Archive for October 2010

Monthly Archive

Traditions (At Halloween)

I’m big on creating traditions. Wish I had more of them, actually. If Halloween was a day to make resolutions, I would pledge to increase my family traditions. But I’m mixing holidays like metaphors…

Children thrive when expectations are fulfilled (think routine, routine, routine); and traditions can be cement in the routine mold. There is something lovely about repeating an activity to mark the importance of a particular day or particular time of year. I mean, this is what birthday celebrations are all about.

Both of the boys’ birthdays are coming up in the next few weeks. Because of Maryann’s (see her comment) contribution to the blog a couple weeks ago, I’m starting the new tradition of kissing the boys at just the moment they were born. A virtual stamp of time and place. Driving to and from work this week (my down time), my head kept returning to thoughts about the new tradition. A big, wet smoooch that I’m giddy about it; it seems an entirely intimate tradition. Now I’m just sitting around waiting for 1:18pm and 3:11pm to roll around. Maryann, thank you for the idea of this symbolic tradition. I figure his tradition can also serve as an insurance plan, too. I will be exactly where I want to be in those birthday moments: with my boys. Read full post »

Faltering

So we don’t have our nanny today. This was intentional, a way to carve out some time with my boys. Our nanny hasn’t had a week day off in months and months. All well and good except I needed to finish a blog post and a letter I’m writing for an advocacy effort. F is at school. O went to music this morning with Grandma. And nap time (now) was supposed to be used for writing. Oh how I expect the plans to work….I am working on finishing a blog post on traditions, and the one I keep promising on booster seats.

But O isn’t napping today. I think it’s the first day in the history of time that he has skipped his nap. He has a crummy cold, he’s markedly congested, and has a barky cough. He is mouth breathing because he has so much snot in his nose. Subsequently, he keeps awkening and then screams and cries. I’m back up in my office just now after my third attempt to rock him back to sleep. But I’m faltering. I know, I mean I know, that if I gave him that pacifier back, he’d konk out and sleep. Despite the effort to keep him as comfortable as possible: 1/2 tsp of honey before nap (to dimish cough), the humidifier running (dimish cough/humidify his nasal airway), and his comfy jammies for nap, I am missing something. In the puzzle of life, I know that pacifier would fit perfectly.

Of course, it’s the small picture solution and a wreck for the big picture (successfully weaned pacifier). Doing my best to take my own advice. But it got me wondering, have any of you gone back on your pacifier plan and given it back to your child in a moment of “weakness” for care or comfort? What happened? Am I right when I say it will be harder to wean the next time? Share.

I need some support before I go rummaging through the shelves/garbage/pockets in search of that pacifier…

If It Were My Child: No Teething Tablets

On Saturday, the FDA released a recall of Hyland’s teething tablets. The recall stems from concerns for increased and varying amounts of belladonna, a toxic substance that could cause serious systemic effects to babies. It’s unclear how much belladonna is found in these tablets normally although it is well known it’s in them. Recently, infants have developed symptoms consistent with belladonna toxicity after using the tablets (change in consciousness, constipation, skin flushing, dry mouth). Homeopathic supplements and medications are unregulated and therefore it’s hard to know what is in them, how consistent one bottle is from the next, and how different brands of the same products compare. Local and national poison control previously deemed teething tablets safe even though it is known that they have trace amounts of belladonna (and possible caffeine). The FDA states it is “unaware of any proven clinical benefit from the product.” Because of safety concerns and no known benefit, I’ve always recommended against using teething tablets. If it were my child, I didn’t, and would not use teething tablets. If you have these at home, throw them out. Here’s some FDA tips of safe disposal of unwanted medications. If your child has had these tablets in the past, there is no reason to worry. Ill effects would have been seen soon after using them.

Some Teething Truths:

Sitting In A Circle

Working-mom-struggle bubbling up. Work life balance. Feels like I’m sitting in a circle; there’s no corners to hide out in. Problem is, this circular spot happens about every 7 days. It’s Thursdays I’m talking about.

This Thursday I was away from home for 14 hours. I left for a talk before the boys awoke, and arrived home well after bed time. During those 14 hours, I was able to hear an incredible talk by Perri Klass on reading & advocacy via the Reach out and Read program, I completed a long day of clinic and saw over 25 patients, I completed an interview with a potential medical assistant, and I had two 30 minute commutes. I am really glad I had those opportunities. For one patient and his mother, I wouldn’t have missed the day. Hands down, good decision to go to work. But these long Thursdays eat away at me. Intellectually I understand trade-offs in life exist (duh). I understand with opportunity comes losses (duh). Despite this acknowledgment, I seem to go through an emotional evaluation every week. Something about Thursdays seems an utter failure on a personal level. A day starting and ending with zero time with my children seems simply preposterous. Outside the scope of travel, having a day go by on planet earth without a glimpse of my children, while coexisting in the same home, seems a minus. My motherhood isn’t supposed to look this way. Yes, I know mothers leave and travel; I know children divide time between parents. I know plenty of parents work harder and longer hours than I do. I know many other mothers and fathers carry more than one job. I remember my co-residents with children (while in training) left their homes for upwards of 30 hours at a time, every week. Yet every Thursday I feel this 14 hours-ish toll. Even though I know my kids endure these long days well, I don’t. The balance between our time at work and our time enjoying our personal lives remains tricky. Read full post »

Coffee

Iron For Babies & Toddlers


This month, the AAP published a clinical report representing the committee on nutrition, urging pediatricians and parents to work together to improve rates of iron deficiency in this country. The reason: iron deficiency is one of the more common problems among children but it frequently goes undetected. We can’t see it, smell it, or detect it easily on exam or with one simple blood study. Oddly enough, it’s complicated to determine an infant/child’s iron status.

New research finds that deficiency of iron, particularly at young ages (0-3 years)–when the brain is forming and growing rapidly–may have irreversible effects on cognitive and behavioral development. Although the majority of infants and children are not deficient in iron, between 5% to 15% of toddlers are deficient. There are no great studies (believe it or not) telling us exactly what percent of infants are truly deficient.

Don’t go nuts about this and don’t let this scare you. You only need to make changes now, not look back and worry. First of all, let me put this in perspective: iron deficiency used to be a bigger problem than it is now. Prior to the 1970′s (when iron was added to infant formula) rates of deficiency were around 30-40% of babies. Breast-fed infants are at higher risk (versus formula fed babes) of being iron deficient if there is delay in introducing solid foods. So when the pediatrician has mentioned waiting until 6 months for solids, we neglected to prioritize iron.

We care about iron deficiency because it can cause two major problems:

  1. Iron deficiency anemia (small, pale red blood cells)
  2. Slowed or depressed cognitive and behavioral development. The first 3 years of life are critical for brain development and there is new research that iron status, starting in infancy, is essential for later cognitive performance. Think of “cognitive performance” as seeing well, reasoning, remembering, and interacting with others. So this stuff matters.

My biggest hesitation when I read the report the first time was that we were sending yet another message to breast-feeding moms that their milk wasn’t enough (ie your baby may need a supplement of iron in addition to that vitamin D). Furthermore the recommendations are filled with testing, re-testing, and follow-up evaluations that may be confusing and scary for families. Yet after numerous conversations with other doctors who were initially skeptical, and about 4 personal reads of the report, I have come to the same conclusion as those with who I spoke: We need to protect infants from deficiency of iron and we need to do more comprehensive screening of those babies graduating into toddlerhood. So some facts and explanations: Read full post »

Pacifier Free

This morning, casually, while at the breakfast table with the boys, I mentioned to O that big boys don’t use pacifiers. I said, “Babies use them, but big boys don’t. You’re soon to be 2 (years) and no longer a baby. You’re a big boy now.”

He asked to get down from the table where his pacifier was sitting. He marched into his room and grabbed his two lovies and came back to the breakfast table. It was as if he instantly knew he needed to look elsewhere for comfort. I didn’t take the pacifier away from the table and he didn’t ask for it again. When I left for clinic a bit later, I asked our nanny to try his nap without it today. Not wanting to set her up, I said, just explain that he’s a big boy (no mean, you’re-no-baby messiness) and see what happens. “If it doesn’t work,” I said, “I’ll do it next week.” But something seemed right about it.

I often tell parents in clinic that they are the experts of their children. Because although as their doctor I may know more about the physical exam, I’ll never understand or trump the instinct of a parent. As one mom mentioned to me in clinic today, we parents simply know who our kids “are” and what is about to happen. Read full post »

Minus One

O lost his front tooth this weekend. This was not one of those tooth fairy glory moments. No wiggling the tooth in the bathroom. No anticipation. No stuffing of dollar bills under the pillow. O is 23 months old, so losing a tooth right now is not only precocious, it’s 5 years premature.

Every time I think of it, I get a pit in my stomach. Maybe it’s my memory of the scream (mid-tooth-flying) or the fact that I was planning on calling the dentist this week for an opinion on how to preserve the tooth. O had fallen a number of times (while learning to walk on planet earth), rendering his front tooth dangerously loose. Sunday night the tooth got caught on a T-shirt as it was being pulled over his head. You can imagine the rest of the story.

Feels like a #mommyfail on some level. I should of made that call.

I was upstairs getting ready for a dinner to celebrate my father-in-law’s 75th birthday when it happened. Last time we tried to celebrate a birthday (mine) with my in-laws, O broke his leg. Doing my best not to read into this.

When the tooth fell out, we didn’t go to the ER. Dentists don’t put primary (baby) teeth back in when they fall out traumatically. And although dentists recommend you bring your child in for follow up after this sort of thing, if there is no other injury to the mouth or gums, there is no need to head to the ER.

Heart in my hand and the tooth on the counter, we celebrated my FIL’s birthday out for dinner. But I remained distracted throughout the night. My boy’s smile altered for 1/2 of a decade and that audiofile of the scream playing and re-playing in my head. Although O doesn’t show any signs of missing that tooth, I do.

There is nothing comparable to the heart-pull-tug-shread we feel when our babies get hurt. We are connected in inseparable ways. And pain travels faster than anything I know.

Why I Hate Sleep Positioners

I hate infant sleep positioners. They are not safe or helpful. If you have one or know a family/friend who uses one for their infant, throw it out. Trash compact it. Stomp on it. Cut it up in bits. This is one rare thing you should feel good about putting in landfill.

When I was first started in practice, I didn’t even know sleep positioners existed; I was shocked at how many parents told me they were using them. We are led to believe (by manufacturers) that positioners confer safety by keeping babies on their back. Since 1994, the Back to Sleep campaign has helped parents become vigilant (yes!) about putting babies to sleep on their backs. But after my sons were born, and while roaming the super-store aisles for bottles, crib sheets, overpriced silicon, and breast pads (oh the glory), I realized why parents get so confused.

In the infant sleep section, I found plenty of products designed for babies I would never recommend. Never. Sleep positioners, head positioners, comforter-like blankets for the crib, bumpers and stuffed animals. Many products went against what I was taught in my pediatric training and what I’ve learned thereafter. Like so many things in life and medicine, less is more. When asked about setting up a safe infant crib I say, “Boring, bare, basic.”

In 2005, the AAP (American Academy of Pediatrics) issued an updated guideline on the prevention of SIDS. Though the message has been effective, sleep positioners have persisted to sell. Two weeks ago, prompted by 12 deaths (over 13 yrs)  due to sleep positioners, the AAP reiterated their position citing the dangers from sleep positioners after the CPSC and FDA (photos seen here) sent out a warning. Even though these positioners go clearly against safety data and medical advice, companies have kept them on the market.

Why? Read full post »

Smooshed

I’m smoooooshed today. Underwater. Submerged. Trapped under my orange scarf (see image). Just back from two consecutive conferences and readying to speak at another. And, drumroll……the in-laws show up in 2 days. I’m in that state of near-paralysis-parenting where there is so much to do I feel incapable of completing any of it. Every parent, working or not, has been here. Right? Here’s to hoping I’m not alone… I nodded my head about 12 million times over the last week when other docs I met at the AAP conference talked about the juggle between work and parenting. One pediatrician, Dr Alanna Levine said, “There isn’t an instant of time left unscheduled.” Yes, and today I’m behind on that schedule.

I started sobbing at my computer this morning after our nanny came home to tell me that I had forgotten it was picture day at preschool. Of course, I wasn’t crying about the reality that F went to school in an old T shirt and a cock-a-doodle-doo hair style (he went straight to bed after family swim last night). No, this is not about vanity or being uptight. I was crying because it feels like failure sometimes when you forget details in your parenting life. F couldn’t care less about what shirt he wears for the photo, and I certainly need to think about that, too.

So as I scour the planet for a shovel big enough to dig me out of this hole, I wonder, what would you most like to hear about this week and next?

My Ideas:

  • Blog post on recent update on recommendations for preventing, treating, and caring for kids with concussion.
  • Blog post on a list of recommended booster seats. And the whys in using booster seats.
  • Why I hate infant sleep positioners and why I think they put kids at risk for SIDS. Don’t believe the advertising hype that they are good for your baby. Video or blog post.
  • The AAP published new recommendations for iron intake in infants and toddlers.  Want to hear about it?

Tell me what you want me to write about; vote below. Yes, I’m asking for audience participation. And, ummmm, do you have a sturdy shovel I can borrow, too?