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Daily Dose

Elf on the Shelf

1:00 to read

“Tis the season”, and many of the families I care for have gotten out their “Elf on the Shelf” to help keep the season as merry and harmonious as possible. I think “TEOTS” is genius, as it is a fun way to use positive reinforcement during the holidays as behavior modification.  That elf needs to stay around a bit longer…but then it would lose the appeal.  The anticipation of the elf arriving plays a major role don’t you think?  


With the arrival of the elf I get to hear all of the cute family elf stories during the month of Dec. I also noticed that “TEOTS” has some new “gadgets” and outfits to add to the fun, such as a zip line to swing from and suctions boots so he/she can climb up walls. Ingenious right? Surely they will soon have an array of elf outfits so the elf can have some choices to wear during zip lining.


During the last year there was also a lot of discussion about what our children were hearing on the news and during presidential debates etc. It doesn’t matter your political affiliation, children were picking up on a lot of what was going on.  Even children whose parents were paying attention to all of the bullying during the debates and atrocious sound bites on the news by limiting TV and electronics told me that their children still overheard things. They were concerned about the messages that both candidates were sending…especially to children.  


So…when one of my families took out “TEOTS”  their son, who is almost 3, decided it was the year to name him. “Of course you can name your elf they said”.  The next day he announced that the was looking for the elf and asked his mother, “where is Donald Trump?”. She was a bit confused…until he returned holding the the elf and proudly announced, “ I found The Donald”!!


Out of the mouths of babes. More elf stories this month for sure!!



Daily Dose

College Students and Curfews

1:30 to read

Colleges are out and many students are home for the summer.  But with the return of your child to “the nest” comes a whole new set of issues. Trust me I have been there (more than once).

Your son or daughter has been living in a dorm, apartment, or house....with their own “rules and routines”.  Most college students living away from home have not had to really answer to anyone. If they want to stay up all night, come home at sunrise or sleep all have not been involved. 

But now they are back....hopefully having managed to do well, despite their crazy schedules.  Does this “new normal” of theirs work at your house? It certainly didn’t in ours, especially where both parents were working.

A friend had advised me, “don’t give them a curfew over the summer , they have not had one at college”.  That may be some of the worse advice I have ever gotten!!  When your child is living in your house and you wake up at 2 am and they are not home....well, you assume the worst, right?  Then you try to call them and it goes to voice mail...of course...more worry. After one night like that pacing the floors I knew in my heart of hearts that summer rules, even for college kids are a must!

So, at our house college students (I don’t care how old), need to be respectful of house rules.  Even if they can get up and go to work after 3 hours of sleep, I can’t.  So midnight curfew, just like high school, goes back into place. Nothing good happens after midnight anyway, right?  If they want to stay up in their room or go watch TV in the den, or make a sandwich at 2 am, that is fine by me. I just want to know that they are home and I don’t have to dream about horrible events that are happening when I don’t know where they are.  They always ask, “you don’t know what I am doing when I am at school, so what’s the difference?”  The difference is , “out of sight, out of mind” (sort of).  In my mind I can imagine that they are tucked in their dorm bed at 10 pm.....I always think good thoughts. Those unsettling thoughts only come when they are home.... and that bed is empty.  

Daily Dose

Parenting is Hard Work!

1:30 to read

Being a mom (as well as a dad) is one of the hardest jobs in the world....and as many a person has pointed out, it pays a lot less than minimum wage.  But, it is also the best job in the world.

I have the privilege of seeing a lot of mothers everyday. From the time they come in with their brand new infant until their children have graduated from college....mothers worry about the “job” they are doing.  For a new mother who is already hearing that voice in her head...”am I doing this right?”, 

it is very reassuring for her to hear me say, “you can’t mess this up yet!” Your baby loves you unconditionally, just like you do them.

But as your child gets older it takes a great deal of self-esteem to sometimes feel as if you are “doing it right”.  Children of all ages can sometimes bring us to our can a small child know just the right thing to say, and that teenager...well, enough said.So, I like to tell them my own stories about raising children and my days of feeling like a failure, or at the least an inadequate mother....especially as your children point this out to you.

When my oldest and very verbal son was about 6, he was riding in the front seat with me (crazy huh) and I stopped the car in front of our neighbor’s house where our 4 year old son was heading to play. I rolled down the window to give the 4 year old some instructions when the eldest son leaned over and started telling his younger brother what to do. So. in my best “mommy voice” I tell the 6 year old that I am the mother and will handle this, to which he doesn’t miss a beat and responds ”if you were doing a better job of being a mommy I wouldn’t have to help you!”  Enough said.

It takes a lot of self esteem and true grit to be a mom. Hang in there.  We all have those days when we know we are doing our best and our kids disagree. 

Daily Dose

Happy Thanksgiving!

1:30 to read

This is the week that really kicks off the holiday season and for me it often begins with reflection.  I am often guilty of not appreciating the many blessings that I have, and rather focus on just getting through one day at a time. But as I reflect, I realize that I have so much to be grateful for and much of that gratitude is for my family.

When you are in the throes of parenting, I think it is sometimes hard to appreciate many of the blessings that we have as families. As parents we are anxious for the next stage, whether that is having a baby sleep through the night or wanting your child to talk, start school, begin to read, or finish their college applications. Parenting is so often about looking ahead rather than living in the moment.

It is sometimes hard to take a breath and sit on the floor and play with your baby, or let your elementary school child read you a book at bedtime, or enjoy editing your high school student’s next paper (why was that always a Sunday night at 9 pm event?).  But, from someone who has been there, sit back, take a breath, put down your electronics and appreciate whatever stage your child is in right now!  For this too shall pass...

Why not take a minute during Thanksgiving and ask each one of your children what they are thankful for, and write their answers down on a note card to file away to read years from now. It is fun to see their answers and how their gratitude changes with age....some of their answers are funny, others are quite thought provoking.

As our family grows, now with a granddaughter and a new daughter in law, I find myself trying to take my own advice. We are fortunate to be gathering together for Thanksgiving and I am going to “re-start” the tradition with their comments on paper... No more trying to remember what they said and no videos either. Just a note card that each of us will write on and a box to keep the cards in.  One day our adult children and their children can read all of these comments...and be thankful for family. 

Daily Dose

Your Teen's Eating Habits

1:30 to read

While seeing patients one evening, I saw a 15 year old boy who had come in complaining of feeling dizzy and tired. It was the end of school as well, so he was busy with studying and finals.  This is the kind of patient that is typically given a 15 minute appointment.....but needs a lot more than that to figure out what is going on.

He was with his father who said that his son had not had a fever, had not otherwise been ill with cough or cold symptoms. Upon further questioning the teen said he was just tired and thought he might faint....although he had not.  He had gone to school that day. He was not involved in athletics and had no history of previous syncope (fainting). There was not a history of sudden cardiac death in the family. He also had a fraternal twin who was healthy. He usually tried to get about 6-8 hours of sleep a night. He denied drug or alcohol use. He had not had weight loss. HIs exam was entirely normal with normal vital signs.

But, when questioned about his eating habits he informed me that he was a vegan.  His father sat there quietly while I discussed his son’s choices.  He said that he had decided to be a vegan about a year prior, and that he rarely ate with his family. When I asked him to give me an idea of a typical breakfast, lunch and dinner I was amazed at what I heard. He really only ate “junk food”. He ate sugary cereal for breakfast, he might eat a veggie burrito for lunch, and he would often eat another fast food burrito or taco for dinner. He did not eat fruit at all. His Dad said that everyone else in the family ate “normal” meals, and that they were offered to his son as well.

I am writing this to illustrate one of the problems I see with teens who decide to become vegetarians or vegans etc, but really are just what his Dad so correctly stated are “junk food vegans or vegetarians”.

After a lengthy discussion and some lab work,  he was sent home with instructions to research ways to improve his diet even as a vegan, which in turn would probably help his fatigue. He was also stressed about the end of school.... which was another discussion as well!

Both eating issues and stress cause teens to have a lot of complaints of fatigue and feeling blah...I see them all day long. This adolescent agreed to   come back in a month with his diary of meals and he is going to see our nutritionist over the summer.

He was a delightful young man....and I was only an hour behind...but at least we got to the bottom of the problem.

Daily Dose

Giving Your Child Medicine

1:15 to read

Since I recently wrote an article about teaching young children to swallow pills, here is another reason to teach this to children sooner than later. The American Academy of Pediatrics has a new policy statement encouraging parents, physicians and pharmacists to use only metric measurements on prescriptions,medication labels and dosing cups to ensure that kids receive the correct dose of medication.

In other words, no measuring medications with teaspoons or tablespoons and especially not the ones in the cereal drawer.  Because spoons come in many sizes, they are not precise enough to measure a child’s medication.  For infants, toddlers and young children, a small error in dosing, especially if repeated for many doses, may be toxic.  

These recommendations also mean that doctors, like myself, need to prescribe medications in metric units like milliliters rather than teaspoons. We also need to instruct parents to use metric dosing devices, and not any measuring devices that have confusing markings with both teaspoons, tablespoons and milliliters. The medication should also come with an appropriate sized dosing device to avoid the possibility of two and three fold dosing errors.

The recommendations also call for manufacturers of over the counter medications to eliminate labeling, instructions and dosing devices that contain units other than metric more 1 teaspoon, but rather 5 milliliters.

I am going to make a conscious effort to make sure that I am now writing my prescriptions with the correct units and help make dosing errors less of a problem and all medications safer for my “little” patients.

No more kitchen spoons!!!

Daily Dose

Kids Are Stressed Out!

1:30 to read

Gone are the “lazy days of summer” and with school back in session the words “stress” and “anxiety” slowly creep back into the day to day language of many families.  In fact, a recent national We MD survey about children and stress found “that most parents rate school and friends as the biggest source of stress in their kids’ lives”.  The survey also found that “72% of children have negative behaviors linked to stress, and 62% have physical symptoms such as headaches and stomachaches”.

So, after reading this survey it only served to confirm what I have been seeing in my practice for years….very anxious, worried and stressed children of all ages.  I can attest to the fact that it is definitely affecting younger and younger children. Much of my general practice now involves more psychiatry than infectious disease (thank goodness for immunizations!).

I have watched younger and younger children come into my office and talk to me about “worries” over tests, reading levels and how they will possibly “get to college”.  Remember the days when you did not know what a SAT or ACT was until you were in the 11th grade? There was no test prep either, other than your parents telling you “you need a good night’s sleep and breakfast”, and  then they handed you 2 number 2 pencils as you walked out the door!!  Just last week an 8 year old patient of mine told me about his recent birthday party and playing video games.  He followed up by saying, “school starts in 2 days and my Mom says I cannot play video games of watch TV during the school week this year”.  I really didn’t think that was such a bad idea, but he then told me the reason was that he “had failed his ERB tests!!!”. He then went on to explain, in great detail I might add, that these had just been “practice ERB’s” and that his reading comprehension was “below grade level”.  He said “next year in 2nd grade these tests count so he was worried about doing well then.”  School had not even started yet!

I also received an email this week from a patient who said her son had just started  back to school 2 days previously and he was having anxiety and not wanting to go to school. He is in middle school at a rigorous private school and had already been diagnosed with ADHD when he was younger, and is on medication.  She and her husband were now having “issues” about how to deal with his anxiety, which was causing the entire family stress. They really “did not want to change his school”.  Not a good way to start off the school year. 

Much of the anxiety I see may also be related to just being “over scheduled”.  Children of all ages need some “down-time” to just “chill”, relax, kick back and even get a bit bored.  With schools piling on more and more academics at younger and younger ages, and then throw in competitive sports for 3-4 year olds….what are we thinking?  Of course children will get burned out and stressed…they are just developmentally too young for some of this.  Not all children are ready to read when 4-5 years old, or ready for athletic practices 2-3x/week. Some children as young as 8 have athletic events starting at 8 pm, when they should be in bed.

Sadly, I know that I will begin to see my fair share of headaches, tummy aches, and “I just don’t feel well” in the coming weeks. It may be time to re-evaluate where our society is heading.  

Daily Dose

No Oreos in Lunch?

1:15 to read

I have been interested in the recent news article about a mother who had packed Oreo cookies in her child’s lunchbox. It seems that although she had also packed other lunch items, the school her child attended deemed the lunch “unhealthy” and not only did not allow her to eat the cookies, they  sent her mother a note encouraging her to “pack a nutritious lunch”.

WHAT?  Are schools and daycare centers now deciding what a parent may put in a child’s lunchbox?  I understand the need for nutritious lunches for our children. I talk about this everyday in my practice. But are there not bigger issues facing our schools than policing every child’s lunch. This mother did not “just” pack Oreos, her child had a sandwich and string cheese as well. Her mother stated that, “she was out of fruits and vegetables that day”, so added some cookies.  

Schools are in the throes of changing menus in an effort to help our children make good choices at lunch. But, even without serving fried foods or soft drinks, they do still offer dessert during school lunch.  They have ice cream, frozen yogurt, pies, cookies....and unfortunately many children probably eat more than one.  

I once headed a committee at our sons’ school to change the school cafeteria’s policy to have a “soda fountain”.   I realized that even if I talked to my children about nutrition and health, and did not have soft drinks in our home , if they were offered a choice between soft drinks and milk I knew  that they would sometimes choose a soft drink (with free refills I might add). 

After about a year of discussions and some very unhappy parents and students our school did stop serving soft drinks. As I pointed out even then, this was for children who were buying school lunch and drinks....we were not telling parents what they could and could not send or have in their own homes.

At the minimum I think this poor 4 year old should not have been put in the middle of this discussion. Would it not have been more appropriate to send the mother a note asking her not to send cookies for lunch again?  Was there a notice of acceptable lunch items that had been posted at the beginning of school?  Is there a “zero tolerance” for cookies rule?

I guess schools will be sending sandwiches home that have white bread or bologna, or who knows what else. While I am a huge advocate for healthy eating habits and making changes in all of our homes...let’s not take it out on a 4 year old.

Daily Dose

Your Child's Blink Rate

1:15 to read

Here goes another one of my “you wouldn’t believe this“ moments from my office. A young mother had a list of questions out during her daughter’s 9 month check up. This was her first child, so of course there were lots of questions about feeding, crawling, childproofing the house, and socialization. But, at the end of her list was her “biggest” concern - “ her child did not blink enough?”. 

I must say, I have never given blinking much thought.  And watching your baby’s eyes and counting how often they blink.....really?   But, after reassuring her that I thought her precious baby, with those big blue eyes looking at me, seemed to be perfectly content blinking how ever often she did... I did a little research.

The average person blinks about 15-20 times a minute (I did not see any data specifically referencing infants) or 1,200 times/hour, or 26,000 times/day!  And to think that we don’t even realize we are doing this!  According to some research, blinking is a time for our brain to rest....and go “off line” for a second. If this is a time for brain rest...I am going to try and blink more often.

While stress and anxiety may cause an increase in the “blink rate”, intense concentration may cause a reduction in blinking. Maybe this little 9 month old is on to something...she is concentrating so hard on all of those developmental milestones like crawling and pulling to a stand that she has reduced her “blink rate”. Or maybe she will be a great poker player one day as she can keep those eyes on the cards and the other players and never blink!

You learn something new every day :)


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A few life lessons & fun with Elf on the Shelf!

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