and weekly time for yourself. You need to take care of you, so you can take care of your child.

 

Resources for Children with Special Needs

I was talking with a grandmother of a child with autism the other day and was sad and appalled that neither the child's pediatrician nor the specialists who had been seen the little boy had referred him  to either the state program for children with special needs or to the Regional Center. The child is autistic and also had a head injury after climbing out of an open window and falling. The mother is a single parent on Medi-Cal (Medicaid) and needs all the financial and other help she can receive. I told the grandmother of the various resources available in California and each state and she was amazed. The little boy is now four years old and needs follow-up for his head injury, but also help with the school IEP. Advocates are usually available to help  parents like this mother. It can be a parent who has been through the process or a special education attorney, as I had in the Center for Handicapped Chidlren that I founded and directed for 23  years. We survived on grants, donations and some insurance payements and were seeing children from all over the U.S. when I closed the Center 11 years ago.

I  printed out the application form for CCS, the state program that will pay for referral to specialists. I am also making calls to see if I can find a good advocate to support the mother at the IEP. She needs to ask that an Executive Coach be included in a new IEP to help the little boy organize this work and make good decisions.  By using the 504 of the Rehabilitation Act of 1973, this individual can be funded. It often takes a lot of work to find just the right resources, but every child with special needs who can profit from help should be receiving it.

Watch Out for Household Hazards that Can Injure Children

There is an excellent article in the October Parents Magazine by Luisa Colon about keeping chidlren safe at home.  One problem I have never enountered is with wire-framed clothing hampers.  If children decide to use these as tunnels or forts, the wire in the hampers can come loose and cause eye injuries. I think using a sturdy hamper makes much more sense if there is a potenial for harm from cloth hampers. Kids can get into almost anything, but a least there would not be loose wires in solid hampers.

Magnets that are found in toys and other articles can  be ingested and cause severe damage. An X-ray should be done as soon as possible and the magnet removed before it can cause permanent injury. Small button batteries can be a choking risk, as can magnets, and also fluid can leak out and burn the feeding tube (esophagus).

Televisions need to be anchored, so they can not tip over. The article states that "a child is treated for a television-related injury every 30 minutes." Kids will often climb up on a TV if there is something they want on the top and cause it to tip over on them. 

Spray bottles with caustic cleaning products should be kept up high or in a locked cupboard. The article does not mention dishwasher washing powder, which can also cause severe damage to the esophagus, if ingested. Dishwasher pods are mentioned and these are now causing children to be seen in emergency rooms  when they been ingested. Hard candies are mentioned and these are a particular problem is a child has one in his or her mouth and starts running. They can also cause choking when a child is not running, as can raw vegetables.

Medications of all kinds can be a real problem when ingested and I have pumped out many children's stomachs when they have swallowed  pills from a bedside table, a purse, or  medicine cabinet. You can never be too careful when there are children in the house. 

Yearly School Physical Examinations

Now that most school are starting, many parents are scrambling to get their children's physical examinations completed. In talking with both parents and kids, I am amazed at the minimal examinations some children have received. I always insisted that I have an hour for a complete physical because this is the best time to talk about problems, check for any new physical or emotional difficulties and to be sure all the immunizations are up to date. I find that few pediatricians and family doctors ask for a yearly urinalysis and tuberculin skin tests seem to be rarely given. I think this is a bad mistake with all the international visitors and immigrants we receive in the U. S. Having seen a child die of miliary or diffuse tuberculosis when I was a pediatric resident and also having detected several cases of TB when I was in private practice, I think a yearly Tb skin test is something  parents should demand. I have done that for my grandchildren when I have taken them for physical examinations.

One youth I was asked to see for a consultation because of his Duchenne muscular dystrophy was in a wheelchair and had recently come for Asia. His good pediatrician, who had previously worked for me, had found tuberculosis in his lungs.  The boy was about to start school, where he would have exposed  teachers, pupils, and staff. Fortunately, there is an excellent TB clinic at San Francisco General hospital, so treatment had been started. There is still tuberculosis in Asia, Mexico, and Africa. A single individual can expose multiple people, as was shown with the terrible Ebola virus.

One thing parents should know if they decide to bypass their child's regular doctor is to not use the retail clinics found in many drugstores and chain stores. The American Academy of Pediatrics is strongly opposed to these because they are staffed by nurse practitioners and there are no provisions for an M.D. to oversee the examinations. The small rooms I have seen for these clinics do not allow a patient to be undressed and examined lying down. A great deal can be missed that way. A physical examination cannot be done adequately without a patient being given a gown and being undressed except for their shorts or underpants.

Constipation in Children

When children are healthy and eat a good diet with lots of fiber, fruits, and vegetable, there usually is not a problem with constipation. There are medical conditions where constipation can be a major problem and constipation can be a sign of celiac disease and hypothryoidism. It can also occur in children with weak muscles and those having to use wheelchairs. This is because of their inability to get exercise. One of the worse cases of constipation I have ever seen was in a new patient with long-standing Duchenne muscular dystrophy.  It took a great deal of effort on both the mother's part and mine to get this under control. However, with the use of laxatives, suppositories, enemas, and a better diet we finally succeeded. The youth was much happier once the constipation was under control.

Two-year-olds who love milk and don't like solid food can develop fairly severe constipation.  By diluting their milk with water and cutting down on the amount of milk the children are given, they will usually start eating better. A fast food diet can contribute to constipation and when kids don't like vegetables or salads, this can create a problem. Sometmes  parents have to be a little sneaky and add bran to foods and make interesting salads, such pears for faces, raisins for eyes, and slices of melon for the mouth. Getting the children to help with meals when they are older and making the food look attractive also helps. All kids need a good breakfast with some protein and having protein in the diet is important for normal bowel movements. Remember, too, that apples and bannans can be constipating, as can cheese.

I have always asked what a patient eats when I do a physical examination. Many medical students and house staff  have told me I am the only physician they have ever heard who did this. We are what we eat and if a child has a problem with constipation a three diet record can tell a doctor and parents a great deal.

Should Kids have Chores?

Now that summer is over and many schools have already started, parents may be deciding if it is worth the effort to get their kids to do chores.  If parents are working long hours in jobs outside the house, it may seem easier to hire someone to do the household jobs. But when this happens, how to children learn to become independent? They may not always be able to afford having others do their household tasks and may be at a great loss. When I was an undergraduate at Stanford University, girls from affluent families usually sent their dirty clothes home in a special suitcase for the family maids to wash. Then, when they needed a blouse or a dress for a date or  every day, they were at a loss. I often helped girls like this learn how to iron and decide which clothes could be washed and which ones needed to go to the cleaner. They had no idea!

I believe both boys and girls should know how to iron, wash, sew, and do household chores. Little children love helping their parents. They can dust, set the table, empty waste baskets, and pick up their clothes and toys, even as three-year-olds.  Teaching the steps of independence is an important part of parenting, I believe, and your kids will profit greatly from learning how to get along without paying for help.

I had a parent who showed me a great chore chart she devised with special stars for jobs well done and a treat after a certain number of stars had been received. Making chores fun and not a burden can be achieved with a little imagination. Yes, this may take a little time, but the rewards will be great. When my son was an actor for five years before he became an M.D., he often worked on costumes and has always been able to sew, cook, iron and do household chores. This was particulary important when he became a single parent. His sister loved to cook, sew and never hired household help, even though she was running a big business with her husband and doing lots of art. We had to  have housekeepers, because their doctor father and I both had night calls, but I still expected them to do their chores. I promise it does pay off in the long run!