When Mommy and Baby Are Ill

Help!

As recently as yesterday, I felt horrible. Vomiting, diarrhea, and all the rest of it. Gross I know, but you get the picture.

I was weak and tired, wanting to sleep, sleep all day. Pre-baby, no problem, I would call in sick to work and then rest became my drug of choice.

Since the birth of my daughter all of that has changed.  I am ill this week and  so is my little girl. Trying to juggle a regular day with baby,home and work is hard enough. But when my daughter is ill, the neediness is exponentially increased. Add to that my run down immune system. I felt like I was drowning, with no energy to fight back to the top.

How, how does anyone do it? Work, get sick, take care of yourself, and your child while baby daddy ploughs away at work. I am not sure there are any good answers to that one, except, get help fast from anyone and everyone.

Here are some of my suggestions to surviving your families illnesses:

1.) make your doctor's visit early on.

2.) take your medicine, (especially if it is sleep)

3.) have a back up plan ; someone to help you, a friend, neighbor, relative or a babysitter.  If you cant get a sitter, find another mommy, have a barter "illness" system worked out. She looks after your kid while you are ill and you look after hers the next time.

4.) take shortcuts. I am not one to take a shortcut to most things, must be the medical training. But if there is anytime to take shortcuts now is it!

5.)have frozen food ready for your kid, go online to get groceries, ask a friend to run an emergent errand. 

6.)and occasionally, if it is really bad, call in sick to work or ask your spouse to.

A-typical day

A-typical day

A close friend of mine is 8 months pregnant. In her pre-pregnant life, she was and is an ambitious, witty professional.  She is not in the world of health care. And she is scared ****less about what comes after the pregnancy. Just like I am nervous about my 15 month old daughter's impending adolescence.

My friend wanted to know what motherhood was like. I could not give her just one answer. I could only tell her about my greatest challenge. The work and home life balancing act.

When I was pregnant, I pressed my supervisors to grant me the extended extended 6 month maternity leave. You know the kind that is only available in Australia. I felt so lucky when they said yes! The first 5 months of my daughter's life I knew she benefited greatly from my being at home. After all the griping I did about the difficulty of breastfeeding, I stuck with it, she and I were bonded and she was thankfully happy and healthy. But really, it took me awhile to realize that it was me who needed to be home with her. 

I needed to be the one person who knew her the best. She may have needed me for sustenance, but I needed her for so much more. Early in the morning my husband would bring her into our room, and despite my chronic exhaustion, when she looked at me with a smile of recognition and sounds gushing from her mouth, I became silly putty. Even now. No matter how tired I was, I was as in love.

Time just flew by. She was one month old and then five months old. With all the sleepless nights, I am at a loss for which month she developed which skill. And I'm supposed to be a pediatrician. 

But, the 5th month something changed in me. I don't know when it hit me exactly. I think it was gradual, but it hit me hard. I needed, I had to go back to work. The incessant routine, which I loved: nursing, burping, changing, napping, playing and then starting over was great, but I needed more. 

Before my daughter was born I decided that I would be back at work at 6 months. So I was only a month away. I was excited to get back to work, be a part of an adult world and return to my professional persona. However, I knew that I had learned so much while staying home and I now loved now so much more.  Thinking all of this made feel guilty.

How could I be excited about going back to work. What about my daughter's well being? But what about my needs? This was my ongoing mental ping pong. 

The first day came. With all of the physical preparation of training the babysitter I did not feel any less stressed out. Add to that, my daughter did not sleep at all the night before my first day back at work. It didn't matter though, I was up until midnight also, wondering if after 6 months of maternity leave I would remember how to practice medicine.  Morning came, and leaving was not easy. I can usually separate emotions enough to keep going, a trait most doctors learn in medical school. But today, this time, I could not. I called and checked on her every hour. Asked about every feeding, nap, pee and poo. I was even thinking of her between diagnosing a child with appendicitis and telling a mother her child had asthma. 

My daughter is now 15 months old. She still misses and wants to be with mostly just me. But life for me is the art of balance, and I am hoping the balance of mommy at work a few days and mommy at home a few days is healthy for both of us.

Nutrition-ista

I hate cooking. I mean I really hate cooking. Growing up, I would tell my mom I wanted to become a doctor so I would not have to cook. (as if doctoring and cooking were mutually exclusive.)  My mom would try to make cooking fun and interesting but I could not be convinced. Many meals and years later, I still hate cooking.

Strangely, however, I love the science of nutrition. Nutrition has been a passion of mine since I was 10 years old.  I have always been a curious investigator about the health consequences of food. As a teenager I remember reading food labels (the few items that had them). As an adult I bought into the low fat diet. However, after doing my own investigations, I have shifted my views.

So instead of a low fat or low carb or low-anything diet, I like to eat foods that are whole and fresh (verus processed or preserved).  Like fresh fruits and vegetables. I limit dairy,eggs and meat. I avoid fried and sugary foods. (The sugary part is really hard for me, I have sweet tooth). 

 

Many people wonder what types of foods I choose for my daughter. With my passion for nutrition and dislike for cooking I try and keep it simple.

Here are the top 4 on my list. 

1.) Avocados are an amazing source of nutrients. More importantly, they are a good source of healthy fats.

2.) Walnuts , flax seed , and almonds are yummy. A handful of nuts a day with a fruit can keep you satiated longer than eating the fruit alone. And the nuts are packed with omega 3  

     fatty acids to help prevent heart disease.

3.) Blueberries , raspberries, and strawberries are all packed with antioxidants.

4.) Amaranth its a grain, my daughter eats it as a cereal with cinnamon and ground nuts and berries. She loves it. It is packed with iron and has a low glycemic load.

It is hard to eat fresh foods without staying out of the kitchen. So I do end up cooking.

The most important to do's on the cooking healthy list include:

• Prepare fresh foods daily (avoid things in boxes or packages). I know I said this, but it is so important it deserves to be repeated.
• Prepare your foods in a healthy way.  For example, french fries are unhealthy because they are deep fried. Baked potatoes carry a high glycemic load. The best option is to steam the potato.
• In general, try and cook at temperatures less than 350 degrees to help maintain the nutritional value of the food.
• Use olive oil for sauteing at low temperatures. Use coconut to almond oils for deep frying as they do not turn into free radicals at high heats.
• Mix it up, try adding new ingredients to an old recipe to give it a fresh flavor.
• Cook with flavor. add garlic, cinnamon, ginger, turmeric. These are all good for you with numerous health benefits.

In short, food is medicine, and you are what you eat. So what do you want to be today?

   

 

Parenting from a Teen's Perspective?

An interesting twist indeed.

Vanessa Van Petten and her crew of teen writers gets it right with her blog Radical Parenting.

She offers parents an inside look at how teens are thinking about life. To make it useful, she offers parents practical advice on how to handle difficult situations. 

Some of my favorites include:

1.) Teacup Parenting: Is your Child Too Fragile? :

Vanessa's view on the 4 types of kids she sees and their pitfalls and strengths

2.) 10 Rules Kids Wished Their Parents Lived By

Vanessa and her Teen Team create a list of radical parenting principles they wish parents could hear

3.) Cotton Candy Friends

How social networking, texting, IMing and the Internet are changing teen's friendships

My favorite blog is Cotton Candy Friends. It offers an inside peak to your teenagers reality.

Happy Parenting.

Sexting= teens, sex and pictures

Sexting= Teens, Sex and Pictures

Recently, I had a 15 year-old girl in my office. We'll call her Emma. She was sexting. 

She was sexting many young men at the same time.

Never heard the term "sexting"? You are not alone.

Sexting is sending sexually explicit pictures (of yourself or another) from your computer or cell phone, to another.

Teens are doing it all the time. A study done by the National Campaign to prevent teen and unwanted pregnancy shows that approximately 20% of teens send sexually explicit pictures. There are some experts who doubt that number. But after having asked my patients over the last month, I can say that most of my teens knew someone who had been "sexting".

Why do teens send nude or partially nude pictures of themselves? The national campaign to prevent teen and unwanted pregnancy research indicates that some teens send pictures to people they know online (have never met), while other send them to people they want to hook up with. Some teens send them to boyfriends or girlfriends and end up with complications, as is the case of one young girl in Cincinnati. This high school senior sent a picture to her boyfriend. He shared that picture with other friends. Embarrassed and possibly depressed, she ultimately committed suicide.

The developmental stages of adolescence include concerns with body image and the very real influence of peers. Certainly, like alcohol and drugs, experimentation is another stage of adolescence. If one teen is doing it another can be pressured to do the same. Even if it were something they would not ordinarily do. The study above states that approximately 40% of teens feel pressured to send these pictures.

Unfortunately, in the wrong hands, the pictures can spread like a bad case of the flu. From one teen to another, from one school to another. After the pictures are sent and re-sent, the photographed child can be left exposed often evolving into a victim of bullying and cyberbullying.

Cyberbullying is anew phenomenon that has risen with the advances in technology. From a 2007 report the CDC estimates that cyberbulying is still the least common form of bullying. Those number are likely to increase with technology rapidly becoming accessible to the masses. The repercussions of cyberbullying include low self esteem, difficulty at school and ultimately depression.

Legal ramifications have been a newsworthy complication of sexting. Strictly speaking, sending nude pictures of underage teens is considered child pornography, even if it sent by the teen. It is presumed that receiver and re-sender of these pictures are culpable under current law. Many cases such as this are pending. But, even so, may courts, school and law officer are not sure what to do with complaints of sexting.

Many parents are opposed to the rigorous laws that hold teens accountable for sending these pictures. A young teen journalist wrote for SF gate, "sexting itself is just not that serious." I disagree.

From a health perspective it can be bad. Depression and legal ramifications are only a couple of problems that come with sexting. There are the obvious sexual issues related with sexting. Are these teens left vulnerable to sexual predators? Does sexting make them more likely to engage in sexual activity? Are these teens already engaged in sexual behaviour? The data from the national campaign to prevent teens and unwanted pregnancy seems to indicate that sexting dose make the teen more likely to engage in sexual behaviors.

So who is responsible for the complications of sexting? schools? parents? the law? the website? For now, many of these questions remain unclear because this is a new phenomenon.

Currently, schools and parents are blaming each other. No one is sure what to do. For sure, schools and parents need to work together in educating teens.

An important message teens need to hear comes form the National Campaign to prevent teens and unwanted pregnancy:

1.)  Nothing you send is anonymous

2.) Once you click "send", anyone can get it

3.) It can be illegal

So what happened to Emma? She ran away from home with help of the young adult male who she was sexting. He lives in another state. She stayed with him and did engage in sexual activity with him and another young adult male. She is now back at home with her parents, without a cell phone or Internet access. And fortunately, she is without STD's or an unwanted pregnancy.

Electronic Babysitting

When my husband and I moved into our suburban utopia, sans kids, we bought a giant flat screen TV. A few months later we could boast of having 3 computers, at home. Media (television/Internet) is like breathing, a necessity to my survival. Embarrassing, but true.


As a pediatrician and mother, if you ask me how I feel about television for my 12 month old daughter, all I can say is no thanks. Not now, anyway. That opinion is supported by the American Academy's Policy statement of television viewing in kids under 2 years. In a nutshell, no TV before age 2.

When I mention this at routine well child visits, many parents tell me that they allow their infants to watch 30 minutes to 1 hour day. They go on to say that they use only what they call "educational DVDs", like the popular Baby Einstein. Most parents, assume that these DVDs are actually educational and help kids learn. To be sure, Baby Einstein was created by a single individual, and as far as I understand has no scientific research to prove educational value.


Until now, it has been challenging for me to convince overwhelmed parents that avoiding the television before 2 years is best. I often explain that talking and singing to your child is better than the 30 minutes of television. Most parents understand my thoughts, but they explain life gets in the way: laundry, dinner, dishes etc. And so, visit after visit, parents tell me that their kids get "educational time" with the tube.

But most pediatricians know, intuitively that TV is not helpful for a child's growth. The March 2009 Pediatrics journal describes a study on the relationship between infants, TV and learning. The study concludes that for kids under 3, television does not assist in learning.

The researchers came to that conclusion by studying children from birth to 3 years. They tracked how much time a child spent watching TV from birth until 2 and at age 3 tested cognitive outcomes. What they found was, that kids who watched television did not have increased language and visual skills.


But what I find fascinating is that Baby Einstein uses this same study in the March 2009 journal of pediatrics on its website as a reason to explain why television is not bad for your child. I was stunned when a blog writer for the NY times writes about this same study and says "But here’s what else the study showed: contrary to what the researchers had expected to find, those babies were not WORSE off, either."



I don't know how anyone can draw that conclusion considering that many previous studies have linked children watching television to ADHD, obesity, violent behaviour, and decreased language and motor skills. Other studies have linked television with irregular sleep patterns in kids less than 2. Early television exposure has also been linked to hyperactivity. An important concept to consider when placing your infant in front of the tube. But, again when you read the baby Einstein websites, they handpick only a few studies from the vast research and then suggest that there is no harm.

The study in this months' pediatric journal did have some shortcomings. The researchers did not address exactly what the infants were watching. It also measure outcomes at age 3, and it is possible that this may be too early to test for improvement or detriments in visual and cognitive skills. An earlier study, tested kids at age 6 and determined that watching TV did lead to lower cognitive outcomes. Despite that the study seems to have many strengths. However, I do not interpret the study to suggest that television is not at all detrimental to a child's health.

That said, I, like many of my parents, am tempted to reach out and place my little girl in front of the TV. So far we have avoided putting her in front of the television. (And I do understand that if I had multiple children, it would be much harder to avoid television for the younger child.) I don't believe that my daughter will never watch television. Remember, I live and breathe media. But, I am going to hold out for as long as I can, hopefully until she is 3 years old.

When she does start watching television, it will be limited as the American Academy of Pediatrics recommends. My goal will be to be particular about what she watches, watch television with her, and talk her to about what she is watching. This will help ensure she gets the messages I want her to get.

In the mean time, I will be spending time with my daughter. The developmental studies have proven that talking, singing and spending time with your child, does greatly assist in your child's cognitive development.

So when families do come back to me trying to figure out how to get their kids away from the TV, I offer the following ideas:

Get outside and get moving.

Talk, sing, dance and jump around.

Sit down and play together

Read together

Make up your own stories

Create art
Build something

Cook together

Use your local libraries, parks and recreation areas.

Hopefully, parents who do use television when they really need to do not feel guilty about it. But, it is important to have the correct information before you decide to put your infant in front of the tube.

Demystifying puberty

As a reminder, this blog does not provide any medical advice, just my mommy opinion.  Please talk to your child's pediatrician about any questions you may have.

My daughter is almost one. When I look into her innocent eyes a part of me wants her to remain exactly where she is. The other part of me is enjoying watching her grow, change and evolve. Regardless, someday soon, she will reach the period of adolescent evolution that we call puberty. 

This is what most of us think about when we hear the word puberty:

Most of us, remember silly anecdotes of puberty from our own adolescence. Being physically and socially awkward was what my favorite 80's movies were about.

So here are some reminders of what is happening to your child outwardly.

With girls, their bodies start to change between 8 to 13 years of age. 

Initially, you may notice their breasts starting to form followed by sparse pubic hair. Later, you'll notice a little hair under the arms or body odor. The average female starts menstruation at around 12 years. Generally, your daughter's growth spurt occurs before menstruation.

It is important to remember that every child is different, and can vary from the listed above. If your child, has any signs of puberty before 8 or has not started menstruation by 15, contact your child's pediatrician. 

For boys, the process begins a little later than girls usually between 9-14 years. Initially, the testes increase in size, later the penis increases and then pubic hair arrives.  You may note hair under the arms, and as he progresses he may develop acne and voice changes. Girls usually get their growth spurt earlier than boys of the same age. Just remember, to contact your child's doctor for any questions.

Back to those 80's teen movies. They did a great job of demonstrating the awkwardness of the teen years. But, it is important for parents to recognize the psychosocial impacts of puberty. 

The cognitive development of teen is divided into early (11-13years), middle (13-15) and late (15+) adolescence. It is important to recognize that most teens struggle with the search for independence,their own identity and the need to be "normal".  That need to be "normal"often leads teens to act with their peers, even when they know better.  Teens influence other teens, so know who your child is befriending.  That last sentence is worth repeating. Your teens greatest influence is other teens, so get involved in their life and know who their friends are.

Adolescence is also a time when teens start to exhibit risk taking behaviours, experimenting with sex, drugs, and smoking. Teens struggle with their sexual identity as well. Unfortunately,  teens often do not understand the consequences of their spontaneous behavior. So, talk to your teen, and guide them about how they will handle situations where they are faced with choices about sex and drugs. Teens are often left with less parental supervision as they move towards adulthood. But it seems to me, this is a period of change, where parental supervision is he most important.

All of this leads me stress the importance of communication. You need to communicate often, early and clearly with your teen.  Schools, doctors and family are important tools to help the parent as part of the communication process. But, parents are always around, and know their teens. That is why it is important to have the conversation about puberty and all that comes with it often and at an early age.  If you are comfortable discussing puberty with your teen, your teen may eventually become comfortable discussing it with you as well. Instead of waiting for your teenager to ask you about sex, drugs, and all those taboo topics, you, the parent should start the conversation.  Other problems which appear around adolescence include, depression and eating disorders.

Puberty is an ongoing process, so the dialogue around it should be ongoing as well.  Instead of just "one" conversation about puberty,  go to the library, check the Internet,  and get information together to learn about puberty together.  Talk about her fears, pressures of being a teen, long term goals, short term goals. This openness will allow you to understand how to guide your teen. When in doubt, seek professional help.

This is how we should be thinking about puberty and all the changes that come with it with the bulk of the responsibility on families.

                                   

For links to helpful information on this topic click on www.thedrmommy.blogpspot.com and scroll to the bottom of the post.

www.kidshealth.org

www.nichd.nih.gov/health/topics/puberty/cfm

www.familydoctor.org/onling/famdocen/home/children/parents/parents-teens/445.html

Books:

Age: 6-10  

Where do babies come from? by Ruth S. Hummel

Age 9-12

It's Perfectly Normal: Changing Bodies, Growing up, Sex, and Sexual Health; by Robie Harris; 

Age 13-18

The Underground Guide To Teenage Sexuality; An Essential Handbook for Today's Teens & Parents, by Michael Basso

Remember, get them involved in the search, you don't have to have all the answers, pick up a book and learn together.