‘parenting’

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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 »

Something For Parents At The Park

Screen Shot 2013-02-16 at 5.37.00 PMThis is post from my friend, Anne Gantt. I love this concept and am inspired by the idea of parents pumping iron at the park. I’m hoping we can move this conversation forward. Please share ideas from your own neighborhoods in comments.

As a stay-at-home mom, I spend a ton of time at our neighborhood park while my 2 ½ and 4 year-old children zip down slides, scramble over the jungle gym, or chase each other in the woodchips. While they’re running around like little olympic athletes, I mostly just stand there doing nothing. A lot of nothing. Sound familiar?

That’s originally why I daydreamed about putting fitness equipment for adults in our park. I’d love to get a little exercise without having to resort to taking a turn on the monkey bars. The interesting thing is that installing adult fitness equipment will improve the park…for kids. This truly can be a win-win.

The park in question is here in Seattle– University Playground— it has a big grassy field, tennis courts, and beautiful new equipment for kids. It also has one of the very few public restrooms in the whole neighborhood–thus attracting a crowd. It sits in a tenuous location, one block from Interstate-5 and smack in the University District, which means the park sees a lot of illicit activity. Even worse, the illicit (I’m talking drug sales, etc) activity tends to happen in the section of the park right next to the playground.

Believe it or not, I’ve picked up more than a couple of used needles out of the woodchips myself.

Our park’s unsavory elements definitely scare some people off. I recently talked with a neighbor who refuses to take his 4-year old grandson to the park out of a concern for safety. This, even though their living room window looks right out onto the playground.

Something had to change. Urban dwelling can be better than this. Read full post »

Soccer Mom

Soccer net

I had an unusually good time watching my boys play soccer this past weekend. It’s not always been easy to get our youngest on the field and I’m not the mom who’s really loved being there. There’s been years of standing on the cold sideline where I didn’t think the boys were getting much out of it. And there have been countless minutes on that sideline where I’ve been consumed, weighing the costs and benefits of the soccer class, while my coffee went cold. Fortunately, something has changed recently. I’m certain it’s not only me who’s noticed–the boys seem differently positioned as well. Although I look in from the net and see something that seems entirely clear (a soccer field, a group of children–excited and eager [or exhausted and angry], and a coach) these little boys have reminded me yet again of the diversity of vantage points we share. They really do see those green fields as a part of their future. A great coach can really make our children immensely proud and excited to be alive.

Wonder is priceless and the pristine innocence harbored within our children often delivers moments unique to childhood. Children often hold the gift of believing that anything is possible. So often when they share this perspective we get to see a glimpse of unconfined opportunity. We’re reminded of our own potential, too.

Two things recently passed through my ears I have to share. They’ve enhanced my soccer mom experience immensely. Read full post »

Let Us Break The Silence on Stillbirth

This is really beautiful. There’s little to say other than we can do a better job supporting parents in their loss and in the celebration of their children’s life and legacy.

Watch this and enjoy the amazing amount of love you will feel…

“I want the baby I didn’t have.”  ”I feel like a bad luck charm around other moms.”

“I couldn’t understand why that happened to me…”

“His life was a good thing.”   “People say really sad, crazy things.”

“We said don’t come and they came….that was what we needed.”

“I love to tell people about my son…I don’t get enough chances to talk about him.”

“His life was a good thing.”

“I’m not afraid to mention him.”  ”Why don’t they tell you about it?”

“You second guess everything you did, everything you didn’t do.”

“I don’t want another baby. I want the baby that I didn’t have.”

“I love to tell people about my son… I just don’t get enough chances to talk about him.”

Mindful Parenting

mindful and the skyThere was a moment, just after President Obama was sworn into the office earlier this week, that I’ve been returning to in my thoughts relentlessly. He turned amidst the regal archway of The Capital and stopped. His accompanying family and tribe of lawmakers waited. He said something like, “I want to take a look one more time.” And then he looked back upon The Mall and seemed to take it all in. A few seconds, maybe 1/2 a minute or so. Not long, no, but the moment seemed to take up enormous space. Quietly, eyes wide open, he looked out to the millions that had come to celebrate and bear witness to his honor and his responsibility. Instead of looking at him, my eyes migrated to his daughter, Malia. I saw her watching.

It may have been mindfulness.

It’s of course never clear to an outsider who is mindful or not. Thinking and spending energy to be more present is a passtime that I was introduced to as a medical student because of the work of Dr Jon Kabat-Zinn. I use lessons from his work in my personal and professional life on a daily basis. Therefore, it was a sincere joy last night to sit amidst 1000 other parents and hear Jon Kabat-Zinn and his wife Myla talk about, “Mindful Parenting.” I was surrounded by my husband and friends, many colleagues and pediatricians, and I was lucky enough to sit near parents of my patients. It was community. To me it felt like a needed touchstone and a hearty reminder of how nicely being mindful fits into a busy, reflective, hectic, and imperfect life.

5 Lessons From Kabat-Zinns On Mindful Parenting:

  • Mindfulness is not the antithesis of anything. There is no single ill or evil that impedes it. In fact, the last question on the night from the audience begged The Kabat-Zinns to detail the biggest obstacle to mindfulness. They couldn’t answer it really. All this, precisely because mindfulness in its simplicity is openness, compassion, and love. At the opening of the talk, Jon helped us recognize the work that it took to bring us there, amidst the heavy Thursday raindrops, rush hour traffic, busy workweeks, needy toddlers or teens at home, and the truth that there was potentially something else we really should be doing. He reminded us all that is was LOVE that had brought us together to listen to ideas about mindful parenting. This we all share. This is why mindfulness is possible for everyone at every time in their life. Each new moment is evolving into something entirely new.
  • At one point, Dr Kabat-Zinn looked down at his watch. At first glance it appeared he was tracking the timing of his talk and then he burst out, “If you check your watch, it’s now again.”  A hilarious reminder that each and every moment that unfolds is always now. We have a chance to bear witness to time indefinitely. We are offered up the opportunity to be mindful, open, and present with an infinite number of “do-overs.” Oh, wow–it’s now again. Myla furthered this saying, “Every moment is the possibility of a new beginning.” Every single moment is a new chance to be aware. Read full post »