Rx For Parenting Today

Skateboard and Scooter Injuries and Deaths

I went out into my front yard this morning to pick up the paper and saw a teenager riding a skateboard down the middle of the street. No, he was not wearing a helmet which is required in California for those under 18 years of age.  I checked my computer to see how many deaths and injuries are occurring because of skate  boards. Thousands are injured every year and at least 30 have been killed in the last year or so.  Of course, those are the ones that have been reported.

Then I started thinking about all the kids and adults riding scooters that I see all over my small town, In checking the statistics, I discovered that in the last year there have been 1500 injuries and at least eleven deaths. I have never seen a scooter rider wearing a helmet. I remember one time I was standing next to a teenager at a stop light. He was holding his bicycle and a helmet was in the basket. I wondered if he wore the helmet when he left the house and then took it off. Many kids think they are invincible. If they have ever spent time in an ER, as I did as a medical student, they might think differently. 

Of course, now we have kids coming to ERs because of gun shots wounds. If you ever saw a child die from a gun shot wound as I did in an ER as a medical student you would fight hard against the gun lobby and the NRA.  I know many schools have gun drills but perhaps they need some ER doctors to talk also about skateboard and scooter injuries.  I had a classroom added to my pediatric office and had ER doctors and other medical professionals give talks. Several parents told me how important these talks were to them. I wonder if any pediatrician still does something like that. I believe we should educate parents  in our practices, as much as we can. Parenting was always hard word, but it seems to get harder and harder. 

 

Finding a Good Pediatrician

I am often asked how to find a good pediatrician. This may be from parents about to have their first child or parents new to an area. My advice is first for the parents to network with friends and neighbors to see who they suggest. When the parents get one or more names I  then advise they check the Internet to see where the doctor graduated, what training he or she has had, is he or she board certified and how many years the doctor has been in practice. In general, I  would want an older, experienced pediatrician.  If there are any malpractice suits filed against the doctor this is important to note, although the  suits  may have no merit. 

The next thing I would do is make an appointment with one or more doctors to see how you  are treated by the office staff and if you feel comfortable with the doctor.  If the parents already have children I would want them to meet the doctor to see how they are treated.  The questions I would ask the doctor are if he or she takes care of his or her own patients in a hospital or if they  leave the care to a pediatric hospitalist. Also will the doctor meet the parents in an ER or leave the child to the care of an ER physician. Unless there has been an injury, I would not want an ER doctor to see a child. The pediatric training many ER doctors get is often minimal. I would also want to know if the doctor does see all of the office patients or leaves a nurse practitioner or physician assistant to take care of some. That to me is unacceptable. You also want to know which hospitals the doctor has staff privileges and does his or her office take the insurance you have.  With what doctors does the doctor trade night and weekend calls and finally are antibiotics ever prescribed over the phone without a child being seen? That is just bad medicine and can lead to some tragic results.

Children and Immunizations

I was asked to reply to a doctors' group yesterday about what I would do if a parent refused immunizations for a child. For me that was a simple answer. Having seen the tragic effects of polio, measles, mumps, and chicken pox, I said I would tell the parent he or she would need to find another pediatrician. Then I would follow-up with a certified letter. 

I agree that children are receiving what seems like too many immunizations these days, but the experts say these are needed. Now that we are seeing over a thousand cases of measles in the U.S. it is even more important that children be immunized. 

I was an interne in the final year of the polio epidemic. We had an entire floor at Children's Hospital in San Francisco of post-polio children. It was heart-breaking to see the children with bodies, or arms and legs that were useless. I also was in the acute polio ward for over a month and had to make the decision when and if a patient should be put into an iron lung. If I waited too long, the patient could die and and if I put a patient in too soon, it could cause problems. I had a resident who should have made the decisions, but he was often not there. That was a very scary experience. 

When I was in practice before we had all the immunizations, I had a youth with limb-girdle dystrophy who was  deaf from mumps. I also had a teenager with encephalitis from chicken pox and numerous other problems because of childhood diseases.

I am puzzled why some parents think they have the right to deny their children protection from diseases when they can have such bad side effects. Dr. Andrew Wakefield did a terrible disservice to children when he published FALSE information that autism was caused by immunizations. Several studies have proved his research was false and yet many parents still believe it. 

Air Travel and Medical Problems

Every time I get on an airplane I offer a silent prayer that there will not be a passenger needing a doctor. I have had to help passengers several times on flights and on one trip had to have the plane land in Detroit because there was no medication available I could use to  treat a man  who was having seizures.

On a recent flight to New York City, I ask ask a flight attendant what medications they carried on their flights. The woman kindly gave me a list of things in their medical kit. They did have epinephrine, which can be life-saving, but there was nothing like Valium or anything to treat seizures. I was glad to see they had gloves and both adult and pediatric airways. The attendant said they were required to to a yearly CPR course and had to also be able to use a defibrillator. 

A recent article in the New York Times discussed chronic drug shortages on airlines. It said the the FDA granted airlines exemptions if the airlines said they could not replenish certain drugs. That is ridiculous and of course is because of the cost of epinephrine and other important drugs.  The article stated that "There are no data on how many airplanes may be flying at a given time without drugs." If you are someone who might have medical problems on an airplane or have an allergic child, it would be wise to carry any drugs that might be needed. I would also be very vocal about asking an airlines what drugs would be on a plane if you have a child with medical problems or are traveling with an adult with known problems. Being prepared before you board is wise if any medical problems  could be possible.

What are We Doing to our American Kids?

I have been reading through several articles I have saved about parenting and they are depressing. The U.S. is ranked 37th in the well-being of children. Yet we are the richest nation in the world. What are we doing wrong? Europe is the top in the world. I have worked in England and visited France many times and been impressed with the concern parents have about their children. Family is very important to them and Sunday meals are a must in many of the families. That means meals without the TV on and no cell phones at the table. How many American families have these rules?

In the U.S., American infants are 76% more likely to die in their first year than in other advanced countries. Part of this may be that 425,000 kids are uninsured in the U.S. That is criminal.  Also 1/2 million kids suffer from lead poisoning and youth suicide in the U.S. is at the highest level on record.  25 % of  shooters have mental illness, yet many of these  have  identifiable signs of problems that are not treated. 

Now we are seeing a problem with vaping in teenagers and vaping appears to be targeting kids.  Six deaths have occurred and vaping is causing lung damage. Where are these children's parents? Do the parents have any idea what their children are doing? Yes, many of the parents are working two jobs to keep their family afloat and all Trump and his group can think of is getting a second term and taking care of themselves. It is embarrassing to be an American these days. My friends overseas can't understand what is happening to our country. Money and position have become all important and for many kids their goal is to find a way to  make a lot of money when they are adults. Instead of finding a job they love and are passionate about, money is the overriding goal. What a tragedy.