Parents, Are You An Active Participant When It Comes to Video Games And Your Children?

Post written by Dr. Natasha Burgert. 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

GamingI am a child of the Nintendo generation. I remember spending hours with that grey box, blowing on the game cartridge base to keep the game from being glitchy.

Personal gaming was fascinating, innovative, and exciting.  Our whole family loved it.  In fact, my brother spent so much time playing Super Mario Bros., he actually gave himself blisters on both thumbs.

Playing video games remains a hobby in our current home.  My husband and I own a gaming system, and a new video game is on my Christmas list this year.

My preschooler loves to play on the iPhone and iPad.  I am in no position to be doom and gloom for gamers.  I do, however, have parental control over our system, create limits for all members of our family, and engage cautiously.

There have been lots of studies about gaming and its effects.  What I find interesting is all the positive things about gaming.  Manipulating interactive media is going to be a critical skill for our kids to learn, and gaming is a fun way to practice.

Gaming is a wonderful social activity, allowing kids to engage in a form of fantasy play.  Developing relationships with peers of similar interest enhances self-esteem.

Studies have even suggested that individuals who are more inclined in gaming will be better surgeons due to improved hand eye coordination.

Games are being developed to help kids with medical conditions communicate and learn.  New Nintendo Wii games and XBox Kinect  are great examples of using gaming systems, or “exergaming,” for possibly productive weight loss.  And, games are fun!

So, why all the negative press about video games?

As game developers and creators know very well, games are additive.  Pediatricians are really concerned about the increasing numbers of overweight kids we are seeing in our clinics.

We know sedentary kids are at increased risk of developing obesity, and gaming is a sedentary activity. Excessive gaming may be associated with ADHD.  Certain types of games, such as first-person shooter games, have been associated with aggressive behavior and desensitization to violence.

Exposure to gaming may be associated with an increased risk of dangerous behaviors.

If your child wants a video games for the Holidays, here are some suggestions of how you can keep gaming a fun and safe activity in your home.

The AAP recommends no media (TV, computing, gaming) until after the age of 2

.Concerning studies have suggested that some families are allowing earlier media exposure.

I agree with the AAP that the formative years of development don’t need to be complicated with digital enhancement.

Learning to engage in independent play is such a critical, early skill that must be learned.  Developing this self-entertaining skill not possible if the majority of play is a passive activity consisting of watching pictures on the screen, regardless of the “educational content” of the program or game.

Early video systems do not help kids “learn” despite the marketing claims.

After the age of 2, what is appropriate for your family? 

There are many early gaming systems available including LeapFrog gaming systems, Nintendo DS, Sony PSP, computer and smartphone games.  These systems are getting increasingly advanced.

Browse the web to see the pros and cons of each gaming system.  In addition, see how much online support you are easily finding for each system. Included in many early gaming systems is an online partnership for additional activities.

For example, LeapFrog has coordinating non-gaming activities to do with your kids available on their website.

For more advanced systems, review the capabilities to determine what options you want available (web browsing, online gaming networks, exergaming, movie streaming, DVD/blu ray, music/photo storage, wifi capability.)

All major gaming companies have extensive websites to review.

When considering games to purchase, know what the game is about. 

Game content can be implied from advertisements about the game.  Most of the game ads can be easily found online, check youtube.com or gaming blogs.  Do you think the content is appropriate for the members of your family?

Does the game have any components that may not coincide with your family values?  After purchasing a game, as soon as the game is opened, be ready to watch your child play the game. If you find some unexpected game situations you are not comfortable with, engage in conversationwith your child about those feelings.

Mind the game ratings, know what they mean. 

Every game is assigned a rating based on content.  Be sure that these ratings seem appropriate for the intended player.

A pre-teen/teen mind is physically unable to receive and process information like an adult.  Even though you think he is “old enough” to play a game like COD Black Ops, he or she may not be processing that input with appropriate filters.

In my opinion, “mature” or M-rated games are not appropriate for kids until late high school, if appropriate at all.

Consider what expectations you have for your family. 

What must be accomplished before play is allowed… homework? chores?  Explain to your kids that the gaming unit isyour property and may be removed from the home at any time.

If your child is unable to engage in other activities without the constant desire to get back home to game, recognize the red flag that is waving.  If you think your child is spending too much time, or too much engagement with the screen, create and enforce new boundaries.

Games are great for passing some time, but gaming should never be a replacement for interacting with your environment. I am surprised how often I am unable to have a conversation with a patient during a visit because they are allowed to stare at a personal gaming unit.

In our family, games are down when kids have the opportunity to improve and explore their social interactions with peers and adults.  That means we, as parents, need to be a model of this respectful behavior for our kids.

Set limits. 

The AAP recommends no more than 2 hours of screen time per day for our kids.  This includes all screens (TV, gaming, movies, internet, smartphones.)

I would argue that with all the media to which kids are currently exposed, limiting gaming to one hour per day is appropriate.

Gaming systems can provide very powerful motivation. Longer amounts of time can then be more effectively used as “special occasion” gaming or as a reward for responsible behavior.

Consider allowing play for the equal number of minutes engaged in active play (gym class, karate class, sports practice.) There are great tools to limit playtime, such as the BOB and the Time Machine.

Consider using these tools early in your child’s gaming experience.  Enforcing limits after your child is already overly involved in gaming is much more difficult.

If engaging in online play, be cautious. 

This is the area of gaming that starts to make me nervous for early gamers.  I am amazed how many families allow their young child to play online without supervision.

Some parents don’t even know their kids are even playing online! I get concerned when parents are not fully aware of the capabilities of the gaming unit in their home.

Online gaming is unregulated, the language can be vulgar and repulsive.  Online gaming is certainly part one part of the gaming experience kids love, and that parents need to be most aware.

One problem…where do most families have their system? In the basement!

Consider only allowing online play in a common area of the home.  Be present by frequently walking through the gaming area.

Headsets off for online play, you should be periodically listening to the conversations.

Know your network downloading capabilities, including pay upgrades, movies, and game update downloads.  Unregulated participation can end up with a pocketbook surprise.

Control your gaming unit. 

If you are allowing online play in your home, review the parental controls for your system. For example, XBox Live has an online family timer and security controls.

PS3 has an online “Playstation Knowledge  Center” to learn about unit settings.   Be aware that although you may have your privacy and security settings up to date, the person with whom your child has engaged play may not have similar values.

With very little effort, information on how to hack games, bypassing parental settings, is available through Google.  Bottom line… if you allow online gaming in your home, be aware.

That being said, keeping lines of communication open about gaming and the games your child likes to play is important.  You can only control what happens in your own home.  Exposure to gaming and an online community may happen when your child visits other homes.

Have fun shopping for these games. Watch their faces light up, then be an active participant.  If you need additional help, here is some information on choosing good video games.  There is also a book available about all things media which may give some good ideas.  Happy Holiday season, and happy gaming!!

P.S.  I do not have any vested interest nor endorse any products mentioned in this post.

2

Expecting a Child? Need to Find a Pediatrician? What Questions Should You Ask?

Written by Natasha Burgert MD

“Who is going to be the doctor for your new baby?”

Your OB wants to know. Your friends have asked. Your mother is wondering.

Finding a pediatrician is on the “to-do” list of all expectant mothers and fathers. New families often begin the search for a potential baby doctor by asking for recommendations from their OB doctor, family, and friends.

Some families begin by looking at the American Academy of Pediatrics website.Regardless of how you find a pediatrician, truly determining if a doctor is going to be a good match for your family is often done by interviewing.

I have seen plenty of glowing mothers-to-be sitting in my office with the seemingly standard “interview sheet” from babycenter.com or WhatToExpect.com.

Parents come to my office with a “recommended question list” because they don’t really know what to ask. This is certainly understandable since, for most families, interviewing a doctor is new territory.

But although these lists of questions are a good start, I don’t think they get to the heart of the matter.

What most parents really want to know is if a pediatrician is likable. Is this person going to be someone I can ask questions? Do we have something in common? Are we going to get along?

Compatibility is what most parents are searching for.

Here are 5 questions I would ask a potential baby doctor during an interview.

1. “Tell me about your office.”

Office hours and locations, contact numbers, hospital affiliations, and basic biographical information is fairly standard on every medical practice website. Use the web to get the basics, but let the doctor tell you where he thinks his office really shines.

This open-ended approach gives the doctor an opportunity to say what he thinks is the most important, interesting, or significant about the place where he works.

If the doctor does not cover any specific question you have about the function of the office, then ask.

2. “Why did you choose to become a pediatrician?”

The million dollar question. This is an opportunity for you to learn about the person behind the white coat. Of all the medical specialties, why did she choose to take care of kids?

3. “What are your thoughts on antibiotics and vaccinations?”

For most doctors in pediatric healthcare, antibiotics and vaccinations are common medical interventions.

How a doctor chooses to use antibiotics, and for what illnesses, does vary. With the increasing concern of antibiotic resistance and super-infections, having a physician who can clearly define when antibiotic use is appropriate for your child is important.

Vaccinations are a fundamental building block for child health. A physician’s beliefs and attitudes towards vaccinations will effect the recommendations they may or may not provide.

Also, some physicians will not see patients if the recommended vaccination schedule is not followed. Allowing a doctor to openly express his opinion on immunizations can begin productive dialog about this very important topic.

4. “What do you love about your job?”

Does this doctor have a passion for the underserved? Does he love to see kids with chronic illnesses, like asthma or ADHD? Does she love to teach?

Asking a doctor to share the best part of his job may reveal a common interest. Or, allow you to determine if your family’s needs will be best supported.

5. “What do you like to do outside of work?”

Pediatricians often look alike on paper. We all go to medical school, complete a pediatric residency, and get certified by the American Board of Pediatrics.

Asking the doctor what she enjoys doing outside of work may be enough to make the person on paper become a new partner in the care of your family.

Good luck in your search!

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

2

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

1

Dr. Google, Friend or Foe?

Written by Natasha Burgert MD

Two articles recently caught my eye while I was spending some time on Twitter. First, an op-ed piece was published on Time.com discussing how patients and doctors perceive the use of the online health information. The article was closely followed by the results of a recent PEW research study which stated that 80% of Americans used the internet to “prepare for or recover from” their doctor visit.

The results of the PEW study were less than surprising to me. Everyday I have a concerned mom or anxious dad refer to something they have read online.

Everyday.

And, everyday I get to learn about new articles and websites that are claiming to have reputable health information. I learn from my families who bring in articles and links, and often share the good information with other families who may be struggling with the same concerns.

As a medical doctor who regularly navigates the web, however, I did not expect nor appreciate the author’s tone in the Time.com piece. I was made to feel that all doctors were like lazy cattle, being poked with an electric switch towards a glowing computer screen.

I find that troubling as a practicing pediatrician. Although doctors have traditionally been thought of as “late-adopters,” not all of us fit that archaic mold. There are many, many doctors who are embracing e-communication of all types within their daily medical practice. And all successful doctors practice “shared clinical decision-making” with their families, regardless if the internet is a piece of the information puzzle.

How can you discuss online health information with your physician, without being labeled a “cyberchondriac?”

Here are some things to consider before you approach your provider with some internet research of your own.

Critique what you find

Commercial advertisers and agenda-based groups can be very deceiving online. Does the information have sources to original, peer-reviewed medical articles?

Who is writing the article, and what are their credentials? Who is paying for the study to be completed? Are there a lot of banner ads, or references to a certain brand of product? Does the writer of the article have financial interest in the items they recommend? Dr. Meisel did state this well, saying,

Many patients are going to discover the best online health information way before their doctors do. They, too, have a responsibility: patients will need to signal to their doctor how they conducted their search in a way that was smart, directed and grounded in evidence. Only then will the Google stack be recognized and used in a helpful, not counterproductive, fashion.

My favorite public sites for health information include:

  • Is your child sick? This feature is on our practice’s website to give families some information about common childhood symptoms. The site also give some guidance about what symptoms are concerning enough to contact the on-call physician.
  • www.uptodate.com This is a very well-designed site providing general information on health conditions and their treatments.
  • www.healthychildren.org A website full of childhood health information developed by the American Academy of Pediatrics.
  • www.cdc.gov General information on illness, vaccines, and travel concerns.
  • www.vaccine.chop.edu Complete, concise vaccine information.

If your provider allows, send links and articles to your doctor before the visit

Bring a list of keywords that you searched. This allows your doctor to look over the information more critically, and hopefully more thoughtfully. If your doctor does not allow you to provide information prior to your appointment, don’t expect organized discussion about your findings in a brief appointment slot. Thinking about online information critically is a time-consuming process. Give your provider ample time to look over the information after your appointment.

Be prepared for a “no”

It may be possible, that despite your best efforts, keywords or articles you have found may have been misleading. If your physician disagrees with some online information you have found, it is very appropriate to ask, “Why?” Your provider should explain why the information may not be relevant or appropriate for your specific situation, hopefully providing alternate online references to help continue your search.

We are partners

Bring information to your provider with an attitude of partnership and shared decision-making. No one likes a confrontation. Navigating health online information is a learning process for all of us. If we don’t listen to each other, we don’t learn.

If patients and doctors can have open dialog about information found online – good and bad – we can take care of patients better. And that is more than Dr. Google could ever do alone.

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

1

Introduction to Solids – 6 Myths

Written by Natasha Burgert MD

 

At the 6-month check up, nearly all of my patient families want to talk about starting their babies on solid food. The conversations usually start like this…

“I go get all of Gerber stage 1 foods and then do all the greens, then the yellows, then the fruit. After she eats all of the stage 1 foods, then she goes on to stage 2, right?”

Or this…

“I have gone to the farmer’s market and bought all organic produce to make his baby food. I am following the [insert name here] recipe book that I got from a friend, and their baby is such a great eater. Do you think bulgar wheat or quinoa is better?”

Or this…

“I have already given some rice porridge with scrambled egg, and some broth with root vegetables. Can I start tofu now?”

As these real-life conversations demonstrate, the plan and expectation for introducing solid food to babies is different for every family. The food items that parents first feed children is influenced more by culture and generational upbringing, than by any scientific research or product marketing plan.

And, that’s OK! In fact, it’s wonderfully liberating news for parents who are really stressed out about first foods.

So, what are my general guidelines when it comes to starting infants on solid foods?

  • I encourage the families of healthy, normally-developing children* to start solids near or after 6 months of age.
  • I want parents to give babies a great variety of real food, in a safe way.
  • I think of pureed foods as practice and play to develop the skill of eating; nutrition is still from breast milk or formula.
  • I try to challenge my families to think outside of the Gerber-defined box and give babies interesting tastes, but no raw honey until after the first birthday.
  • That’s it. Go. Eat.

Wait a minute…. There has to be more. What about the rule about veggies first? Babies can’t have dairy, right? What about spicy stuff? They aren’t supposed to have strawberries or oranges, either!? My mom wanted to give her yogurt, and I told her “no.” Please don’t tell me she is right!?! And you have said nothing about rice cereal.

OK, so maybe there is a little bit more. But, likely not what you expect. When continuing the food conversation with families, some common myths creep to the surface.

It’s tIme to bust some common “starting solid food myths” … for good!

Myth #1: Rice cereal must be first.

Rice cereal has traditionally been the first food for babies in the United States for generations. But, why rice cereal? It is convenient – easy to obtain and easy to feed. Baby cereal is also fortified with iron and other nutrients. This promoted as a benefit for those infants who need some supplemental vitamins and minerals in their diet. Click here for information about iron recommendations for infants.

Giving rice cereal as a first food is under active debate. Specifically, Dr. Alan Greene is noted for starting a “White Out Now” movement. He encourages families to feed infants whole, natural first foods instead of rice cereal.

Dr. Greene discusses how the food industry has marketed and advertised to parents so heavily, the industry has created doubts in our minds regarding what is best to feed babies. We, as parents, start to believe that the healthy foods that we eat are not “good enough” for our babies.

Dr. Greene’s is also concerned that rice cereal primes infants to crave only carbohydrate-rich foods, contributing to the obesity epidemic. Other physicians have debated his theory,but I think his general concern for the quality of first foods is worth notice.

For the first few months of eating solids, an infant’s nutrition is still based upon the healthy calories given by breast milk and formula. That allows pureed foods of all forms to be first foods, as they have for centuries.

Expand beyond the rice cereal “default”. What about some pureed red meat as a first food? What about whole grain cereal, oatmeal, or a pureed fruit or veggie? Maybe, something you have in the fridge? (see #2)

Myth #2: Making baby food is hard (A.K.A. I don’t have time to make baby food.)

I hear this a lot; mainly from parents whose only experience with baby food making is observing a few moms with fancy baby-food makers, complicated recipe books, and bags of locally-sourced organic ingredients. This “all-in” approach to pureed food making can seem overwhelming and unreachable.

But, let me offer a suggestion…

In my clinical experience and personal experience, the earlier you get your baby eating the healthy meals that you provide your family (in a safe, modified way), the better they will eat as toddlers. So, I challenge all my families to try to make some first food… simply.

I do not talk about making baby food with the claims that it is of greater superiority to jarred baby food. There are some great commercial baby foods on the shelves today. But, babies have survived for many years before infant food was available in aisle 4B of the grocery store; and I think only offering what a food company can put in a jar is actually quite limiting to a baby’s early taste experiences.

To make baby food, you need soft foods (fruits, veggies, whole grains, meats), a little water, and a machine to puree. The machine could be a food mill, a blender/food processor, or a strong arm with a fork. Voila! Simple as that. I bet there is something in your kitchen right now that you could whip up for baby. Last night’s grilled chicken breast? Leftover green beans? Melon? Avocado?

As a working parent, I certainly bought prepared baby food. But, I made a lot of food for my infant, too. For me, it was easy, cheap, quick, and just part of the routine.

So, I challenge you to try to make some of your baby’s first tastes. Experiment and have fun! Decrease your family’s food cost, decrease shipping and packaging waste, and increase the palatable options for your baby to try.

Myth #3: Starting solids will help my baby sleep through the night.

Nope. It doesn’t.

Starting foods too early may actually have some negative consequence including obesity, food allergy, and decreased sleep!

Yikes!

Currently, it is recommended that first foods should be started around 6 months of age. This age is preferred for both the developmental ability of an infant to take food off a spoon, in addition to decreasing the risk of food-associated allergies and obesity.

Eating solid foods is a developmental skill, not a way to “fill baby up” to sleep longer. So don’t let this myth determine when you start solid food.

Myth #4: Greens, then yellows, then oranges.

There is no evidence to suggest that if you offer baby fruits first, she will never eat veggies. Regardless of what order food is introduced, kids (and adults!) will always prefer sweeter-tasting food items. Offer your baby foods of all colors of the rainbow, in no specific order.

Myth #5: My baby can’t really have the food that I am eating.

I think the origin of this myth/concern stems from parents knowing the kind of diet they have. Feeding our children is often an examination of what we, as parents, feed ourselves.

If a parent’s diet consists of fast food, takeout, and late-night snacks then the thought of feeding baby exactly what you eat is ridiculous. Agreed. But, if you are not willing to feed what you eat to your baby, maybe it’s time to think about the nutrition and healthy eating choices for the entire family.

If a family eats a healthy, well-rounded diet then the concept of offering baby what you eat is not such a scary idea. Make healthy, positive food choices, include your baby, and see the long-term benefits for the whole family.

Myth #6: Oh, no.. baby can’t have that.

Currently, for healthy babies who are not in a family with significant food intolerance and allergies, the only thing babies under the age of 12 months cannot have is raw honey. Honey may contain harmful botulism spores that could make small babies very ill.

That’s it.

The research regarding introducing solid foods is actively changing. This means the foods that have been traditionally restricted until later in toddlerhood (eggs, shellfish, peanut butter) are no longer on the “Do Not Have” list. In fact, some recent data suggests that delaying the introduction of high-allergy foods (shell fish, nuts, eggs) actually increases the risk of developing a food allergy.

Other studies do not show an increase in allergic disease by starting allergenic foods early. In addition, adding dairy sources (cheeses, yogurt) and animal proteins (meat, chicken, pork, fish) can be added at any time.

Expand the box. Think about your own diet, and what you want your kids to eat. What is acceptable for your family, your culture? Don’t let Gerber or Earth’s Best or [insert baby food company here] make those definitions for you.

Your baby just might surprise you… mine certainly did. Within a very short period of time, my 8-month old son’s favorite food was my husband’s recipe for chili (pureed) – extra spicy!

Have fun!

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

* Starting solid foods may be very different for children with a significant personal or family history of allergies, milk intolerance, or skin issues. It may be very different if a sibling had challenges with foods. It certainly will be unique if a child is not growing correctly. If your child has any of these issues, or you have specific concerns about your child, please ask your pediatrician for guidance.

2

We can take care of patients better. And that is more than Dr. Google could ever do alone

Written by Natasha Burgert MD

Two articles recently caught my eye while I was spending some time on Twitter. First, an op-ed piece was published on Time.com discussing how patients and doctors perceive the use of the online health information. The article was closely followed by the results of a recent PEW research study which stated that 80% of Americans used the internet to “prepare for or recover from” their doctor visit.

The results of the PEW study were less than surprising to me. Everyday I have a concerned mom or anxious dad refer to something they have read online.

Everyday.

And, everyday I get to learn about new articles and websites that are claiming to have reputable health information. I learn from my families who bring in articles and links, and often share the good information with other families who may be struggling with the same concerns.

As a medical doctor who regularly navigates the web, however, I did not expect nor appreciate the author’s tone in the Time.com piece. I was made to feel that all doctors were like lazy cattle, being poked with an electric switch towards a glowing computer screen. I find that troubling as a practicing pediatrician. Although doctors have traditionally been thought of as “late-adopters,” not all of us fit that archaic mold. There are many, many doctors who are embracing e-communication of all types within their daily medical practice. And all successful doctors practice “shared clinical decision-making” with their families, regardless if the internet is a piece of the information puzzle.

How can you discuss online health information with your physician, without being labeled a “cyberchondriac?”

Here are some things to consider before you approach your provider with some internet research of your own.

Critique what you find.

Commercial advertisers and agenda-based groups can be very deceiving online. Does the information have sources to original, peer-reviewed medical articles? Who is writing the article, and what are their credentials? Who is paying for the study to be completed? Are there a lot of banner ads, or references to a certain brand of product? Does the writer of the article have financial interest in the items they recommend? Dr. Meisel did state this well, saying,

Many patients are going to discover the best online health information way before their doctors do. They, too, have a responsibility: patients will need to signal to their doctor how they conducted their search in a way that was smart, directed and grounded in evidence. Only then will the Google stack be recognized and used in a helpful, not counterproductive, fashion.

To get you started, a few of my favorite public sites for health information include:

  • Is your child sick? This feature is on our practice’s website to give families some information about common childhood symptoms. The site also give some guidance about what symptoms are concerning enough to contact the on-call physician.
  • http://www.uptodate.com This is a very well-designed site providing general information on health conditions and their treatments.
  • http://www.healthychildren.org A website full of childhood health information developed by the American Academy of Pediatrics.
  • http://www.cdc.gov General information on illness, vaccines, and travel concerns.
  • http://www.vaccine.chop.edu Complete, concise vaccine information.

If your provider allows, send links and articles to your doctor before the visit. Bring a list of keywords that you searched. This allows your doctor to look over the information more critically, and hopefully more thoughtfully. If your doctor does not allow you to provide information prior to your appointment, don’t expect organized discussion about your findings in a brief appointment slot. Thinking about online information critically is a time-consuming process. Give your provider ample time to look over the information after your appointment.

Be prepared for a “no.”

It may be possible, that despite your best efforts, keywords or articles you have found may have been misleading. If your physician disagrees with some online information you have found, it is very appropriate to ask, “Why?” Your provider should explain why the information may not be relevant or appropriate for your specific situation, hopefully providing alternate online references to help continue your search.

We are partners.

Bring information to your provider with an attitude of partnership and shared decision-making. No one likes a confrontation. Navigating health online information is a learning process for all of us. If we don’t listen to each other, we don’t learn.

If patients and doctors can have open dialog about information found online – good and bad – we can take care of patients better. And that is more than Dr. Google could ever do alone.

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

4

Anti-vaccine Stories Sell Papers, Children Suffer

Written by Natasha Burgert MD

A recent Baltimore Sun op-ed headline popped with an eye-catching and concerning title. It read, “We don’t know enough about childhood vaccines.”

After reading the headline, I immediately raised my eyebrows and took a deep breath. As a pediatrician who recommends and administers vaccines during my clinic time with children, I thought

“We don’t?”

I continued to read Ms. Dunkle’s commentary with the goal of learning something new, something relevant. Keeping up-to-date with medical science is an important part of my job. I need to be confident and certain, to the best of my ability, in the recommendations I give my families. As a advocate for the health of children, I owe my patients and their families that dedication. So, if there is peer-reviewed, evidence-based data that challenges or disputes current medical practice, I need to know.

In that framework, the opinion piece by Ms. Dunkle was sorely disappointing. She attempts to report on “new” findings revealed in the Journal of Toxicology and Environmental Health claiming to associate increased vaccination rates with increased rates of autism and speech/language impairments. She attempts to poke and prod at the reader, trying to pick a fight about semantic details; events, doses, shots. Then she quickly turns the corner, bringing up intentionally alarming half-truths about vaccine components, preservatives, and stabilizers.

Ms. Dunkle, however, failed to mention a very important point. The author of the reported study, Gayle Delong, is not a scientist, a medical doctor, or doctorate researcher. Ms. Delong is a economics professor with expertise in “international finance” and “money and banking” (as listed on her public CV.) More importantly, she is also on the executive board of a large, anti-vaccine group. The results obtained by Ms. Delong’s research have been shown to be biased and statistically flawed by additional reviewers. Therefore, the interpretations made from her analysis need, at minimum, recalculation.

With a small amount of fact-checking and investigation into these stories, the intention of the authors quickly become clear. Ms. Dunkle and her analysis is a great example of how anti-vaccine groups create junk studies to promote fear. And how media outposts, eager for a hot headline, will regurgitate this information with complete disregard of the potential effect this propaganda could have on our children.

Anti-vaccine stories sell papers, your child suffers.

In the face of the resurgence of measles and other vaccine preventable illness, it is unfortunate that the editors of the Baltimore Sun allowed this manipulation of its readers.

For an additional response to Ms. Dunkle’s commentary, click here.

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