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Parenting a sick child: When a child’s cough is cause for concern

I was recently asked by a concerned parent, “When is a kid’s cough something you should worry about?” As a pediatrician, I feel obligated to point out from the outset that, in most instances, this is a question that really needs to be discussed directly with one’s own pediatrician. There are, however, several general cough concepts I can share with you that will hopefully help you gain a better big picture perspective.

It’s first worth pointing out that a cough, at the most basic level, is simply a reflex that exists to help keep things out of the airway. Even though it may not seem like it when your child is up and coughing in the middle of the night, a cough (like a fever) can actually serve a useful purpose.

As for considering the various causes of a cough, some of the most common in children include infections, asthma, choking or having something stuck in the airway, croup, habit coughing, and certain medical conditions (usually ones children are born with). Some are easy to identify, while other causes can take a bit more sleuthing. Even when you have identified the underlying cause, it may not always give you a definitive answer as to whether to be concerned. In the case of cough-inducing infections, plenty of common colds can cause an inconvenient, annoying cough. Pertussis, on the other hand (also caused by an infection and referred to as “whooping cough”) is known for it’s nagging cough…and the fact that it can prove deadly to infants.

When it comes right down to it, figuring out when to worry about a cough needs to be treated as a problem-solving venture. The following are some of questions most worth considering and the symptoms you’ll want to be on the lookout for.

Age matters.  Any cough in a baby three months or younger warrants a visit to the doctor’s office.

At a loss. It’s one thing to cough. It’s altogether another when the cough takes one’s breath away and is accompanied by more concerning signs such as troubled, noisy, and/or fast breathing.

Time of day. Taking note of how much, how often, and even when during the course of the day and/or night your child coughs can provide some telltale clues. Mucus drainage, for example, typically tends to trigger an increase in nighttime coughing. Habit coughs, on the other hand, tend to go away during sleep.

Persistence counts. More than 2 weeks of a cough definitely warrants a check-up. Coughs associated with run-of-the-mill colds don’t usually last this long, while pneumonia, sinusitis, and other causes of persistent cough often do.

Describe the circumstances. Any history of a sudden cough – especially following a gagging or choking episode – is particularly concerning for a foreign object in an airway.

Over-exposure. Consider if your child’s cough matches that of his siblings, his preschool classmates, or others he’s recently come in contact with. While I’m on the subject, let me also take this opportunity to add that while it’s a very wise idea to take advantage of practical and effective measures to stop the spread of germs – think hand washing, vaccines, and basic disinfection of contaminated surfaces – it’s unnecessary and, more importantly, unrealistic to think that you can (or should) keep your child away from all germs.

Wet or Dry. A mucusy cough is often referred to as a “wet” cough, whereas a cough without mucus is more likely to be called a “dry” cough. While determining whether a cough is wet or dry doesn’t automatically determine the underlying cause or inherently tell you how concerned to be, it can prove to be useful information.

For better or for worse. It’s fairly straightforward but worth saying that taking note of what triggers your child’s cough and what makes it better can be key in figuring things out. Croupy coughs tend to be worse at night and better with moist air. Asthma coughs can be caused by known allergens, may worsen with exercise and respond well to albuterol or other asthma medications.

Additional warning signs. Any time a child has other accompanying symptoms of concern such as a high fever, coughing so hard they are vomiting, coughing enough that they refuse (or are unable) to drink, or cough up blood, it’s time to head to the doctor. to the doctor.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Tending to Tummy Time Troubles & Going Back to Sleep

Back-sleeping and tummy time are common phrases in today’s parenting lexicon. Yet that hasn’t always been the case.

The Back to Sleep Campaign – primarily responsible for the switch to back-sleeping babies and related recommendations for tummy time while awake — was launched in the mid-1990s to educate parents, caregivers and health care providers about ways to reduce the risk for Sudden Infant Death Syndrome (SIDS).

At the time, this represented a big parenting shift. Before this public education campaign, parents had little reason to think twice about putting babies to sleep on their bellies. Generations of parents routinely did so. But with compelling evidence to support the Back to Sleep campaign’s primary message — that placing babies to sleep on their backs reduces the risk for SIDS (sometimes referred to as “crib death”) – great progress was made in helping babies sleep safer.

Just how much progress? It is estimated that since the campaign started, the percentage of infants place on their backs increased dramatically while at the same time, overall SIDS rates decreased by more than half.  As far as public health campaigns go, the Back to Sleep campaign is a hands-down success, and the benefits of raising back-sleeping babies and creating safe sleep environments are as clear as ever.

What isn’t always so clear, however, is how parents and caregivers should go about compensating for all this additional time that babies spend sleeping on their backs. By compensating, I mean tummy time. Encouraging back-sleeping babies to spend awake time on their bellies can help stave off the dreaded “positional plagiocephaly,” more understandably referred to as a flat head.

This all might sound fairly straightforward, but I am routinely asked about, interviewed on, and pressed on the subject of tummy time (and the challenges it seems to pose). How much time should babies spend on their tummies? What can one do to encourage tummy time? Is there a certain position babies should be put in? What if they don’t like it?

My first child was born right around the time that the Back to Sleep Campaign was really taking hold. As a pediatrician-in-training, I was well aware of the recommendations, and my daughter didn’t seem to have any problem following them as she established herself as a very good back sleeper. The problem was that I was far more comfortable with the recommendation for her to spend plenty of time on her tummy while awake than she was. Every time I put her on her belly, she’d squawk, cry, push off with her feet, and convince most everyone around her that she was in great distress. I managed to convince myself that her tummy time displays weren’t truly those of a distressed child, so she did get in a sufficient amount of tummy time. I find, though, many parents find tummy time troubling.

Try the following tummy time tips and tricks to help take the pressure off of you as well as your baby!

  • Tummy timing: The key here is quite simple. Just remember back while sleeping and tummy while awake. Despite what you may have been led to believe, there are actually very few rules about how much time a baby needs to spend on his tummy. There’s no need to set a timer, mark your calendar or otherwise formalize what essentially boils down to a simple concept. Just make sure your baby sleeps on his back, and then I commit to trying to make tummy time your baby’s default for hours when he’s awake.
  • Make tummy time a habit. I’m well aware that this may sound like stating the obvious, but it has been my experience – both in dealing with parents and with child care providers – that laying a baby down on her back seems to be somewhat of a force of habit. That’s great if you’re talking about a baby who’s going to sleep. But if it’s on the floor or a playmat, for example, it can take a conscious  effort to switch to the routine of placing an awake baby on her tummy.
  • Understand the benefits. There’s no magic to tummy time. Simply put, until they  learn to roll, sit and crawl, babies generally spend an impressive amount of their time laying down. If all of this down time is spent with pressure being put on the same spot(s) on the back of their skull while it’s still somewhat soft and not fully formed, it’s bound to make an impression. Tummy time not only takes the pressure off, but also allows babies the ability to strengthen their head and neck muscles.
  • Tummy time entertainment. Not all babies need to be entertained in order to be coaxed into spending time on their tummies. Some are perfectly content to lay there and look around. Feel free, however, to help your baby enjoy this new view of the world by placing toys in front of him, help him prop himself up a bit on his elbows, and even lay down facing him so you can look at, talk to, and even sing face-to-face.
  • Tummy time dissenters. If your baby is a tummy time squawker, as mine was, then don’t be discouraged. Make sure you ask yourself whether your baby’s squawks truly count as cries of distress or rather of effort. While my daughter’s cries certainly had my mother-in-law distressed, in reality my squawking little newborn really wasn’t truly upset, she managed to keep her perfect little round head and build up her tolerance for tummy time while all the while mastering the skill of scooting long before she could even roll, and I have some impressive baby videos to prove it.

Originally posted on Omaha World Herald’s Live Well Nebraska

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I admit it – I do well with resolutions. I truly believe that people tend to accomplish more when they have a set goal in mind. I personally love to rise to a challenge, and find that setting a formal (and preferably public) goal definitely has a way of bringing out one’s competitive nature.

So when it comes to New Year’s resolutions, I have to say I’m a believer. As someone dedicated to promoting health and safety year-round, I obviously think it’s important to set goals throughout the year. But if ushering in a new year happens to give you an increased sense of motivation, then by all means, run with it because now is the perfect time to shift gears from helping your children create holiday wishlists to helping them (and you) focus on setting some realistic family goals that are sure to deliver on the promise of an even happier, healthier 2012.

Okay, so what’s the best way to figure out what one’s family goals should be? While each of your family members’ individual resolutions can be customized according to age, ability, and circumstance, I figured it might be helpful to get you started by offering you some simple family-friendly resolutions – you know, those completely do-able resolutions that don’t seem nearly as challenging as, say, signing up for a gym membership in January only to lack the willpower come March to make use of it. Or running a marathon. While there’s nothing wrong with either of those resolutions (I’ve made them both myself in years past), there’s nothing wrong with first reaching for the “low-hanging fruit” resolutions that are sure to give your family both a sense of accomplishment and a big bang for your buck when it comes to improved healthy, safety and well-being.

–       Walk more. That’s right, walk more. Around the block, to the grocery store, with friends, on the treadmill – wherever and whenever you can. Running is fine, too. But if that seems a bit daunting or impractical, the important thing for kids and adults alike is to be more active in 2012. As someone who just placed my own order for a FitBit, let me add that if you and/or your children are more likely to put their best foot forward with a concrete goal (or a cool new gadget), then using a pedometer may prove to be just what it takes to get up and get going.

–       Sleep more. You see – I told you these resolutions would be attainable, if not downright desirable. I mean, who doesn’t want to sleep more? But as a pediatrician married to a surgeon and therefore accustomed to dealing with the demands of both professional schedules and with the many sleep-related challenges of parenthood, I fully understand why most of us simply don’t get enough sleep. I have also become increasingly impressed with how important sleep is to one’s overall health. So whether it’s an improved bedtime routine for babies or toddlers, taking/keeping the TV set out of your child’s bedroom, keeping tabs on your teenager’s sleep habits or simply placing more value on your own sleep needs – I strongly recommend it.

–       Read more. Daily, whenever possible. Not just for work, not just when your kids are required to, but for fun. Read aloud to your kids. Read quietly alongside them.  Make a point of reading the newspaper. Encourage your tweens or teens to start reading it too. Read on paper or in any electronic form you choose. Regardless of what angle you take, resolving to read more will enrich your family’s new year.

–       Drink more. Water, that is. Just back from a recent trip to NY where I discussed water as a key aspect of health, hydration, and tackling the obesity epidemic with a wide range of magazine editors, I decided to toss it in my resolution list. It’s not just because I think drinking more water is the one and only solution to better health, but because it strikes me as such an easy one once you and your family set your minds to it. The goal in encouraging more water consumption in large part actually relates to getting everyone (kids and parents alike) to drink less soda, less juice, and less sugary liquids in general. If your family is not in the water-drinking habit, consider committing to milk with meals and water with snacks, and making water more appealing by filtering it (typically tastes better), bottling it (re-usable water bottles are both convenient and better for the environment), or simply adding some natural flavor (a wedge of lemon/lime or even a slice of cucumber!).

–       Engage more. Social networking now seems to be the key to everything from successful weight loss to professional success. Yet one of the things we risk in what is sure to be an increasingly wired (or wireless) 2012 is the lack of meaningful, personal engagement with others in our community. That’s why I firmly believe that all families should set a goal of teaching their children to more actively engage and become contributing members of society. Taking some lessons from the Helping Hands curriculum at my child care center, this can be as simple yet meaningful as having even very young children visit the Humane Society or a local retirement home; send letters of thanks to those serving in the military; and/or collect mittens, books, pennies, diapers, coats or cans of food for those less fortunate. Whatever you choose, remember that one of the most powerful lessons we stand to teach our children (and live by ourselves) is that it is our meaningful connection with others that brings the most happiness.

–       Laugh more. At yourself, with your kids….the point is that while resolutions can be a good way to improve one’s health, it’s just as important to make sure that stress doesn’t get the best of you. I’ve found the best way to do this is to remember to laugh, and always remind yourself of how fortunate you are to have your family, your friends, your health, and the gift of another year.

On that note, I want to take this opportunity to wish you all a very happy, healthy and accomplished new year. I’ll look forward to sharing 2012 with you and everyone in the Live Well Nebraska community.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Parenting News Flash: TV Under 2 isn’t exactly educational

Recent advice from the country’s largest advocacy group for children leaves me concerned that what I’m about to write is going to be met with poor reception. Following extensive review of more than 50 research studies, the American Academy of Pediatrics released its October 2011 Policy Statement: Media Use by Children Younger Than 2 Years. I would like to think that all parents of young children tuned in, but for those of you who missed it – here are some of the highlights.

First, let’s start with a few facts about the current state of our children’s media diet. A full 90 percent of parents report (admit?) that their children under the age of 2 watch some form of electronic media – on average consuming 1 to 2 hours of television a day. For 1 in 7 of these young children, we’re talking 2 or more hours a day of media. By age 3, nearly one-third of our nation’s youngest have televisions in their own bedrooms. While these numbers may not be entirely surprising, given the ubiquitous nature of ipads, iphones, ipods, computers, laptops and TVs, they should nevertheless be disturbing given what we know about the potential effects of screen time for babies and toddlers.

There are several important questions we all should now be asking before taking even one more baby step towards the TV set.

  • Are infant- and toddler-directed programs educational?
  • Is there any harm in letting babies and toddlers watch TV (and other screens)?
  • What is “secondhand TV” and why should I care?

Let’s start with the question of educational value. In the words of my pediatric colleague (and the lead author of the policy statement) Dr. Ari Brown, the phrase “educational TV/videos for children under two” is an oxymoron. That’s because in order for anything to be educational, children need to “get it.” This inherently involves understanding both the content and the context. Given that young children have been shown to fundamentally lack the ability to distinguish between programs shown backwards from those shown forwards, one would be hard pressed to suggest educational benefit from watching. Sure these TV-viewing infants and toddlers laughed at viewings in both directions – suggesting some entertainment value – but entertainment does not equal education.

That’s not to say that there’s no such thing as educational television, or that educational television can’t be entertaining. Studies have actually shown proven educational benefit for children over the age of two from quality shows such as Sesame Street. It’s just that if you happen to be one of the majority of parents who have been led to believe (most likely by extensive explicit and/or implicit marketing) that TV programs and/or videos are going to enhance your baby or toddler’s intellect, you need to tune into the fact that it’s simply not.

Okay, so screen time isn’t the answer to making your baby smarter. What about those parents who readily admit they use the TV (and various other screens) as a sure-fire reprieve from entertaining their babies/toddlers just long enough to make dinner, take a shower, make a phone call….you know – all those things that just about all parents of young children struggle to find time to do in the day. I get that, and readily admit that TV did, on occasion, get used as a babysitter in my own household.

But the fact of the matter is that there are several key concerns regarding the time toddler and infants spend in front of screens, not the least of which involve language development. We already see expressive language delays in the short term. And the fact that we don’t yet know for sure about screen time’s long-term effects on language should not rule it out. In the meantime, there is a valid concern that screen time interferes with “talk time” – especially given findings such as the fact that 84 percent of parents talk less when the TV is on, and 74 percent use fewer new words. This is huge, considering that we’re talking about the most crucial time for language development.

There’s also reason to worry about the quality of sleep our children are getting. While most studies thus far have looked at media effects on older children, we know that healthy sleep habits impact just about every other aspect of all children’s health. Remember that a reported 30 percent of kids under 3 have TVs in their bedrooms. We clearly need to tune in to the possibility that their sleep may be suffering as a result.

Even during our children’s waking hours, the time that babies and toddlers spend in front of screens may simply not be time well spent. Not if it ends up displacing reading, playing, and entertaining oneself. We know that free play is hugely important for young children’s development, as are 3-dimensional, real world interactions with parents and other caregivers.

I would imagine with all of that, many of you may now be tempted to adjust your child’s media diet just a bit – and that’s great. But before you simply commit to eliminating an episode or two of toddler TV from your child’s daily viewing schedule or limit how often your baby watches his admittedly captivating video, don’t forget to take into account your own viewing schedule. That’s right – the evidence presented by the AAP is equally worthy of your attention when it comes to having your own shows on in the background. In other words, as parents we also need to take into account what is now being referred to as “secondhand TV” – an unintended exposure that is occurring in an estimated 40 to 60 percent of households across America. While parents may report “the TV is on but no-one is watching,” the fact of the matter is that someone is watching. Someone, as in our children. One study found that young children playing in a room shifted their gaze to the television that was left on in the background three times every minute!

So with that news flash, what’s a parent to do? Pediatricians fully understand that screens are everywhere, and it is entirely unrealistic to avoid exposing young children 100% of the time. But it is well worth your time to acknowledge that in many instances, there are better things for them to do to help them learn and develop. The AAP recommends the following strategies for making this happen.

  • Set media limits for children under two, bearing in mind that the AAP discourages media use for this age child.
  • Opt for supervised independent play rather than screen time to occupy your child when you aren’t able to sit down and actively engage in play. A simple set of nesting plastic cups on the floor can work wonders for engaging toddlers while their parents prepare dinner.
  • Keep TVs out of all children’s bedrooms
  • Recognize that your own media use can have a negative effect on your children. Help your child avoid secondhand TV exposure.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Feeding Children: Palatable Strategies for Winning the Nutritional Challenges of Parenthood

Whether you’re an Omaha parent or the First Lady of the United States, it has become all too clear that childhood obesity is a large and growing problem that warrants it’s current spot at the top of our collective parenting priority lists (not to mention our country’s). Sure, there are some bigger-picture issues at stake here than whether or not you are successful in your attempts to get your child to eat green vegetables. And yes – it can easily seem like some of the root causes of the obesity epidemic fall far outside of our parental control – from the multi-billion dollar a year business of marketing unhealthy foods to children to the concerning inadequacies of lunch programs and drastically cut physical education activities in schools. In other words, we have our work cut out for us.

I remain convinced, however, that as parents, we all still have the ability to significantly shape our children’s eating habits, teach them an healthier approach to food, and ultimately impact their overall health and nutrition. I don’t hold any misperceptions about the fact that it will take quite a bit of parental effort and commitment. But it’s well worth the effort.

Okay, so I imagine that very few, if any, parents would disagree with me thus far. And there’s certainly a cornucopia of nutrition resources out there custom-designed to make it exceedingly easy to figure out exactly how much calcium or vitamin D your child needs in any given day, what types of fats to avoid, and even how to serve your child’s nutrition up on a proportionally pleasing plate.

The problem is that few things are harder than getting a child to open his mouth when he doesn’t want to. Instilling healthy eating habits in our children isn’t just about knowing what we should be serving our kids – an admittedly very important first step in the right direction – but figuring out how to get them to play along. In other words, it’s one thing to know what it is we’re supposed to be doing and feeding our children. It’s altogether another to know how to go about doing it.

And that’s why I want to share with you several of the ten overarching peacekeeping strategies my Food Fights co-author and I distilled in order to arm all parents with the skills and approaches necessary to wage war on the childhood obesity epidemic – one French fry, grocery store meltdown, or food refusal at a time.

  1. Don’t fight over food. Mealtime was never meant to be contentious, and no matter how much you commit yourself to instilling in your child healthy eating habits, vow never to turn the dinner table into a battlefield. In short, this means committing to some basic ground rules about how you’re going to approach food (including those listed below), and then applying them calmly and consistently.
  2. Never let them see you sweat. In other words, don’t let your child know just how much parental self-worth you have resting on whether or not he eats a bite of broccoli. Studies show that the more you blatantly “push” healthy foods, the more likely your child is to resist. Conversely, I might add, the more that foods are restricted, the more likely children are to want them (and eat more when given the chance). It’s simply your job to place healthy foods in front of your child, and your child’s job to decide how much to eat.
  3. Try, try…try, try again. If I were really to make this point, I would write out the word “try” ten to fifteen times to add greater emphasis to the number of times it can take for a child to try a new food before accepting it. I know it may seem a bit shocking. But once you understand that calmly offering new and healthy foods on a regular and repeated basis makes a very real difference, it is usually much easier to swallow the many predictable rejections. In particular, I like taking the low-key approach of teaching children to ask for “No thank you” bites. Children get to retain a sense of control, know that they will not be forced to eat, and you accomplish your goal of exposing them to new foods.
  4. Out of sight, out of mind. This may seem like stating the obvious, but when it comes to your child wanting, begging, and/or whining for unhealthy foods in lieu of healthier ones, let me remind you that it is under your complete control to regulate what foods come into your homes. If you don’t want your child begging for it, then don’t buy it. Of course trips to the grocery store, visits to the grandparents, and child care (all topics addressed in detail in Food Fights) can all pose more of a challenge and will require additional consideration.
  5. Eat by example. I would be remiss if I didn’t make the closing (and perhaps most important) point that all the nutrition resources, no thank you bites, and dietary directives in the world won’t stand nearly the chance they would otherwise if you don’t eat by the same principles. From the time you enter parenthood, your children will be watching you, and they’re far more likely to eat as you do than as you say.

With that said, I wish you and your entire family good health and a lifetime of “peas and homini!”

Originally posted on Omaha World Herald’s Live Well Nebraska

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Raising Healthy Kids: Reaching for the Low-Hanging Fruit of Parenthood

For good or for bad, parents today are faced with the fast paced nature of both the real world and a virtual one. Much of the virtually continuous stream of information, videos, tweets and texts we receive on a 24/7 basis relate in one way or another to what we can, should, and/or are expected to do to be good parents. And let’s face it – keeping up with all of the modern-day parenting advice would be hard enough even if all of it was fact-checked for us. Unfortunately, this is not often the case, as much of what we hear, see and read is unfiltered, potentially unfounded, and confusingly contradictory.

Having spent much of my professional career as a pediatrician increasingly committed to making sense of pediatric and parenting advice in both of these worlds, I have found that what parents often want to know from me is simply how to filter the good from the bad and separate fact from fiction.

Knowing that you all are probably as busy as I am, I decided that this week I would distill down to as few words as possible the handful of things I consider to be some of the most well-founded, important things you can do as parents can do to make your kids smarter, safer and healthier. In other words, the following is my list of the “low-hanging fruit” of parenting.

Move more. I feel the need to say this because it’s painfully obvious that it has become incredibly easy for our children (and for us) to barely move in the course of any given day. Whether it’s walking instead of driving to school (or work) or taking an evening walk around the block, getting out of the car instead of rolling your way through drive-thrus, or signing up for organized sports, joining a gym, or participating in more vigorous daily exercise regimens – every step counts towards an healthier life style.

Use restraint. Literally speaking, I’m simply referring to the use of car seats and seat belts in motor vehicles. With motor vehicle crashes clearly identified as the number one cause of death in children, and the correct use of car seats and seatbelts clearly shown to have a huge impact on reducing motor vehicle-related injuries and deaths, taking the time to buckle up comes with a huge return on your parenting investment.

Read. For every parent who has ever asked my opinion on what they can do to help their children become smarter, excel in school, or head down a path of success, reading always factors in to my answer. Reading aloud to babies, toddlers, young children and teens alike not only fosters improved language skills, but also a love of reading that will serve children well for their lifetime. One of my favorite sayings to emphasize this point is that children spend the first few years of school learning to read, and the rest of their lives reading to learn.

Sleep. For parents of infants and young children, this conversation usually focuses on getting children to fall asleep, stay asleep, sleep in their own room, and do so without requiring repeated interventions. For parents of teens, the conversation often shifts to too little and too late. But regardless of your child’s age, it is becoming convincingly clear that instilling your child with good sleep habits is not only a good thing for your own chances of getting a good night’s sleep, but your child’s overall health and well-being.

Wash your hands…and while you’re at it, remember to cover your cough (preferably with your arm rather than your hand) and vaccinate. The fact of the matter is that while modern day science and research is continually coming up with new medicines, treatments and technologies to improve our families’ health and more effectively treat disease, the simple act of teaching our children to wash their hands (which includes committing to consistently doing so ourselves) remains one of the single most effective things we can do to limit the spread of disease. So is protecting against all of the vaccine preventable diseases.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Helping Children Live Their Lives in a Post 9/11 World

As we near the tenth anniversary of the September 11th attacks, I find myself, like so many others, reflecting on where I was at the time of the attacks and vividly recalling how feelings ranging from disbelief and overwhelming sadness to anger, fear and unity all but overwhelmed our country in the subsequent days, weeks, and months that followed.

In the hours immediately following the attacks, I have a particularly clear memory of exactly what I was thinking and feeling, if for no other reason than I hurriedly but carefully wrote down my thoughts and any words of parental support I could come up with in an article that was distributed around the country entitled Helping Your Children Cope with the News of Reported Terrorist Attacks. In the years since, I have repeatedly been asked about (and struck by) what I wrote that morning, not only because I too was feeling an overwhelming sense of loss, but because the steps I outlined for parents to take in order to comfort their children and help them make some sense of the tragedy apply as much today as they did back then.

At the time, I wrote that no matter how upset we are by the grim reality that our country is not as safe as we would like to believe it to be, we have to offer our children some semblance of security in their world. The fact of the matter is that I believe this is what we, as parents, should always strive to do. To that end, I wanted to share with you what I wrote so you can continue to offer your children a sense of security each and every day.

  • Immediate reassurance. In the event of any tragedy, start by emphasizing your child’s personal safety and the safety of loved ones. Let your child see, hear, and tangibly feel a sense of security that comes from knowing that he/she is safely surrounded by adults who care about him/her. At the time I wrote this, I recommended letting children talk to relatives on the phone or reach out by email. Ten years later and I firmly believe it shouldn’t take a national or even a personal family tragedy for us to remember how important our family and loved ones are to us and reach out, whether by phone, email, text, Skype, Facebook, or the good old fashioned way…in person.
  • A sense of structure. Even before the events of September 11th,  I was one of a vast majority of pediatricians, including Dr. Benjamin Spock himself, who expressed concern about the inappropriate and potentially harmful violent images children were being exposed to – from prime time television to Saturday morning cartoons and the evening news. Perhaps one of the most vivid memories I have of the morning of September 11th, 2001 is that of watching the televised coverage of people in the World Trade Center Towers jumping to their deaths. While these horrifying images may well have been permanently emblazoned in my mind had I only witness them once, the fact that they, along with all of the equally tragic and impossible-to-comprehend events of the day were repeated over and over and over again in the twenty-four-hour a day newscasts and on the internet made it impossible for me, as an adult, to escape. I certainly understood (and still recognize) the feeling of needing to leave the television set on and watch events unfold. But my cautionary advice to parents was and is that children (and all people, for that matter) are more able to handle shocking news when it is not immediate in time and when it is presented in print, rather than on television. Now think about where we are today. The next couple of days are sure to be filled with a lot of re-living of the events of that day ten years ago. And while I agree that we should never forget, and that we should honor those whose lives were lost, it’s as important today as it was ten years ago to protect our children from having to repeatedly witness and re-live the horrors of the day. Let me also just say that I believe that the world would be a better place if we all made a concerted effort to limit the amount of violence, so often disguised as entertainment, that our children are exposed to each of the other 364 days of the year as well.
  • Showing emotions and patience. Regardless of the circumstances and even if they are too young to fully understand, from a very early age children are acutely aware of the emotional state of their parents and loved ones. My advice to parents now is the same as it was then: It’s fine to let children know that you are upset and sad, but make sure to make it clear that you’re not upset with them. Also, as with any tragedy, loss, or change in routing, don’t be surprised if children show signs of distress. Whether in the form of fussiness, fear, nightmares, or tantrums, all of these reactions are normal and are best handled with patience.
  • Mutual support. When our country was telling from the attacks on the World Trade Center and the Pentagon, it only made sense to focus on our national unity and resolve and encourage parents to seek the support and solace they needed in order to be able to be calm and confident with their children. The fact of the matter is that raising our children to be happy, healthy, and safe and with a sense of belonging to a bigger community is what we should all be striving for. While raising a child may not technically require a village, having a community of support sure can help. It is my sincere hope that we all look for ways to teach tolerance, come together, and support each other.

And that leads me to one of the most important things we need to remember and teach our children as we reflect on the past ten years, and that’s the importance of teaching respect for differences and tolerance. I was recently reminded of the fact that in the period following 9/11, there was a disturbing backlash agains Muslims that sadly does not seem to have fully subsided. Despite the fact that the religion of Islam preaches peace, justice, and tolerance, and those who follow the religion of Islam are estimated to make up more than one-fifth of the world’s population, there are still many Americans who continue to direct their post-9/11 anger and distrust towards all Muslims. Even here in Omaha, a close friend recently told me that her own daughter was no longer allowed to be in contact with another family’s son, simply because her father was an “Arab Muslim.” In response to this sadly racist statement, I suggest that in remembering what were the most tragic attacks to ever occur on American soil, we also remind ourselves and our children that these attacks were carried out by extremists and not representatives of any certain color, religion or race.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Childhood By the Numbers: Helping Parents Count on Fostering Their Children’s Healthy Development

I admit that I sometimes (often) sit down to my computer to get work done while at the same time leaving the TV playing in the background. It was in this context that I recently overheard a discussion on one of the national morning news shows about how numbers can define women – most notably numbers that pertain to one’s age and weight. Without paying too much additional attention to the ensuing conversation, the idea nevertheless spurred me to write a blog on the subject. In part, that’s because I think it’s a fairly sad statement on our society when someone’s weight and waistline does more to define them than their skills and accomplishments. But that’s a topic for another day.

For now, I thought I’d take this interesting concept and take a closer (and hopefully more uplifting and lighthearted) look at how various numbers have a way of defining several stage of childhood.

Newborns by the numbers. Even the instant newborns make their appearance in the outside world, many run the risk of being defined by the number of hours of labor they subjected their mothers to. That said, newborns also start out being largely defined by their birth weight – which is more often than not included in announcing a baby’s arrival. I feel compelled to note that the accompanying but often-neglected length and head circumference measurements may seem of less immediate interest to proud parents, but they’re actually of equal importance.

And then, of course, there’s the number of diapers, the numbers of hours of sleep (or lack thereof), and the numbers of daily feedings that make up the bulk of a new baby’s day. These numbers are unarguably important, but I like to remind new parents that it’s good to make sure that these numbers don’t count for more than they’re worth. After all, getting to know and love your newborn goes well beyond a singular focus on numbers.

First year figures. What often wins out in the most noticeable numbers category for infants is simply the number of times you’re likely to call and/or visit your doctor, if for no other reason than the first colds, first fevers, and first (and many subsequent) shots that typically take place during this first fun-filled year. That said, don’t let these numbers scare you. Having numerous questions is to be expected, it’s a great time to take advantage of the frequent contact to establish a healthy relationship with your pediatrician, and the five to seven well-visits (along with their associated vaccinations) and any necessary sick-visits will all serve as an integral part of insuring your child’s health and well-being , not to mention your confidence as a parent.

Toddlerhood by numbers. Toddlerhood is all about numbers. Numbers of words, number of steps, numbers of teeth, and making the celebrated association between one’s age and one’s finger count as evidenced by the skill of holding up two finger to proudly answer the commonly asked question, “How many years (or fingers) are you?” Of course this age may also unfortunately give rise to keeping count of how many times one bites ones friends before learning to curb this normal but socially unacceptable impulse. While it can be painful to live through for everyone involved, toddlers usually overcome this impulse within a matter of weeks to months.

Keeping Count for Preschoolers. Number one and number two come immediately to mind, as three is the typical age at which children master the life skill of putting their pee (number one) and poop (number two) in the potty. While using the potty is a frequent focus of the age, this is also a time when children start to figure out (please note that as the owner of a child care center as well as a pediatrician, I said start, not necessarily master) social skills involved with interacting with, playing with, and negotiating with an increasing number of friends.

Kindergarten counts. At this age, the number of new crayons in the box (with the more the better) and the number of wheels on ones bike (the fewer the better) endearingly add up to quite a lot in the world view of a kindergartener (and more than a few early elementary age children as well!).

I could keep counting, but for the sake of space and time I won’t, except to fast forward to the age at which children start middle school. I can tell you from recent parental personal experience that an impressive amount of effort (and sometimes anxiety) is directed towards remembering the numbers associated with ones newly assigned locker combination, as well as the added challenge of finding ones way to a larger number of classes in a larger number of classrooms.

There are obviously plenty more numbers that relate to each of the ages and stages of early childhood. I’m just glad that for the most part, they all generally add up to fun, meaningful, and important aspects of an healthy childhood.

Originally posted on Omaha World Herald’s Live Well Nebraska

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From Earthquakes to Outbreaks: Keeping Kids Safe

In the wake of this week’s earthquake, I’ve noticed that there’s been lots of subsequent commentary – from TV to Twitter feeds – about just how uneducated and unprepared east coasters were/are when it comes to earthquakes. This has been repeatedly noted to be in stark contrast to anyone and everyone who has ever lived on the west coast, for whom the eventuality of earthquakes and the associated disaster preparedness has become an accepted way of life. To be fair, I must say that it certainly seems understandable, given what most of the general public has been taught about plate tectonics, that we cut those east coasters who mistakenly ran out of buildings rather than hiding under their desks some slack.

That said, I also firmly believe this week’s unlikely earthquake has the potential to serve as a powerful teachable moment. No, the lesson learned isn’t that everyone on the east coast needs to go take all the same precautionary measures as those who live on known fault lines, or that any of us in the Midwest (with a few geographic exceptions) need to hurriedly sign up for a remedial course on “what to do in the event that an earthquake hits the heartland.” Rather, all the talk about earthquake preparedness (or its lack thereof) gives me the opportunity to bring up many important instances in which parents can and should expect the unexpected and plan accordingly. As a pediatrician, I can think of countless ways in which parents can better insure their children’s health and well-being by simply understanding the risks and planning ahead. For the sake of today’s blog, I offer you the following examples.

Tornados. For us Midwesterners, tornadoes are naturally of much greater relevance than earthquakes or hurricanes. And just as bolting one’s bookshelves to the wall may be foreign to us, I’m not sure how many Californians would recognize the meaning of a tornado siren and know to immediately head to the center of an interior room on the lowest level of a building away from corners, windows, doors and outside walls if a pre-designated storm shelter or basement isn’t available. All of the 250 students and staff at my child care center know what to do, however, as we faithfully practice each month getting everyone down into our custom-built basement storm shelter…all in 8 minutes or less. Similarly, my family has a game plan in place at home. Now would be a good time to make sure yours does as well.

Fire. Although tens of thousands of Americans die or are injured in fires each year – with a vast majority caused by house fires – I consider my family fortunate to have never personally experienced one. And I certainly never hope to. I don’t smoke, so the likelihood of cigarette ashes or a lighter starting a fire aren’t of concern. Nor are lit candles or the flames from a gas stove, since we don’t have either in our house. But that doesn’t mean that I don’t bother to take extra precautions, because I do. I have smoke detectors installed on every level of my home, and yes….they all have new batteries in them that I make a concerted effort to replace every year. These and other home prevention measures require minimal time or expense, and are more than worth the effort. While you’re at it, I also suggest inquiring as to what fire prevention and response measures your children’s child care and/or school have in place, and make sure they include regular fire drills and appropriately placed fire extinguishers/ sprinkler systems.

Vaccine-preventable diseases. Natural disasters, as well as man-made ones, shouldn’t be the only focus of your preventive efforts. Considered to be one of the greatest public health discoveries of all time, vaccines now offer us the opportunity to prevent diseases that in generations past claimed the lives of millions. Now I know that the threat of a disease such as polio (which until recently was all but eradicated) may not seem as real as it used to in the days of iron lungs, but the fact of the matter is that the threat of vaccine-preventable-diseases has proven itself time and again to be anything but hypothetical. And the likelihood of an outbreak of measles or pertussis, for example, is much greater than, say, an earthquake on the east coast, given that exposure to these diseases is only a plane-ride away.

Transportation Safety. I won’t belabor the importance of parents being committed to understanding, promoting, and enforcing transportation safety principles, except to say that injury-prevention innovations such as bike helmets, car seats and seatbelts should be considered worth their weight in gold. I don’t care if you’re the world’s best driver and your child is the world’s safest bike rider – you still need to prepare for the unexpected. I am also well aware that even if I convince you, you may well be faced with resistance from your children, as I have three helmet-resistant children of my own (who nevertheless have always been required to wear a bike helmet since the day they were introduced to tricycles). While lots of kids loudly and often successfully protest the use of booster seats, mine didn’t, because they knew it would fall on deaf ears.

Given that there are many, many more worthwhile preventive measures that you can take, I hope that your own pediatricians continue sharing these and other tips with you. I also want to leave you with several useful resources that will allow you to hope for the best for your children while pro-actively avoiding the worst.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Applying the “Kohlrabi Principle” to Practical Parenting

I recently made it out to Midtown Crossing. This was actually the first chance I had to see it since it’s completion, and I was quite impressed with the family-friendly atmosphere, the Jazz on the Green’s outdoor festivities, the whole layout, the convenient free parking, and the wide array of stores and restaurants.

As a LiveWell Nebraska blogger, I also enjoyed the opportunity to spend time at the Omaha World Herald’s booth and meet those of you who chose to stop by and say hello. As is often the case, I was asked what I thought the secret was to getting people – parents and children alike – to change their ways and live healthier, safer lives. While this is clearly a subject I spend a lot of time thinking about, I don’t presume to have the one right answer. In fact, I don’t believe that there is one, single cure-all answer to the question of how to get people to change their behaviors. But for the sake of today’s blog, I’m going to go with kohlrabi.

That’s right, kohlrabi (pronounced “cole – rah – bee”)

For those of you who have never heard of kohlrabi, much less know what it means or how to pronounce it, you have to admit that the word itself has a way of catching your attention. Try teaching your preschooler the word, or better yet – reading aloud the ever-popular Eating the Alphabet book – and you’re sure to find that children are easily intrigued with an impressively wide range of fruits and vegetables.

Okay, so reading about (and hopefully popularizing) kohlrabi, along with other fruits and vegetables, is a big step in the right direction towards better health. But better yet is when you’re able to translate linguistic & literary intrigue into dietary practice.

This noble goal brings me back to the subject of kohlrabi. Prior to three years ago, I knew nothing about it beyond the fact that it had helped round out the “K” page of Lois Ehlert’s bestselling book. Until my 8-year-old son and I came across kohlrabi at the Village Pointe farmer’s market, it had never occurred to me to actually buy or try kohlrabi (or jicama or boysenberries, for that matter).

Before deciding to buy one, we first had to ask what one was supposed to do with a kohlrabi. Not unlike an artichoke, kohlrabi can admittedly be somewhat intimidating if one doesn’t know what to do with it. Fortunately, all it takes is simply cutting off the outer “rind” and cutting up the white, crunchy interior.

Billed by wikipedia as “a low, stout cultivar of the cabbage that will grow almost anywhere,” the taste and texture are said to be “similar to those of a broccoli stem or cabbage heart, but milder and sweeter.” My kids and I think it’s better described as more like the cross between a radish and a cucumber – with the crunch of a radish, but a more mild taste. Cut it up like a carrot stick and it can be dipped in ranch dressing or hummus. Dice it up and you can sprinkle it on a salad. Google it and you’ll find that you can also season, sauté, bake, or puree it.

So back to my initial conclusion that part of the answer to getting people to live healthier lives involves kohlrabi. No, your family’s discovery of the existence of kohlrabi won’t rival Alexander Fleming’s discovery of penicillin. But I am convinced that if we all committed to applying some basic “kohlrabi principles” like those I’ve listed below to how we feed our children (and ourselves), we might all be a bit healthier for it.

  • Read all about it. It’s no secret that I’m an outspoken advocate for early literacy and reading books to kids (and babies). And there’s certainly no shortage of books with positive, healthy messages. Eating the Alphabet will get you off to a good start, but there are many, many more that stand to get your children interested in a much broader range of fruits and vegetables. Check out How Are You Peeling?, for example, and you’ll see what I mean.
  • Paint a positive picture. Books can paint a positive picture, but so can you. Rather than taking a “you have to eat your vegetables” approach, remember to put a more positive spin on it. You’ve got plenty of shapes, sizes and colors to choose from and work with as you expand your family’s palette.
  • Reach for the unknown. Given that people don’t tend to buy what they don’t know, I like to think of this as taking the kohlrabi challenge. Whether you go to a local farmer’s market or take a closer look at what the produce department in your grocery store has to offer, challenge yourself and your children to find a fruit or vegetable you’ve never had or heard of before… and then buy it.
  • Challenge yourself in the kitchen. Like I said before, I am not a kohlrabi expert. I simply asked a few questions of a friendly kohlrabi farmer and made good use of Google. Fast forward three years and our refrigerator is frequently stocked with cut-up kohlrabi, which now plays a role in helping my family meet the latest MyPlate recommendations (which include the challenge of consistently filling half the plate with fruits and vegetables).

Originally posted on Omaha World Herald’s Live Well Nebraska