After our kids work hard all year-long they are thrilled for the break of summer vacation! I remember well how great those seemingly endless days of sleeping in, playing outdoors and reading books in a sunny spot felt. But now that I am the parent, I worry summer months represent a time for my kids to lose ground academically and as a doctor, I know they can be months of slipping into unhealthy habits. Teachers know they send kids home in June at a certain level of knowledge only to expect them to return in the fall having slid down a bit lower Summertime with its long, lazy days of freedom is a hallmark of childhood but can be a harm to children’s education and fitness.
There are far-reaching benefits to the free-form days of summer. They can be a time of family connection and exploration – I wrote about this last summer. You can focus together as a family on the value of fitness by heading out for a walk or to the park after dinner each night. Summer can also be a time to develop new skills. And the slide in knowledge base that teachers experience is something parents can help prevent.
Making regular reading part of those summer days at home can help kids avoid losing academic ground. A recent study: “Stories to Stop the Summer Slide: Books to Prevent Summer Learning Loss Among Low-Income Students” demonstrated this. Providing our kids with books (preferably of their choosing), the time and sunny space to read in should be one of our goals each summer.
Ideas to get started with:
- Does your child have their very own library card? Time to get one! Many libraries have summer reading programs and competitions to motivate young readers.
- Let your kids choose their books. Comic books? Age-appropriate graphic novels? Say yes!
- Ask their teachers for ideas that fit well with your child’s current reading level.
- Check out these reading lists for ideas:
- American Library Association Recommendations
- For middle school kids
- For elementary school kids
- By elementary grade
- For high school kids
- Be sure to let your kids see you reading. In this electronically focused age it can be hard for parents to put the phone down and read something paper based. Summer can motivate us to take time to relax with a good book too – let your excuse be acting as a role model for the kids!
- Consider hosting a beginning-of-summer book swap party.
- Start a parent-child book group. I have been in one with my daughter and her friends since she was in elementary school and have enjoyed reading their books as a way to bond and understand their world.
- Choose a book to read as a family. One year we read The Calder Game together. It provided plenty of opportunities for conversation and we even tried making mobiles together!
This year at the start of school maybe our teachers will smile to see that our kids have climbed up a ladder to better reading over the summer! Because as they read this summer, our kids will have grown through the stories they soaked up – those of adventure and laughter, those of mystery and fantasy.
We read fantasy to find the colors again, I think. To taste strong spices and hear the songs the sirens sang. There is something old and true in fantasy that speaks to something deep within us, to the child who dreamt that one day he would hunt the forests of the night, and feast beneath the hollow hills, and find a love to last forever somewhere south of Oz and north of Shangri-La.
It was about 7:30 one morning 10 years ago when, while rushing to clean up breakfast, make lunches, dry my hair and convince three slow kids to move along I heard my son say, “Mom, I don’t feel so good!”
We have all had mornings where we have heard those words but – what do we do next? How do we know when to keep our kids home and when to send them off to school?
Part of our job as parents is to get our kids to school on time everyday. Doing so helps ensure their success in school. We know this and yet, the decision about when a child is too sick for school can be a very difficult one.
While your decision must involve a healthy dose of common sense, here are some basic guidelines to help you:
- You child should not attend school if they have had a fever over 100.4 in the last 24 hours.
- If your child is contagious to other kids (some examples are: fever, vomiting, diarrhea, uncontrollable coughing, red and oozing eyes) she should stay home.
- Keep your child home if they seem too sick to be able to participate actively in school.
Here are more specific examples (each with links to help you know when it is time to see a doctor):
If your child has had a fever in the last 24 hours, the child is likely contagious and does not feel well enough to participate in school.
While one isolated urp is unlikely to be a reason to keep them home, vomiting right before school or twice within 24 hours should be a cause for staying home under your care. If vomiting is paired with belly pain, fever, decreased urination or an inability to take any liquids, see a doctor.
Some kids have chronically loose stools (often from drinking juice) but, if their poops have been watery or bloody or they have had three bowel movements in 24 hours you should consider keeping them home. Diarrhea can be from an infection.
If the white of the eye is just slightly pink and the discharge is watery, your child should be good to go. However, if the eye is red, hurts or has yellow/green discharge, it is time to see a doctor.
If a sore throat is accompanied by fever, swollen glands, rash or stomach ache, then you should arrange for a strep throat test. If the sore throat is only paired with a bit of runny nose, the child may be well enough for school.
A new rash on a child that does not feel well should be evaluated by a doctor. If the rash is accompanied by a fever, a doctor must see the child.
We know that school-aged kids get sick an average of 6-10 times a year – that’s a lot! There are a few things you can do to keep your child as healthy as possible:
- Teach them to wash their hands often. Most childhood illnesses are spread through germs shared by touch (one child wipes their runny nose and turns a doorknob and the next child who touches the door knob gets the cooties). Helpful tip: they will do a more effective job of washing if they sing the ABC song twice through while sudsing up!
- Fully vaccinate your child including the yearly influenza vaccine. Vaccines are safe and effective.
Know that, despite your best efforts sometimes your choice will turn out to be wrong. You may send a sicker-than-you-realized kid off to school and get called by the school office. Or, you may keep your child home, only to be stuck with a way-too-healthy child bouncing around your home! To help avoid repeating that last scenario, I always try to make staying home very unappealing: no TV, no play dates and not too much fun with mom.
Sometimes children begin to try to avoid going to school. This can become a real problem with chronic absences impeding their ability to achieve in school. If you are struggling with a child who often seems to be asking to stay home, check out this toolkit from Attendance Works and this helpful resource on school avoidance from Kaiser Permanente for more guidance.
On that morning that I had a decade ago, I looked at my kiddo and said: “You have no fever, you aren’t throwing up or coughing, you look good enough to me so – hop into the car!” Off we went. Then, 3 hours later the school called me – the poor kid had thrown up. All over his teacher’s shoes. My son is in college now but – I’m guessing I will never live that one down!
I was at a work meeting recently. One meant to address physician “wellness”, but held ironically at my kids’ dinner and bedtime. We were given a stack of Post-it notes and asked to write down things that made us happy during our work days. I wrote:
- laughing 6-month old babies
- having time to get to know patients’ families
- choosing stickers with my patients
The doctor next to me wrote:
- no shows
Well, there is that. What doctor doesn’t dream of the occasional break in the schedule created by a patient not keeping their appointment?
One morning recently, I saw the name on my schedule of a patient that led me to spend the rest of the day hoping for a smile-inducing no show. When the patient arrived, I sighed a deep sigh but, then decided to test out some of the mindfulness-in-the-workplace practices I have spent the past few months learning. As I headed to the room, I thought to myself:
S for stop what you are doing (hand on doorknob, poised to enter into the room and
Take a breath. Stop thinking of the name on the schedule that brings you stress. Put aside the last phone call. Put aside worrying that the dog stuck at home alone might be eating the trash and the kids need rides to practice and that you need to be home on time tonight. Stop and
Observe how you feel. Yes, your jaw is, as usual, tense. Your leg hurts. Loosen those. Let go of the stress. Ask yourself what you can offer this family. What do they need from you? What can you bring to the exam room behind the door; what can you be open to? And then,
Proceed – open the door.
I have known this family that makes me hope for a no-show for many years and through several children. On that day though, somehow, we connected. I asked first how their ill father was feeling. I asked about their financial struggles. I asked how school was. Then I turned to the reason for the visit. It felt softer and easier to work together. We left with smiles and, for the first time in ages, they left without an antibiotic prescription.
I do not find this physician wellness, mindfulness stuff easy. All the deep breathing tends to send me off for a nap. But on that day, giving it a try worked well. I’ll be S.T.O.P.ing again.
I heard a few people talking about spoons on Friday morning at Stanford’s Medicine X conference . They were wondering why artist-in-residence Rachel Stork Stoltz, had asked us all to bring a spoon to the conference? After listening in a bit, I leaned over and tried to answer their questions. The spoon theory was created by Christine Miserandino and is a powerful way of explaining to a healthy person what it feels like to live with a chronic illness. You start the day with a finite amount of energy and as you move through the day you use quanta of energy (spoons) with even the smallest tasks of daily living. You count your spoons and may find you do not have enough spoons (energy) left to do what you want or need to that day because of the demands of your illness.
At its best moments Med X was a masterpiece of collaboration. It was a bringing together of patients, physicians, thought leaders and innovators to work together to discuss the future of medicine. Our recursive efforts mirrored and repeated each others’ in a way that built a powerful basis of understanding to move forward with.
Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.
- How will I recognize the daily efforts of patients in the days of their lives not in my office?
- How will I be as caring as an old-school physician and as vital as a fully connected 2.0 MD.
- How will I allow a space of communication about patient’s emotional challenges (as well as those physical)?
- How will I shape my efforts to motivate health change through social media?
After this, the first day of Stanford’s Medicine X conference, my mind is blown and my heart is full.
This word cloud of tweets today from @tmlfox Symplur.com analytics sums it all up well. “Patients” are at the center and are surrounded by “empathy”, “team”, “livestream” and “care. We see “relationships”, “mind” and “stories.” All are the spirit of MedX. All represent why I attend this amazing conference. There is the pure fun of the technology: tweeting, scanning our neighbor’s barcodes and using an app to request blanket deliveries. There are the people – each more inspiring than the next. The food is great and, have you met @therealzoechu?
At the end of the day though, none of that is really to the point. Instead, what matters is that I am left here pausing, quietly asking myself how I can be as caring a doctor as medical historian Barron Lerner’s physician father. He was a doctor of another generation. A generation of men faulted now for practicing paternalistic protection of their patients but praised for giving all to their work. They took call 24/7, they took every opportunity to reach out when needed, they went the extra mile.
In this era of technological involvement and focus, in this time of schedules and hurry, how do I go that extra mile? How do I pause and turn towards the person in front of me take the opportunity to reach out and care?
Everyone loves summertime, right? Books, songs and movies speak poetically about the long, lazy days this time of year. We remember our own summers fondly. But I talk with many parents who have a less rosy view of summertime. Kids are home underfoot and rattling around complaining about being bored. Or, kids are home alone while parents go to work distracted by worry about the kids.
I experienced this worry one recent morning as I left my three to head to the office. I left them a hopeful note with chores for each (little brother: put away all the dishes and reload the washer, sister in the middle: mow the grass, big brother: sort the laundry). I reminded them of all the healthy leftovers in the fridge to munch on. In a feeble attempt to keep them away from too much screen time, I added reading suggestions. As I drove away I envisioned a Utopian day filled with cleaning, reading and sibling harmony. Instead by the end of the day I was reminded of Erma Bombeck’s humor:
Being a child at home alone in the summer is a high-risk occupation. If you call your mother at work thirteen times an hour, she can hurt you.
So what’s a parent to do? Throughout the school year, our kids learn about fitness and nutrition. They work their minds and bodies. How do we keep our kids active and healthy during the summertime? I find it helps me to think like a child; it helps to think back to what I enjoyed in the summer as a kid. Here are some ideas (inspired by my childhood memories of summertime) that my family has enjoyed this summer:
- Swing. The other evening, I was watching TV with my youngest child. In one scene, a character was swinging her child at the park. I remarked to my son that I missed swinging. He paused the show, looked at me and said “Let’s go!” So we did! Remember the floating feeling of swinging? Head to the park and try it with your kids.
- Play outdoor games. What games did you play as a kid? I needed to look up the rules to some but, we have found the old-fashioned ones are still a hit. Try kick the can or can of sardines. My favorite as a child was ghost in the graveyard. Can your kids teach you how to play flashlight tag?
- Grow. Kids love to grow a garden and we like to see them eat their veggies. It’s a match made in heaven that most parents can facilitate. Even in the smallest backyard you can grow some food. Try radishes first – they are fast and fun! In a city kitchen you can grow some sprouts for salads.
- Cook. Head to the kitchen to cook inspired by your garden harvest. It makes for a great chance to talk about what foods are healthy for us and which ones should be eaten in moderation. If you find that your garden produced too many zucchini, here’s a great recipe for zucchini bread. Or try these fun smoothies and let your kids choose what to throw in the blender.
- Fly. When I was a kid, my dad and I made a box kite once. It was an elaborate and fragile thing made of paper and balsa wood. This summer, my son and I tried this far easier version of a simple kite made of things you already have at home. Then we had fun for days flying it. Took a lot of running to get that kite up!
- Watch. After running that kite for a while, my son and I collapsed in the grass and lay there watching the clouds. As we did a rabbit, a scary big-jawed fish and a palm tree floated by.
- Create. There are endless art projects to enjoy in the summer. One we have had fun with was making mobiles. The kids and I read The Calder Game by Blue Balliett then looked up information about the artist Alexander Calder. Inspired by his art, we searched at the park for things to balance for our own mobiles.
- Imagine. Reminiscing about my childhood summer times inspired my son to imagine the future. He is building a time capsule; a box filled with tidbits from our time to bury for people to dig up one day in the future.
- Build. Take all the blankets stored for winter and let the kids use them to make a blanket fort. If it is hot outside make it under a table. Nice day? Tie them to a tree branch. Then sneak a few healthy snacks and books under the edge and let your kids relax.
- Hunt. Not for deer. Make your kids a scavenger hunt using a list of things found at the park or in your house or yard. Or better yet, have them make one for each other.
The summers of my memories were endless days of exploration and fun. I remember eating summer veggies from the garden and drinking lemonade. I roamed and read. I think I was bored but my mother had the wisdom to let that boredom be the opportunity for me to create my own fun. It is indeed wise to let our kids relax into their summertime to find their own adventures. It is also fun to join in and fly a kite or sit under a blanket fort with them!
It’s that time of year again. The time of year when I get sneaky.
I have a passion for cooking and a love of gardening. An interest in nutrition and, a love for my children. Combined, these had me convinced that if kids were given the chance to grow their own food in their backyard or patio garden they would eat just about anything they grew.
My garden space is small but full and in July it is full of zucchini. But, it turns out that zucchini is not my kids’ idea of good food. Even if they did grow it. Funny thing that I can’t remember this in May when I put in the seedlings.
So, every year, this time of year, I am forced to hide zucchini everywhere in order to use it up. I have the most fun sneaking the truly huge, two foot-long zucchinis (that seem to grow ignored under those big leaves) in my neighbor’s beds. I sneak over when they have headed out to walk the dog and place, like the tooth fairy but different, a big zucchini under their pillows. Hee, hee.
Then, I turn to cooking up the more manageable fruits. For dinner there is no better choice than the recipe found in Barbara Kingsolver’s book Animal, Vegetable, Mineral for Disappearing Zucchini Orzo. It is a perfect way to hide three large ones. Hee, hee, hee!
Then for breakfast I whip up zucchini bread from a recipe I have tuned and tweaked for the past 18 years of feeding children. It is a perfect way to thin the crop and a fabulous way to trick reluctant youngsters into eating their veggies.
1/2 cup canola oil
1 cup granulated sugar
1 teaspoon vanilla
2-3 cups grated zucchini (or a mix of zucchini, yellow summer squash and carrots)
1 cup white flour
1 cup whole wheat pastry flour)
2 teaspoons baking soda
1 teaspoon baking powder
1/2 teaspoon salt
1 teaspoon cinnamon
1 teaspoon cloves
1 cup chopped walnuts
Preheat oven to 350 degrees. Grease a 9 x 5 loaf pan.
Beat eggs, oil, sugar, vanilla until light. Mix in zucchini.
Whisk together dry ingredients then fold into wet. Stir in walnuts.
Pour into pan and cook for 1 hour and 15 minutes or until center springs back and tester comes out clean.
Cool for 10 min then turn onto cooling rack.
When asked, don’t tell them what the green flecks are just let them try it first!
I have learned a new trick. On a busy day of seeing patients it is easy to run from exam room to office desk and off to the next exam room at a frenzied pace. The charts, the orders even the patients can blur a bit. It is not a way to move through my day.
Now before entering the next exam room, I put my hand on the doorknob and pause. I take a moment to notice how I feel, take a deep breath and let it go. I let go of what ever might be distracting me from what is behind the door. Then I turn the handle and focus more fully on the person inside waiting to see me.
One day last week when I opened the door there was some fun waiting for me. A boy had a wart that needed freezing with liquid nitrogen. It is a simple procedure that he had done before and he and I settled in to chat while I worked. Also in the room was his much younger sister – maybe five years old. This girl was wearing a dress and holding a rose. She was smiling and excitedly hopping from foot to foot but – not saying a word obviously trying hard to be polite and wait for me to finish up.
Now, this clinic day was as busy a day as could be. But when my wart treatment was done and the bouncy little sister finally got her turn to talk, I listened. She said:
Please freeze it.
And smash it!
And so we did. I dipped her rose in the liquid nitrogen and handed it to her. With great joyful enthusiasm she smashed that rose into tiny fragrant icy pieces!
Then with wide smiles we said goodbye. She and her brother got their stickers. I went on, placed my hand on the next door knob and fully focused, went to the next patient.
The American Academy of Pediatrics has clear words for parents seeking advice about screen time limits for children. No screen time for kids under 2 and no more that 2 hours a day for kids over 2. Less is better and content matters.
While I find these guidelines challenging in my office and in my home, my mother would have had no trouble enforcing these guidelines with me – for most of my childhood we did not have a television. I remember mornings in junior high school as being rough. Not only those mornings too early, cold (N.Y. State in winter is COLD) but once I made it to school everyone around me was discussing last night’s episode of this or that show. I tried to look casual and preoccupied while they sounded so…. cool.
As a Pediatrician, I understand the social power that being up to date with the latest show, game or video has. Being connected on each of the latest social media tools be they Instagram, Vine or Snapchat, matters on today’s Monday mornings.
We are all going to die. We don’t get to decide where or when.
But we do get to decide how we are going to live. So do it.
Is this the life you want to live? Is this the person you want to love?
Is this the best you can be? Can you be stronger, kinder, more compassionate?
Breathe in, breathe out and decide.
When you put it this way, few kids would choose to spend their time in front of a screen. And definitely not the average of seven hours a day on entertainment media, including televisions, computers, phones and other electronic devices that our kids are currently spending. Tonight at dinner, ask your kids to Decide. And then come up with a plan together for media use in your home.
Research is mounting; the evidence is weighing in on the side of the health benefits of having kids walk or bike to school. This is termed active school transportation or, AST. The benefit to our children of getting to school in an active way is clear: increased aerobic activity leading to healthier, leaner bodies. There are additional benefits to our environment of fewer cars and to our neighborhoods of greater social cohesion.
Even given that actively moving to school would make our kids healthier more and more kids are driven by parents every day. In 1970 42% of kids actively got to school. Today? Closer to 13%. Changing these numbers can change our kid’s health.
When asked why their kids are not actively getting to school parent express concern about street safety, weather and distance. I understand these concerns. As a mom of three kids I have driven miles (in small ant-like circles around town) carting my kids to school, music and sports practices. However, my kids for the most part ride their bikes to school. Their elementary school is a 6.5 mile round trip which my youngest asked to do on his bike first in fourth grade. To calm my maternal concern I spent a good deal of time traveling with him to teach the ways of the roads and bike lanes and equipped him with a cell phone much earlier than his sibs were given one. Even now, a few years later I worry about his journey – is he safe? is it too long is he cold or too hot? For the most part though, I know that encouraging him to ride helps him: his body is stronger and he is more mature.
Deciding to chauffeur less can seem challenging. Here are some ideas to get you started:
- Consider starting a neighborhood “walking school bus.” Neighbors and friends can take turns walking groups of children from “bus stops” to school.
- If you plan to have your child start biking spend some time teaching them the ways of the road. Then bike with them until you are convinced they are ready to roll solo.
- Some parents fear that their children may be intentionally harmed by others as the child walks to and from school. To help protect your child read my post on safety around strangers.
Above all rules, the one I have been strictest about is the helmet rule. When on anything with wheels they have to wear a well-fitting helmet. And it has to be strapped! To enforce this rule I used the “it takes a village” concept and have told all of my friends to notify me if they see one of my kids without a helmet. The kids know that they will be fined $25 dollars for the first time and that fine will be doubled with each “offense.” Years of safe bike riding had gone by when last spring I got a text from a friend saying she just saw my child without a helmet. I quickly fired of a text:
You owe me $25.
I immediately got the answer:
Wait Mom! My helmet is broken!
He biked in 5 minutes later looking worried and holding his helmet – in nearly two pieces. He had fallen and it had saved his brain. Fine revoked.
Active school transportation is an important step towards a healthier community of children. It is worth trying for your child! In a commentary written for the journal Pediatrics Dr.s Liu and Mendoza sum this all up well:
We recognize the many societal changes that have led to more students being driven to school. As parents, we empathize with families who worry about dangerous streets, distracted drivers, and challenging weather conditions that give pause to even letter carriers. When viewed through the eyes of child health, AST is an ‘old school’ form of physical activity that more children should adopt to make the daily trek to and from school.
We are becoming increasingly aware that our children are in many cases, over scheduled, over stressed, over involved. As parents we feel overwhelmed by time pressures. The American Academy of Pediatrics has published several recent articles on how to help families with these challenges. One discussed the importance of play for kids themselves and also for us as parents. Play helps us maintain strong bonds with our kids.
As my kids are getting older I am increasingly listening to the little voice in my head telling me that they won’t be young for long. Now, when they ask to play or read I have begun dropping everything on my to-do list to jump up and join them. Rarer even than these requests for my time are pickup games of ball. Who just plays ball these days? Rarer still? Pickup games of kelpball on the beach at sunset.
I heard once that my influence over my kids’ final outcome ended when they turned five. By age five they had soaked up all the manners, values and habits they ever would from me. Now, on the occasion of my first child’s sixteenth birthday I find myself wondering if perhaps I have become dispensable.
His manners are for the most part lovely. Check. He is usually kind and generous. Check. He is clean and well dressed. Hmmm …clean – check. But do the pants around the buttocks count as well dressed? (before having kids there were several silly things I said in the category of “I’ll never”. “I’ll never let my boys wear their pants sagging” was one). He works hard in school – yes, and room to grow. He has commonsense. Um…. not always. This was demonstrated this week when he donated blood in the middle of lacrosse season and then wondered why he was so winded while running. Sigh. He understands the importance of physical fitness. Check! He understands the importance of good nutrition…. Uh oh. Wait, yes, I am sure he understands. This is where I see the wisdom of the five-year old rule.
As a mother there are household chores that I do happily, there are others that drive me slowly insane day after day. Making lunches leads the list of things making my hair go gray. One recent afternoon on the way to his lacrosse practice, my son asked if we could stop by his school locker to pick up something too big to carry on his bike. Indeed, the sack of old lunches filling his locker was big. And smelly. Turns out he wasn’t eating much of what I had packed. The carefully cut veggies, the fresh fruit, the whole grain bread all…moldy. Later that night I had one of those “Look out: Mom’s head is spinning!” moments that all children should see occasionally. Now I no longer make lunch, they do. I made some rules: each lunch must have a fruit, a veggie and some protein. It has worked well for the most part. Those were rules they knew by age five, right?
Yesterday my friend told me a story. She was at the grocery store during the high school lunch hour and happened to see our sons there. She quietly watched them go through the checkout aisle. My son had a 2 liter bottle of Mountain Dew. Her son, a family sized bag of Cheetos and their friend had a bag of Oreos. Well, I guess that explains the lunches in the locker. Why eat vegetables when you can eat your Cheetos with Mountain Dew? So, by age five he knew the food pyramid well enough to scold me when I crept up too high on it, but by age sixteen he is apparently very comfortable at its apex.
Now, I am left both looking back and hoping I taught him enough and gazing forward and hoping that the knowledge will resurface in time. His recent choice of a birthday dinner reflects this split in a way. He requested steak (“to replace the iron lost from donating blood this week so I can run better”), potatoes and … a vegetable. Great! Which one? Asparagus?
Are you kidding Mom?
How about roasted broccoli?
No mom, just carrots.
The endless stream of baby carrots was part of what made me hate making lunches so much. Maybe if I show him this article about how eating beets can make you run significantly faster he’ll change his mind? ©
In my post on eating dinner with my teens I owned up to sometimes cutting corners by ordering pizza for dinner. During a recent interview with the group Thriving Schools I also referred to surviving the work-kid juggle by ordering pizza. I was asked about the wisdom of these admissions. Perhaps @KPKiddoc should be putting a healthier face on her slice of life?
Let’s face it – pizza is everywhere. Hard to raise kids without pizza. Schools serve it often. Every soccer team party features pizza. And yes, tired working moms depend on it. Pizza can indeed be a nutritional nightmare. Given this and its ubiquitous nature, it is not surprising that I might be warned to appear more health conscious.
We want to feed our kids well. We are looking out for tips on how to do so; a google search of “is pizza healthy?” generates 132,000,000 responses. My answer is yes – it can be. Here’s how:
Have just one or two pieces. One piece is more than enough for a small child; consider cutting it in half. Two pieces are sufficient, even for my athletic teens. At the dinner table discuss the concept of moderation with your kids.
Fill the rest of their plate with salad.
Have a whole wheat crust. And definitely don’t “stuff” it.
Order or use less cheese. You can order extra cheese right? (don’t do it!) Turns out you can order less cheese also.
Skip the meat. Your kids will be happy with pizza – they don’t need to pepperoni to bribe them into eating it… just say no.
Add veggies. Same concept – kids like pizza enough that they usually will choke down some veggies with it. If not – that’s what the salad is for.
Skip the fast food restaurant version.
Make your own. Ok, not for a night when you are tired but – definitely a fun family project. Try this healthy recipe from 9-year-old Kayla Wayman of Montana.
Given that 93% of Americans eat pizza once a month, 3 billion pizzas are sold annually in the U.S. and 350 slices of pizza are eaten each second – it seems that our love affair with this meal is here to stay. Let’s just work to make it a healthier message for our kids.
In Napoli where love is king
When boy meets girl
Here’s what they sing
When the moon hits your eye
Like a big pizza pie, that’s amore
– Jack Brooks
As we stood at my kitchen counter today my friend said
You ought to write about it. Makes you seem human, you know?
So in the spirit of self disclosure inspired by two recent articles by parents who admit their shortcomings, here I am doing the same. First John Sarrouf director of The Family Dinner Project, wrote about missing too many dinners with his family. Then fellow pediatrician Kathleen Berchelmann wrote about what happened when her daughter went to bed with an iPad.
Sometimes my kids and I eat dinner in front of the TV.
When I was a kid I watched very little TV. Except when I enjoyed summers with my grandparents. Then after spending the days outside, I spent the evenings watching TV. My grandmother was a well-educated, cultured Southern woman who believed in table manners and personal style (I spend a lot of time walking around with a book on my head for her.) So in retrospect, it surprises me that during those summer vacations we ate nearly every evening in front of the television. On a TV tray, with china and silver but while watching TV.
Hogan’s Heroes. Mash. Hee Haw (seriously.) The MacNeil/Lehrer Report. Lawrence Welk (they were my grandparents after all.) The Mary Tyler Moore Show. Watergate.
Was it wasted time? Dinners without conversation made therefore a loss? I think perhaps, not. Instead I remember that what we watched together united us around shared references. We had plenty to talk about after the shows were done.
So perhaps my friend was right when she told me to stop worrying. The occasional dinner in front of the television without attention to table manners and conversation won’t damage the kids.
As a pediatrician and a member of the American Academy of Pediatrics’ Council on Communications and Media I am passionate about helping parents navigate their families’ use of media in a healthy way. I support the AAP’s recommendations that we turn off our screens as much as possible – especially at the dinner table. Dinners eaten together are important to me. Conversation a priority.
However, parenting is a messy business and we are indeed human. Parents need to forgive themselves errors – be they missing meals, giving kids iPads or eating dinners in front of a screen. TV dinners are certainly not ideal but perhaps my kids will benefit from my bending the rules occasionally. Perhaps we will have some incredible dinner conversations about what we watched. Goodness knows, How I Met Your Mother provides loads of teachable moments.
Finish each day and be done with it. You have done what you could. Some blunders and absurdities no doubt crept in; forget them as soon as you can. Tomorrow is a new day. You shall begin it serenely and with too high a spirit to be encumbered with your old nonsense. -Ralph Waldo Emerson
Last week I tried something new. Something a bit out of my comfort zone and something I have long resisted doing. I enjoyed the experience largely because of its novelty; it felt good to stretch.
A few years back, I hurt my leg. Badly. So badly, I wasn’t walking well at all, was predicted to never run, ski, swim competitively or, do what had injured me – skate. The injury was dramatically sudden, painful and scary in ways I had never experienced. My first doctor was unsure exactly what I had done. The next ordered the right test but told me there was no repair. The next consultant agreed.
Then a friend stepped in to help. He lives in Switzerland but even from that distance, managed to turn the tide for me. How? By going online and searching for doctors and surgeries related to my injury and by finding a support group of people who also had my unusual injury. He emailed me the link to the support group and I responded:
Thanks but, I’m not that kind of patient.
Don’t be silly, he told me. So I clicked the link and found a world of education and support. In that moment of clicking, I became an “e-patient”
This new term, “e-patient”, is meant to describe a patient who is involved in their healthcare as an equal partner to their physicians. e-patients use electronic tools. They are empowered, educated and engaged. They see the importance in being equipped with the tools to help make decisions about their care. These tools can give e-patients access to medical records, education about their condition, or the support of groups of patients like them. e-patients are producing a culture shift in medicine.
This culture shift is especially visible in the area of breast cancer care. It is perhaps best illustrated with the story of one specific support group. Two friends who are breast cancer survivors teamed up with a breast surgeon from L.A. to start the support group #BCSM. It is held every Monday night as an hour-long “tweetchat” on Twitter. These three women explain:
While other physicians and academics debated how health care could even be discussed in social media and patients were warned to “be careful with research on the Internet”, two important facts didn’t budge. The Internet was not going anywhere. Neither was cancer. This year, some 290,000 women in the US alone will be told they have breast cancer. The need for #BCSM was clear. The project was on.
The mission of this impressive group is to support, educate and empower patients diagnosed with breast cancer. Patients meet and discuss their situation online to come out of the isolation that cancer diagnosis and treatment can create. Last Monday, 156 people actively participated and through their discussion, sent 2,724,048 impressions to their Twitter followers. Every week, expert physicians are invited to add “perspective and clarity” by discussing evidence-based recommendations and research with the group. The #BCSM support group’s mission has been accomplished through this inspiring model of weekly collaboration between physicians and patients. Both benefit.
This shifting paradigm is one we physicians may respond to with trepidation. We can feel irritated and challenged by patient involvement. And our patients do not respond well to our irritation. We are highly trained and this expertise gives us the ability to make informed decisions. However, our patients, especially those with chronic or unusual conditions, are also experts. They know about their own unique experience and through research can often know more about their specific diagnosis than their generalist physicians do. Patients can have an expertise to contribute to our decisions.
While I did not face the sort of life-threatening illness that catapults many into their role of e-patient, my experience taught me much. I see clearly that a well-educated patient has much to offer us. Seeking, supporting and trusting that input will serve us all well.
- In 1900 influenza was the leading cause of death.
- In 1918 Influenza killed between 50-100 million people worldwide.
- It is estimated by the WHO that in 2009 the H1N1 strain of influenza killed up to 575,400 people.
In the medical community, we’ll work to undo myths around vaccine safety for the rest of our lives.