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. 

Should I Vaccinate My Baby?

Disclaimer: this blog does not constitute medical advice. Please contact your doctor for advice. The names of the patient and mother have been changed.


One afternoon, on a busy winter day, I saw a patient in my partners practice. She was a 15 month old healthy toddler named Emma. Kate, Emma's mother, tearfully explained to me that Emma had had a raging fever of 103, for 3 days. Kate was upset because the fever would not go away, and now Emma was developing a rash which was worsening. Emma was becoming more irritable and miserable.

Emma was so uncomfortable, that she would barely let me examine her. 15 minutes and all of my energy later, (and all of poor Emma's too), I was able to coax her into a quick check. I discovered that Emma had chickenpox.

Kate, proceeded to explain to me that Emma had 2 other siblings at home, a 10 and 13 year old. Kate had chosen not to vaccinate them hoping they would get the chickenpox "naturally". Kate assumed chicken pox was harmless and could not develop into a severe illness. After seeing Emma miserable and suffering, Kate tearfully regretted her choice not to vaccinate her kids.

Because of Kate's decision not to vaccinate, Emma was ill. Although severe complications of chickenpox are rare, they do occur and include neurologic and skin infections.

Given the option to prevent the possibility of these complications Kate now felt that her own reasons for choosing not to vaccinate her children were unclear even to her.

This is a common scenario in the office. Parents choose for one reason or another, not to vaccinate their child. Sometimes, it is the mythical link between autism and vaccines, which has been repeatedly been dis proven by science, and now by the courts. However, these myths plant the seeds of fear into the minds of many concerned parents. And like all myths, the voice of one misinformed parent can cause panic and replace actual facts for many other parents.

So when parents and friends come to me for my advice on the subject I talk to them about the disease in the pictures below. These diseases are real, and sadly do still occur in other parts of the world.

I talk to them about how they feel about the picture below: a young child with tetanus

or this: Two young boys with polio:

or what little Emma could have been facing: A complication of Chickenpox (varicella)

Many of us are fortunate enough that our kids have access to vaccines. We are lucky, we have a choice. A choice which allows us to prevent the spread of these types of debilitating diseases. Many kids in the developing world have no choice. They are faced with the possibility of these illnesses daily.

It is important for parents to remember that these are the diseases that vaccines prevent. Many children and parent don't have a choice. We do.

Choose facts, not fear.

For more information, talk to your child's doctor. Please check out the links below.

Websites:

www.aap.org

www.vaccineinformation.org

www.vaccinesafety.org

www.cdc.org

Top Ten Dont waste your money on!

I love to shop. But I don't like to buy anything unless I know I need it. So when I was pregnant with my little girl, I decided I would shop, but only if the item was functional, practical and necessary.

So here are my TOP TEN ITEMS you DON'T need.

Happy Shopping.

1.) Video Monitor

Parents often think they want to know every move their infants makes.

But, what I know as a pediatrician is that when baby sleeps it is time to give yourself a break.

A video monitor only increases your anxiety.

So enjoy yourself, relax, sleep or watch TV instead!

If your walls don't allow noise to permeate then an alternative is to invest in a sound only baby monitor.

2.) Ear Thermometer

Plain and simple, they are not accurate. We use them in clinics out of convenience, but if I really want to know what temperature my child is, I use a standard digital thermometer. If you are not sure how to use it, check with your doctor.

3.) Baby Scale

Your pediatrician should be monitoring your baby's weight. If your doctor is concerned ask them about the need for a scale. Otherwise, save your money. The one thing your baby will do naturally is gain weight! And you will notice, because the babies grow rapidly their first year, doubling their birth weight by about 4 months. 

4.) Wipes warmer

Not much to say here except, no you don't need this at all. Put the 20$ in a college fund.

5.) Sleep cushion for babies back

Unless your pediatrician recommends it, I don't think this is useful.

6.) Baby Mirrors Car

My daughter cried and cried in the car. We finally figured out that a specific song would sooth her. I bought various baby mirror (at least 3), they don't work! You can hardly see your child and in between you are trying so hard to find her in the mirror, it affected my driving.

7.) Boppy pillow for nursing

I got a hand me down, and I used it for about 1 week. Then it went into the closet.

A regular pillow works fine and doesn't cost more money or clutter.

8.) Bassinet: Oh, how I wanted one. They are so sweet looking. But! But,

if you have one or have a hand me down great you are lucky, use and recycle. But don't go out and buy a new one. They cost around $100 and your infant will grow out it so quickly. A pack n Play is a more practical alternative which can be used for multiple purposes as your child grows.

9.) Baby Einstein and baby DVD's

If you don't have them, you wont need them. if you start using them, it will be taught to survive without them. Contrary to popular belief, they don't help you baby learn.

10.) Bouncy seat:

Useful if you don't purchase a swing, buy realistically, you don't need both. Pick one. I preferred the swing, it was a more expensive, but your baby can use it longer.

The Top Ten on My Baby Registry

Because I am a pediatrician,  everyone assumed that I knew exactly what I needed when my baby was born. 

Part of that was true, I had seen so many versions of car seats, strollers, toys, and bottles. And I knew which items were gimmicks, (which I will get to at my next post).

But as a mommy to be, I too felt like buying cute baby stuff I knew I did not really need. However, with the help of my baby daddy I stayed true to my "needs" list, not my "want" list.

So here are my picks!       

      

                             1.) Graco Snap and Go Stroller 

Say forget it to those amazingly expensive strollers. I too, liked the look and feel of them, but really, how necessary are they? 

Do they really make a difference in the long run?

 No, your kid wont remember what you toted him around in.

This stroller was practical and easy to use.

It is inexpensive, portable, lightweight, durable, has a coffee cup holder for those java addicts and it fits with most standard car seats.

2.) Medela Breast Pump- FREESTYLE

This breast pump is like a blue tooth headset, you can type, talk on the phone,even make dinner, without having to hold the annoying breast pump to your chest. 

And, for you wild women, you could double pump at the same time, hands free. This is a bit pricey, but if you know you will breast feed for a while, and you have to go back to work, this is definitely worth it. 

Added bonus, lightweight, compact and can operate 

on a battery. I took this to Vegas in my purse.

3.) Organic Crib Bedding and Mattress

This is a more pricey option than the conventional crib mattress and bedding, but babies spend so much time sleeping. Because of that, the crib mattress and sheet seem to me to be the most important thing to buy organic. So be frugal on organic clothes and other stuff, because your child will grow out of it, but you know the extra dollars will last longer with the organic mattress and crib sheets.

I purchased mine from the store listed below, they were fast, efficient and so far the mattress has worked out great. There were many other options online, but this was the best bang for my buck.

www.daxstores.com/v-snq-crib.html

4.) Breastfeeding Cover-up

Oh, how I needed this. 

I love to wear short skirts, but I was never into nursing in public.

This cover-up allowed me to feed my baby, pay attention to her and actually leave my house!

www.rightstart.com/global/store/product-item-9199-dept-feeding.html

An inexpensive version of this is also available at Target, or if you are creative, you can stitch one yourself.

              

  5.) Activity  Mat

All infants love this and it is portable and easy to clean and assemble. Great for vacations, if you are luck enough to have one!  Go to google and type in infant activity mat and you will find this priced around 30-40$.

6.) mypublisher.com

OK, this doesn't go on your registry, but it is so important I could not wait until I do my blog on the best websites!

Upload your pictures fast and easily. You can create great photo books, calendars etc. 

My favorite feature, they have great sales and discounts at Costco.com 

7.) Favorite Book!

"My Friends", by Taro Gomi

I love this book, my daughter loves it too. Great pictures, easy to read, and will entertain as they get older. Most people love Goodnight Moon, but this was my favorite.

8.) Colic Woes?

Harvey Karp's, "Happiest Baby on the Block is awesome, the DVD is great for those who don't have time to read, but what got us thru many many rough colicky evenings was his White Noise CD- called the "Super-Soother" White Noise.

My daughter would be screaming and as soon as we turned on "Rain on the Roof" she would stop. Thanks Dr. Karp!

Cheaper option:

I tell my patients to use a vacuum cleaner or hair dryer to create the same effect, but when you are in the car, on vacation, or just strung out, the CD by Dr. Karp works wonders.

go to www.thehappiestbaby.com

By the way, it is best to know about colic before it happens, so if you have the extra cash, get the book/DVD before the baby arrives. If your baby is colicky, this book will save you a few trips to the pediatrician and the stress of not understanding the screaming.

9.) California Baby Body Wash

Gentle, non-toxic and bio-degradable. All words you want to hear when you apply something to your babies face. Added bonus, easily available at Target.

10.) AAP guide to your child's first year.

Order it before your baby arrives so you might actually get to read it.

Another tip- ask your pediatrician for a copy, I always hand this out to my new families for free!

That is all for now. Stay tuned for the top ten what not to buy list.

Breast Feeding 101

Many nursing mom's switch to this.





Without judgement, I completely understand why.


Although I am a pediatrician, I did not want to breast feed my baby. I know, having learned over and over again in medical school and then again in residency all of the reasons why women should breast feed.
I had heard the mantra "breast is best" over and over. Many of you know that breastfed babies have better immunity, tend to "bond" with their mothers and the books say, it is easier than formula feeding!

Regardless of all of this information, I had decided in my mind, at some point in medical school that I hated the thought of "me" breast feeding. I wanted everyone else to do it, all my patients and my friends. But, me, breast feed-- No Way! I mean no thanks. But, before my baby was born, I promised my baby's daddy (also a pediatrician) that I would at least try to breast feed.

The day arrived unexpectedly, and so did my first true test.

Day 0, hour 1 of my daughter's first day. I lay awake and asleep in my hospital bed to find my precious little daughter in my arms. It was time for her to eat.

She latched. She sucked, She drank. We did it! To be honest, the first time around, I was so dough eyed in love that I didn't really know what was going on.

And then, we got home and it started to sink in. She cried with hunger, she cried with exhaustion, I breast fed. But, I was exhausted and in pain from surgery. I was also overwhelmed by the new person in our home, yet for some reason I continued to breast feed. My little daughter lost weight the first week and was jaundiced. I worried she was not getting enough to eat, and despite that I continued to exclusively breast feed.

There it was. I had not given her any formula. Hip Hip Hooray!

But I still felt, well, not comfortable with breast feeding.

Despite that,I marched on. I continued to love, love and love my little daughter. But the breast feeding all I could express to others was, "they say, "breast is best."

so, at 3 months post partum I felt like this:

What job can only one person perform every 2hours, for 20-30 minutes at a time, 24 hours/day, 7 days a week for months and months at a time.
Breastfeeding. Only a mommy can do that.

This is what no one talks about. The challenges of breastfeeding. No coffee breaks, no bathroom breaks and certainly no meal breaks. How does anyone manage to take a shower, answer a phone call, or have a coherent thought in the middle of all of this. And I did not even mention the middle of the night feedings, diaper breaks, dirty laundry, oh yes, and grabbing a bite to eat yourself.
With all of this, it is no big surprise that most woman in the US don't do breast feed for long. Most women give up or wean before or around 6 months post partum.

All the while, that powdered white formula is sitting there, like a tiny while bottle of evil, calling my name, enticing me to pick it up and use it.

Some of my colleagues, wondered why I didn't give my daughter the occasional bottle of formula. But they just didn't know me in that special way. My obsessive compulsive tendencies weigh in and prevented me from going for the formula. If I was going to do something, I always do my best. And then was the other simple truth about me, if I tried the bottle of evil, a quick and easy shortcut, would I even be able to go back to breastfeeding?

So, I trudged on. Exhausted, and waking up every 2-3 hours to feed her all day and night.

As a mommy who has been exclusively breast feeding her baby for 10 months (no formula yet). I can say it ain't easy.

So why did I keep going? Because my daughter was thriving, and she was thriving so beautifully I did not want to give her any less than my personal best. I'd be lying if I didn't tell you there were many moments where I loved being the one person who she needed the most, for love, attention and her meals, but it went beyond just that. Something I just can't explain. With the combination of sleep deprivation and breast feeding, somehow, perhaps with the help of all of the maternal hormones still surging thru me, I was able to manage to wake up every day and be excited about seeing her and breastfeeding her.

In the end, I think that if someone had told me how much work the breastfeeding was, I might have been better prepared. Now, I hope you might be. But realistically, I don't think anyone can know, until it really happens.

As far as I can tell, I just passed my first test of motherhood, with patience, dedication, hard work and lot of love. Now, only many many more years to go.

A Doctors Guide to Choosing Your Child's Doctor

How to pick a pediatrician?

Stressed out. Sleep deprived. Tired. Excited. Getting the nursery ready, checking off your "before baby arrives" to do list. Seeing old friends and relatives and working overtime to get extra time at home with baby once she arrives. Sound familiar? If so,you'll find this guide to the "Pre-Baby Basics" helpful.

I was so excited before my baby was born, but it felt like life was chaotically in limbo. And I still had not picked the pediatrician.

Take it from a pediatrician, choosing your pediatrician can be a daunting task.

So here I am, a pregnant pediatrician, ready to become a mommy, but not ready to become a mommy either. It just happens to be that my baby's daddy is a pediatrician also. So the task of finding our pediatrician seemed even more challenging.

All of my friends, and family assumed with my unique situation that I, or my husband would be our baby's pediatrician.

No way, I thought!

Here's why: You want your baby's doctor to remain objective. Anytime I give advice to family members about their kids, I find myself wanting to tell them what they want to hear. I find myself wanting to give them advice I would never give to my patients. The best doctors remain objective about the situation. It is difficult to remain objective about a child who is part of your friends and family network.

For example, my baby had terrible reflux in her first few months of life. On many occasions, my husband and I wanted to treat her condition, but I knew that I would advise my patients not to do anything in this situation. Yet, I could not watch my daughter suffer with it. I could not be objective. Thankfully, we found a doctor who was objective.

That said, how did we find our pediatrician?

Take it from a mommy who loves to shop. The first rule for shopping, buy something only if you LOVE it! Finding the right pediatrician can be similar to finding a pair of shoes you could live in forever. So, in order to get it right, you may have to meet a number of different doctors until one "feels" right. What do I mean by, "feels right?" There are many issues that go into that "feeling".

For me, it meant finding a doctor who really listened to me. Someone who not only listened to what I said, but actually heard me. When my daughters reflux worsened I called my pediatrician. He was out of town. So, I decided to speak to the on call physician. The on-call pediatrician knew I was a pediatrician, yet,he talked down to me, and further went on to tell me- "you already know your options." In reality, he was right, I did know my options for my daughter's condition. And I also knew how I would approach a patient with a similar issue. But, what I needed at that moment, was a doctor who could realize my fears as a mom. A doctor who could say, "Wow, that situation sounds scary know, but here is what I think, here is what you should do and this is why everything is okay."

As a pediatrician, some doctors may assume that I already know everything. But, my daughter has taught me that being a parent means. It means on occasion all rational thoughts vanish. So, find someone who you can ask the silliest and most embarrassing questions. You will be surprised what questions you may have for your doctor in the future.

Some other important tips to find the pediatrician that is right for your family.

1.) Is he/she board certified in pediatrics?

2.) Find out who takes calls after hours and on weekends.

3.) Find out what their weekday schedules are. Many pediatricians work part time, so find out if their schedules fit your families needs.

4.) Meet the other doctors who work in their office, chances are, you may see one of them on occasion.

5.) Ask where you go for labs, x-rays and in emergencies, much of this is dependent on your insurance, but it is still important to know.

6.) Oh yes, this may seem basic, but find out how far they are form your home? When your child is ill, you want to be close by. I ended up picking someone 20 minutes away, but when your baby is ill, that feels like a long drive.

7.)Ask the pediatrician questions about what is important to you. Examples may include their philosophy on child rearing, vaccines, co-sleeping,antibiotics and anything else that may be important to you.

8.)Ask how they keep up with medical advances.

9.) Word of mouth is important. Talk to other mothers locally and get their feedback.

10.) If you don't know any moms, you can always check the local mom's groups for opinions.

Most importantly,if you choose someone and later on it doesn't "feel right", its not too late. You can pick someone else and you won't hurt any-one's feelings. You are your child's advocate so follow your instinct. And remember, before your baby arrives, go meet the different pediatricians. Comparison shopping is best to do before your baby arrives.