Rx For Parenting Today

Some States still Allow Underage Girls to Marry

Nicholas Kristof wrote a frightening column in June that still bothers me. I did not realize that several states: Delaware, Minnesota, New Jersey, Pennsylvania and Rhode Island allow girls under the age 18 to marry. Often they are married to their rapist and are pregnant. With the marriage the parents will not have  the embarrassment of a pregnant teenager and the man will not go to jail. There is a group called Unchained at Last that has been working to bring this to state number to zero. Previously, 50 states allowed marriage of underaged girls. That is appalling!

I cannot imagine any parent allowing this, but I guess for some parents their reputations or religions are more important than their daughters. I remember one mother of a pregnant teenage girl who insisted the girl carry the baby to term because the mother wanted a baby to raise. 

Mr. Kristof noted that we campaign against child marriage in Bangladesh and Yemen, but we still allow it in the United States. 

If parents allow their daughters to date much older men and are unable to say "No, to their  girls, there can be trouble. If I were still in  active pediatric practice, I would  have a  hard time being the  pediatrician for parents  like this. Today, the fad seems to be that as a mother you want to be your daughter's friend, not their parent. I had one father tell me that his wife "never said "No" about anything to her daughter." The father knew better, but he was a step-parent, not the girl's father, so he had little say. I have great worried about how the teenager is going to turn out since her every need is met and with a credit card, her own car,  and no discipline, I fear there will be stormy days ahead. 

What You Should Expect when an M.D. does a Physical Exam on Your Child

Sadly, I find these days, after speaking to many parents, that a complete physical examination seems to almost be a thing of the past. I always had the secretary plan an hour for me to do a complete yearly examination on a child or teenager. Just taking a good history, which included a diet history and a family history took a while. When I did what is called a system review that took a while also. The patient was always given a gown and asked to undress to their shorts or underpants. I was frequently amazed at things I found. One teenager had not started her periods but in doing a rectal examination I  could feel a big mass and realized she either had a tumor or had started menstruating and the blood was not able to get out. This is a rare finding, but does occur. After a surgeon took care of the problem, she was a much happier teenager. I found things such as a big mass in the neck, a foreign body in a child's foot which turned out to be a needle and foreign bodies in the nose and the rectum. When a  parent tells me their family doctor or pediatrician never looks below a child's waist, I want to scream. That is just bad medicine. I find sadly that many medical schools are teaching more about technology than how to do  a complete physical examination. Many medical students have told me I am the only doctor they have ever heard take a diet history. That is appalling. I have letters from parents saying a change in a family's diet  made a difference in all their lives and they were very grateful for my advice. We are what we eat.

 

Finding an Answer for a Child, Teenager, or Adult with Muscle Weakness

It makes me sad that so many parents and adults have to go through a great deal to find the answer for muscle weakness. I have parents in Africa and India looking for answers for their children. Both children have had countless tests, but and no diagnosis has been made. Hopefully, once the travel restrictions are loosen I can help get them to doctors who are neuromuscular specialists. Sadly, we have few real neuromuscular experts  in most countries.  Four of the most brilliant have died within the last few years. With the great increase in the number of genetic test that can be done, many doctors now order countless genetic tests which may not help. About 50% of diagnoses of muscle disorders are incorrect. This is particularly tragic now that there are medicines that will help spinal atrophy patients, Duchenne dystrophy boys and others. Neurologists usually get excellent training in their specialty, but unless they train in a neuromuscular center, their knowledge of neuromuscular disorders can be minimal or none at all. I think some of my happiest days have been when I saw a child or (adult) who was diagnosed with muscular dystrophy, but their muscle biopsies and lab work showed they had myositis which is very treatable. I still hear from several patients who are doing well after treatment for polymyositis.  Even children and adults who are seen in prestigious medical centers can be given an incorrect diagnosis. I now send patients to Dr. Selcen at Mayo Clinic In Minneapolis if they can come to the U.S. London also has an excellent neuromuscular center. The NIH in the US also has an outstanding program. The popular specialties in the U.S. are those where the doctors can make a lot of money. Sadly, neuromuscular disorders are not a specialty where a lot of money can be made, but what a difference you can make in a child or adult's life.

Traveling with Children

Now that the pandemic is beginning to lessen and summer is coming, many families are thinking about taking trips. Traveling with children of any age can be tricky and  a lot of thought and preparation are needed. I have traveled by plane with a tiny newborn, traveled with small children across country in a car and to Europe when my children were ten and twelve. I learned a great deal on the trips and have some wonderful memories and some that are not so good. Traveling with Jennifer when she was a few weeks old from California to Pensacola, Florida  was probably the hardest trip, but it taught me a lot that I passed on to my parents who were military wives.  The hardest part was keeping people away from Jennifer. I was amazed how many people wanted to hug and kiss her. I  had to be very unfriendly and keep a blanket around her. 

If you are traveling by car with small children having lots of surprises and treats ready to hand out works well. Now that most kids have some type of smartphone, there are lots of games they can play. Reading is not a good idea because many kids get carsick that way.

Playing "I spy" is fun, looking for different state license plates and similar games can help pass the time. Stopping frequently, so the children  can stretch their legs and run around is a good idea. Be careful if you plan to spend the night in a motel or hotel. Be sure the doors can be carefully locked, particularly if one child is autistic and likes to run away. In hotels you want to be sure there are screens on all the windows. 

I would talk to older children before you  leave on a trip and outline the rules you expect them to follow. Getting their ideas is also a good idea. Kids can be very helpful if you really listen to them.  Happy traveling.

Children's Safety and Passwords

 I have been re-reading Betty Mehmoody's true story about how she escaped from Iran and her Iranian husband with her daughter. Her great fear on  getting to the United States was that her ex-husband would find a way to get to the U.S and kidnap their daughter. Sadly, we  have a lot of people with problems who do make an attempt to kidnap a child. It can be a woman, as well as a man, who is the kidnaper.

One of the things I taught my children and my patients is that all children should know a password. Thus if someone comes to a house where they are playing or to a school, the adult must know the password before the child goes with them. I had a good high school friend who went with her husband to South America. She left their two children with their father  when came to the U.S. to see her parents. She did not realize she would not be  see her children again until they were teenagers and escaped with the help if a friend and made it to the U.S. What a terrible experience. She had met her American husband in college and had no idea of the problems she would face going with him to South America.  He was working for an American company there.

So caution is always wise with your children. You don't ever want to frighten them, but simple things can keep them a lot safer.