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Ten Tips to Help Prevent Childhood Obesity

Written by Dr. Jennifer Shaer MD., FAAP., IBCLC

There is a lot of attention these days on childhood obesity. How do cute chubby babies grow into unhealthy overweight children? It’s very easy. Weight management is an uphill battle for everyone. It is only successful for adults when they have the desire and determination to make a change. The problem for kids is that they want what they want, when they want it. Children cannot understand the consequences of overeating and lack of exercise. They cannot be expected to make healthy food choices on their own. It is up to parents to instill healthy eating habits in their kids. Here are a few tips.

Be a role model

Eating healthy is a family affair and children learn by example. It is unreasonable to expect one person in the family to be on a “diet”. Set the house up properly and think of healthy eating and exercise as a lifestyle change instead of a diet. Fill the cabinets and refrigerator with healthy snacks, fruits and vegetables. If the chips and junk food are not there, then they are not an option. If a child is whining that he wants the cookies, it is easy to say “no” if there are none in the house.

Watch portion sizes

There is an absolute distortion of what a portion size is these days. Read labels and measure your food just to get a sense of what a portion size is.

Recognize appetite as opposed to hunger

There is a big difference between appetite and hunger. Offer anyone an ice cream sundae and he will have an appetite. Just because your child will eat an entire plate of cookies, does not mean he is hungry.

Stop making your child clean his plate

It is really important to let your child decide how much he wants to eat. Young children have the ability to actually eat when they are hungry and stop when they are full. Your job as a parent is to choose what foods to offer and when to offer them. Your child’s hunger should determine how much of the meal he eats. If he chooses to eat very little at one meal, he will eat more at the next. Mealtime should not be stressful.

Do not use food as a reward

There are better ways to reward good behavior than giving junk food. Everyone should be allowed to eat junk food on occasion. The key is to limit unhealthy foods and limit the portions. Good behavior is an expectation aside from food.

Don’t drink your calories

An easy way to watch calorie intake is to drink more water. Kids can absorb a lot of calories by drinking juice, soda and even milk. When drinking milk, choose fat free.

Slow down. It takes time for the brain to realize that the stomach is actually full. If your child eats slower and drinks water while eating then he will get full faster. Do not allow second portions unless he is truly still hungry. Keep the serving platters off the table to make it more inconvenient to reach for a second serving.

Avoid emotional eating

If your kids are bored or happy or sad, then help them find something else to do.

Do not allow your kids to eat in front of the television or computer

Lots of calories can be eaten without even realizing it when you eat in front of the TV.

Be active as a family

Take a walk or go for a bike ride. Get off the couch and get moving.

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.

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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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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

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Your Child’s Fever, Good or Bad?

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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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.

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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.