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6 tips to help make the best of the time your teen spends with your doctor

Written by Natasha Burgert MD

Summer is the time most teenagers come to the pediatrician’s office for their annual health exams. Here are 6 tips to help make the best of the time you spend with your doctor.

1. Make an appointment. Now.

Teens are a dynamic animal. And fortunately, most are very healthy. But healthy kids need doctors, too. Subtle changes in physical exam, measurements, and lifestyle can be concerning issues to a trained pediatrician’s eye. And if teens are not routinely seen by a provider, opportunities for easy correction and treatment can be lost.

A pediatrician is expertly trained to provide a complete physical exam for your teen child. Our job is to be sure that your child’s global health is optimal, physically and mentally. We specialize in the growth and development of teens, as well as discuss the risks and challenges of their age.

Most importantly, seeing healthy teens and their families is when pediatricians can make the biggest relationship impacts. Well child visits are instrumental in developing a working partnership with someone in the health care field that can be your family’s partner and advocate should challenges or illness arise.

And, we love to see you. Please make an appointment for your teen to be seen.

2. Define your concerns.

Since teens are generally healthy creatures, parents and kids often have absolutely NO concerns about their child’s health. GREAT! These visits can be used to review healthy habits, safe living practices, and look at vacation photos. I love those check-ups.

Your teen’s appointment is, however, the only time we will likely see each other this year, so please take a minute to think about any issues you would like to discuss. In fact, make a list. Then, remember to bring the list with you to the appointment.

3. If you have significant issues to discuss, consider sending an email or letter giving some details prior to your appointment.

Issues such as depression, weight gain or loss, menstrual concerns, ADHD, and headaches much more effectively addressed if your provider has had some extra time and some extra history prior to the appointment.

If you know that you have a significant concern to discuss, please let the person who is making your teen’s appointment know. This is to allow for extra time, if needed. In addition, ask the scheduler if you would be able to send a note to the physician prior to the appointment. This will optimize our time together.

4. Have the parent’s section of camp forms, health forms, and athletic participation forms completed.

Please.

5. Prepare to spend some time apart.

After talking with a patient with his or her family, pediatricians often speak with teens privately. It allows an opportunity for us to get to know each patient on a more personal level, without parental interruption. In addition, this allows your teen to “practice” talking with a physician – a very important life skill.

The goal of this time is to repeat and reinforce the healthy habits you are already discussing with your teen. The more we know about your family, the better this is accomplished. In addition, private conversations begin establishing a foundation of trust with each patient. As your teen’s trust with a physician grows, it is easier for them to have honest and open dialog about potential health risks.

In pediatrics, the conversations with teens are confidential and protected. Providers are obligated to share information with parents in defined situations, such as patients who are at risk of harming themselves or others.

6. Never promise your teen that there will be “no shots.”

The recommendations from the vaccine advisory boards are always changing. Vaccines are a very important way of protecting your teen from significant, deadly diseases. Teens are getting protected from chicken pox, meningitis, tetanus, pertussis, hepatitis, and human papilloma virus with some of today vaccines.

Have a great summer, and a great checkup with your pediatrician!

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

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Child Proofing Your Home: 21 Tips

By Jennifer Gruen, MD

By the age of six months you need to think very seriously about protecting your children from the world around them, before they become mobile explorers.

The best approach to childproofing is to think in terms of multiple barriers.

The first barrier between a child and any danger is generally you, always watching out of the corner of your eye. But that doesn’t always work- particularly with the distractions of ordinary life such as phones, computers, and other children.

Unfortunately, we cannot avoid such distractions, but we can create additional barriers. For example, a second barrier is to keep the door to a dangerous room closed at all times, and maybe locked.

But sometimes that might be left open. So, a third barrier is to keep the dangerous stuff high in a cabinet. But sometimes an older child will be visiting and might climb up there and offer that forbidden substance to your child. So, a fourth barrier is to keep it locked.

Most protective measures you will be able to figure out for yourselves with a trip to the childproofing section of ToysRUs, Target, or children’s store. Here are a few tips to get you thinking:

1. Get down on your hands and knees and crawl thru your home- you will get a child’s eye view of what is easy to access.

2. Use the “toilet paper roll rule”- if it fits thru the tube, it can be choked on.

3. Put all dangerous items (medicines, cleaning agents, knives, small choking hazards) up high- and preferably in a locked cabinet (remember your child will one day climb!)

4. Beware of where you put what you are drinking. Coffee cups belong far out of reach of toddlers. Pots on the stove should have their handles turned inward. If you have a party, don’t leave your drinks around afterwards .

5. DO NOT USE WALKERS-they allow children to access dangerous areas such as stairs.

6. Sharp objects, especially little ones such as toothpicks, are dangerous. Keep them well hidden, preferably locked and at a height.

7. Electrical outlet covers are essential- I prefer the kind that require you to insert a plug in partway, then turn to access the holes of the outlet. Plastic plug-in protectors are often easily removed by an adept toddler.

8. Keep electrical appliances such as blow dryers and toasters unplugged when not in use.

9. Never leave a child unattended in a bath, even for a minute.

10. All children should learn to swim by the age of five to seven; we also have brochures for a terrific water safety program for children as young as infants in the office. The more barriers between a pool and your child the better- think safety covers, pool alarms, and multiple fences at least 5 feet high.

11.Turn down your water heater, if you can, to a maximum temperature of 120 to 130 degrees. At these temperatures accidental water burns will be much less severe.

12.All stairs need two sets of gates- at the top and bottom. Gates at the top of stairs must be bolted to the wall, and have vertical slats so that a child cannot easily climb them.

13. Cut window-blind cords, or use safety tassels and inner cord stops so children can’t get entangled.

14. Lock stove knobs- keep kids from igniting stove burners by using protective appliance knob covers.

15. Hide all cords (electrical, computer, phone.)

16. Don’t use bumpers in the crib, nor have blankets or toys in there. Once a child can sit up, lower the mattress down to the lowest level. Once a child can climb out of the crib, take the side off to create a toddler bed, or put a mattress on the floor. Put a gate in the doorway to prevent wandering toddlers at night.

17. Secure furniture (bookcases, chest of drawers) that can topple to the wall.

18.Avoid choking foods for infants and toddlers, and never let your child wander while eating. Worst offenders: hot dogs, whole grapes, popcorn, dried fruits such as raisins, small candies.

19. Help older children store small items and toys in labeled bins that are put out of reach of toddler siblings- if they have their own room, allow them to gate it off from their younger sibs.

20.Put stickers with the poison control # on all phones: 1-800-532-2222. If you fear your child has ingested a poison, or taken too much of a medication, call poison control rather than the pediatrician- PC is much better equipped to calculate whether there is a need to seek medical help. Never give a child ipecac or any other liquid after an ingestion without calling poison control first. If your child appears to be in distress (difficulty breathing, choking, trouble swallowing, drooling) FIRST CALL 911, then poison control.

21. LEARN CPR. We can arrange for individual classes with our certified CPR instructor, or help you find a class.

With all these necessary precautions, we still have to strike a balance and leave our children room to wander. One of the best places to do this is in a controlled area- try to make one central room a safe place to explore, and a location where you can safely deposit your child should you need to run to the bathroom, or answer a call.

Fill your bottom kitchen cabinets with pots, pans, Tupperware and other items that your child can discover and play with. Let your child have adequate floortime to explore in a safe environment (walkers and exer-saucers actually delay a child’s walking !)

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

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Gifts of a Father’s Presence. Part 3 of 3

Written by David R. Sprayberry, MD

My last few posts have revolved around the negative effects that absent fathers have on their children.  So far, we have talked about how the absence of a father contributes to poverty, substance use and abuse, psychological and behavioral problems, poorer educational performance, and increased participation in criminal activities.  Today we turn to the positive things that a present father brings to the lives of his children.

Effects on Infants

Let’s starts with infants.  Even in the first few days of life, the effect of a father’s presence can be discerned.  Newborns will preferentially turn their heads to the voice of their fathers over the voices of other men.  Premature infants whose fathers visit the NICU more often tend to have better weight gain during the hospitalization and perform better on behavioral and social-developmental tests during the first 18 months of life.  Infants who demonstrate the most emotional security and attachment have fathers who are affectionate, who spend time with their children, and who have a positive attitude.  Keep in mind that these effects are happening long before the child can even walk and talk.

Effects on Mothers

What about mothers?  When fathers are involved, their children’s mothers are more likely to start and continue breastfeeding.  Mothers with positive relationships with their children’s fathers also demonstrate better parenting skill and fewer emotional difficulties.  Mothers who are feeling supported are more likely to encourage the fathers to be involved with the children.

Early Childhood

Fathers can help reduce the likelihood of stranger anxiety in their children.  Toddlers with present fathers are also less likely to worry and less likely to disrupt the play of other kids.  Preschool children of involved fathers have been found to have higher cognitive development.  They also exhibit more empathy and have a greater sense of mastery over their environment than their peers with less involved dads.

Long-term Benefits

Children who live with both parents are more likely to finish high school, be economically self-sufficient, and be physically healthy.  Fathers have a unique and strong influence on their children’s gender role development and serve as important role models for both boys and girls.

Discipline

Fathers who set appropriate limits for their children and who provide sufficient autonomy have children with higher academic achievement.  Fathers who discipline harshly and/or inconsistently have a negative impact on emotional and academic development.

Educational Benefits

When dads are involved, kids tend to have improved educational outcomes.  Children of fathers who are involved in their children’s education are more likely to achieve better grades, more likely to enjoy school, more likely to participate in extracurricular activities, and are less likely to have repeated a grade.

Additional Benefits

There are numerous other benefits that result from fathers who are involved.  Fathers who spend time alone with their kids and perform routine childcare at least twice a week raise the most compassionate adults.  Physical play with fathers promotes intellectual development and social competence.
Fathers are capable of doing incredible good to their kids by staying involved in their lives.  Dads, you only have a few years with your kids at home.  Make the most of them and be their dad!  Perfection is not necessary.  Presence and participation are.
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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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.