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6 Simple Back-to-School Tips For Parents

ImageMost kids are back in school. But that doesn’t mean we can’t make on the fly improvements to help us get back into a routine. Here are 6 quick tips to help you get back on track:

  1. Restart the bedtime routine: It’s hard to get up for school the first day unless you start back into a normal bedtime routine now.
  2. Set up a place for homework: Set expectations now and get organized. Kids thrive on routine and organization.
  3. Talk to your child’s teacher, school psychologist or nurse: If you have ANY concerns about your child academically, socially or medically, reach out in advance. Being proactive is always better than being reactive.
  4. Prepare for sick days: Kids will inevitably get sick at the beginning of the school year as they come back together in such close quarters. Kids who have asthma often benefit from restarting their controller medications in anticipation of this. Visit your doctor to discuss this or any other medical needs before school starts.
  5. Consider helping kids in school districts with less: DonorsChoose.org makes it easy to help classrooms in need. Public school teachers post classroom project requests. Find a project that has some meaning to you and your family.
  6. Don’t stress: Back to school can be stressful for everyone. Try and relax and take it one day at a time.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.

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O Father, Where Art Thou? Part 2 of 3

Written by David R. Sprayberry, MD

In my last post, I introduced the problem of absent fathers in the U.S. and described the magnitude of the issue. What I hope to do today is to present a strong case for why fathers need to be very intentional about staying involved in the lives of their children.

This topic is important to me for several reasons. First, I am a father of three children (hopefully four sometime in the next year or so) and I want to be the kind of father they need. Second, I am tired of seeing friends separate and/or divorce. If these posts do anything to help just one father decide not to leave, it will have been a worthwhile endeavor. Third, I see kids who are suffering the consequences of father absence in my office very frequently and I am often called upon to help the kids deal with them. I see these kids spiral downward in the wake of their parents’ divorces and would love to see less of it.

So, what are the consequences to children when their fathers are absent from the home?

Let’s start with poverty.

Young children living with unmarried mothers are five times more likely to be poor than other children and ten times more likely to be extremely poor. Nearly 75% of children living in single-parent homes will experience poverty before the age of 11. Only 20% of children from two-parent homes will do the same. Homelessness is more common among children from broken homes. Finally, children of teen mothers are more likely to be unemployed when they become adults.

Tobacco, Alcohol and Drugs.

Children who live apart from their fathers are 4.3 times more likely to smoke than those who grow up with their fathers in the home. Adolescents living with both biological parents less frequently engage in heavy alcohol use. Latchkey children, children who have daily unsupervised periods at home after school, are more common when the father is absent from the home. These children are more than twice as likely to abuse drugs as children who are not left alone after school and begin abusing substances at younger ages. Latchkey children are also at greater risk for teen pregnancy and are more likely to be victims of sexual abuse.

Emotional and Behavioral Consequences

Children from single-mother homes have a greater risk for psychosocial problems, an effect which is over and above the impact of coming from a low-income home. Young girls experience the emotional loss of a father as a rejection of them. Continued lack of involvement by the father is experienced as ongoing rejection.

Post-traumatic stress disorder is significantly more common in youths with an absent parent. Children with eating disorders and children who self-mutilate (e.g., “cutting”) often come from homes where fathers are absent. Antisocial symptoms are also more common in kids with absent fathers, a risk that is not mitigated by the presence of a stepfather. Even more frightening is this: three out of four teen suicides occur in households where a parent has been absent.

Education and Development

Children living with a single parent have lower GPAs, lower college aspirations, worse attendance, and higher drop-out rates. Fatherless children are 1.7-2 times as likely to drop out of school. Father absence has also been associated with delayed motor skill development in preschool children. I would suggest that this is due to the fact that the way fathers interact with their kids is different than mothers. Play with dads is often characterized by physicality – wrestling, tickling, tossing, spinning, etc. This physical play certainly contributes positively to the motor development of children.

Criminality

Given what we have already discussed, it is likely no surprise that criminality is more common among children with absent fathers. Delinquent behavior is more likely in father-absent homes, especially when combined with socioeconomic disadvantage. Children born to teen mothers are 3 times more likely to be incarcerated during their adolescence and early twenties than children of older mothers (as you will recall, children of teen mothers frequently have absent fathers). Boys born to unmarried teen mothers are 8-10 times more likely to become chronic juvenile offenders.

Sexuality

Children with an absent parent have been shown to be more likely to be perpetrators and victims of sexual abuse. Teens from two-parent households have been found to be less likely to be sexually active. Studies have shown that about 70% of teen pregnancies are to children of single parents.

Girls from father-absent homes tend to begin puberty earlier, have sex earlier, and have their first children earlier than girls from father-present homes. According to a study conducted in the U.S. and New Zealand, the risk of increased sexual activity is greater the earlier in a girl’s life that the father becomes absent. Higher socioeconomic status does not protect the girl from these effects.

Medical Consequences

Unmarried mothers are less likely to obtain prenatal care and are more likely to have a low birthweight baby. Infant mortality rates are higher for unmarried mothers and teen mothers (roughly 50% higher for teens). Sudden Infant Death Syndrome has also been shown to be more common in children of unmarried and teen mothers. Asthma and obesity are both more likely in children of single mothers, and blood sugars are more poorly controlled in diabetic children of single mothers.

For married men and women, hopefully this post will help strengthen your conviction to stay married and help maximize the positive impact you can have on your children. For divorced men and unmarried fathers, I hope this will convince you to stay as involved as possible in the lives of your children in order maximize your positive influence. For mothers who are not married to the father of their children, my desire is that you will encourage the fathers to remain involved, so long as they do not pose a threat to the children.

My final post on fatherhood will summarize the positive things that occur when a father is present and some practical ways that pediatricians can encourage fathers to remain involved.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.

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Should I Ditch the Pacifier?

Written by Melissa Arca, MD

My baby girl, who is on the verge of turning three, has three big loveys in her life: blankie, paci, and bear. And I, nor she, are in any rush to give them up. Still, the question creeps in from time to time…Should I ditch the paci?

With my firstborn, my son, I felt pressured to wean him by a certain age. Mostly because I was a first time Mom and Pediatrician and felt I should do things “right”. So I was all proud as could be when his paci was completely weaned by the time he was two. Even at that age I felt I waited too long.

Well guess what went along with the pacifier? Nap time. Now I would NOT call that a success story. I would call that a painful mistake. He never went back to his daytime naps after that. Why oh why did I hold firm? I should have just gone out and bought another one.

Now, here I am, a bit more experienced. More comfortable with my mothering and doctoring abilities. The Mom side of me knows the comfort it provides my daughter while the Doctor side still wants to make sure I’m not overlooking any potential harm.

So in my effort to answer my own question, I’ve decided to have a conversation about the paci…with myself. Yes you heard me right…Mom and Doctor discussing the whole pacifier issue. Bear with me, it should be good…

Melissa: Do you think it’s time to wean my daughter from the pacifier?

Dr.Mom: Why? Does her pacifier use bother you?

Melissa: No, not really.

Dr.Mom: Does it bother your daughter?

Melissa: No. Actually, it is a great comfort to her.

Dr.Mom: What is your concern about the pacifier?

Melissa: Well, I’ve read that it can interfere with speech development.

Dr.Mom: Does your daughter have her pacifier in her mouth all day?

Melissa: No, she only uses it for nap, bedtime, and car rides.

Dr.Mom: And, have you noticed any impairment of her speech?

Melissa: No, she’s quite the talker.

Dr.Mom: Okay then…

Melissa: Well, I’ve also heard that it can effect the development of her teeth, is she going to have crooked teeth?

Dr.Mom: Well, she might but then again, she might not. The changes are usually temporary and self correct once the pacifier is no longer in use.

Melissa: Okay then…I won’t worry about it anymore.

Dr.Mom: One last thought Melissa

Melissa: Yes, Dr.Mom?

Dr.Mom: Honestly, when is the last time you’ve seen a child walk in to kindergarten with a pacifier in her mouth?

So there you have it…no I’m not going to ditch the paci…not for now anyway. I’m sure the day she’ll have to give it up to the paci fairy is just around the corner. I’ll let her lead the way and we’ll see how things go. It’s one of her comforts and as far as I can see, there is no harm…only comfort.

I really love how Joey from Big Teeth & Clouds put it: “…hang onto whatever she needs. Life is tough, we should use what we can to get by”. Fantastic point Joey and I couldn’t agree more.

So, tell me, what do you think? Did you feel pressure to ditch the pacifier by a certain age? If so, what did you do?

Dr. Arca is a pediatrician. She works part-time while raising her two young children, Big Brother (age 6) and Little Sister (age 3). She is passionate about writing and writing about motherhood, parenting, and children’s health is what she does best. Dr. Arca blogs regularly at Confessions of a Dr. Mom

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Is Finding a Pediatrician Like Buying a New Car?

Written By Nelson Branco M.D., FAAP

Several weeks ago, a posting on The Huffington Post by Meredith Lopez titled “An Open Letter to Pediatricians” generated lots of commentary and discussion among pediatricians.  Ms. Lopez described her experiences with her son’s (former) pediatrician, who was apparently not available to answer her phone calls in the middle of the night or on a holiday, and was unable to diagnose and cure her son’s diaper rash despite several visits. When I read Ms. Lopez’s blog post, I see a relationship between a mother and pediatrician that just isn’t working because they aren’t communicating.As a practicing pediatrician, I know that not every visit leads to a definitive diagnosis and cure.  I also know that being available, professional, knowledgeable and compassionate are just as important as how quickly I can come to the correct diagnosis and recommended treatments. Communication is at the heart of all that we do in medicine.  If you can’t listen effectively and let the patient or parent know that they have been listened to, you have not really taken care of them.

I’ve practiced in cities, suburbs and rural areas.  Many times, patients, family and friends ask “Should I go into the city for this?”  For me, that city has been Boston, Providence, Albuquerque, Denver, San Francisco and Phoenix.   Which city doesn’t matter – what drives them is the desire to get their care from “the best” for whatever problem they are having.  My answer to them is always the same – the best doctor for your problem is the one you can communicate with, the one who is available to answer your questions and the one who makes you feel like they can take care of you and your problem.  Sometimes that person is right here in your own backyard, and sometimes that person is at the biggest hospital in the biggest city with the biggest reputation.  But you should do your homework to find out who that is, and part of that homework is calling your pediatrician.

Part of my job is to direct my patients to the right specialist.  In the days when HMO insurances were more popular, primary care doctors were the so-called ‘gatekeepers,’ and many patients felt that their doctor was trying to deny them access to specialists.  Now, with PPO and EPO insurance plans being the norm, primary care doctors are not necessarily involved in their patients decision to visit a specialist.  That isn’t good medicine or good care for your child.  My job as your primary care physician is to take care of all your problems – including getting help from a specialist when we need it.  I need to know where you are going for your care so that I can get information from the specialist, help you understand it and integrate it with any other issues or conditions you might have.  It’s also my responsibility to lead you in the right direction, and send you to the specialist who will help you get to the bottom of the problem.  Often, that means referring you to the person that fits your needs and personality; I know you and usually I know the specialists.  I may not be a professional matchmaker, but I usually have a good idea who you’ll work well with.

The other advantage to local care when it is appropriate is that it can be much easier to get.  All physicians know that a medication prescribed twice a day will be taken much more consistently than a medication prescribed three or four times a day.  So it is with visits, tests and follow up visits that you can do close to home.   What about when those specialists aren’t available close to home?  Or if there is only one choice for a particular specialty?  That’s the time when it’s most important to have me working alongside the specialist.  When there is only one Child Neurologist, they will be busy and won’t be able to see you frequently.  Then it becomes my job to communicate with them about questions, concerns or issues that may come up.

The bottom line is that it is important to pick the right pediatrician for you and your child.  Their personality, communication style, office setup and availability are all important.  Ask your friends, your family and co-workers.  Check the practice website, call the office and see if they are set up to do a prenatal or ‘meet and greet’ visit and meet with the doctor if you can.  Most pediatricians are kind, caring and dedicated – you’ll find the right one for you, if you look.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.