Rx For Parenting Today

Parents and Teenagers

Recently a teenager told me she "didn't like to spend time with her parents." It hurt me to hear her say that since I knew how important the teen was to her mother and father.  As an only child she had never had chores, nor had to wait for anything. Money seemed always to be available to her, even though the parents were not wealthy and worked hard.  She had had one job, but quit after a few days. 

I spent some time thinking about my two children when they were teenagers. We had fun together and worked as a unit, even before I was divorced. Their father was a wonderful doctor but we rarely saw him. His patients loved him.

As kids are growing up, I believe they need to feel they are an important  part of the family. It does not take money to  have special times together. I remember  a mother of two disabled children tell me "We celebrate even the smallest things."  The children loved her deeply.

When parents try to be friends and not parents, I suspect their teenagers don't want  this to happen.They have friends their own age. Instead they want to feel safe, loved and that their parents are in control. They want and need limits. Becoming an adult takes time, though some teens never really grow up. As parents, we need to  help them learn the steps to becoming adults. To do this some time together is needed. We are their role models.  I worry about teens who feel they are already adults and don't need to spend time or listen to their parents. Life is not easy and if they don't learn how to handle difficult situations and make lasting friends, the years ahead may be extremely hard. I  have always valued the time I was able to spend with my two children. Even when they were in college  and working in other cities we kept a close connection. I have  many of their letters in my book Letters Home. 

 

Kidney Stones in Children

When I did a post recently about stomach aches in children, I should have added kidney stones to the list of things that can cause them. For some reason kidney stones are occurring more frequently in kids now than in the past. There has been a three to five-fold increase in the last 15 yeas according to the physician, Dr, John Foreman. For some reason teenage girls  have these more frequently than teenage boys. I wonder if it is their diets and poor eating habits?   It is interesting  that African-American kids have fewer kidney stones. The symptoms of  blood in the urine and abdominal pain may not be present in some children, so doctors might not consider kidney stones. Under the age of six, the stones may be associated with a urinary infection. I always checked a urine if I couldn't come up with an answer when a child was not feeling well. I also always had a urinalysis done whenever I did a complete physical examination. I find that is not happening as it should when  complete physical examinations are done. This is particularly true when a nurse practitioner does an exam in a store retail clinic. The American  Academy of Pediatrics is very opposed to these clinics. 

One thing physicians also may not remember or know is that kidney stones can be associated with metabolic disorders. These are an unusual group of diseases and little may  be taught about them in many medical schools. I had a good physician friend, Dr. Milan Blaskovics, who was an expert in the disorders and also one of  the co-authors of a textbook about them. I always called him if I needed help. He was also an extremely good practicing  pediatrician and it was a great loss when he died. 

Stomach Aches in Children

Children get stomach aches for many reasons. Some pediatricians, even prominent ones, emphasis that most are functional. I disagree with that. When school starts and a child is unhappy about going that does occurs. However, there are several medical reasons children have stomach aches and many can be helped. One of the first things to consider, particularly in a small one who likes to drink a lot of milk rather than eating regular food, is constipation. Constipation can be the primary cause of a stomach ache and often urinary infections are associated with the constipation. I always had a parent keep a three day record of everything a child ate and mail it or bring it to me. I saw some unbelievable records. 

Allergy can also be a cause of stomach aches. Eggs, fish citrus, chocolate, nuts, and milk are the primary causes of many food allergies. There may be a family history of allergy or a child may also  have eczema, asthma or hay fever. Migraine headaches can also be due to an allergy.  A pediatric allergist should be consulted if allergy is a consideration. 

Problems with the urinary system should be considered. Congenital abnormalities of the kidneys, bladder,or ureters are often not thought of.  A urinalysis and urine culture should be done and if necessary a MRI or CT scan. I have detected a lot of congenital abnormalities of the urinary system and also had a sibling with a hydronephrotic kidney that  had to be removed. 

An unhappy child or one with learning disabilities or other problems may use stomach aches as a way to get attention and also get out of different activities. 

Excessive Parenting

I learned a new parenting term yesterday when I had lunch with a young woman who  had been one of my pediatric patients. She said the new term for over-parenting is "Lawnmower parenting" .
 She defined this as parents who clear away any obstacles their children might encounter in their lives, so  the kids don't have to make choices or overcome any difficulties. In thinking about this I wonder how these children learn to handle problems, manage stress and grow up. Childhood should be fun and safe, but there may be unfriendly classmates, difficult teachers and parents who  have goals in mind for their children that have nothing to do with what the kids want. There are also parents who push their children relentlessly because they want them to get into Ivy League colleges and become doctors, lawyers or financial wizards.

I know parents who start their children as young as age two in educational  pre-schools. Starting school later, particularly for many boys has shown it causes less stress and the boys do better long-term. Girls are usually able to start school earlier. I don't understand why there is such a push to get children to read by age five or earlier and homework starts even in the first school years.This is hurting children. 

One of the major problems some Ivy League colleges are having is students committing suicide. If a student has not learned to handle  stress or devise ways to keep going despite problems, they may see suicide as the way out. A recent report showed that even five-year-olds are committing suicide. That is appalling. I think it is time for  parents and doctors to re-think parenting. Children should have fun, feel safe and  be given lots of time to play.  I don't see this happening.

Treating a Low Grade Fever in a Child

A father called me from out of state one day about his little girl. He was a single, divorced parent and was concerned about the child's persistent fever. I asked him what the pediatrician said and his reply startled me. He said the doctor told him just to give Tylenol and let him know if the fever persisted. The doctor had not examined the little girl and didn't suggest he do so. Neither did he want a urine or blood count done. I could not believe the doctor's response. I said that if the father was unable to get an appointment with the doctor that day I would call him. My call resulted in the child being seen. I also asked that a urinalysis was done. The little girl  had a urinary infection and fortunately responded well to antibiotics. Little girls are more prone to urinary infections than little boys. I told the father to be sure that a repeat urine culture was done when the antibiotics were finished. I also asked if the child was constipated and the father said that was an ongoing problem. We talked about the child's diet and the father promised to make some changes. I checked two weeks later and the father had not only changed pediatricians but said the constipation was under better control and he and his little girl were a lot happier. 

The low grade fever could have been several things including an ear infection and a beginning chest infection. I would have examined the child after a day or so of a low grade fever and then every two days if it persisted. I certainly would have ordered a urinalysis, urine culture and blood count. Children can become ill very quickly and six days of a low grade fever without being seen by a doctor is just very bad medical  practice 

Keeping Children Healthy During Winter Months

Now that the days are getting colder, it is  time to "winter-proof" your children if you live in a cold climate. I am often amazed at seeing even little babies in light clothing when I am wearing warm clothes. I was waiting for a prescription one day at a big grocery store. In front of me was a mother and a cute little boy, about a year old. It was a cold morning but the child was running around on the concrete floor with no shoes on his feet. He also was not warmly dressed. I overheard the mother saying she wanted to pick up  prescription for the little boy's cough and ear infection. I had to bite my tongue not to say something. What was she thinking? I saw another child walking outside on a cold day and he was barefoot. I said something about him not liking shoes and the mother said causally, "Oh, he's a California boy". I wasn't sure what that had to do with walking around on a cold day without shoes. 

I was sitting in my car some years ago waiting for a friend when a saw a mother and her child. It was raining and the mother didn't have an umbrella. Neither she or the child were dressed for a cold, raining day. I had my own pediatric practice  at that time and was not surprised when the mother and child came to see me the next day because he was coughing and had an ear infection. The mother had no idea I had seen her the previous day. 

In addition to be appropriately dressed for cold weather it it extremely important that each child's immunizations are  up to date. The recent statistics are alarming because fewer parents are getting their children immunized. Dr. Andrews Wakefield, who  reported the false studies about the connection with autism, seems to still be having an affect. He even had an appointment with Trump one day. If you have ever seen a child die or become seriously ill from a preventable disease like meningitis you would rush right out to your doctor's office with your child if the child was not immunized.

Hearing Loss in Infants and Children

Hearing is so important to all of us that missing a loss of hearing in an infant or child can change their lives. I was  pleased to see an excellent article in the October 9, 2018 New York Times by Jane Brody. She noted that all newborns are supposed to have their hearing checked in the nursery after they are born. In my experience  this does not always happen and sometimes the test is erroneous. The article notes that "One baby in 1000 of those screened will turn out to have moderate, severe, or profound hearing loss that if not promptly and properly treated can delay the ability to speak and understand speech." The American Academy of Pediatrics says that every baby should be screened for hearing by one month of age, a diagnosis of hearing loss made by 3 months and special help started by 6 months. Sadly that , too, does not always happen. It often takes an alert parent or doctor to realize there is a problem.

Now that we have cochlear implants, they have made a great difference in the lives of people with hearing loss. I was talking to a college student one day who had had a recent cochlear implant put in place. She told me how her life had changed. Unfortunately, there are still the old school people with hearing loss who feel cochlear implants are bad and a child should be taught to sign instead. That makes little sense to me. Yes, there is a risk of meningitis with the implants but this is a treatable disease. I  have treated numerous children with meningitis and all have done well.

It is important to note that the earlier the cochlear implants are put in place the better the outcome will be. I always  had a child's hearing checked when I did a complete physical examination. I suspect this rarely happens in pediatric offices these days. So if parents have any doubt about  a child's hearing, it should,be tested in a special  pediatric hearing center. 

When One Parent has a Mental Health Problem or is Difficult after a Divorce

Children are often caught in the middle when parents divorce. Sometimes it is the father who makes it difficult and sometimes it is the mother. I have cared for children of divorce when a mother had an affair during the marriage and children whose other parent was abusive. Fortunately, now there are legal services for children that can help. There is an excellent one in San Francisco to which I have referred several parents. If children can be the concern of both parents rather than putting their own needs first, everyone wins. Children can pay a high price if a parent starts saying ugly thing about the other parent.  

If a child or children in the family are getting some counseling, sometimes one may refuse to go. My suggestion then is for the parent who has primary custody to suggest that he or she needs to talk with someone and asks the refusing child to go along. This usually works. 

When one of the parents has a mental health diagnosis, counseling is needed for both that parent and the children. With all the  new medications, quite a few mental health problems can be kept under good control. However, it is important that the adult continue to receive help and also take their medicine. It may take considerable legal help to establish guidelines about when a child or children can be with this parent. I'm sure  this is a constant worry for the custodial parent. Most children want to spend time with both of their parents, so it can be a difficult balancing act.  A good therapist and a good support system can make a great difference. I know adults who became excellent therapists because they  survived a divorce and a parent  with major problems. 

Raising a Child with a Disability

In my many years of  pediatric practice, I have cared for several hundreds of children with disabilities. I have been impressed by the strength and caring shown by most of the  parents.  Having a child with a disability either from birth or from an injury later on is devastating. Yet with only a few exceptions I have been amazed at how the parents managed. Many had little financial means but even those who did were quite remarkable. In many ways it was easier to care for these children than the children I cared for when I had my own private pediatric practice. When I made a suggestion about a child  with disability it was always taken seriously by the parents. Yet some of the parents in my private practice didn't seem to care if they were the source of problems with their children. I remember the mother who was a chain smoker and had a little boy with asthma. The allergist reported that smoking was causing a lot of his problems. When I told the mother she said. "Well, he can just  have his problems, I am not going to stop smoking". I was appalled and asked that she find another pediatrician. 

I think the answer for parents who have a child with a disability is to see the child and not the problem. Kids are wonderful and often handle a medical problem far better than other children. They are grateful for the love of  their parents and try to make the best of each day. One of my favorite patients, who died at age 22 from Duchenne muscular dystrophy, had a letter to be given to me after his death. He thanked me for my care and for helping to him to live  as normal a life as possible. His mother was a widow and a remarkable woman. She treated  the youth like a normal child and expected him to do  chores and have manners and respect for others. 

Treating Children's Eye Problems

Now that many physicians have an eight minute limit on how much time they spend with their patients, I hope all parents will be aware of some important problems that can be missed. Let me give you a specific example. A few years ago I was teaching in our nearby medical school and as we finished I walked outside with another instructor. She was a young practicing pediatrician. Her husband and baby were waiting outside.  Of course I had to  talk to the baby. I was concerned when I  saw the little little girl squinting. She had one eye closed and just looked at me with the other eye. I asked the mother if the baby did this often. "Yes" she said. "That worries me, I said. " What does the baby's pediatrician say?" "She hasn't said anything, the mother replied" I was greatly concerned and urged the mother to  have the baby seen by a pediatric opthalmologist. I also called a good friend who had been on the National Board of Opthalmology. My friend said "The child is probably seeing double, so if she closes one eye, then she sees normally."  I didn't know the mother's name, so did some checking and got her e-mail. Fortunately, with a little pushing, the mother took the child to a pediatric opthalmologist. The baby had bilateral strabismus or was cross-eyed. Had she not been treated by age 5 or 6 she could  have ended up with a blind eye. It is very simple for a doctor to do what is called a "cover test" to be sure the  eyes are working together and there is no sign of strabismus.

Another simpler problem that is often seen in children is an eye infection or "pink eye". This can be easily treated with antibiotic drops that the child's doctor needs to prescribe.