Rx For Parenting Today

Feeding Children

The is a hard time to feed children when even going to a store can be risky.  I go at seven a.m. with a mask on and plastic gloves. Most doctors are taught little about diet and nutrition. I don't remember anyone talking about it at Stanford when I was in medical school there and my son agrees that he had no nutrition teaching at Washington University Medical School. 

There is an excellent book by Dr. Henry Legere entitled, Raising Healthy Eaters. He makes some good points and it is easy reading. I particularly like his discussion of vegetarian diets for kids. He notes that this type of diet can cause real problems unless parents understand how little protein such a diet can give a child.

I have great concerns about the advice some doctors are giving parents about feeding even little children  allergen foods, such as peanuts, eggs, fish, citrus, and  chocolate. There was an excellent allergist when I was on the staff at University of Rochester and he cautioned parents about these foods. I had married a man who had strong allergies in his family and was very careful about not  feeding allergenic foods to my two children. It certainly paid off.  Some children are very allergic to cows milk and when mothers can breast feed, that is much safer. Milk between meals for older children will decrease their appetite for regular meals, as will snacks, such graham crackers etc. If a particular food is disliked by a child, he or she could be allergic to it. No child should ever be forced to eat everything on their plate. Also children should not be catered to as to what  foods they will and will not eat. Fast foods and pre-packages foods may not be the best for children, except now and then. We are what we eat is still a wise saying. 

Babies with Special Needs

It is heartbreaking for parents and family members when an infant is born with a problem, such as spina bifida or cerebral palsy. I have been impressed with the strength that some parents have shown and been dismayed at some who did not want anything to do with a child with a disability. 

One of the first two things that needs to be done is find a physician who is caring and and willing to take on the task of caring for a baby with problems. The doctor who delivers the baby could  have a good suggestion or an agency taht cares for similar babies. Other parents who  have a special needs child can be helpful also.

The second thing that is MOST important is to connect with your state's agency  that handles children with disabilities. Most states can help financially. You can find the state agency on the Internet or a good social worker at the hospital should know this resource.  Even if you have good insurance, you may need some financial help because hospital bills can be very large.

Another work of advice is taht mothers in particular should not spend most of their time at the hospital but be sure they take time for themselves and their own needs. Caring for a baby with a disability can take a great deal out of a person and if a parent does not take care of themselves.

Birthday Celebrations

I know several people who never had a birthday celebration as a child.  One had two parents who were professionals,  another came from a poor family. Others came from middle-class families. Even poor families can  have a celebration without spending a lot of money. Just having  a cupcake and lighting a candle can make a difference.

I think a birthday should be a special day, so the individual knows the family was or is glad they were born. I realize that many pregnancies are not planned, but if you have a child, I firmly believe the parents deserve to give that child the best parenting possible. Yes, there are lots of ways to parent, but a child being abused or ignored is  unacceptable. I have seen far too much abuse and the children being ignored. Also when parents have a great deal of money a birthday celebration can turn into an opportunity for the  parents to show how much money they have. The birthday child can feel the celebration is really not for them but for their parents' friends. Money can do very bad things for parents or it can offer great opportunities. 

Halloween Safety Tips

Halloween will probably be very different this year because of the Pandemic. However, if you live in a small town and know your neighbors your children might be able to go trick or treating. Some safety tips that could keep the kids safe are these:

Children need an adult or someone older go with them. A flashlight is important to have or you could put reflecting tape on the child's front and back. Cross only at the corners and use well lighted streets or go out in the daytime.

Masks are still important because of the virus and hopefully the kids are old enough to have had  immunizations.  Costumes should be made of flame retardant materials. Always walk on sidewalks. Remember also to go to the houses of friends or family members. When you get home throw away any treat that does not look right. Social distancing is still important and you could have a few friends in for a small party if they have all had vaccinations. 

 

Eating Disorders in Kids

I  have had far too many kids with eating disorders as patients.  These were not only mostly girls with anorexia, but kids who would eat only certain foods. These were not foods they were allergic to but foods they just did not like. Once in a while I had to ask for help from a psychologist, but generally I solved the problems in a simple way. I asked the parents just to give the patient the same food that everyone else had and not offer special foods the kids would eat. Snacks were not permitted, so of the patients got hungry enough they started eating what the family did.

I think these problems started when special foods were provided and then the problem  would get worse and worse. The family could not go out to dinner unless the particular foods were available. One mother was a physician and I think it was just easier for her to provide the special foods rather than call it a problem. That particular youth did need some counseling and for him I think a lot of it was attention-getting. He seldom saw his mother, never saw his father and was seeking attention. Gradually he became happier as the parents paid more attention to him. So for some food was certainly an attention-getting mechanism. 

Teenagers and Social Media

It is hard to watch the news and hear statistics about teens, who because they are active on social media,  may do harm to themselves. It  got me to thinking about what I would do if I was the parent of a teenager. I would certainly find a lot of fun activities the kids could become involved in, jobs they could do, or ways they could volunteer to help others. What are parents thinking if they allow a teen to spend hours on a computer being involved on social media sites? Don't parents have any  control of what their kids are doing these days? What about chores, helping around the house? Do teens these days learn to cook, sew, knit, iron, have music or art lessons, or have homework to do? I started working when I was 12 and later on worked as a waitress after school and on weekends. Money was tight for us as a family, even though my father was a college professor. 

Both of my children had sports activities and music lessons, and my son became very involved in theater.  My daughter volunteered at a school for children of  low income parents.  Then  later, after college she started a  program in San Francisco to help kids with disabilities find jobs and my son became a physician. If you are going to  be a parent, it is a hard job, but very rewarding if you take the job seriously. Are parents too involved with their social life, their jobs, shopping, or themselves? Something is very wrong if a child thinks suicide or hurting himself or herself is the answer. One of the reason I sold my much loved pediatric practice was  either I was going to  have to adopt some of the children who were in such pain or  open an orphanage.  

Do Your Kids Have Chores?

I am finding that more and more kids these days have no chores or allowances and use their parents as ATM machines. I always asked about chores when I did a complete physical examination and was usually pleased at what I was told. Now  kids tell me they are not given chores or an allowance, but just get money as they request it. How are children going to learn about doing various jobs or the value of money if they expect to always be given what they ask for? Something has changed, as so many parents want to be friends and not parents. I think both boys and girls need learn how to cook, iron, clean, do jobs around the house and be able to take care of themselves. 

I do not support wiping out all student debts, because how many of the students in debt did anything to earn money for college? I know a former medical school professor who came from a very poor family and worked 40 hours a week all through medical school. I have always wondered how he did that. I worked summers and waited tables during my years at Stanford. That was hard because the affluent girls looked down on those of us who were waiting table. However the group of hashers, as we were called, turned out well unlike many of the students we had to wait on. 

If a child has a disability, there are usually jobs they can do. One teenager with cerebral palsy was severely disabled but he was a  great source for dates, telephone numbers and other information. It gave him an important role in the family. One favorite youth with Duchenne muscular dystrophy was required by his mother to do the same chores his brother did. He was a remarkable boy and never felt sorry for himself. He had many friends and always looked out for others.

I give lists of possible chores by age in each of my parenting books. I always kept a chore chart on the kitchen bulletin board where my two children checked off the chores they had completed, so they could be eligible for their allowances. 

Urinary Infections in Kids

I have always done a  yearly urine check when I did a complete physical examination. Sadly, I am not sure many family doctors or pediatricians do that today. I  have been amazed at the various problems I have found. The most important one was on a teenage girl. She complained of not feeling well, but her physical examination was negative.  I still wasn't satisfied, so I asked her mother to bring her back the next day. I then requested another urine specimen. "But you just checked one", her mother said. "I won't charge you," I said, "but I would  like another one." When they returned and the girl gave me a urine specimen it was brown. She had glomerulonephritis that can be very serious. Once she was started on medication she did well. I then referred her to a urologist  to be sure there was not other problems. 

 Girls are more likely to  have urinary infections because of having stool get into the bladder. Usually girls can have one treated urinary infection and not have a urological workup until they get a second one. If a boy  has a urinary infection, he should have a workup after the first one is cured. As a parent, if your child's doctor does not request or order a urine specimen, I would ask for one. I remember taking my grandson to a pediatrician and the doctor not only did a poor examination, but did not request a urine specimen. When I said I wanted one she said "We don't do those!" I pushed and did get one. Of course, she never saw my grandson again. 

I  have picked up enlarged kidneys, problems at  the junction at the pelvis and ureter and several other problems. The most likely congenital anomaly is of the kidney, ureters or bladder, so it is important that doctors look for problems of the urinary system.

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.

 

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.

Raising Children as a Single Parent

Whether you are a single parent by choice, divorced or widowed, raising children alone can be a challenge. The up side is that your voice is the one the children should listen to and there can be no arguments about difficult problems with a partner. I was married for 17 years before I filed for divorce. However, I always felt like a single parent because the children's father was first a flight surgeon overseas in the Navy and then a very busy orthopedic  surgeon with long hours for training and then seeing  patients in his practice.  He loved our two children, but the adoration of his patients and his love of orthopedics  and surgery took first place. 

I was very fortunate to  have two wonderful children  who listened when I spoke and could not have been more caring and helpful. They knew quite a few of my patients, particularly those with neuromuscular problems and were often helpful when I was deciding what to tell a teenager. 

I think the most important thing I did was that I was the parent, not a  friend, as so many parents try to be today and the children knew the rules and what I would and would not tolerate. Children desperately want guidelines about what is right and what is wrong. I think a lot of the lack of morals and ethics we see today goes back to the way the individuals were parented. Lack of respect for an individual despite their skin color, the amount of money the family has and what they do is certainly lacking today. Money has become so important in the United States that it is creating terrible problems. GREED can destroy both individuals, families and nations.