Can I Spoil My Newborn?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

Photo Courtesy – http://blog.kidsfunplaza.com/

Parents of newborns often ask me if holding their baby too much will spoil him or her. The answer to this question is a resounding “No”.

Newborn babies are accustomed to being held 24/7. This was their existence during their entire gestation. Any amount of time that a newborn is not being held can be stressful. An infant does not need to learn and cannot learn to be independent immediately after birth. Newborns do not have the capacity to be lazy or manipulative at this stage.

The best way to comfort and care for a newborn is to imagine recreating the feeling of being in utero. If your baby falls asleep on your chest, enjoy it. Newborns regulate body temperature, heart rate and breathing best when lying chest to chest with mother or father.

Because of this, baby wearing has become popular of late and is a great way to nurture your baby hands free while taking care of yourself and even your other kids.

However, this does not mean that you need to be a slave to your baby. If you need to put your baby down and he cries, it will not harm him in the long run.

My advise is to follow your instincts. Hold your baby whenever you want to without the guilt that you are spoiling him.

Cherish this time. All too soon he will be grown up. On the other hand, do not fret if you have to or want to put him down to take care of something. Consider using a sling which will allow you to multitask.

As babies grow up, this advice changes. Older babies do benefit from learning how to self soothe. For now, enjoy those first few months. Forget the laundry, cooking, entertaining and other chores unless critically important. Spend this time bonding with your newborn and enjoy every moment while it lasts.

 

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.

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

Written by Natasha Burgert MD

Photo Credit – http://blog.cakehealth.com/

“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

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.

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.

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

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.

How To Help your Kids With Homework?

Written by Kristen Stuppy MD

Any parent with school aged children knows that homework can be a battle. Even good students can procrastinate, prefer to play, or have practice after school leaving little time for homework. Then there are the kids who struggle.

I think I threw my son’s middle school homeroom teacher for a loop on back to school night. She mentioned that I can always look on line to see the assignments, and I replied something to the effect of, “I don’t have homework, so I’ll never look. It is his responsibility to know what is due.” I am not an absent parent.

I do ask about his day, what he’s doing in class, and what his plans are with friends. He knows I care because I show interest in him, but I don’t micro-manage his day. I do not want to be the parent responsible for the college kid who fails because Mommy can’t manage his schedule.

Of course, I know my son and he’s self motivated and capable of keeping track of assignments. Another child might need more help, but at this age I would recommend covertly looking at the assignments and guiding with questions and looking for the student to offer solutions and plans to get the work done.

How can you help your kids with homework without letting it become your problem?

I am a firm believer that kids are the students, not the parents. Kids need to take ownership of their homework and all other aspects of school. Of course, for many kids this is easier said than done, but I hear all too often of college kids who have Mommy call the Professor to question a grade. That is totally unacceptable. Kids need to practice ownership from early on. Parents need to guide always, but manage less and less as the kids grow.

Not every solution comes from a cookie cutter mold. Kids have different personalities and abilities. You know your kids best. Think how they work and what makes them tick.

Many parents underestimate the problem with missing out on basics: sleep, nutrition, and exercise. If kids don’t get the amount of sleep they need, healthy foods, and regular exercise, they will not be as successful academically. I have blogged on this previously, and really feel that finding balance is important for everyone.

Kids have different problems with homework at different times, and they each deserve their own solutions. Not one of these “types” fits every child perfectly. Most kids have more than one of these qualities, but tend to fit into one type best.

Procrastination:

There is always something more fun to do than work. Kids will put off overwhelming tasks or big projects because, well, there’s a lot to do.

Ask not only what homework they have for tomorrow, but if there are any big projects due in the future. See if they can estimate how much time it will take to do the project and help them plan how much to do each night to get it done on time.

Breaking big assignments or long worksheets into small pieces with short breaks in between can help kids focus. Use a timer for breaks or do a fun quick activity, like silly dance to one song.

Allow kids to have some “down” time after school for a healthy snack (brain food) and to run off energy. Limit this time with a timer to 30 minutes or so. The timer helps kids know there is an end point to the fun, and then it’s time for work. Play can resume when work is done correctly.

Poor Self Confidence:

Kids who are afraid they won’t understand their homework might fear even starting. They blame the teacher for not teaching it correctly. They might complain that they are stupid or everyone else is smarter. They blame the class for being too loud, causing distraction and therefore more homework. They might complain of chronic headaches or belly aches.

Be sure to praise when kids do things right and when they give a good try. Be honest, but try to think of something positive to tell them each day. When they don’t meet expectations, first see if they can see the mistake and find a solution themselves. Guide without giving the solution. Then praise the effort!

Find their strengths and allow them to follow those. If they are poor in math but love art, keep art materials at home and display their projects with pride. Consider an art class. Remember to budget time. Over scheduling can result in anxiety, contributing to the problems.

Perfectionist:

While the desire to do everything right has it’s benefits, it can cause a lot of anxiety in kids. These kids think through things so much that they can’t complete the task. See also the “poor self confidence” section above, because these kids are at risk for feeling they are failures if they don’t get a 100% on everything. They can have melt downs if the directions don’t make sense or if they have a lot of work to do.

Help your child learn organizational techniques, such as write down assignments and estimate time to do each project. Plan how much time to spend each day on big projects and limit to that time. Help them review their progress in the middle of big projects to see if they are on track. If not, have them establish another calendar and learn to review why they are behind. (No self-blame. Is it because one step took longer than projected, they were invited to a movie and skipped a day, they got sick and were not able to work… This helps plan the next project and builds on planning skills.

Remember to give attention and praise for just being your kid. These kids feel pressure to succeed, but they need to remember that they are loved unconditionally.

If you notice they have an incorrect answer, state “that isn’t quite right. Is there another way to approach the problem?”

Not everything is about the grade. Praise the effort they put into all they do, not the end point. Make positive comments on other attributes: a funny thing they said, how they helped a younger child, how they showed concern for someone who was hurt.

Encourage them to try something new that is outside their talent. Not only are they exploring life, but they are developing new skills, and learning to be humble if they aren’t the best at this activity. Help them praise others. Model this behavior in your own life.

Co-dependence:

Helicopter parenting is a term often used to describe the parent hovering over the child in everything they do. This does not allow a child to learn from failing. It does not allow a child to grow into independence. It allows the parent to “own” the problem of homework. These kids call home when they leave the homework or lunch on the kitchen table for Mommy to bring it to school. These kids grow up blaming everyone when things don’t go their way and Mommy can’t fix it. They don’t learn to stand up for themselves. They seem constantly immature with life situations.

Young children need more guidance, but gradually decrease this as they get older. Teachers can help guide you on age appropriate needs. Most parents must sign a planner of younger kids, but as kids get older the kids become more responsible for knowing what the homework is. Many schools now have websites that parents can check homework assignments, but be sure the kids own the task of knowing what is due too.

Have a place that children can work on homework without distraction (tv, kids playing, etc).

Be available to answer questions, but don’t do the work for them. If they need help, find another way to ask the question that might help them see the solution. Get a piece of scrap paper that they can try to work through the problem. If they have problems with reading comprehension, have them read a few lines then summarize to you what they read. They can take notes on their summary, then read the notes after the entire chapter to get a full summary.

Busy, busy, busy:

Some kids are really busy with after school activities, others just rush through homework to get it done so they can play.

Set limits on how much screen time (tv, video games, computer time) kids can have each week day and week end. A maximum of 10 hours per week of screen time is recommended by experts. If they know they can’t watch more than 30 minutes of tv, they are less likely to rush through homework to get to the tv.

Ask kids to double check their work and then give to you to double check if you know they make careless mistakes. Don’t correct the mistakes, but kindly point them out and ask if they can find a better answer. Once they learn that they have to sit at the homework station until all the work is done correctly, they might not be so quick to rush.

If kids have after school activities the time allowed for home work and down time are affected. Avoid over scheduling, especially in elementary school. Be sure they have time for homework, sleep, healthy meals, and free time in addition to their activities. Are the activities really so important that they should interfere with the basic needs of the child? Is the child mature enough to handle the work load?

Kids who are in constant motion can’t seem to sit still long enough to do homework. Be sure they have the proper balance of sleep, nutrition, and exercise or all else will fail. Praise their efforts when they are successful. Set a timer after school to let them play hard for 30 minutes, but then make them sit. Help little ones organize what needs to be done and break homework into several smaller jobs. Set regular 5 minute breaks every 30 minutes so they can release energy. Set a timer to remind them to get back to work and compliment them when they get back on task.

Struggling despite help:

There are many reasons kids struggle academically. Reasons vary, such as behavior problems, anxiety, illness, learning disabilities, bullying, and more.

If they are struggling academically, talk with the teacher to see if there are any areas that can be worked on in class or with extra help at school. Can the teacher offer suggestions for what to work on at home?

If kids have chronic pains or school avoidance, ask what is going on. Depression and anxiety aren’t obvious and can have vague symptoms that are different than adult symptoms. Bullying can lead to many consequences, and many kids suffer in silence. If your child won’t talk to you, consider a trained counselor.

Talk with your pediatrician if your child is struggling academically despite resource help at school or if he suffers from chronic headaches or tummy aches. Treating the underlying illness and ruling out medical causes of pain is important. Depression, anxiety, ADHD, and other learning disorders can be difficult to identify, but with proper diagnosis and treatment, these kids can really succeed and improve their self confidence!

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.  

When The Joy Goes Out of Eating, Nutrition Suffers

The title of this post is a partial quote from pediatric nutritionist Ellyn Satter. Here is the entire quote:

“The secret to feeding a healthy family is to love good food, trust yourself, and share that love and trust with your child. When the joy goes out of eating, nutrition suffers.”

The quote comes from a blog post titled Constructing Snacks into Mini-Meals on Dr. Wendy Sue Swanson’s blog, seattlemamadoc.com.

I found the article very interesting. Particularly because in our house, snacking is a bit of an issue. In fact, for my kids, snacks seem to be more important than the actual meal.

I’ve come to the conclusion that the only reason my kids eat regular meals, is because otherwise, they won’t be able to have a snack or dessert. It is like they view it as a means to and end. This is what I assume goes through their heads:

“The only way I’m gonna get the snack, is if I eat my lunch. Might as well eat the lunch, so I can get to my snack.”

And apparently, my family is the not the only one with this issue. It is a growing trend in the US.

Over the past 20 years, the amount of calories consumed by children from snacks has increased by 30%. Kids eat a third more calories everyday from snacks! What kids snack on certainly can reflect how their diet is shaped and how they grow. Plain and simple: snacks make us fatter by packing in lots of calories in relatively small bits of food, the definition of “calorie dense” foods. They also discourage our eating of things like fruit and veggies because they fill us all up. One recent study found it was our over-consumption of snacks more than our under-consumption of fruits and veggies that is getting us into trouble.

Dr. Swanson says that there has a huge shift in the way children eat and get their nutrition in the US. She highlights some examples, such as:

• The introduction of processed foods in the 1970’s transformed what we eat from fresh to packaged food
• TV advertising of snacks directed at kids increases their desire for snack foods
• The challenge for busy families to find time to sit down and eat meals together
• Watching TV during meals in households
• Ubiquitous availability (they are everywhere!) and easy access to snack foods
• It is okay to be a little hungry. Dr Grow says, “Teaching kids it’s okay to get a little bit hungry (not ravenous) and work up an appetite for a regular meal” is a healthy way to learn to eat right.
• It’s our worst fear that our kids will starve. It’s almost an instinct to offer and offer and offer food all day. Our kids won’t starve, especially if we offer 3 meals and 2 healthy snacks daily.
• Red/Orange/Yellow packaging is dangerous. These colors are known to make you hungry and eat more. Advertisers know this! Think about leading fast-food chains, junk food, candy bars and soda containers. Red/Orange/Yellow is threat level alert for high-calorie foods that often have little nutritive value.

We’ve written about snacking before on Survivor Pediatrics. In the this post, Dr. Hackell ask: with the national alarm increasing about the rate of obesity in our children (and adults as well), what message are we giving our children about eating when we provide them with a continuous stream of things entering their mouth throughout the day?

Dr. Swanson does offer a possible solution. She mentions the idea of switching the snack for a mini-meal. So, anything that we would feel comfortable eating during a normal meal, but in smaller portions.

I like this idea. Except the part about preparing yet another meal, even if it is mini. Snacks in little packages are just so convenient. But I guess I’ll give it a try and see.

To read the rest of Dr. Swason’s post, click on the link.

Should I Ditch the Pacifier?

Written by Melissa Arca, MD

My baby girl, who is on the verge of turning three, has three big loveys in her life: blankie, paci, and bear. And I, nor she, are in any rush to give them up. Still, the question creeps in from time to time…Should I ditch the paci?

With my firstborn, my son, I felt pressured to wean him by a certain age. Mostly because I was a first time Mom and Pediatrician and felt I should do things “right”. So I was all proud as could be when his paci was completely weaned by the time he was two. Even at that age I felt I waited too long.

Well guess what went along with the pacifier? Nap time. Now I would NOT call that a success story. I would call that a painful mistake. He never went back to his daytime naps after that. Why oh why did I hold firm? I should have just gone out and bought another one.

Now, here I am, a bit more experienced. More comfortable with my mothering and doctoring abilities. The Mom side of me knows the comfort it provides my daughter while the Doctor side still wants to make sure I’m not overlooking any potential harm.

So in my effort to answer my own question, I’ve decided to have a conversation about the paci…with myself. Yes you heard me right…Mom and Doctor discussing the whole pacifier issue. Bear with me, it should be good…

Melissa: Do you think it’s time to wean my daughter from the pacifier?

Dr.Mom: Why? Does her pacifier use bother you?

Melissa: No, not really.

Dr.Mom: Does it bother your daughter?

Melissa: No. Actually, it is a great comfort to her.

Dr.Mom: What is your concern about the pacifier?

Melissa: Well, I’ve read that it can interfere with speech development.

Dr.Mom: Does your daughter have her pacifier in her mouth all day?

Melissa: No, she only uses it for nap, bedtime, and car rides.

Dr.Mom: And, have you noticed any impairment of her speech?

Melissa: No, she’s quite the talker.

Dr.Mom: Okay then…

Melissa: Well, I’ve also heard that it can effect the development of her teeth, is she going to have crooked teeth?

Dr.Mom: Well, she might but then again, she might not. The changes are usually temporary and self correct once the pacifier is no longer in use.

Melissa: Okay then…I won’t worry about it anymore.

Dr.Mom: One last thought Melissa

Melissa: Yes, Dr.Mom?

Dr.Mom: Honestly, when is the last time you’ve seen a child walk in to kindergarten with a pacifier in her mouth?

So there you have it…no I’m not going to ditch the paci…not for now anyway. I’m sure the day she’ll have to give it up to the paci fairy is just around the corner. I’ll let her lead the way and we’ll see how things go. It’s one of her comforts and as far as I can see, there is no harm…only comfort.

I really love how Joey from Big Teeth & Clouds put it: “…hang onto whatever she needs. Life is tough, we should use what we can to get by”. Fantastic point Joey and I couldn’t agree more.

So, tell me, what do you think? Did you feel pressure to ditch the pacifier by a certain age? If so, what did you do?

Dr. Arca is a pediatrician. She works part-time while raising her two young children, Big Brother (age 6) and Little Sister (age 3). She is passionate about writing and writing about motherhood, parenting, and children’s health is what she does best. Dr. Arca blogs regularly at Confessions of a Dr. Mom

To Teen Guys: Yes, We Really Need To Check ‘Em

Recently, I was called to our community hospital to consult on a teenager with severe lower abdominal pain. The young man, whom I’ll call Dan (not his real name), lived outside of our community, and I’d never met him before. I arrived in Dan’s hospital room, introduced myself, and started talking to him and his mom about his symptoms. After reviewing his chart and getting his history, I proceeded to examine his heart, lungs, and belly. Then I told him, “OK, I need to check your privates, to make sure everything looks healthy and normal. Is that OK?” I was unprepared for Dan’s surprised, negative, very forceful reaction: “NO WAY!” and his mother’s simultaneous exclamation, “No, you DON’T need to do that!”

I asked permission, as I always do, and he definitely hadn’t given it! So I backed up a little bit. “I know it’s embarrassing to have your privates checked. But we don’t have a good explanation yet for the pain you’re having, and if it’s related to something going on with your genitals or your bottom, I definitely don’t want to miss that.”

Dan was still pleasant, but I could see in his eyes he was definitely not buying my explanation. “If you would feel more comfortable with a man doctor, or without your mom in the room, we can definitely do that.” His horrified expression spoke volumes; I think he would have preferred a spinal tap without anesthetic.

His mom said, “Why do you have to do that? The emergency room doctor and the surgeon who’ve seen him today didn’t feel that was necessary.” I explained, in that case, if no one else had checked “down there,” I felt even worse about blowing off that part of the exam. Dan, still with the deer-in-the-headlights look, volunteered, “I had it checked at the clinic where I got my sports physical done. Can we count that?”

We talked about it some more, but Dan stood firmly to his position: “My genitals are not your business, doc!” In the end, I never did perform this important exam.

Clearly, I failed Communication 101 with Dan at explaining the importance of a complete body check, especially in a kid who’s sick enough to be in the hospital. I suspect if I’d known Dan better, he might not have felt so awkward. What I really wanted to communicate was this:

• It needn’t take very long. A comprehensive external genital exam takes under a minute in boys.
• We can do whatever it takes to satisfy modesty and cultural appropriateness. It’s OK to kick your mom out and have your dad come in. Or vice versa. It’s OK to request a male doctor. Or vice versa. It’s OK to have a chaperone — in fact, I prefer it that way.
• We do find problems “down there.” Honestly, most doctors are in such a hurry – we wouldn’t waste time doing something if we never found a problem. In Dan, a rectal exam for his kind of pain would have helped reduce his need for expensive, high-radiation tests. From time to time, either as part of a problem check or as part of a checkup, we’ll find hernias, hormone problems, cancer, eczema, abnormal birthmarks, ulcers, urinary issues, and infections of many kinds (not just STDs). Many years ago, a wise pediatric infectious disease physician taught me to check the whole body – even the unmentionables – for clues to “mystery patients.” He was right, and since then I’ve diagnosed herpes encephalitis, Behcet’s disease, and Crohn’s disease – based primarily on what I found in the genitals and rectal area.
• Parents, assume nothing. You may think your child has no concerns about his genitals because he’s never mentioned them to you. You may think your son could never have an STD. You may think your son would notice if he had a small amount of blood in his stool. You may think he knows what a hernia or testicular mass feels like. And all these things might be completely true. But they might not.
• Getting it all “out in the open” makes it easier for a child to bring up a concern. Let’s say a young man discovers a small lump on his genitals, and it’s worrisome to him. When I’m doing a genital exam and already have things uncovered, it seems easier for a concerned teen to “casually” point to the spot and say, “Hey, [indicating] is this OK?” I can easily say, “Oh yes, that’s a ______ and lots of guys have those. They’re normal and won’t interfere with peeing or sex or anything. I have a great handout about that for more information.” It’s harder for a kid to bring up issues “down there” if he thinks that a genital exam isn’t part of the equation. Will I think he’s a pervert or weird for asking: “So… doc…. I have this… thing… on my… privates?”
• Your female counterparts seem to have gotten over this. I’ve noticed (and I’m not sure why – maybe because I’m a woman) that I rarely have girls or their parents look horrified or surprised when I ask to check a girl’s breasts or pubic area. Much more frequently, I have mothers ask me, “Are you sure 13-year-old Kathy doesn’t need a complete pelvic exam, now that she’s having periods?” Sometimes this is a subtle hint to check for pregnancy or STDs; sometimes parents are trolling for information about their child’s sexual activity, or lack thereof. But much of the time, parents know that ensuring “the lady parts” are important to keep healthy, just like everything else.

So: It’s OK to be embarrassed. It’s OK to sigh, blush, groan, and/or roll your eyes at the doctor. But guys, yes, we really need to check ’em.

Suzanne Berman is a general pediatrician in rural Tennessee. She tries to minimize embarrassment to her husband and son, too.