Parenting Solved

Parent Empowerment

Last evening I called a mother to discuss the results of her daughter’s recent upper endoscopy. It was a standard discussion where I discuss the findings of the pathologist and try to put it into the context of the child’s complaint. As it turns out, this child had a fairly common inflammatory condition of the upper small intestine referred to as eosinophilic duodenitis. As my explanation progressed it became clear that the mother wasn’t paying any attention to what I was explaining but was instead intent on getting the spelling of every unusual word that fell from my lips. Sensing that she was interested only in catching key words for a Google search, I encouraged her instead to follow my explanation of how inflammation in the upper intestinal tract can lead to nausea and poor tummy ache. She humored me and promised to follow my lead but I could still sense scribbling in the background. In the end, despite an impressive list of search terms, she had no idea what I had told her.

This encounter illustrates the change that has taken place between doctor and parent over the past few years. We have entered an era of parent empowerment driven by the Internet, mass media and different varieties of social media. There was a time when a parent’s network was limited to the neighborhood or mother’s group. The pediatrician was king and the parent-doctor relationship was paternalistic. Now mothers are talking and learning in more ways than ever. Things have changed. Seth Rubel of Micropersuasion discusses how social media is influencing this fundamental shift in healthcare.

This availability of information is intoxicating for some parents. And any good pediatrician will tell you that controlling that feeling of personal power can be difficult for some parents. But no one should fear anyone’s access to information. Parents and patients learn what works and what doesn’t. My patient’s mom, for example, will learn that while eosinophils in the gut can indicate a parasite, they’re more often a nonspecific indicator of irritation in kids.

In 2006 pediatricians help interpret what parents come to learn and believe on their own. While the Internet has not created this pattern it has certainly amplified it.

Clean Hands, Dirty Politics

The Purell dispensers that have become a fashionable appendage on baby bags seem to have made their way onto the campaign trail. The New York Times this morning reports on the hand sanitizing habits of some high profile politicians. Of interest is the comment by (Doctor) Howard Dean that he doesn't use the stuff since he's "immune to everything." Dick Cheney likes to sanitize out of the public view. And it seems Senator Barack Obama was turned onto Purell by none other than dubya himself.

I guess kissing babies is out of the question?

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The Reflux Medicine Mystery

The New York Times reports this week that reflux medications “may not do babies any good.” The article which appeared in the NYT weekly Health page was based on a pilot study presented at the North American Society of Pediatric Gastroenterology, Hepatology & Nutrition national meeting in Orlando. The study looked at the effect of different acid suppressant medications on acid and non-acid reflux events as measured with a special pH meter. The investigators sought to know if the suppression of acid in babies lead to less reflux? As it turns out, H2RAs (example: Axid, Zantac) didn’t decrease the number of acid reflux events experienced by the babies in the study. PPIs (example: Prevacid, Prilosec) decreased acid reflux events in babies fed by mouth but not in those fed with a feeding tube.

On the surface this study is interesting because it might suggest that the sweeping conclusion of the New York Times is correct. On the other hand these findings support what we already know: acid suppression doesn’t fix the happy spitter. It would appear, however, that PPI use might make things a little easier on a baby by minimizing acid exposure to the esophagus and throat.

The burning question: How effective are acid suppression medications at controlling the miserable symptoms of reflux esophagitis? Unfortunately the pilot data in this study don’t address this. The pediatric tummy docs of the world debate this question and the jury is still out. Given the absence of adequate research in this area most pediatric gastroenterologists have taken to treating sick reflux babies with some type of acid suppression.

Dr. Ajay Kaul and his colleagues at the University of Cincinnati should be commended for stepping up to address the questions of infant reflux. But like all good research, we wind up with as many questions as answers.

Should Parents Weigh Their Babies?

This is the era of parental self-empowerment and it seems more parents are looking to take their baby’s health into their own hands. BloggingBaby raises the question of whether parents should own their own baby scales. With few exceptions infant scales have no place at home. A baby’s gain or loss of weight needs to be considered in the context of their age, history and state of health. And unless a parent is prepared to act on information that they get from the scale, it only creates anxiety. When babies don’t grow it’s usually for a reason that requires professional attention.

Do Babies Need Organic Formula?

It seems we’re feeding our babies dirty formula. At least this is what the recent surge in organic infant formula would suggest. Just this month the manufacturers of Similac released Similac Organic, the first infant formula from a major manufacturer to be certified organic. But despite the press releases, organic baby formula isn’t new. Earth’s Best has been in the game for some time. And if their blossoming end cap displays at Babies R Us are any sign of success, the organic baby business is looking healthy.

But should we see the non-breastfeeding world as made up of dirty and pure options? There’s insufficient evidence to support the idea that traditional infant formulas contain pesticide residue at any appreciable level. And it’s inconceivable to believe that the casein (one of the milk proteins used in infant formulas) found in organic formula is somehow different from the casein in that of a traditional infant formula. The nutritional content is, of course, not an issue when comparing the two.

The rise of clean formula may be more about the 3.1 billion dollar baby food market than it is about changing the health outcomes of the next generation. Perhaps it's all about the yoga mommies, the latest hot market segment in baby food. Beyond yoga mommies, the organic option is fueled by parents who will go to no end for their children and see this as the pure choice. The market never lies and we’ll have to see how this one plays out.

So what's a parent to do? As a pediatrician I recognize that the impurities of traditional formula don’t represent a real threat to babies who can't breast feed. But as a dad, I think I’ll buy organic.

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Balance

The challenges of being a parent and a professional are terribly underrated. Our lives are a zero sum game. What we put into our careers we take from our families. And what we give to our families is taken from our church and community. So what’s a dad to do? This is the challenge of balance, something that very few of us achieve. We all have the ability to be as successful as we choose to be in our professions. We’re all naturally committed to our children. Putting the two together to achieve equanimity is possibly the greatest preoccupation of the modern parent.

Goofy's New Diet

It seems Mickey Mouse has jumped on board the obesity gravy train and everyone’s cheering. The execs at Walt Disney World announced this week that new measures were underway to make their parks less of a threat to the young American waistline. We can now rest assured that during our once-in-a-lifetime trip to the Magic Kingdom the absence of trans fats will make our kids just a little bit better off.

But don’t blame Walt Disney or its corporate managers. The pressure to engage in this type of public posturing is intense. There’s a witch hunt underway and Mickey’s in the crosshairs. And just like the afternoon parade on Disney’s Main Street, the response is staged, predictable and above all else, very entertaining.

Trust Yourself

I attended a lecture at the American Academy of Pediatrics national convention by two of the country’s leading authorities on child behavior. It was billed as something covering basic behavioral problems in the office setting. Both speakers came from prestigious children’s hospitals – pediatric blue bloods with good lineage.

This is what I expected: Statistics, jargon and out-of-touch advice.
Here’s what I got: Practical, grounded information from two parents who happen to be behavior experts.

It was comforting to learn that even ivory tower experts have their pet tricks on what to do when a child refuses to sit on the toilet or throws a tantrum in the grocery store checkout line. Surprisingly little of what was discussed was backed up with studies or statistics. As I discovered, experience, an understanding of the toddler mind, and a confident approach will get you further than a graph.

A couple of take-away points:
• While child behavior can’t be described as simple, most issues come down to simple behavioral conditioning.
• Parental limits and consistent responses to behavior will serve our kids best.
• Absolute right and wrong is a matter of opinion. Every child is different, every parent is different and no two situations are ever quite alike.

Sometimes the best parenting advice comes with the “permission” to trust our own intuition. I think it was Benjamin Spock who said, “Trust yourself. You know more than you think you do.”

American Academy of Apple Dippers

I was walking the exhibit floor at the national meeting of the American Academy of Pediatrics and I spotted the McDonald’s golden arch rising above the crowd. It seems they were giving out packaged apples to hungry conventioneers. Not a Big Mac or nugget in site. Only packaged apples.

This attempt at reshaping its brand in front of America’s baby doctors is a strange one. McDonald’s is what it is and free apples won’t change the opinion of the medical community. When we’re looking for fruit or all natural food for our kids, Mickey Dee’s isn’t likely to come to mind anytime soon.

But the coexistence of fast food in our culture shouldn't be a problem for parents who exercise discipline when feeding their children. Bad feeding, like bad behavior, can become a habit without discipline. Feeding discipline should include balance and dietary limits. Like birthday cake, Halloween candy and other dietary indiscretions, fast food should fit into the occasional category. Young children are provided with fast food by adults. And I’m still waiting for that first case of a four-year-old who drives herself to McDonalds for a Happy Meal.

McDonalds should be applauded for providing alternatives to french fries although it doesn’t take a Harvard MBA to figure what’s behind their AAP presence. While easy access to calories has been a major contributor to our obesity epidemic, it’s our lack of feeding discipline that’s ultimately to blame. We’ve created the first generation in American history that’s unlikely to outlive its parents. And no one wants to be accountable for that.

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AAP - Working For Kids

This week the American Academy of Pediatrics held its annual meeting in Atlanta. Most reading this post will never witness what happens when thousands of pediatricians meet under one roof to deliberate the issues facing America’s kids. It’s a chance to learn what’s new in vaccinations and how to treat infections with the latest and greatest new drugs. As a pediatrician it’s just another meeting.

Stepping back as a dad, however, it’s remarkable.

While you may never see it during your child’s 15 minute well-baby exam, pediatricians are passionate about what they do. And you’ll never quite understand true child advocacy until you see two grown adults nearly come to fists over bicycle helmet policy. From setting the standards for vitamin D requirements in breast fed babies to learning how to best handle parents who want to use herbs, the arguments we’re all involved in are about making sure your kids have every chance in life.

While it may be one of the lowest paid specialties in medicine, pediatricians do what they do because they love what they do. As a professional it’s all in a days work. But as a dad it’s remarkable.

Photo courtesy of the National Library of Medicine