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First Movie With My 4 Year Old


I’ve had media on my mind lately. And Finn McMissile, I’ve got my eye on you.

We took F (age 4 1/2 years) to his first movie about a month ago. It is something we’ve been talking about for over a year. He’d built up a sense of anticipation that we could have bottled. F is a focused boy. The only movie he has chosen to watch from start to finish his entire life is the original Cars. So with the news of Cars 2 coming to the big screen, we plotted our first big family trip to the cinema. F lost sleep with anticipation. He studied (and slept with) the New York Times synopsis. The NYT review, we didn’t share with him…

What age did you first take your child to a movie? Did you go because of a certain film or because the timing was right?

I’m asking because I think although there is no perfect answer (3, 4, 5, or 6), I wish our first movie had gone better. All in all, our experience was a great success in the eyes of my son, but Pixar let me down. As did Finn McMissile.

McMissile, why the unnecessary ammo? Read more »

Partnerships In Health Care

I got a parking ticket today. It was worth every penny. The logistics behind why I was in the wrong spot don’t matter (do they??). What does matter is the fact that I made a conscious decision at 10:30am that I was happy to pay the fee that was going to be coming my way if I didn’t exit the building.

I was able to attend a portion of the Pediatric Bioethics conference entitled “Who’s Responsible for the Children” this morning. I was planning to return to other work after a couple of talks. But I couldn’t pull myself away. In perfect form, bioethics’ discussions draw a feisty and varied crowd. In keeping with this, I sat between a lawyer and a nurse, behind a pediatrician, and in front of a philosopher. For someone who has studied bioethics, this is a little bit of nirvana.

Did you know that recent data finds that 40% of children in the US have Medicaid and/or no health insurance?

I’m left reeling, my head spinning webs of thoughts and streams of information together that make me want to do more, speak out, stand on a table and improve health care for children. I’m somewhat humbled and intimidated by the brilliant thinkers I heard. So until all that settles, there’s one thing that came up, and often does, that I must write about. It seems it’s a theme. Read more »

Colic, Crying, And The Period of PURPLE Crying

Every infant cries. It’s a part of being a newborn, yet infant crying still puts many of us on edge. As parents, we want to calm our babies and prevent crying; it’s simply instinctive to want to make it go away. The period of time when our babies cry most (between 1-2 months of age) can be entirely exhausting, unsettling, and unnerving. As we transition into parenthood, one of the most difficult challenges can be learning to soothe our crying newborns. One expert, Dr Ron Barr, refers to this period of crying as the PURPLE period. I’ll explain, but first, let’s talk a bit about colic and news today about using alternative “folk” treatments, and ultimately what it may mean when someone, a doctor or not, tells you that you’ve got a “colicky” baby.

This morning I did an interview for Good Morning America Health about a Pediatrics systematic review evaluating 15 large studies (including nearly 1000 babies) to determine if things like infant massage, probiotics, chiropractor’s manipulation, herbal supplements, and sugary/glucose solutions really helped “colicky” babies stop crying. The results proved unfortunate. No, these interventions don’t tend to help infants who are crying/fussy/screaming their heads off. Two things to think about with the new findings: first, when you’re frustrated with a baby’s fussing/crying, don’t reach for these remedies as solutions or as “cure alls.” As we know it now, there’s not a lot of evidence to use any of these remedies. Secondly, don’t confuse the word “natural” with “harmless” or “safe.” Many of these herbal and complementary remedies come with labels that say “natural.” Natural doesn’t confer safety. Some limitations of interpreting data from the 15 studies reviewed was the reality that little time was spent reporting side effects to interventions and therapeutics. It may simply be because there were few, but researchers are unsure. We only want to use medications in infants that prove effective.

The most important thing to do for a fussy infant is to find ways for you to soothe your baby. But know that you won’t always be successful. Read more »

Radiation Disasters And Children: Why No Potassium Iodide Now

There is a lot of talk about radiation and radiation effects because of the ongoing tragedy in Japan. It’s a bit overwhelming and confusing, to say the least. Ultimately, fear motivates us to act in bizarre ways and this current catastrophe in Japan is no exception. I find myself a bit nauseated when my mind drifts to Japan, yet I can’t seem to curb the urge to watch the updates. I don’t normally watch live news because I sincerely don’t think it’s good for me. But this horrific human tragedy steals me away from my typical distance while simultaneously reminding me of two quotes, one posted earlier:

Disasters are about people and planning, not nature’s pomp.” ~The Economist

and

Human inability to detect radiation can pose more of a psychological threat than a physical one. ~The Washington Post

The ongoing tragedy in Japan will help motivate us to prepare. But fear of the unknown can eat away at us, too. Anxiety surrounding Japan’s struggle may be higher than what we experience typically with catastrophic events, in part because of the complexity in understanding the effects of radiation. Because radiation is invisible to the eyes and undetectable to the nose, its presence is difficult to detect. We know that fear and anxiety are common in children affected by natural and radiation disasters but its psychological effect may be the most lasting and intrusive to health.

We can do things to protect our health, too. First, if your children are watching TV, sit with them and provide honest, age-appropriate explanations. Turn the TV off whenever possible. Next, discuss what your family is doing to help prepare for unexpected emergencies. Preparing your home and family for disasters with both a communication plan and an emergency kit can be a great way to decrease anxiety for both you and your children and will arm them with tools to protect themselves. A great antidote to fear is to regain your sense of control. I hope this post, and ongoing ones, help us all calm down.

The bottom line is this: with what we know now about Japan’s current disaster, even with the possible worsening nuclear crisis, medical countermeasure such as potassium iodide (KI) are not indicated here in the US. Don’t pop the Potassium Iodide (KI). And don’t feed it to your kids! Although Japan is advising KI use in the close vicinity to the damaged reactors, the US Nuclear Regulatory Agency and the Washington State Department of Health have both said that harmful effects of radiation are not expected in Hawaii or the US West Coast.

I believe every decision we make in medicine is a balance between risk and benefit, from intervention to doing nothing. This radiation question is no exception. Potassium iodide can protect the thyroid gland from the devastating effects of high levels of ionizing radiation. But, when used inappropriately or unnecessarily, potassium iodide has the potential to cause very serious side effects such has abnormal heart rhythms, bleeding, nausea, vomiting, and electrolyte abnormalities.

The risk of using KI far exceeds any benefit right now. Read more »

Japan Tsunami: Reminder For Parents To Prepare

I was up until nearly 1:30am today watching the Tsunami in Japan live online. Terrible for the psyche and hard on the heart, I simply couldn’t stop watching it unfold. It’s utterly terrifying to imagine the devastation and separation that catastrophic events like this cause for people. In the face of this terrible news, there is much we can do as parents. In addition to donating to relief organizations, we can prepare our families. We have incredible strength and insight as the proud providers and nurturers of our children. Now, today, is the time to utilize this reminder for good and harness your concerns into preparedness.

On the news last night, reporters kept repeating that every home in Japan had an emergency kit…that every family had a plan for an earthquake. They detailed how children knew at a very young age what to do when an earthquake began and families had communication plans to re-unite.

Today is a day to begin to create the same for your family. Emulate the universal emergency plans of families in Japan. I trust these kits and plans have saved many lives in the past 12 hours and lessened the worry of the millions of parents reuniting with their children as I type.

Last year, I made a disaster kit and blogged about the experience. Today, in the wake the Japan Tsunami, please consider doing the same. I’m re-posting some of the content here.

I’m gonna be honest, making a disaster kit completely stressed me out. I hope my experience will make it better for you. I guarantee with each step you take, you’ll feel an incredible sense of relief as you ready your family. I’m no expert at this but have learned a lot along the way. And there is no question, I feel so much better with my family prepared and my preparedness tidied.

As The Economist said last year when discussing Iceland’s volcano, “Disasters are about people and planning, not nature’s pomp.”

Prepare.

I believe in the 3 tiered approach you see everywhere:

  • Make a Kit (detailed below and in my video)
  • Make a Plan (how to communicate and find your family)
  • Stay Informed (what disasters are likely to happen, where to find info) Read more »

If It Were My Child: No Baby Food Before 4 Months

Last week news of a study evaluating the timing of solid food introduction for infants emerged. It got a ton of press because the study evaluated the timing of solids on the likelihood of obesity at 3 years of age. Researchers divided babies into 2 groups, those that received partial or full breast milk until 4 months, and those that were weaned from breast milk and received formula exclusively before 4 months of age. Researchers then determined when babies were given solid food (rice cereal, biscuit, pureed “baby” food, etc) of any kind.

The results proved notable. Babies who received exclusive formula and solid foods before 4 months of age were 6 times more likely to be obese as a 3 year-old (defined as BMI over 95%, sum of triceps and subscapular skinfolds). This however, was not true for the babies that were receiving breast milk of any kind. So this study may not be applicable to many babies; in the US for example, 25% of infants are never breastfed and approximately half are breastfed for less than 4 months. Yet still, this sheds light on what we can do to help. Use this data when Grandma Trudy is urging you to feed your infant cereal at 3 months. Or why it’s best to wait until 4 months when you get excited about starting solids. Those of you who didn’t wait? Before you spin your wheels with worry about that bite of rice cereal you gave your baby at 3 1/2 months, read on. Because although, if it were my child, I wouldn’t give baby food before 4 months, there may be more to consider when it comes to timing. Read more »

The Tiger Mom

I really didn’t want to write a post about Tiger Mom. I didn’t want to lend credit to her media bonanza. And truthfully, I’ve been intimidated by the exceptional writing in response to her words. At first, I didn’t think I had anything unique to add. I don’t like her message (tough/conditional love, tyranny and insults, achievement=happiness) but she probably doesn’t like mine, either. I have high expectations for myself, my friends, my family, and my co-workers. I expect my children to challenge themselves, to learn to communicate, to learn to love, and to work hard to make their conditions good enough so that they can enjoy their lives. I expect them to contribute. I may roar but I really don’t bite. I don’t hit, spank, grab, or insult either. I expect, at particular points in life, many people won’t meet my expectations just like I won’t meet theirs. I believe in forgiveness. My love and adoration doesn’t waver based on performance.

We don’t tolerate aggression in our children, why would we tolerate it in ourselves? Abuse is far more complicated than that which comes from the force of a fist. Just to be clear, I’ll never call my children, “Garbage.”

I’ve read somewhere over 40-50 reviews of the Tiger Mom. If for some reason you’ve not heard of her (who are you??? They’re looking for you to sit on a jury somewhere), Amy Chua is a self-declared Tiger Mom. She wrote a piece entitled “Why Chinese Mothers are Superior” in The Wall Street Journal, January 8th. It marks the beginning of the Amy-Chua era. Since then, buzz around her book, Battle Hymn of the Tiger Mother, hasn’t diminished. A pulse on her perspectives remains one month later.

I don’t want to read her book. The more I read about her, the less I want to know about what she says. I’d rather read something by Peggy Orenstein. I do, however, remain drawn to read what other people think about what this Tiger says. There is an unequivocal sociology brewing. Clearly Amy Chua did more than strike a chord. What’s interesting is not Chua’s idea (that one privileged, hyper-educated, heavily-connected, wealthy, Chinese American mom believes her parenting is superior) but rather, the response of our nation. I mean, EVERYONE has something to say about this. Why would we care that some mom, in one corner of our country, thinks she is doing a better job raising her kids? Why would we care that she equates happiness with achievement or “Westerners” with weakness? Why would we care that she believes intellect is only captured in music capability/competitions and SAT scores? She misses so much about humanity. So much about what defines our connection to others. We care, I suspect, because she was strong enough to state she believed she was right. And that she’s better.

She’s a bully. And a lucky one. Her kids have the wealth of good health.

Read the most memorable response I’ve read, to keep any fascination with Amy Chua’s words in check:

Battle Hymn of A Bereaved Mother

Really, stop reading what I wrote. Go and read what Ben and Ryan’s mom wrote (above).

I’ll tell you, I won plenty of music competitions (oboe), I went to an Ivy league medical school, I have a good job and an innovative career, I married a fantastic partner, and have the fortune of raising two darling boys. I didn’t come anywhere close to perfecting the SATs, I made mistakes, I quit lots of things along the way. Clearly I don’t think my accomplishments (or failures) define my worth, my happiness, or my sense of purpose. I agree more with David Brooks when he said “Amy Chua is a Wimp.” Brooks points out that, “Practicing a piece of music for four hours requires focused attention, but it is nowhere near as cognitively demanding as a sleepover with 14-year-old girls.” Emotional intellect means something. We test for it, just not inside the classroom. And it’s far more difficult to measure than math. Read more »

Treating Ear Infections With Antibiotics

New research on ear infections confronts a challenging conundrum: What should pediatricians do for a toddler with a real-deal ear infection? Treat with antibiotics or “watch and wait?” New research and a nice editorial published in The New England Journal of Medicine this week add to the stew of information about how to manage ear infections in young children. The new research confers benefit to using antibiotics at initial diagnosis of a true ear infection in children under age 2 or 3.

But wait. Seemingly simple, treatment decisions for ear infections are far from it. It can be easy for a pediatrician to prescribe antibiotics, yes. But those of us working hard to perfect how we care for children think long and hard prior to writing a prescription for the pink stuff. Current guidelines from the AAP (published in 2004) make us pause. The AAP recommendations embody the “watch and wait” approach in most children with uncomplicated, acute, middle ear infections between 2 months to 12 years of age. The AAP recommendations include:

  1. Proper inspection
  2. Pain control (Tylenol or Advil, etc). Ear infections hurt!
  3. Observation (waiting for 48-72 hours for relief)
  4. Treatment with high-dose Amoxicillin first and foremost if selected to treat.
  5. Return check after 48-72 hours if no improvement (then moving to treatment with Amoxicillin or changing to Augmentin if child on Amoxicillin)
  6. Prevention efforts (encouraging breast feeding, no bottle propping, working to decrease exposure to cigarette smoke)

But the “watch and wait” approach can be challenging for parents, pediatricians and family practitioners alike. Particularly with a child in pain, a gnarly looking eardrum, and/or a fever. Because of this, studies have found that the majority of physicians who see ear infections in the US don’t necessarily subscribe to these recommendations; we all really like to do something to make our kids feel better… Read more »

Do You Believe in Vaccines: (Part II: Evidence)

I asked a group of 33 pediatricians what they would say to the question, “Do you believe in vaccines?” while standing in line for coffee. I asked for their help in thinking about an effective, 2 minute answer.

This is part 2 in a series. For detailed information behind the why, read part I (emotional responses) or watch the video explaining how this came to be. As I said, I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. Part of the reason I started this blog was that in practice, I realized when I told families what I knew and learned in training, they listened. When I told them what I did for my own children and how I felt, they made decisions. Telling my story seemed essential.

(This is going to sound familiar) I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

Today I’ve included responses from pediatricians that mentioned things that I experienced as “evidenced.” But rather than talk to you about numbers, causality, rates of autism, and the absence of thimerisol in all childhood vaccines (except multi-dose flu shots), these comments focus on the evidence that helps physicians discuss immunizations with families. There was a paucity of numbers in the responses from these physicians.

Dr Gayle Smith (@MDPartner), a general pediatrician in Richmond, VA says it best:

I’d say how much I wished pediatricians were better ‘rock stars’ with our message of prevention so we could be more effective in the media limelight.  I’d speak my own willingness to touch the hearts of the families I care for, to carry the bag of fear and worry for them, perhaps lessening their load a bit. Read more »

Do You Believe In Vaccines? (Part I: Emotion)

I wrote 33 pediatricians an e-mail asking what they would say, while in line for coffee, to the parent of a newborn when asked if they “believed in vaccines.”  I wrote the e-mail not as a gimmick or a way to frame the issue of vaccine hesitancy, but because this happened to me. Rather, this happens to me. Often. When a new father asked me this question while carrying his newborn baby 2 weeks ago, I told him what I thought.  I then ruminated about my response for 24+ hours and wrote a group of colleagues. How do we talk with parents we don’t know, outside of the exam room, to help them understand why we feel so strongly about protecting children with vaccines?

I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. I wanted to hear what these expert pediatricians would say to get a sense of their collective insight. I wanted you to see it, as well.  I want to be really good at my job as a pediatrician when helping families understand the science, the evidence, and the emotion behind raising healthy kids and preventing illness with vaccines.

But I also really want families to understand why pediatricians work so hard to vaccinate children. I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

We are all so similar.

We all want to do what is right for our children.  That’s why everyone is so nuts about this. Simply stated, we all care immensely.

This was confirmed when I wrote docs from all parts of the US. I got over 20 responses.

I’ve arranged these pediatricians’ thoughts based on how I experienced their comments:

  • Emotional
  • Evidenced
  • Experienced

These thoughts are not mutually exclusive; you’ll hear evidence in the emotional comments, experience in the evidenced ones, and emotion in the experienced ones. Today’s post includes responses that felt emotional.

As I said in the video, it isn’t just parents who are emotional about vaccines. Read the comments to that post and you’ll see—some 30+ comments, mostly written by pediatricians, full of energy, data, and emotion. Pediatricians (and scientists/public health experts) are ultimately responsible for improving the way families understand immunizations. So this is weighty.

Emotional:

Most of these doctors wrote me about listening more than about talking.  But here’s some of what they said:

Dr David Hill, a pediatrician in North Carolina wrote:

Boy is this an issue on all of our minds! For me this question has particular poignancy, as we all watched our partner’s (a pediatrician) 22-year-old daughter die of H1N1 last year. To see her face-down on a ventilator, bloated and pale and then to have a parent tell me, as one did last week, ‘Everyone knows the flu vaccine causes just as much disease as it prevents.’

Gulp. His response to that parent’s viewpoint: Read more »