‘parenting’

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Picking A Summer Camp

As you construct a schema for your summer, plot vacation time, and plan for summer camps, more than anything I think you should build in some unstructured time. Carve out hours, half, or even full days each and every week with an absent itinerary. Wide-open days inspire creativity (in us all) and allow children to stumble upon a little boredom. I would suggest boredom is a helpful tool for everyone here and there, especially our children. Just think of the motivation that comes from it! Read this perspective: What Caine’s Arcade Teaches Us About Modern Parenthood.

Good thing for those of us who are less organized: unstructured time comes without difficulty as the camps fill up and we run out of options. Now (May) is the time to sign up for many camps, so get on it. The unstructured time I mention is only delightful if peppered into a summer filled with adventure and discovery. Summer camps offer a great place and space for fostering independence, building skill and esteem, and forging new friendships. Choosing a camp may feel entirely daunting if your child has special health needs, you have limited money for camp, or you’ve never separated from your child for long periods prior. Here are a few tips and resources I’ve found that may help: Read full post »

Imperfect Pediatrics

I had a phenomenal day in clinic yesterday. Imperfect for sure but inspiring, connected, and busy. I felt useful and like anybody else, that feels so good to me. Productivity can be defined in various ways and yesterday I fulfilled my personal definition. I wrote an email to a friend and cardiologist this morning where I said,

But I must say, it’s a sincere fortune to be a doctor some days. Yesterday was one of those…

It was typical day in the sense that my schedule was crammed full of well child check-ups, newborn visits, and a few scattered visits for acute care–colds, depression, and belly pain. As is typical, I arrived in the morning with absolutely no open spots on my schedule. I saw 25 patients, squeezed in 2 patients to “double book” who needed to be seen by a pediatrician more urgently, and we provided vaccination updates for over 1/2 the patients. The “productive” feeling washed over me a number of times. At one point a mom said, “I knew that but I just needed you to guide me to know that I was right.” Another moment when I confirmed the correct diagnosis for a patient who’d been into doctor’s offices twice where the diagnosis had been missed. It’s exhilarating to help people understand health, highlight their understanding of science, and calm them down. Parenthood can be extraordinary (understatement of the century). The best part of my job is when I can help clear off the windshield of doubt. I do want parents to see the road…

But the day wasn’t perfect. Read full post »

Idaho: Vaccine Safety, A Desert, And A Networked Community

I’ve just returned from a week in Idaho where I had the privilege to do a series of talks for the Idaho Department of Health (DOH) about using social media to communicate about vaccines. The best part of the week was all of the education I received. I traveled around the state (see those photos!), witnessed the DOH at work, connected with Idaho physicians & politicians & advocates & volunteers, and talked with many Idahoans about changing the understanding of vaccine science. Three times I heard Dr Melinda Wharton from the CDC present on vaccine safety. And more, in a matter of 4 days we talked with a clinician, nurse, or medical assistant from every single office in the state that provides vaccines to children. I mean, that’s a wow–a sincerely networked community circa 2012.

If all states had the opportunity to convene like they do in Idaho we’d really improve understanding, communication, and opportunities in health care surrounding vaccine safety and decision-making.

After arriving home to my boys, I’m compelled to share 3 things I learned in Idaho:

ONE:

I think it’s essential that we talk about the risks associated with vaccines when we give them–each and every time. Dr Wharton discussed known risks to vaccines and the science to support those risks. She also talked about inferred risks that aren’t backed up with science (autism, for example).

Take fainting: we know teens faint after shots sometimes. Read full post »

Concerns About Autism: Reasons To See The Pediatrician

When it comes to autism, we’ve all been rocked by the recent CDC data that found ongoing increases in the number of children diagnosed with autism annually; it’s estimated that 1 in 88 children has autism in the US. The rates are unfortunately higher for boys. The number is unsettling to say the least, particularly as the cause of autism is multifactorial and not entirely understood. Although we know genetics and family history plays a role, we don’t know what causes the majority of autism.

Read more about the science of autism from Autism Science Foundation.

We do know one thing: research proves the earlier you intervene to get a child additional services, the better their behavior, the better their outcome, and the better their chances for improved communication. You don’t need a diagnosis to access services for your child.

When you worry and can’t find resources online that reassure you, it’s time to check with your child’s clinician. That’s the point of a real partnership and a true pediatric home. Fight to find one if you don’t already have one. Fight to improve yours if it’s imperfect. The feedback I receive from families in my clinic allows me more leverage to make change. We’re all responsible for improved health communication…

Signs of Autism In Infants & Toddlers:

There is not one specific behavior, test, or milestone that diagnoses autism. More than any one behavior,

  • You should observe your infant demonstrating curiosity.
  • You should observe your baby expressing joy nearly every day after 4 months of age. Your child should smile when they are 2 months old, 4 months old, 6 months old and thereafter.
  • Your child should show you they know their name by 1 year of age.
  • You should see that your child tries to communicate thoughts more effectively with each month that unfolds during infancy and toddlerhood.

Here’s a list of specific Autism Warning SignsRead full post »

The Right Choice

Every once and a while I make the right choice. I mean when it comes to work and life and striving for balance. Sometimes I say “No” just when I should. Those “No’s” gain access to the best “Yes’s” in life.

Last week at the end of a series of 3 weekends of work, I was finishing up a conference and decided at the last minute to decline the dinner with peers. I felt pressure to go but just couldn’t stand missing out on the night with my boys. I had that longing in my heart–you know the kind–where you can feel the ache of absence, where you sincerely feel the separation from your kids like a missing body part? It was strong; all at once I said “No,” just in time.

We went to a baseball game here in Seattle. We sat only 8 rows back behind the dugout. The foul balls flying near our heads (me ducking for cover), the crowd screeching, and the sky blue. The husband and the boys had their gloves. We counted airplanes flying above. We cheered and jumped up with home runs. It was a perfect night out. Delighted to be there I had these passing waves of mindfulness, or gratitude, for being with my family and not missing out once again. We were all a little giddy to be at a real baseball game and then 2 things happened that affirmed my “No” was really a magical “Yes” afterall:

  1. A teenager caught a foul ball. Then he caught another ball. Then he did what many kids do—he acted generously. He saw F sitting right in front of him with his glove up and he tossed him the ball. I mean, can you believe that? A teenager gave my little 5 year-old boy a Major League baseball…bliss.
  2. During the middle of the sixth inning, after a bag of popcorn, a small tantrum from O, a bag of peanuts, and 4 hot dogs, Pennington went up to bat. Jon leaned over to F and said, “This guy’s hitting a ball to us.” They got their gloves up and ready. The foul ball did come. And the husband really did catch it. And my boys (all 3 of them) really did leap up for joy. We even made it onto TV (see photo above)!

Two foul balls, one perfect “No,” and a Saturday night with my boys illuminated a momentous “Yes.” It doessn’t always work this way yet every once and a while we make really good and really lucky choices. And then we’re fortunate enough to witness and celebrate them while they happen. For all the suffering that remains in so many of our lives, these little spots of light must be spoken…

Baby’s First Shots: Swaddling And Shushing

The 2 month-old check up may be harder for parents than it is for babies. Getting the first set of shots is anxiety provoking for we moms and dads; no question that it’s unsettling to allow a medical provider to cause our beautiful, new, healthy baby pain. Research has found that the pain and discomfort associated with shots is one of the primary reasons parents “elect not to perform timely vaccination.”

A study published this week affirms two truths. First, structured soothing may be a great tool for families to control crying after discomfort from shots. A group of pediatricians in Virginia used Dr Harvey Karp’s Happiest Baby on the Block 5S’s technique (shushing, swaddling, side positioning, sucking, and swinging/swaying) as an intervention for crying after the 2 and 4 month shots. The technique has been advertised to parents as a way to soothe and comfort fussy and colicky babies in the first few months of life. The researchers found that compared to a control group with no intervention and  a group of babies that received a sugary solution for comfort prior to the shots, the 5S technique helped soothe crying and pain more rapidly. Most babies that were swaddled, shushed, swung, and offered a pacifier for sucking stopped crying within only 45 seconds. Second, the great reality is that most babies stop crying within 1 to 2 minutes of getting injections anyway. The study confirmed that, too! In my experience, only rarely does a baby leave clinic still crying. Some of our anxiety about the discomfort as parents can be relieved–we really need to get the word out this is a short process. It’s rare for a baby to cry for even 3 to 4 minutes after their injections. Read full post »

Flying With Toddlers: Tips For Distraction, Tips For Tantrums

Flying with toddlers is far more difficult than flying with an infant in my opinion. It’s the need to get up, run the aisles, move around, have another snack, read a different book, take an abbreviated nap, go pee, and that minute-attention span that makes it not only exhausting but nerve-racking for most of us. Although the challenge is real, success comes with having a good plan, allowing extra time, and packing the right snacks, toys, and books to keep your toddler occupied. That 3,000 mile flight at 30,000 feet can be a ton of fun! The above tip came from a friend years ago. Prepare for the worst and expect the best when flying with toddlers–hopefully this blue tape idea sticks. (ha)

Now dealing with tantrums while up in the air is another challenge in and of itself. Many of us heard about the toddler kicked off an airplane, and have also heard about the opinion for commercial airline children-free flights. Although I wholeheartedly disagree that we should segregate flights by age, I do think these stories in the news media elevate our anxiety for flying with our children. Don’t let it. You’re always the best one to support and help your child on the ground or up in the air. Don’t let the public shake that truth. My tips for dealing with tantrums at 35,000 feet aren’t very different from those on the ground: provide consistency, provide distraction, and provide comfort. But more, set yourself up for success by clearing the tension with passengers sitting next to you ahead of time. Acknowledge the challenge. I’ve found it not only decreases my own anxiety, it allows for a much better reception when things don’t go as planned.  Click to read full post for my additional 1-minute video explanation and a few ideas. What are yours? Read full post »

If It Were My Child: No Football For Now

This is a position post where I take a stand that represents no one other than myself as a mom and a pediatrician. The reason I clarify this, is that my position is a strong one. No one wants to go up against someone like the NFL, it seems. But let me say this very clearly: It if it were my child, I’d never let them play football. No way. For my boys, the risks are too large, the sentiments too cruel, and the gains simply not worth it. There are plenty of other sports teams out there to grow, exercise, form friendships, and excel. I never want my children to be a part of any institution that houses intent to harm another human being. Although direct harm may not be a tenet in pee wee football, we all know that young sports teams are built to emulate the pros. If the NFL is the inspiration, for now, count my boys out. This isn’t just about the risk of concussion…

On my way into clinic on Saturday morning, I heard the alleged tape of Gregg Williams directing players to seriously harm opposing teammates. In the tape Mr Williams, the previous defensive coordinator for the New Orleans Saints, employed his players to inflict harm on multiple players–for example, attempt to tear the ACL of Michael Crabtree and work to re-concuss another player, Kyle Williams. Let me point out, some data finds the harms of concussions (particularly in adolescents) may be longstanding, and the risk of a second concussion may rarely be deadly.

In the tape you hear Gregg Williams repeatedly say, “Kill the head, the body will die” followed by, “We want his head sideways.” The tape goes on to capture more directives for harming additional players. It’s nauseating and provoking–got my fingers shaking during my drive. And really more than anything else, it was wholeheartedly disappointing. Particularly for me as a pediatrician. When parents now ask me about football, instead of talking about concussions as a significant risk, I’ll also be talking about ethics, sportsmanship, and integrity.

The great thing is that as parents we have lots of choices. Read full post »

Cocoon A Newborn, Only An Email Away

This week, Washington State declared that whooping cough (pertussis) has reached epidemic levels. Since the beginning of the year, we’ve had more than 600 documented cases in the state, a dramatic increase since last year. The increase puts our new babies at risk.

In clinic I’ve been urging new parents to cocoon their babies. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections.

Whooping cough is a highly infectious respiratory illness spread by sneezing and coughing that can be deadly to young infants. Getting a Tdap shot is the best way to avoid getting whooping cough. Amidst an epidemic, we worry most about newborns because they are most vulnerable to complications and lack vaccine-protection. If every child and adult that surrounds a newborn gets a Tdap shot, the likelihood of the baby getting whooping cough approaches zero.

Most newborns get whooping cough from their family or adults around them. That’s where an email comes to play.

You’re going to have to be fairly Mama-Papa-Bear about this. You’ll have to show some strength to create a very safe home, even when it feels somewhat over-the-top. As I said to a number of families in clinic today, “It only seems entirely over-the-top-nuts until we lose another newborn to pertussis.” Being smart now will save lives.

Make a new rule: no visits with a newborn until all visitors have had the Tdap shot. Even Grandparents.

Write an email to family and friends to explain.

A sample email for you to use/copy/share –written today by a friend of mine–mother to that darling baby girl born last week: Read full post »

Not Always As Bad As You Think

Sometimes TV is really good. We pediatricians forget that every time we advise against television-viewing using restrictive language. Yup, there’s a lot of bad television. And yup, there is good evidence that TV doesn’t do your baby’s brain any good before age 2. And yes, there is also evidence that what your child watches on TV matters. Yet every once and a while, we can be reminded of the magic in beautiful cinematography. And we can feel the bonding that arrives from the shared experience of traveling around the world (from the couch) while at home watching public TV.

I love this New Yorker article by Emily Nussbaum: It’s Good Enough For Me. She describes the drill (how we all are supposed to report our hatred of TV) and how she’s found a bit of beauty amidst the “renaissance of children’s programming.” There is something to be said for moderation when it comes to nearly all things in life…

When I grew up we had about 6 channels and with the current 600 channels to peruse I wouldn’t suggest the content is any more compelling. But tonight we had a mesmerizing night watching a show about dolphins and whales called Deep Thinking– how they communicated, how they empathized, how they think, and how they grasp their sense of self. It happened by accident after the boys had watched an episode of Bob The Builder. We were jumping off the couch heading for books and bed when Nature came on. It was the scenes from the Serengeti that caught my attention. When the images advanced to the ocean and the dolphins started to squeak, we all sat back down.

The boys stayed up 1 hour past their bedtime. We snuggled under the covers. O pretended to be a whale. F stared.
Imagine four of us in front of the screen, eyes wide open, sitting in stillness for an entire hour bearing witness to the intelligence of dolphins and whales. The show schooled us in geology, biology, communication, and the incredible beauty housed underneath the surface of the water. The boys talked about blow holes, fins, squeaks, and sea grass. They watched a sting ray detect an octopus in the ocean floor. We saw dolphins delight while playing with rings of bubbles. We learned about camaraderie under the sea.
So, should you have a television in your child’s room? NO
Is television all bad? NO
After a terrifically insane day the best moment I had was amidst those images of the sea, my boys nestled tightly into my side, while the clock ticked well past bedtime. All thanks to TV.