Rx For Parenting Today

Retail and Mini-Clinics and School Health Examinations

Now that August is almost here and many public schools start in August, parents are beginning to think about scheduling school physical examinations. I cringe when I hear an announcement in big drugstores that their mini or retail clinics are offering these. Having done many hundreds of school examinations, as a pediatrician, I know all the problems I have detected. If a teen is going out for sports, especially football or some of the more dangerous ones, a school examination can be crucial. Is there a heart murmur, high blood pressure, diabetes, or other medical problems? These cannot be found in a quick examination by a nurse practitioner in a small examining room when the child or teenager is not undressed. A urinalysis and basic blood count are also needed. What if a child has Type I diabetes or anemia, and they are not found or if there is a bad scoliosis. Several parents have told me that even their family doctors and pediatricians don't have the kids undress down to their underwear and put on a gown, but just look at the children above the waist. That is sloppy medicine and a great deal can be missed. 

Nurse practitioners do not have adequate teaching of pediatric physical diagnosis  in most programs. I recently helped a teen with a severe congenital abnormality get the needed quite dangerous surgery. She could have had an early death if the anomaly had not been corrected.  The mother, a nurse practitioner, said she felt guilty  about not recognizing the problem. My answer was that even though she went to a good nursing school, apparently physical diagnosis was not something they taught. The American Academy of Pediatrics has come out strongly against children being seen in these retail clinics. Parents need to insist that no matter where an examination is done that it is thorough and that a urinalysis, blood count and any necessary immunizations are included.

Teenagers in Night Clubs

 Why was a 12 year-old was in a night club in Florida after midnight when three or more gunman started shooting? Was the 12-year-old there with a group? Even if he or she was with other older teens, no 12-year-old should be out after midnight partying. Where were the parents? I was not aware that teens were allowed in night clubs where there would be drinking. Doesn't Florida have any laws against teenage drinking? I wonder what the rate of teenage deaths is in Florida when they drink and drive? 

I am seeing more instances of parents being so wrapped up in their own business and social lives that their children rarely see them. So how can the parents know what the kids are doing? Were these underage kids from wealthy families? I talked with a young woman in New York City one day and she told me how poorly her rich friends had turned out. She, herself, had an ongoing battle with anorexia and some of the teens from her private school had committed suicide, several girls had anorexia and few had gone on to have healthy, happy, productive lives. She said one rich father rented a nightclub for a teenage party where no parents were present and there was a lot of drinking. The young woman was not sure she wanted to have children, because she had no role modeling to be a parent and her life was an on-going battle, despite an excellent education and plenty of money. 

I am puzzled why some parents have children if they are not going to act like parents. Saying "no" is often unpopular, but in the long run, you will find that that is what children want. If parents are in charge then kids feel safe and loved. 

 

A Second Opinion Could Save Your Child's Life

If your child has been given a diagnosis that could mean prolonged medical treatment or a diagnosis for which there is no treatment, I hope, as parents, you will get a second opinion, unless the diagnosis is made by a physician who is a world's expert with that disorder. I have seen errors in diagnosis with both patients and my own daughter. When Jennifer graduated from college, a doctor in Colorado  referred her to the head of GYN at UC Medical Center in San Francisco, where I was living. The doctor ordered X-rays and other tests and when these  came back, he told Jennifer that she had a brain tumor and needed surgery. I immediately took the X-rays to a radiologist I trusted who had written a textbook on radiology. He looked at the films and said they were perfectly normal. The next day I was in the pathology department at UC and one of the pathologists was complaining about all the normal brain tumors she was having to look at. One of those could have been my daughter's. 

Countless times I have been asked to see patients with muscle and other disorders who had been completely misdiagnosed. One study was done showing that 50% of muscle diagnoses are erroneous. Some are treatable, such as dermatomyositis or polymyositis. These two causes of muscle weakness are most often called muscular dystrophy. 

Sometimes a treatable diagnosis can be made by something as simple as having a urinalysis done. I do not understand why doctors don't get yearly urine tests on children and also order one when a child has a high fever or just doesn't feel well. By always looking at a urine specimen, I have found pyelonephritis and glomerulonephritis. Also, a simple thing like a TB skin test can pick up treatable tuberculosis. Attention to detail in medicine as in many other fields is extremely important, so as parents don't ever be afraid to seek a second opinion. You could make the difference in a child's life.

Finding Safe, Reliable Out of Home Childcare

Finding safe and reliable childcare both in and out of the home is certainly a major problem for all parents. I had some scary times, both for my children and my little patients. Recently, I found a new book entitled The Importance of Being Little. It is by Erika Christakis and is primarily for teachers and those in education. However, she gives the interesting statistic that " almost half of the states don't require a license to operate an early childhood center, in his or her own home." She notes that the organization, ChildCare  Aware says about one-fifth of children who receive government subsidies for childcare are in totally unlicensed childcare. That is terrible and certainly something should be done.

In my new book, Your Personal Parenting Guide, I give a list of things parents need to check before signing up a child for childcare. First, you want to check that the center is licensed and accredited. I would also talk with other parents who have children there to see how they feel the children are treated. Is the place clean, have the staff had their backgrounds checked and have they been finger printed? Also, have they been cleared medically and had a recent chest X-ray or TB skin test? What is the ratio of staff to the number of children? Do little children get to take a nap and are sick children sent home? How close is the  nearest doctor or hospital and have the staff members had CPR training? 

I had one little patient who frequent bad ear infections. Once the parents changed her childcare, these were no longer a problem. Another child got into detergent and had to have surgery on his feeding tube or esophagus. So drop in now and then if you have chosen a place for childcare and see what is going on. You cannot be too careful. Children are precious and it just takes one bad incident to cause a lot of problems.

 

 

Mothers of Youths with Some Muscle Disorders are at Risk for Heart Disease

I find that few physicians these days take family histories and this is particularly important for women who have sons with some muscle disorders. If a son has Duchenne muscular dystrophy, Becker muscular dystrophy, or Emery-Dreifuss muscular dystrophy, it is important that the mother's doctor knows this and does the appropriate yearly tests. Because neuromuscular disorders are given little attention in most medical school and resident training programs, patients need to be aware of the dangers and remind their physicians about them. 

I had a favorite little boy as a patient when I was in practice in San Diego. I told his mother of her possible risk for heart disease because I had diagnosed her son as having Emery-Dreifuss muscular dystrophy. When I moved to the Bay area, I lost track of the family, but fortunately my son had an appointment for a physical examination when he was a college student and this mother turned out to be the doctor's receptionist! She asked if Geoffrey was my son and that evening I had a telephone call from her. She said she had been having shortness of breath and chest pain, but the cardiologist she had just seen wasn't worried. He did do a couple of tests, but then sent her on her way. I called the doctor the next morning, because I was concerned the woman might need a pacemaker. The doctor brushed me off, so I faxed several articles to him He called the mother the next day and a pacemaker was inserted.Later he told me I had probably saved her life. 

Another mother was not as fortunate. She, too, was having cardiac symptoms and I had her see a cardiologist. I did speak with him, but he did not do anything. I then urged the mother to get a second opinion also to no avail and then a cardiologist at my old medical school brushed her off. She was sadly found dead in bed one morning at age 45. The autopsy showed marked cardiac changes. The boys with this disorder often need a pacemaker in their teens, so parents need to be aware of this and let the boy's attending physician know there can be a potential problem.

Asking Parents of your Children's Friends about Guns and other Safety Questions

When I was raising my two children, it never occurred to me that access to guns in other people's homes could be a problem. I knew all the parents of my children's friends and was the pediatrician for many of the children. Now with guns such a political issue and with 33,000 gun deaths a year, asking about guns in other people's homes is something parents may have to think about and do. In Florida, a bill was passed that makes it illegal for a child's doctor to talk to parents about guns in their own homes or to suggest that they ask about guns in other people's homes. How can legislators tell pediatricians and family doctors what questions they can ask in their offices?  I know the American Academy of Pediatrics has tried to do something about this, but to my knowledge this law stills stands. Thus, I think parents have to be the ones to get to know the parents of their children's friends and perhaps over  coffee or a glass of wine talk about safety issues for their children. Checking on whether a family has a swimming pool is important and if an adult is always home when there are children there. If there are problems with allergies or other medical issues, these can also be discussed. This way guns can be brought up as a general safety issue. Talking with your children from a young age about what to do if they see a gun is also important. Little children do pick up loaded guns with tragic results. They think they are toys and have no idea what will happen when they pull the trigger. Mothers who carry guns in their purses and travel with little children are just asking for a tragedy to occur. Carrying a gun puts that individual and their family at great risk. 

4th of July Safety for Children

Most children love the excitement of the Fourth of July and remember it as one of the fun holidays. Those of us who have  had to work in an emergency room on the fourth have some different memories. I remember one little boy who held a live fire cracker in his hand and lost several fingers on his right hand. Other children came in with burns and then there were the children who were bitten by spiders,or snakes. Fortunately, we have  antidotes for the dangerous spiders and snakes. A first -Aid kit and some knowledge about what to do if you are camping and have problems with spiders or insects is a good idea. You can also call the National Poison Center at 1-800-222-1222. 

If you are traveling and staying in a hotel, please check to be sure the windows cannot be opened. Children  will climb out of windows and if you are in a room high up this can be very dangerous. Hotel swimming pools or any swimming pool should always have an adult in charge if children  are swimming. Diving into lakes can be dangerous if they are not deep. Using your  common sense can keep a vacation or a holiday from being a nightmare. 

Sun screen applied liberally and often on children over six months is important and having children wear hats and sun glasses can prevent a lot of damage. Insect repellent if you are in areas where there are mosquitoes or other bugs is also wise, especially now that the Zika virus is on the rise. 

I would not want your children to become neurotic about all the problems that can occur, but just teaching them some basic rules of safety is wise. Older children can help their siblings remember to watch for dangerous spiders or snakes if you are camping and they can also know how to call the Poison Center or 911. Kids are a lot smarter and wiser than many parents think. Happy Fourth of July!