Rx For Parenting Today

Foster Kids and the Challenges they Face

It must be so hard to either be taken away from your parent or parents because of drugs, prison, or other problems or to be given away by a parent. I have a long-time friend who was given away by her mother and said she has always had to fight rejection.  She did not end up in a foster home, but was adopted by two older parents. She later found out her mother had another child after she was born and kept that child. A friend who was a social worker was in charge of a unit that handled foster children and she often told me of the great problems foster kids face. She said the worse problem was what was called "foster child drift." If one family decided they no long could or wanted to take care of one or more foster children, the kids would be sent to another foster home and often other and other.  Some foster parents are great and some are abusive and just want the kids so they can do work for the family or to receive the money they receive for the care.  

In the United States today there are now 450,000 foster children. The number has been growing steadily in the  last five years. I do not understand the push against abortions when an unwanted baby or one with  problems is frequently  sent to a foster home. I cared for one child with spina bifida who was put in foster care because the parents said they  were not able to handle her care. They were affluent but had no desire to meet the needs of the child. They were fortunate that the foster mother who received the child was loving and excellent. Just think of that child's life knowing she had affluent  parents who did not want her. The harm that can be done to a child's mental health can be great and not many find the wonderful care that  the child with spina bifida received. We must not eliminate Roe versus Wade. Without the ability to get an abortion, an unwanted child can be greatly hurt. 

Children of the Rich and the Problems They Face

When I was a practicing pediatrician in La Jolla, California, I had many patients from affluent and even very rich families.  Some of the  parents did an excellent job of parenting, but the majority did not. Many of the children were raised by nannies and some of the kids just had to learn to take care of themselves. I remember one teenager who made an appointment to see me and said she had a sore throat. I could not see a problem with her throat and had her come back to my office, so we could talk. When I asked her what was going on,  she said "It is my birthday today." I asked if  she had had a special breakfast and was there going to be a party? "No", she said, "My mother gave me a 100 dollar bill and she will be gone the rest of the day. The girl said "I don't need anything and don't know what to spend it on." I wanted to say, "You do need something and that is love and parenting." After 15 years of  hurting for so many of the patients, I finally decided to sell my practice and move to Northern California where I was offered a job running a  program for children with disabilities, because of my neuromuscular training.  I knew otherwise I was  going to have to adopt some of the kids or open an orphanage! 

Recently, there have been several drug related deaths of young people from very affluent families. I am aware of one family were thousands of dollars were given to the young people, but parenting was almost totally absent. No wonder the kids took drugs hoping that would replace what they were missing from their parents.  If you want to be a parent, this is a life-long commitment. Nannies can play an important part when parents need help, but they can not and should not replace rules, discipline, love, hugs, and time spent with parents.  

When a Child Becomes Violent or Out of Control

In watching the  violence at the Capital on the sixth, I wondered  about the participants who joined the violent mob.  I remembered two patients I had seen and knew violence and out of control behavior can begin early in life. One particular patient I thought about was a small boy who was new to me. I am not sure how his mother got him to my office or who referred him. The child was almost dragged  into my examining room and immediately started pushing the music boxes that were on a low shelf on to the floor.  His mother was desperate and said "Do what ever you have to, I can 't control him any more." I had read somewhere that if you have a patient like this, control can be obtained by getting the child onto the floor and literally sitting on him or her. So that is what I did. If he had been a big child, I would not been able to control him. I talked very quietly to the child and the boy soon calmed down. Thus I was able to get some history from the mother and also to ask my secretary to call an ambulance, the police, and my favorite child psychiatrist at at St. Mary's Hospital. Sadly, his special unit was closed several years ago. Now the pediatric patients have to go to  UC San Francisco Medical Center. I don't remember  being when told the child started becoming violent. Usually, you can pick up  problems early on if you take a good history and do a good physical examination. The child's severe problems should have been addressed and treated long before I saw him. Unfortunately, the five to ten minute examinations now dictated in some HMOs do not allow a child like this to get adequate care. If any parent reading this  has concerns about their child, an appointment with a good child psychologist or psychiatrist is the place to start. Any delay can make the condition worse and a child's life and the life of others may be affected.

When Children Bully, Tease, or Hurt Other Children

I have often been asked by parents what they should do when they discover or are told by school personnel that a child of theirs has hurt another child, lied or been a bully.  The first thing I always did was to ask that I do a physical examination. Sometimes I could find neurological signs that were troubling and often just talking with a child I could get an idea of what was going wrong in their lives. Often a child feels others are picking on him or her and he or she just wants to fight back. Often there is a deeper problem and for that I needed the help of a  child psychologist or psychiatrist. It always surprised me at some of the things that were found. Sometimes a marked learning disability was found or the child was being bullied by a sibling or someone at their school. In rare cases it was a deep psychiatric problem. Medication was usually not needed, but was in some cases. Ongoing counseling was  often a must. It  can be hard to find just the right specialist to test or counsel a child and I was fortunate to have several professionals I could call on. 

Children who stutter, have a physical disability, or other problems have told me how they were often bullied, called "crip" or their speech mimicked. Some administrators tell teachers they should not make more than two or three referrals for children in trouble because of budget considerations. I have had to fight with several principals in order to get help for patients. Frequently, I used my Center's grant dollars to pay for testing or treatment. If a child is in trouble a way must be found to get the child the help they need. Otherwise there could be long-term consequences.

Parenting the Siblings of a Child with a Disability

When a child has a disability, many parents find their days filled with trips to doctors, PTs, and other specialists. Sadly, if there are other children in the family they often get much less attention from their parents. In caring for children with disabilities for many years, I often held groups for the siblings of the children.  The groups taught me a great deal and also gave the boys and girls the chance to realize they all had similar problems. Even though you may love your siblings and want the best for them, it is hard to watch them get more attention from your parents than you do. The groups I held gave the siblings a chance to talk about the problems they were encountering and to say things they did not feel they could say to their  parents. Some children with disabilities become very manipulative and find ways to always make themselves the center of attention. 

I am the sibling of a girl with a disability and I do not remember my mother ever asking her to perform a chore, while my brother and I were given frequent jobs.  My sister became very spoiled and my brother and I both chose jobs in the medical profession. He became a hospital administrator and I became a pediatrician with special neuromuscular training. I still help parents around the world with questions about their children with special problems. 

If you are the parent of a child with a disability, I hope you will think about how you are parenting and if you are giving each of your children the same attention. It will make a great difference.

Hospital Care for Children

These are scary times for children with the Corona Virus infecting both children and adults across the world. Care in the United States is particularly worrisome when so many pediatricians are not seeing their patients but are leaving the care to Urgent Clinics, ERs, and hospitalists if a child has to be in a hospital. I could not do that if I was still in private practice. Children and teens want to see a familiar face, as do their parents. 

Even in this terrible time, you want to be sure if your insurance needs a prior authorization for the admission of your child to a hospital. Also you want to be sure there is an available bed. A parent, relative, or child should always stay with a child. Children also need to take a favorite stuffed animal or blanket  and don't  let any staff member intimidate you. There are some wonderful nurses and doctors in hospitals but some can be scary. I remember a nurse who left an empty syringe on the bed of one of my patients. 

Insist that your doctor or the hospitalist speak to you daily.  I also would keep a written record including the names of those caring for your child.  You may later need to file a complaint. If you are not happy about the care your child is getting,  talk to the head doctor or the CEO. The squeaky wheel does get attention. If the care is really bad, I would try to transfer to another hospital. You can also always seek a second opinion if you have concerns.  It is not a good idea to overwhelm your child with gifts or toys. 

After you leave the hospital, do check your bill carefully.  Many mistakes are possible. Let's hope this is a better year for everyone and we all avoid hospitals!