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Your Toddler

Hitting & Biting

A normal part of develop with a young child is for them to experiment with hitting and biting. Child neuropsychologist Dr. Kristy Hagar says it’s normal and the hitting and biting comes out as a front-line reaction during the course of normal play. Dr. Hagar says it is important for parents to intervene every time they see their child hit or bite. “First thing is not to hit or bite back to teach them a ‘lesson’. It sends the wrong message.” Dr. Hagar recommends telling the child “no” in a firm voice and then do a consequence, like a time-out to reinforce the message.

“It’s a parents role, and teachers role too, to make sure the message is given back that it’s not an appropriate behavior,” Dr. Hagar says. But there is good news for parents worried that their child may turn in to a life-long hitter or biter. The behavior normally stops by age three, when a child’s language skills start to develop more.

Daily Dose

Happy Mother's Day!

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So, what if you were given a second chance as a mom? I know this is supposed to be a short blog, but I may need several pages to get this all out. 

As a mom, I know I have made many mistakes over the years while raising our three sons. They are adults now, but will always be “my baby boys”.

If I could re-play anything, I would advise moms to enjoy and embrace every stage of parenting as it all goes by too quickly. I always remember looking at other families and thinking, “when will I get to that stage?” as it always looked like the next milestone would be easier or more rewarding or more anything. But in reality, every single stage of parenting has its ups and downs and you can only realize that in retrospect. I was guilty of looking ahead too much rather than enjoying whatever present situation we were in. The old adage of “live in the moment” is never so true as while you are a parent. I say enjoy playing blocks with your baby, reading to your children every night, playing games in the yard, trips to the pool or long chats with your teens about their friends and making good choices. For each of these things goes by so quickly and cannot be replayed except as special memories in your mind. I would also remind you to take more pictures, and videos, as these are the things that will jog your memory later in life.

All of the memories that are hidden away in some remote spot in a mom's aging brain become clearer when you see a picture of an event. This was evident when I was trying to pull together our family pictures for our oldest son’s wedding. Why is it that I took pictures of everything when our oldest son was little, and by the third child, the pictures are fewer and farther between? He was no less important for sure, but the time issue just didn’t seem to allow it to happen. I should have made the time!! How long could it have taken to take a picture of kids playing together in the yard, or eating dinner at the table together or doing homework? Those are the memories I long to have, the “normal” family times. Most family pictures are of “events”, which is fine, but documenting the simple things too, for they are the most special memories.

Lastly, I asked “my boys” about a re-do, and they all said, “You should have let us wrestle more!” How funny is that! Seems like such a simple thing, but I was always breaking up those boys for fear of them hurting one another. The louder it got, the more I was sure it would only lead to trouble, so I was the “girl” in the middle pulling them off of one another. My advice to young parents, enjoy the ride and try to live in the moment that you are given. You never know what lies ahead, and some of the hardest times in parenting may actually help you appreciate the wonderful times even more. I am continuing to give myself that advice as I am learning about parenting grown sons and now a grandmother! Thankfully, parenting never ends! 

Daily Dose

Mommy Guilt

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I spent part of my Mother’s Day reading the Time magazine article on attachment parenting.  The cover is obviously quite provocative and has stirred a lot of discussion in and of itself.  Even SNL spoofed it! But the greater discussion seems to me to be on how women mother and parent. What constitutes a good enough mother? (wonder if there is going to be a follow up article on fathers just in time for Father’s Day - what would that cover look like?) 

I guess my first thought about the article is that mother’s often feel like they are not good enough. I don’t think that is necessarily influenced by how long you breast feed, or if you let your child sleep in your bed, or if you ever yelled at your child. It is something about the female brain and we feel guilty about so many issues as they relate to mothering.  I have now practiced for over 25 years and the topic of maternal guilt has always been an issue for so many of the mothers I see on a daily basis, it doesn’t seem to change.  Me included! 

For some reason, the female hormones estrogen, progesterone, and prolactin that surge at the time of a baby’s delivery must also turn on some deep area of the brain related to guilt.  I often joke that “with the final push” comes enough guilt to last a mother’s lifetime. (seems to happen with a c-section as well).  The attachment to that baby is so deep that any little thing can cause maternal anxiety and it often starts with whether or not to breastfeed your baby. So let’s start with that subject. 

As a pediatrician I am a huge advocate for breast feeding, but with that being said I have also seen many a mother who is unable to breastfeed. There are any number of reasons (including breast reduction surgery and no let down, maternal medications which might affect the baby, and a mother who was diagnosed with breast cancer while pregnant who started chemo immediately after delivery.) 

There are also some mother’s who just don’t want to breastfeed. Should they be judged inadequate right out of the gate? I don’t think that is my role as a pediatrician to make that mother feel guilty. I think I need to discuss the options and the benefits of breastfeeding but at the same time realize that one size does not fit all. Is it worth having a depressed, sad and anxious mother who is unhappily breastfeeding, over a bottle fed baby with a happy mother? I think maternal well-being and feeling bonded to that newborn is what is important, whether that be with a breast or bottle. You can be attached to that baby without out actually having a latch. 

So...I digress. What about guilt and motherhood? I just don’t know how to fix it but I don’t think that the front of Time magazine really helped, but did provoke lots of conversation. 

What do you think?  I would love your thoughts! Leave them below.

Daily Dose

Pregnant? Get Your Flu Shot

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If you are pregnant, know someone that is pregnant, or are even thinking about becoming pregnant, you need a flu vaccine!!  (That is not to say that we all need to be thinking about flu vaccine’s right now!)

A study out of Duke University showed that of 1,600 women who delivered during the 2009-2010 flu season, those that had received a dose of flu vaccine delivered more term babies and also delivered babies who had higher birth weights. Women who received at least one flu vaccine during the season were also less likely to require a doctor’s visit for flu prior to delivery and they had lower hospitalization rates.

Another study out of Wake Forest University which was recently published in the Journal of Obstetrics and Gynecology looked at women who had received flu vaccine during their pregnancy.  This study showed that infants born to mothers who received flu vaccine while pregnant were 50% less likely to be hospitalized with flu than infants born to mothers who had not received flu vaccine. This was a study conducted over the years 2002-2009 (before H1N1) Impressive!

Flu vaccine is recommended for everyone 6 months of age and older. Infants 6 months of age and younger have the highest rate of hospitalization for flu related illness among all children.  The only reason that flu vaccine it is not given to younger infants is that the vaccine is not effective. How do we protect those babies, by protecting the mothers who are carrying the child? 

So…bottom line, pregnant women who get their flu vaccines not only protect themselves, they are protecting their newborn infants as well. A mother’s job of protecting her children is life long, but it begins even with a baby in utero. Go get that vaccine, as flu season is upon us!  

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Foods You Can Eat When Breast Feeding

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Should breast feeding moms avoid certain foods?I was making hospital rounds today and talking to all of the new moms (and dads) about their newborns.  I love talking to new parents about the importance of having healthy meals to support breast feeding! I even had a young dad asking “what foods should I avoid cooking for my wife while breast feeding?”  How cute is that! Can we clone him?!

After breast feeding my 3 children, I have decided that you can really eat whatever you want!  I know some people swear that certain foods you eat will cause a breast fed baby to have gas. But think about it, bottle fed babies and breast fed infants all have GAS!  None of the formulas contain broccoli, or cauliflower or beans or tomatoes and bottle fed babies have gas too. It is just a fact, newborn babies are gassy for the first several months as their digestive tracts mature. And yes, it is stinky too! So… I told this dad, “good for you for cooking for your wife.  Make her healthy, well balanced meals and throw in a few of her favorite foods.”  I would not change anything unless you can definitely correlate that a food ALWAYS makes your baby more uncomfortable (and that is so hard to keep track of). Eat what you want (in moderation) to be healthy and happy.  I have no data but feel certain that happier mothers must in some way have an effect on a  baby, so at least enjoy mealtime. When I had a colicky baby (previous post), I tried eating only broth and bland foods, and with me equally miserable and starving…this stressful situation only got worse. Final words, if I was going to try eliminating anything from my diet while breastfeeding to try and help “relieve “a gassy baby, it would be excessive dairy, as there has been some data on this. Remember, everything in moderation. I’m willing to bet that by the time your baby is 4 months old (the magic age) you are not even worried about what you are eating, as you are having too much fun laughing with your baby! What foods (if any) bothered your baby while breast feeding? I would love your comments.  Leave them below. That’s your daily dose for today. We’ll chat again tomorrow.

baby, breast feeding, Daily Dose, mom
Daily Dose

Moms & Dads Need Vaccines Too!

Moms and dads need immunizations too!I saw a two-week-old baby the other day who is the second child for one of my many families. Their first is a precious 2 1/2 year old girl. I must admit, this is one family I really enjoy.

The mother was in and is doing well being a mother of two.  Her infant son is gaining weight well and is as cute as a button. The mom mentioned to me that they had all been sick with a cough and cold, but the baby is fine and asymptomatic.  At any rate, the evening before the baby’s visit, the Dad was not feeling well, complaining about a headache, sore muscles and feeling badly and he had also noted a scratch on his leg.  He reported to his wife that he had a temperature of 99.2 degrees. By now it was 1:00 a.m. and she was tired as she went off to nurse the baby. A few minutes later, her husband came in to talk. He told her he had figured out what was wrong with him, he thought he had tetanus (admittedly this was his internet diagnosis) due to the scratch on his leg and his symptoms of muscle aches etc.  She told me she was LOL as he walked out of the room! They were both just too tired for him to have tetanus! So, with the fear of tetanus, he made a doctor’s appointment for the next day. While I was seeing the baby and hearing this story, dad called mom to report the results of his doctor’s visit. Good news; no tetanus, and only sinusitis. The doctor put him on a round of antibiotics to treat his sinus infection. The doctor had also looked at the scrape on the dad’s leg and agreed  that the he did NOT have tetanus but because he was due for an update on his immunizations, he received a Tdap vaccine while he was there.  That was even better news!!! As you know, I have talked about the need for adults to get updated immunizations and most importantly  to vaccinate against pertussis (especially during the current pertussis outbreak). What an opportune time for this father’s internist to take the opportunity to vaccinate this father, which in turn will protect his own newborn son as well as the rest of the community. Many of my young adult parents are unaware of the need for continued immunizations and have not received a Tdap vaccine. All adults who are younger than 65 years of age,  and who have not had a recent Tetanus shot, probably in the last 5 years, need to receive a Tdap vaccine that provides protection against tetanus, diphtheria and pertussis (whooping cough). This shot is then repeated every 10 years.  In some cases new parents are receiving information about this vaccine from their Ob-Gyn. Some new mother’s report to me that they were given the option of receiving the vaccine in the hospital after having their baby, but is seems to be dependent on the OB that delivered them, rather than a standard order for all women in the post partum unit. At the same time, the hospitals are not offering the vaccine for the father of the baby, so this means that the new dad needs to find a place to get his own Tdap. It seems like we (the medical community) should make it a little easier and more consistent to get this vaccine, especially when we are having an outbreak in the U.S. and there have even been infant deaths reported in Northern California. The funny story of a father who was convinced he had tetanus ended up with a happy ending for all. Dad got his Tdap, mom had a cold which she is recovering from and the baby slept 6 hours the other night! That's your Daily Dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue

Daily Dose

Breast-feeding is ‘On the Job Training’

So many of my mothers breast feed their babies and enjoy the experience. I think it is a little harder to breast feed in the early days after the your-baby is born, as your milk "comes in" and you deal with sore, full breasts as well as little sleep. Even with a well-prepared mom who has read all of the books, and practiced with dolls in different holds, real breast-feeding comes from "ON THE JOB TRAINING." But, over the next few weeks as the milk supply is established it will become much easier to breast feed and both mother and your-baby get the hang of nursing.

Saying this, it is not always possible for every mother to be successful at breast-feeding and not every mother wants to breast feed her your-baby. Although breast milk is ideal for an infant, formula works well too. The most important thing for your your-baby is for you to be a happy mother. Numerous studies have corroborated this fact, and if mother is happy, your-baby will thrive on breast milk or formula. When I discuss this with many mothers who are unhappy nursing, or are not making sufficient milk to provide enough calories for their your-baby to gain weight, there is such a sense of relief. Guilt is part of being a parent (seems especially so in us moms) but to start off your parenting feeling this way is not good for anyone. Do what is best for you and your child, and don't feel pressured by family, friends or coworkers. Lastly, there are all sorts of ways to successfully provide both breast milk and formula for your your-baby, so discuss your options with your doctor before feeling like a failure or stressing out. Just like babies, moms are all different too. That's your daily dose, we'll chat tomorrow.

Daily Dose

Teaching Good Manners

I have been noticing how many of my little patients have such nice manners. It is hard to watch a toddler say "thank you" to their doctor even after they have had a shot, but their attentive mother is wiping tears while simultaneously teaching good manners.

Teaching manners is still an important part of good parenting and as my mother said to me, "good manners never go out of style." Teaching those manners has to begin early from those first thank yous, to good eye contact and a firm handshake, and personal thank you notes. Thank you notes are another art that my mother insisted on. When my boys were younger we would sit down together after birthdays and Christmas and carefully write a hand written note to their grandparents. It was fun to watch their signatures mature from thumbprints in ink, to first wobbly letters, and eventually signed in their "adult" mature style.  The grandmothers still talk about these notes. So don't let manners in your house become a lost art. Teach those little things like please and thank you, boys opening doors, offering to help clear the table when having dinner at a friends, and always respecting adults. If you can get them to write thank you notes, their grandparents will be proud too! That's your daily dose, we'll chat tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Talking To Children About Sex

With the recent news that teenage pregnancy rates are on the rise for the first time in over 20 years, it seems to be a good time to discuss the importance of talking to your children about sex.With the teenage pregnancy rates on the rise over the past 2 years, it seems to be a good time to discuss the importance of talking to your children about sex. The “birds and the bees” talk is a sentinel moment and should be a required prerequisite before your child enters middle school. For some parents this “talk” is easy and does not intimidate them, but for others they get sweaty palms, and feel sick to their stomachs.

I am sure there is also a group in between. Wherever you fall in the spectrum really doesn’t matter, but this is one of the most important discussions parents will have with their children.  Many parents start discussing the differences between boys and girls as young as age 4 or 5. I myself have given this talk countless times and teach a class at our church as well. But, when it was time to discuss this with our first son, I too felt ill prepared. The discussion was necessitated as he was about eight-years-old and kept singing a song with the words “sex you up” in it. Obviously, I had let him listen to some inappropriate song on the radio. Nevertheless, this prompted my husband and myself to head to the bookstore to look for the appropriate book/books to begin the initial discussion and I know that book has been well worn over the years. It was not detailed, but explained in fairly simple terms how a “mommy and a daddy” each had “special parts, (which were identified correctly) that “connected” and that a sperm and an egg came together to make a baby. It was very basic, with simple cartoonish type pictures. We read the book and had a discussion together and answered any questions that he had. It went fairly well, he took in the information and went outside to play. That is just the beginning. The time came up again for further discussion when he announced at about age nine that his pet hamster, Sally, “was going to have babies.” Immaculate conception alone in her cage. Discussion number two was just around the corner. I myself do not think that any one discussion about human reproduction and sex is enough. It also depends when you begin these discussions. Some inquisitive children will ask hundreds of questions, while others won’t say a word, either way the talks must go on. Keep the information age appropriate no matter where you begin. Don’t be embarrassed as if you are they will be too. That is why it is called: The Facts of Life. But as children enter their teen years I think the discussions should be explicit and open. If you think they cannot find any information they would like by just surfing the web, then wake up, as it is all there. I would much rather sit down with my own children and discuss every detail they would like to know and at the same type impart factual information as well as our family values. The more information you give them the better decisions they may make. I believe that they should be taught abstinence, but also what to do if they are going to engage in pre-marital sex, which by the way does include oral sex. Let them know about condoms, birth control and other methods to prevent STD’s and pregnancy. We are failing our children if we do not empower them to make thoughtful, well informed choices with as much guidance as we can give them. Seeing the teen birth rate on the rise should never be due to lack of information and family discussions. That’s your daily dose, we’ll chat again tomorrow. Send Dr. Sue your question now!


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When should you get your flu shot?

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