Rx For Parenting Today

Anorexia and Other Eating Disorders

There was an interesting article by Jane Brody in the 7/28/20 new York Times about Eating Disorders. She brought up some interesting points but did not address two important subjects. As a practicing pediatrician I treated many girls with anorexia and bulimia. I was fortunate to have a wonderful woman psychiatrist to help with the girls and as I remember we  did not have to hospitalize a single one. What we both found was with eating disorders there were things going in the patient's family and social life that were contributing  to the problems. Now with social media, there is an even greater problem. Also with the focus on both female and male beauty , we are seeing even more teens with major eating problems. 

The one major fact that Jane Brody overlooked or doesn't know is that nutrition is seldom or never taught in medical schools. I don't remember any mention of nutrition  when I was a Stanford medical student or pediatric intern and resident. I learned about nutrition on my own  and from feeding my own children. I have had many medical students and house staff  tell me that I am the only physician they have ever heard take a diet history. That has always been part of my physician examination. Now that doctors often limit time with patients to ten to fifteen minutes there is just no way an eating disorder can be discovered unless that is the subject of the examination or a teen is obviously gaunt. 

Males can have eating disorders, as well as females. Sometimes their disorders are more about wanting to build body mass and not to look skinny. They may eat a lot of supplements or even take something like steroids. Those can be very harmful if not well regulated or prescribed for something like polymyositis. Parents, too, can be in denial or insist that their children look perfect. 

Finding Services for Children with Disabilities During this Pandemic

It must be especially hard for parents who have a child with a disability to get the services their son or daughter needs during this awful pandemic. I received the PACER newsletter today that is about kids who need special help. There is an excellent quote by Rachel Pearson " We don't know the magnitude of the skills that students with disabilities have lost, so it's hard to fully realize the colossal work that families and school districts will face in the future to help students with disabilities recover those skills."

A good resource for parents of special kids is the telephone number 1-952-838-9000 and their email is PACER@ PACER.ORG. They offer support and advice and have several pamphlets, as well as workshops online. These can be found at PACER.org/workshops.

I have always found their newsletter informative and would suggest any parent who has questions about how to handle their child's special needs during this difficult time to give them a call.

All parenting is hard work with many worrisome times, but I have found working with these special parents to be rewarding and inspiring and have met some amazing parents.

 

Medical Concerns and Tips about Infants

If you are a new parent, it is important to know the signs to recognize that the baby should be seen by a pediatrician or family doctor. Hopefully, you will have a baby scale, so you can check for weight gain or loss. If an infant is not interested in nursing or a bottle, I would be concerned. A poor suck can be a problem, although it might just be that the nipple of a bottle is not right or some help is needed with breast feeding.

If an infant seems listless or is not moving very much that is a real cause of concern. Breathing problems or a yellow color to the baby's skin are signs medical advice is needed. Oozing around the navel should be investigated, as  should pus oozing from one or both eyes. If you are hearing a high-pitched cry or non-stop crying something is definitely not right. Diarrhea or an elevated rectal temperature means a doctor should be seen. 

I remember being called to a hospital nursery one day by the doctor in charge. He was sure an infant had a tumor surrounding the penis. I asked one of the medical students or residents to bring me a gauze and gently teased back the foreskin.  A substance called smega had collected which I removed. The resident and medical student were appalled since the doctor in charge had said the baby had a tumor. I was never that doctor's favorite consultant after that!  Little girl babies  may also have a cheesy-like substance around the labia. 

If an infant has an obstructed tear duct, some doctors advise a surgical procedure. This can usually be avoided if you try  massage at the corner of the eye for several days and warm compresses. 

Emergency room doctors are not the ones to see because many of them have had little pediatric training. I would also not want a nurse practitioner to be seen because they also may not have had training in problems like these. 

Questions to Ask Before Children Return Safely to School

I have  a list of 14 questions to ask schools before allowing a child to return to school. 

1. Will the kids have daily temperatures taken?
2.  If a child's temperature is elevated and the parents can not be found what will be done with the child?
3. Will a nurse be present each day at the school?
4. How many children will be in each school room and will the desks be separated by six feet?
5. How will the children be kept apart on the playground?
6. Will school be a full day or just a few hours?
7. Will staff wear protective masks?
8. Will the staff have virus checks before they return and how often will they be checked?
9. What protections will there be on buses and how often will buses be cleaned?
10. Will there be daily cleaning of classrooms, bathrooms, door handles and desktops?
11. Will the children have to wear masks before they enter school?
12. How will lunchtime be done safely?
13. Will box lunches be served at the children's desks?
14. Will special ed students still receive, P.T., O.T. speech therapy etc, as mandated by their IEPs?

A Controlling Parent Can Have a Life-time Impact on a Child

As a practicing pediatrician, I saw wonderful parenting and some that was truly terrible. I think the hardest thing was seeing parents who wanted to control everything their children did, said, and how they looked. I have long-term follow-up of many of the children and know what damage was done to the children.  Far too often the parents who came to the  parenting classes I held were not the parents who truly needed them. Perhaps I persuaded some parents to change but it always was an up-hill battle.  One father insisted on weighing his teenage daughter every morning. When she developed anorexia, I was not surprised. 

One parent was abusive and his son paid for this by becoming very closed and unwilling to trust. His relationships were not happy ones. Another parent was very strict and always wanted a male child. Instead he had five girls. One of the girls was accepted by a medical school, probably to impress her doctor father, but she committed suicide her second year. What a tragedy. 

Parenting is hard work and means a lot of worrisome times, but the joys far outweigh the problems if the kids become well-rounded, loving adults. They should be allowed to make their own choices when they become adults and their talents should be encouraged not controlled. 

How Foster Children are Treated in the U.S.

I  wonder if people who are against abortions have any idea of what happens to the mothers who cannot get an abortion and have to give up their children because they can not feed and clothe them. To be a foster child in the United States can be good or terrible. We now have 400,000 foster children in the U.S. and twenty-two babies are left each year at hospitals.

I have a long-time friend who was given up for adoption and spent many years in foster care. Social workers tell me many children go from foster home to foster home in what they call foster home drift. How can you have any sense of being valued or wanted if you know your mother gave you up and often continued having children? Some foster parents are great and I have met several. One wonderful foster mother adopted two of the children after her own daughter was killed in an accident. 

Some foster children are abused, some run away because they are being used as a way for a parent to make extra money.  Many are treated like servants and forced to work very hard. We don't have enough social workers to regularly check on foster children and so many of those who are abused have no recourse but to run away. Then they often become homeless or some turn to working for drug dealers.

In this rich country where some CEOs are paid as much or more as 25 million a year it is embarrassing to be an American. Poor people have little power and yet perhaps with the new marches about black lives and poverty we hopefully will see some changes in this country. However, if Trump gets his way in appointing more conservative judges we will have more homeless and foster children. Something has to change!

How Can Schools Open Safely?

The mother of two middle school children asked me if I felt it was safe for her kids to go back to school in September. She lives in one of the best school districts in San Diego and they are asking for thoughts from parents. I sent her a list of my questions and told her I would be glad to talk to  her about them some more. She was a favorite patient of mine, as were her sisters and we have kept in touch for many years.

In thinking about the problems parents are having in deciding whether they were willing to put their children at risk if they go back to school I thought about how I would feel if I had small children.The American Academy of Pediatrics, of which I am a fellow, has said children should back to school. However, they give no specifics about what the schools should do, nor does Trump. Children certainly need socialization with their peers and online school is just not the same. I do not understand why any parent would either home school or allow a child to have schooling entirely on-line if they had a choice. I don't think either are healthy for children or teens. A particular problem with online or home schooling is for children with special needs. P.T., O.T., speech therapy, and other things specified in an IEP would not be available.

I think I would find a way for small children to have lots of books and other learning tools and not  allow them to go back to school if I was not satisfied with good answers to my 14 questions. If any parent would like a copy of my questions, you can e-mail me at [email protected] and I will be glad to send them to you.  

Finding a New Pediatrician

A young mother was moving with her husband to a different state and asked me how to find a good pediatrician. I suggested she check with parents in the new town, but reminded her that the most popular pediatrician was not always the best. There are doctors who have great personalities but their training and care may not be good. My parents had a doctor like that, who they loved, but he was very inadequate. 

Once the woman was given one or two names, I suggested she look on the state medical board website to check on the doctor's training, if he or she was board certified and any comments about the doctor. Then I suggested making an appointment without her child to see  how she felt about the  office staff  and the doctor.  When she found a doctor she liked who was board certified, I would  make an appointment for her child. If the doctor answered her questions, did a thorough examination and took a good family and medical history then she had made a good choice. However, if her child was not asked to be undressed and given a gown, the doctor did not sit down to answer questions and take a good history, that was not an adequate examination. One mother of a teenage girl told me the child's  pediatrician had never looked below the girl's waist. I was amazed, thinking of all the problems I had found by checking patients all over. My grandson said he had a pediatrician who had never asked him to undress below the waist. 

The other questions the woman needed to ask was if she could call the doctor if she had a question or did someone in the office answer parent' questions. One nurse in an East coast office told a new mother that " the  doctor won't tell you anything that I can not tell you." The woman's child had had a small seizure  and should  have been seen right away. The mother was a former patient of mine who had moved to the east coast. She called her mother and I immediately called the doctor. The child was seen within the hour. 

A little Child's Life Can Be in Danger if a Parent or Caretaker is Otherwise Busy

I was driving slowly on a busy beach-front street today when I saw two little children being completely ignored by their parent or caretaker. One little child was trying to catch up to the adult who was busy on her iphone. Another child was in a stroller trying to get out when the parent or caretaker was looking away and busy talking on a phone. It just takes a minute for an accident to happen. I know of two adults who lost a younger sibling because the parent was engrossed in something else and had no idea where the child was. A child can slip away quickly, particularly if the child is on the autism spectrum. Windows and doors must have locks up high and never be left open. Neighbors and the police should also be notified that the child has a habit of trying to run away. If you are having a party or entertaining that is a time when a little child can easily slip away.     Two parents, who were both M.Ds, lost a two-year-old that way because the child slipped outside and drowned in the fish pond. If you are entertaining, it is a good idea to hire someone to keep a constant eye on a little one. Some children love to climb and can be quite adept at doing so. I know because I had a child like that when she was little. I can remember some scary episodes and tried to never let her out of my sight. As a college student she took a rock climbing course with a poor instructor and had a  narrow escape. I think that put an end to  her climbing days, because of the fall she almost had.