Parenting Solved

Wakefield and the Fall of the Vaccine-Autism Connection

It’s been a tough week for he anti-vaccine movement.  Mounting evidence of fraudulent manipulation of data by Andrew Wakefield has all but put the light out on the MMR autism connection.  The U.S. Court of Federal Claims put the kibosh on the compensation of thousands of families by the U.S. government when it found no evidence linking vaccines with autism.  And over at Age of Autism, anger is advancing to bargaining and acceptance like the Kubler-Ross progression of a terminally ill patient.  Gone are the glory days of thimerosal.  

And what’s become of the man who started it all?

The emasculated Andy Wakefield, unable to practice medicine in the U.K., has taken safe refuge at the Thoughtful House in Austin where Texas law allows him only to watch patients from a distance, much like a curious nurse’s aide.  Wakefield’s muted existence is a far cry from his heady days in the spotlight when the world believed for a moment that his contrived ideas actually amounted to something.

While I’d like to say that it’s finally over, the vaccine-autism connection was dead before it ever began.

Those still at the party should heed the insight and courage of Alison Singer, executive vice president of Autism Speaks, who recently resigned her post recognizing that the game was finally up.  It’s time to give children with autism the attention and resources they deserve, she noted.  It’s time to move on. 

Effective Doctors Listen - Reflections on The Happy Hospitalist

There was an interesting rant last week at The Happy Hospitalist.  It concerns one doctor’s point of view on listening to patients.  As a patient I wouldn't want this person as my doctor.  As a doctor it’s embarrassing to be reminded of colleagues with such contempt for patients.

Here’s where I agree: Patients don’t know what’s critical and what isn’t.  The parents who come to my clinic with sick kids are desperate to get answers.  Many have been waiting a long time and most arrive with the false belief that they won’t have much time with me.  So the tendency is to want to tell me every little thing, and quickly.  They’ve rehearsed their stories and want to let it all out when they see me.

My job, however, is to control the interview and extract the information that I need while allowing the patient the opportunity to vent their concerns.  In the case of abdominal pain, for example, I have a very systematic interview that I conduct.  When parents want to give me information that I don’t need I’ll let them digress momentarily but then I gently redirect them.  As the interview progresses parents grow more at ease when I showcase a compulsive, thorough evaluation.

As I finish my history, stand up and segue into the exam, I allow parents the opportunity to open up and offer their thoughts and feelings about their child.  And it’s here that I’ve learned some of the most interesting tidbits of information.  It’s this time between the computer and the exam that I’ve learned things that have made all the difference.

The frightening part of The Happy Hospitalist's angry diatribe is the belief that he has it all figured out; the trivial concerns of the patient are simply obstacles to what he needs.  I haven’t figured it all out yet and when I do, I hope I’ll still respect the needs and concerns of those who trust me with their children.

The Transparent Pediatrician

In social media circles I hear a lot about the concept of transparency.  Transparency is the quality of disclosure about who you really are and what you’re about.  It’s about expressing yourself beyond the surface and hype.  And full disclosure is one feature that differentiates the great blogs from the mediocre.

But genuine transparency may have real utility beyond blogging.  Doctors, for example, could learn from this.

I came to think of this recently when I received a warm letter from a mother detailing the things that made her feel at ease when caring for her daughter.  And other patients have shared similar feelings from time to time. 

Putting them together I can see some patterns in what’s worked for me.  And in many cases the positive feelings about these encounters have come down to transparency.  It’s a quality that helps us believe that the person caring for us is like us: Vulnerable, human and at times uncertain.  And when I expose myself in this way I connect. 

Here are a few things that I do to to show myself:

I let families know that I’m like them.  I always find some common ground with a family during the first couple of minutes in the exam room.  Be it revealing that I have a daughter of the same age or recognizing perhaps that they’re from another part of the country.  Common ground opens the door.

I’m honest.  When I don’t know exactly what’s going on with a child I make it very clear.  I’m comfortable with my uncertainty.  But I always have a plan and make it very clear to families the course we’re going to take to make things as certain as we can get them.

I practice a little self-deprecation.  I naturally look for the occasional opportunity to poke fun at myself, my issues and my quirks.  It helps parents understand me and lets them know that they’re dealing with someone a little like them: Less than perfect.

I understand your crazy world.  As a father, recognizing the concerns, preoccupations and worries of parents is critical to understanding their hidden agenda.  When I genuinely disclose that I understand a parent’s worst fears, they know that they are heard.

Cultivating relationships with these features is critical to building trust with parents.  And without trust a pediatrician is ineffective.

When you listen to the complaints of patients they often center around a lack connection from providers.  Doctors are too hurried and don’t take the time to understand the concerns of their patients.  Perhaps a little transparency is all that’s needed.  

When Pediatricians Pass Judgment

If you’ve ever wondered what your pediatrician thought of you, check out Dr. Perri Klass’ recent column in the New York Times.  As always, her angle on the experience of doctoring children is unique.  This piece draws light on the fact that pediatricians often draw conclusions about child behavior and manners that are never discussed.

So watch your (kid’s) P’s and Q’s.  Remember that as parents we’re charged with the responsibility of cultivating the next generation.  And you never know who’s got their eye on you.

When Patients See You at the Gym

Today a patient’s mother reported that she had seen me at the gym.  Apparently she and her husband had seen me working out and briefly debated whether I was the doctor in question.  I was able to confirm that I in fact had been at the Y over the weekend, sans khakis.

It’s a strange feeling to know you’ve been seen, especially when you didn’t know you were being seen at the time.

And I often run into mothers in the grocery store.  For some reason they always look into my cart.  Looking in someone’s grocery cart is an intimate act, I think.  Especially when you dole out nutritional advice for a living.

There are parents who have picked me up on Twitter.  Microblogging is another place where I disclose parts of myself not seen in the clinic.  For better or worse.

The gym, grocery store and Twitter are personal spaces.  But as long as my patients don’t mind seeing me speak my mind in my Underarmour with a 5 o’clock shadow and a package of Mallowmars in my cart, I’m good.

I guess this is what the social media experts call transparency.

Are You Structured When it Comes to Feeding Your Kids?

I’m always amazed at the structured discipline that parents hold themselves to when getting their kids ready for bed.  Almost on the clock:  bath, story, bed.  And for good reason.  Any parent worth their salt knows that successful sleep patterns begin with the repetition of a nightly routine.  Routines tell children what’s about to happen and what’s expected of them.  Rituals create order for children.

But when it comes to eating, structure seems to go right out the window.  So often when children are hungry, they expect snacks.  When they’re fidgety at the pediatrician’s office, out come the Goldfish.  Often the limited diets and poor habits that children develop are our doing.

The foundation of healthy feeding is a tight routine.  While I’m a strong advocate of feeding on demand in early infancy, it doesn’t work for toddlers.  Why?

• Feeding on demand promotes grazing.  This creates havoc with our digestive hormones and stunts the appetite.  Just like your mother used to tell you, if you fill up on junk, you won’t eat your dinner.
• Feeding on demand puts feeding on their terms.  While children do have to assume responsibility for what they eat, they lack the judgment to do this entirely on their own.  You set the boundaries of what’s appropriate and leave the rest to them.
• Feeding on demand sends the wrong message about food.  Children must learn that the impulse to eat will not always be fulfilled.  Older children are more apt to use food to fulfill other impulses other than hunger and the need to nourish.

After the first year, plan on three squares a day, two snacks and watch out for that appetite-numbing wander cup with milk and juice.

By the way, my weakness is a handful of cashews during the hour before dinner.  Of course when I grab ‘em the kids are in tow looking for their own.  So as we eat, so shall they feed!

Free Range Kids, Helicopter Parents and Baby Monitors

There’s an interesting conversation going on over at Strollerderby.  Do babies really need monitors?  Or, as it’s been suggested, is it negligent to not use a baby monitor?

It’s an interesting question because it defines a recently evolving split in parenting styles:  The helicopter parent vs. free range parent.  The hand wringing helicopter parent hovers and the free rangers sits back and see the merit of an unrestricted environment.

And the antagonism is mounting.

While I’m hoping to get my hot little hands on a copy of Lenore Skenazy's upcoming book on Free Range Kids, I can’t yet say that I endorse her style.  But I’ve followed her for some time and I think that we all may be able to pick up a few pointers.  Lest we become a Nation of Wimps.

What Would You Do if This Were Your Child?

Many times when faced with a clinical dilemma a parent will turn to me and ask, “What would you do if this were your child?” 

When faced with this question I never quite know what to say.  And each time I feel a little on-the-spot.  But why is that?  Aren’t I comfortable recommending for someone else exactly what I would do for my own child?  After all, what have I got to hide?

Here’s the problem: the decisions we make as parents involve our values, tolerance of risk, level of concern and frustration, prior health experience and religious belief to name but a few.  There’s no way to fully tease those things from the parent sitting across the room.

Perhaps it’s the intensity of the fact that my child would or could be in the same situation that bothers me.  When I disclose what I would do myself as a dad, it’s intimate.  The decision I make for my child says a lot about me and my fears and concerns.  When I disclose that I’m biasing their decision with the things that are important to me.

When I get this question, what I really hear is, “I can’t really weigh the options so help me out.”  And I do.  With my answer they believe that I’m telling them what I would do.  But in fact it’s nothing more than an exercise to help them understand what they really want.

When I’m in an exam room I’m a pediatrician, not a father.  But the art of what a great pediatrician does involves understanding the mindset of a parent.  Through this understanding I can frame my recommendations in such a way helps parents make the best decisions for their kids.

Child Drives Car After Watching Grand Theft Auto

The AP has reported that a 6-year-old Virginia boy who missed his bus tried to drive to school in his family's sedan — and crashed.  The boy fortunately suffered only minor injuries.  His parents were charged with child endangerment.

And here’s the punch line:  The boy told police he learned to drive watching Grand Theft Auto.

This story at its core level is tragic.  A six-year-old child, unsupervised by his sleeping mother, endangers himself and others in an automobile that he felt empowered to operate after watching a mature rated video game that glorifies auto theft, prostitution and murder.  Rich. 

What’s remarkable is that while you need a permit to go fishing, anyone have children.

Are You Tuning Your Kids Out?

A mom I follow on Twitter noted last night that her daughter has requested a media-free period between 5-10 pm.  No phones, no laptop, no TV and no electronics.  Charming in its simplicity but it has to make you think:  Are parents too connected and can our children sense it?

True confessions:  I tune my family out more than I should.  It’s wrong but I do.  While I love my kids and the time I spend with them, I also enjoy the hangin’ at the Twitter water cooler or seeing what my favorite bloggers are posting.  So compelling.

So what to do?

It’s pretty clear, actually.  As a dad I have to set a good example for my kids and that includes separating my Twitter/Blog time from my family time.  Like so many things involving personal change, it’s nothing more than raw discipline and the firm decision to do what’s right.

If it’s not too late for resolutions, I plan to work on the following:

• Avoid my laptop between dinner and bedtime
• Avoid using my iPhone when out and about with my family except for important calls
• Never passively dismiss my kids for online activities

I really want my kids to a life that goes beyond online social networks and that can only begin with truly living that life myself.  I’ve got some work to do.  How about you?

Tip to @holly_t for the inspiration