Category Archives: Parenting

A Sister and the Dog Fur

My kids were wild the other night. Absolutely wild. All the hoopla ended up with the usually calm, easy-going middle child in tears. Her brothers were having fun together  while she was studying for finals but, apparently the fun had gotten out of control. I headed into her room to see quite a mess (it involved a lot of newly brushed out dog fur and her bed… I’ll let your imagination take it from there.) But, more impressive than the disarray was the look of remorse and concern on the boys’ faces. They saw their fun had crossed a line.
This level of sibling conflict is rare around here. Somehow I have raised three kids who like each other. Most of the time. In the office parents often ask me for help with sibling issues. While there is endless advice one could give about not playing favorites and listening well, the first answer I give is always the same and often sufficient.
Way back when my first was 3 and about to have a sister I panicked thinking that life might never be the same again. The new baby would be an intruder into her brother’s world. He would feel cheated, lonely without my undivided attention. He might resent her. About that time, I read some advice for how to avoid sibling rivalry that seems to have worked:
Brainwash ’em.
Tell them from day one how lucky they are to have each other. Tell the big brother that his sis is so lucky to have him in her world. Tell her the flip side. Remind them often, that they will be in each other’s lives forever – through everything life throws at them.
Even dog fur.
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Is Your Child Too Sick for School? Or, When Doctor Land’s Kid Threw Up On The Teacher.

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):

Fever: 

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.

Vomiting:

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.

Diarrhea:

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.

Red eyes:

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.

Sore throat:

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.

Rash:

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!

 

 

Summertime And The Livin’ is Easy – If You Think Like a Kid!

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:

  1. 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.
  2. 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?
  3. 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.
  4. 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.
  5. 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!
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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!

 

Media and Your Teen: Ask Them to Decide

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.

However, I want my teens and my teen patients to turn off their screens more. I know that doing so will broaden their horizons and shrink their waistlines. They also on some level, get this. It is though, hard to translate advice and understanding into action. Teens especially do not like to accept rules made for them without their input and buy in. At my house I always begin change with a discussion around the dinner table. It is a perfect chance to ask and listen.
It is perhaps ironic that I found some words to inspire teens to turn off their screens from a recent episode of Grey’s Anatomy. They have just the right touch of inspirational simplicity that appeals to the Pinterest set:

Decide .

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.

Decide.

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?

Decide.

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.

For ideas about how to decrease your family’s media use read this blog post by Corinn Cross, MD or see the AAP parent’s web page healthychildren.org .

Hoofing it to School “Old-Style”

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.

 

 

 

 

Kelpball

Daily Tile

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.

#savoredmoment

Birthdays, Beets and Baby Carrots

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?

Ew, no.

Beets?

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? ©

Veggie Pizza

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

Confessions of a Closet TV Diner

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

Teens and Table Talk

Before kids and when they were very small, I used to fear the teen years. Visions of my sweet cuddling tots turned goth, rude teens hiding in their rooms with ear-buds in danced through my brain. Now, with 2, nearly three teens at home I no longer fear. Their reality is a thing of wonder to me. They are not rude. Quiet at times but, not rude. I have to pull out the ear buds all too often but, they do not sulk behind closed doors. And most reassuring, they are still quite cuddly – when they want to be.
Given this reassuring state, I can be taken aback when they momentarily act like “real” teens.
I have held family dinnertime sacred in my house. Even through change, upheaval and redefinition of family itself, dinners together come first. Last night at dinner I asked the kids why they thought dinners together were so important. My middle child said with a snarky tone, “because they keep us connected at the heart.” Her hands acted this out with fingers first intertwined and then in the shape of a heart. Eyes rolled. But then, thankfully there came a smile.
The evidence continues to pour in. Eating meals with family is good for kids.  In 2010 a study of nearly 9,000 4 year-old children published in the journal Pediatrics concluded (in part) that young children who regularly ate the evening meal as a family had a significantly lower prevalence of obesity. Other studies recently published in the journal Obesity have supported the idea that teenagers who eat with their family are less likely to be obese at baseline. Then last month yet another group of researchers published data showing that teens who eat with their families have higher well-being, lower depression and fewer risk-taking behaviors. More work has shown frequent family meals were significantly associated with a lower likelihood of adolescent alcohol and tobacco use. In the May 2010 issue of Journal of Health Psychology teens’ experience at the mealtimes was found to be connected with this decreased rate of substance use.
Looking at all of this evidence makes it very clear. We need to eat dinner with our kids for the sake of their health. We need to cultivate ways to make our dinnertime conversations meaningful, interesting, thought-provoking. Sure, some of the research shows a benefit to simply sitting around the table together but, you might as well have fun while you sit there. Around my table we have through the years talked about almost everything. Any topic is acceptable if brought up with good intention and true curiosity. Politics, sex, religion? We have covered them all. We have played games. I have been repeatedly accused of being a pain about their manners. There have been giggles, anger and tears. We rate the meals so I know whether to cook the recipes again. Lots of meals have been rejected. And instead of cooking, many pizzas have been ordered.
Now with so many sports teams, part-time jobs, extracurricular activities and social engagements that my head spins keeping it all straight, we don’t all sit together every night. But, whomever is at home sits and talks. Sometimes I wait up and eat with the late-after-practice arrivers. Sundays we all meet – even if other invitations have to be turned down. I’d like to think this commitment has paid off through the years.
My eldest can be a bit quiet. I generalize this into fitting his teen boy status – they all keep to them selves a bit don’t they? Once not too long ago, I challenged him on his laconic nature. I asked if he would talk to me when it really mattered? He stopped, looked at me and said yes. I asked why? How could I be sure? He explained that he knew I could handle talking about anything. After all, we do just that on any given Sunday around the table.

Fall and the Flu Vaccine: Believe.

I am tired. And, I’m not the only Pediatrician who is tired. It is fall, the traditional calm before the storm of sick patients that hits our offices every winter so why tired?
Because, visit after visit we hear parents tell us that they “Don’t believe in the flu vaccine.” Really?
  • 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. 
So, I ask, what is there to “not believe in?”
The flu vaccine does not give you the flu.
Influenza is not a cold.
It is not the stomach flu
 
In 1918 every mother in town would have been beating down my office door to protect her child against influenza. They believed in its power. I have had influenza twice, once was H1N1 in 2009. I too believe in its power and yes, I get my flu shot and give the nasal vaccine to my three children every year.
As Seattle pediatrician Wendy Sue Swanson said:
In the medical community, we’ll work to undo myths around vaccine safety for the rest of our lives.
We may be tired but, it is a battle worth continuing.

All the Cool Cowboys Eat Yogurt (or, Nutritional Soundbite #3: limit drinks that taste sweet)

Two of my patients came into the office recently with their parent for check ups. I was a bit late coming in to see them so, started of with the all too familiar apology. Then we chatted about the heat and then summer books, movies, camps and camping. I asked what questions they had and, they asked if they needed shots (one did, one did not – always awkward to explain, that one!) All the while I realized I was stalling, dancing around the issue at hand.
Both children have weight problems. Technically speaking, their body mass indexes or, BMIs  are well out of the normal range or, in the range we physicians rather horribly term “obese.” They are both attractive, happy, smart and one is really quite funny. They like each other, they are respectful and fun. How on earth am I to find the words to tell them they are dangerously overweight without wounding their young confidence? Without alienating their parent?
I breathed in and began with the usual questions and followed with a display of their growth charts. It turned out the family had already been discussing change. They were walking each night. They were trying new veggies and thinking about serving sizes. I asked about what they thought I wanted them to drink?
Water!
And, what do you drink?
Juice! Apple and orange!
Ah, there was the change to focus on. I offered the rule of thumb that one 8 oz cup of juice a day has enough calories to cause a 15 lb weight gain over a year. That one usually works. But the parent looked at me and said with an exhale
But, it is just so hard to say no.
I get it. My 17 y/o son has a close friend that I adore. They have know each other since preschool days. I have watched this boy move from sandbox play to stellar sports play,  through cowboy costumes to awkward gangsta-style hats and now to be a rather stunning, clean cut young man. He is at my house often and when he arrives he walks straight through the door, around to the kitchen and opens the refrigerator. Spoon in one hand, he then heads to the boy-den in the garage with his bounty. It makes me happy every time. There is something in my refrigerator that he wanted? Cool.
We get such joy out of feeding our children. I cook well, my kids eat well and usually healthfully. My refrigerator staples are rather boring from a kids perspective. But, every now and then I will head off to the store and come home with some major treats. Watching the glee that comes as the kids root around and find these treats is fun. I feel, oddly as if I have done a good job. But after a bit, I get a bad taste in my mouth (and it is not from the chips 🙂 )
In fact, doing the right thing by our children means being a bit tough. Don’t buy the juice. Definitely skip the soda. Cut up the apples and put them in a central location. Skip the chips. You’ll never know what they learn to like. My friend the cowboy-gangsta-lacrosse star? He devours, container after container, case by case, high-protein, low sugar greek yogurts. And, go figure, all this time I thought I needed to bribe them with junk.

Love and “Non Sequitur” Defined (or, A Weekend Alone)

What does a working mother of three do when she finds herself home alone for three days? Well, true story, I can tell you the answer:

Bake, lots. Clean, prune and organize. And think. Lots.

Turns out though that I wasn’t completely alone. I had two rambunctious, trouble-generating puppies to keep me company.

Okay, I baked. First though, I started to clean the kitchen cabinets. As I cleaned I found bits and pieces of things that needed using up. The first was a jar of soy flour from… well, a while ago. So, I baked 8 dozen pumpkin muffins using the soy flour (there was more to use up than I thought.) Then I found a tube of almond paste left over from making stollen this Christmas so, I baked an almond pound cake. I found 3 half bags of chocolate chips. You guessed it – cookies.  Then a bag of golden raisins, a 1/2 box of currants, and some walnuts? Oatmeal cookies.

I thought about the meaning of love – after all, it was Valentines Day this week. Turns out, when you look on-line for a definition of love you may find out that

Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres. 

The dogs certainly challenged this definition; I may not have been endlessly patient. I may have angered. I’m afraid I can list their wrongs (they got in the chicken coop – twice, vomited on the rug – once, peed on the rug – once, made a hole in the fence – once, escaped through their new hole in the fence – once, woke me at 530 – three times). And, I did boast a bit when a nice lady complimented my ability to walk two young labs at the same time (didn’t mention that I had run them in the fields for two hours before she saw us limping home.)

I watched TV and learned, from an episode of  “How I Met Your Mother”, that

opening yourself up to another person means opening yourself up to going a little insane

Okay, that definition of love I’ve got covered.

 

I looked up the meaning of the word non sequitur.

I did some laundry (I may have been alone but, I do have three kids.) Pruned the roses. Organized the freezer (to fit in all the baked goods) and then felt compelled to eat all the odd bits of frozen things there for breakfast, lunch and dinner. Read the NY Times all the way through. Looked at Twitter despite planning to take a “holiday” from social media. And there I found this definition of love:

Love, I’ve recently recognized, is that moment when you desperately need forgiveness from the one who inspires your best self for having just been, in some small, petty way, your base self.

I walked the dogs again. Made the beds. Cleaned a closet. Sorted through the CDs; listened to lots of Alexi Murdoch, Macy Gray and The Cure. And, spent several nice hours on the phone talking with a handsome man from Switzerland who has always inspired my best self. My Swiss friend asked me – It is hard to live alone isn’t it?

Its going to rain Tuesday.

 

2pooches

Of Babies and Donuts

Some silliness unfolded this morning on Twitter. I think it began with this tweet (apparently sent by a tired pediatrician, early in the morning, after being called to a baby’s delivery):

Let’s play a game: what do babies and donuts have in common? #WhatDoTheyHaveInCommon

Let me explain a bit about Twitter. Somehow I, a fairly non-techy sort of gal have 3 Twitter feeds. Two for work: @KPHealthed and @KPBabydoctor. On these I try to be professionally focused. On my personal feed, @KateLandMD, I relax a bit more. My non-medical, non-tech savvy friends are completely mystified by Twitter let alone why a doctor would be using it. I explain that there can be power and value to the connection found in the space on Twitter. That it is important for doctors to be present for the discussion. That it is important to battle misinformation with truths; important to be accessible. I explain that we learn from each other; we stay current. I tried to explain that we make friends. Well, that last bit drew guffaws from one person recently. “Friends? Really?” she said with a sceptically arched brow.

Well yes, friends. Take this morning for example – we went on for quite some time making ourselves giggle by answering the question about babies and donuts. Here is a bit of the transcript:

You never want to squeeze too hard.

There is a powdered version of each.

Eventually, they both wind up stuck on your hips.

Oh good grief! You all crack me up! #giggleswithmycoffee Now I want a donut.

Now I want a baby and a doughnut.

Coffee is a good accompaniment.” And necessary!I just have to pause and say, I am cracking up over these tweets! #WhatDoTheyHaveInCommon

A dozen is probably too many.

Have U noticed, while we are being silly some folks here are still thinking big thoughts #classclowns

Silly is such an important part of life. I never want to forget how to have fun.

This fun question brought back two memories of babies and donuts that I couldn’t quite squeeze into 140 characters. First, from when I was pregnant with my middle child. I was a resident working way-to-many hours in the neonatal intensive care unit, not my favorite place to be even when not pregnant. The call nights were many and long; it was hard to talk myself through them at times. So, I developed a system: if I could make it through the night I earned a donut, an apple fritter to be specific. I had a lot of fritters. At birth she weighed in at 10 pounds – no surprise there.

The second memory, triggered by the Twitter silliness, was about this same donut-fed baby a bit older. In kindergarten she developed a problem with her blood cells. The diagnosis was at first unclear – she seemed quite ill;  and the treatment was very high dose steroid pills. These made her a bit  nutty and put her appetite off. In our state of worry we gave into the one food she would eat. Yes, donuts. Donuts for breakfast, lunch and dinner. Soon we got the news that her condition was benign and to be short-lived. So, we sat her down at dinner and explained that this was her last donut for a while. Later I found her talking in her sleep:

Pretty donut…pretty donut…

My time spent on Twitter can be hard to explain. Another pediatrician there, Bryan Vartabedian, often does a much better job in his infinitely readable blog 33 Charts. Recently when discussing physician’s roles in social media he said:

There are 50 ways to use something like Twitter to make your world, or the world of those around you, a better place.  YouTube’s potential application in health care is limited only by the imagination.  While no one has to use any of these tools, believing that Twitter is only a place to share what you’re eating for breakfast is to live with your head in the sand.

Ah yes but, while we explore Twitter’s more meaningful side, a bit of banter over breakfast with our friends is awfully good fun.

box

Thanks for the fun to these and others: @rychoiMD,  @thegrandefinalle, @jensen_jessica@DNich09

I Resolved To Bake Better Cookies – It Was a Tough Year

Yesterday I called a friend near the time his clock would tick over to 2013 to wish him Happy New Year’s. I was informed in so many words that, while happy to hear from me, he doesn’t buy into the whole New Year’s thing. This set me thinking.

Today resolutions abound. We all know that tomorrow most will be broken. In fact, one study from 2009 showed that a full 88% of resolution-makers fail. So, why keep trying? Why make such a big deal of New Year’s Eve and Day?

I too think they are overblown; you certainly won’t find me celebrating on Time’s Square. But, I do enjoy the chance to reflect backwards and to look forward. As I wrote, in my very first blog post on January 1st 2011, it seems better to assess our life’s path as we walk it rather than on one night a year. However, there is a nice symbolism to the passing of one year into the next that provides many of us the focus required to pause and reflect.

I have often resisted making a resolution. Last year I made one and succeeded gloriously! My resolution, broadcast far and wide, was to move through my cookbooks, recipe by recipe, to find, make and perfect my favorite cookie recipes. It took a lot of diligence; it was hard but now, my work has paid off: I have my perfect versions of chocolate chip, oatmeal, ginger, black and white, almond and snicker-doodle cookies. My kids loved it – they were thrilled by watching their possibly insane, semi-perfectionistic mother make batch after batch until she was happy. They, in turn, kept telling me more work needed to be done, that whatever one I had just produced wasn’t quite right, that I needed to try…just one more revision.

Was this resolution silly? Perhaps. It was a fun-loving way to make myself take more time to do something I love with and for those I care most about. Less work, more time with the kids. Who cares about the extra cookie weight? If I were a person who went in for making much of New Year’s Resolutions, that might be the one for 2013.

Postcards2CardsNewYearsResolution1915

 

 

 

 

 

 

And, now if I am ever asked if I ever made a NY’s resolution I kept, I can say “Yes!”

 

The Rough Shifting of My Brain From “Mom” to “Doctor”

DSC_0885My favorite day of the year is December 26th. All work done, house a mess but, who cares – the kids are happy. No dinner to make. There’s enough left-over turkey for the apocalypse. I was sitting by the fire, new book in one hand, glass of Prosecco in the other. I never sit and haven’t read much this year so you’ll forgive me that I did not at first jump at the voice from upstairs.

Mom?

I am reading a good book, The Memoir Project. It is perhaps worth a blog post soon. I was sucked in by the promise of relaxation (fire, Prosecco) and uninterrupted creative thought (book). But then, there was something in the tone of voice that made me ask

Do you need me?

Yes!

Is someone …hurt ?

This last bit uttered as I ran, up the stairs, because by then I already knew.

The big brother sat wide-eyed by the crying, stiff little brother. They had been wrestling as bear-cub brothers will and, it had ended with the little guy crying out. Later, I asked his brother what made him stop the grip he had on his brother’s neck and he said simply that he said “ow.” Must have been a loud “Ow.”

And that is where the point of this story begins. They say that doctors should never practice on their families. There are good reasons and, dire examples. But how, I ask you, is a mother (doctor) supposed to not treat her kids? I don’t do their well checks. I don’t treat their colds. But I am present for their emergencies. At those , there is always a juncture when I have to wrench my mind out of motherhood and disassociate to be … a doctor. Sometimes it works.

This time it worked fine. I was able to calm the little guy, assess his sore neck (muscle spasm) and hug his sorry brother. Whew. But, don’t think that visions of quadriplegics weren’t dancing through my mind as I acted.

Other times it has been harder. I was an exhausted intern, coming home off a 36 hour stretch when I saw the rash. My firstborn (a.k.a. the big brother) was at a friend’s house when I picked him up. She calmly said that he had the strangest rash. I looked. He did. His rash was that I saw in the hospital on kids who died. My mind churned; it twisted – I had to be the doctor again?

Another day, one when I was supposed to be home recuperating from a big leg surgery I again, had to make that shift. The kids had gone kayak camping with their dad. They had paddled into a remote lake and broken camp, gone to bed and the next morning the sister felt ill. All their dad can tell me now a few years later, is that he just “knew”. So, he and her brothers packed it all up, boated everything out and then carried her out. She came home to me and they asked

is she okay?

Well, I will say I tried. I tried to make my mind turn from mommy to doctor. I tried to think clearly but.. it did not happen. Thankfully, her dad was wise and took his little girl with the near-ruptured appendix to the hospital.

I’ve also missed a few broken bones. Correctly pegged headaches as nothing to worry about. Ignored appropriately, several random stomach aches and, imagined cancer at least a half-dozen times.

The New England Journal of Medicine reports the dangers of treating our families. The American Medical Association advises against it. Many hospitals forbid it. I am a fine doctor. I am the best mother my kids have. I should not though, have to play both roles. But, I do at times and during those moments I hold my breath and try to avoid the worst while I summons a brain-shift from mommy to doctor.

The Incredible Lightness of Self

On my far too long flight home from Zürich recently, I watched a dumb movie. I love unchallenging, predictable, movies. Best of all? Dumb romantic comedies. In this one a man and woman who are discovering that they care about one another, are out at lunch. He invites her “to spend some time getting to know each other better.” As they sit, leaning in together, she asks a question about his work. Then she asks another and, another. Then? One more. We know she is curious and cares to understand him; we can see she is nervous. He answers but, after a bit squirms and jests pointedly , that he feels as if he is being interviewed. She sits back abruptly.

Even in the best of relationships (romantic or parental) there pass small moments of strife. Socks on the floor again, toothpaste left in the sink set us on edge. A comment about what the partner is wearing or their hair color that  triggers some deeper insecurity. A word carelessly said. Or, not said. Most of these moments should be allowed to pass by; they are not worth making much of. But, so often we chase them down and chew them apart and, in doing so cause injury. Unintentional injury.
Often as they build, I can feel these moments creeping up on me. There hangs in the air a sense of tottering balance. I could respond with a not really meant vitriol that somehow in these stupid moments can fly out of me. Or, I could choose to walk by the moment without response and take a deep breath. A breath full with understanding that the little things are just that.
If I could wish, I would wish for a warm humor at those times. An ability to shrug my shoulders and laugh at myself and ask, “why take life so seriously?” Socks on the floor, toothpaste on the sink and questions about hair color are just socks, messes and curiosity. They are not more.
While watching the movie I momentarily held my breath. I could see myself there on screen (as the leading lady of my own life) and knew the response to his jest could go one of two ways. I would understand her hurt retreat back into the chair, her stiffened chin and internal kicking herself for going overboard in her attempt to understand him. I could see myself doing just the same defensive retreat.
It was a relief to see her pause, and then laugh and say that “yes, she had a way of going too far when she felt nervous!” What a gift – to accept and to lightly laugh at oneself! What lightness!

Trying on The Coat

I spoke with a patient’s mother this week. She said that she was sure doctors hear this all the time but… “thank you.” She explained that it seemed what we do must become commonplace in our minds. That we could not really grasp the meaning to her as a parent, of the work we do. She thought I could not understand how much it means that her child is alive and I found it hard to answer her. “You are so very welcome” of course came to mind. Beyond that I felt a bit tongue-tied.

A friend of mine lost a beloved family member recently. The tragedy is overwhelming. So overwhelming that when I was talking earlier to a mutual friend he commented that it was bringing up his own past struggles. He said he felt as if he was “wearing her coat” of pain along with her.  Yes. Exactly.

I have at times shouldered that same coat. In random dark moments my mind slips into thinking about my children’s mortality. Just last night as my eldest drove off in the minivan (a hot date car for certain), I called out to him to “please drive safely!” As if that call out could prevent anything. But still, as my mind wandered towards the worst, I tried. Last year a child I knew (out side of work) died in a heart breaking way. It took me months to stop waking up on the occasional  dark, early morning in a cold, silent panic imagining the pain that her family must feel. I imagined the tragedy, the event. I dipped my toe into their shoes. I wore their coat for a bit.

How could simple words tell my patient’s mother how well I understood her thanks? While I have not walked in her shoes, I have tried her coat on at times. Doing so gives me the strength to reach out and help her more fully. And to answer her that “No, what we do is not commonplace at all. I too feel the wonder of a life helped.”

“Membership”, Connection and Being Present

Earlier this evening while having a beer with a friend at an outside cafe table, I watched a pink haired, belly ring-showing girl walk down the sidewalk. She was  giggling and talking with animation into her cell phone. While I kind of admired her style, she made me long for an earlier time. A simpler time.

I grew up in part, in a very small, rural town in Virginia. There were three hundred citizens there. Three hundred and, one little girl who spent every vacation possible with her grandparents in the woods and on the water. It was peaceful and simple. We talked to each other directly. The electronic communication then consisted  of listening in on the party line while waiting for our turn to make a  phone call (seriously).

Today we are all glued to our phones. Many days in the office I have to ask a parent or two to please turn their phone off so we can talk about their child’s health without distraction. Even I feel a constant compulsion to check email, text, tweets….It is not a simple world. On a radio ad the other day I heard that  one car insurance company now considers those that purchase from them – “members”. When I shop for groceries I am a “member” of the big box store nearby. My own company is now recruiting “pre-members”. Pre-members? What kind of marketing nonsense is that phrase?!

This made me look up the definition of the word “member”.

mem·ber [mem-ber] noun

1. a person, animal, plant, group, etc., that is part of a society, party, community, taxon, or other body.

2. Government .

a. a member of Congress, especially of the House of Representatives.

b. a member of the British Parliament, especially of the House of Commons.

c. any member of a legislative body.

3. a part or organ of an animal body; a limb, as a leg, arm, or wing.

4. Botany .

a structural entity of a plant body.

5. the penis.

Focus on item #1 above (and for now, ignore #5 ) for a moment. In the past we were members of our communities and families. Now our devices allow us to be connected with everyone, everywhere if we choose to be. This may be making us in turn, less in tune with the people who most matter. And this is an important point to discuss with our teens.

The American Academy of Pediatrics published a report last year entitled The Impact of Social Media on Children, Adolescents, and Families. It looked at the benefits of allowing kids to be online and ran through many of the risks. The report seemed though to miss a subtlety. Many of the risks of social media may stem from a preoccupation with the online world that precludes being truly present in the physical world. If we are constantly driven to check our devices do we fully experience the moments occurring in front of us? We risk being made less members of our towns and homes and more members of marketers toolboxes.

Ask your kids if they agree. Do they feel this disconnect at times?

Son, Eating Your Beets Will Make You Run Faster

I heard once some time ago that my influence over my kids’ final outcome ended when they turned five. That by age five they had soaked up all the manners, values and habits they ever would from me. I have thought about this snippet of trivia often. Is my role as family educator done? Did I squeeze enough knowledge into them before they left for kindergarten? Now, on the occasion of my first child’s sixteenth birthday I find myself again 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. Check, and room to grow. He has commonsense. Um, not always as 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. But this point 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 wholegrain bread all…moldy. That was IT. 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 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. Hers 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 it’s 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?

Ew, no.

Beets?

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 recent article about how eating beets before running can make you run significantly faster he’ll change his mind? ©