Who’s Your Daddy?: Part 1 of 3

Written by David R. Sprayberry, MD

You have undoubtedly heard this question used as a taunt of another, but let’s take the question seriously.

What do you know about your dad? Do you know him or do you know of him? I grew up in a two-parent home with my birth parents.

Things were not always perfect. I can tell you the positive things about my dad and some negatives.

The reason, though, that I can tell you the negatives is that I know my father and I know him well because he was there.

He was there at the dinner table. He was there at my baseball practices. He was there at my basketball games. He was at all the school functions and awards nights.

He was there.

During my pediatric residency, one of my classmates was posed this question by one of the kids he was seeing in the clinic: Are you my daddy? Sadly, this was not a joke.

The child had no idea who his father was. More and more American kids are growing up not knowing their fathers at all or having minimal relationships with them. Their dads are just not there, either partially or fully.

The absence of a father from a child’s life can do immense harm and the presence of a father can do immense good.

Scope of the problem

In discussing this issue, it is important to define what an absent father is. In general, when we use the term absent father, we are speaking of fathers who are physically absent from the child’s primary home. This includes fathers who have only joint custody of their children.

The degree of this issue is immense. Over one-third of all U.S. children live absent from their biological fathers. Nearly half of all children from disrupted families have not seen their fathers in the past year.

Nearly 20% of kids in female headed households have not seen their fathers in 5 years.

From 1960 to 2000, the proportion of children living with just one parent increased from 9% to 28% over that 40 year span. When the statistics are broken down by race, results become even more alarming.

As of the year 2000, 20.9% of all white children lived in single-parent homes. At the same time, 31.8% of all Hispanic children and 57.7% of all black children were living in single-parent homes.

The reasons for the racial differences are debatable, but what is clear is that this is a problem that is not limited to a single race.

Reasons for father absence

Why do we have so many absent fathers? There are many factors that contribute to this problem, but a large proportion of absent fathers are absent for one of the following reasons.

One of the largest reasons that fathers are absent from the homes of their children is divorce. The number of currently divorced adults has nearly sextupled from 4.3 million in 1970 to 23.7 million in 2010.

The number of divorces per year has increased from 390,000 in 1960 to 1.2 million in 2009.

There are recent reports of decreasing divorce rates, but these decreases are generally looking at divorces as a proportion of the general population, not as a proportion of marriages. Additionally, the marriage rate has declined considerably, likely leading to an increase in the second factor contributing to absent fathers.

A second significant reason that fathers are absent is births out-of-wedlock. Forty-one percent of all newborns in the U.S. were born out-of-wedlock in 2009, up from 33% in 2000.

About 75% of all teen births are out-of wedlock. In many of these cases, the father never lives in the child’s home, even at the beginning.

A smaller, but still significant, reason for father absence is incarceration. As of 1991, there were an estimated 423,000 fathers in prison with children under the age of 18. That number has increased to 744,200 as of 2007.

To be fair, many men may not be able to control the amount of time they are with their children. They may want to be involved, but are prevented by factors beyond their control.

As a pediatrician, I understand how difficult it is to balance a demanding work schedule and family life, and I don’t always do a great job at maintaining that balance.

I point these issues out not for the sake of being critical, but in order to spur men on to take a larger role in the lives of their children and to become more physically and emotionally present for them. We have a relatively short time to raise our children. Let’s make the most of it.

My next post (the second in a three-part series) will discuss the consequences of father absence and the benefits of father presence.

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.

 

Photo credit:  Chin.Musik

Your Child’s Fever, Good or Bad?

Photo Credit: http://www.thesitsgirls.com/

Written by Kristen Stuppy MD

Fever is scary to parents.

Parents hear about fever seizures and are afraid the temperature will get so high that it will cause permanent brain damage. In reality the way a child is acting is more important than the temperature. If they are dehydrated, having difficulty breathing, or are in extreme pain, you don’t need a thermometer to know they are sick.

Fever is uncomfortable.

Fever can make the body ache. It is often associated with other pains, such as headache or earache. Kids look miserable when they have a fever. They might appear more tired than normal. They breathe faster. Their heart pounds. They whine. Their face is flushed. They are sweaty. They might have chills.

Fever is often feared as something bad.

Parents often fear the worst with a fever: Is it pneumonia? Leukemia? Ear infection?

Fever is good in most cases.

In most instances, fever in children is good. It is a sign of a working immune system.

Fever is often associated with decreased appetite.

This decreased food intake worries parents, but if the child is drinking enough to stay hydrated, they can survive a few days without food. Kids typically increase their intake when feeling well again. Don’t force them to eat when sick, but do encourage fluids to maintain hydration.

Fever is serious in infants under 3 months, immune compromised people, and in under immunized kids.

These kids do not have very effective immune systems and are more at risk from diseases their bodies can’t fight. Any abnormal temperature (both too high and too low) should be completely evaluated in these at risk children.

Fever is inconvenient.

I hate to say it, but for many parents it is just not convenient for their kids to be sick. A big meeting at work. A child’s class party. A recital. A big game or tournament. Whatever it is, our lives are busy and we don’t want to stop for illness. Unfortunately, there is no treatment for fever that makes it become non-infectious immediately, so it is best to stay home. Don’t expose others by giving your child ibuprofen and hoping the school nurse won’t call.

Fever is a normal response to illness in most cases.

Most fevers in kids are due to viruses and run their course in 3-5 days. Parents usually want to know what temperature is too high, but that number is really unknown (probably above 106F).

The height of a fever does not tell us how serious the infection is. The higher the temperature, the more miserable a person feels. That is why it is recommended to use a fever reducer after 102F. The temperature does not need to come back to normal, it just needs to come down enough for comfort.

Fever is most common at night.

Unfortunately most illnesses are more severe at night. This has to do with the complex system of hormones in our body. It means that kids who seem “okay” during the day have more discomfort over night. This decreases everyone’s sleep and is frustrating to parents, but is common.

Fever is a time that illnesses are considered most contagious.

During a fever viral shedding is highest. It is important to keep anyone with fever away from others as much as practical (in a home, confining kids to a bedroom can help). Wash hands and surfaces that person touches often during any illness.

Continue these precautions until the child is fever free for 24 hours without fever reducers. (Remember that temperatures fluctuate, so a few hours without fever doesn’t prove that the infection is resolved.)

Fever is an elevation of normal temperature.

Normal temperature varies throughout the day, and depends on the location the temperature was taken and the type of thermometer used.

Digital thermometers have replaced glass mercury thermometers due to safety concerns with mercury. Ear thermometers are not accurate in young infants or those with wax in the ear canal. Plastic strip thermometers and pacifier thermometers give a general idea of a temperature, but are not accurate.

To identify a true fever, it is important to note the degree temperature as well as location taken. (A kiss on the forehead can let most parents know if the child is warm or hot, but doesn’t identify a true fever and therefore the need to isolate to prevent spreading illness.)

I never recommend adding or subtracting degrees to decide if it is a fever. In reality, you can look at a child to know if they are sick. The degree of temperature helps guide if they can go to school or daycare, not how you should treat the child. Fevers in children are temperatures above

• 100.4 F (38 C) rectally
• 99.5 F (37.5 C) in the mouth
• 99 F (37.2 C) under the arm

Fever is rarely dangerous, though parents often fear the worst.

This is the time of year kids will be sick more than normal. With each illness there can be fever (though not always.)

What you can do?

1. Be prepared at home with a fever reducer and know your child’s proper dosage (especially with the recent dosing changes to acetaminophen!)
2. Use fever reducers to make kids comfortable, not to bring the temperature to normal.
3. Have an electrolyte solution at home in case of vomiting.
4. Teach kids to wash their hands and cover coughs and sneezes with their elbows.
5. Stay home when sick to keep from spreading germs. It is generally okay to return to work/school when fever – free 24 hours without the use of fever reducers.
6. Help kids rest when sick.
7. If the fever lasts more than 3-5 days, your child looks dehydrated, is having trouble breathing, is in extreme pain, or you are concerned, your child should be seen. A physical exam (and sometimes labs or xray) is needed to identify the source of illness in these cases. A phone call cannot diagnose a source of fever.
8. Any infant under 3 months or immune compromised child should be seen to rule out serious disease if the temperature is more than 100.5.

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

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Top Ten Newborn Questions, and Answers

Written by Jenn Gruen MD

Photo Credit: http://www.newbornbloodspots.org

1. Does my baby have a cold?

Many, if not most, newborns have a congested nose and frequent sneezing for the first month or so. Unless you see mucus coming from the nose, it’s usually not a cold. Unless your baby has difficulty with feeding due to nasal congestion, you do not have to use the nasal bulb syringe. In fact, if you use it frequently, you may irritate the nose linings and make the congestion last longer.

2. What about my newborn’s peeling skin?

It looks so dry—should I use lotion? This is normal – most newborns “peel like a snake” and this requires no treatment. If there is some cracking or excessive irritation around the ankles or wrists, you can lubricate with a little Vaseline or diaper ointment.

3. Should I worry if my baby is breathing funny?

Well, yes and no. Normal newborn breathing can seem strange. Sometimes they will stop breathing for a second or two and then breathe very quickly for several seconds. Sometimes they sound funny because they snort due to a congested nose (see #1).

Sometimes they make a high-pitched whistle when they breathe in due to a flexible windpipe (tracheomalacia). However, if you see very fast breathing (more than 70 times a minute) that persists, or if the baby has to work very hard to breathe, or you have worries about his or her breathing, don’t hesitate to contact us.

4. What if there is oozing or blood when the cord falls off?

A bit of yellowish wet gunk at the site of the cord that dries over a few days is normal, as long as the skin around the base of the cord remains normal color (if it becomes increasingly red, call us immediately).

You do not need to use alcohol. A few drops of blood on the diaper as the cord is falling off is also normal. If it bleeds a whole lot (which almost never happens), apply pressure to stop the bleeding and call us.

5. How many bowel movements are normal?

Breastfed newborns generally have 3 or more bowel movements per 24 hours by day 3 or 4. Formula fed infants generally have at least 1 bowel movement per 24 hours. But some infants can have up to 20 per day and still be normal! And normal breastfed newborn stool is extremely loose.

In an adult, this would be called diarrhea, but it is normal for a newborn. Formula fed stool tends to be more pasty. Any color from bright yellow to green to brown is normal. By age 3 to 6 weeks, the frequency of stool decreases (even once a week for a breastfed infant at this age can be normal as long as it is soft and passes easily).

6. Is the discharge from my baby girl’s vagina normal?

Yes, it may be clear, white or bloody, and it is from withdrawal from the mother’s hormones. You don’t have to wipe it away, but you can if you want to (top to bottom).

7. Is it normal for my nipples to hurt (for breastfeeding mothers)?

It is normal in the first week to have pain for the first 1-2 seconds of latch on, but if you have pain in the nipples beyond the first second or two, ask us about it.

8. Can my baby see me?

Baby’s sharpest vision is the distance from the breast to the face. Babies recognize their mother’s faces within a short time after birth. They can identify their mother’s breastmilk smell immediately, and will recognize the voices (and soon the faces) of close family that they heard talking while in the womb, like fathers or siblings.

9. Is it normal that my baby lost weight after birth?

Yes, most babies lose weight after birth and this is normal. We will tell you if we are concerned that the weight loss is too much.

10. When should my next appointment be?

Usually 1-2 days after you leave the hospital, we would like to see you back in the office to check your baby’s weight, color, and heart.

If your baby has a fever more than 100.4 rectally (only take temperature if baby seems warmer than usual), is irritable, lethargic or not feeding well, call right away. If your baby seems yellow other than the eyes/gums/face (i.e. chest/abdomen/legs), call us during office hours. Also call during the day if your infant is not having normal stool (see #5).

Have your baby sleep on the back or side. Make sure that your car seat is correctly installed and used, call 1-866-SEATCHECK or go to seatcheck.org for a free car seat checkpoint near you.

CONGRATULATIONS! ENJOY YOUR BABY

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

On Mother’s Day, We Should Be Supporting ALL Mothers

By Jennifer Shaer, MD FAAP IBLC

Time Magazine has caused quite a stir this week with its cover featuring a three year old breastfeeding. The article is about a philosophy of parenting called attachment parenting and the controversy is two-fold.

The first issue surrounds the cover title “Are you mom enough?”. This provocative title implies that if you do not breastfeed your child until he is three and do not practice attachment parenting then you are less of a mother.

While attachment parenting works for many, to imply that it is the only way to raise a well-adjusted child is misleading and inflammatory.

The second issue surrounds the cover photo and the concept of nursing a toddler. As a pediatrician and a breastfeeding medicine specialist the photo of a three year old standing up while nursing and looking at the camera should be easy for me to look at, and yet it is not.

Why does this photograph evoke such emotion?

Medically speaking, there is every reason for a child to continue nursing until he self-weans. In most societies that embrace self-weaning, children routinely breastfeed until well over two years old.

However, it is so rare to see a toddler in our society nursing that the image is unsettling. I ask myself, “why am I uncomfortable looking at this picture when I am such a strong supporter of breastfeeding?”

There is truly a societal and social expectation that is ingrained in all of us, and it works to the detriment of breastfeeding as a whole. As I think about my patients, I recognize a pattern.

Upon initiating breastfeeding, most women are proud to give their baby the best start to life and are proud of themselves for being successful in the first big parenting challenge. However, as mothers continue to breastfeed, there comes a point when they turn from proud to embarrassed.

I see the look on their faces or the tone in their voices when they tell me that the 15 or 18 month old is STILL nursing. The mother who was once confident and proud begins to feel like an outcast and a social deviant.

Many women at this point either force the baby to wean, secretly nurse (the “closet nurser”) or stand up for themselves as Jamie Lynne Gumet has done in this article.

What can I say about this situation? This child is not being forced to breastfeed. He is not being abused and this is not pornography as some people suggest. Nobody can force a 3 year old child to do most of anything that he doesn’t want to do, let alone breastfeed.

The problem with this image is that it is so contrary to what we accept as normal. The problem with this image is that we as a society cannot accept breastfeeding a toddler.

I know in my heart that this is normal but my gut reaction can’t easily be changed. Just as I know in my heart that gay couples should have the right to marry, yet when faced with two men kissing in front of me, I am uncomfortable.

The unsettled feeling that I get when looking at this picture is my own weakness. I applaud Jamie Lynne Grumet and Time Magazine for helping me take one step closer to accepting what is biologically normal.

On mother’s day, we should be supporting ALL mothers. If we stop passing judgment on one another then we will truly be showing our children how to behave as adults.

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. Dr. Shaer is dedicated to helping nursing mothers achieve their breastfeeding goals.

Do you ask if the adults supervising your children have had background checks?

Written by Kristen Stuppy MD

Recent news about a well known person repeatedly sexually abusing children over many years has many parents angry, confused, and simply aghast.

Many of us feel like we do all we can to protect our kids and our kids aren’t at risk, yet statistics show that any child could be a victim. Studies reveal that about 20% of women and 10% of men experienced sexual abuse as children.

Sexual abuse crosses all socioeconomic groups, all racial groups, all ethnicities, and all neighborhoods. Often the perpetrators are the least suspected: a family member, a coach, a neighbor.

Signs of abuse in kids can be subtle. They are often attributed to something else.

If kids do try to talk about feeling scared or not safe with someone: LISTEN. They don’t make this stuff up!

I appreciate the organizations that require background checks on all adults around kids. I have had my background checked on many occasions: job related, coaching my daughter’s cheerleading squad, volunteering at my children’s school, and volunteering at a local children’s theater.

I was never offended by these requests and always supported these checks, but some parents grumble. I suspect they just don’t understand. Many schools, sports organizations, and scouting organizations require teachers and volunteers to have routine background checks. Does yours?

Do you ask if the adults supervising your children have had background checks?

Most do not.

I am not even sure how I feel about this. I suspect it gives a false sense of security, knowing that many abusers have many victims before being caught. They would have normal background checks. They are often personable, friendly, someone who grooms victims and their families to gain trust.

If background checks aren’t full proof protection, what should a parent do? I believe that the best protection about abuse is to show love to your children, educate yourself and them about abuse, and frequently talk with them.

Knowledge is Power!

Teaching kids about proper boundaries is important. Let them know that their swim suit area is private, and no one should be able to look or touch there without permission from mom or dad.

Young children should learn their full address, phone number, first and last name (and first/last names of parents).

Remind kids that there are no secrets between kids and their parents. They can tell you anything. They can keep your birthday gift a surprise though! Secrets that scare them are especially important to tell! They will NEVER get in trouble for telling about a scary secret.

Know your children’s friends, their friend’s parents, teachers, coaches, piano teachers, etc. Offer to help as much as possible at school and activities.

Be sure there are no secluded areas in the places your child goes. Kids should always remain in a group with adults. A minimum of two adults is safest.

For your protection, if you must take other kids to a public restroom, stand in the main door with it open and let the kids go into stalls alone.

Teach kids that adults will never need help from kids to find a missing puppy. Adults can ask other adults, not kids, for directions if lost. Give examples and role play.

Caution kids when they wear shirts with their name clearly posted on the outside that strangers will “know” their name. Stay especially close when your kids have their name displayed. It is easier for a stranger to trick them: “Johnny, your mom told me to come get you. She is hurt. Come with me.” What kid wouldn’t question that???

Question about new toys or gifts. Kids might earn token gifts from coaches or teachers as a reward system, but if your child is getting bigger, more expensive gifts, that is a cause for alarm.

If kids are lost, have them find another child to ask for help. Usually the other child has a safe adult with them that can help. (Plus kids are less intimidated talking to other kids when they are already scared and lost.)

Parents of today need to learn about protecting kids on line.

Bullying now does not stop in the safety of one’s home. On line threats, photos, and comments follow kids everywhere and are very dangerous. Keep computers in public areas, monitor cell phone use, teach kids to never give identifying information on line, and use a computer monitoring system.

Abusers often target kids who are feeling unloved. They groom those kids (and their families) by befriending them, making them feel special, and giving them gifts. The kids start to deeply care for that person, and then the confusion of feelings does not allow the child to easily tell on the person.

Show your kids love in many ways: time spent one on one talking and playing (not watching tv), show interest in your children’s activities, give good touches (ruffling hair, pat on the back, hugs), and build your child’s self confidence.

Building confidence in kids is tricky. Be careful in how you word things… it is always okay to say “I enjoyed watching your game,” whether your child was the star player or had a horrible game.

You can say something about how proud you are of the effort they put into something even if the outcome wasn’t good. Try to avoid saying “better next time,” since that means they didn’t do well this time. Praise frequently and honestly from the heart.

Create a safe environment at home. If kids witness fighting among parents, or parents don’t treat others with respect, the children will learn that this is acceptable behavior.

They have a strong potential to get seriously injured at home or to enter abusive relationships as adults. Seek help if your home is not safe! Use a public computer if yours might be monitored and click here or call 1.800.422.4453 (1.800.4.A.Child) from a safe phone.

Learn more about protecting against abuse and what to do if you suspect it. There are on line resources, such as TheSafeSide or PreventChildAbuse, and locally The Sunflower House to learn about abuse. GetNetWise and NetSmartz411 have information about keeping kids safe on line.

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

I’m Not Sure I Support Your Decision to Homeschool

Written by Suzanne Berman, MD, FAAP

My dear friends Matt and Jill are homeschooling their four children, and they’re doing an awesome job of it. Matt, no stranger to education (he has two master’s degrees) is a great communicator and very involved in his kids’ lives.

Jill is smart, sweet, and a model of organization; the “master whiteboard” in her kitchen reflects an orderliness worthy of a military quartermaster. Their kids are well-behaved, smart, curious, and articulate, just like their mom and dad. And the more time they spend with their parents, the more their parents’ character, values, and personality will be instilled in their kids. What’s not to like about homeschooling?

In the ‘80s and ‘90s, homeschooling pioneers fought for the right to direct their children’s educations. And they got good results, too. The original predictions of warped, antisocial children didn’t seem to pan out, and the early generations of homeschooled kids turned out as well-educated (if not better) than the average public schoolchild.

But I’m starting to see some disturbing trends in homeschooling: less Matt and Jill, and more child neglect and perjury.

Not too long ago, an 11-year-old boy came to my office for a well-child check, accompanied by his mom. “How’s school going?” I asked, as I a do always do. “Oh, I’m homeschooled,” he replied. “Tell me about that,” I continued, “what you like to learn about most?”

“Well,” he said, thoughtfully, “we usually do it on the computer. But we haven’t really done any school for a long time, so mostly I watch TV with my dad.” The boy and his two school-aged siblings had been pulled out of school one year prior because dad disagreed with the school’s assessment that the son was not performing at grade level.

The boy reported watching six hours of TV per day most days, with another two-to-three hours of computer game time per day. He might get in thirty minutes of the school program per day. Mom (and later Dad) separately reported that the boy’s self-assessment of school hours was correct.

“We’ve just been so busy with life,” they admitted, “we just haven’t gotten around to doing much school this year.” However, I didn’t see many hopeful indicators that things would change soon; mom works long hours at her job; dad is too disabled to work. When I checked in with them later, the boy couldn’t remember doing any appreciable school work in over six months.

Another mother came in with her 17-year-old daughter, 12 year old daughter, and 7 year old son. Mom reported that her three children are homeschooled; however, she is a single parent and is working 2 jobs to make ends meet.

Mother reports that her kids enjoy staying home. “We have it worked out,” mother explained, “so that while I’m at work, the oldest does her work on the computer. Then she can help the other two with their assignments.”

I gently asked the mother if being responsible for their schooling wasn’t overwhelming, given her work hours as a single parent. “No,” she said, “I don’t have to get them off on the school bus in the morning, so that saves me a lot of time.”

Similarly, a twelve-year-old told me this week that her “homeschooling” for the past three months has consisted of reading a novel — plus cleaning the house and keeping an eye on her fellow foster sibs so her foster parents can work. Other subjects? “No,” she said thoughtfully, “I really haven’t done any math or social studies or anything like that.”

Another mother came in with her twin 7-year-old daughters. The girls had matted hair and body odor. Mother, who had trouble keeping her eyes open during the visit, had lost custody of the twins when they were three years old for about a year; details were sketchy, but the Department of Children’s Services had been involved for a time.

“We’re doing great now, and I’m homeschooling them,” mother stated proudly, if sleepily. “They know all their shapes and letters, and we’re working on their colors and numbers.”

Families don’t have to be accountable to me for their school choice, but they need to be accountable to someone.

The homeschool umbrella (either a private school or local school district) at least nominally asks for attendance records and progress reports.

Even informal homeschool co-ops, which exist in many communities, help parents share best practices with each other. But the families that give me the most concern seem to have a lot of self-imposed isolation: the children don’t participate in music groups or sports teams, and the family doesn’t participate in community activities or attend worship services.

In extreme (and fortunately rare) cases, this can have heartbreaking consequences society expressed its disgust in the failure of child protective services workers to identify this perilous situation, but if someone from outside his family read Christian’s anguished “school essays,” might the outcome have been different?

There’s plenty not to like about public schools and private schools, and families in America certainly have the right to opt to home educate their children.

But public and private schools at least have requirements for transparency and accountability – in fact, that’s usually how we know which schools are winners and which aren’t.

Families like Matt and Jill, who still make up many of the homeschooling families I see professionally, occasionally express annoyance at required record keeping; they’re motivated to do it right even without oversight.

But when homeschooling families don’t appear to take their education responsibility seriously, and there are no consequences from their umbrella, who will hold them accountable?

Suzanne Berman is a practicing general pediatrician in rural Tennessee. Her study of Medicaid access was supported by a grant from the American Academy of Pediatrics’ Community Access to Child Health (CATCH) program.