Tag Archives: parenting

Halloween Candy is a Learning Opportunity

As @KPKiddoc I posted this recently on Twitter:

Don’t have 2 hand out candy on #Halloween Kids like stickers, pencils & sm toys as much! http://1.usa.gov/1N1HVcC 

Only to get this response from a follower:


Beyond guessing this person had not read the study I linked the tweet to, I was sure she was not giving our kids enough credit. Sure, they like candy but, they enjoy toys and non-candy treats. If you allow Halloween to be a “learning opportunity” as the nutritionist Ellyn Satter advises, you will find that they learn to manage their own stash of candy and make wise choices. Those choices may be a cool Halloween pencil over yet another mini candy bar. And, I know this works – for 19 years I have offered both candy and fun non-candy items. The pencils and toys are definitely popular!


Before becoming a parent, there were many things I thought I’d never do as a mom. You know, like just wipe off the pacifier and plug it back in. Or, buy them a cell phone. Or, let teens wear sagging jeans. Or, let them eat as much Halloween candy as they want. I have had to eat my words a few times and Halloween is one of those.


I enjoy Halloween with its fall colors and crisp air. It has little in the way of obligation or work associated with it and feels for the most part, like pure fun. But as parents and teachers, we worry about the amount of sugar kids get each Halloween. This concern is for good reason. The average child in the U.S. is reported to eat 32 teaspoons of sugar a day.  The Centers for Disease Control tell us that American children eat 16% of their total caloric intake or 442 calories a day from added sugars. We buy nearly 600 million pounds of candy a year for Halloween.


Given this, Halloween offers us a chance to educate our kids about sugar, nutrition and exercise. Here are some ideas for how to navigate around these mounds of sugar:


  • Tonight at dinner, talk with your kids about sugar, candy, excess and moderation. Is it ok to eat small amounts of candy? Is it important to learn how to stop after one piece? How does eating too much candy make them feel? What can they do with extra candy?
  • Partner with your children’s teacher to teach about nutrition. Kids respond well to the graphics of http://www.choosemyplate.gov/kids/ . Consider using the statistics and articles about sugar consumption cited above.
  • Volunteer to bring a healthy snack to school for Halloween parties. One idea are these seasonal pumpkin muffins.
  • You don’t need to hand out candy on Halloween. Try packs of sugarless gum. A recent studyshowed that kids like getting stickers, pencils and small toys as much as candy!
  • If you hand out candy, give out one small piece per kid.
  • Start off Halloween night with a big, healthy, plant-based dinner. Full kids eat less candy (full grownups too!)

Then, after trick or treating comes the biggest challenge: what do parents do with all the candy? There are many approaches to this and you have to find what works for your family. I suggest that teaching kids moderation is important. Trying to control or prevent all sweet intake can backfire.

  • Some families allow a piece or two a day (many a mom takes one piece for herself each day too!)
  • Some parents “buy back” candy from their kids. For example, a pound of candy can earn a book.
  • Candy can be donated.
  • Show younger kids they can have fun by sorting the candy by color, shape and type. Make graphs of what they got.
  • Do some candy science– there are lots of fun experiments to try!
  • Make trail mix with dried fruits, nuts and small candies.


I asked my kids last night at dinner about Halloween candy. I asked why they end up with a pile of uneaten candy each year – rather than chowing down every last grain of sugar? They all felt that it had a lot to do with my unconventional approach. You know those things I said I’d never do as a parent? Well, I do tend to let my kids eat what they want out of their bag of candy. I recognize how crazy that sounds coming from a pediatrician, but – I temper my laid back approach with loads of education. It all comes back to using Halloween as a chance to talk with our kids about health choices, nutrition and exercise.



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.

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):


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.

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.


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!


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.





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.


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? ©

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.

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?
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.

The “Dog”. What is your theory?

Late one night in January last year the kids came running in the front door thrilled with a fuzzy new find. Percy was an abandoned, dirty, matted and very hungry 2 month old puppy of indeterminate breed.  We tried all the usual channels but, no one ever claimed him. Puppies, it turns out, are a bit of work. We (read that as: the grownups in the house) were thrown into a cycle of late night runs for the backyard and endless rainy walks saying (on the advice of a well-respected puppy trainer) “Do it, Percy, Do it” to train him to defecate on command.  As if. I started searching for recipes that would separate the meat from all that hair. No luck. It has since then been pointed out to me that I did not actually have to keep the critter that perhaps, I should have told my three beaming children “No”. Right. You try.

Everyone likes to give us their theories about  what exactly, he is. Portuguese water dog? Something-a-doodle? Bijon frise? The cat thinks he is a cat. He thinks he is …comfortable here.







Hungry Caterpillars and Hungry Minds

The AAP decided recently to use the book The Very Hungry Caterpillar as a tool to promote healthy eating. Great idea! In fact so great it brings me back 7 years ago to a presentation I gave to my daughter’s preschool class. I used the food pyramid and The Very Hungry Caterpillar to explain healthy eating to that group of 3, 4 and 5 year olds.

You know the story right? That little guy starts off well, growing up eating lots of fruit. Then he branches out to the junk. Sausages, lollipops, cake, pie. Not surprisingly he gets a stomach ache which is only cured by a return to his prior plant-based diet. Since that preschool presentation I have time and again explained this story to my patients and given them the book (courtesy of fabulous Reach Out and Read).

When I heard about the AAP’s promotion I tweeted about it “This is great! I have used same book to teach nutrition for years!”. A fellow tweeter was surprised. His response (in 140 characters or less):

I can see the connection, but I would not have made it myself. Are the kids really open to understanding nutrition that young age?

Ah, yes. They are. Here is a little understood fact (one my mother understood well):  talk to children just as you would any other human and they rise to the occasion. If they don’t understand they will ask you. If you teach down to them they will tune you out and you will lose their respect.

This point came up again this week while I was in the locker room after a swim. We swimmers solve all the worlds problems in the locker room. I ask the vet about my “dog”. Folks ask me about their kids. The discussion Tuesday was how and when to have “The Talk”. My answer was simple: don’t. I suggested instead, that making sex ed a natural part of their upbringing week in and week out was far more effective. Don’t wait for a big talk at a time when you think they are ready or old enough. Have books to read together. Have books for them to look at alone. Talk early and, talk often. And that brings me back to the caterpillar: answer their questions as they ask them without worry for what material they are old enough to understand. Kids are curious sponges; ready to soak up whatever knowledge you are ready to offer them be about sex or caterpillars.


“You have to be a bit outside of something to see it.”

Since reading the New York Times this Sunday I have been thinking about Glenn Ligon’s quote:

You have to be a bit outside of something to see it

These words have been rolling around a bit in my head. He was describing another artist’s work and these words had a specific meaning. However – like many quotes taken out of perspective we make them our own; we give them our own new meaning. For me they brought to mind the truth that can appear when we have the opportunity to view not only art, but people a step apart from them. There can be such breathtaking  beauty found in seeing someone we care about unexpectedly before we realize they are our own.

We are usually so embroiled in the daily work of parenting that we do not often have a chance to see our children (our greatest works of art) from a view a bit outside of the experience of parenting them. A few years back I wrote a brief article about nurturing friendships in young children. Part of the advice I offered was about how to handle the end of a playdate:

When it is over and you deliver the friend to their parent take time to praise their behavior to the parent – this makes both child and parent feel good and ultimately helps strengthen the budding friendship.

Taking time to reflect positively on another child to their parent can share with them one of those magical moments of seeing their child outside their usual perspective – it indeed makes all involved feel great! This advice and Glenn Ligon’s words also came back to me in the office recently. I was seeing an emotionally challenged child and her parents. Somewhere near the end of our visit I commented on what a beautiful person she was and how her strength of character combined with her parent’s incredible support would help her rise above her struggles. As I mentioned her shining nature I saw a glimmer of relief in her mother’s eyes. For a second her haze of stress and worry parted and she could see her daughter there across the room as I did – a beautiful person with a positive future.

These times of seeing our children a bit outside of our usual view are gifts to be savored and shared. Enjoy!


Preserve Arts Education; Preserve a Sense of Wonder.

The most beautiful thing we can experience is the mysterious. It is the source of all true art and science. He to whom this emotion is a stranger, who can no longer pause to wonder and stand rapt in awe, is as good as dead: his eyes are closed. – Albert Einstein

My eldest is almost fifteen and is beginning the process of planning his high school and college “careers”. This proves to be a rather stress-inducing experience; apparently very different from the casual way I approached high school. Late the other night he admitted he was worried about choosing classes for the upcoming years. So, in the spirit of facing our fears we curled up together right then and went the through the high school graduation/college entrance requirements. The school had provided worksheets and lists which we dove into. Amongst scads of science, math, and language requirements I learned that of the 230 units required to graduate only 10 of those need to be in arts education.

This made me start thinking again about the lack of value we place on arts education and the consequence of this devaluing. This is evident in the currently proposed national budget; some members of the House of Representatives have proposed deep cuts or even total elimination of the National Endowment for the Arts. This represents a huge loss nationally. On a more local level our school systems face severe budget crises and are viewing arts education as expendable – Leaving it acceptable to require only 10 units out of 230 for a young person to graduate from high school and enter college.

What is the cost of this devaluing? Put differently – what is the value in teaching kids arts? We teach art and teach about art because doing so:

  • sharpens critical thinking skills. Cassandra Whyte is credited with early work showing that artistic experiences develop creative and independent thought processes that are important throughout an individual’s lifetime
  • teaches innovative thought
  • widens perspective, encourages acceptance of generational, cultural, social and geographic diversity
  • teaches empathy and sensitivity to other’s experiences by exposing them to other world views, brings about a deeper understanding of the world
  • Therefore, teaching the arts nurtures skills that improve our kid’s future ability to work successfully in the global marketplace
  • calm the soul and brings beauty to daily life

Art washes away from the soul the dust of everyday life – Pablo Picasso

  • preserves our cultural history and heritage; preserves our collective memory

My son and I filled in the worksheet with lots of science, language and math. And art? Well, not so much. He moaned at my suggestion of various art classes let alone art history. His groaning made me realize that I had before me, fodder for another great dinnertime conversation. Tonight I am going to ask them why I talk so much about the arts. Why I drag them to museums? Why we have lots of paint, pastels and paper? Why are our walls covered with art? They may generate some new ideas from my list above. I’ll get back to you with them.

If you want to help promote arts education yes, of course generate your own dinner table conversation. You can also look at the work of the Americans for the Arts Action Fund.

Perfection. Pressure. Price.

I have tried hard to avoid adding to the general buzz surrounding the “Tiger Mother”. I resolved to stay out of the fray. Really I did. But, a convergence of discussions with reading a review of the book has pushed me into adding my thoughts to the collective. I’ll be brief.

Twice this week I have had conversations about girls feeling the pressure of attempting to be “perfect”. One girl was in tears telling me that she was trying hard in all she does (arts, sports, school) to literally be perfect. The pressure had brought her in to see me. The mother of another talked with relief about how her junior high aged girl was moving away from a friend who on the surface seemed so very “together” that her child had been feeling the strain of trying to keep up.

I had heard of the Tiger Mom; she sounded quite awful when I listened to the general hub bub. Then one day earlier this week I found myself stuck in a waiting room reading a review of her book in Time magazine. A review that was surprising. I tend to try to look at life from all sides and enjoyed finding through this review that perhaps the feline had some good ideas for raising children after all. Do I agree with them all? Well no, of course not. However, she has some powerful theories about the value of hard work and repetitive practice. I went home that evening and announced to my kiddos that from now on they were going to practice their instruments longer. Everyday. No more nice mom.

However what is clear to me about her child raising technique is that it is fraught with danger. The danger that comes when a child is held up to perfection as the yardstick by which they are being judged and by which they judge themselves. So the question becomes how to find the balance. How to push our children to work hard, really hard so that they become the best versions of themselves they can be, while also teaching them of unconditional love. For with this love comes an innate self-confidence and strength that will allow them to use their hard-won skills in creative and meaningful ways.

Perhaps we explain to them that perfection is not obtainable. It is defined individually and changes with the viewer’s perspective. That it does not actually exist. Nor would it be desirable if it were found. Our children need to accept that life is messy and people are complex. The friend who seems so together, so perfect, may have hidden flaws. The people we most enjoy being with, those that most fill us with joy, are often those that are flawed. Take one of my dearest friends. She is great looking, can make any item of clothing look like haute couture, is kind as the day is long, a great athlete and, a bit of a slob. Yes, a slob. But, we all love that about her. It makes it easier to be with her. Her house is great to be in – enter there and immediately relax for, while there you know what really matters the most to her: your friendship.

Our challenge as parents is to endorse maximum effort and to teach the embrace of the diverse, unexpected and messier parts of living life. How do we proceed? Perhaps by opening this dialog with our kids. Ask if perfection is a goal? Is “perfect” possible? At what cost? Let me know what you learn.

Dinnertime Art Continued: Art in the Moment

What do Jean-Michel Basquiat, Tino Sehgal and Andrew Goldsworthy have in common?

Well, I didn’t really expect you to get that one. But the answer to this question is one worth discussing (in the ongoing dinner-table conversation with your kids that I have by now stirred up).

Jean-Michel Basquiat was an American who began as a graffiti artist and developed into a respected painter of canvases hung in galleries and museums. I was fortunate this year to see an extensive retrospective of his work in a museum. His paintings have an Afro-Carribean influence and also show hints of the influence of other artists of his time. But, for the purposes of our conversation, think of him as a graffiti artist. Andrew Goldsworthy is a british sculptor who works primarily in the outdoors making site-specific and land art. He makes art created out of what he finds in nature. Breathtaking, monumental art made of icicles, twigs, leaves and piled rocks. Tino Sehgal is an artist who creates situations meant to move his audience, meant to make them think but – not meant to be preserved. His work occurs in museums but is not documented in anyway. I recently saw his work “This Progress” – an installation of progressive encounters with people who walked with me, asking me questions (“what is progress?” “is progress always good”) as I ascended the spiral at the Guggenheim museum in New York. While my memories are sharp, there is no image to link here for you to see.

The answer to my question is that all three men created in part, art meant to be temporary. Graffiti and land art are to more or less degree ephemeral in nature. Sehgal’s work is designed to be such. When you look at each of these art forms you find an unarguably appealing nature to them. Certainly Goldsworthy’s is the most widely approachable so, start there. What is it about the fleeting nature of his work that adds to its beauty?

I asked my children this tonight at dinner. I admit, the 15 y/o rolled his eye a bit but then, even he joined in the conversation. They all agree that Goldsworthy’s installments are “really cool” but we struggled with the question of what their impermanence adds to the art. Does its fleeting nature make it more precious and therefore simply more valued (volunteered by the 9 y/o)? Do the changes that occur as Goldsworthy’s sculptures are decayed by the forces of nature (tides, wind, heat) allow for our own interpretations; our own artistic input in how we see them? Do my memories of Seghals situations similarly add to the interpretation of his art? Questions of vandalism aside, I find something magical about the creation of a graffiti mural that will soon simply become a canvas for the next artist.

Is there something about art meant to be physically transitory that makes us pause and stretch our mind’s eye to really take it in? We are perhaps, encouraged to be really in the moment with this art that is by nature of the moment.

To start your own discussion at home try watching these two very different but equally moving videos: Goldsworthy in action and graffiti being created. Consider making some of your own art at home as Meg Schiffler and her son did described in her terrific blog post for the SFMOMA Andy Goldsworthy: Big Tears (Part 1) and A Gift to the Backyard (Part 2).

Help dealing with your child’s habits: Knowledge and Humor

On Twitter this morning I saw several tweets about how to deal with undesirable habits in children. These started me wondering why, exactly we are so bothered by our kids habits. For the most part nail-biting, hair twiddling, lip licking and their ilk are not harmful. Sure – there are some undesirable consequences (raw little fingers, frazzled hair, dry lips…) but I am guessing that really, our parental reactions come from a different category of worry. It may be that when we watch our child fidget, pick at their scab or chew absent-mindedly on their shirt, some of our reaction is based on a worry that perhaps they will never grow out of these habits and we will fail by sending little nail-biters into the world. We wonder if perhaps Dostoevsky was right when he wrote:

The second half of a man’s life is made up of nothing but the habits he has acquired during the first half.

And, if he is right we feel there is so little time to shape our children into successful adults; will we cram in all the lessons in time? Do we also react so strongly out of concern about how our parenting skills will be judged when others see their little habits? It seems a difficult time to be raising children; we are surrounded by a constant influx of pressure and “advice”  about how to parent.

There was another, well done article posted on Twitter this morning –     Kids Affected by Parent Stress More Than We Recognize. This talked of the consequences of our stress and worry on our children. It is true, there is much to legitimately worry about (jobs, health, finances, world affairs, etc)  and given this I would challenge us all to look hard for the spaces in our days where we can let things slide.  One good place to start is with our reactions to our children’s habits. I find that when reassuring parents in my office two things seem to help the most: knowledge and humor. For knowledge there are many places to turn, here I have gathered some basic information about habits and their counterpart, tics. I find the best advice is to try to not nag instead, to talk calmly and directly with your child about his habit. After all he may not be aware of doing it; as Agatha Christie said:

Curious things, habits. People themselves never knew they had them

Awareness is the first step to breaking the habit. Have the conversation at a quiet moment. At that time explain you have noticed that he sometimes has the habit and that you would like him to think about stopping and why. Brainstorm with him a list of ways to learn to stop. Even very young children respond well to being included and respected in this way!

And now, for some humor:

My problem lies in reconciling my gross habits with my net income – Errol Flynn

Zoo: An excellent place to study the habits of human beings – Evan Esar

Or, as I tried last night when watching my handsome near-15 y/o absent-mindedly chew on his t-shirt – just smile at your sweet monsters and have a private giggle. They will have grown up and out of most childhood habits so quickly (I hope… the T-shirts are suffering) that letting them slide at times may be the best approach.

Lice again? It is nice to know we learn.

Last year I wrote an article for patients at work incorporating the American Academy of Pediatric’s recommendations for the treatment of head lice. Their recommendations and my article we aimed at being calming and reassuring. Lice are indeed gross but – they are not harmful so we mothers need to calm down a bit. As I was writing it I remembered a certain mother’s day I had and changed the article to include this introduction and summary:

Picture this: 0630 Mother’s Day 2008 morning …my dear daughter climbs into bed with me to read a book and snuggles up in the crook of my arm. I decide I will have to do without the dream of sleeping in on mother’s day in order to well, enjoy being a mother. I give into the joy of her good morning love and snuggle in with a nuzzle of the top of her sweet head…only to find….Arrrggghhh! Lice nits! Good grief, what a way to start the day, any day let alone Mother’s Day! So, I did what most mothers would do jumped up and entered into panic/action mode and spent the day (btw that was supposed to be my day) washing, picking nits, combing, doing laundry, vacuuming and cleaning. Let me emphasize the laundry; I totally went overboard with the laundry and did dozens of loads!

And that is really where we need to begin here. So, let’s take a few deep cleansing breaths together (lice tend to reduce the most composed mothers to crazed hyperventilating insane people – me included). Now I know and believe much of what I put my self through that day was unnecessary. We as a nation are too afraid of lice. Yes, they are really, really yucky. Yes, we don’t want them on our children’s heads. However – lice do not hurt our kids (deep breath) and they do not live well or long off of a human head so huge cleaning efforts are unnecessary (deep breath). Having lice is common, does not mean you or your house is dirty and, happens to the best of us (breath).

My Mother’s Day 2008 ended up with a very clean house, 3 slightly traumatized children and 1 exhausted mother. Next time we have lice, and there will likely be a next time, I hope to be able to breathe my way through a more rational response!

So, this week when yet again I was reading and snuggling the very same child and looked below to see…could it really be? Nits? I was able to indeed breathe, relax and not go so overboard. She and I both survived relatively unstressed which made me realize that I too learned in the process of interpreting information for my patients. Glad to know that the deep, subconscious part of my brain that reacts in horror to the idea of bugs on my child was soothed by learning the facts. Education is indeed powerful.

It of course also helped that after a good shampooing the white stuff went away – proving the point that even the “professionals” mistake dandruff for lice!

How parents can help break the cycle of childhood obesity: raise a cook and dance!

I spent a thoughtful few days after first reading Chop, Fry, Boil: Eating for One, or 6 Billion from the 12/31/10 New York Times followed by seeing a blog post from KevinMD.com entitled Childhood obesity and chronic illnesses that result from being overweight. Of course, I read much about childhood obesity and have a seemingly endless stream of conversations in the office about this topic. With parents and kids I try to navigate this delicate but medically urgent issue. With fellow pediatricians we express frustration over the mounting problem and despair of being efficacious in our attempts to help parents and children carve a healthier path through the mess that it seems our society has created.

Results from the 2007-2008 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that an estimated 17 percent of children and adolescents ages 2-19 years are obese.

The blog post outlines the problem of childhood obesity and examines some suggested remedies: limits on the sales of sodas and educational initiatives for parents and doctors alike. These add to what is necessarily a multi-pronged approach. Physicians need to educate and discuss, schools need to examine what is in their vending machines and in their lunches, food manufacturers, store and restaurant chains need to have a conscience that examines their role in this nation-wide crisis.

What can we as parents add to the mix? Among many small steps we can take (pack lunches, serve water, model exercise), falls the idea so well outlined in Chop, Fry and Boil. We can and should, raise a nation of cooks. No, not chefs – no perfection or creativity required. We can raise our kids ready to go forth able to provide for themselves simple, tasty, home-cooked meals. Giving the next generation of Americans basic cooking skills gives them the ability to avoid the cycle of fast food consumption and its inherent physical and economic costs. The author provides us three basic recipes to learn. I am an avid cook but, somehow have never learned how to make an edible stir fry. I thoroughly enjoyed Mark Bittman’s Broccoli Stir-Fry with Chicken and Mushrooms; enjoyed the learning, the cooking and the eating. Better yet – I invited my 11 y/o daughter to learn with me and she joined in; the recipe was indeed that approachable.

We teach our children so much. We feed them well. Many of us let our kids play in the kitchen…here we call this baking “experiments”. Let’s also arm them with some basic dinner-making skills;

By becoming a cook, (they) can leave processed foods behind, creating more healthful, less expensive and better-tasting food that requires less energy, water and land per calorie and reduces our carbon footprint. Not a bad result for us — or the planet.

Then we can start on the next step suggested in a recent interview with our Surgeon General Regina Benjamin: that we as a nation maybe need to dance more.

That exercise is medicine. It’s better than most pills.