Zika Virus: An Update

Aedes mosquito-01The Zika virus was first isolated from a Rhesus Macaque monkey in 1947 in the Zika Forest in Uganda (zika meaning “overgrown” in the Luganda language–gotta love useless trivia!); it was first isolated from a human in 1954 in Nigeria. It appeared sporadically along the equator in Africa and Asia for several decades until it spread to French Polynesia in 2013 and then to Latin America, Mexico, the Caribbean, and now the US.

Illness from Zika was rare until the pandemic began in 2007. The illness it caused was mild and self-limited until October 2015, when we began to see babies with microcephaly (very small brains) born to mothers who had been infected while pregnant. Evidence shows that these babies may also have eye abnormalities that will  effect their vision. There have been links to serious deformities in the joints in the arms and legs of affected babies. A report published August 30, 2016 noted that 6% of the babies affected by Zika also have hearing loss. According to the AAP as of November 4, 2016, their are five main birth defects: severe microcephaly with partially collapsed skull, decreased brain tissue with subcortical calcifications, extreme muscle tone, eye damage with macular scarring and increased pigment, and limited joint motion range.

There have now been more than 1500 cases of microcephaly in Brazil; in the most severe areas the incidence has been as high as 1:100 births.  On August 15, 2016 a state of emergency was declared in Puerto Rico, where they now have 10,690 confirmed Zika cases, including 1,035 pregnant women. Currently, more than 500 pregnant women in the US have shown evidence of a possible Zika infection.

Symptoms

Zika is a flavivirus related to Dengue, Chikungunya, and West Nile encephalitis. It is transmitted by several species of Aedes mosquitos which can, after biting an infected human, infect another person. Transmission has also been reported through blood transfusions and sexual contact.

The newly infected person may not have any symptoms at all, or may develop symptoms of illness within 2 weeks: fever, a bumpy red rash, sore joints, and pink eye. Less common symptoms include aching muscles, headache, and vomiting. The illness itself is usually mild and self limited.

Treatment

There is no preventative vaccine available yet and no treatment, other than pushing fluids, resting, and treating the symptoms with acetaminophen (Tylenol). The ill person should not take aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve) until Dengue fever is ruled out, to avoid the risk of bleeding.

Where is it?

As of now, local transmission has been reported in more than 0 countries and territories. Current recommendations are that women who are pregnant, especially in their first trimester, do not travel to any of these areas. If they have to travel, they should do what they can to protect themselves from mosquito bites: wear long pants and long sleeved shirts, preferably treated with permethrin insect repellant; sleep in air conditioned rooms, screened in areas or with permethrin treated mosquito nets; and wear insect repellant, because these mosquitos are active during the daytime.

If you do travel to these areas and develop the symptoms of Zika after returning home, pregnant or not, see your doctor. Avoid mosquitos for the first few days, so that you will not be the source of spreading infection.

Men who have had Zika should use barriers during sex for at least 6 months after the infection; women for 8 weeks. Use of a barrier is recommended for at least 8 weeks after travel to endemic areas even if you have no symptoms.

As of today, we have had 1962 confirmed cases of the infection in the US, with 413 in Florida. Twenty eight of those were caught from local mosquitos. We have the Aedes mosquito along our southern coast and in southern California.

Prevention

In all likelihood the same measures we used to contain Denque in the US will contain Zika, but its spread is still possible. Taking precautions is certainly sensible.

  • Get rid of standing, stagnant water.
  • Clean up piles of garbage, because mosquitos love to breed in trash.
  • Put up or repair your window screens.
  • Spray.

Another possibility to limit spread of the infection is releasing GMO mosquitos with a lethal gene, to decrease the population of the bugs. When this was done in the Caman Islands the mosquito population decreased by 80%.

If you are pregnant, stay out of the endemic areas when possible. Take sensible precautions: clean up standing water and trash, put up or repair window screens, and wear insect repellant.

And keep an eye out for current recommendations from public health officials, because the places and numbers change daily.

DomesticatedMomster
The Blogger's Pit Stop

Summertime Injuries: Preventing the Scary Stuff

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 themselves… 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?

Domesticated Momster
The Blogger's Pit Stop

Fever is Good. Really.

sick kid-01In about 400 BC, Hippocrates said “Give me the power to create a fever, and I shall cure any disease.” Hippocrates knew that fever was a symptom of disease, not the disease itself. It is the body’s response to illness-its defense against infection.

It’s 2400 years later, and I still spend my days telling people that fever is good, we want fever, fever means that our child’s immune system is working… Fever rules!

A normal human oral temperature is between 97.6 and 99.6 degrees Fahrenheit (37.5 – 38.3 Centigrade). Rectal temps are about a degree higher, axillary and ear temps about a degree lower. Temperatures vary by about a degree through the day, increase when you exercise, and vary from person to person.

The most common cause of fever is infection, but there are other causes: illicit drug use (amphetamines and cocaine), medicine side effects, brain trauma, heat stroke, cancer, vaccine reactions, hyperthyroidism, and inflammatory diseases like lupus, rheumatoid arthritis, and irritable bowel disease. Most of the non-infectious causes give a persistent fever, while fever from infection generally gets better after 3-5 days.

Note that teething was not on that list. Teething can increase a baby’s body temp a little, but not to the point of fever.

Pediatricians define fever as a rectal temp above 100.4 F. Random, but it works as a general rule of thumb.

We get fever when a part of the brain called the hypothalamus is triggered by “pyrogens,” which cause release of prostaglandin E2. Prostaglandin E2 resets the hypothalamus to a higher temperature, like the thermostat in a house. This causes peripheral blood vessels to constrict (thus your munchkins cold hands), generation of more heat, and shivering (small muscle constriction to generate even more heat).

Fever works to fight infection in a variety of ways. High temperatures:

  • Limit the spread of a virus (like the common cold),  by blocking that virus’s ability to explode the cells in which it has been multiplying to spread further throughout your body.
  • Hinder a bacteria (like strep throat)’s ability to divide and make more bacteria.
  • White blood cells, the cells that fight infection, move around better with a fever.
  • White blood cells also chomp on bacteria better with that high temp (phagocytosis).
  • Toxins produced by bacteria don’t work as effectively with a fever.
  • T-cells, which also fight infection, proliferate better.

Fever is good.

There are doctors who will tell people that they should never treat a fever. I, however, am in the “treat for comfort” camp. Fever generally makes kids feel tired (not always a bad thing), fussy, and can make them feel cold. It is uncomfortable and can burn off a lot of fluid at a time when we want our children to stay hydrated. A rapid change in temperature in a young child (6 months to about 5 years) can cause a febrile seizure. If your child is miserable, not drinking as much as you would like, or in pain from a sore throat or headache, acetaminophen or ibuprofen will help him or her to feel better.

Brain damage occurs with temperatures above 108 F (42 C), with things like anesthesia reactions and heat stroke. Only in Hollywood do you get brain damage from a common illness with a 104 F  temperature.

Normal childhood viral infections like colds and gastroenteritis generally trigger fevers in the 99 F to 104 F range. Fevers tend to go up a little in the morning, improve during the day, and spike higher at night. That 103 temperature that improves during the day but then spikes at 10 PM is actually pretty reassuring, because that is the classic viral fever curve. Kids generally get better on their own with rest, fluids, and time.

Bacterial infections, like strep throat, pneumonia, or sepsis, are more serious and sometimes need treatment with antibiotics. They classically give fever all day long, rather than in that morning and evening viral pattern. They are accompanied by symptoms specific to the source of the infection, like lethargy, breathing problems, sore throat, earache, or pain with urination.

So, when to worry? Your doc will want to see any baby under 3 months with a fever, because their immune systems are inexperienced at that age. We like to see kids with 104 F temperatures or fevers that persist longer than 3 nights, just to make sure there isn’t anything bad going on. Call us if your munchkin has trouble breathing, lethargy, inconsolable irritability, an earache, or pain with urination. We like to see kids with fever if they have compromised immune systems or serious medical problems. We like to see kids with fever caused by heat stroke rather than infection.

Never throw them into a cool bath or rub them down with alcohol, because fever seizures are caused by a rapid change in temperature, not by the actual height of the temperature. It is safe to give a child a tepid bath about an hour after they have a dose of acetaminophen or ibuprofen, because the medicine will keep the temperature from bouncing back up.

Never give aspirin to kids because it has been linked to Reye’s syndrome.

And if you’re worried, call your pediatrician. It’s what we’re here for.

Domesticated Momster

Lead, and the Children of Flint

Toddler-Playing-With-A-Chair-01In April of 2014 politicians in Flint, Michigan changed the city’s water supply from Lake Huron and the Detroit River to the Flint River, in order to save money. The water from the Flint River was more acidic and had more salt and chlorine in it, and it corroded the aging lead pipes through which it flowed, allowing lead into the water and poisoning the inhabitants of Flint.

The EPA allows 15 ppm (parts per million) of lead in drinking water. Water from homes in Flint tested as high as 13.2 thousand ppm. Lead levels in children’s blood doubled, then doubled again.

Nontombi Naomi Tutu said we “needed the people of Flint to remind the people of this country what happens when political expediency, when financial concerns, overshadow justice and humanity.”

Why do we worry about Lead?

Lead is a soft gray heavy metal that functions in our bodies as a neurotoxin–it poisons nerves. Acute lead poisoning causes headaches, stomach pain, clumsiness, agitation or drowsiness, convulsions and death.

Chronic lead poisoning is more insidious. Lead is most harmful to infants, children and pregnant woman, because it damages developing nerves. Kids who are poorly nourished will be more affected because deficiencies in iron, calcium and zinc increase their body’s absorption of lead. Babies are more at risk because they live closer to floors and surfaces and everything goes into their mouths. Exposed children:

  • can lose cognitive function and develop speech and reading problems.
  • can be unable to focus and organize their thoughts, and exhibit behavior problems.
  • have a higher school dropout rate, problems with aggression, and a higher rate of delinquency.
  • can have damage to their hearing.
  • will have problems growing because lead messes with their ability to use Vitamin D and iron.
  • become anemic, which leaves them less able to transport oxygen around their bodies.
  • can cause damage to their kidneys, giving them lifelong problems with hypertension and cardiovascular disease.

Where is lead found?

When I was a kid we wrote with lead pencils and had lead in our gasoline!

Nowadays, lead is used in some industries, found in deteriorating lead paint in old houses, and leached out of old lead water pipes and pipes with lead solder. We also occasionally run into it in old toys, old Christmas decorations, and jewelry, and in toys, ceramics and cans imported from other countries. Cosmetics such as surma and kohl can have lead, as can some home remedies and dietary supplements. A few years ago there were crayons with lead in them. The manufacturer said, “Kids weren’t supposed to eat them!”

Ideally, we prevent lead poisoning.

  • If you work in an industry that uses lead, take off your shoes when you enter your home.
  • Don’t give your kids old toys and jewelry to chew on.
  • If you have lead pipes in your home, run the water for 30 seconds before you use any of it to drink or cook, because lead will gradually leach from the pipes it is sitting in. Never drink or cook with water run hot from the tap–hot water leaches out more lead.
  • If you live in an old house, clean up peeling paint and household dust with a wet mop.
  • Check for lead paint before any home renovations.
  • If you have well water, test it for lead. Most well filters do remove lead.
  • Give your child a nutritious diet to avoid deficiencies in iron, calcium, and zinc.

Treatment for Lead Poisoning:

Pediatricians generally check children’s lead levels at 12 months and sometimes 2 years, and any time there is concern.

Treatment of lead poisoning varies with how high the level is.

Between 5 and 45 mcg/dl, treatment involves finding and eliminating the source and optimizing the child’s nutrition. Levels as low as 5 mcg/dl have been shown to have lasting effects on children, but chelation therapy at these levels has not been proven to have any effect on kids’ cognitive ability or behavior.

Kids with levels over 45 mcg/dl need to be treated with chelating agents, which can be quite dangerous. Chelators bind the metal in the blood and improve its excretion into urine and stool. Unfortunately chelators also bind minerals that your child’s body needs for normal growth and development. Also, kids can be allergic to the chelators, and the medicine can damage their liver or kidneys.

Far better to prevent the exposure.

I do not have words for how horribly the people of Flint were betrayed by their elected officials.

Some resources if you have concerns:

  • EPA Safe Drinking Water Hotline  800-426-4791
  • Poison Control 800-222-1222
  • Pediatric Environmental Health Specialty Unit Network (PEHSU) 888-347-2632

 

Domesticated Momster

Zika Virus and the Brain of the Unborn

Aedes mosquito-01The Zika virus was first isolated from a Rhesus Macaque monkey in 1947 in the Zika Forest in Uganda (zika meaning “overgrown” in the Luganda language–gotta love useless trivia!); it was first isolated from a human in 1954 in Nigeria. It appeared sporadically along the equator in Africa and Asia for several decades until it spread to French Polynesia in 2013 and then to Latin America, Mexico, the Caribbean, and now the US.

Illness from Zika was rare until the pandemic began in 2007. The illness it caused was mild and self-limited until October 2015, when we began to see babies with microcephaly (very small brains) born to mothers who had been infected while pregnant. New evidence shows that these babies may also have eye abnormalities that will  effect their vision.

There have now been more than 1500 cases of microcephaly in Brazil; in the most severe areas the incidence has been as high as 1:100 births.  On August 15, 2016 a state of emergency was declared in Puerto Rico, where they now have 10,690 confirmed Zika cases, including 1,035 pregnant women. Currently, more than 500 pregnant women in the US have shown evidence of a possible Zika infection.

Symptoms

Zika is a flavivirus related to Dengue, Chikungunya, and West Nile encephalitis. It is transmitted by several species of Aedes mosquitos which can, after biting an infected human, infect another person. Transmission has also been reported through blood transfusions and sexual contact.

The newly infected person may not have any symptoms at all, or may develop symptoms of illness within 2 weeks: fever, a bumpy red rash, sore joints, and pink eye. Less common symptoms include aching muscles, headache, and vomiting. The illness itself is usually mild and self limited.

Treatment

There is no preventative vaccine available yet and no treatment, other than pushing fluids, resting, and treating the symptoms with acetaminophen (Tylenol). The ill person should not take aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve) until Dengue fever is ruled out, to avoid the risk of bleeding.

Where is it?

As of now, local transmission has been reported in more than 50 countries and territories. Current recommendations are that women who are pregnant, especially in their first trimester, do not travel to any of these areas. If they have to travel, they should do what they can to protect themselves from mosquito bites: wear long pants and long sleeved shirts, preferably treated with permethrin insect repellant; sleep in air conditioned rooms, screened in areas or with permethrin treated mosquito nets; and wear insect repellant, because these mosquitos are active during the daytime.

If you do travel to these areas and develop the symptoms of Zika after returning home, pregnant or not, see your doctor. Avoid mosquitos for the first few days, so that you will not be the source of spreading infection.

Men who have had Zika should use barriers during sex for at least 6 months after the infection; women for 8 weeks. Use of a barrier is recommended for at least 8 weeks after travel to endemic areas even if you have no symptoms.

As of today, we have had 1962 confirmed cases of the infection in the US, with 413 in Florida. Twenty eight of those were caught from local mosquitos. We have the Aedes mosquito along our southern coast and in southern California.

Prevention

In all likelihood the same measures we used to contain Denque in the US will contain Zika, but its spread is still possible. Taking precautions is certainly sensible.

  • Get rid of standing, stagnant water.
  • Clean up piles of garbage, because mosquitos love to breed in trash.
  • Put up or repair your window screens.
  • Spray.

Another possibility to limit spread of the infection is releasing GMO mosquitos with a lethal gene, to decrease the population of the bugs. When this was done in the Caman Islands the mosquito population decreased by 80%.

If you are pregnant, stay out of the endemic areas when possible. Take sensible precautions: clean up standing water and trash, put up or repair window screens, and wear insect repellant.

And keep an eye out for current recommendations from public health officials, because the places and numbers change daily.

 

Domesticated Momster

How to Play with a Two Year Old

toddler with toy-01Two year old’s are different. They are too big to carry around and talk at, but too little to hit a ball with a stick. Games don’t work because they can’t understand the rules: they have more fun throwing game pieces in the air or sorting them into like colors or shapes, than they would moving them around a board.

Before you hang out with a two year old it is useful to understand their world view.

In a two year old’s mind, they are the center of the universe with the whole world revolving around them, for their amusement alone. They are just beginning to see themselves as separate people, and just starting to enjoy the company of other children. Everything that happens has to be caused by something they did, because what else is there? They are not terribly clear on what is reality and what is fantasy.

This world view is part of the reason they don’t understand when things do not go their way, or when people leave or die.

Developmentally, a two year old is beginning to think. They can form concepts in their minds. Where before they learned by touching, seeing, and manipulating objects, now they can form images in their brains and work through scenarios to solve problems. They begin to understand cause and effect.

As part of this thinking thing, they sometimes try out independence and defiance.

Separation anxiety also shows up here because they can now understand that when you walk away you are going somewhere else, away from them, with no surety that you will ever come back.

Physical skills are, of course, a big part of play. A two year old should be walking well and beginning to run. They should be able to carry a toy or pull one behind them. They can kick a ball, although not well. They like to pour things out of containers, and can build towers of about 4 blocks.

Language development is also important in play.  A two year old can usually point to things you name, repeat words after you, and speak in simple phrases. He or she can follow simple instructions (not game rules).

So, given this brain, how to play with them?

First, get down at their level and look them in the eye. Listen to them. Then prepare to be drug around by a finger and told what to do, because a two year old likes to be in charge. She will be most interested in toys that challenge her or teach her something new, as long as they are not beyond her abilities. He will want to imitate his grown-ups or his older siblings. They will want to act out action sequences: first put the baby doll in the chair, then feed it, then it’s time for a bath. They like to sort things by shape and color. And last, they want to be told how wonderful they are when they figure something out.

Every bit of play is a learning opportunity and a chance to develop their self confidence.

One warning: a two year old has a very shaky understanding of cause and effect, and does not yet learn from experience. He or she will do again that action that hurt them the first time–which explains why they keep putting things up their noses. They have yet to learn self control, and have little experience with anger. They need constant supervision because they are physically capable of doing some very scary things, and not mentally capable of understanding injury and death.

So hold out that finger, and prepare to be drug around and dictated to. Enjoy being invited into the center of their universe. You’ll miss it when they are 13 and want to pretend you do not exist.

Dometicated Momster

Parenting: Top Ten Transforming New Year’s Resolutions

storkHappy New Year! Time for those resolutions. This year, instead of resolving to lose that last ten pounds or eat more veggies (although I will applaud you if you do), resolve to do the best job at parenting. The reward is so much bigger than going down a clothing size! So, my Top 10 Amazing New Year’s Parenting Resolutions:

I will henceforth…

10. Require chores. Equal participation is fundamental to receive the reward of being in a family. The pride your child feels serving the carrots he helped peel is well worth the time it takes to get him to do it. Every member of the family contributes, to the best of their ability. Family bonds and trust will form over the raking of leaves.

9.   Make rules, and enforce them consistently. Rules keep kids safe, teach them right from wrong, and civilize them. Make sure your child understands the rules, and every single adult in his life needs to enforce every rule each and every time, the first time it is broken. No “warnings,” because you made sure ahead of time that they understood the rule. Decide what the consequence will be for a broken rule long before you need to do it; make the punishment appropriate for the crime (timeout? loss of the toy? paying for the damage?).

8.   Feed my munchkin a healthy diet: whole foods that look like they either grew out of the ground or walked on it (I know, but not everyone is a vegetarian). Teach your children to eat when they’re hungry, and stop eating when they’re not hungry anymore. Aim for about half fruits and vegies and about half protein (meat, eggs, cheese, beans or nuts) and starch (potatoes, bread, pasta, corn). Everything else will be easier if they are well nourished.

7.   Keep a regular sleep schedule – both enough hours and at about the same time every day – as much as possible. Kids who are short on sleep are irritable, tired and have no attention span. Everything else will be easier if he or she has had enough sleep.

6.   Keep them safe when I can. There are lots of surprises out there to keep life interesting; there is no need to risk the preventable injuries. Use those seat belts and bike helmets, lock up the household poisons, guns and Grandma’s meds, and get those vaccines.

5.   Teach financial responsibility. Spend less than you make, stay out of debt, and save for the future. Do it where they can see you and explain what you are doing. Go through your budget with them in an age appropriate way, and feel free to say, “We can’t afford that.” Give them an allowance for those chores and require that they save some.

4.   Not wear blinders. Your primary job is to protect this child, even if it is sometimes from themselves. Children will lie, take things that are not theirs, and sneak out at night when they are 14. You need to catch them so that they learn that it doesn’t work. If they get caught stealing at 7, they have an embarrassing memory of having to go back and pay for what they took. If they get caught at 25, they land in jail and loose their job, partner, and children.

3.   Give them love without condition the child you have, not the one you dreamed they would be. Love is not a prize you can give when your child is good, and take away when they do not live up to your expectations. Without the absolute faith that no matter what happens or what horrible thing they do you will still love them, the foundation on which they build their life will by shaky and unstable. You chose to have them; unconditional love was part of the deal.

2.   Nurture my child’s unique talents and abilities; don’t try to fit the ones you want them to have on their unsuitable frame. This little person is an original – why would you want to shove him or her into a standard form? And what irreplaceable gifts would be forever lost because you did not value them? Respect the exceptional person that he or she is.

1.   Inspire them with myown life. Be what you hope for them. Find work you love, maintain a healthy relationship with your partner, eat a healthy diet, and exercise. Learn something new every day. Never lie. Give respect, and demand it for yourself. Keep an open mind, explore the world and grab opportunities when they happen by. Make your children proud.

Reading Milestones

ROARlogo2-01This week’s blog comes curtesy of the Reach out and Read program.

Reading together is the single most important thing you can do to develop language skills and learning ability in your children, especially between the ages of six months and five years. Nothing will do more to prepare kids to excel in school: reading increases their vocabulary, their understanding of phonics, familiarity with the printed word, storytelling ability, and comprehension. Snuggling up and reading with your children will also help them feel loved and secure; do this at bedtime and it will help them sleep.

All this is before we get to the actual contents of the books!

For tricks on how to read to tiny people, check out my blog on Growing Brains.

Read, love reading, and encourage your children to love reading and their world will open up with possibilities.

The Reach out and Read people have come up with a very neat chart of reading milestones by age, from six months to five years. I thought I should share. Just click on it to make it bigger:

Reading Milestones

Domesticated Momster

Conflict Resolution in Parenting: Prevention

CinemaUsher-01A good friend of mine, not realizing how complex a subject it was, and how much work it would be, asked me to write a blog about conflict resolution.

He may no longer be on my good list (coal for Christmas, you!), but for the next few weeks I will be blogging about conflict resolution because he got me thinking. This week is for the groundwork: exploring the issues that are at the root of many conflicts between parents. Next week will be about the most (and least) effective ways to fix those conflicts; after that we can expand into parent-child conflicts and those between children.

The first, most important, and absolutely non-negotiable concrete foundation of conflict resolution between parents is that parents are equal partners, and have to respect each other as such. You chose to have a child together. It is the privilege and responsibility of both to parent. It does not matter if you are married, partners, or single, or if one parent is taller, stronger, richer, smarter, more talented…. That child belongs to both of you and needs both of you. I once saw a child in the post office with a parent on either side holding onto an arm and pulling. Don’t do that. Your child is not a rope in a tug of war.

Conflicts can only be resolved by compromise. If one side wholly wins, the other has no choice but to keep fighting. Both sides have to give a little; both have to feel that they have won something. None of us are always right; we can afford to be flexible. In the end it is far more important that your children see that their parents respect each other, can listen to each other and discuss problems, and are able to compromise, than whether or not their bedtime can be changed, or they can go to a party.

If parents cannot respect each other as equals, that is the lesson their child will absorb, and someday he or she might accept something less than respect from their partner.

The structure we build on that foundation is agreement on common goals. It seems, going into parenting, that we should all have the same obvious goals. We want our child alive, healthy, happy, self-confident… Obvious, yes? It’s amazing how much variation there is within these bounds. Ideally, parents discuss and agree on goals for their children before they actually have any. In reality, many parents discuss religion and not much else.

So, ten things to talk about with your partner before things go ka-BOOM:

  1. Where you will live: Having a child is a lifetime commitment, so this means 20 years of where you will live, not just right now. Talk about location, type of home, whether you want to be near family, if you will move for a better job…  whatever is important to you. Things change, and it is nice to know where your partner stands on the subject ahead of time.
  2. Finance: Children need security to feel safe enough to explore and grow. Financial worries can plant their lives on shifting sands. Sit down together and figure out how much money you make, what you will spend it on, and how you will save for an emergency and the future. Make a budget. Your child does not want to loose a parent over the electric bill.
  3. Diet: You want them to be healthy, right? Not to have diabetes at 12, back pain at 15, and heart disease at 40? That means agreeing on what to feed them, and on being a good example yourself. It also includes not using food for emotional support or rewards. And don’t get me started on using food so that your child will like you better than the other parent.
  4. Routines and schedules: How obsessive are you going to be about homework, meal times, and bedtime routines? Routines can be incredibly helpful: kids don’t argue over something (like bedtime) that is a habit. On the other hand, routines can become rigid and squash all random opportunities and creativity. Where do  you put that balance? Routines work only if both parents are in agreement on them, so talk.
  5. Sleeping arrangements: I have seen more than a few marriages end in an ugly divorce over this one. There is really no moral right or wrong on it, but you must both agree. Just don’t co-sleep with a baby under 6 months. I’ve lost two small patients that way, and never want to lose another. Just don’t.
  6. Education: How important is school? (Guess which side I took on this one) Are some subjects more important than others? Do actual grades and the particular school matter, or is it learning and inspiration that is important? How about learning technical skills versus book learning? How about “useful” skills versus not so obviously useful? Did I mention that I also have an a degree in anthropology? I am married to an engineer. We have discussions.
  7. Careers: Which career choices are acceptable, and which are not? You might want to write these down and then switch lists – surprise! When I was a child, my options were nurse, teacher, or housewife. My mother had crossed “nun” off the list and not replaced it with anything. I was a big surprise.
  8. Athletics: How important are sports? Life ending? Or just done to be well rounded and get exercise? Any particular sport in mind?
  9. Criminal behavior: This is a biggie. Children start out as small barbarians, travel through self-involved, and wander into insecure before they become adults. They will try out hitting, biting, lying and stealing along the way. How will you react? What will you do to discourage this behavior?
  10. Privacy: Children have no legal right to privacy. They have what you give them, and they deserve your protection from their own … lack of insight, so their privacy cannot be absolute. Where is that line? How much do you trust before you verify?

So, I have managed to write a blog on conflict resolution without ever discussing how to resolve a conflict. Hmm. We will do that next week. First and foremost: respect your partner and set common goals. Once you have that foundation and framework, everything else falls into place more easily. With a little nudge. Or two.

Build that foundation. If parents endlessly argue and fight, marriages self destruct; if parents cannot treat each other with respect and decide on common goals, children self destruct.

Have that conversation before you need it.

Top Ten Rules for How to Raise a Child You Will Like as a Grown-up

storkWe spent last Saturday at BabyPalooza, handing out T-shirts and talking about the importance of reading. There were many lovely, very round, exhausted women, and many questions. Apparently, babies still don’t come with an instruction manual, so here goes: not too long, so you can read it in the scant minutes you have when you are not so exhausted that your eyes won’t focus.

How to Raise a Kid you will like as a Grown-up:

10. Require chores. Equal participation is fundamental to receive the reward of being in a family. The pride your child feels serving the carrots he helped peel is well worth the time it takes to get him to do it. Every member of the family contributes, to the best of their ability. Family bonds and trust will form over the raking of leaves.

9.   Make rules, and enforce them consistently. Rules keep kids safe, teach them right from wrong, and civilize them. Make sure your child understands the rules, and every single adult in his life needs to enforce every rule each and every time, the first time it is broken. No “warnings,” because you made sure ahead of time that they understood the rule. Decide what the consequence will be for a broken rule long before you need to do it; make the punishment appropriate for the crime (timeout? loss of the toy? paying for the damage?).

8.   Feed your munchkin a healthy diet: whole foods that look like they either grew out of the ground or walked on it (I know, but not everyone is a vegetarian). Teach your children to eat when they’re hungry, and stop eating when they’re not hungry anymore. Aim for about half fruits and vegies and about half protein (meat, eggs, cheese, beans or nuts) and starch (potatoes, bread, pasta, corn). Everything else will be easier if they are well nourished.

7.   Keep a regular sleep schedule – both enough hours and at about the same time every day – as much as possible. Kids who are short on sleep are irritable, tired and have no attention span. Everything else will be easier if he or she has had enough sleep.

6.   Keep them safe when you can. There are lots of surprises out there to keep life interesting; there is no need to risk the preventable injuries. Use those seat belts and bike helmets, lock up the household poisons, guns and Grandma’s meds, and get those vaccines.

5.   Teach financial responsibility. Spend less than you make, stay out of debt, and save for the future. Do it where they can see you and explain what you are doing. Go through your budget with them in an age appropriate way, and feel free to say, “We can’t afford that.” Give them an allowance for those chores and require that they save some.

4.   Don’t wear blinders. Your primary job is to protect this child, even if it is sometimes from themselves. Children will lie, take things that are not theirs, and sneak out at night when they are 14. You need to catch them so that they learn that it doesn’t work. If they get caught stealing at 7, they have an embarrassing memory of having to go back and pay for what they took. If they get caught at 25, they land in jail and loose their job, partner, and children.

3.   Love without condition the child you have, not the one you dreamed they would be. Love is not a prize you can give when your child is good, and take away when they do not live up to your expectations. Without the absolute faith that no matter what happens or what horrible thing they do you will still love them, the foundation on which they build their life will by shaky and unstable. You chose to have them; unconditional love was part of the deal.

2.   Nurture your child’s unique talents and abilities; don’t try to fit the ones you want them to have on their unsuitable frame. This little person is an original – why would you want to shove him or her into a standard form? And what irreplaceable gifts would be forever lost because you did not value them? Respect the exceptional person that he or she is.

1.   Inspire them with your own life. Be what you hope for them. Find work you love, maintain a healthy relationship with your partner, eat a healthy diet, and exercise. Learn something new every day. Never lie. Give respect, and demand it for yourself. Keep an open mind, explore the world and grab opportunities when they happen by. Make your children proud.