Monthly Archives: September 2011

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New Year’s Resolutions in October?

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Written by Jennifer Gruen MD

Most people make resolutions on New Year’s, but I find winter too depressing to embark on ambitious, life changing projects. Instead, I view October as a chance to work on change. It is a good time for kids to try a new sport or set goals for school, and for parents to resolve to change the way they approach the new school year.

Resolutions are notoriously hard to stick to. Remember to make your goals POSITIVE. State what you WILL do, not what you won’t do… “I will eat fruit for dessert 5 days a week,” instead of “I will eat less candy.” Make your goals specific, as in “I will run 30 minutes a day, 5 days a week,” instead of “I will exercise more.” And make goals measurable- “I will do an outdoor activity with the kids 20 minutes a day,” instead of “I will get the kids outside more.” Set end dates when possible- “I will organize my closet by next Saturday.” This approach works better for children too: they can make a chart and visually document their progress in areas such as reading, exercise, or eating more fruits and vegetables. Build in positive rewards such as special trips or choosing a meal.

Perhaps your family has overindulged on ice cream at the beach this summer. Fall is a good time to reassess your children’s eating habits and make simple, step-wise changes in what they consume. Make a single change at a time. First, cut out juices and sweetened drinks. The next week introduce whole grain breads and pastas. The third week show your kids how to fill half their plates with fruits and vegetables at each meal. Resolve to pack a healthy lunch for school or work once a week. Then twice. Swap out the potato chips for dried fruit chips. Allow your kids chocolate milk once a week rather than everyday. Change your family’s milk jug from whole milk, to 2%, to 1%, and then skim- do it over time, cover the label, and they won’t notice the change.

Is your child spending too much time inside playing video games? Brainstorm ways to get them outside and moving. Be creative- if your child doesn’t want to do a team sport (or you would rather not spend a lot of money on classes or time driving there) challenge her to run around the house a few times, and see how many more rounds she can do each day. How many continuous jumps can he do with a jump-rope? How many hoops can she shoot without missing? The more interesting the activity, the more it will engage and challenge your child. My son hates playing soccer, but will do the same running around outside pretending to be Harry Potter playing Quidditch with his friends. A few hoops on sticks and we had a field!

The key to making all these resolutions work is making changes small and steady. How many pledges to lose 25 pounds in the New Year work? Aiming for a 5 (or even 1) pound weight loss is much more achievable, and avoids the feeling of failure that dooms many a diet. These small changes are also more likely to persist, and your whole family will feel a sense of accomplishment long before 2012 rolls around!

Dr. Gruen opened her practice, Village Pediatrics, in 2009, but prefers spending time creating fantastic kids birthday parties.

Preparing Your Child For The Fall

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Written by Richard Lander, MD

Fall is fast approaching; the leaves are beginning to change colors, vacations are behind us, and our bathing suits are put away with the suntan lotion. We no longer have to worry about swimmer’s ear and sunburn and the children are back in school. So now we have nothing to worry about, right?

Ah but fall brings its own worries. In early fall we can have and Indian Summer so children playing sports have to think about not getting a sunburn. They also have to remember to drink plenty of fluids so as not to dehydrate. It is important to make sure that all sports equipment is in good shape and review the rules of the sport being played. Warming up and stretching before a practice or a game is a good idea.

Fall is a time of year when there is work to be done around the house. After raking those leaves, don’t leave the rake lying on the ground. Where somebody can trip, fall or be impaled. If you are doing work on your roof or putting up storm windows, replace ladders in the garage; never leave them standing against the house.

Many children are riding their bicycles to school so this is a good time to review road safety. Remind children to look both ways before crossing the street and always wear a helmet. Parents, be sure that bicycles are in good working order. For those who walk to school, never accept a ride from an unauthorized person. To avoid uncertainty regarding who is a stranger, arrange a pass word to be used if Mom or Dad are not picking up your child. Never go with anyone who does not give the correct password. For those students who will be driving to school for the first time, remind them of the rules of the road, and the importance of defensive driving. Of course, seat belts should be worn by all passengers in the car.

Back to school can be a trying time for some. The little ones might experience some separation anxiety at first. Give an extra hug and reassure you will see him/her after school. Many middle schoolers will be coming home with more homework than they did in grammar school. Help them organize their time and work with them on study skills. High schoolers have their own issues. Some mid-adolescents are starting to feel their oats. Their friends become their primary company; they are all knowing and you parents know nothing. Give your adolescent some space but be present and involved in their lives. Give yourself permission to question where they are going, with whom they are going and tell them when to be home. They won’t admit it even to themselves but they both need and want limits. Be supportive, offer advice but don’t force it and always remember your child has friends; you be his/her parent.

For senior high school students, this is a very anxiety producing time of life. The future is so uncertain. Your student is wrestling with where he/she will be going to college, will he/she make varsity this year, will he/she have a date for prom? Don’t ask too many questions but be available. The family dinner table can present a perfect opportunity for sharing.

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.

Photo Credit: Svetlana Hanina

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The Toddler Who Refuses to Nap

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Written by Melissa Arca MD

Toddlers and not napping are three words that never go well together. And yet, right around the ripe old age of two, many children start to put up quite the fight when it comes to naptime.

Does this mean they don’t need a nap? Should I make my child take a nap? Help, my toddler doesn’t nap anymore!

These are questions and pleas I hear all the time from mothers in desperate need of that one to two hour window of reprieve. Sleep is important for all of us, this much we know.

But, how exactly do we make a toddler take a nap? As you and I both know, we really can’t make a two year old do anything.

The art comes in the form of gentle coercion and setting the magical scene that will translate into a solid and predictable nap-time.

Sounds simple right? Believe me; I know this can be quite the struggle. My son gave up his naps right before he turned three. This seemed way too early for me, especially since I had a newborn on my hands and rest at that point was not just a luxury, it was a necessity. Unfortunately, his naps never magically reappeared. I cursed the nap gods but realized he was catching all the zzz’s he needed at night.

So while trying to determine whether naps are gone from your life forever or whether you’ve simply hit a bump in the road, the two questions you should ask yourself are:

how many hours is my child sleeping at night and is this enough?

Children between the ages of 2 and 4 need about 11-15 hours of sleep within a 24 hour period. This is such a huge range and if you’re lucky enough to have a child that falls on the latter end of the spectrum, your child will most definitely still be taking a midday snooze.

I, however, had a wonderfully active toddler who clocked 11 hours at night and apparently that’s all he needed. If I was fortunate enough to lull him into a nap, it always came at a price, namely a super late bedtime. So, I no longer enforced his naptime.

He (and I) still needed some down time during the day, so I starting scheduling quiet time (for both of us). More on that later.

Now that you’ve figured out how much your child regularly sleeps at nighttime, how do you know if that is enough, or if he still needs a nap? If he regularly shows you signs that he’s sleepy, such as eye rubbing, yawning, zoning out, or is easy to meltdown, then in spite of his resistance, naps should still be part of his day.

Create a naptime routine that is a mini version of his bedtime ritual. Give him fair warning too. Tell him that after his snack and some coloring, it’s time for a nap. Children this age refuse naps because they can.

It’s an opportunity for them to exercise some control over their world. By letting him know what to expect and prepping him with a naptime routine, he can better accept what is to come.

Still won’t nap? Start instituting quiet time.

Even if he’s ready to kick those naps to the curb, he would still benefit from some down time. You will too. Tell your resistant napper that he may play quietly in his room with books, cars, or puzzles. Let him know that you will set a timer and that he can come out to play after an hour.

I have been doing this with my three year old daughter recently as she has started to resist naps. About half the time, she ends up dozing off and on her own terms. Quiet time is completely working in our favor.

As you can see, nap scenarios vary from one child to the next. Some will stop napping at age two, while others will be on the verge of entering kindergarten and still crave a midday nap. The key is determining your child’s sleep needs and making sure she gets it within a 24 hour period.

The bottom line is this: nap or no nap, children and parents need down time during the day. Whether this comes in the form of a nap or quiet time will depend on the needs of both you and your child.

When did your child give up napping altogether? Did you benefit from some quiet time?

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

Does Apple Juice Contain Dangerous Levels of Arsenic?

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Written by Lacey Raburn, MS, CLC

On September 14, 2011, “The Dr. Oz Show” claimed that, through independent testing of selected samples of apple juice, they found unsafe levels of arsenic. This report would, of course, alarm many parents who provide apple juice to their children. Unfortunately, Dr. Oz failed to convey the entire story to the general public. For this the ABC News Health and Medical Editor, Dr. Richard Besser, publicly accused Dr. Oz of “fearmongering” on the popular show “Good Morning America.” 1

A little background on arsenic

Arsenic is a metal found in everything from our water to air. There are two types of arsenic: organic and inorganic. Organic arsenic is naturally occurring and not absorbed by our bodies. Because of this, it is not thought to have any harmful effects. Inorganic arsenic is not naturally occurring and can be harmful if consumed in large amounts and for a long period of time. The level of arsenic determined to be safe in drinking water is less that 10 parts per billion; most of the arsenic found in drinking water is inorganic. 2 3. Apples and apple juice contain organic arsenic. 4 Additionally, there are some levels of inorganic arsenic in apple juice; however, this is usually a fraction of the total arsenic and well below acceptable levels of inorganic arsenic in drinking water. 4

Measuring arsenic in apple juice

When arsenic is tested in apple juice, first the total arsenic levels are reported.4 This is a measurement of both organic and inorganic arsenic. If the total arsenic levels are high, the levels of inorganic arsenic are measured. Usually, the inorganic arsenic levels are well below what is considered safe. If they are too high, the Food and Drug Administration (FDA) will alert consumers. The FDA has regularly tested arsenic levels in foods and juices for many years to guarantee the safety of those foods. 4

Dr. Oz only reported levels of total arsenic in the apple juice, not inorganic levels. Also, he obtained all of these reports from one lab. When the FDA learned of Dr. Oz’s intent to report these findings on television, a letter was written that alerted the producers that this data did not accurately reflect inorganic arsenic levels. 5 Additionally, two more labs obtained samples from the same lot that Dr. Oz tested to determine total arsenic levels.6 Their results indicated much lower results of total arsenic compared to those that the lab Dr. Oz used. From this, the FDA concluded that the first lab’s results were unusually high and most likely a result from an error in the testing process. Another letter was written to the producers of the show encouraging them not to air the episode as it would cause unnecessary fear among consumers. 6 The following is an excerpt from this letter:

“In short, the results of the tests cited above do not indicate that apple juice contains unsafe amounts of arsenic. The FDA reaffirms its belief, as stated in our September 9, 2011 letter, that it would be irresponsible and misleading for the Dr. Oz Show to suggest that apple juice is unsafe based on tests for total arsenic.”

The FDA also released an update reassuring consumers of the safety of apple juice. 4

The bottom line

According to the FDA, apple juice is safe to drink and the levels of arsenic found in apple juice are well below what is considered safe and acceptable.

If you would like to read more information on this topic, please visit the FDA website.

References:

1. Gann, C. Apple juice and arsenic: Dr. Besser vs. Dr. Oz. 2011. Available at: http://abcnews.go.com/Health/dr-richard-besser-dr-mehmet-oz-debate-arsenic/story?id=14526426. Accessed September 15, 2011.

2. Arsenic in Drinking Water. 2010. http://water.epa.gov/lawsregs/rulesregs/sdwa/arsenic/index.cfm. Accessed September 15, 2011.

3. Questions and Answers: Apple Juice and Arsenic. 2011 http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271595.htm. Accessed September 15, 2011.

4. FDA: Apple Juice is Safe to Drink. 2011 http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm. Accessed September 15, 2011.

5. Zink, D. Letter from FDA to “The Dr. Oz Show” Regarding Apple Juice and Arsenic (09/09/2011). 2011. http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271630.htm. Accessed September 15, 2011.

6. Zink, D. Second Letter from the FDA to “The Dr. Oz Show” Regarding Apple Juice and Arsenic (9/13/2011). 2011. http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271632.htm. Accessed September 15, 2011.

Lacey Raburn, MS, CLC is a dietician at Plateau Pediatrics in Crossville, Tennessee.

New Rule: Be Without a Ceiling

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Written by Wendy Sue Swanson MD

I’ve got a new rule. And this is coming from a woman who grew up in Minnesota and who lives in Seattle. I’m stating clearly first: weather is no excuse.

I’ve talked in many places on this blog about the reality that there are only a few “rights” to parenting. In my opinion, as a mom and pediatrician, the “rights” include things like getting your children immunized and properly using car/booster seats.

Beyond that, the rest of the parenting is a smattering of “doing right,” versions that vary and resonate from person to person and child to child. The thing is, most of us do it very well, without strict rules. That is, out of love and instinct, we parent our children well. We shelter them. Protect them. Feed them. Shield them from harm. Provide opportunity.

Often, the information we read about parenting does more to break our spirits than it does to bolster phenomenal, inventive ideas. And even though a physician friend recently told me that he subscribes to “‘good enough’ parenting,” and that I tend to agree, I believe this week I’ve stumbled upon the third possible “right.” Tell me if you think I’m wrong because I just can’t conceptualize the counter-argument to my claim:

Go outside with your children every day. Move in a space that has no ceiling.

With the rising digital demand on our lives and with technology seeping into every space, getting outside remains one basic and beautiful way to stay healthy, connected, and opportunistic with your children. And better yet, it’s a great way for your children to be afforded the luxury to roam, create, and play.

Not only will your children move and exercise, they’ll experience nature. Nature, as simple as the sticks on the sidewalk or the grass in the boulevard–or nature, like the spaces where you see-hear-smell-touch nothing man-made. All of it, any of it, every day. It seems to me that nature is something we’ve nearly forgotten to prioritize with our time here on earth.

So don the coat, the mittens, the hat, or the sunscreen. Whenever illness doesn’t get in your way, do whatever you can to remain comfortable and protected, and then get outside each and every day with your children. Move in a space with no ceiling.

Dr. Swanson practicing pediatrician and the mother of two young boys.  She sees patients at The Everett Clinic in Mill Creek, Washington. She is also  on the medical staff at Seattle Children’s and am a Clinical Instructor in theDepartment of Pediatrics at the University of Washington. Dr. Swanson is passionate about improving the way media discusses pediatric health news and influences parents’ decisions when caring for their children.

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Michele Bachmann Is Not a Doctor (she reveals), But Pediatricians Are

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Written by Brandon Betancourt

Last night was the GOP debate. We saw the usual stuff that is expected in these things. The candidates debated Social Security, jobs and the economy. During the debate, however, Michele Bachmann, member of the United States House of Representatives, said that vaccines, particularly the HPV vaccine, caused “mental retardation.”

Bachmann, in a post-debate interview, told Fox News that a woman had approached her and told her that she had a daughter who “suffered mental retardation as a result of the vaccine.”

Bachmann shared the same story on the Today show, telling Matt Lauer that the woman’s “little daughter took that vaccine, that injection, and she suffered from mental retardation thereafter.”

In an interview with Sean Hannity she had this to say when asked about her claims

“I have no idea … I am not a doctor, I’m not a scientist, I’m not a physician. All I was doing is reporting what this woman told me last night at the debate …”

I find it irresponsible that a congressional representative, or anybody with that kind of influence, would make such a claim on a national stage going only on the anecdote of a stranger.

I hope that parents listening to this type of rhetoric understand that politicians are politicians, who may or may not have people’s best interests at heart.

Michele Bachmann is obviously not educated enough in the science behind vaccines. But here is what I hope parents understand. Your pediatrician does have your children’s  best interest at heart. That is why pediatricians recommend that girls receive HPV vaccine around age 11 or 12.

The American Academy of Pediatrics issued an important press release rebutting Bachmann’s HPV claim. Here is the official response from the American Academy of Pediatrics:

“The American Academy of Pediatrics would like to correct false statements made in the Republican presidential campaign that HPV vaccine is dangerous and can cause mental retardation. There is absolutely no scientific validity to this statement. Since the vaccine has been introduced, more than 35 million doses have been administered, and it has an excellent safety record.

“The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians all recommend that girls receive HPV vaccine around age 11 or 12. That’s because this is the age at which the vaccine produces the best immune response in the body, and because it’s important to protect girls well before the onset of sexual activity. In the U.S., about 6 million people, including teens, become infected with HPV each year, and 4,000 women die from cervical cancer. This is a life-saving vaccine that can protect girls from cervical cancer.”

For other related stories, click on the links below.

Vaccination Causes ‘Mental Retardation’? Fact-Checking Michele Bachmann’s Claim

GOP’s Bachmann claims shot to prevent cervical cancer can cause mental retardation. That is simply a lie

Pediatricians Fact-Check Bachmann’s Bashing of HPV Vaccine

 

Brandon is a practice administrator for Salud Pediatrics and blog at PediatricInc

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A Day in the Life of a Pediatrician

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Written by David Spraberry MD

Ever wonder what your pediatrician does all day? Ever wonder why you sometimes have to wait to be seen (or, in my case, many times)? Doesn’t he or she just spend 8 hours a day at the office and then go home? Why does he sometimes seem a little tired? How can she be tired if she only works 4 days a week in the office?

If you have ever wondered about those things, I am going to give you a peek into what my typical work day looks like.

6:00 a.m. – Get up and get ready for the day. (If I am really disciplined, I will get up at 5:00 or 5:30 so I can exercise.)

6:45 – Leave for the hospital

7:05 – Arrive at first hospital, make rounds in newborn nursery, then move on to the pediatric ward to round on inpatients.

8:00 – Leave first hospital and go to second hospital. Repeat the above.

8:45 – Leave second hospital and drive to office.

Note: I do not always have patients at both nurseries and both pediatric wards. I do often have to go to both hospitals, though. If I don’t have patients at both hospitals, I go get some coffee and spend some quiet time before the office.

9:00 – Arrive at the office to start the office day. I am usually met with multiple questions that relate to patients who might need to come in immediately but don’t want to, or who must have this form now or they won’t be able to go to football practice (but they didn’t bring it in until this morning), or I find out that a staff member won’t be at work today because they are sick or something urgent happened. Or, if it is winter, “The schedule is full already, where do you want to add sick patients?”.

9:05 – Start seeing morning patients. I will generally see an average of 4 patients per hour. In winter I may see 6 per hour. In summer, I may see 3 per hour, depending on the type of visits. Between patients, I am usually greeted with more questions about where to fit someone in, presented with more forms to sign, forced to be cordial to the drug rep who is bringing in the samples that we need and has her boss with her, have to call back to the hospital about a patient, or have to argue with an insurance company about approving the MRI that our patient desperately needs to prove she does not have a brain tumor or spinal injury.

Along the way, I do have the great privilege of conversing and playing with lots of fun little kids while making the best medical decisions for them that I am able. The relationship with the kids and their parents is what makes all the other hassles worthwhile.

1:30 – I finish my “morning” after 6 1/2 hours of work. I then move on to my lunch “hour”, which is usually less than 30 minutes and is spent reviewing labs, returning phone calls, and signing forms while shoveling in whatever I happen to have available for lunch that day.

2:00 – I start the afternoon and do more of what I did from 9:00-1:30. The after school phone calls begin and we work to try to fit in those kids who got picked up from school sick. If our schedule for the afternoon is already full, we usually add those kids on anyway and stay late to see them, unless I have a firm evening commitment that requires me to leave by a certain time. Right before closing is when the asthmatic in severe respiratory distress walks in and must be urgently treated in the office while arranging for admission to the pediatric ward.

5:00-7:00 – I will finish seeing patients somewhere between 5:00 and 7:00, depending on the time of year and day of the week. Once all patients have left the office, I will usually still be at the office for another hour or two finishing documentation and making phone calls. If I admitted someone, I will also dictate the admission note and follow up on any admission orders that I have done.

6:00-8:30 – I finally make it home somewhere between these hours, depending on time of year. My family has usually eaten dinner already, so I will either eat quickly and start hanging out with the kids, or I will hang out with the kids and then eat dinner once they have gone to bed.

9:00-11:00 or 12:00 – The kids have made it to bed and I can then start handling the personal responsibilities that I have that are not directly related to seeing patients, like paying bills, catching up on medical reading, working on “maintenance” of my board certification, and, oh yeah, actually having a conversation with my wife.

11:00 or 12:00 – Finally I go to bed so I can repeat the above tomorrow. I will probably get about 6 hours of sleep, though I need about 8.

Not every day is this way, but many are. Once the kids are in bed, I may do some kind of leisure activity instead of the work-related things mentioned above, but this is a fairly decent representation of my average day.

Since my partner joined the practice last year, I do have more time for leisure activities since she splits the hospital duties and phone calls with me. My days and weekends off are usually spent hanging out with the kids and taking care of office planning activities that I can usually not accomplish if I am scheduled to see patients.

So there you have it. A typical pediatric work day for me. Some pediatricians will work longer hours than I work. Some will work fewer days and fewer hours than I do. Most will have a similar set of responsibilities that they must somehow manage while seeing patients in the office, making the right medical decisions, and not getting too far behind schedule.

Despite how hectic things can sometimes be, I am glad to be a pediatrician and I don’t know what else I would do with my life. The whole professional athlete plan just didn’t pan out, although some of those NFL kickers manage to keep kicking until they are 50…

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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Vaccines: Why Your Pediatrician May Ask You To Go Elsewhere

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The Today Show had a really good piece concerning a growing trend relating to the vaccine debate. The piece talks about how some pediatrician are asking parents that don’t vaccinate their children to find another doctor.

We’ve addressed this issue before here at Survivor Pediatrics in our piece “Vaccine Refusal Endangers Everyone”. Dr. Lessin, author of the vaccine refusal piece says:

Prevention of childhood illness is the heart of a pediatrician’s mission. Immunization refusal violates that mission, putting everyone at risk. If we allow families to remain in our practices unvaccinated, we are giving tacit approval to parents that refusing vaccines is just fine. It is anything but fine.

As you’ll see mention in the piece, the notion is that pediatricians are abandoning their patients. But it isn’t like that all. It is about having trust. Here is what Dr. Lessin had to say:

For me, it comes down to whether you can have a relationship with a family when their choice not to vaccinate goes against pediatric core values and puts so many innocents at risk. I don’t believe that I can have a functioning doctor-patient relationship with parents who aren’t willing to accept my advice about such a critical issue as keeping their children safe from potentially deadly diseases.

Click on the link below for the Today Show piece:

Won’t Vaccinate? Find care elsewhere, some docs say

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