Archive for February 2011

Monthly Archive

An Amalgam In The Exam Room

This post is an amalgam. Not the kind that fits in your back molar, but the kind that exists in my head. I’m trusting you have this type of overlapping-quilt-like-consuming-idea-thread that resides in your head at times and ultimately becomes thematic. How one event in life opens a new window into others and then suddenly there is sense and commonality in different spaces and experiences. You know what I mean? Evolving wisdom or simply experience, I don’t know. But I mean how something persists in your every-moment and helps you define meaning  with each new space and time. I’ll explain…

On Monday, a blog post of mine from last summer was published on Dr Kevin Pho’s blog, KevinMD. The post detailed my mom finishing her chemo and 5 words that her oncologist spoke one sunny afternoon: “You’re the picture of health.” The post is about the power of a physician’s words and how words spoken in the exam room linger in our life. In this post, I spoke about words we hear as patients (and caregivers) and how it’s essential that doctors detail wellness when they see it (rather than always focusing on illness). But reading the post again brought me back to last summer. More than once this week (let’s be honest, maybe like 6 times) I’d think about the post and well-up with tears. Maybe it’s the reality that we all face mortality or that I’ve been ushered into a new moment with my mom in her current remission where I am not filled with worry every day. Or maybe it brought me back to the emotion that was in the exam room that day, too. The same emotion I’ve typically divorced myself from. But,

It got me thinking, how was it I was starting a blog, helping my mom through chemo, moving to a new home, and caring for two little boys while caring for a panel of patients during that time? Why wasn’t I in a puddle of tears? Well…see…we do this. Parents (and children) do this ALL THE TIME. They muster incredible courage. Parents face fears. They exceed expectations and bust through boundaries for their children. For example, in the exam room, I tell parents we’re admitting their child to the hospital and then they listen, they thank me, they discuss.  They rise up to what is asked of them without their heart falling out of their chest and landing on the floor. They endure. They “keep it together,” they advocate. They share. Yes, they break down sometimes, too. Yes, they tremble. But they always do what they need to. They endure.

Which got me thinking, we really can be the balogne in the generational sandwich. Read full post »

Formula, Breast feeding, And Solids

Here’s a response to some of the comments about the post I wrote earlier this week. As I’ve said before, I support parents feeding with breast milk and with formula. Studies like this aren’t designed to alienate parents who feed with formula. Take a listen. Here’s a post I wrote about the juggle/struggle to breastfeed while working. Ultimately, the goal of the Pediatrics study on timing of solids was to illuminate ways to improve obesity prevention. Not divide us or cause us to doubt ourselves.

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 full post »

Guest Blog: Dr. Ari Brown on Dr. Oz

Dr Ari Brown, a pediatrician and author (books in photo), was on Dr Oz yesterday. She was asked to join a discussion about autism. Dr Brown is a board-certified developmental pediatrician, a mom to two, and an advocate for science. She is passionate and clear about what she believes. She is speaking all over the country about how to protect children from illness, particularly when making decisions about vaccines. She contributed ideas in my series in late 2010 entitled, “Do You Believe in Vaccines: part I, part II, and part III.” On Dr Oz, she was asked to contribute to a discussion about autism that ultimately focused on fears about vaccines. I worry the discussion wasn’t a representation of most American families and even Autism Speaks refused to join the show.

She’s shared with me a blog post she wrote after being on the show. Many other pediatricians are writing about the show; read Dr Natasha Burgert’s post, too. On the show, Dr Brown sat next to Dr Bob Sears, a pediatrician who deviates from the recommended AAP schedule and had a chance to discuss her take. She sheds light on what we can do as parents to really understand. Thanks, Dr Brown.

I am thankful, Dr Oz, for the opportunity to participate in your autism show. Both the American Academy of Pediatrics and I hoped the show would help educate the public and move the conversation forward.
As a pediatrician who talks with families everyday in my office, I know parents want to know more about both vaccine safety and about autism. I’m also a mom. Like you, I need accurate information to protect my kids as best as I can.
I am concerned that viewers took away a very inaccurate view of vaccines. The most vocal audience members represent a small minority. Most parents of children with autism agree with the scientific evidence and do not believe that vaccines cause autism. Read full post »

Influenza: Still Time For A Flu Shot

It’s not too late to protect yourself and your family from influenza. Influenza peaks during February and March in the United States. Now is the time to be vigilant in protecting against and preventing the spread, of flu. Washing your hands, staying home from work/school, and covering your cough can be incredible steps. BUT:

The most effective way to prevent influenza is to get vaccinated. If you haven’t had a flu shot, get one this week. Your child can be immunized if over 6 months of age, and remember that many children under age 9 will need a second dose (booster shot). Read about how to determine if your child needs a second dose <—-here.

10 Things To Know About Influenza:

  1. Influenza peaks in February and March in the United States. Look at the CDC data that reflects ongoing influenza activity
  2. Vaccination is the best way to protect you, your family, and your community from the flu.
  3. Children under age 5 are at higher risk from complications from the flu. Children under age 2 are at even higher risk. Children with asthma and with some underlying medical conditions are at high risk as well.
  4. Pregnant women are at exceptionally high risk from influenza and complications from the infection due to changes in their immune, cardiac, and pulmonary (lungs) systems. While pregnant women make up only 1% of the US population, they accounted for 5% of the country’s deaths from H1N1 (Swine flu) in 2009. All pregnant women are recommended to get a flu shot. However we know that only about 30% of moms are immunized at the time of delivery. The bonus of protecting themselves? New research shows how vaccinating pregnant women protects babies. When moms protect themselves by getting flu shot, they also prevent spreading flu to their babies. Babies born to vaccinated moms have a lower risk of flu (and hospitalization) under 6 months of age when they are too young to get the flu vaccine.
  5. The best way to protect a newborn baby from the flu is to have all caregivers (parents, grandparents, nannies) get the flu shot.
  6. People can spread the flu to others before they even now they’re sick. People also spread the infection after they have had it; they can continue to spread flu for 5-7 days in mucus, sneezes, and cough. The best way to protect yourself is to get a flu shot, and second to that: wash you hands, cover your cough, and stay home from school or work when sick with fever and cold symptoms.
  7. Each year 20,000 children under age 5 are hospitalized with flu or complications of the flu. 11 children died from influenza during the week of January 30-Feb 5th in the United states.
  8. Although flu is reported as widespread in 37 states, nearly all areas have circulating flu right now. See the most recent CDC data on influenza around the country.
  9. Overall flu vaccination rates are less than 50% for people under 65 years of age. To best protect our communities, vaccination coverage rates should be about 90%. We’re not there. Immunizing yourself and your family protects those who are too sick (or too young) to get the flu shot and are also at higher risk of complications.
  10. Flu shots for children under age 3 do not have thimerosal. Nasal Flumist doesn’t have thimeroal. Read National Network for Immunization Information (NNii) page on mercury in vaccines. I don’t believe you need to find a thimerosal-free flu shot.

Love: Unequal And Incomparable

When I was pregnant with my second son, I had no idea how much I would love him. It didn’t seem possible that I could love him like I did my first. As I awaited his arrival (on bedrest), my expectations for him grew but my projected love and feelings remained very measured. I imagined having a blueprint for love, a near duplicate map of that with my first son. I was imagining a replica; I had no other schema for having a baby of my own. In this space, I expected it would all feel very familiar in my heart. And although this hope and anticipation fueled my pregnancy, I remember housing doubt that I would have the capacity to love another like I loved my first son. In some moments, it didn’t seem possible; the love already felt immense and unconstrained. As any parent knows, it’s simply insurmountable to quantify or govern love for your child.

If anything, I think I expected my love to feel equal for each boy, despite not understanding the mechanics of how it would happen. Part of that came from my mother telling me that she loved my brother and me equally when we were growing up. This often came up at incredibly sentimental times (note: sarcasm) like epic battles in sharing or when choosing which one of us needed to take the garbage out.

Of course, I’m sure my mom’s feelings are more complex, but her assertion of equality was the foundation in my thinking.

Out popped O in November of 2008. And just like everyone said, I fell in love with him…Desperately.

But my love wasn’t simple; it wasn’t the same. My heart didn’t mimic any pattern I’d developed for F. O was an entirely unique person in my life. And I generated an entirely new sense of connection.

My love for my boys isn’t “equal” in height, weight, or circumference. The love I feel for O is absolutely incomparable to the love I feel for F. As if it’s a different color, a different language, a different texture, or a different tonality. The space they occupy in me is immense and limitless, separate, and only occasionally overlapping. I don’t love one more than the other, but I can’t articulate how I love them in unequal ways. But I do.

Does the love you feel for your child equal that for anything else?

RECALL: Baby Monitors, Cords, and Strangulation Risk

The Consumer Product Safety Commission (CPSC) issued a recall on video monitors made by Summer Infant Inc today. Summer Infant makes over 40 models of video monitors. Look at their recall information if you have one, or call their information line Monday through Friday at 1-800-426-8627 for more information about getting a kit to secure the cord properly.

Recalls always make me feel uneasy; the photos accompanying recalls are often terrible to look at and the messages are impregnated with fear. As a mom and doctor, however, I tend to be reminded of things I can do to refresh the layers of safety I have at home for my children. I’m also reminded of the times I messed up. I end most 15, 18, and 24 month-old checks-up talking about our role as parents: to provide a safe and loving home for our children. I mean “home” in the greater sense, but also in the functional one. We need to create a place that allows for exploration. Our infants’ and toddlers’ curiosity is constantly expanding; and most importantly, their judgment lags behind their curiosity.  We have to have a safe place for them to mature. This recall can serve as a great reminder of ensuring your baby, toddler, or preschooler has no cords within 3 feet of their crib, bassinet, or bed. Strangulation can easily be prevented.

After two recent strangulation deaths, and one near strangulation (20 month old was found with cord wrapped around neck), the CPSC announced a voluntary recall of these products. And although most of us don’t have this particular model, most of us have baby monitors. Check your baby monitor (video or not) to make sure the cord is not within 3 feet reach of a crib, changing table, or the floor.

Video and audio baby monitors are designed to work when distant from your baby or child’s crib/bed. You’ll still hear that baby screaming when it’s parked across the room!

The American Academy of Pediatrics says:

Place your baby’s crib away from windows. Cords from window blinds and draperies can strangle your child. Use cordless window coverings, or if this is not possible, tie cords high and out of reach. Do not knot cords together.

As I said, I had MANY lapses in creating a perfectly safe environment for my boys. We moved a number of times during their infant/early toddler years and I remember realizing at one point after a move that I had the baby monitor (we didn’t have a fancy video one) too close to O’s crib. I’d rested it on the top of his crib rail one time after vacuuming. O was about 11 months-old and exploring every corner of the crib at nap time (read: not sleeping). Only when I heard (through the receiver) that O was playing with the monitor did I understand the mistake I’d made! I’d unnecessarily plugged the monitor into the same wall as the crib.  Eeeeps.

I moved the monitor to the other side of the room, about 6 feet away. Of course the monitor still worked fine. And yes, I felt a little stupid but I also wasn’t the only adult caring for my boys in our home. All of us had carelessly been using the monitor in that location. We all can use reminders…

As parents, we change rooms around, particularly with moves and new babies or transitions. Remember that all cords, those from blinds, monitors, and nightlights, need to be at least 3 feet from the crib and up out of reach of the floor. Using cordless blinds can be a great solution, too.

Do you remember a time when you realized you’d lapsed in creating a safe room for your child? Tell me I’m not alone…

Working Moms: An Association With Overweight Children

A study about working mothers is getting a lot of buzz. The official title of the paper: Maternal Employment, Work Schedules, and Childen’s Body Mass Index. Most media summaries however are entitled something like, “Mothers Who Work Have Fat Kids.” I’m not kidding.

I hate seeing studies (and media reports) like this. Not because they’re not helpful or worthy of our time, but because they examine the effect of mothers working, not mothers and fathers working, on our childrens’ health. In addition, the media/blogosphere goes bananas. This is the stuff that sells; studies on working moms get our attention. They feed the so-called “mommy wars.” They suggest that with the rise of women in the work force over the last 5+ decades, our children are suffering. No mention though, that fathers have been working during this time, too. No mention that, “In general, children whose mothers worked outside the home were less likely to live in low-income families.” That’s a direct quote from the results section of the study.

These studies dole out merit to the ever-present struggle that most working moms feel–the constant tug-of-war in our hearts between the need to be home and the need to work outside our home. I don’t read about men having this struggle. Is this biologic? Why are woman held more responsible for our child’s health? Can’t we evolve and get past this archaic notion? How many more studies will narrowly look at women in the workforce while leaving the role of fathers’ employment aside? As we come to embrace a more diverse family unit, we must rid ourselves of these rigidities. Studies like this suggest that men aren’t to blame if kids are overweight, but that women are. Most of the children in the study had more than one parent at home (on average, children with working mothers had 1.91 adults at home, therefore the far majority had either an additional parent or adult around). Seventy-nine percent of working moms were co-habitating or married.

It just can’t all rest on the moms’ shoulders. Really, overweight is more complicated than finger pointing; the authors know this. They didn’t set out to create blame, rather to create ideas for solutions for busy families with working moms… Read full post »

2011 Immunization Schedule Recommendations

This week, Pediatrics published their yearly update to the recommended immunization schedule. Each year, the immunization schedule is reviewed, and when necessary, guidelines are changed to improve protection for children. Changes stem from new studies that provide insight into immunization spacing, infectious disease experts’ analysis of data from new trends in infection, or epidemics, like that from H1N1 or Whooping Cough. All of this data changes our understanding of how and who we need to protect as time unfolds.

Some of the new recommendations announced this week may require your child to get an additional shot when at the office next. Often we think our kids are up to date when they aren’t. We’re often wrong because of changes made to the recommendations or because our child has missed a dose at some point along the way. Or the records at the office aren’t complete…

Recommendations change yearly to define and hone the best practice for preventing infection in children and in our communities at large. The full recommendations are available in Pediatrics with a nice summary in Health Day geared more for parents.

If you have any questions about your child’s immunization status and their protection from infection, contact the physician’s office.

Talk with your child’s physician about these recommendations to clarify rationale and get their take and opinion. And, bring the immunization record with you! Keeping the book has been shown to protect your child and improves the likelihood of accurate records and thus, staying up to date.

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 full post »