Parenting Solved

Thankful in the New Year

I’ve always said that it was easier being a pediatrician before I had children. Every day I’m truly thankful for the health that my children enjoy. While social forums like blogs allow the parents of chronically ill children to network and share their experiences, they also allow us a window into their lives.

For those parents needing a little reality check, read Samantha’s Story. It details the day to day experiences of a 3½ year old with neuroblastoma. Her blog is written by Samantha’s parents in her voice. I also enjoy The Wait and the Wonder written by Moreena. Her blog details (among other things) life with her daughter Annika (pictured on the left) who is awaiting her 3rd liver transplant. The title of her blog says it all.

Infant Formula After 12 Months of Age

What is it about a baby’s birthday that marks the transition from formula to cow’s milk? The question of when and why we stop using formulas relates to when babies become dependent upon solids. Both breast milk and formula bring babies to the point of weaning where they are able to support themselves on a variety of age-appropriate foods. This may happen late during a baby’s first year or early into the second year of life.

During the first year we pay close attention to the mineral and protein concentration in a baby’s diet. This is why we mandate that babies be fed only breast milk or formula. The first birthday marks the point where a baby’s body is able to handle many of the foods that adults eat. The additional protein, potassium and sodium found in cow’s milk, for example, is handled by a baby’s kidneys and intestinal tract without a problem. Another reason cow's milk is inappropriate under a year is its lack of appropriate levels of iron, linoleic acid, vitamin E.

But a baby could conceivably lag into her second year feeding Enfamil, Similac or Good Start without any repercussions. It is assumed, however, that toddlers at this point are receiving protein and vitamins from solid food sources. Infant formulas alone are unlikely to provide everything that a toddler needs for growth and development.

For many toddlers, milk may be considered a supplement, a nearly irrelevant source of bonus calories. For those who struggle with solids, however, milk is a key supplement. But as pediatricians we assume that for most kids the buffer offered by milk is a good thing. In fact, whole milk is recommended over lower fat milks to cover for the calories that some picky toddlers lack.

So while the 12-month point for eliminating formula may seem fairly arbitrary, it’s safe to say that it arises from the timing of what babies do on their own (wean) as well as the development of their bodies to take things beyond breast milk or formula. But like so many other things in parenting and pediatrics, we’ve got more wiggle room than you know.

Preventing the Swallowed Coin

Preventing coin ingestion in your child is easy: never allow them to be around coins. Easier said than done. Ultimately your toddler will find a stray penny.

When it comes to preventing that from happening, sometimes the best policy is not to bring it up. It’s what I call a “bean in the nose.” The idea is this: if you don’t want your three-year-old to put a coin into her mouth, the last thing you should do is tell her not to put that coin into her mouth. Because you and I both know that as soon as you turn around, the coin is going in her mouth.

This is called a “bean in the nose” because in the old days kids rattled uncooked beans around in cups as makeshift toys. Apparently it wasn’t uncommon for kids to stuff these things into their noses where they would absorb moisture and swell creating an obvious problem. And the idea of stuffing a navy bean into one’s nose isn’t something that toddlers think about on their own.

When it comes to small objects, less may be more. Keep quiet and do your best to keep coins an other small objects out of reach.

Magnets - New Risk for Toddlers

Add swallowed magnets to your list of child health threats in 2007. It seems new technology has allowed the proliferation of small, powerful magnets for use in toys and games. The Centers for Disease Control and Prevention reports this month on several cases of complications arising from magnet ingestion. All the cases involve kids swallowing more than one magnet.

The issue of magnets and tummies comes down to where the ingested magnets connect. If two or three powerful magnets are swallowed and find each other in the stomach they’ll likely remain happily attached during their journey through the intestinal tract. If, however, the magnets are in different parts of the intestinal tract then find one another through the thin wall of the bowel, their powerful attraction can create problems. In the cases reported, the constant pressure of the tight magnetic linkage created pressure on the bowel wall that ultimately eroded through causing intestinal perforation. Abnormal ‘linking’ of intestinal loops that are near one another can create twisting and blockage of the bowel. Isolated magnets swallowed by children don’t appear to be a problem since they have nothing to stick to.

It’s been suggested in the medical literature that handheld metal detectors may have a role in the localization of ingested foreign bodies. An interesting variation on this idea suggested in one case report: try a compass.

So be on the lookout for toys with small magnetic pieces. These should be avoided in children under age 6 years. Any question of foreign body ingestion warrants a call to your doctor.

The Hazards of a Large Family

My father used to tell me that I was driving him to an early grave. It seems he was probably right. The BBC is reporting today on a study that found the more children couples had, the worse their health and the more likely they were to die early. The researchers conclusions were based on historical data looking at couples having kids in Utah between 1860 and 1985.

Interesting reading and I find this very easy to believe.

Flea's Vaccine Extravaganza

The Master Flea’s recent tour of infectious threats to your kids is worth a look. He’s posted on diptheria, haemophilus, polio and smallpox. This holiday season we can be thankful for the vaccines that keep our kids safe from these debilitating infections. Too often these infections are taken for granted, if not forgotten.

Deadly Cookie Dough

Don’t eat the dough … or don’t let junior eat the dough. While once a source of fond memories from mom’s kitchen, this habit is going the way of black and white TV and Sunday drives.

So what’s the danger with cookie dough? It’s the raw eggs and what’s on and in the eggs: Salmonella enteritidus. Salmonella makes kids sick with diarrhea, fever, chills and abdominal pain. And the younger and older you are the sicker you get. This bug can be deadly in infants and the elderly. Raw and uncooked eggs have been implicated in over 80% of Salmonella infections. Once believed to be an organism found only on the outside of eggs, it’s now known that these organisms can make their way into the eggs before they’re fully formed.

Other foods that commonly contain raw eggs: homemade ice cream, Caesar salad dressing, hollandaise sauce, tiramisu, frostings and eggnog. Prepared products such as these are typically safe as they’re made with pasteurized egg products.

A few tips to keep Salmonella away:
- Say no to cookie dough
- Keep eggs refrigerated – while it won’t kill the bacteria on the eggs it will prevent bug proliferation.
- Use proper hand washing and discard shells to prevent cross-contamination.
- Avoid dishes in restaurants cooked with undercooked eggs
- Don’t kiss the family turtle (known carriers of Salmonella)

Since my son behaves like some sort of crazed crack addict whenever around chocolate chip cookie dough I’ll be preoccupied over the next couple of weeks with keeping his roaming fingers out of the bowl.

For more information on salmonella check out the CDC's FAQ on Salmonella

China Tightens Adoption Rules

This morning’s New York Times reports on China’s new adoption rules for foreigners. It seems that if your fat, fifty or depressed you’re no longer considered fit to provide a loving home for China’s orphans.

Formally stated, “…the Chinese government has formulated guidelines intended to recruit adoptive families with qualities that Chinese officials believe will provide the greatest chance that children will be raised by healthy, economically stable parents.”

It’s ironic that a system with such a despicable record of rejecting its female progeny would place such restrictions on those willing to accept them.

Cosmetic Surgery for Teens and Tweens

Just like the chiropractors looking to expand their market share in pediatrics, some desperate plastic surgeons are marketing their craft to the younger set. This blogger was apparently contacted by a publicist to help pitch cosmetic surgery to teens and tweens.

It seems when child protective services removes children from unkempt homes it’s neglect. When parents allow their blossoming children to be mutilated it’s nothing more than a sign of the times.

Via KevinMD

Antiterrorism Board Game

If tattoos on your kids isn’t enough to make the season bright, why not gather ‘round the kitchen table for a little War on Terror. In what appears to be Risk for new generation, players fight or fund terrorism after spinning the ‘axis of evil.’

Family game night will never be the same.