‘parenting’

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Friday Night Tykes As Seahawks NFC Championship Beckons

Wait, did he just say what I think he did? (minute mark 1:18)

I want you to put it in his helmet…I don’t care if you don’t get up. Let’s go!

Or is it:

I want you to put it in his helmet…I don’t care if he don’t get up. Let’s go!

Either is grim. The new show, Esquire’s Friday Night Tykes, is getting quite a bit of attention. I suppose this was exactly the network’s intent but there are very few cells in my body that can stay quiet about this. Reality TV has submerged to profound depths.

Seahawks In Seattle!

We’re pulsing blue and green around here. There are 12s affixed to most every man-made structure in this town and our sense of Seattle-cohesion is undeniably improved. It’s exciting to dream of a Super Bowl win for our Seahawks. We’re ready for the 49ers this weekend (we even have our own Macklemore & Ryan Lewis playing at halftime) and most everyone in the Puget Sound is aware that football is providing a reason for giddiness. Like or hate the NFL, it’s my experience that we’re excited about our team…

First thing first: I know this is a pipe dream but I really wish a Seahawks player or coach would take the lead and discuss the disgust we should all have with Esquire and the crew involved in Friday Night Tykes promoting the abusive coaching. It’s an understatement to say that I’m outraged some think it is not only permissible for children to participate in this program but that we are willing to elevate the scenario and call it entertainment. Perhaps the NFL won’t permit this kind of public advocacy. Any ideas? Read full post »

Birthdays

Stomp rocket jumpingSomething amazing about birthdays. Just a day of celebration in our child’s life, perhaps, but something altogether different for we parents. It seems to me that birthdays serve up quite vivid moments for reflection.They offer up a day to assess progress, loss, growth, and quite easily acknowledge the annual tick of time. Earlier this fall a 70+ year-old man at a conference said to me (I’m paraphrasing), “Well, life as a parent is simply a blur. It’s a hazy smattering of years of frenetic events peppered with poignant traditions–all you can do is look back and remember the holidays and birthdays in a sea of years that go by.” He may be right. All the more reason these birthdays carry so much meaning.

Our youngest just turned five. And although it was quite a wonderful day of celebration (see evidence in that photo), I couldn’t suppress the ever-rising pit in my stomach. I have vivid memories of my own 5th birthday and it’s clear that time really is flying by. “The days can seem like years and the years like days,” yes of course, but on birthdays I think we parents experience complex emotions. It’s easy to suggest we should just celebrate and rejoice. “Consider the alternative!” you could say. I’d suggest we do celebrate and we do rejoice; it’s a settling and lovely thing to watch our children soak up their birthday. I’m uncertain though that’s enough of a description of these days for most parents.

Like so many other friends and parents have shared, I’m really starting to want things to slow down. I can’t help thinking about the reality that I can barely carry my 6 year-old anymore and there are mornings when he beats me to the kitchen and pours his own bowl of cereal. I know soon the days will close when O wants to eat dinner sitting on my lap. This grace of intimacy in parenting young children is for me the treasure of life. And I’m mindful, thankful, present, and proud but I can’t help hurting as I witness the sunset on this time.

I love these boys more and more and more every day I know them and I enjoy parenting them more and more and more each day too. I know it will only get better as so many ahead of me suggest. It doesn’t mean though, that it doesn’t hurt to see the candles multiply on top the cake.

The Value of Play

bike ride 2013

As we transition to summertime we get to focus even more intently on play. Not as easy as it sounds.

There’s a balance with having a routine and structure for your child while also facilitating some time for creative play. Unstructured play doesn’t get the voice it deserves in my opinion. Parents ask me about the camps I’ve signed up for far more than they ask what downtime my children will get this summer. In my mind, the perfect summer is a blend of scattered exciting opportunities with swaths of time ready for unstructured play.

Boredom can be good for heavily scheduled children and can foster creativity

There’s lots of stress amidst the celebrations and change that comes with the end of the school year. Children thrive in routine, so even a good transition out of school can cause disruption. Some children will have insomnia, decreased eating, or even feelings of anxiety. Big changes can trigger feelings of depression in some children, too. Check in with your child if you’re worried and remember that more important than what you say will likely be that you listen.

Play

Maria Montessori famously identified the value of play saying, “Play is the work of the child.” Play is so important it is a protected child human right by the United Nations. Just as labor laws protect our children from hard labor and work, we parents must protect their chance to wander, dream, roam, and discover. Research shows play is important for brain development, an important platform to learn decision-making, and offers up a tool for children to identify their passions. I don’t mean time in front of the TV or DS. I mean time outside, in the backyard, or in a child’s room. In the 2007 American Academy of Pediatrics statement on play, Dr Ken Ginsburg wrote, “In contrast to passive entertainment, play builds active, healthy bodies.” Read full post »

Brothers And Sisters Who Fight

From Pop Strip http://popstrip.com/sticks-and-stones

Lots of people ask me how my boys get along. I never know quite how to answer. They are pals most of the time, they play and invent and create games and fun together. But they also fight. I suppose I expect it as a mother but I admit that even as a pediatrician, ex school teacher, and younger sister in life, I sometimes don’t know exactly when to intervene and when to leave them alone to resolve disputes unassisted.

Our society seems to have more tolerance for sibling bullying than peer bullying whether in the schools or at the playground or at home. Traditionally we’re taught to expect sibling rivalries and often chalk it up as an expected or normal part of childhood. “Boys will be boys,” we say.

Some experts are urging us to think again.

Sibling violence is often minimized yet new research shows this violence and bullying can have lasting and serious mental health effects.

Parents and others often minimize the frequency and severity of aggressive behavior among siblings

Typically, I’m a stickler for a no-fighting-no-warzone type home. I hate the noise that comes with fighting and I hate the tension. When things escalate I tend to banish the boys to their rooms individually to help them cool off and make apologies and amends. Sometimes I let them sort it out themselves of course, as it can work wonders to plant myself squarely on the sideline. It’s luck of the draw though on how I respond from day to day–I have no clear system on when and why I intervene. I’ve been imperfect, too –in fact one tug-o-war between the boys with a bath towel landed my older son in the ER for stitches. I wasn’t even thinking about his mental health…

New research published today offers up some compelling data for we parents unsure how and when to respond or intervene when our children fight. We may need to get more involved. Researchers found that bullying at home from siblings can have lasting effects on mental health. And by the way, it isn’t always the oldest who bullies. Read full post »

End Of School

Screen Shot 2013-06-13 at 3.40.58 PMLast day of school this week. The backpack is nearly as big as his body; that’s no optical illusion and the body-to-backpack proportionality serves up a dutiful reminder for me that my little boy is still small. To me it feels like he’s perfectly diminutive amidst the big surroundings of his school– it’s boards and doors towering high enough to accommodate the 8th graders yet inclusive enough to welcome him gently into grade school.

It’s clear that as Kindergarten lands in the rear-view mirror my hearts aches. I know I’m supposed to celebrate his growth and accomplishment for finishing. And I do. Yet all I can think about today is the reality that now that he’s technically a first grader he is also a bona fide “school-aged boy.” In pediatrics that does mean something altogether different. In fact once a child is 6 years of age, we often tell families it’s fine to come in for well child care check-ups every other year, absent concerns, until a child is 11 years of age. Growth typically is steady and stable, children advance in school, and routines are made–this is “school-age.” Fortunately even though some of this time between 6 and 11 may be very routine, even in 1st grade, a friend reminded me last night, “They are still made to believe they are the center of the universe.”

Every parent ahead of us warns us about the speed of travel through parenthood. They reflect on the g-forces of time and the flash of light between Kindergarten and the day they find themselves standing in an archway with a mature child at the end of high school. Often those ahead of us couple the warning about the velocity with an instruction. “Savor this time,” they say. And so many of us do. We savor, we relish, we reflect, and we love. It isn’t always perfect and pretty, there are tantrums and accidents, mess-ups and failures, but we do savor and we really are present in the moment so often.

Sometimes I want to scream out that we parents (of young children) –we get it, too.

I’ll admit though that amidst the myriad of moments this past year that I have felt mindful and present, I’ve also had plenty of others where I lacked attention.

Read full post »

No More Clean Plate Club

Some new advice allows us to do less, not more. Turns out, new research finds that controlling parenting styles may hinder children’s healthy eating habits. New data published in April 2013, finds that not only are controlling, food-related, parenting practices common, they aren’t helping teens maintain a healthy weight. In the Pediatrics study, researchers found that parents often encourage teens of healthy weight to finish all their food, providing pressure to eat. While parents to overweight teens ban some foods and encourage restriction. Neither practice is proven to improve teens’ habits or improve their health.

We really want our children to self-regulate their energy intake (food) and mounting evidence reports that controlling habits hinder this essential skill.

Four Golden Eating Rules

  • Divide responsibilities. Parents have the job of purchasing and serving healthy food. Infants, children, and teens have to choose what to eat and how much of the food that’s offered. The division of responsibilities allows you less of a role. Every parent knows that you can’t force a child to eat–the best thing to do is stop trying. Let mealtime be about feeding your body. If they don’t eat much, wait until the next meal to offer food. Children eat for themselves, not for their parents. Turn the TV off and let children feel their fullness when it arrives. 
  • Eat when your body is hungry. Stop when your body is full. Infants do this naturally when breastfeeding and when starting solids. We have to do our best to maintain that natural habit throughout toddler to teen years. This skill of responding to natural hunger and normal cues of satiety can be a huge asset for children for their entire lives. Do your best to stop engineering how much your children eat and let them learn to feel necessities.
  • Don’t make children Clean The Plate. There’s absolutely no reason to provide pressure to eat for children with normal development and normal health. Don’t reward children for finishing their dinner with more food (ie dessert) as children will often eat past their fullness. New research also finds that using smaller plates can also help control portion sizes and ultimately will reduce number of calories eaten. The benefit: it will also trigger less need to ask them to clean their plate, they’ll do so naturally on a smaller plate.
  • Eat together. The most potent education we give our children comes from our modeling habits and behaviors we think are most important. Eat together with children at meals from infancy until they leave home. Make a goal for at least one meal a day, and it doesn’t need to be dinner. That being said,  I love the book The Family Dinner by Laurie David. There’s no reason to cook special food for your children. Involve them in any part of meal prep you can, eat the same foods, and share your love of eating.

Beads Of Courage

beads of courageI met Lowie backstage, about an hour before my own talk earlier this month. I had butterflies in my stomach for all sorts of reasons. I’d read about him prior to arriving and perused the blog he’s written about his daughter’s cancer and his family’s journey during her life and death (you can have Google translate it into English). It was so nice to meet him.

I was really looking forward to his talk although a part of me knew I’d need to brace myself, dig fingernails deep into my legs and let my throat tighten when he started to speak. I knew his words would fill my eyes with tears.

His story detailing Guusje’s voice and needs during her cancer treatment did, of course, cause me to cry. But the images he shared also gave me great hope. Learning about his daughter’s life implored me to share his lessons. I realized we could share the beads of courage widely and put these beads in the hands of other families everywhere. You know we can learn a lot from those in the Netherlands — they did just top this list from UNICEF for child well-being for the wealthiest countries on planet Earth.

Beads of Courage

In the Netherlands when a child is diagnosed with cancer, they immediately spell out their name with beads and then chronicle their courage each and every day in order on a string. Each day of chemo, each radiation treatment, each terrible, bad day (green), and each good day gets documented, strung up in line, and valued. A ledger and journal of the courage a child maintains as they fight for life.

To me it seems obvious that these beads of courage can represent a child’s endurance, perseverance, experience, and will. A hand-held way for a child to see where they are and where they’ve been. Yet reflecting on and re-watching Lowie’s talk I realized that more, these beads can represent the wishes and life experience of a child who courageously fights for life during a chronic or life-threatening disease in a health care environment.

These beads can be a tactile acknowledgement of  humanism  in health care. Read full post »

Boston Marathon

Another tragedy in our country today has us all bracing ourselves. I’m so sorry to hear about this horrific tragedy at the Boston Marathon and so hopeful that the chaos quickly comes to a close and injuries are rapidly treated with compassion.

I’m not sharing the news about the bombing with my boys. I’ve been following live coverage quietly on Twitter but we won’t be turning on the television tonight.  My boys are very young and so it’s easier to insulate them from the news. I know it’s not so easy as children age and many parents find themselves overwhelmed tonight.

It is really hard to turn the news off, log off Twitter, and return back to life as normal after we hear this kind of news. The randomness of this bombing again has us shaken. I’ve found this particularly gruesome as it was at such a symbolic and nearly sacred place…

The end of a marathon finish line is truly an inspiring and cooperative place.

As I sort out my own emotions, I’m doing my best to hold onto the image I just read about on Twitter—there are runners that kept running past the finish line straight to Mass General to donate blood.

We are a wonderful people in a wonderful country steeped with love. We are full of generosity. We can continue to see this and remind our families as we hold onto hope. So many helpers around…

Helping Children Tonight

  • Turn off the television and/or radio when you can if children are around. 
  • Remember young children, under age 8, have a difficult time sorting out reality from fantasy and may not understand the true distance between you and Boston.
  • Tips for talking with your children about tragedies from Healthy Children.
  • As the details get sorted out, remember it’s okay to tell children you don’t know why this happened or how.
  • More than anything, tell children the truth but avoid horrific details, numbers, and gruesome images that are circulating online whenever possible.
  • Here’s a very good blog post from my friend Dr Claire McCarthy who is a pediatrician in Boston on supporting children and talking about tragedy as this unfolds.

Chickenpox Parties

pox party de-identifiedToday a Seattle mom advertised on an online parenting community that both of her children had chickenpox and then invited (non-vaccinated) children over for exposure. That’s the invite from 1:19pm today.

It turns out people are still having chickenpox parties.

Part of this makes my head spin. I just don’t get it, despite having had many families in my practice decline or hesitate or delay the chickenpox shot. I don’t think parents know what virus they are dealing with. After I posted this invitation on Twitter, I had physicians all over the country sharing stories (some included below).

Chickenpox can cause serious infection complications and rarely it can be lethal. Before the vaccine was approved and put into use in 1995, hundreds of children and adults died in this country every year from chickenpox and thousands were hospitalized. Although most young children get chickenpox and recover (only left with pox or scars) some children develop life-threatening secondary infections. Some children develop severe pneumonia (1 in 1000 children), some develop brain infections, and some children develop flesh-eating bacterial infections in their scabs that can even be fatal.

There is a safe, highly effective vaccine for chickenpox: Varicella Vaccine.

After I saw the pox party invite this afternoon I became slightly enraged. I mean, there are NUMEROUS children and adults in our community immunosuppressed and/or on chemo that could develop life-ending complications if exposed to varicella. And some families are intentionally exposing their children to a potentially harmful infection. After 2 doses of the chickenpox shot (varicella) 99% of patients are immune to chickenpox. Although some children can get chicken pox once vaccinated, they typically only have a few pox and do not develop severe side effects or die.

The pox party just shows me how much work we have to do to build trust in vaccines and vaccine-safety. My boys have both had 2 doses of the varicella vaccine. I’m thrilled they are protected and unlikely to ever get chickenpox or spread it to a community member who could be more at risk. They likely won’t get shingles, either.

Chickenpox Facts & Stats:

  • Varicella shots hurt upon injection (children tell me it really stings). We give the shot twice, once at 1 year of age and once at 4 years of age. The shot can commonly cause arm soreness and lowgrade fever. In less than 5% of children, a small rash develops, often around the site of the shot. That’s a good sign the immune system is being triggered to fight off future infections. The rash that can develop after the shot is not contagious. Read full post »

Listening To The Periphery

hallway baconWe learn so much from our children. How to slow down, how to speed up, how not to behave. How to be present, mindful, and attentive to immediate needs. I’m not always entirely mindful and I certainly find myself easily distracted–it’s not just the phone I need to put down. Yet one low moment of distraction came to light late last summer when my 4 year-old literally put his body between my phone and my face to get my attention.

But ever since August I’ve felt more aware of the moments that pile on and feel more able to witness those I am lucky enough to work with and those with whom I am lucky enough to spend time. I enjoy clinical medicine more since I felt a more intimate proximity to my own mortality. I enjoy my children more and my time alone more, too.

It’s often those much younger and those much older and more experienced that clarify issues and help us focus the lens. It seems to me the simplicity of knowing what to do and what matters most stems up from those at the periphery. I’m not saying those of us stuck in the middle of this generational sandwich don’t have insight, I just think we draw heavily from those for whom we are indebted for their pace, their age, and their innocence.

I learn so much from children every day. In clinic today my stomach dropped at one point simply because of the story shared by a 6 year-old. The day had been laid out differently because at our morning huddle in clinic we review comments that come in. A patient had detailed in a comment card that he/she felt the nurse and medical assistant had spent more time listening to them than the doctor had. Sometimes we can do such a bad job showing those for whom we care we’re listening. It’s pretty obvious that as we work hard to witness our lives we often get more quiet. I feel so much more porous to the lessons in this wicked-packed-full-generational sandwich. Which reminded me of this: Read full post »