Rx For Parenting Today

Children and Christmas

For those who celebrate Christmas, much of the real joy is centered around children. It is special to see their faces  on Christmas morning when they rush to see what is under the tree. For those without children or are single, divorced, widowed or have lost a child, this can be a very difficult day. Then there are the children in shelters, out on the streets or those who are with their parents, but are emotionally or physically abused. For many adults, the holidays are just times to get through the best way they can. Some find that helping out in soup kitchens, delivering food or gifts to shut-ins or the elderly can make the day go more quickly. Holidays too, can bring out the ugly side of people if they have had too much to drink or there are family conflicts.

One of the last Christmas cards I opened yesterday  was from a long-time doctor friend who lives in another state. Enclosed I found a short note about one of his sons, who died a month ago. I cannot imagine what this Christmas is like for him. My daughter died four years ago of cancer and Christmas is hard, but how fortunate I am to have a wonderful son and two grown grandchildren. A parent whose son died of muscular dystrophy told me  "You never accept the loss, but you just adjust to it." How wise she was. So my wish today for parents with growing children is that they hug their children tightly, make the day special for them, and reach out to all those who are not as lucky. I find that going one day at a time is the best way to live while trying to do what each of us can to help those with problems or are less fortunate. No matter what religion an individual practices or does not practice, trying to reach out to others always pay off.  Merry Christmas and Happy Holidays.

 

Sinus Infection in Little Children

I was recently at a gathering where I spent some time talking with a young couple who had a beautiful two-year-old. The child was fill of energy, but I was concerned that the parents had to frequently wipe her nose because of the thick pus that was draining out. They knew I was a pediatrician, so I asked what her doctor said about this and they answered that she was talking about a tonsillectomy and adenoidectomy or T and A. They also said that the little girl, I will call Nancy, had not had ear or throat infections. I didn't say any more to the parents, but kept wondering why the doctor was not referring the little girl to a pediatric ear-nose-and throat doctor to take care of what I am sure was sinusitis. Many doctors, even pediatricians and family doctors don't realize that small children can have sinusitis. There is no reason to remove the tonsils without a history of tonsillitis and ear infections. Removing the adenoids might help if they were enlarged. Instead the nose should  be  suctioned out with a bulb syringe or a nasal spray or nose drops can be used. If there is a strong history of allergy in the family, a pediatric allergist might also help. A humidifier can also help sometimes.

Babies have two sinuses present at birth, the ethnoid and maxillary sinuses and the frontal  sinuses develop about age seven. The sphenoid sinuses don't  develop until the teenage years.

When I was in private pediatric practice, we had a wonderful ENT doctor who taught me a lot about sinusitis in small children. He was always amazed at how much infection he found in the sinuses of even very little children. He frequently said how much he wished pediatricians were taught more about this in their training. So sometimes parents have to take things in their own hands and get a second opinion from a pediatric ENT doctor. A tonsillectomy should never be done if it can be avoided.

Handling the Stress of the Holidays

Many parents find the holidays to be a time of great stress because they try to do too much for their children, as well as entertaining and reaching out to others. The holidays are particularly hard for single parents, who often try to make up for being a single parent by buying their children too many gifts and giving them extra expensive fun times. Many children have told me they wish their parents would be less crazy during the holidays. They would rather have fun time with their parents, than having them so busy.   Expensive gifts can never make up for quiet time with parents, a walk, an ice cream cone or just talking.

My wish for both mothers and father during these holiday days is that they take some time for themselves, spend some fun time with their children and enjoy the beautiful music and wonderful decorations. Trying to keep up with or outdo their neighbors and friends makes no sense. Elaborate decorations,  both inside and outside the house don't mean much to children. They would far rather have some special times, with the TV, cell phones, and video games off, making cookies, decorations and even gifts for friends and neighbors. Even though money was not plentiful, I well remember the  gifts we helped make for good friends and neighbors. Delivering them was part of the tradition.

Having some special family traditions is important. Children love and need traditions and structure. This makes their days more fun and helps them feel loved and safe.

Children Two and Under are Being Given Anti-Psychotic Medicines

According to an article by Alan Schwarz in the 12/11/15 New York Times 20,000 prescriptions were written in 2014 for a powerful anti-psychotic medicine for children two and younger.  I cannot image what the doctors were thinking. I wonder if any medical studies were done? It is so much easier to write out a prescription than it is to spend time ordering studies, talking with other specialists and seeing a child frequently. I wonder if the children even had physical examinations? Also, did they have brain scans, an EEG, metabolic studies and a blood panel. There are many reasons that children have convulsions or seizures and metabolic studies are seldom done in my experience and according to one of the  the authors of the best metabolic book for physicians. Dr. Milan Blaskovics, a long-time friend, taught me a great deal about children with metabolic problems and I also brought him to San Francisco to see some patients about whom I had questions. Sadly, he is not longer living, but his book that was written with two others is still available for doctors. Unfortunately, pediatricians and other doctors seem to  have little knowledge or training in these disorders according to Dr. Blaskovics.

Sadly, there are just 8,350 child psychiatrists in the U.S. This is partly because this is not a money making area of medicine. It takes a really dedicated doctor to put up with all the present rules and regulations and also make a small income. Pediatricians are also at the bottom of the income scale for doctors and so many try to see as many patients as they can each day to boost their income. Sadly, this leaves parents with a child who is having problems to try and find answers on their on. I think these parents may have to try several different doctors before they find a really special one, who cares more about the children than his or her income. There are some centers, such as the Mayo Clinic where the old-fashioned practice of medicine still exists. Lots of networking is required often to find the right doctor, but having a doctor write a strong adult prescription for a screaming child, who may also be having seizures, is not the answers.

Teenagers and Sexting

I talked with two thirteen-year-olds a few days about sexting and asked if they knew anyone their age who was doing this. They both said "Yes." One girl goes to a private school and the other to a public school. When I asked why any girl would want to send a nude picture of herself to a boy, the one girl answered, "She wants a boyfriend!" I was appalled.

Where are the parents of these girls and what are we teaching our teenagers? Is having a boyfriend when you are thirteen that important? I think the magazines, the Internet and society are all pushing teenage girls to grow up much too fast. My grandson told me that when he was a teenager, he would notice after summer vacation that some of the girls in his class had had facial or breast surgery. Is there a certain  picture of beauty that teenage girls and young women are trying to achieve in order to be attractive to boys and men? What about just getting a good education, being introduced to art, music, literature, theater, and dance? Europe is so far ahead of us in their schools and I believe in many ways in what they are teaching their young people. I believe that France actually subsidizes artists, which we certainly don't do in the U.S., according to my artist friends. When I was a teenager, the farthest thing from my mind was having to have a boy friend. I started working when I was about thirteen after school and weekends, had chores, lots of friends and went by myself to concerts at Pomona College where my father was a professor. We had little money, but life was rich in other ways. Perhaps if parents spent more time talking with their kids and having fun with them, the need for girls to do something like sexting would disappear. Also if parents brought up the subject of sexting with their teenagers, that could be very helpful. It would also be important to talk about sex in general. I gave many sex education talks when I was in private pediatric practice and at one private school,  a girl's mother asked that  her daughter not attend my talk. A few days later, the mother called and asked if I would talk with  the girl about intercourse and similar topics. She said she was unable to do it, but realized it was time!

Breast Feeding Found to be Good for Mothers as Well as Babies

Breast feeding can be a special experience for women, if someone helps them to get off to a good start after a delivery. Until now most of the benefits were thought to be for the baby, but now an article in today's New York Times by Roni Caryn Rabin states there are medical reasons why breast feeding helps lower the risks of several disorders. The most important ones cited  are breast and ovarian cancer, Type 2 diabetes, and rheumatoid arthritis. One professor of medicine said that if almost every woman in the U.S. breast-fed, there would be about 5,000 fewer cancers diagnosed each year. She also said that there would be 14,000 fewer heart attacks. Women who developed gestational diabetes, and are said to have a seven times great risk of developing regular diabetes after pregnancy and they could cut this risk by 50%. Further discussion of rheumatoid arthritis was not given, but since the immune system is involved, the reduction in the disease makes sense.

Breast feeding has long been said to be good for babies, particularly if there is a strong family history of allergy. It also seems to help babies ward off diseases while they are breast-fed. However, I worry that when a mother is unable to breast feed even with good help that she will be made to feel guilty. I have seen this happen, both in the hospital and in mothers' groups and on Blogs.  Many babies, who were not breast-fed or breast-fed for just a short time, have grown up to be healthy, intelligent women. Like all medical studies, these  could prove to be over-stated, so  each mother should make the decision about what is best for her. Women who work and try to both breast-feed and carry heavy loads may put themselves at risk for all kinds of medical problems. So using good commonsense about what is right for you is still the best answer.

 

Can Parents Help Stop These Mass Shootings?

When so many teenagers were being killed because of drunk driving, mothers banned together and got stricter driving laws passed. I believe that if mothers, fathers, grandparents, friends, and family members joined together and forced Congress to do something about guns in the U.S. that we would have fewer deaths from these daily mass shootings. Thirty murders are committed each day and there are 300 million guns in the U.S. Of course, the NRA wants every citizen to own one or more guns, so their supporters, the gun manufacturers can make more money. They are immoral and not supported by even the majority of gun owners. My father, brother, and former husband enjoyed hunting, but they would have been the first to want stricter gun control. Background checks and the steps that Senator Bernie Sanders has outlined to help control these mass shootings are all needed. Even Ronald Reagan supported gun regulations and this included a mandatory waiting period before a gun would be available after a purchase.

We certainly do need better access to mental health care, but if Paul Ryan has his way, he will reduce very possible support for people in need. With forty percent of the wealth of this country going to the top 1%, mothers, fathers, and family members are going to have to make their voices heard if we are going to get any kind of gun control and mental health legislation. If we value our children and families' lives we must vote and get involved. We can all make a difference, as did the Mothers against Drunken Drivers.

Scoliosis in Children and Teenagers

There has been a lot of progress made in the treatment of scoliosis (curvature of the spine), but there  has not been much progress made in the early detection and diagnosis of this problem.  Because of inadequate teaching of physical diagnosis in medical and nursing schools, the diagnosis is often greatly delayed. Another reason for the delay in treatment is that children are not being undressed when they are given physical examinations. The store retail clinics are a place where the diagnosis could be made during a physical exam, but if the nurse practitioner does not have a child undress down to their shorts or underwear and the back examined, the curvature will be missed. Occasionally, I see an adult with obvious scoliosis and wish so much that their curvature of the spine could have been detected early  and treated.

I remember, as a young doctor, doing a school physical examination on a small child. She had an obvious scoliosis and I knew she was being followed for a congenital heart by a prominent pediatrician. When the mother asked why the doctor had not found the curvature she answered her own question by saying. "He never had me take off Ellen's blouse!"  I almost missed a congenital scoliosis in a beautiful doctor's child because she had long curly hair and if I had not lifted up her hair to see the top of her spine I would have missed the early curvature. How glad I was that we had had such good physical diagnosis and orthopedic training in medical school.

My many patients with neuromuscular disorders, such as spinal muscular atrophy, Duchenne muscular dystrophy, and cerebral palsy all were likely to have scoliosis. I worked with some outstanding orthopedists and the patients did very well. It was so important after the scoliosis surgery that the patients get upright as soon as possible and start having physical therapy. One arrogant orthopedist, who would not listen to me, had a teenager lie in bed for almost a year after her surgery and  greatly changed her life. I finally told the parents I could not be involved in her care because they would not  change orthopedists and how important it was to get her up and moving. Their orthopedist had no knowledge of spinal atrophy and thought he had all the answers. So parents need to be sure that a surgeon has adequate knowledge of the neuromuscular disorder if he or she is going to do scoliosis surgery.