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Daily Dose

Waiting for the Doctor

1:30 to read

I just read a really good article from The Huffington Post that was written by a young woman from the UK.  She was discussing the issue of waiting for a doctor. She herself had been waiting for her doctor when she noticed another patient who was being very loud and quite verbal about waiting. He engaged her in conversation and said, “I bet that doctor is back there having a cup of tea”. He must have been stunned when she replied, “well, I certainly hope so”.  She knew that the doctors had recently seen her as an emergency when she began bleeding during her pregnancy. She knew that they had dropped everything to attend to her and her unborn baby and for that she was eternally grateful.  

I also “hate to wait” when I am seeing my own doctor, but I do know that he or she is not “back there eating bon-bons".  I also know that many patients have waited for me, sometimes for up to an hour.  I promise you that I know that I am running late and it makes me very anxious. But at the same time, I am doing the best that I can to treat each and every patient as if they were my own child or family member.  Sometimes a patient comes in with a more complicated or urgent problem and the time taken with that patient is much longer than was expected. Or, a child arrives wheezing and in respiratory distress without even having an appointment….they to will be “worked on” in front of everyone else…as they need a doctor immediately. 

The article continued to re-count how many times during her pregnancy that she had needed to be seen as she continued to have issues with bleeding, and each and every time, the doctors were there, no wait and no questions….they just did their job.

It is difficult to explain why doctors run late and I understand how patients are frustrated when they wait. But at the same time, how do you schedule the appropriate amount of time for a patient who calls for an appointment because their child is sick with a fever and a sore throat. But, while you are seeing their child they break down in your exam room and tell you that they have found out that their husband is “cheating on them” and that “he wants a divorce”.  As their pediatrician, do you tell them that you don’t “have the time” to listen to their problems. Do you just deal with their child’s sore throat and ignore the mother’s anguish. In my case, I choose to spend time with the mother, to empathize with her, and hope to help her.  I know that this reaction will make me late….but it is what I need and want to do for my patients and families.

Whenever I am talking to prospective patients I am perfectly honest when they ask me, “will I ever have to wait?”.  My response has changed over the years as I have come to realize that there will be times when they do wait….but it is not because I ever want to “run late” or make my patients wait. It is because, I have decided that my practice has just as many flaws as my parenting, not perfect. But similar to my children, at times one will need me more than another, and when they do I will spend more time with the one that needs me the most.  It may not seem “fair”, but how do you make it always be “fair”?  I hope that at the end of the 23-25 years I spend with these families they come to realize…it all evens out in the end…there are times that I spent too much time with them and then there are times that they waited.  But, just like parenting, you do the best that you can.  I will continue to practice that way as well. I promise, if you are waiting I am not having tea and bon-bons!!!   

Parenting

Choosing a Dog for the Family

2:00

Dogs make great companions and it doesn’t take long before they become “one of the family.”

If you’re considering adding a dog to the family unit, there are several questions you need to answer first.

What kind of dog is best for your family? It depends.

What kind of space can you provide? You'll want to pick a dog whose size and needs are a good match for your household. Do you live in an apartment – where a smaller dog might do better – or do you have plenty of space in a backyard for a larger dog to run and play?

What is your family lifestyle like? Is everyone on the go most of the time, or is someone typically around to train and care for your pet?

Does anyone suffer from pet allergies? There are breeds that don’t shed or shed very little. There are even some that are considered “hypoallergenic.”

Who is the one in the family that will spend the most time caring for the dog?

When kids are in love with the idea of getting a dog, they often make promises to walk, clean up after and feed it. But, who is really going to be the dog’s caregiver? The younger the child, the more likely a parent is to be the one who takes care of the dog. Are you ready to make that commitment?

However daunting it may feel, remember that a funny thing often happens when a dog enters the family dynamic, they usually win everyone over; so caring for one may become more of a loving habit than an unwelcomed chore.

Having a dog can be a great way to help instill responsibility, empathy and life’s difficult lesson on how to say goodbye to a loved one, in a child. If you’ve grown up with pets, you already know how many special moments they provide. If you've never owned a dog, read up on the benefits verses the challenges. There are pros and cons to seriously consider. Dogs need love and to feel welcomed to thrive - just like people. 

The American Kennel Club lists several breeds of dogs that are usually very good with children. Some of the top suggestions are:

·      The Boxer

·      The Beagle

·      The Golden Retriever

·      The Labrador Retriever

·      The Weimaraner

·      The Soft Coated Wheaten Terrier

·      The Newfoundland

·      The Bulldog

·      The Bull Terrier

These are all specific breeds, but many a great dog can be found in a shelter or adoption center. These are typically mixed-breeds but often have fewer health problems than full breeds and a unique sense of appreciation. There are also rescue organizations that find homes for particular breeds.  

If you decide on a puppy, know that there will be several phases it will go through. If you have the patience and the puppy gets positive training along the way – you’ve got a dog that knows and understands your family. 

An older dog can be just as valuable, doesn't need potty training and after a transition period, can fit in remarkably well. 

Not every family is ready to take on the responsibility of owning a dog; sometimes the timing just isn’t right. But when the stars align and you’re ready to give it a try, there’s nothing better than the smile on your child’s face when he or she meets the new family member – and not to forget – that sloppy kiss and wagging tail that greets you when you start the day!

Story source: Joan McClusky, https://consumer.healthday.com/general-health-information-16/pets-and-health-news-531/choosing-a-great-family-dog-725834.html

http://www.akc.org/dog-breeds/best-dogs-for-kids/

 

 

 

Daily Dose

Parental Anxiety

1.15 to read

This is from the “I can’t make this up and I learn new things everyday file”!  

I was getting ready to enter an exam room to see a patient when my nurse pulled me aside. Now that I have EMR (electronic medical record) I sometimes have not “clicked” to see what is going on with the patient until I am already in the room, which is different than the days of paper charts when the patients chief complaint was always right in front of you.  

At any rate, she said the mother of the baby was worried that “he wasn’t growing well”.  That is not an uncommon concern for parents with a new baby, but as I entered the room I realized that this was an 8 month old patient of mine. He was sitting in his mother’s lap, adorable and happy with plump little cheeks and legs. I glanced at his weight and saw that he had gained over a pound in the last month and he appeared to be “growing and developing” normally. 

So, when I asked the mother why she was concerned she told me she knew that he was gaining weight, but she didn’t think he was getting any taller.  WHAT??  I get lots of questions about a child’s height and predicted adult stature, but typically not in baby under 1 year of age. What made her think or worry about this? His growth velocity at 2,4,6 months had been entirely normal and his next check up was scheduled for 9 months. 

Seems that she had routinely been laying him on a table to measure him and she didn’t think he had grown in length. I had never even thought about having a baby measured at home, it is hard enough for our nurses to get an accurate height on a squirming baby and I sometimes have a nurse do several height measurements as they seem to be “off”.  It is really when your child is 2 -3 years of age and they are able to stand and are measured on the wall stadiometer that the heights seem to be more accurate and significant. 

I guess the “root” cause of many parental concerns is anxiety, and unfortunately parental anxiety just seems to be escalating.  I am continually trying to help “calm” parents about so many worries but there seem to be new ones cropping up all of the time.  This sweet mother was losing sleep because she just wasn’t sure if her baby’s height was increasing. 

I hope that I reassured her and she agreed to stop the home measurements. I told her that my job was to track the baby’s height and weight and I promised that I would tell her if I was concerned. I wanted her job to be to enjoy the baby and get on the floor and play before he started to crawl! 

Your own pediatrician will also tell you when they are concerned, so let them relieve some of that anxiety.  Lastly, don’t go to the internet and “Google” some topic as it seems to always head parents to the worst possible scenario. Do you think that is planned?  

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

Parenting

Parents, Encourage Your Child to Stand Up to Bullying!

2:00

We’ve all read the stories about how a crowd of bystanders have not intervened or called the police for help, as someone was being bullied, attacked or beaten. It’s a horrible thought that if you need assistance, no one will respond.

When children grow up in a home that encourages standing up to bullying, they are more likely to step up to the challenge than kids who’ve been taught to stay out of it, according to a recent U.S. study.

About one in 10 children are victims of bullying, and many anti-bullying programs are focused on getting bystanders to intervene, researchers note in the Journal of Clinical Child and Adolescent Psychology. While previous research has linked certain parenting practices to higher odds that kids will be victims or perpetrators of bullying, less is known about how parents impact what children do as bystanders.

Researchers surveyed more than 1,400 fourth and fifth graders about how their classmates responded in a bullying situation. On average, the kids participating in the study were 11 years old.

They also interviewed parents at home and gave them hypothetical bullying scenarios, asking them how they would advise their children to respond.

In school, kids whose classmates said they might intervene to stop bullies and to comfort victims were more likely to have parents at home who told them getting involved was the right thing to do, the study found. At the same time, kids whose parents told them to stay out of it were both less likely to help victims and more likely to become perpetrators. 

“We were surprised to find that when parents told children not to get involved, children were actually more likely to join in the bullying,” said lead study author Stevie Grassetti, a psychology researcher at the University of Delaware. 

Based on the study results, it makes sense for school anti-bullying efforts to involve parents and endeavor to give children consistent messages about prevention in both settings, the authors conclude.

One limitation of the study is that during school visits; researchers didn’t define what constitutes bullying the authors noted. With home visits, researchers assumed parents gave kids the same advice about the hypothetical incidents that they would offer in real life, which might not always be the case, the researchers also point out.

Parents are role models for how children learn to respond to life’s unpredictable situations. They see and absorb everything their parents say and do. To teach your child compassion and courage, start by being a good example of both and letting them know that standing by and doing nothing to remedy the situation is not an option.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-children-bullying-parents-idUSK...

Parenting

Back to School Road Safety Tips

2:00

Millions of U.S. children are starting a new school year and along with the joy and excitement comes traffic congestion.

It's never more important for drivers to slow down and pay attention than when kids are present – especially before and after school.

The National Safety Council offers these tips to drivers sharing the road with parents and caregivers dropping off or picking up their kids and school busses loading and unloading students.

If you’re dropping off your children, familiarize yourself with the specific drop off rules of your child’s school. More children are hit by cars near schools than at any other location according to the National Safe Routes to School program. These tips can apply to all school zones:

·      No double-parking. It blocks the visibility for other children and drivers.

·      Don’t load or unload kids across the street from the school

·      Carpool to reduce the number of vehicles at the school.

When you’re sharing the road with young pedestrians, remember these safety tips:

  • Don't block the crosswalk when stopped at a red light or waiting to make a turn, forcing pedestrians to go around you; this could put them in the path of moving traffic
  • In a school zone when flashers are blinking, stop and yield to pedestrians crossing the crosswalk or intersection
  • Always stop for a school patrol officer or crossing guard holding up a stop sign
  • Take extra care to look out for children in school zones, near playgrounds and parks, and in all residential areas
  • Don't honk or rev your engine to scare a pedestrian, even if you have the right of way
  • Never pass a vehicle stopped for pedestrians
  • Always use extreme caution to avoid striking pedestrians wherever they may be, no matter who has the right of way

Most likely, you’ll be sharing the road with school busses as well as other cars. A school bus is large, allow a greater following distance than if you were driving behind a car. It will give you more time to stop once the yellow lights start flashing. It is illegal in all 50 states to pass a school bus that is stopped to load or unload children.

  • Never pass a bus from behind – or from either direction if you're on an undivided road – if it is stopped to load or unload children
  • If the yellow or red lights are flashing and the stop arm is extended, traffic must stop
  • The area 10 feet around a school bus is the most dangerous for children; stop far enough back to allow them space to safely enter and exit the bus
  • Be alert; children often are unpredictable, and they tend to ignore hazards and take risks

Cars and busses aren’t the only vehicles on the road around a school; there are also kids on bikes.  On most roads, bicyclists have the same rights and responsibilities as drivers. Bikes can be hard to see though, particularly small ones with little riders. Children riding bikes create special problems for drivers because usually they are not able to properly determine traffic conditions. The most common cause of collision is a driver turning left in front of a bicyclist.

  • When passing a bicyclist, proceed in the same direction slowly, and leave 3 feet between your car and the cyclist
  • When turning left and a bicyclist is approaching in the opposite direction, wait for the rider to pass
  • If you're turning right and a bicyclists is approaching from behind on the right, let the rider go through the intersection first, and always use your turn signals
  • Watch for bike riders turning in front of you without looking or signaling; children especially have a tendency to do this
  • Be extra vigilant in school zones and residential neighborhoods
  • Watch for bikes coming from driveways or behind parked cars
  • Check side mirrors before opening your door

School zone speed lights will soon be or are already flashing, so you’ll have to retrain your eyes to look for them. By exercising a little extra care and caution, drivers and pedestrians can co-exist safely in school zones.

Story source: http://www.nsc.org/learn/safety-knowledge/Pages/back-to-school-safety-ti...

Your Child

Talking to Your Child About Tragic News Events

2:00

Another tragedy has taken place, this time a terrorist attack in Paris, France.  Children, adolescents and adults have lost their lives or been seriously injured while out for an evening of fun, errands or romance.  Media outlets have been covering the events, sometimes showing graphic video or photos from the bloody scenes.

When children view these images or hear the stories, they can become scared and worried that the same thing will happen to them. 

Whenever catastrophic local, national or global events take place, it’s easy to assume that your child doesn’t really know what is going on or understand the gravity. But, in this age of instant and abundant information, they most likely do. Children are very sensitive to their parents and friends’ feelings. They are more tuned in than you might think.

Children sense when their parents are really worried, whether they're watching the news or talking about it with others. No matter what children know about a crisis, it's especially disconcerting for them to realize that their parents are scared, angry or shocked.

When bad things happen, children want to know what is going on.  It doesn’t have to be an international event. Local tragedies such as a flood, tornado, shooting, kidnapping, suicide, house fire or car wreck can be more frightening to children than events taking place across the world or in another state.

So, how do you talk with your child about such unhappy and threatening things? I’ve turned to Mr. Rogers to share with you his calming and thoughtful insights. The first time he addressed this topic was after Robert Kennedy’s assassination. Parents and educators turned to him for guidance then and his advice still holds true today.

In times of crisis, children want to know, "Who will take care of me?" They're dependent on adults for their survival and security. They're naturally self-centered. Their world is small and their life experience is limited. They need to hear very clearly that their parents are doing all they can to take care of them and to keep them safe. They also need to know that people in the government, in their community and in the world, and other people they don't even know, are working hard to keep them safe, too.

One of the ways young children express feelings is through play. However, sometimes events that happen are violent, so parents need to be nearby to redirect play if it takes a turn in that direction. More nurturing play can help children process the different activities and needs that happen around certain types of events. Play involving being a doctor or nurse in a hospital setting or creating a pretend meal for emergency workers or families can help children understand that there are good people and helpful actions that also take place when something bad happens.

When children are scared and anxious, they might become more dependent, clingy, and afraid to go to bed at night. Whining, aggressive behavior, or toilet accidents may be their way of asking for more comfort from the important adults in their lives. Little by little, as we adults around them become more confident, hopeful and secure, our children can experience a more calming sense of security.

When shocking event happens, it’s easy to get drawn into watching the news for hours and hours. Think back to 9-11 when there was non-stop coverage for days with repeated video of the towers being hit and falling. It created post-traumatic stress disorder, nation-wide. As hard as it is for adults to assimilate, it’s even harder for children. Once you have the information, turn the TV off or find something else for your kids to watch. Monitor their online activity as well to see if they are seeing too much graphic information or too many stories of “What if this happened here?”

Exposing ourselves to so many tragedies can make us feel hopeless, insecure, and even depressed, feelings that even young children can sense. We help our children-and ourselves-if we're able to limit our own television viewing. Our children need us to spend time with them-away from the frightening images on the screen.

Limiting our child’s media exposure doesn’t mean we don’t talk about what has happened with them.

Even if we wanted to, it would be impossible to give our children all the reasons for such things as war, terrorists, abuse, murders, fires, hurricanes, and earthquakes. If very young children ask questions, our best answer may be to ask them, "What do you think happened?" If the answer is, "I don't know," then the simplest reply might be something like, "I'm sad about the news, and I'm worried. But I love you, and I'll take care of you."

If we don't let children know it's okay to feel sad and scared, they may try to hide those feelings or think something is wrong with them whenever they do feel that way. They certainly don't need details of what's making us sad or scared, but if we can help them accept their own feelings as natural and normal, their feelings will be much more manageable for them.

Your child’s age and emotional IQ should be your guide on how much detail you go into when discussing tragic events. Very young children do not need a lot of detail. Children 7 and under are most concerned with safety. They need to know that you and they are secure. That’s why it important to keep the TV at a minimum for kids in this age group. They can identify strongly to pictures of other young children in peril or crying because they’ve lost someone dear to them. At this age, kids are most concerned with separation from you.  Assure them that you are watching out for them and will protect them.

Children between the ages of 8 and 12 will often notice the morality of events.  You may have to explain the basics of prejudice, bias, and civil and religious strife. But be careful about making generalizations, since kids will take you at your word. This is a good time to ask them what they know, since they'll probably have gotten their information from friends, and you may have to correct facts. This age group will most likely be online more. While it’s still important to keep news viewing under control, online viewing and searching should be monitored as well. It’s a good age to discuss lots of views and opinions about events. Read stories together and then ask them what they think.

Teens will probably get their news independently of you. Talking to them can offer great insights into their developing senses of justice and morality. It will also give you the opportunity to throw your own insights into the mix, but don’t dismiss their opinions or insights just because they may not be the same as yours. They will shut down communication quickly if they feel their ideas are not being valued.  Discuss the ways that different media covers events. Again, ask them what they think.

Having to discuss tragic or scary events with our children isn’t new. Generations of parents have had to address various topics from volcano eruptions that wiped out an entire city to the Holocaust to the cold war. But how we get our information has changed dramatically. Media in one form or another is prolific with gory images and misinformation available at the touch of finger. So parents have to react quicker and with more assurance and details than they would probably like. But that’s what we do. We protect our children in all ways, as best we can, with loving and clear information.

Sources:  http://pbskids.org/rogers//parentsteachers/special/scarynews-thoughts.html

Carolyn Knorr, https://www.commonsensemedia.org/blog/explaining-the-news-to-our-kids

 

Your Child

Pre-teen Football Linked to Brain Changes in NFL Players

2:00

The start of a new school year also brings after-school sports programs. Late summer and fall is prime football season for many middle and high schools. In some states, it’s a hallowed tradition that boys and girls look forward to participating in whether it’s running down the field or cheering on the team.

While school football doesn’t typically offer the same ferocious body beating and brain –rattling that are seen in the National Football League (NFL), a new study shows that brain development can still be affected by playing football at a young age.

The study looked at the possible connection between a greater risk of altered brain development in NFL players who started playing football before the age of twelve as opposed to those players who began playing later in life.  The study is the first to show a link between early repetitive head trauma and future structural brain variations.

The study was small but interesting. It included a review of 40 former NFL players between the ages of 40 and 65 who played over 12 years of structured football with a minimum of 2 years at the NFL level.

One half of the players took up football prior to the age of 12 and half started at age 12 or later. The number of concussions suffered was very similar between the two groups. All of these players had a minimum of six months of memory and cognitive issues.

"To examine brain development in these players, we used an advanced technique called diffusor tensor imaging (DTI), a type of magnetic resonance imaging that specifically looks at the movement of water molecules along white matter tracts, which are the super-highways within the brain for relaying commands and information," study author Dr. Inga Koerte, professor of neurobiological research at the University of Munich and visiting professor at Harvard University, said in a press release.

The researches believe their findings add to the growing amount of scientific evidence that shows the brain may be especially vulnerable to injury between the ages of 10 and 12.

"Therefore, this development process may be disrupted by repeated head impacts in childhood possibly leading to lasting changes in brain structure," said study author Julie Stamm, currently a post-doctoral fellow at the University of Wisconsin School of Medicine and Public Health.

Despite finding a link to the brain development window where kids are more likely to suffer brain injury by repeated head impacts, the small size of the study means the results may not necessarily apply to non-professionals.

"The results of this study do not confirm a cause and effect relationship, only that there is an association between younger age of first exposure to tackle football and abnormal brain imaging patterns later in life," said study author Martha Shenton, a professor of psychiatry at Harvard Medical School.

Because of the intense publicity about and the findings of many studies on the short and long-term dangers of concussions, many school sports programs are looking at changing how they allow students to play in games associated with head injuries.  Where it was once common for coaches to let players continue playing after a particularly rough tackle or head butting, they are more likely now to insist that a field medical professional examine the child. Some schools are also implementing no tackle policies to protect very young players.

While traditional football isn’t likely to become extinct, parents and coaches can educate themselves about brain injuries and learn how to best protect young players from the chances of long and short-term disabilities.

Source: Brett Smith,  http://www.redorbit.com/news/health/1113407634/pre-teen-football-linked-to-more-severe-brain-changes-in-nfl-players-081115/

 

 

Daily Dose

Needs vs Wants

1:30 to read

While on the subject of the New Year and resolutions I started thinking about another topic that I am going to keep top of mind…the difference between “need and want”.  I think this is such an important discussion to have with our children as well, and to begin that discussion at young ages.

After all of the excitement of Christmas (as well as Hanukkah and Kwanzaa) and the gift giving associated with these holidays it is a great time to reflect on the topic of need and want.  For many of us and our fortunate children the gifts that were wanted and wished for have been opened and are being enjoyed.  

But this time of year also makes me reflect on how fortunate I have been and that there is really not much that I need… and I am going to remember that. I am going to consciously try and curb my wants this year.  Less impulsive buying and more giving to those that are less fortunate and using any opportunity that I have to give rather than receive…and not only with material items.

Teaching this to children begins with that age old adage, “model the behavior” that you desire your children to have.  I imagine that most parents believe in teaching their children the difference between needing and wanting things. There are  so many day to day opportunities to teach even young children this concept.

I see this discussion in the grocery store as mother’s are checking out and their children want a pack of gum, lifesavers or even a toy and their mother (or father) calmly tells them, “you don’t need that” and puts the item back. Even though their child will often “lose it” and begin to cry or whine the parent finishes their purchase and carries the unhappy child out of the store. Lesson begins….

hat about the dinner table….When your child says, “ I don’t want/like that” and you can calmly respond that they “need a healthy diet” and ignore their wants for unhealthy foods.  

Another easy opportunity to begin the discussion comes around birthdays and gifts. I have had several different families tell me that they sat down with their child and discussed what they really needed and then decided that they did not need any gifts but rather donated toys to less fortunate children….what a great idea.

Teaching our children and ourselves is an ongoing process…and I am going to keep teaching myself!

   

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