Pesticides: Not a Major Food Group

bleach boy-01A recent statement from the American Academy of Pediatrics suggested that we should limit our children’s exposure to pesticides.

It turns out that chemicals designed to kill insects and rodents are not good for children. Who knew?

In large doses, pesticides cause acute poisonings, with symptoms including dizziness, nausea, headaches, twitching or weakness. Smaller doses over a longer time can harm your child’s brain or hormonal systems. When pesticides injure a child’s brain they can cause developmental delays, and attention and behavior problems. Hormonal effects can impact your child’s growth and perhaps his or her reproductive ability. We do need to limit our children’s exposure!

Children are more vulnerable to poisons than adults, not less. Their bodies are actively growing and maturing and are thus easier to damage, like a gymnast caught mid leap. They have faster metabolisms: their hearts beat more quickly and their lungs breathe more rapidly, allowing chemicals in more quickly and in larger amounts. Also, their protective systems aren’t mature and don’t work as well as those of adults to stop the damage.

So, how do we lower children’s exposure in our day-to-day lives? The most common place for your child to ingest pesticides is in the food that they eat, particularly the fruits and vegetables. This does not mean they can skip their veggies! Just wash them first, eat a variety of different produce (different vegies have different amounts of pesticides), and buy organic when you can. Your local farm stand is, of course, your best friend.

Children are also exposed to pesticides in their homes and yards, so we may need to make some changes there. Keep all of your household pest products in their original containers with child proof caps intact. Just today I had a child drink a degreaser because her mom had stored it in a soda bottle! Store poisons out of reach and out of sight in a locked cupboard. If you are using a pesticide and the phone rings, close the container and put it out of reach while you are out of visual range. I have seen more than a few kids poisoned when mom went to see why the baby was crying, or to answer the door. Kids are quick.

Read and follow the directions on the container. Use pesticides only when there is a problem, never to just prevent one. Less is always better. When you do use them, use crevice and crack treatments, not bombs. Think about how your kids live on the surfaces to which you are applying the treatment: kids lie on the ground, crawl under things, and touch stuff and put their hands in their mouths. Don’t put the rat poison behind the couch – your 2 year old will find it. My amazing, brilliant grandchild found the mouse poison behind the dishwasher. World’s worst grandma.

Change your clothes after you use pesticides, and store your shoes outside.

If you have a wooden play structure that was built between 1970 and 2004 and not made of cedar or redwood, the wood was probably treated with chromated copper arsenate. Arsenic also is not good for children, so you may want to replace the structure.

Read the ingredients on lawn and garden products and any pet products. Organophosphates (most commonly malathion, but there are dozens) were banned from home use in 2001, but many people have old products sitting around, or use commercial products at home. They are also still used in public parks and schools.

In America we use more than 1 billion pounds of pesticides every year in our farms, homes and public spaces. Ask what is used by your city and at your child’s school. There are many newer, safer products that have been developed in the last few years, so suggest alternatives and avoid the organophosphates when you can.

Stay safe and be healthy!

How to Nurture Self-confidence in Your Child

skateboarder-01In the last several weeks I have seen a mother trying to make her daughter look prettier (she was beautiful without the make-up), a father pushing a son better built for track into football, and a parent making fun of a son’s drawings.

These parents might someday wonder why their children did not have the self-confidence to achieve more in life.

Let’s not do that.

So… top ten ways to nurture a confident child

  1. The most important single factor in building a child’s self esteem is unconditional love from their parents. Children need to be certain that no matter what dumb thing they do, or how badly they fail, you will love them. You may not always like what they’ve done, but you will always have their back. They will have the courage to try, when they are sure you will catch them if they fall.
  2. Give your child a chance at success by laying out clear expectations; they need to know what success is in order to achieve it. Nothing will destroy self-confidence more quickly than trying to shoot at a moving target. What do you hope to see in your child: honesty? hard work? creativity? Be consistent. If you want them to be honest, then you need to be stringently honest in your own life, and require it of them in every part of theirs. No telling your child not to lie, then suggesting a fib about their schoolwork! Expect hard work? Work alongside them, and let them know how much you appreciate their labor.  Exhibit, and reward, the behavior you want to see.
  3. Make your expectations something at which your individual child can succeed. Any child can give their best, work hard, be true to themselves, and be honest. Not every child can be a football star, brilliant musician, or great artist. If your expectation is that your child try new things and do his or her best, then they can succeed at putting paint on canvas, and they will feel pride in their accomplishment.
  4. Find activities in which your child will thrive. You may have to try a few new things; break out the ballet classes and art lessons. Learn to throw a ball. Read books, tour a museum, travel… Explore the world in which your child will live his or her life. Nothing will build self-esteem like success, so seek out and encourage activities they love or for which they have a talent.
  5. Be interested in what inspires them. It’s impossible not to be: you are interested in their hair color and their height, how could you not be interested in their minds and talents? In the end, if mom or dad is interested, they will know that their accomplishments – and they themselves – have value.
  6. Allow time for free play and creative activity. Children do amazing things when they are allowed access to their own imaginations. Freedom will allow them to get in touch with their innate abilities, so that they can discover their best future. Self-confidence thrives when we do work at which we excel.
  7. Examine your own mind. Any left over preconceptions that might injure your child? Your small human is new. He or she embodies a combination of mind, talent, and ability that has never existed before. If you think science is the most important subject, but gave birth to a poet, you need to make sure that small poet doesn’t get the idea that you would have been happier if he or she could grasp algebra.
  8. Expect them to fail: the only people who do not fail are those who do not try. Show them with your own behavior that failure is a learning opportunity, so they will not think that they have less worth when they, in turn, fail. Let them watch you try new things. When you fail, make sure they see you accept that failure and learn from it, so that you can succeed next time. When they fail, tell them it was great that they tried, and redirect them to what they can do differently next time, so that they will get better. No defeatist talk, for the entire duration of their childhood!
  9. Spend time with friends with like interests, and friends who are completely different. Friends who value the same things your child does will reinforce his or her worth; friends who are very different will teach your child that every person has equal grace, whether their talents lie in building an app, a home, or a business.
  10. Be true and honest. Your children know you, and will know when you are not being real. Children do amazing things every day: there is no need for fake, meaningless praise. You love this child, therefore you love and will value the things that he or she is good at, even if you never thought you would before you became a parent. True praise builds healthy self-confidence.

While you’re at it, work on your own confidence. The world has probably battered it a bit. Children will always follow our example. If that example is self-confidence, courage, and honesty, how far might they go?

What To Do When the Screen Goes Off

girl with plantMedia addiction in children and the importance of limiting their screen time is a big topic in pediatrics this week.

The American Academy of Pediatrics has always recommended no more than two hours of screen time per day for children over 2 (none for those under 2), and they have lots of data to back that up. Adding to this was a recent study suggesting that toddlers who watched more TV than average were more likely to be bullied later in life: reported bullying went up 11% for each additional hour of TV viewing, over the average of 1 1/2 hours. Scary.

Time spent watching TV is not spent developing social and verbal skills, and not spent using and exercising young bodies.

Children sitting in front of a screen develop a disabling habit of being more passive in their interactions with others.

They put on weight because while they are sitting, with their metabolic rate near what it is when they sleep, they are frequently munching on snack food.

They are more likely to have attention problems because TV teaches them to experience the world in 5 minute pieces.

Last, their perceptions are significantly skewed because they take the behavior of characters and people on TV as normal. Which they are not.

It seems reasonable that since I am one of those pediatricians constantly nagging people to turn off their screens, I have a responsibility to come up with some activities they can do instead. All those hours to fill, and all those useful skills to learn!

Our children need the abilities that excessive TV viewing destroys: social knowledge and the ability to interact with actual humans, verbal skills, an attention span adequate to complete a project, and physical exercise. Let’s throw in knowledge of the real world too, just to be complete.

So, ten things to do after you turn off the TV:

  1. Read a book. I know, it’s obvious, but that doesn’t make it any less important. The most rapid development in the brain’s language and learning centers occurs between 6 months and 3 years of age; we need to take advantage. Just 15 minutes of being read to each day between 6 months and 5 years adds up to 500 hours of reading before they even enter kindergarden, boosting development in these areas. Daily reading in older kids improves their comprehension and speed, in addition to adding to their store of knowledge. Hit that library!
  2. Experiment with science. My all time favorite science site is at Roots of Action. They have experiments in all kinds of science, organized by children’s age and type of science, from astronomy to zoology. There is enough there to keep your kids busy all summer long.
  3. Be creative. Break out the crayons or paints and draw. Make music. Write a story. Perform a theatrical: what kid doesn’t love performing in front of their most supportive audience? Creation exercises and stimulates the brain, making it more imaginative and receptive to new ideas.
  4. Garden. Not only does your munchkin get to play in water, dig in dirt and make a mess, but he or she will also have the pleasure of seeing their plants grow and flower. There is self confidence to be grown along with those beans for diner, and those flowers for the kitchen table. Also, they learn a little responsibility along the way, because they won’t want their precious plants to wither and wilt.
  5. Have a cooking class. Again, you get pride of accomplishment (they peeled those carrots!). They will eat better, because they won’t want their own hard work to go to waste, and they will learn an undeniably necessary skill.
  6. Make a chore list. Exercise, a sense of accomplishment, and lessons on responsibility all wrapped up in one. Give an allowance for completed chores and you can have financial lessons as well.
  7. Play a sport. With them please and have fun, so you have family time and everybody gets some exercise.
  8. Learn a new skill. Summer is the traditional time for classes and camps. Learn to draw, play an instrument, ride a horse… Anything your child has shown an interest in, someone is out there teaching, if you cannot teach it yourself
  9. Volunteer. Aiding others in need will help them appreciate what they have, and will feed their souls. The right sort of volunteer activity can also teach useful skills: Literacy promotion (reading), working with the elderly (communication, patience),  hospital work (medical knowledge), food banks and kitchens (cooking and nutrition), and Habitat (building and repair) are all enriching.
  10. After all this activity, take a backyard vacation. Put out the blow up pool and some beach towels, and drink things with tiny umbrellas. Have a trail hike through the neighborhood with a campout at the end. Have a day in Paris, with a home made Eiffel Tower and a French dictionary. Go to a Broadway show produced by your favorite tiny actors. Backyard vacations are limited only by your imagination, never your wallet.

Who has time for a screen? There is just too much to do! Turn that box off and put away that phone!

Anonymity and Denial in the Twitterverse

turtle2-01Playwright Tom Stoppard said, “Words are sacred. They deserve respect. If you get the right ones, in the right order, you can nudge the world a little.”

I am old enough to be amazed by social media, with its multitude of words and pictures. It did not exist when I was new. If we wanted enlightenment, we went to the library or read the Post. By the time we found our information, the events were already in the past. We knew people of different cultures existed, and events happened, but it was knowledge that came at a distance, blurred by its time-consuming transformation into letters and pictures.

When we curious children wanted to see what a woman looked like without her clothes, we stole our parent’s National Geographic and leafed through it for pictures of deepest Africa. Kennedy and Lennon were shot, but there were no cell phone videos or instant interviews. The stories unfolded over weeks, with time to adjust and get a little distance.

Social media now comes with immediacy and savage intensity. People’s lives are flayed open and placed on the screen for my perusal. If I presume to know anything about that woman in Africa, she can knock me upside the head minutes later, because she is in reality just a hairsbreadth away. If I pretend to wisdom, the whole world can judge me and let me know where they think are my errors in judgement.

This brilliant transparency should make us more authentic, more determined to write nothing that we would not stand behind to our deaths. We should claim our words without reservation. These words. are. me. Sadly, from a place of weakness and fear it can instead make us deny what we know, as we buffer our truth so as not to be responsible for it.

We write, “Tweets do not replace medical advice, retweets are not to be considered an endorsement.” We backtrack, and pad ourselves against risk. The most powerful thing we can do – put our thoughts into words for other people to see – we disclaim and weaken with “tweets are not meant to be advice.”

Of course they are! What would be the point, otherwise?

If we give thought to and write words down then they need to be true. Words are sacred. We record our words in the hopes that they will “nudge the world a little.” If our words are our truth then they have earned our faith: we have to stand behind them with our names and our identities.

Weakening our words by buying into a fear of lawsuits and judgement is a betrayal of our selves; it costs us a piece of our souls. Our words are us and denying them, even in a small part, allows decay to eat away at our own value.

Conversely, since we wrote those words with our very own minds and hands we should never, in the rush to say something, write down what we know is not truth: those words will also follow us through our lives. People sometimes feel that they can be nasty, petty, or judgmental on the internet because they are anonymous. They can twist the facts just a little to make their point. We must realize that there is no such thing as true anonymity. Even if no one else ever knows who wrote those words, you yourself do.

Persian poet Hafez wrote, “The words you speak become the house you live in.” Write only words that have a strong foundation and the solidity of truth, so that your house is yours alone and can hold up to the hurricane force winds of opinion. Hafez’s words are as true on the internet today as they were in the fourteenth century in ink on paper. Such is the power of words. Believe in them, and in your self.

4th of July: Avoid the Doctor!

safety signSunshine, water, and fireworks. What else could you need? To avoid the ER afterwards!

Oddly, most 4th of July injuries actually have nothing to do with fireworks, and everything to do with parents being so busy that they are not as watchful as usual. Sports are more dangerous when we want to impress cousins. Teenagers tend to get more reckless during a celebration, and young children sneak away quickly.

Most injuries are from everyday activities and household objects made dangerous by the craziness. So,…

Top Ten things that will land you in my office after the fireworks:

1.  Drowning: The 4th is all about water. Every year pediatricians see drownings and near drownings on the 4th. Never leave any child alone for even a moment near open water, whether it is an ocean, a bathtub, or a water bucket.

All it takes is one moment of inattention for a child to slip away. If there is open water, you need to be within touching distance and focused on your child. Pools should be fenced in and closed off with a self-latching gate at the end of the day, and all the toys should be put away. Life vests are fabulous for a parent’s mental health and relaxation (swimmies and floaties are not life jackets). Life preservers and a shepherd’s crook should be placed obviously nearby wherever kids are swimming. For more tips on water safety, check out my summer safety tips.

2.  Fireworks: I know, it’s obvious, but it had to be on the list. Please leave them to the professionals. It’s not worth months in the burn unit and doing physical therapy.  No-one thinks it will happen to their kid, until it does.

3.  Choking: Toddlers will put anything in their mouths. This means that everybody needs to pick up his or her stuff. Items over 1¼ inch in diameter are generally safe. Items smaller than 1¼ inch can go straight into their gut or lung. The most dangerous items to swallow are button batteries and magnets; the most dangerous to choke on are grape sized (older children’s toys, hard candy) or stretchy (balloons, plastic bags, marshmallows). Clean up!

4.  Allergic reactions: Holidays provide a banquet of things to irritate children’s allergies. Plants, foods, cigarette smoke, bonfires and other people’s homes and pets come to mind. Avoid them if your child has allergies.

5.  Fires and electrical injuries are especially common during holidays. Decorations can be flammable, candles and fires are commonly nearby. Frayed and loose wires easily start fires. I have had an astounding number of children run through banked campfires after dark. Block them off please!  Keep your eyes open for dangers.

6.  Poisonings: The one I see most is an overdose on Grandma’s meds. At Grandma’s home they are left on countertops; at your home they are in her purse. A left over drink is also a common way to poison children. A little alcohol can drop a child’s blood sugar and throw him or her into a coma.

7.  Alcohol inside the grown-up: does this really need explanation?

8.  Dehydration/Food poisoning: Watch their intake. It’s hot and the kids are running around in endless circles. Bring lots of water (the stuff mother nature made for you, not the stuff with caffeine and sugar added). Food left out in the heat for hours can grow things that cause vomiting and diarrhea. If you don’t know where it came from and how long it’s been there, don’t eat it.

9.  Scarce common sense: If it doesn’t seem safe, don’t let people pressure you into it. Make them wear that bike helmet! Trampolines and motorized vehicles (Sea Doos, dirt bikes) are never a good idea.  Feel free to let watching your kids take precedence over seeing Uncle Joe’s trophy or Aunt Mary’s vacation photos. “He’ll be fine” doesn’t make him fine. Keep an eye on him.

10.  Politeness: Feel free to be rude and head for home when the kids get tired, if a situation feels out of control, or if your child is being exposed to something you aren’t happy with. Use the munchkin’s youth or fatigue as the excuse for you to head home, relax and read a bedtime story.

The point of celebrations is to solidify relationships and give hope for the future. Focus on family, rejoice in the day and be careful.  Keep plans simple, pick fewer things to do, and do them together. Be safe and stay healthy.

That Tricky Line Between Safety and Smothering: Summer Injuries

safety signSafety is not simple. There is no clear division between “this activity will be safe,” and “this activity will injure my child.” We could wrap our children up, keep them indoors, and not allow them to play with anything remotely dangerous, but then we would have a child who is lonely, overweight and really bored…who would get into trouble and injure himself. Or not get in trouble and develop diabetes, heart disease and knee problems from obesity.

Kids need to be active, and summertime brings many interesting opportunities for exercise, adventure and injury.

Wouldn’t it be great if some doctor type person would tell you what activities were the most likely to bring ER bills into your life?

Oh, wait. That’s me. So:

The most common causes of accidental death are gunshots, motorized vehicle and bike accidents, drowning, poisoning, and fire. Drowning, MVAs, bike accidents, and trampoline accidents are all more common in the summer, when kids are out of school.

Water Safety

Drowning is every pediatrician’s worst nightmare. It is currently the fifth leading cause of accidental death. An average of 700 children drown each year: about 2 each day. Most are under 4; 80% are male. For every death, there are 5 more children who drowned but survived, commonly with irreversible damage to their brains.

Infants and toddlers drown in bath tubs, buckets, toilets – it only requires is about an inch of water, just enough to cover their nose and mouth. Older children drown in pools, rivers, lakes, and oceans.

Never leave any child alone for even a moment near open water, whether it is an ocean, a bathtub, or a water bucket. All it takes is one moment of inattention for a child to slip away. If there is open water, you need to be within touching distance and focused on your child. The story I have heard over and over is, “We were right there, just talking, but nobody noticed anything until we realized he was gone.” Keep your kids in sight, and don’t let yourself get distracted. Be especially careful at the end of the day, as the water empties and people are gathering up their belongings and leaving. Children will want to swim just a minute more, or will attempt to go back for that last toy floating in the water.

Pools should be fenced in and closed off with a self-latching gate at the end of the day, and all the toys should be put away. Life vests are fabulous for a parent’s mental health and relaxation (swimmies and floaties are not life jackets). Life preservers and a shepherd’s crook should be placed obviously nearby wherever kids are swimming.

Sign your kids up for swimming lessons, even if you are afraid. A middle schooler or teen will never admit to their friends that they don’t know how to swim. They will fake it, sometimes unsuccessfully. Don’t, however, trust a young child to remember his or her swimming lessons when they need them. If they are startled or scared, they will forget everything they learned and just sink to the bottom.

Know what to look for. In real life, drowning does not look like it does in the movies. It is possible to miss someone drowning right in front of you if you do not know what you are seeing. They do not shout for help and wave their arms. They tire, and panic. A drowning child might never make a sound, but quietly slip under the water. An older child might keep themselves above the water for a while, but their head might be low in the water, with their mouth at water level, or perhaps with their head tilted back. Their eyes might be blank or closed. They will sometimes hang vertically in the water without paddling their legs, or appear to paddle with no purposeful movement. A drowning person is very easy to miss if you are not vigilant; and easy to help if you are.

Somebody should know CPR—why not you? Your local fire department or hospital will have classes.

Swimming is a necessary skill, fun, and excellent exercise; it is also a time for close observation and care.

Motorized Vehicles

The other motorized vehicles—ATVs, dirt bikes, snowmobiles, and Sea-Doos—are also commonly out in the summer. They are the perfect storm: they go fast, have no outside framework, roll over easily, and the only things that keep them from crashing are your children’s foresight, common sense, and trained reflexes. The United States averaged 23,800 dirt bike crashes requiring emergency room visits every year between 2001 and 2004; these numbers go up as dirt bikes become more popular. Don’t. Really, just don’t. You do like the kid, right?

Bikes

Bikes come out of the garage when the weather warms up and the roads are not covered in ice. And yes, the dorky bike helmet is an excellent idea.

Thousands of children are injured or killed every year due to bike accidents, frequently right near their homes. In 2010 alone, there were 800 deaths, 26,000 traumatic brain injuries and 515,000 emergency room visits after bike accidents.

Asphalt is not soft, even right next to your house. When a car hits a child, the child flies through the air. The heaviest part of the child—the head—lands first.

Make them wear the dorky helmet, on top of the head please, covering the top of the forehead, and tied snugly under the chin, not dangling on the back of the head. Hang it on the bike handlebars when not in use so that it is the first thing on and the last thing off. Keep a big lock handy so that if you catch them on the bike without the helmet, you can lock it up and they can walk for a week. Sorry kid, that was the rule and you knew it. There is no need for any argument.

Please don’t buy a bike two sizes too big. Your child will fall off. Children should be able to place the balls of their feet on the ground while their rump is on the seat, and their whole foot should be flat when they are standing over the crossbar. An extra bike or two over the years is cheaper than a broken child.

Trampolines

Trampolines are a huge source of income for surgeons and orthopedists. If you would like to make them poor, don’t buy a trampoline. If you have one, please be careful. Most trampoline accidents occur when there is more than one person on the trampoline, especially when they are not the same size. The smaller one goes flying or is fallen upon. Safety nets and pads are better than no safety nets and pads.

On second thought, forget I said all that. Let’s go back to no trampolines. Kids break bones, damage their kidneys, and hurt their heads and spines.

Children will at some point injure themselves because they need to be free to run, swim, and climb monkey bars and trees. Try not to obsess over scraped knees, a goose egg on the forehead, or a few stitches. Everybody gets those, and your children will find a way. Concentrate on the risks that will kill them or seriously injure them: motor vehicle accidents, drowning, fires, poisonings, and gunshots. Don’t go out of your way to buy things that will hurt them, such as trampolines and ATVs. Make it so they have to get creative if they want to injure themselves. Creativity is good, right?

My Rant: It is not Malpractice to be Tired

kidsfightingFair warning: I am on a rant. Skip this one is you don’t want to hear me whine.

In the last few days I have seen doctors in the media picked on because they fell asleep (“Doc, there are patients who need to be seen!”), because they were burnt out, and because they didn’t smile, explain things thoroughly, and ask about the patient’s home life while checking for an ear infection. Doctors fought back with comments about their long hours, intense work schedules, and exhaustion.

It didn’t work. The comments just changed to: “Well, fight for better hours!” Or: “Be willing to make less money!” (umm, I did go into pediatrics…) One person was actually so narrow minded and idiotic as to tell us we were harming patients by working too hard, and that it was sheer laziness that kept us from improving our schedules. That we “were keeping our heads buried in the sand” so that we did not see the important issue: that the business of medicine was as important as the practice of medicine. That what we were doing was “not good enough,” and that doctors never fight for anything. How that person knitted all those ideas together in one head is beyond me, and I don’t believe that I, or any other doctor, deserved it.

First, no one was harmed in any of the situations. The sleeping doc got up and went back to work, probably better for the quick power nap. The child whose doc did not smile and ask about their home life nevertheless fit that child into her already full schedule and took excellent care of her. I have in thirty years never harmed a child because I was exhausted. I did once tell a mother that I was too tired to care for her child and would find them another doc, after which I walked back to the office, sat down, passed out and had a seizure. Doctoring is a different sort of job.

Second, doctors have been fighting far longer than I have been one. We fight with insurance companies every day. Through the AAP we fight in the legislature for pediatric issues. We fight for universal vaccination. We fight for neglected kids, for abused kids, for healthy foods in schools…

Last, our heads are about as far out of the sand as they can get, as we care for children whose parents have poured boiling water over them, for teenage girls gang raped at parties, for gay children who are thinking of slashing their wrists…

There are a limited number of hours in the day, and every single time the kids matter more than how overworked we are.

The one thing that I am never willing to compromise is the care of my patients. Jumping from “doctors are overworked and stressed” to “doctors are harming patients because they are overworked and stressed” is a leap. The data actually proves otherwise.

Presuming we can simply work less and everything will be fine is naïve.

One of the biggest problems right now is that there are simply not enough docs, and fewer of them are going into and staying in primary care. Those of us in the trenches cannot do less when there is no one to take up the slack. Legislation can not fix this problem, and the fact that we are judged and condemned at every turn just puts another nail in the coffin of primary care. The doc above fit an extra patient into her day, took care of the acute problem, and was spat upon because she didn’t smile and answer questions that weren’t even asked. If burnout is a concern, then stringing us up for target practice just because we are doing our jobs is a problem.

So here is my fight for the day, because I do not want to be accused again of not fighting enough: please appreciate the 11 or more years we spent in school and worked for free, accumulating debt while you were already earning a paycheck. Please appreciate the fact that when you call at 2AM, we answer. Please appreciate the times we miss important events in our children’s lives because we are helping someone else’s child. Please appreciate the fact that we carry the responsibility inherent in our jobs on our backs every minute of every day.

A simple “Thank-you for fitting my child into your busy day,” will go much further toward keeping doctors in primary care than any change in our work hours or income. We are not the enemy; we became doctors because we wanted to help people. Please let us do our jobs, and don’t snipe at us because we are tired. The fact that we are tired and overworked is not a good enough reason to fault us. We do not deserve it, and we have earned at least that much respect.

Whether or not the insurance company pays that $35.00 is always going to be at the bottom of my priority list, as it should be. The business of medicine will never and can never be as important as helping that little boy in room 2 to breath better.

Your Daughter’s Vagina

marilynThis week my amazing daughter handed my son-in-law a daughter. This brand new person has lots of silky dark hair, deep blue eyes and 2 dimples. She is a 7# 8oz miracle.

In the last few days my son-in-law has heard endless versions of “You’re in deep trouble, man,” “You’ll need a shotgun,” and “The boys will be after her!” My son-in-law is a deep thinker, so he gave it some deep thought and said, “Why?”

Assuming we want our daughters to have joy in life, fulfillment in their chosen work, family, and love: why then do we not want them to have sex? It seems an essential part of the picture.

When we actually consider why we feel this way, it comes down to the unfortunate fact that we equate a woman’s value with her sexual appeal, but devalue women when they actually have sex. No sex? Virginity and a pedestal. Sex with one man? Mother and Madonna. Sex with more? We have a direct line of descent into whoredom, where your daughter can be given a monetary value.

Then we confuse this scale by judging a woman’s value by how sexy she is. I once heard a med student say about the best kid cancer doc I knew, “What else could she do? She’s damned homely.” We want our daughters to be sexy, but not to have sex.

The valuation for men is perhaps equally harsh, but diametrically opposed. Virginity brings snickers and derision. Faithfulness to one women is sometimes thought to be gullible and foolish. Sex with many women is part of the admirable macho stereotype: men have conquests and “sew their wild oats,” admire James Bond, Casanova and Don Juan, and slap each other on the back as they carve notches into their belts or acquire trophy wives.

Math works, and these numbers do not add up.

There are of course other problems with these assumptions: not only are we devaluing our daughters, we are also making life difficult for our sons. We want our boys to have self respect, good long term relationships with their partners and the maturity to hang around to see their children grow up. Herpes, AIDs, and serial shallow relationships devoid of respect will not bring them this future.

So what is the solution?

We need to give our own values serious consideration, and then evenhandedly teach those values to both our sons and our daughters. We cannot tell our boys that it is OK to get a girl drunk so that she will have sex with them, and then tell our daughters that if they drink too much and have sex they are whores. We cannot tell our boys they are not manly if they choose to wait for love, and our girls that they must wait, or they are trash. It does not work to dress our seven year old daughters in spangles and teach them to hip thrust to sexy music, but then insist they remain innocent.

We need a coherent, honorable, human plan. Consider the future you want for your child, give thought to how sex fits into that future, be fair, be stringently honest, and build rules consistent with that future.

Some simple rules might be: we don’t want you to have sex until you are fully mature; we want you to be in a relationship built on love and mutual respect when you do; we want you to be safe and responsible.

Follow your own rules. Start when your babies are brand new, behave honorably, and be consistent throughout their childhoods. “Do as I say, not as I do” has never and will never work, because in the end your children will know you very well indeed.

  • Watch what you say, both to your own partner and about the other people in your life, because words and judgments will worm their way into your child’s mind and later poke holes in his or her self worth.
  • Keep conversation open, so that when they hear something at school or at a friend’s house they know they can ask you about it. They need to be able to come to you when they have questions. Give them knowledge so that they will be able to make good decisions.
  • Monitor what they see on the internet and on TV. Much of what is on screens these days will need explanation.
  • They will probably make mistakes. When they do, it is perfectly all right to discipline them, because they did break your rules (aren’t you glad you made those rules beforehand, and made sure he or she understood them?) Do not, however, add judgment to the mix. Give them time and space to think and consider the consequences of their actions. Allow them the chance to do better next time. Everyone makes mistakes, and it is hard enough to forgive yourself and go on, without the ones you love adding to the weight of regret in your heart.
  • Never throw labels at them, because labels will leach onto their brains forever. They will never forget that their parent, who should love them no matter what, called them trash, or a slut. They might even feel that they have to live up to the label.
  • Sex is a powerful weapon. If handled well it can bring joy, deepen a loving relationship, and create life. A parent’s example provides the model, good or bad, for their child to follow; thoughtless words from that same parent’s mouth can echo in their brains and make them bleed.
  • Society’s views, as seen in your neighborhood or church, and on the screen in everything from commercials to movies to music, have an impact.
  • How we think about sex, our behavior, and the inner judgments of our own actions effect everything from our relationships to our health, our self esteem to our future.

Sex can be a natural part of a fulfilled life, or it can injure your child’s mind, body and soul, up to the point of self-injury, depression, and death. It is important. It is deserving of respect and careful consideration, and an absolutely equal and consistent application of those conclusions to the parenting of both our sons and our daughters.

My son-in-law is brilliant, you know, and he was right.

Bullying, and the Battle for Equality

Hasardous waste-01This week I have been called immoral, evil, ignorant, and bigoted. I was told I care nothing about children (this after almost 30 years as a pediatrician). I was told that I was going to burn in hell. It has been a very odd week.

None of these things sounded much like the me I know and love.

Each time I was simply standing up for what I believed was right, and the “adults” with whom I was conversing were so astonished when I did not simply cave to their obvious superiority that they went straight to name calling, rather than reason.

I could almost feel the thrill they took in shouting their beliefs from their shaky mountain top, refusing to even consider a different viewpoint.

I am a grown up, I can hold to my beliefs and not shed a tear, but oddly… it still hurt.

So how must it feel as a 10 year old, when enormous adults are towering over you, talking at you and not giving you a moment to speak for yourself? How, when the popular kid in class, the one with all the social power, calls you a dork and shoves you into a wall? How, when you know you are different and different is immoral, ignorant, and hell bound, if only because it does not sanctify their views and might poke a hole in the fragile balloon of their security?

We are fighting in the streets now, for equality not based on religious views, skin color, sex, or sexual preference. I wonder if the people demanding they be respected even though they are Muslim, or Black, see that their fight is the same as those that demand equality even though they are gay. Do the women ( and the Pope! ) fighting for equal pay see their battle as a part of the never-ending fight for all humans to respect each other as equals?

Can we ever get to a point where we realize that no one wins, as long as someone else looses?

That someone else’s success does not subtract from or in any way prevent ours?

As usual with social change, evolution must start with the children. Children are pure potential; their minds are open, interested, and willing to love. A baby looks at any face with wide open eyes and an ear-to-ear smile, not caring what color or sex that face is, what church they go to, or whom they love. We as their parents and teachers sometimes ruin that. We damage their beautiful, open minds and darken their young hearts, forcing our reality upon them. We teach them to smirk and squint, to judge and condemn.

If we want our children to be happy and fulfilled, to be able to think and create, and to be open to the opportunities the world puts in their paths, we must examine our own thoughts, pack the ugly ones up and cart them off. When we catch ourselves starting to say something unkind, we must stop. When we find ourselves treating someone as if they are less, we need to realize that this gives permission for another person to treat our child as if he or she is less. If our children see us treat every person with respect, they will know they also are deserving of respect, simply because everyone is.

Take the positives from our separate cultures and celebrate them, but allow that other cultures have positives too.

Be proud of our accomplishments, but also find it in our hearts to congratulate others on theirs.

Step up when someone is cruel.

Understand that we are not fighting for Gay Rights or Black Justice or Women’s Rights, but for Equality. We cannot hold onto our own rights if we do not grant everyone else theirs. It makes no sense to insist that a person respect our beliefs and then turn around and denigrate theirs. It is immoral to campaign for Black justice then go home and vomit up ugliness about gays or women; to fight for equal pay for women then turn around and gossip about the mixed race marriage down the block.

Until we can give respect, we ourselves do not deserve it, and our children will follow in our path.

When we stand up to our own bullies (especially the ones squatting in our own brains), we teach our children how to stand up to theirs, and they will be able to grasp and hold the life we wish for them.

Perhaps now is a good time to remember the words of Martin Niemöller (1892–1984):

First they came for the Socialists, and I did not speak out—

     Because I was not a Socialist.

Then they came for the Trade Unionists, and I did not speak out—

     Because I was not a Trade Unionist.

Then they came for the Jews, and I did not speak out—

     Because I was not a Jew.

Then they came for me—and there was no one left to speak for me.

 

 

Top Ten Summer Activities to Abolish Boredom

2013-09-06 13.00.12A short gap-toothed person looked at me today, smiled, and said, “…only fourteen more days of school!”

Summer is on its way!

No need to run screaming to hide in a closet. Below are my top ten ideas to fill those sunny days with things that will engage their brains and bodies:

  1. Exercise. They have been cooped up all winter. Throw them outside with a ball, bike or roller skates.
  2. Be creative. All those regimented classes, begone! Break out the finger-paints, colored pencils, and charcoal and let them draw anything they want. Find some sticks and build a fort. Act out a drama. The world is their canvas! I mean that literally: they can draw on bark, rocks, the sidewalk…
  3. Listen to music, and make your own. Break out the kitchen utensils if you don’t have instruments. Write your own songs and play them on pots and pans. This is a two-fer, because you will also build reading skills as you play with the words. Listen to music from other cultures and styles and you will painlessly add on lessons in history and anthroology.
  4. Explore. Hit the museum, the library, and the internet, where the world awaits. If nothing comes to mind, ask them what they find interesting and start with that.
  5. Volunteer. Not only is a great way to spend their time, it also fosters an appreciation for what they already have.
  6. Do chores. Chores bind a family together, allow for pride of accomplishment, teach responsibility, and provide a source of money so you can…
  7. Teach financial lessons. What better way than with summer money? Decide before they have it in their grubby paws what they want to save for and how much of their earnings will go into savings. Then watch the pile grow. This works even better if you can match their savings for a little extra inspiration.
  8. Learn a new skill. Make sure it is something they want to learn, of course. Summer is the traditional time for classes, camps, and music lessons. Have a “we’re only speaking spanish” hour, learn to swim, make a tile mosaic – the options are endless.
  9. Introduce yourselves to strangers, especially those who look different than your usual friends. Compliment what they are wearing, ask about what they are doing – be interested and start a conversation. Seeing the world from another person’s point of view can up possibilities for your child.
  10. Get a modern sort of pen pal. These days it’s as easy as getting a twitter account, search #WhatYourChildFindsInteresting and see who pops up. Your child might end up with friends from all over the world. Umm, monitor that, OK?

Keep them moving, reading, and doing, so they won’t turn into sloths.

Have they ever seen a sloth? Isn’t it amazing how slowly they move? Let’s go find a video on Google! Or hit the library! Or draw a picture of one, and make up a story! Or do the sloth dance!

School will start back in no time.