Rx For Parenting Today

Persistent Coughing in Children

Dr.Perri Klass, a pediatrician, wrote an interesting article about coughs in the New York Times on 12-22-16. She quoted several so-called experts, but did not emphasis some things I believe parents need to know. If a child has a cold and  continues to cough for several days, I would want the child to be seen by a family doctor or pediatrician. If there has not been a fever and the child is eating well and nothing is seen or heard on physical examination, then perhaps a chest X-ray can be put off for a day or so. However, if the cough continues, I would want a chest X-ray to include the neck. I saw a child who had been seen by several doctors for a cough that was thought to be croup. A chest X-ray had been taken and was negative. When I saw the child, I asked that the X-ray be repeated to include the neck and there was a safety pin in the windpipe or trachea. Once it was removed, the cough went away. Lobar pneumonia can show very few symptoms  and often can only be seen on a chest X-ray. Sometimes, it takes a few days for the pneumonia to be seen, so a repeat X-ray needs to be done if the cough does not clear up. 

When there is a family history of allergy, it may be particularly necessary for a child to be seen by a pediatric allergist. Often household pets, dust or other things can trigger a cough. Croup has a very distinct sound and can be dangerous if it is not adequately treated. When we lived in Rochester, New York, my children both frequently had croup during the winter and we became adept at setting up a croup tent with a cool mist vaporizer running inside of it. Cough medicines that don't suppress the cough can be helpful in older children. A cough medicine that contains DM should not be given to children because coughing helps bring up  mucus.

My Holiday Wishes for Parents

I hope this holiday can be a time of special memories, instead of a time of great stress or family illnesses. Many parents, particularly mothers, try to have  the perfect Christmas or other holiday celebration and do too much shopping, cooking, and entertaining. Finding ways to keep children occupied when there is no school can be hard, particularly if a child has ADHD, autism, or another special problem. Having some extra help, if that is financially possible, is a good idea and also giving older children chores to do and other responsibilities is wise. It is important, too, for parents to take times for themselves because this can decrease the stress level considerably. Many teens seem to expect their mothers to be constantly on-call to drive them to friends' houses or various activities. Saying. "no" appears to be difficult for some parents, while chores, time alone. or reading a book are a concept lost on many kids. They just assume their demands will be met, which amazes me. 

This time of year is particularly hard for parents who have lost a child, as I have. Remembering your special times together can get you through the days. Also, grieving for a few minutes every so often and then going on with your day is one way to ease the pain. Not only can losing a child be worse this time of year, but also a parent or partner's death can be much more painful during this holiday season. So my best wishes to all parents and let's hope that 2017 brings better times than many anticipate.

Betsy DeVos and her Terrible Plan as Secretary of Education for Public Schools

Mrs. Devas, a billionaire, and the proposed Secretary of Education is a product  of a Christian private school and Christian college. I find no evidence that she has had any training or education in how children can and should learn. It seems that her whole focus is going to be on trying to close the public schools and have only charter schools with a curriculum based on evangelical Christianity. To me this is a scary concept. Yes, our public schools in many places, particularly in the inner cities, need a great deal of help, but taking money from public schools and putting the dollars into charter schools is not the answer. I have many retired teacher friends. who are terrified about what will happen if Mrs. DeVos is allowed to become Secretary of Education. If parents can afford a good private school, they are very fortunate, but most parents do not have that luxury. The charter schools are not the answer because many of the students don't attend classes, but do everything , even tests, online. They miss interaction with teachers, other students and outside activities, even sports. 

I am puzzled why someone like Besty DeVos and others in the evangelical movement think they have all the answers about religion. I have taught several Sunday School classes and think having faith is very important. But for those in power to force religion down everyone's throats is just plain wrong and also arrogant. How can a billionaire, with no training in education, possibly know what is best for America's children? I think as parents and grandparents we must speak up and demand someone with training in education to be the new Secretary of Education. As the daughter of a college professor, I know how important education is for everyone. We need better schools, including trade schools, and adequate pay to give us excellent teachers. Otherwise I am afraid America is in for a rough time in the next four years and beyond.

Children and Teens Want and Need Limits

I was talking with an older woman the other day who said she had just had had a bad experience with her teenage granddaughter. The grandmother had offered to drive the teen to school and when the girl was ready to leave she said, "I want to stop by Starbucks." The grandmother was surprised by the request since the girl never ate breakfast and she did not know the parents let her drink coffee at age 14. When the grandmother said "No, I am sorry but we need to leave right now for your school." The teen looked at her in amazement, the woman said as though no adult had ever said "No" to her before. The girl started pouting and went back to her bedroom probably to call her mother. The grandmother went after her and said "We need to leave now." The ride to school was tense with few words spoken by the teen. 

I told the grandmother how many times teenagers had told me how they wished they parents would set limits, so they would know the rules. When parents or grandparents are in control, children and teens feel safe and know what to expect. It is more difficult to say "No" than it is to let kids be in charge, but the children pay a high price for not having an adult in charge.

Keeping Children Healthy During the Winter

I was waiting for a prescription one day recently at a pharmacy located in a large grocery store. As I waited, I saw a mother approach with a cute little boy, who was probably about a year old. It was a cold morning and I looked with amazement as the mother let the little boy run around on the cold concrete floor. Despite the cold weather, the child had no socks or shoes on his feet, no sweater, and no hat. Then when I overheard the mother say that she was picking up a prescription for the little boy's middle ear infection, it was hard for me to keep quiet. What was the mother thinking? She was warmly dressed in long comfy  boots, jeans, and a heavy sweater.

I remembered another young mother walking down the street with her child in the rain. I was sitting in my car waiting for one of my children and saw that the little boy didn't have on warm clothes and the mother had no umbrella. Guess what? The next morning the mother and little child were in my office because he was  quite ill. 

It is very important during these cold winter months to be sure children are warmly dressed when they go outside. Also, it is extremely important to be sure their immunizations are up to date. There are been deaths from flu and pneumonia recently and ear infections can quickly take their toll.  Untreated ear infections can lead to mastoiditis and even meningitis. Then, if a child has not had any immunizations serious problems can result. To lose a child from a preventable illness is something I cannot understand. I wish parents who refuse immunizations could see the kinds of problems I have seen during my pediatric training and in my pediatric practice.

Problems with Vegetarian Diets for Children

I was talking with a grandmother recently who was concerned about her small grandson. The child's mother was a vegetarian, she said, and the little boy always seemed irritable and unhappy. When the child was at her house, the grandmother fed him non-vegetarian meals and the child seemed much happier. The grandmother felt the little boy was not getting enough protein because of the restrictive diet he had at his house. He was underweight and didn't sleep well when he was with his parents, but at the grandmother's he slept well.

There is an excellent book by Henry Legere, M.D. where on pages 116 and 117, he discusses vegetarian diets for children. He states that a "child would need to eat anywhere from three to seven times as much non-meat protein foods to get the amount of protein found in a single serving of meat and cheese." Few children are able to eat such large amounts of food and particularly if it is not very tasty. I cannot imagine having to live on tofu and vegetables. I think if a parent or parents want to be vegetarians that is fine, but I have seen bad results when they try to make their children eat vegetarian meals. Adequate protein is needed for good muscles, bones, the brain, and general health. Dr. Legere also notes that "the body absorbs only about 5% of the iron in vegetables and grains, compared to about 20% of the iron in meat, poultry, and fish."

A young woman I know is a vegetarian and had problems with breaking bones. She consulted different doctors and was not given any answers. None of the doctors asked her about her diet. When I suggested she speak with a dietitian, she was grateful, because it turned out her intake of protein was very inadequate. She gradually increased the amount of protein she ate and has not broken any bones since then.

Parenting a Child with Rheumatoid Arthritis

I was working in a neuromuscular clinic, before I started my own pediatric practice, and the head of the program asked me to see a six-year-old girl referred by a doctor who thought she had a muscle disorder. In taking a history from the parents, I was told that the little girl would wake up and cry in the middle of the night because of pain in her hip. That immediately rang a bell for me and I suspected the child had rheumatoid arthritis, because hip pain is a common presenting symptom. In doing a physical examination, I could not find any muscle weakness and told Dr. Munsat that I was sure the girl had rheumatoid arthritis. He didn't believe me and went ahead with a a muscle disease workup. A year later he called and said, "Do you remember the child you thought had rheumatoid arthritis? You were right!"

Unfortunately, few physicians have training in this disorder, unless they have pediatric training in a place like Los Angeles Children's Hospital, where they have an outstanding teaching program in rheumatoid diseases. I don't remember even hearing about the disease as a medical student and sadly that seems to be what still occurs in the U.S. Unfortunately, the early lab work is usually withing normal limits, so the diagnosis has to be made by someone who has had training and experience with the disorder. It is an important diagnosis to make becasue early treatment can prevent some of the bad side effects, such as eye problems, smallness of the jaw and on-going pain.