My husband and I are in the process of not only trying to teach our 16-month-old son how to talk, but how to talk politely. We could use some tips.

Tonight, as Kellen reached for something that was in my hand, I asked him in my usual sing-songy voice, “What do you say?” And he promptly responded, “Mine!” LOL. That wasn’t exactly the “please” I was hoping for. I even would have been happy with “peas.” Or settled for just the “p” sound.

Why is it that “mine” is a word that resonates so much with toddlers? It’s so strange how they transform from cooing little balls of chub to these strongly opinionated little ogres (and I mean that in the nicest way possible) seemingly overnight. Suddenly all we hear from Kellen is “no” and “mine.” It sounds like he has forgotten most of the other words in his limited vocabulary. Either he wants to disagree with you, or tell you that everything in our home belongs to him (where, again, we disagree).

We do get an occasional “day coo” (thank you) from Kellen as well…but never when requested. Usually, our son uses the phrase as a gentle warning that “yeah…I’m going to go ahead and get my way right now, so I’ll just say my ‘day coo’ in advance, to make sure everything goes according to plan.” And then, of course, we are so bowled over by his cuteness that he gets whatever it is that he wants. It’s like he is using this whole manners business to manipulate us! How does a 16 month old know how to do that?

I wish I could remember what I did to teach my 4-year-old daughter how to be polite, but nothing stands out in my memory. It just seems like it was easier with her. As long as you weren’t trying to put Anna to sleep, she was always a very compliant kid. And she didn’t have the fun of having an older sibling to steal toys from, while shouting “Mine! Mine!”

So what I need are some experienced parents of more “strong-willed” toddlers to share their secrets for teaching them to be polite, and turning them into kids that other people want to be around. Or…an expert explanation that convinces me that this type of behavior is perfectly normal and manners will eventually catch up with my youngest child. And I could use one or the other as soon as possible! Please…and thank you.

Every once in a while, I go a hair on the philosophical side. Medicine is a science for sure, but as a frequent reader of this blog, you’ve probably noticed that there is some art to it as well. Well, there’s another aspect of medicine that we see everyday and yet don’t always acknowledge, though we work extensively with it. Medicine is a uniquely human. Yes, we can talk about veterinary medicine in many of the same terms as human medicine, but there is something very different about the effects of illness and health on humans, versus animals.

This became abundantly clear to me after I spoke to my mother the other day. I am currently rehabilitating from a surgery to my left knee. The surgery that was planned was a relatively minor cleaning out of the knee. The plan was to be back on my feet within a few days and back to running, if I still wanted to, within a week or two. Once my surgeon got into my knee, however, he found a rather big mess. Not too surprising, since my MRI results were terrible. What was surprising is that he had crossed off “limited weight-bearing as tolerated” off my discharge instructions and replaced it with “non-weight-bearing. Use crutches for 4 weeks.” Now that throws a monkey wrench into things!! I had planned on going back to work in a few days and getting back to full speed relatively quickly. Now I’m on the slow burner for several weeks!

So getting back to Mom…she had reminded me of her experience having each of her knees replaced. Our short-term rehab plans were about the same. The discomfort was different and yet the same for each of us. So we commiserated for a little while and hung up the phone with words of love and encouragement. It got me to thinking, though. She had a vertical cut about 6-8 inches long; I have two small puncture wounds. Her surgeon had to cut through large portions of her muscles to get the device into her joint; my surgeon avoided the muscles all together and went in the side of the joint. You see, here I was whining about 4-8 weeks of not being able to put weight on my leg, while she had gone through a great deal of discomfort (admittedly relieved by chemistry) as her muscles had to knit back together in order for her to walk again.

It got me to thinking further, though. Sometimes we forget, when we give or receive a diagnosis that others have been there before. We also can easily forget that others have been through much worse. I can’t bear weight on my leg for a month or so, but I have a patient who is 18 years old and has NEVER been able to bear weight on her legs. She has cerebral palsy and has lived in a wheelchair all of her life. My work and personal life is disrupted for a month or two. My running may be on hold indefinitely. BUT…I haven’t been diagnosed with leukemia. My life will not be centered around some medication regimen that keeps me alive.  I’ve been inconvenienced, but I haven’t lost a loved one to an accident or a disease.

As physicians, we give inconvenient news to patients all the time and become somewhat numb to the consequences that this news means to families. As the receiver of inconvenient news, we easily forget that the news could have been worse. News is neither good nor bad. It’s just information. It’s what we do with that news and how we choose to live our life as a result of it that ultimately makes medicine a uniquely human experience.

From time to time in my medical practice, I encounter parents who express concern over (and eventually choose not have their children participate in) some of the “best practices” of modern medical care. Sometimes it is apparent that they have decided to make that decision based largely on information (or misinformation) that they have read on the Internet. That concerns me. Don’t get me wrong; I think the Internet is a great tool. Obviously, I have a blog…and that’s where you read it. But I find it troublesome that some parents are willing to take the anti-medical advice offered by random Internet articles, whose source and accuracy is “iffy” at best, over the advice and practical experience of their own family pediatrician.

Take for example the vitamin K shot that is given to newborns at birth. I have worked with parents who decide that they don’t want their infant to receive this shot. What I can’t understand is why. Let’s review the facts about vitamin K:

Vitamin K is required by the body in order to produce four different clotting factors. If these factors are low, there is an increased risk of bleeding longer and more severely than normal and into places you shouldn’t bleed, including your brain. In newborns, these clotting factors are deficient for a number of reasons, including a low amount stored during pregnancy, poor GI production of vitamin K, and a sole diet of breastmilk, which is relatively deficient in vitamin K. 

Once in a while, we’ll see symptoms of a vitamin K deficiency in the first 24 hours. This is rare. More commonly, symptoms occur during the first two weeks from bleeding at a puncture site, a circumcision, or from the umbilicus as it starts to come off. These are mild symptoms that have very little effect on the newborn. More ominous is bleeding that occurs after the second week of life. This is when intracranial bleeding is most common. Once an intracranial bleed occurs, the chances of death or permanent brain damage are about 50%! This would be a disaster for the family of a newborn…especially when that potential disaster is easily prevented with a single shot of vitamin K at birth. 

The single dose of vitamin K at birth has virtually eliminated this problem in the United States.  The incidence of vitamin K deficiency disease in newborns in the U.S.  is quoted as 0.25-1.7/100 newborns. In nations where the vitamin K shot at birth has not been routinely implemented, the disorder is seen in up to 7.5% of newborns!

Sometimes, the information you get on the Internet can be misleading. Please, when you make medical decisions that affect your children and/or the children around your children, get all the facts from a reliable source, and carefully weigh whether your concern about doing too much to your child really outweighs the risk of not doing the medically prudent thing.

Upon waking up the other day with a scratchy throat:

“Cough, cough. Ahem, ahem. AHEM!”

What’s wrong, Anna?

“I don’t know. I guess I have some trash in my throat.”

Trash? What kind of trash?

“Probably just some junk food or something.”

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Upon thinking about a lost loved one:

“I really love my family. I love my mom, my dad, my brother and my dogs. I especially love my doggie Rolen, because he’s up in the sky in Heaven.

How does Jesus even get us up to the sky anyway? Does he have a car that can drive up there? Does he have an airplane? Or a helicopter? Does he have a sleigh with reindeer hooked to it? How do you think he does that, Mom?”

I wish I knew. But I will gladly wait to find out.

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This afternoon, as I was getting a ba-ba for her brother:

“Hey mom…Remember when YOU used to be Kellen’s bottle? That was funny.”

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After Daddy asked Anna if she thought that Kellen had his chin:

“No. He doesn’t have lots of sprinkles on his chin like you do.”

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All I know is that you certainly don’t have to look to Hollywood for entertainment when you have KIDS!

Okay, so if you’ve been watching the news, then you know that the “swine flu,” known in the scientific world as the H1N1 virus, never really “left.” We just haven’t heard as much about it over the summer, after that huge media blitz in the spring.

However, since I work in health care, I am hearing plenty about H1N1 again. Not because there is another “major” outbreak at the moment…but because health care workers are trying to plan ahead for a swine flu resurgence this fall, especially as kids head back to school. There they will eagerly swap tales of summer camp and family vacations…along with plenty of germs.

Health officials now call swine flu a pandemic. That means the virus has spread throughout the world. Currently, the strain that is going around is brand new – meaning that most people have no immunity to it, and no vaccine exists (although health officials are working on one). Fortunately, the swine flu has been relatively mild in most people who have had it. But the scary part is that could change as the virus spreads.

So what does all this mean for parents? It means that as you are preparing your kids to get back into the habit of waking up early and doing homework after school, you should also be preparing them for FLU PREVENTION. Really emphasize “the basics” of proper hand-washing techniques, not sharing cups or utensils with other kids, and keeping their hands out of the holes in their faces! These are things that are easy for parents to assume that our kids already know…but trust me, they are kids and they “forget.” So be sure to touch all those bases again. Repeatedly.

Here is a great resource for kids who can read with more facts about swine flu and swine flu prevention (along with all other health topics…www.kidshealth.org). Also be sure check out this link on the Mayo Clinic website that talks about the RIGHT way to wash your hands. Does anyone really do this? I’ve been to thousands of public restrooms, and I don’t think I have ever once seen anyone wash their hands longer than five seconds. Yuck! A good alternative that you may want to consider for your kids is an alcohol-based hand sanitizer (which, the Mayo Clinic article explains, needs to be at least 60-percent alcohol). I actually have bottles of this in all four of my bathrooms at home, as well as the kitchen, both cars, my purse, the stroller, and the diaper bag. The great thing about this stuff is that it is actually much easier to get your kids to apply it (at least it is for mine), and you know they are doing it right. 

Oh yes…one more little thing…if your kids DO come down with flu-like symptoms, please keep them out of school, stores, restaurants, playgrounds…and pretty much anywhere else that my kids are likely to be. And I promise to do the same for you. Thanks!

Last night, at the end of my day, I had a very perplexing case. Mom had brought her young teenager in for a cough that just never seemed to end. As we got to talking, it became pretty clear that her son has asthma, but that we had never really considered the possibility before. He had never wheezed. He had no allergy problems. No one else in the family has asthma. We really had no reason to consider the possibility before. Yet, there he was in my office clearly having trouble with asthma.

So when should parents be worried about asthma? We don’t have the space here to go into a full explanation, but we’ll cover some basics. Asthma, by definition, is a chronic disease that inflames and narrows the airways, making it harder (or sometimes impossible) for a person to breathe.  The word “chronic” tells you that you will notice at least some of the symptoms over a long period of time.  The most obvious symptom is wheezing, that sort of whistling noise that some people make when they are trying to get the air out of their lungs. Usually, when patients are wheezing, there is some measure of discomfort to their breathing as well. Wheezing can be triggered by cold temperatures, upper respiratory infections, allergies, irritants (cigarette smoke), sinus infections, exercise or even emotions. Shortness of breath and chest pain accompany the wheezing most of the time.  In addition, a cough is almost universal in kids with asthma. It is usually a dry cough, but since sinus infections are a common trigger, we’ll often see a wet junky cough as well. A cough that persists through the middle of the night and wakes other family members frequently is more common with asthma than with other illnesses. Furthermore, since asthma is an allergic disease, you will often see allergy symptoms along with the asthma.

Individuals with asthma are treated in a step-wise manner. Those who only have minor symptoms of wheezing once in a while are often treated only with albuterol, the inhaler that you have probably seen people carrying around. This is considered a “rescue inhaler” and is central to the care of patients with asthma. It is the only medication that will rapidly reverse the shortness of breath. Steroids are the mainstay for any asthma attack. Steroids work by reducing swelling and mucus production in the airways of a person with asthma. The albuterol will only temporarily relieve symptoms; the steroid is what really settles down the respiratory system and allows a patient to return to normal. As patients present with more persistent symptoms, preventative measures are taken which might include a daily inhaled steroid, long-acting inhaled albuterol equivalents, and allergy medications. Often, an allergist is asked to assist in the planning since controlling allergy symptoms may completely eliminate asthma symptoms.

Asthma is a very serious illness. Our society tends to make light of it, because so many people have extremely mild cases.  But it’s that tendency to under-recognize and under-treat the symptoms that will get patients in trouble. So, if your child has a family history of asthma, allergies or eczema, experiences a cough that won’t go away, or has wheezing or shortness of breath with exercise, a trip to your pediatrician is likely in order. A few simple steps might improve his or her quality of life significantly.

Music is a big part of life in our house.  Dad loves music, mom loves music, and the kids love music.  Our son Kellen is a regular dancing machine.  That kid cracks us up with the way he grooves to every possible musical beat.  He dances to the sounds of noisemaking toys, commercials, and even his sister’s singing.  The other day at the park, some woman’s cell phone rang and Kellen started dancing to her ringtone.  She laughed and asked if she should just let it ring so he could hear more of the song.  He is not choosy.  He would listen and dance to anything.

Anna, our four year old, enjoys dancing as well…but she has always been more of a selective listener.  She and I sometimes battle over what we’re going to listen to in the car.  When she was very little, I made the mistake of playing kids’ music in the car’s CD player to keep her happy.  DON’T EVER DO THAT!  Buy the kid their own iPod, but don’t ever subject yourself to days on end of listening to the “ABC’s” and “I’ve Been Working On the Railroad.”  I just don’t think it’s healthy. 

So luckily, after Anna got over a hard-core Elmo phase, she and I both went through a serious John Mayer addiction at the same time. That was nice. Now, she has a good appreciation for listening to most of mom and dad’s grown-up musical selections, which tend to vary from jazz to jam bands to Christian music to 70’s rock to acoustic/ coffeehouse music.  Most of the lyrics of the songs that we listen to are completely innocuous – or, if they reference a mature subject matter, they do it in a way that I know my kids won’t understand. 

Take the lyrics below, for example.  These are from a song called “You and I” by Ingrid Michelson, which I really like.  We were listening to it in the car last night, and Anna was giving me a hilarious running commentary of her take on the lyrics.  I thought I would share.  I have italicized her comments:

Don’t you worry there my honey (I’m not worried.)
We might not have any money (What?  Everyone has money!)**
But we’ve got our love to pay the bills.  (How can you pay the bills with love?)

Maybe I think you’re cute and funny, (That’s just like me! I’m cute and funny!)
Maybe I wanna do what bunnies do with you
If you know what I mean (Hehehe…that’s the funny part, mom! She wants to hop like bunnies!)

Oh, let’s get rich and buy our parents homes in the South of France.
Let’s get rich and buy everybody nice sweaters and teach them how to dance.
(What? I don’t like sweaters and I already know how to dance!)
Let’s get rich and build a house on a mountain making everybody look like ants,
From way up there, you and I, you and I.  (People are not ants.)

**Keep in mind, that comment is coming from a child who believes if you have a piggy bank full of pennies that you are set for life.

Anna’s current favorite song that I listen to though, is “1,2,3,4” by a band called Plain White T’s. I knew that she loved it, because she is always asking me to play it.  I assumed it was because it is a very nice, catchy song with sweet lyrics.  But just last night she asked me if I know WHY she loves it so much.  I said no.  “Because it’s about love, and it has counting in it.” Ahh yes…love and counting.  What more could you ask for in a song?

Not too long ago, I was asked by a colleague to review data on how and why people die. This was a review to look at how certain diseases affected life span. We were hoping to help physicians look at their patients from a different view point. The goal was to help them realize just how severe their patient’s illnesses were. What I came away from the study with, though, was a better understanding of how to live as long as genetically possible.  You see, when it comes to longevity, there are only four questions you need to answer. 

First, what do you eat? Your diet affects everything about your body. Your weight, your cholesterol levels, your insulin levels, and a variety of cancers. A simple rule is that the more natural stuff you eat, the better for you. Fruits, vegetables, and nuts are absolutely key. Fish and dairy products are critical in moderation. There is a lot of question regarding the value of other meats, but most of us need protein and iron, so an argument in favor of them can be made. Eat them only in moderation. There is also clearly evidence that less is more. People who eat less (other than those who are intentionally or unintentionally starving themselves) live longer.

Second, do you exercise? The benefits of exercise are far-reaching. Heart health, brain health, and energy levels all depend on regular exercise. I’ve probably talked too much on this ‘blog about exercise, but it’s that important. Get your heart rate above 140 for an hour or more 4-6 days a week in order to derive maximal benefit. If you can do this with a brisk walk, then go for a walk. Those of you in better shape will need more vigorous, intense exercise. It is also clear that short bursts of higher intensity exercise mixed in (interval training, weight lifting, etc) will increase basal metabolic rates, leading to more weight loss.

Third, do you smoke? The first two questions have to do with things you need to do to live long. This third is something you need to NOT do to live long. Cigarettes and other forms of tobacco, both first-hand and second-hand, are the most important things to remove from your life if you expect to live for a long time. Just think of all the dinners out you can enjoy with the money you will save!

Finally, we come to an issue that didn’t come up in my research, but has been adequately documented in a variety of studies...your “spiritual” health. By this I’m not necessarily referring to church attendance and religious affiliations, although these are a part of the issue. More importantly, how do you attend to your inner self and how do you relate to the wider world around you? Studies have made clear that our relationships, the way we deal with stress and the way we relate to ourselves affects longevity. All of these are aspects of our spiritual health. Activities that fall into this category might include religious services and activities, periods of meditation, gatherings with close friends, and maintaining a healthy marriage.

So, you see, the secret to living a long life is not really a secret. What do you eat? Do you exercise? Do you smoke? Do you tend to the relationships in your life? Honest answers to these questions will give your physician a very good idea of whether or not you are at risk of dying early. Fortunately, you can modify the answer to each of these questions with a good dose of willpower and persistence. Good luck in your search for good health.

For those who have been reading this blog for a long time, you may recall that when I was 23 weeks pregnant with my second child, Kellen, I was placed on permanent bedrest because he was trying to, well…escape. The kid literally had one foot in the door, so to speak, and was caught by my awesome OB/GYN just in the nick of time. Fortunately, thanks to a emergency cerclage, I was able to incubate Kellen all the way to 38 weeks gestation (full-term), and he was born completely healthy.

From the moment Kellen became mobile at five months old, he has shown us that he is still very much the same boy who couldn’t wait to get out of the confinement of the womb. He is quite…active.  He runs, he jumps, he dances, he climbs, he falls. He laughs and repeats with vigor.

The other night, my husband put Kellen to bed, while I was reading a bedtime story to our four-year-old daughter, Anna. When I left Anna’s room, I could hear Kellen jabbering away in his own bedroom…not unusual in itself. But this time I thought, “What is he doing in there…he sounds awfully close to the door!” And as I opened his bedroom door to take a peek, I was greeted by my now 14-month-old, who was happily running around his room talking to himself. That is to say…my husband put him in his crib…and Kellen then climbed OUT of the crib. By himself. At 14 months.

AHHHHHHHHHHHHH!

That was the beginning of a long night for my husband, who then spent about three hours watching our son from his doorway, and placing the screaming boy back in his crib everytime he tried to climb back out. Finally, Kellen fell asleep out of sheer exhaustion. The next morning, all was quiet when I got in the shower. But as soon as I got out and started to get ready for the day…THUMP! WAAAHHH! I ran to Kellen’s room, and there he was, lying on the floor screaming because he had hurt himself in the fall from his crib. That is, he screamed until his big sister ran in and exclaimed, “DUDE! Did you climb out of bed all by yourself?!”, which is when he proudly nodded his head and said “Dah! Dah!” (we think he might speak Russian) and the tears magically dried up.

That night, my husband lowered the crib one last notch to the “toddler bed” setting, so that the mattress is now practically sitting on the floor. And so far, Houdini Junior hasn’t been able to climb those few extra inches to freedom. But I wouldn’t put it past him. My husband and I are already talking about what to do once he figures it out. Put an air mattress on the floor next to his crib? Put him in a toddler bed? That idea makes me tired just thinking about it. What 14-month-old is going to stay put in a toddler bed? Certainly not our little escape artist!

If anyone has any suggestions on what to do with a baby who knows how to climb out of his crib, I could certainly use them! 

Why do we rush to get where we don’t want to be and bend over backward to be nice to people we really don’t like, only to come home and be crabby with the people we love the most?

Sometimes I have the luxury of time. I usually get into the office anytime between 7 and 9 a.m. which means there is a lot wiggle room regarding how long it takes me to get to work. The other morning, it was so nice outside that I was taking the drive into work very slowly with the windows open, enjoying the cool breeze. Don’t get me wrong…I was traveling at the speed limit…but barely. I got to the interchange between highways and in narrow lanes on curves, people were flying by me and changing lanes in front of me. All I could think was, “Why are you in such a hurry to be where you probably don’t want to be?”

I like my job. I also like a lot of the people I work with. I really like the relationships I develop with most of my patients. Would I give it all up if I didn’t have to work for a living? Probably not…but I sure wouldn’t work as much or as hard while I was there. Most days, given the choice between going to work or staying home, most of us would stay home. Likewise, most of us would choose to hang out with family rather than
coworkers most of the time. So why is it that we race to do these things? Why do we treat time at work as our highest priority? Don’t get me wrong…you have to earn a living, you have to do your job well, and you generally have to be on time to work. In spite of all that, watching how crazy people are on the road makes me wonder why they are in such a hurry?

On the other side of this same coin is the way we treat family when we get home. I’ve often wondered why we allow ourselves to behave at home in ways that we would NEVER attempt at work. Are we afraid that at work our image will be affected? That we’re more likely to be called to task for bad behavior? I’ve already established that I’d rather be with my family, so why do I treat my family worse than I treat my co-workers?

The balancing act is always tricky. We often slip into certain behaviors that allow us to maintain the balance with the least amount of resistance. What I’ve come to realize more and more is that sometimes we have to work when we least want to work, try harder when we least want to try harder, and maybe let a thing or two “slide” that we wouldn’t normally. My family is far more important than my colleagues. My time at home is far more important than my time at work. Therefore, I need to be careful with my balancing act to make sure I keep my priorities in line.

“So what should I write an article about?”  My eight-year-old daughter and I were driving home from an errand.

“What do you need to write an article for?”

“My ‘blog about kids and families and medical stuff.”

“Oh, then you should write about taste!” she told me, as she contentedly sucked on the banana split flavored Dum-Dum she had just received.

“Why would I write about taste?”

“Because it’s interesting.”

“It is?”

“Ya!  You know you can only taste four things, don’t you?  Bitter, salt, sweet and sour.”

“Oh really?”

“Ya!  And if you can’t smell, you can’t taste very well.”

You see, she happened to also know that if you could really only “taste” four tastes, then eating would be a very boring activity.  It turns out that the vast majority of perceived taste is really smell.  The odor drifts up through the hard palate (the roof of the mouth) to be received in the nose.  Some of the smell is also received before the food ever enters the mouth and is perceived as taste even though all the action occurs in the nose.  

“So what else should I write about taste?”

“You should say where taste is located on the tongue.”

It turns out that the tongue is very specialized.  It is divided into several parts.  The tip of the tongue is most sensitive to sweetness.  The sides close to the tip of the tongue are sensitive to salt.  The back of the top of the tongue is most sensitive to bitter flavors.  The sides closer to the back of the tongue are most sensitive to acid or sour tastes. 

“So why did you think of writing about taste?”

“Just because it’s interesting.”

“It had nothing to do with the Dum-Dum in your mouth that tastes like banana split?”

“No, of course not.”

And so, great ideas for ‘blog articles are born.

Early morning at my house:

The baby is still sleeping.  Mommy is trying to finish getting ready for work before he wakes up.  Four-year-old Anna is playing quietly in her room. Loki the dog is on the first floor, minding his own business, when he hears a noise...as dogs sometimes do...and lets out a few quiet barks.

Anna decides to help keep the peace, and walks out to the second floor landing, right outside her brother's bedroom door.  "LOKI! BE QUIET!!  KELLEN IS SLEEPING!" 

And that's how we wake up babies at my house. 

I am just back from a nice, long vacation.  But I think my brain melted somewhere in the hot Florida sun.  Either that, or the mosquitoes sucked it out of me (along with half my blood supply).  Or maybe it stopped functioning sometime on the 15-hour drive back home.  I guess what I’m trying to say is…why is it so darn hard to get back into the swing of things once you have finally remembered how to relax?

Yes, despite the title of this post (got you to look, didn’t it?), it really is possible to relax on a family vacation with a four year old and a one year old, even when there is a 15-hour drive involved.  We had lovely house on a private beach, with a private pool, and did a whole lot of NOTHING that involved anyone other than our family.  Not that I’m not a
“people person,” but it was nice to spend a week outside of reality, when I didn’t see anyone, talk to anyone on the phone, or email anyone other than the people I love the most.  I think every family needs that kind of time to reconnect once a year…especially families in which both parents are always “on the go.”  I had fun being a full-time mom for a week, and I learned a lot about my kids in the process.  Here’s a short list:

•  Anna likes to build sand castles. 
  
  
•  Kellen likes to smash sand castles. 
   
• Anna is afraid to get too close to frogs, turtles, crabs, and pretty much anything that moves.
   
• Kellen is eager to touch, squeeze, and potentially ingest frogs, turtles, crabs, and pretty much anything that moves.
   
• Anna is NOT afraid of water slides (We did take her to a water park one day, and she could not have been more brave.  Who knew??)
   
• Kellen likes to eat sand. 
   
• They are BOTH currently afraid of the ocean. Oh well. That actually made it easier to relax while we were on the beach, since we knew they weren’t going near the water. And at least they both loved the pool.

For the record, that 15-hour drive really wasn’t so bad.  On the way there, we broke it up into two days.  On the way back, when we couldn’t wait to get those kids back in their own beds, we just “went for it.”  Kellen had a few melt-downs, but Anna was a perfect angel…not one whine in 15 hours!  Pretty impressive for a four year old. She learned how to operate her own DVD player, and was able to change movies to her heart’s content without having to ask me for help. Good times!

The recent posting by Kate regarding ear tubes got me to thinking. I realized that even though most of our readers have heard of ear tubes, they might not really know what their pediatrician is talking about when they recommend having tubes placed.  

To start with, ear infections generally occur when there is trouble equalizing the air pressure behind the ear drum. Ordinarily, this is accomplished as air passes freely through the eustachian tube which extends from the middle ear to the back of the throat. If the eustachian tube is functioning normally, air pressure in the middle ear is the same as air pressure outside the ear. If it is partially or completely blocked (because of allergies, a cold, small size, etc.), negative pressure builds up behind the ear drum. This pulls fluid into the middle ear space. Now we have a perfect environment for bacteria: dark, warm, fluid-filled and poor blood flow. Bacteria from the upper respiratory tract work their way into the middle ear and set up camp, multiplying into the billions. Now we have a full-blown ear infection.

Studies have shown that in children older than two, ear infections heal on their own within a couple of weeks in 90+ percent of cases. It is likely that they go away faster when antibiotics are given, though some experts dispute this. In younger children, there appears to be a higher risk of complications, so antibiotics are a prudent treatment… when they work. Unfortunately, as antibiotics have become more pervasive in our environment, bacteria have become increasingly resistant to them, limiting the efficacy of antibiotics in any given patient. There is no way (short of sticking a needle through the ear drum of a screaming child) to know for sure which bacteria is in the ear and which antibiotic will treat it.

In some children, no matter how many different antibiotics we use, the ear infection just won’t clear up. There is antibiotic resistance, or the eustachian tube is completely blocked, or the sinuses are completely full of mucous, or there are allergies interfering. In these cases, it can be helpful to provide an alternative to the eustachian tube, ie. a tube!

Myringotomy tubes (tubes, ear tubes, etc.), are small tubes of either plastic or metal that look a lot like a bobbin on a sewing machine. They are inserted into the ear drum to create an alternative method of ventilating the middle ear space. They have an average life span of about nine months if they are short-term and two or three years for the longer term tubes. They will often reduce the frequency of ear infections from six or more a year to only one or two a year. They rarely create problems for children who have them and they generally need no special care. They do require general anesthesia to place. This is probably the biggest reason not to just rush out and place tubes in every child. Every anesthesia event has a small chance of complications. If the frequency and severity of ear infections are bad enough, however, this is a risk that may be justified.

Ear tubes aren’t for everyone, but if your child has many ear infections in a year, there may be a place for them in your child’s future. As always, consult your pediatrician for further information.

By now, most of my readers are aware of the Missouri law that took effect in August of 2006 regarding car seats and children. For those who aren’t aware, the significant change was that children older than four, but younger than eight years old (who are less than 4’9” or 80 pounds) must be in an approved car seat or booster seat appropriate for age and size when riding in a car. This was a significant change which, when adhered to, will probably save some lives.

What most people are unaware of, however, is a study that was published in 2007 in the journal Injury Prevention. The authors of the article looked at accident and mortality data from 1988-2003 in the United States. They were specifically looking to see how children fared in rear-facing car seats versus forward-facing car seats. Their data demonstrates some interesting points. When children under one year old were involved in an automobile accident, the ones that were facing forward were between two and five times more likely to sustain a “serious injury.” Side impact collisions were much more likely to result in a serious injury than frontal impact. We (pediatricians) have always recommended that children younger than 12 months old be rear facing, so these results didn’t surprise anyone.

What was surprising, however, was when the authors looked at children between the ages of 12 and 23 months old.  When children this age were involved in a motor vehicle collision, they were also up to five times more likely to sustain a “serious injury” if they were forward facing instead of rear facing. This is an age group that pediatricians routinely recommend switching to forward facing!

While the nature of the study prevents researchers from knowing exactly what happened to reduce risk for rear-facing kids (are rear-facing 15-month-olds safer because they are rear facing or are rear-facing 15- month-olds generally smaller or do their parents generally drive more safely?), the conclusion is strongly suggestive that there may be reasons to keep children rear facing until they are two years old. The American Academy of Pediatrics has stopped short of recommending this universally to parents because further study needs to be done. I have been routinely recommending it since first reading the article just over a year ago.

“But my child is too big!” Car seat manufacturers are a little late to the show on this one so it may be difficult to find the right car seat. I recommend that when you are shopping for the car seat after the “pumpkin” seat, get the largest car seat you can find that can be both forward and rear facing. Make sure to look at manufacturer recommendations as these reflect the safety testing that has been done with that particular seat. Then, leave the seat rear facing until your child is two years old (or older, by some recommendations). In this way, you can ensure that you have done your best to keep your child safe while on the highway.

Well, I finally took a vacation with my wife and kids to see my family back in California! It has been a very good time. As I have taken my morning runs and enjoyed the different environment, I have thought a lot about the “Balancing Act” that we are all participating in. You see, my vacation kind of gets to the heart of the balancing act. We get so caught up in all of life’s day-to-day activities and “busy-ness” that we forget the balance. Free time gets lost, stresses increase, “life” gets eaten up day by day.

I’m completely convinced that free time is a matter of priorities. Everything we do is what’s most important to us at the time. “But wait,” you say. “I HAVE to go to work. I don’t have a choice about it!” “I HAVE to make dinner.” “I HAVE to mow the lawn.” (I just had to throw that one in for the few men who can relate to this). The truth of the matter is that you don’t HAVE to do any of it. You CHOOSE your priorities. If living in a nice home with good food and nice clothes is one of your priorities, then you make sure you get to work daily and bring home a good income. If one of your priorities is not missing a moment of your child’s life growing up, then you take careful and good care of your children. If your priority is having a lawn that is the envy of the neighbors (or getting the neighbors off your back if you don’t take care of it), then you mow and take care of the lawn (Just an FYI, I got rid of my lawn with our last move…taking care of lawns was NOT a priority to me!).

Likewise, free time only occurs if you make it a priority. Why do I discuss it as a physician in a “balancing act” blog? I believe that it is at the heart of what causes our relationships to fall apart. When relationships fall apart, the people that suffer the most are our children. Free time, family time, relaxing time…I don’t care what you call it… is the glue that holds relationships together. When we actually have fun together, we bond. Obviously, challenges also bring us together, but the boring day-to-day grind does nothing to bring families close. Free time also recharges our batteries to see life, each other, our jobs, and our hobbies from a more relaxed perspective.

Let me suggest that making free time should be a priority. Take vacations. Walk your spouse through the park. Take the kids for a bike ride. Take a look at your hobbies and commit to spending some time on them (ladies, if you don’t have a hobby, get one, then you might understand your hubby’s compulsion). Read a book to your children (They’re too old? Not really). Take it a step further. Come home with an unexpected gift for a spouse. Write a cute little note to your kids or your spouse. Have a good tickle session. Go see some place you’ve always dreamed of seeing with your family. Recharge, reconnect and relax. Isn’t that what the balancing act is really about anyway?

If I were a good, consistent blogger, you would know by now that my one-year-old son, Kellen, had ear tubes put in about a month ago. But since I haven’t been very good at keeping you up-to-date lately, I’ll start from the beginning.

Ear infections are bad. They are very, very disruptive to any family’s lifestyle...mainly due to lack of sleep and the inability to go anywhere due to a fussy baby. And of course, above all else, they are very painful for our little ones!

I don’t understand why some kids are prone to get ear infections and others aren’t. My four-year-old daughter never had a single ear infection as a baby. So when I found out that Kellen had his first one (by accident…I had taken him to the doctor for a different reason), I thought it was a fluke. Then, as soon as Kellen went off the antibiotic, he got another one…then another one…then another one. Five ear infections and four different antibiotics later – not to mention months of trying to comfort a crabby, mostly miserable kid – a quick visit to the ENT convinced us that ear tubes were the way to go! We had the procedure done a few days later in the Outpatient Surgery Center at SSM St. Joseph Hospital West. It was quick, painless for Kellen (who was briefly under anesthesia), and he seemed like a different kid by later that evening.

I am certainly not a medical expert, but the way it was explained to me is that ear tubes help to clear fluid from the middle ear and to prevent future fluid build-up. That was always a problem with Kellen – even when he didn’t have an actual ear infection, he had fluid sitting in his ears, which I’m told is a “breeding ground for bacteria.” Then, another infection would soon occur.

Now, Kellen has not only been infection-free for the past month, he also seems to be hearing better as well – which is a benefit that my husband and I did not even think about before the surgery. The very night he had the tubes put in, Kellen started making all kinds of sounds that we had never heard him make before. We wondered if it was because he was hearing them clearly for the first time, since he didn’t have all that fluid in his ears! His vocabulary continues to improve – which I know is also due to him growing older – but we’re convinced that he is hearing much better than he did before.

Would I recommend ear tubes to other parents? You betcha! I would do anything to make sure that my kids are happy and healthy, and this was one easy way to make both happen for my son. People are finally starting to sleep through the night again at my house. Hooray for ear tubes!!

The recent death of boxer Mike Tyson’s 4-year-old daughter, after her neck apparently got caught in a treadmill cord, is a stark reminder to take safety around the house very seriously. While I certainly can’t claim to know all the details, it certainly is eye-opening that such a thing can happen. This tragic accident should remind all parents to look around the house with a different eye to the myriad of things that kids can get into.         

Accidents are THE leading cause of death in children and adolescents. They are also a huge cause of life-changing disabilities. A quick tour around the house should reveal all sorts of things that kids can get into.

Physical accidents are the most obvious. Things fall on kids all the time. TVs, dressers and bookshelves tip over very easily and can crush children. Children fall off of things all the time. They climb up onto bookshelves, counter tops, table tops, stools, and beds. Especially when the floor beneath is hard, these falls can potentially cause serious injury. Tripping over cords and hoses while running is another common cause of falls.

Poisonings are very common. Toddlers have no clue what that clear fluid in the big bottle in the laundry room is, nor do they understand the concept of rat poison.

Suffocations also are unfortunately common. Window blind cords, electrical cords, jump ropes, plastic bags, and now, treadmill cords, are all causes of strangulation and suffocation. Infants placed in cribs with soft pillows or blankets can turn their face into the object and suffocate. Sleeping in bed with a parent is an unnecessary cause of death by suffocation, when the parent accidentally rolls toward the infant or toddler. Don’t forget that a toddler can fall into a bucket or toilet and be unable to extricate themselves before drowning.

The pool requires special mention. Many studies have been done to look into how to make pools safer. The only safety measure ever proven to keep kids from drowning in pools is a fence on all four sides of the pool with a gate that closes and latches automatically so that kids can’t get in without a parent opening the gate.

Likewise, guns require special attention. While the statement that “guns aren’t dangerous, the people that use them are” is certainly true, when children get their hands on a gun, curiosity over takes any knowledge they may have. Lock the guns in a safe and lock the ammunition somewhere else.

Cars are an especially heart-breaking cause of injuries. Every year, you hear tragic news stories about babies who are forgotten in a car in the scorching heat (or freezing cold). Children, while playing around a car, may not be noticed as a parent pulls out of the driveway. And, of course, children tend not to look both ways as they cross the road to their neighbor’s house.

This is just a very short catalogue of the things I’ve seen and heard about in my years of pediatric practice. A good rule of thumb that I give to all my parents is that if you can’t see them or hear them…assume the worst, until you find out otherwise. When it comes to the safety of our children, we CAN’T be too careful.

I was recently asked a question by a former patient of mine who is now a college reporter and who will be spending her summer as a blogger for a financial news service. She asked about the safety of plasma donations. It seems that students at her college were repeatedly giving plasma donations in return for money to cover their weekend expenses. This practice was news to me, so I did a little research. I wish I could reference her article to give her credit for her idea, but just know that this blog entry is because of her question and the research that occurred as a result.

Plasma is the portion of blood that is not cells. Red blood cells, white blood cells and platelets are all removed, and what you have left is plasma. In the plasma are a number of proteins that are critical to our survival. There are proteins that cause the blood to clot (clotting factors) and immunoglobulins, those wonderful proteins that help us fight off infections. Needless to say, there are many patients who are short of these proteins that need them to be replaced. Also, there are numerous companies that make a great deal of money preparing plasma for patients who need either immunoglubulins (IVIG) or clotting factors. There is also a small group of patients, particularly those with severe infections or burns, that need whole plasma, called “fresh frozen plasma” or FFP.

The process of donating plasma is a little more complicated than donating whole blood. The donor is hooked up to a plasmapheresis machine that draws out the blood. The cells are all then filtered out of the blood and the rest is kept. The cells are then suspended in a saline solution and returned to the donor.

Apparently, current standards suggest that donors can donate up to twice a week. If cells are removed, as in whole blood donation, it takes several weeks to replace the lost blood, but if no cells are removed, the proteins that have been removed only require a few days to replace.

Thanks to Dr. Louis Katz, VPMA of Mississippi Valley Regional Blood Center, I now know that there are federal regulations in place for donors. There are limits on how many liters a year may be removed and there are recommendations for medical screening tests (especially protein levels) for regular donors. These rules are in place to keep donors from donating too often. This benefits the donor, keeping them from depleting their protein levels. It also benefits the company, because it ensures that the samples they receive have as much of the required protein in them as possible.

I am comforted that the process is safe if the proper safeguards are upheld. Unfortunately, one of the things I’ve learned about life is that when there is money involved, short cuts are inevitable. So, if you have a college student who has chosen to make a little bit of cash on the side, make sure that they are using a reputable donation center and find out what evaluations are done each time they donate plasma.  If they are unable to tell you, consider consulting with your child’s physician regarding the correct course of action.

‘Tis the season to be rugged! I spent my weekend with the family on our annual camp-out. We like to tent camp and pretend that we’re “roughing it.” Never mind that the bathroom and showers are less than 100 yards from the camp site! Anyhow, when my son pulled the tick off his neck, I was reminded that spending time outdoors has its fair share of medical hazards this time of year.

Ticks and mosquitoes are the big problems when we head outdoors. Both of these ravenous creatures are capable of carrying a multitude of diseases. Ticks can carry Lyme disease, ehrlichia, Rocky Mountain spotted fever, and a variety of other more obscure illnesses. Most of these illnesses require the tick to be attached for a few days before they can pass the disease, but it is still a good idea to remove ticks as soon as they are spotted. Gently pull the tick with a pair of flat tweezers as close to the head as possible. It will require firm consistent pulling to get the tick to let go. Inadvertently jerking the tick will cause the head to break off and remain in the skin, which could lead to a skin infection. Do not try to burn the tick out. You may end up with a child with a burn that has a tick in the middle of it!  And you cannot suffocate a tick by using oil or Vaseline. They must be gently pulled.

The primary concern from mosquitoes is West Nile virus, a virus that can cause fever and headache, confusion and disorientation, very similar to meningitis. There are a couple of other mosquito-borne viruses that produce very similar symptoms in the United States, but they are less common.

Clearly, the best method of taking care of all these problems is prevention. DEET is the short hand name of the primary chemical in insect repellents in the United States. It has been extensively tested for safety by a number of organizations. It will repel mosquitoes and ticks and should be used any time your children are in an area where either are present.  (It is not for use in children under two months old.)  An alternative to putting it directly on the skin is to spray clothing with it. The 10% concentration is probably appropriate for children, but should be reapplied every couple of hours.

Other methods of insect-bite prevention include wearing long-sleeved shirts and long pants when in the woods or fields. A thorough “tick check” when returning from these areas can spot both crawling and embedded ticks. Mosquitoes do prefer to “hunt” in the mornings and evenings. Avoiding outdoor activity at dusk or dawn may also help prevent bites. These basic steps can help prevent a host of difficult issues. Enjoy the beautiful spring outdoors, but when you do so, be aware of the tiny creatures that can cause harm to you or your children.

I can’t believe it. Exactly one year ago, I was writing a blog entry telling my soon-to-be-born son that his “lease was up”…it was time to get out! Now I’m starting to wish that I could turn back time and put him back in (well, figuratively anyway). I want my baby back! Kellen turned one year old today. When I look at him now, I see a capable toddler instead of that helpless little bundle we welcomed into the world just 12 short months ago. My, how time flies!

Don’t you just marvel from time to time at all that your children can learn and accomplish in what seems like no time at all? Kellen is now walking, climbing (vigorously), eating “big people” food, saying a few words (ba-ba, da-da, ma-ma and ball), and most importantly…asserting his own opinions and strong will at every turn. He LOVES to be outside, enjoys playing with blocks, and thinks it’s the most fun to jump/fall off of things and scare mommy whenever he can. He is quickly becoming an independent little man!

Anna, our four-year-old daughter, told me yesterday that she thinks Kellen already knows what he wants to be when he grows up. “Really?” I asked. “What’s that?”

“A dog!” she confidently responded.

“What do you mean? Why do you think he wants to be a dog?”

“Because he’s always getting into trouble and eating yucky stuff off the floor, just like Loki” (Loki is our family dog.)

While those observations may be true, I have higher aspirations for my son on his first birthday. I pray everyday that God will surround him with angels to keep him from harm and bless him with a long lifetime of love and happiness. I hope that he is able to do something that truly fulfills him when it’s time to go to work. And I also pray that the years between now and then will pass much more slowly than this first one, so I can spend more time soaking up the memories of my rambunctious little boy and his funny big sister.

Happy First Birthday, Kellen!

As yesterday was Mother’s Day, I thought it would be fitting to make my next blog entry about Moms. You see, I see a lot of you Moms throughout the course of my work day. I get to see you happy, and I get to see you sad. I get to see when you’re holding in your frustration, and I sometimes get to see when you lose it. I see how you protect your little ones, and I get to see when you let them fall down and get hurt. I get to see when you’re confused, and I get to see when the light comes on and you figure it out.

Mom, you get to come into the office when Dad says, “I think you should go have the doctor look at it.” You get to come into the office when your own mother tells you, “I think he’s too skinny.” You get to come into the office when the teacher says, “Maybe you should talk to your doctor about it.” You get to come into the office when you haven’t had any sleep because you were the one up taking care of that cough so that your little one could get some rest.

Mom, in most homes, you make the dinners. You clean the floors. You fold the clothes. You get the kids to and from school or day care. You do the shopping. You plan the menus. You may even plan the nights out. I realize that in many homes, these roles are changing, especially in homes where moms are working outside the home. But in most homes, the roles have stayed fairly traditional.

Mom, you nurse the “boo-boos.” You provide comfort during thunderstorms. You are the first to say, “You did a great job!” You provide the arms of comfort to cry in when the job wasn’t so well done. You’re the one who usually picks up the pieces when your little ones’ lives come falling apart.

You single moms amaze me (some of you married moms may feel like sigle moms…I understand that, too). You not only do all of the above, but you also hold down a job that has to cover more of the expenses than you ever thought would be your responsibility. Some of you even manage to go out on a date once in a while to hopefully meet up with someone who can help meet your needs.

In short, I think very highly of you Moms who make meeting the needs of your children your top priority in life, day in and day out. I hope you had a wonderful Mother’s Day!

It’s all everyone is talking about on the news. Some parents, like Kate, are becoming “freaked out” by what they’re hearing…which is totally understandable. With so much “information” out there, it’s hard to know what to follow and who to believe. Let’s take a look at the basics and see what we can learn.

The  Swine Flu is really a different form of influenza A. Each year, in the United States, influenza A and influenza B sweep through the country during the months of January through March. This is what we normally call “flu season.” Every year in the United States somewhere around 40,000 people die of influenza or its complications. These deaths, usually in the very young and the very old, are why the flu vaccine is highly recommended for certain age groups and certain populations of people. Each year, the genetic make-up of the influenza virus changes. This is why there is a different vaccine each year. It is also why we have to get a flu vaccine annually instead of the usual 2 or 3 shots with boosters every so many years. The usual flu only has genetic information from viruses that infect humans.

The difference between the  Swine Flu and the usual flu is this genetic make-up. This current batch of  Swine Flu has pieces of DNA (genetic material) from pig flu, bird flu and human flu. This combination of genetic material makes this virus unique. Most of us have had some exposure to regular flu. When our immune system sees this, it makes a response that makes our bodies less sensitive to other flu exposures. The “swine” flu is different enough that our bodies haven’t made a response to it. Since the body hasn’t built up immunity to it, most of us are susceptible to catching it. This is one of the reasons this illness seems to be spreading rapidly. For those of us who watch the annual flu season, this spread doesn’t really seem any more rapid than any other flu.

There is some evidence that the usual influenza vaccine will provide a small amount of protection against the  Swine Flu. This is believed to be one of the reasons why it is young adults (who have not had the vaccine) that are most susceptible to this virus.

The flu is a respiratory virus. It is caught by sneezing, coughing, or kissing, just like any cold. It can also be caught by shaking hands with someone who has coughed into their hand and then rubbing your hand on your nose or eyes. You can not catch it by eating pork (although undercooked pork is not without other dangers).

Persons catching the “ Swine Flu” show symptoms that are identical to any other influenza infection: fever, muscle aches, cough, congestion and fatigue. There have been some reports of vomiting and diarrhea with this infection, but for most people, there is no vomiting or diarrhea. If you don’t have a fever and muscle aches, you probably do not have  Swine Flu. If you do have fever, muscle aches, and fatigue, you should call your doctor. You should know that at this point, Missouri doctors have been instructed to ONLY test patients who have flu symptoms along with a fever AND who have recently traveled to an area where Swine Flu has been confirmed OR have had contact with someone who meets the above description.

The rapid flu test, which involves a nasal swab and a few minutes of your time, can detect the  Swine Flu in most cases. If this test is positive (which must be confirmed through the state laboratory), Tamiflu and Relenza, two ordinary flu medicines, have been shown to treat it and your doctor will prescribe one or the other for you.

In short, while this may seem like a relatively scary time, good hand washing and good respiratory hygiene will help prevent illness, and for most people this flu should not be any worse than the regular flu bug that we see each winter.

When I wrote last week about exercise, I focused my advice on you, the parent. Now… what about the kids? It goes without saying that exercise is critical for children. Other than what you feed your kids (and the love you provide them), exercise is one of the most important health issues in your child’s life. But what is “exercise” to a kid? You can’t really put them on a treadmill. Besides, you can barely keep up with them during the day because they are always on the run…doesn’t that count as exercise?

Exercise for kids is a tricky thing, as demonstrated by how often I hear the comment, “But doctor, he plays football…why is he still overweight?” The current exercise recommendation for children and adolescents is one hour a day, five or more days a week. Since children’s maximal heart rate is higher than adults, their heart rate for useful exercise is as much as 150 or higher. This is sustained heart rate over the course of an hour (or more).

Using the above definition, football practice once a week with a game once a week is NOT exercise. While the heart rate may get high, it doesn’t do so for a full hour and the practice is only once a week. “But he also plays a game once a week!” During that game, he may have more intense activity, which is good, but I suspect that he has even less time in sustained activity. The same goes for so many other sports. Sports are good for you, but they don’t have the sustained level of activity that kids need in order to call it “exercise.” Two sports I can think of that do have enough activity are soccer and hockey. But the problem, once again, is that the kids usually only do these activities once or twice a week, instead of the needed five days a week.

Gym class also doesn’t meet the requirement. Most children these days only have gym class two or three times a week, and the actual amount of exercise in these classes is of short duration, say 10-20 minutes total time with an elevated heart rate. Neither of these quantities is enough.

So, what should you do for kids? Anything that gets them out running around, riding bikes hard or swimming hard! It doesn’t all have to be in one batch, but try to accumulate around an hour of vigorous activity almost every day. Once this is well established, it becomes a lifestyle. Once it’s a lifestyle, kids tend to keep it up even into adulthood. So make it a habit! Get outside, run around with the kids. Make them work up a bit of a sweat and you’ll both start to see the benefits!

I can hear you now. “I can’t believe he’s talking about it again!”  Ok, ok, I get it.  Some people might think that I talk about fitness too much.  Having said that, in reviewing the evidence that I have concerning health and longevity, there are only three controllable factors that strongly affect your lifetime health: what you eat, whether or not you smoke, and whether or not you get regular exercise.

So how does one to find time to add exercise to the balancing act we all do on a daily basis?  I have to admit, I’m spoiled.  While I do work long hours, I don’t put in near the hours that I know some others have to work.  I also have a wife that is very accommodating and understands the need for exercise.  She also mostly stays home to take care of the kids, and I’m able to do the same for her when she needs to get her exercise in. Having admitted to all this, it is not unusual for me to leave the house between 4:30 and 5:00 am to get in my morning run.

To have a truly healthy balance in our lives, we must figure out a way to get in some form of exercise regularly.  Exercise helps us in countless ways.  It pushes HDL (good) cholesterol up and LDL (bad) cholesterol down.  It keeps our weight down and our mood up.  It improves sleep quality and keeps our minds alert while we’re awake.  Arguably, one of the most important things is that it sets a good example for our children. 

So what qualifies as exercise?  In short, anything that gets your heart rate elevated above 130-140 beats per minute! Weight lifting, running, brisk walks, swimming, and organized sports all count.  The big trick is getting in 45-60 minutes of exercise four or five days a week.  As I mentioned, I usually have to get up very early to get my exercise in.  I often get to see the sun rise as I’m on my early morning run.  My wife catches her exercise any time I can distract the kids long enough for her to get out the door.  Some people break their exercise into small segments throughout the day.  The bottom line is to get your heart rate up for a total of 45-60 minutes.

Since this is hopefully going to be a lifelong project, start slowly.  Don’t try to do it all at once.  Make gradual lifestyle changes that allow you to get into it. The worst thing you can do is to start too fast and then injure yourself.  Start with five to ten minutes of a slightly challenging activity, just enough to start to sweat.  Then gradually challenge yourself to longer periods and more intense levels of activity.  Hopefully, you’ll gradually move to periods of exercise that are very intense with heart rates up to even the 170’s.  For most people, starting with brisk walks works best.  It’s easy on the knees, doesn’t leave you too tired after you’re finished, and can be done without resorting to expensive clubs or having to travel to a specific site to get your exercise in.

In short…get up, get moving and break into a bit of a sweat. It is one of the most important things you can do for your own health and that of your family.

Isn’t it crazy how babies can evolve from helpless little blobs to bonafide acrobats in less than a year? 

Our son, Kellen, who less than one year ago was still chillin’ in my belly, is now undoubtedly the most physically active person in our family. I don’t remember my daughter being nearly this rowdy at his age!

While Kellen began the process of trying to walk around Christmas time, it didn’t really “click” for him until a few weeks ago…right as he was turning 11 months old. And when it clicked, boy did he take off! After several days of hilarious, wobbly staggering (see video), our little man is now circling the house faster than we can keep up with him!  And he is a CLIMBER! He even figured out how to push random objects next to things he wants to climb on so that he can use them as stepping stools (which he does in the blink of an eye)! He has already made it onto my in-laws’ kitchen table!  (He also uses his sister as a stool about half the time, and has no qualms about stepping on her face if necessary. Poor Anna.) The scary part is that while Kellen now knows how to get on top of everything, he still has no concept of the fact that you can’t just dive head first to get OFF. That’s the exhausting part. Everynight I fall asleep praying that God will surround his head with padded angels the next day. We are only able to catch him about 97% of the time. By the time this kid starts to get some concept of gravity, we (and the angels) are going to be absolutely worn out!

So that’s the latest from my house. If you know of anyone who is filming a movie and needs a little stunt baby, just give us a call!  And check out the video!

http://www.vimeo.com/4313151

How many times has this disrupted the balance in your house? Everyone’s getting ready for school. Mary needs to get her backpack together and get her shoes on. Johnny is just sort of dragging along. Suddenly, you hear the dreaded words, “My stomach hurts.” Not again, you think. This is the third time this week. You’ve ignored the first few complaints and sent him to school anyway, but maybe he really does have something going on.

The problem with stomach aches is that they are very common, there are many causes for the pain, and very rarely is there anything really wrong. So what’s a mom to do to restore balance? Needless to say, stomach aches are a very difficult problem in pediatrics.

So, if there’s usually nothing wrong, why do children say their tummy hurts? It turns out that many of the chemicals in the brain that affect mood (neurotransmitters) also have some effects on the bowels. So one explanation is that varying amounts of stress, exercise, and sleep affect the bowels and subsequently, can cause abdominal pain. I believe that, often, simple day-to-day life for a child causes just enough tension to create belly aches. For this kind of belly ache, I assume that the children really do feel a pain and that a parent acknowledging the pain can be very helpful. Providing a TUMS may be just enough to acknowledge the pain and let the child know that you’re treating it.

Another consideration should always be diet. Many children are sensitive to many foods. Milk is probably the most common culprit and a trial period off all lactose-containing products may solve the problem in a couple of days. Another common one is too much fiber at one sitting. Fiber is good, but works best if given in gradual amounts. Fiber also helps with constipation, which, if prolonged, can cause some crampy abdominal pain.

So when do you worry about abdominal pain? The usual red flags are blood in the stools, frequent diarrhea, alternating diarrhea and constipation, vomiting, weight loss, pain that interferes with regular activity, or pain that keeps children up at night. Any of these symptoms might cause me to investigate further. A family history of a significant disease such as Crohn’s would also cause me to look further. Clearly, abdominal pain that lasts for several days to weeks should also prompt at least a basic evaluation. As usual, if you have concerns, please speak with your pediatrician.

My four-year-old daughter referred me to a website this morning. She actually used the words “dot-com” in a sentence…that made sense…all on her own! The conversation went something like this:

Anna: Sigh. Mom, I really wish we had more games on our computer in the office.

Mom: Oh yeah?

Anna: Yeah. Kaylee and Courtney (her friends) have lots of games on their computer. They have one that I really like. It’s a Barbie game.

Mom: Uh-huh (typical “mom-busy-doing-other-things” response).

Anna: In fact, Courtney says you don’t even have to buy it. You just need to go to Barbie-dot-com, and there you go!

That is when I stopped and took notice of what Anna was actually saying. The expression on her face was so sincere and matter-of-fact…like it was absolutely no big deal at all that she possessed that knowledge. Every preschooler knows about the world wide web, right?

I constantly find myself in awe of how much that kid knows that I don’t even KNOW she knows. And how much she THINKS about things that I never think about! Like the meaning behind words, for example. Before Easter, Anna asked my mom if the Easter Bunny comes from the East. A few weeks ago, she asked me if we call it a “rainbow” because it has to rain before you can see one. I was impressed. That had never crossed my mind before…and I was an English major in college! I haven’t looked it up, but I’ll bet she is totally right!

I wish my brain still had about half the “sponge” power that Anna’s seems to have. Quite the opposite, I feel like mine is always leaking. I’ll have to see if Anna can teach me anything new tonight while we’re checking out Barbie-dot-com.

You know what you have. The itchy eyes, itchy nose, constant drainage from the nose, the near constant sneezing, and the morning yuck stuck in your throat. It’s allergy season again and you’re miserable! This is not a difficult problem for adults to diagnose…but for children, there are as many questions as there are answers.

The big question is whether or not children really can have allergies. Many experts believe that children under the age of three can not be shown to have a true allergic reaction to environmental allergens…that is, a reaction to pollens, molds and pets. At odds with this belief is my own personal experience, as well as the experience of many parents who have seen their children experience the chronic runny nose, red eyes and sneezing when they go outside during a certain time of the year. I also believe that some form of allergies can contribute to sinus infections and ear infections. And I have seen children as young as one year old respond appropriately to allergy medications.

The first thing to try to do when confronted with possible allergies is to minimize exposure. The easiest way to do this is close up the windows and turn on the air conditioning as allergy season approaches. But you don’t want to stay inside, you say! Again, we’re trying to minimize, not eliminate exposure. Spend short periods of time outside, and then head back in.

Medications have come a long way in treating allergies. Benadryl is the old stand-by. It probably works better than most other oral medications, but it is likely to be sedating, and interferes with concentration in school age children. Zyrtec, Claritin and Allegra are also antihistamines that have some effect on allergies. The nasal steroids, in my opinion, produce a much more significant response to the nasal symptoms of allergies. These are once or twice-daily medications that may also help with snoring and have few side effects other than the occasional nosebleeds. Singulair is a non-antihistamine medication that seems to work best in kids with asthma who also have allergies (which is most of them). It recently obtained approval for the treatment of pure allergies.

Allergy testing is something I reserve for when all of the above treatments fail. Allergy testing is not 100% reliable. A patient may test positive for something they don’t react to and may test negative for something they do react strongly to. It’s unclear why this happens. Nonetheless, if avoidance and medications don’t work or become cumbersome, allergy testing can give guidance to an allergist in developing an allergy immunotherapy plan (allergy shots) for you or your child.

As you can see, the treatment of allergies can be very complex. If you have questions about whether or not your child has allergies, it may be time to contact your pediatrician.

So there is one new thing that can completely throw my life off balance. Ear infections.  I think about half of you just groaned in agreement.

I never used to be an “ear infection sympathizer.” I just didn’t get it. My first daughter, although anyone who knew her then will tell you she was not the easiest baby to raise, never had ONE ear infection. So while I heard people talking about the frustration of having their children get these painful infections over and over and over, I didn’t really realize how hard it was on their entire family…until now.

Poor, sweet Kellen, who is now nearly eleven months old, has had what I would describe as a perpetual cold since about mid-October. He’s fine one week, then sick for the next two weeks…then the cycle repeats itself again and again.  Sometimes, we think it’s just that he’s teething. Some of the time, we take him in to the doctor’s office, and he is diagnosed with “just a cold.” Which it is…at that point. Then another week goes by of him not eating, not sleeping, and just acting like a completely different kid, we take him back to the doctor…and viola! Ear infection. Then we feel like terrible parents, wondering at what point during that week did the cold switch from just annoying to agonizing, and how long were we disregarding cries of agony as sheer whininess? The last thing you ever want to do as a parent is to cause your child any pain!

The ear infections are physically hard on us too. Mainly, I think, it’s the lack of sleep! When he’s well, Kellen is a champion sleeper. When he’s sick, especially with the ear infections, he wakes up multiple times a night…and this last time, there was just no consoling him. My husband and I start getting so tired and worn down that we end up getting sick too! This is a bad pattern.

I hear other parents talking about “ear tubes” and now I’m wondering, at what point does that become an option? Does someone with experience have any advice on this topic?

What parent hasn’t seen it?  Your son (or daughter) is running along, trips and hits his head on the (you fill in the blank).  Now, there’s a huge “goose-egg” on his forehead.  If the bump protrudes out then it’s ok, right?  Isn’t it better than having a dent in his head?  Both perceptions are common, but wrong.  With the recent death of actress Natasha Richardson, head injuries are back in the news and scarier than ever.

The first thing to know is that this happens all the time, with over 1.5 million reported head injuries in the United States annually and 300,000 pediatric hospital admissions.  The vast majority of these result in no long-term problems. However, as in Richardson’s case, results can be catastrophic.  So how do you decide which kind of head injury your child has?

There are two bad outcomes from head injuries: concussion and intracranial bleeding.  A concussion is ANY change in mental status following a head injury.  That means even a small amount of confusion, dizziness or disorientation following a head injury is considered a concussion.  Most of the time, these symptoms are trivial.  On occasion, however, these symptoms can persist a very long time.  They may even progress to chronic headaches, chronic mood changes, and chronic trouble concentrating.  Many of these symptoms are not treatable, as scientists do not really understand why they happen.  Most importantly, if a child has ANY residual symptoms of a concussion and then has another head injury, it can lead to severe consequences, including death.  This so-called “second impact syndrome” is the reason I do not allow any athlete to compete in any sport with the potential for head injury until ALL symptoms of the first concussion are resolved.

Intracranial bleeding is the complication that killed Richardson.  There are two kinds of bleeding in the head. The first, subdural, is inside the skin that surrounds the brain, called the dura.  These bleeds are relatively common and usually lead to progressive headache with some vomiting. They usually show up on the first CT scan done in the emergency room. They also tend to not cause sudden catastrophic outcomes.  The second type of bleeding, epidural, is outside the skin around the brain. These bleeds often cause an initial bad headache, followed by a period of hours to a day or so, where the patient feels totally fine.  Then all of a sudden, the patient will develop a severe headache and mental status changes that appear to have no cause, except the injury from the day before.  These bleeds are absolute emergencies and can cause death very quickly.  It is unclear from press reports what caused Richardson’s death, but I suspect this latter type of bleeding was the cause of her demise.

Needless to say, any head injury that causes symptoms should prompt at least a phone call to your physician.  The vast majority of these are harmless, but any persistence or worsening of symptoms can be very concerning and should be managed in concert with your physician.

I was talking with a colleague of mine the other day and, as usual, the conversation turned to our children and their challenging behavior. I continue to be surprised by how often behavioral issues come up in both the office and in general conversation. Behavioral challenges so often tip the balance in our “balancing act.” So how do you restore that balance in your home?

On the surface, behavior problems seem to come in a wide variety of forms. You would think that the behavior of your tantrum-throwing two-year-old would be different from the issues your friend is having with her teenager…but maybe they aren’t so different. When you think about the basic underlying problems (for example, temper tantrums, talking back, defiance, opposition, pouting, etc.), they really aren’t all that different between different ages.

The good news for you is that these problems are common to all children in all families. All children are trying to “grow up.” They are trying to be in control of their own choices and actions. They want to know what it’s like to be independent. And our natural instinct, as parents, is to question their readiness to do so. On the other hand, if you can recognize these “behavior problems” as simply limit-testing and attempts to make some independent choices, it’s easier to step back, defuse the situation, and still allow your child some measure of autonomy appropriate for their age. There are literally hundreds of books in the local bookstore that address these kinds of problems using behavioral management techniques. Any of these resources are a good starting point for most families with basic behavioral struggles.

So when do you look for professional help? The most important time to seek such help is when circumstances in the home have escalated to the point at which you, as a parent, have lost the ability to keep your calm. When you respond to your child regularly with frustration, tears, anger or violence, it’s time to seek a counselor who can help you respond in ways that will build up relationships rather than destroying them.

Certain symptoms strongly suggest a medical problem rather than a basic behavior problem. Pervasive apathy or sadness might suggest depression. Always being angry and constantly ignoring rules no matter what setting your child is in might suggest oppositional-defiant disorder or bipolar disease. Inability to stay with any task other than watching TV or playing video games might indicate attention deficit problems. A final red flag would be any behaviors in your child that you can’t talk about with friends at all because you’re afraid they’d never believe you. Any of these types of problems should push you toward seeking medical or psychiatric assistance.

The good news is that behavioral challenges are something that almost parent has to deal with at some point. You are not alone.  The better news is that there are a wide variety of resources available to help you understand the problems, from books and magazines to professional help. The best news is that, in spite of us, most of our kids will turn out just fine.

“I’m bored! What should I do?” It seems these words flow all too freely from the mouths of my children. Somehow, I’m expected to figure out what they are supposed to do! Now, I know that I am largely talking to an audience of women, so you all are NEVER bored. There’s always this, that, and the other thing to do. You can’t even begin to comprehend the idea of “nothing to do.” However, after you suggest to the kids that they could help you with the laundry or vacuuming or dinner or making the shopping list, I doubt you ever hear, “Alright! Great idea, Mom!”

I find this “boredom” particularly disturbing when I tell my kids to get off the computer and do something else for a while. This habit of kicking them off the computer has gotten me thinking, though. Is it really such a bad thing that they play computer games? They’re really just entertaining themselves to fill up some downtime. In some sense, it’s not THAT different than what I do when I have free time…or is it?

What’s the difference between playing computer games and having a hobby? Computer games and video games do require thought, creativity, and planning, which are all traits that we should encourage in our children. With all of the online gaming going on these days, there’s even a sense of community often associated with gaming. And if you REALLY get into it, there are conventions one can attend and actually interact with real people. In addition, my son’s social life at school revolves around the popular computer games. So what’s missing from this pastime?

I can sum it up in one word: productivity! Every other hobby I know about produces a useful outcome. I love to run and lift weights. The outcome is a stronger, healthier, better-looking me. I build scale models, both train layouts and plastic kits of planes, tanks, automobiles, and ships. The outcome, I hope, is a miniature piece of art. Often these pieces of work are contest quality. I also participate in social groups that share the same interest in model building. My wife and I like to hike and enjoy the outdoors, identifying birds, plants and natural features. The obvious outcome is a respect for nature in all its beauty. We also care for the yard, helping to create a beautiful place to live and share with friends and family.

That’s the way it is with most hobbies. Whether it is stamp-collecting, gardening, biking, playing a musical instrument or playing soccer, most hobbies are associated with a beneficial outcome. Better yet, obtaining outcomes requires thought, creativity, planning and perseverance, all traits we want to see in our kids.

So the next time you kick the kids off the computer or hear, “I’m bored,” encourage the kids to work on their hobby instead. It might even become an activity you can share with them, like the first time my daughter completed a model airplane with me! That’s a tangible outcome which, unlike a video game score, you’ll both be able to treasure for years to come.

When I was a kid, cassette tapes were the latest thing. Since we didn’t have many of those, I spent most of my time trying to figure out how to put the record player needle down somewhere near the song I actually wanted to hear. And I still remember how amazed I was when my family purchased our first VCR. The fact you could decide to play a movie anytime you wanted just astounded me! And then…to top it off…you could record things off the television to watch again and again! How could technology get any smarter than that?

The life that my four-year-old daughter knows is SO different from the life I knew in 1982.  I feel like there is a bigger technology gap between my generation and my kids’ generation than there was between me and my great-grandparents! Sometimes I just stop and take inventory of all of the things that she has that I could have never even dreamed of…in college!

• Unlike myself, who listened to the same kids’ albums from the seventies over and over (because, let’s face it, there just wasn’t that much to choose from back then), Anna has so many CDs to choose from that she gets overwhelmed when she gets them all out.  I have to tell her “just one at a time.”  But those CDs are kind of old news, anyway. Lately, she just plugs her mp3 player into this cool fuzzy speaker that she has, tucks it next to her pillow, and drifts off to sleep while scrolling through her favorite songs. 
   
• She only remembers life with a DVR. (Now, she doesn’t realize that for her first two and a half years, we somehow muddled through the “old-fashioned” way, and just bought up lots of DVDs of her favorite shows, and had to insert them into the DVD player when she wanted to watch them.) No…all Anna knows is that our TVs are equipped with this magical endless library of episodes for any show that she’s ever expressed even the slightest interest in. On Sunday, I found out she liked a show called “iCarly.” By tomorrow, she’ll have about nine episodes of iCarly ready for her viewing pleasure with the mere touch of a button. And she doesn’t even realize how awesome that is!
   
• Speaking of iCarly, while my daughter was watching Nickelodeon the other day, I realized that if she actually had access to money, that every advertiser on that channel would be rolling in our dough. She is a sucker for commercials! She saw one for these funny-looking dolls called “Bratz,” and quickly turned to me and said, “Look at those Ratz dolls! How come I don’t have a Ratz doll?” I suppressed a chuckle and said, “I think they’re called Bratz. I don’t think any little girl would want to play with dolls called “Ratz.” (Like the name “Bratz” sounds any more appealing to us parents.) Anna, however, was skeptical. “Hold on a minute,” she told me. “I need to check something out.” Then she ran into the room and fetched her Leapster, which is this handheld computer game device for kids. She brought it to the table where I was sitting, turned it on, and then…BLOOP-BEEP-BEEP-BLOOP…her little fingers hit a short series of buttons until she found exactly what she was looking for: another Bratz commercial that was on her Leapster! She held it up to her ear and listened closely before solemnly concurring, “Yep. You were right, Mom. It is Bratz, not Ratz.” (Remember, she can’t quite read yet.)  I was just staring at her and the Leapster, trying to figure out: a) how she knew exactly how to get to that particular commercial so quickly, and, b) how those marketers can be sneaky enough to brainwash my kid with toy ads without my knowledge while she is playing her “Learn your letters and numbers” video games.  That seems a little underhanded to me.

The world has changed, my friends. I think I’m going to keep her off the Internet as long as I possibly can!

Kids…they stretch you, they pull you, they make you cry both tears of joy and tears of frustration, they test their limits and they test your limits…yet still, we love them. Yes, I do know some people who truly are happier without kids, but most of us are glad we have them and would be lost without them. Have you ever thought about what it is about kids that makes this all work?

I have two of my own, as many of you know. My oldest is challenged with a difficulty seeing anyone else’s point of view. You see, his point of view is always right (even when it is clearly wrong!) My youngest is a charmer, always looking out to see if she’s pleasing everyone she can. Needless to say, the two of them just can’t seem to get along. The oldest doesn’t understand why the youngest even needs to live under our roof, and the youngest doesn’t understand why her brother doesn’t cut her some slack. Constant bickering is the result. I suspect it’s not much different in your home if you have more than one. If you only have one, then all the backtalk probably comes entirely to you rather than a sibling.

So how do you put up with it? Well, for one, as Kate keeps bringing up in this blog, there are those “magic moments.” While my son can’t get along with his sister, he has a particularly fond spot for our cats (all six, yes, six of them!). We have the privilege of living in the woods, so if one of the cats were to get out and not come in at night, there is the very real possibility of it getting eaten by a coyote. The other day, two of them got out! While my son couldn’t care less if his sister were to get eaten by a coyote (just kidding…kind of), the thought of one of the cats getting eaten sent him into a flurry of activity, looking high and low outside and then gently, yes, gently, cajoling the cats to come back to him so he could bring them back safely indoors! Who’d have thought that my hard-headed son could be gentle?

Then there’s the look that my daughter gets when I quietly tell her we’re going to leave my son at home and get something special for ourselves. Fortunately, spending time with my daughter is not a chore. I can sit with her at a restaurant, buy her a small dessert, ask one single question and then just sit back and listen to the results. I barely even have to talk at all, which is a good thing as those of you who know me already know.

We have hopes and dreams for all our kids. They all produce magic moments. They all come back for help at times. They all need a shoulder to cry on at times. Eventually, they will be our hope for a better neighborhood, city, state and country. Yes, even the good ones are very trying. I have my fair share of kids that are more than difficult in my practice. Every day, I wonder how some parents cope with their difficult children, but I hope that noticing the magic moments and treasuring them continues to make it all worthwhile for all of them.

Last Thursday evening, my four-year-old daughter matter-of-factly informed us, “I used to be the boss of two dogs, but now I’m just the boss of one dog.” While she had successfully performed her first subtraction problem, it certainly wasn’t a moment of parental celebration.

Hours earlier, I had to tearfully inform Anna that the dog she had known as a “buddy” her entire life had gotten very sick and went to Heaven that afternoon.  My husband and I didn’t tell her that Rolen was in such agony that we had to make the painful decision to have him put to sleep…one of the most heartbreaking things I have ever had to do. But it broke my heart even more to see my little girl burst into tears, crying “I want my doggie! I want my doggie!” It was one of those tough life lessons that I just wasn’t prepared to have to teach.

Fortunately, it seems that little kids rebound from such loss much faster than their parents do. After crying for about 30 minutes, Anna quickly came to terms with the fact that Rolen is now much happier in Heaven, where he has no pain and all the toys and doggie treats that he wants. (I’d like to believe that such a place exists for our pets…wouldn’t you?) Meanwhile, I’m still struggling with grief and regrets over how I might have been a better “doggie mommy.” If only I could’ve played with him more and let him kiss me on the mouth sometimes, even with his stinky breath. If only I wouldn’t have complained so much about having to clean up after him when he had accidents. I miss my sweet Rolen!  I feel like I can’t let his little life pass without some sort of recognition…so if you’ll indulge me, here is what made Rolen, the rat terrier, such a special guy:

·         Rolen thought he was a person. Really. I’m pretty sure that he had no idea that he was a dog. When my husband and I got married and merged our “dog” families, Rolen always seemed surprised and offended when we would try to “shoo” him outside to play with the other dog. He would just give us a questioning look that said, “You mean him…the dog…not me, right?” Then, while Loki chased bugs and barked at cars, Rolen would just wait patiently by the back door for someone to let him back in.

·         As a continuation of his “I’m not a dog” mentality, Rolen loved to snuggle in blankets. Lying on the floor was never an option for him. He was always looking for the coziest resting place in the house. He preferred to have both a pillow and a blanket. And once he found a blanket, he knew how to cover himself up with it. Just sitting on top of it was NOT good enough for Rolen. He had to be snuggled underneath! Who can blame him?

·         When I first got Rolen as a puppy, we lived next door to a sweet woman with two dogs of her own. He would sneak under the fence to play with them, until eventually we took to letting the three dogs have play dates almost every afternoon. Buddy and Poochie were Rolen’s best friends! Sometimes he even got to sleep over at their house (seriously)…and get this…while Buddy and Poochie slept on the floor, Rolen still insisted on sleeping under the covers in Vicki’s bed! I guess I wasn’t too successful in teaching him guest etiquette! J

·         Rolen was born without a tail. So when he was happy, he just wiggled his whole behind. It was so cute!

·         He was so good with our kids. They could do anything to him, and he never got snippy with them. I think he genuinely loved them and understood that they were just babies. When Anna came home from the hospital, I remember him being so protective of her that he would sit on the top of the sofa to look over the shoulder of whoever was holding her. That’s a good dog.

·         Before we lived with Loki (our big dog), Rolen used to have his own basket of toys. He would get out a toy when he wanted to play with it, and then put it back when he was done (I’m not exaggerating about that). His favorite toys were these soft balls that he would jump into the air to catch like a little circus dog. And he would use his mouth to throw the ball at your feet when he wanted to play! I always felt bad that after Loki came along, Rolen couldn’t have toys anymore because Loki was so strong that he just immediately demolished them. I kept crying about that on Thursday night. I just wish Rolen could’ve had his toys longer! Hopefully he has lots of toys in Heaven.

Rolen…rest in peace, buddy. You were a good boy.

Rolen makes himself comfortable, as usual.

I miss our little guy!  So does Loki.  He's probably the saddest one of all.

It’s the middle of the night and suddenly… What was that sound? You head to the kids’ room and find your daughter in a pool of fluid that vaguely resembles her dinner! It’s a scenario that happens all too often and this season seems particularly bad.

Gastroenteritis, or the “stomach flu,” occurs year round, but seems to be the worst in the dead of winter. It is caused by a wide variety of organisms. Most are unidentified viruses, but rotavirus, salmonella, shigella and e. coli account for some of the havoc. Usually the symptoms are vomiting for 6-24 hours with diarrhea that may be only one or two stools a day for a couple of days, or as many as 10-15 stools lasting one or two weeks. The two biggest concerns with gastroenteritis are dehydration and spreading the illness to someone else.       

There are no magic bullets that make the dreaded vomiting go away. The treatment is to make sure your child does not become dehydrated. Once your child starts throwing up, give him or her 20-30 minutes for the stomach to settle a little, then try a few SMALL sips of water. Keep trying small sips as frequently as every 10-20 minutes. Other clear fluids can be used such as Gatorade or Pedialyte. In older kids, chicken broth, Sprite, tea or apple juice may be helpful. Just remember small volumes frequently. Sometimes, your child’s doctor may be able to prescribe a medicine called Zofran to ease nausea and vomiting. If after 8-12 hours of this treatment, your child continues to vomit every time he or she gets sips, it may be time to receive IV fluids in the emergency room.

Once the vomiting stops, usually, the next step is to prevent dehydration from the diarrhea. In older kids, yogurt may play a role in slowing the stools. Over-the-counter anti-diarrhea medications are not very helpful for diarrhea in children, so I don’t recommend them. There is also some evidence that 20 mg of zinc a day during diarrhea episodes may help; however, I’ve been unable to find a preparation that children can take.

Often, younger children will develop quite the diaper rash from the diarrhea. A combination of Desitin, Neosporin, and Lotrimin AF, all over-the-counter can be very helpful as a diaper cream.          

The question always comes up, “When should I take my child to the ER?” If your child is becoming lethargic, not urinating over the course of 8-10 hours, refusing to drink fluids and/or very irritable, IV fluids may be the only way to make your child feel better. At that point, it’s time for an ER visit.

I vaguely remember taking a college psychology class where we learned that every young child goes through a stage where the world, in their mind, revolves around them. I think it’s called “egocentric thinking,” or something like that. At any rate, I’m pretty sure that my daughter Anna is right in the middle of it.

Anna truly thinks that everything my husband and I do – or don’t do – is for her. And I mean this in the most un-bratty way possible. It actually makes her extremely grateful (most of the time) for the simplest things. Examples:

• I bring home groceries and Anna comes over to help me unload the bags. “Milk! You got me my favorite milk! Thank you, Mommy! And bananas! You got me bananas!  And cereal! I love cereal! Thank you, thank you!”  (Of course, I would buy milk, cereal and bananas no matter what. But in her mind, it is solely because she likes them.)
   
• She loves to help me fold the laundry. And I am not kidding about this – she gets really excited whenever she finds a piece of her own clothing. “My Ariel nightgown! Thank you for washing my Ariel nightgown, Mommy! And my favorite underwear! You cleaned them just for me!” (Yep. The fact that they were making the laundry room smell funny had nothing to do with it. Let’s just pretend that I washed them just to put a smile on Anna’s sweet face.)
   
• Then there was the time a few weeks ago when Anna came home from school to find that my husband had set up a very large flat screen television in our family room (his Christmas/birthday present) and exclaimed, “You got me a bigger TV to watch my princess movies on?! Thank you, Daddy!” My husband just laughed. For a long time.  
   
• Anna also sincerely believes that her little brother was created purely for her enjoyment. Honestly. Just ask her. I think that’s why she likes him so much.

All that said, what I have an even harder time understanding is how a child who is constantly thanking us for things that had nothing to do with her can also be so ungrateful for things done specifically for her.

Anna turned four over the weekend. We had a big birthday party for her at one of those places filled with inflatables where the kids jump and the parents don’t have to do any work. It was fantastic. And after having us cater to her every whim all day long (beginning with cinnamon rolls at 6:30 a.m.), and opening enough presents to fill a toy store, she absolutely threw a fit when we wouldn’t buy her a ball out of a vending machine as we were leaving the party. Seriously? Sometimes I just can’t figure that kid out.  I can’t wait until Anna gets past the “age of me” and makes it into the “age of making sense.” Only about 21 years to go!

We’ve heard a great deal about the “whooping cough” lately. The St. Charles (Mo.) county health department and Francis Howell school district have both released statements indicating “epidemic” concerns.

But what really is whooping cough and are your kids safe from it?

Whooping cough is the name given to the illness caused by Bordatella Pertussis, a respiratory bacteria. This bacteria, unlike a cold, gets down into the lungs and causes its mischief there. In most children over the age of four or five, it causes a prolonged cold. Initial symptoms are those of a basic cold with runny nose and cough and sometimes a low grade fever. Children may or may not feel a little run down. At this point, whooping cough is indistinguishable from the common cold.  The only difference is that if a child receives the correct antibiotic at this point in illness, the illness may not last as long.

As the illness progresses, children may develop the classic hard, non-stop cough that leaves them gasping for air at the end of a coughing fit, the classic “whoop.”  Most teens won’t develop the “whoop,” but many younger children will. Another indication of the severity of the cough is throwing up because the cough is so hard.  At that point, antibiotics don’t help the child, but they do prevent further spread of the infection to others. The illness typically runs its course over four to six weeks.

Infants and toddlers who catch pertussis are much more likely to become quite ill.  They may require supportive oxygen. Some will end up in the intensive care unit.  Infants also have a tendency to just stop breathing due to the infection. These are the patients at the highest risk.

There is an immunization for pertussis. It is part of the DTaP that all infants and kindergarteners receive. It is only about 85 percent effective, but each booster doses increases its effectiveness. This immunity tends to wear off over time, however, so many five year olds are not immune until they get their five-year-old booster shots.

Teenagers are not immnune. But the thinking that they are immune has led to them being carriers of the illness and also prompted notices from health departments and school districts. The newest national vaccine guidelines now recommend that children 11 years old and up receive a pertussis vaccine as part of their tetanus booster. This booster used to be given at 15 years old and did not contain the pertussis component. While this booster is also not perfect, good immunization levels in the community will help prevent the spread of this illness to those most susceptible to severe illness. Check with your physician.

(I'm going to file this away for someday when the kids are grown and I start feeling too nostalgic.)

6:45 a.m.  Wake up to 3-year-old daughter crying in the hallway outside my bedroom door. She has wet the bed. Why? "I was too tired to get up," she tells me. I know the feeling. Husband has already left for work. I go to work cleaning up the mess.

8:00 a.m.  After feeding the baby his bottle, making Anna's breakfast, painting Anna's nails (due to begging only), and getting myself and both kids dressed and ready to face the day, I change Kellen once more and notice that there is something wrong going on in his diapered region. I won't get into details, but let's just say there was oozing and I immediately knew that we would be making a trip to the doctor.

8:30 a.m.  Drop kids off at babysitter's house. Call doctor's office on cell phone while ordering coffee in drive-through.  Make an appointment for the only time available: 10 a.m.

8:45 a.m.  Arrive at work. Frantically try to reschedule the meeting that I previously had planned for 10 a.m. Attack e-mails with gusto until it's time to turn around to pick up Kellen for his doctor's appointment -- a mere 45 minutes later.

10:15 a.m.  Kellen is seen at the pediatrician's office. As it turns out, the disgusting oozing problem is painful, but temporary and normal. Good to know. However, it also turns out that Kellen has a double-ear infection. WHAT??? Mommy Guilt! Mommy Guilt! Mommy Guilt! I had no idea there was anything wrong with his ears, and who knows how long our poor child would have suffered had we not found this out by accident. Thank God for the oozing!

11:00 a.m.  Leave pediatrician's office to pick up prescription at local pharmacy. Meanwhile, call babysitter to let her know that Kellen is actually sick and then call my Mom to see if she can watch him for the rest of the day. Pharmacist is mad at me for multi-tasking while she is trying to talk to me. By the way, it will be 30 more minutes for the prescription.

11:10 a.m.  Get Kellen home, feed him and put him down for a nap while waiting for Mom to arrive. Throw a corned beef in the crock pot for dinner while waiting.

11:30 a.m.  Mom arrives to take over. I drive back to pharmacy to pick up needed antibiotic and drop it back off at home so that Kellen can take it as soon as possible. Then I head back to work, picking up a quick lunch to eat in my office on the way.

12:00-1:00 p.m.  Work, work, work, work! Double-time, now! I had SOOOOO many things to do today! Start figuring out what can wait and what absolutely has to happen now...and make it happen!

1:00-1:30 p.m.  I have to take time out again because I actually have a C.T. scan scheduled for myself. The doctor is hoping to figure out what is causing the cough that I have had non-stop since October. Luckily, it is right down the hall from my office and they get me in and out even before my scheduled appointment time. Hooray for the radiology department at SSM St. Joseph Hospital West!  What a nice break!

1:30-3:30 p.m.  Work, work, work, work! Triple-time, now! Sometimes I work best under pressure. I am checking things off my list left and right. 

3:30-4:30 p.m.  I attend a meeting via phone. Secretly, I multi-task again and design some flyers while I'm listening.

4:30-5:30 p.m.  I squeeze in another hour of productivity before heading home to take over Mommy duties again. I usually work until at least 6 and my husband takes care of dinner, but he has a rare night when he has to work late.  Of course.

5:30-7:30 p.m.  I feed Anna dinner (thank goodness my Mom had already fed Kellen), bathe both kids, give Kellen three different medicines and fold the four loads of laundry that I dumped all over my bed this morning when I had to use the laundry baskets for Anna's soiled sheets. I also try to squeeze in some playtime and tell the kids over and over how much I love them. Just in case it doesn't show.

8:00 p.m.  Give Kellen one more bottle and put him to bed. Paint Anna's nails AGAIN (more begging)! Remember that I still have to put the sheets back on her bed. Sigh.

8:30 p.m.  Read a “Berenstain Bears” book after telling Anna that after the day I've had, I absolutely cannot read the same Disney princess book for the fourth night in a row. Together we learn what happens when certain cubs eat too much junk food. Say prayers. Kiss goodnight.

9:00 p.m.  Hubby has finally made it home. "What a long day," he sighs. HA! He is already halfway through his plate of corned beef, cabbage, carrots and potatoes when I come downstairs. How is it that I've been home for almost four hours and he still beat me to dinner?

9:10-11:10 p.m.  Enjoy my delicious corned beef and some quality time with my husband (while watching a movie and doing more work on my laptop). Then he goes up to bed while I do the dishes and throw one more load of laundry in the washing machine.

At nearly eight months old, my son Kellen is now old enough to express his adoration for his big sister. Every time she enters the room, his face lights up like a Christmas star. He just beams (and drools) his adoration all over her. Everywhere she goes, he tries to crawl after her. Anytime she touches something, he wants to have it. And she is still the only person in our house who can make him roll with laughter (He doesn’t just give away giggles for free like some babies; he is one serious little dude!).

Now I know that part of the reason for this is that Anna, our three year old, is really good to her brother. She always talks softly to him and is always giving him toys to play with…plus, she does neat things like walking and making weird noises. I mean, who can beat that in an older sibling? I have been counting my blessings that their relationship has seemed to have gone so well thus far, and wondering how long that will continue in the future. And after this morning, I’d have to say “Forever,” if my daughter has anything to do with it. How’s that, you ask?

I caught her brainwashing him.  That is, through the baby monitor, I overheard her quietly singing her own little made-up song to him (I quickly grabbed a pen and wrote it down). It went something like this:

“You love your sister,

She’s so cool!

She sleeps close by

In the very next room

And she does all the things

That you want to do!

She’s al-ways a-rou-hound,

And you’ll al-ways be brother and sis-ter!

As I laughed to myself (and thought that Anna might have a future in songwriting), I began to wonder how long she’s been doing this. I know that she sings to him a lot, but I don’t always pay attention to what she’s saying. It could very well be that Kellen has been getting subliminal messages for the past eight months that I knew nothing about. “You love your sister. Your sister is so cool. You want to be just like your sister.”

Oh well – as long as the messages stay positive, I guess that’s not such a bad thing. Now that I know what she’s up to, I’ll just have to be on the lookout for “Give your sister all your toys and candy,” and “You will join your sister to team up against mom and dad to reverse the balance of power around here.” Siblings…gotta love ‘em.

Besides a brain charger (mine may actually need brand new batteries), a six-pack (I’m talking bellies, not beverages) and a long winter’s nap (or even better, just one day that I can sleep in until ten)...what I want most for Christmas this year is to make lasting memories with my family, while the “magic” of the season is so real for my little ones.

My daughter Anna, who is almost four now, is just eating up the whole Santa Claus business this year. Last year, she had a love-hate relationship with Santa. She really loved the idea of him in theory…but when it came time to actually meet the man with the white beard, it was “Santa! Santa! (glee)…Sant-AHHHHHHHH! (terror, followed by meltdown). This year, we want back to Breakfast with Santa, and as soon as he entered the room she was jabbing me with her elbow, “Mom, where’s my list? Give it to me!!” And she got that list into the big man’s hand before you could say “Ho-ho-ho.” She didn’t even wait until she got a chance to sit on his lap! I guess she wasn’t taking any chances.

The funny thing about her list is that she made it a long time ago…like, in October…and I, not realizing at the time that it was THE list, didn’t really pay that much attention to what she was doing. So Anna is telling me, “I’m going to ask Santa to bring me (some toy),” and then makes a scribble on her paper. “And (another toy)” Sribble-scribble. “And (another toy)” Scribble-scribble. I think you get the idea. In the end, what we had was a page full of scribble lines, and a Mommy who didn’t remember one thing those scribbles were supposed to mean. That becomes a problem when Mommy and Daddy start asking Anna what she wants for Christmas in December, and her only response is, “I already put everything on the list! Santa Claus knows…”  Sigh. What can you do? We tried to buy one of just about everything she’s ever shown any interest in, and we have our fingers crossed that “Santa Claus” won’t be disappointing one of his biggest fans this year.

My seven-month-old son, Kellen, doesn’t really have a clue about Christmas or Santa or baby Jesus or anything else yet. All he knows is that we now have a giant tree in our family room that is lots of fun for him to try to pull shiny things off of. He is crawling now, and moves at warp speed anytime he sees anything that is NOT a toy within grabbing distance...i.e., the remote, our laptops, cell phones, my husband’s watch, shoes, Anna's games and books, etc.  What I don't understand is how does he KNOW the difference between toys and NOT toys?  He’s got some really cool toys…toys that I enjoy playing with.  But you set a tub of baby wipes on the floor, and that’s the only thing in the room that he cares about.  That said, I'm now sitting here wondering why we bought him even more toys for Christmas. We should have gotten him something he'll actually want to use, like office supplies. Oh well…at least it will be fun watching him “open” his presents and eat the wrapping paper.

I just keep thinking to myself, “I’m right in the middle of my best years ever.”  Having kids around at Christmastime is a chance for us grown-ups to relive the magic we experienced at their age, yet really “store away” those memories and treasure them for all they’re worth. Just one more day until Santa Claus comes to town! I can’t wait.

     Anna with Santa in 2007          Anna and Kellen with Santa in 2008

   (Note the fear and anguish)         (Yep...Kellen slept through it all)

Can a test tell me if my kid will excel at sports?

I enjoy exercise. Many who have read other articles I’ve written know that I enjoy a good long run. I feel good after a good weight-lifting session and, in my time, I played a pretty mean game of volleyball (I’m old now, you know).  In addition to this, as a physician, I believe exercise is extraordinarily important.

Having said that, I’m not a big sports fan. I never watch professional sports. I love the Summer Olympics (what’s a bobsled?), but at times, I'm still really frustrated by what I see. I believe that the money in professional sports and the fans' expectations of athletes has truly ruined all that is beautiful about athletic endeavor. My daughter participates in gymnastics, but she does so because it’s fun, not to win prizes. My son dropped out of sports and it’s all right with me.

With that in mind, it was with quite a bit of interest that I read about genetic testing for sports potential (http://www.nytimes.com/2008/11/30/sports/30genetics.html?em). It seems that a company in Colorado (the fittest state in the nation) is participating in testing for athletic prowess. According to what I’ve read, they charge a fee that is larger than any of my fees in order to obtain a sample for genetic analysis of ONE gene, the ACTN3 gene. I am unable to find a test for any other genes on their Web-site. The argument goes that, if a subject has a certain combination of the ACTN3 gene types, he or she may be more suited for endurance activity. If a subject has a different combination, they may be more suited for strength and speed-type sports. A third gene combination may indicate a combination of skills.

While there are many problems with this approach, some ethical/moral, some medical and some scientific, let me just address the scientific question. If one is truly interested in this kind of analysis, even a brief review of the available scientific evidence (which I just did in about 15 minutes) demonstrates at least 185 different genes that in some way influence athletic prowess.

Moreover, in the original studies of the ACTN3 gene, there were many athletes who did not fit their correct category genetically. That is, some sprinters had endurance-type genes and some endurance athletes had strength-type genes. These original tests were done in elite-level athletes demonstrating that even with the “wrong” ACTN3 type genes, one can excel in one’s sport of choice.

There is no question in my mind that genetics plays a huge role in whether one becomes an athletic superstar or not (I never would have been an Olympic-level athlete no matter how hard I trained). There is also no question that passion for the game, excellent training and excellent nutrition all come into play as well. The results of a single genetic test are just not enough to tell you what kind of sport your child is suited for, let alone whether or not he or she will be any good at it. At this point in time, genetic testing for sports aptitude has a VERY low return on investment potential.

So, let your kids PLAY sports. Take the pressure off. Let them have fun. Their sports are not your ticket to fame or fortune. If your kids happen to excel at sports, let them go with it. Keep the pressure low-key, have fun with them, don’t over-train them to premature exhaustion or burn-out. Let them develop a lifelong love of physical activity.

It’s hard to believe that I’ve been writing this blog for over a year now! Last year at this time, I was thankful that I made it to the second trimester of my pregnancy. This year, a new list of items quickly comes to mind:  

1)      My washing machine. That’s not just something I’m writing for your sake. I have literally thought those words hundreds of times in the past few weeks. “Thank you, Lord, for my washing machine!” I currently do about two loads of laundry every day. That’s a lot, considering we’re usually only home for a few hours of “awake” time during the week. My son is a spitter-upper by trade, so that fact alone accounts for 75 percent of the laundry I do. Spit rags, bibs, towels, his clothes, our clothes, his sister’s clothes…we are all constantly covered in spit-up. We also have white carpet, so we can’t allow Kellen to play on the floor without putting a giant quilt under him. After about two hours, I have to rotate one baby-barf-covered quilt out with another one. Of course, now that Kellen is mobile, he doesn’t always stay on the quilt, which leads me to number 2 on my list…

2)      Carpet steam cleaners. I can’t imagine what our floors would look like without this nifty modern marvel. Well, yes I can. I wouldn’t want to set foot on them. No one with children should ever have white carpet…but until we can afford to replace it with something more forgiving, we frequently have to clean it. That is, deep clean it. It’s not just the spit-up stains, either. It’s the mud from the dogs’ paws…and chocolate smears…and strawberry milk…and other, much more disgusting things that I won’t get into. You name it, and it finds its way into our carpet fibers, screaming at everyone who walks in that “We have kids and dogs, but we don’t always find the stains they make until they’re set in!” Sigh. Like I said, I’m thankful for steam cleaners (and our Dyson, which I pretty much use on a daily basis).

3)      That Thanksgiving is over. Is it just my family, or does anyone else’s family have a tendency to get sick right before a holiday? I know…I probably sound like a broken record. My family is always sick. But it really bugs me that something always seems to “get” us just when we think we’re about to have fun. On the Wednesday before Thanksgiving, I walked in the door after work, ready for a nice four-day weekend, and my husband announced, “I don’t feel so…BLAHHHH! (That’s the sound of him becoming violently ill, which he repeatedly did all night long, making it “the worst night of his life,” in his words). Then I got sick (I don’t even remember much about Thanksgiving, except that I missed it). And the baby had it the worst…he couldn’t keep anything down until Sunday. And he wouldn’t sleep at all. It was horrible. So I’m glad all of that is over with, and that we have a few weeks to rest up before the next “holiday.”

4)      My Family. Yes, I like to poke fun at the trials of parenting young children…but in all reality, I have never felt more blessed. Every time my son wakes up for a bottle in the middle of the night, I just snuggle him to me and try to remember how he feels in my arms, because I know that all too soon, he’ll be grown. I have two great kids and the best husband ever, and I get to relieve any frustrations that come along by sharing them with you. What a great set-up! I am so thankful.

Once again, it has been several weeks since I have been able to find 10 spare minutes to write about my life. Sigh. I think that’s a statement about my busy life in itself.

So in addition to the usual craziness of trying to balance work and motherhood, and everyone in my house dealing with some form of respiratory nastiness (including my husband, who actually had pneumonia), one of our “other” children has been seriously ill. By “other,” I mean the smelly ones. Actually, that’s probably not enough of a distinction. I mean the furry ones.

In addition to Anna and Kellen, my husband and I are also the proud parents of two dogs. Loki is an Australian Cattle Dog. He is always trying to “herd” me up and down the stairs…which I just love. Rolen is a Rat Terrier. He was my first baby. Before Anna came along, he used to snuggle with me under the covers in bed every night. Now, even though he was long ago relegated to a dog bed, Rolen still loves me unconditionally and constantly tries to kiss me on the lips…which I also love (I hope you’re getting the sarcasm there. I much prefer that any creature that licks itself in places I don’t care to mention NOT kiss me on the mouth). But he loves me, and I love him back. After all, I’m his Mommy too.

Thus you can understand how worried I became when, over a period of several days last week, Rolen stopped eating and drinking and became more and more lethargic. On the third day, I returned home from work to find a lovely neon green puke stain all over the white carpet in our family room and poor Rolen nearly paralyzed with sickness. My husband rushed him to the emergency vet, and over the past few days we’ve shelled out

a grand to help cure our sweet little furball of Pancreatitis and a secondary infection. He had to spend two nights in the doggie hospital. And we had to shampoo the carpet…twice.

All of this made me reflect on what it is about our pets that makes us go to such extremes to make sure they get better. I mean – there is plenty not to love. They’re expensive. They have really bad breath. Loki has a tendency to be awkward and clumsy and unintentionally knock over small children. I have to vacuum dog hair out of the carpet every other day. And sometimes you really have to watch them when they’re in the backyard, because they like to treat each other’s rear ends like vending machines (which is probably the reason for the bad breath.)

Yet, on the very night that my husband had to rush Rolen to the vet, a 3-year-old boy from our community was found after being lost in the woods for more than seven hours. He was brought to the hospital where I work and was found to be perfectly healthy...thank God! I was called back into work to give a media report (requiring me to find a sitter, of course, since my husband was at the doggie hospital). While talking to the little boy’s mom, I was amazed when she told me that the family’s dog never left her son’s side that day. The dog was with him when he wandered off, and she was with him when the rescuers found him. How wild is that? What a wonderful, loyal, protective creature!

What a timely reminder for me about why I love those “other” smelly kids of mine. I have no doubt that both of my dogs would keep watch over my children in a similar situation. They already do. They have this innate sense to nurture and protect that is pretty impressive. Any time Kellen wakes up from a nap, they are both there outside his bedroom door reminding me to go in and get him (as if I could forget). I just love them for loving us so much. They are so sweet and loyal…and even if they are a little hairy, stinky and expensive…I couldn’t imagine our lives without them. I’m so thankful that Rolen is on the road to recovery!

BPA -- Bisphenol A. What is it and why do I care?

BPA is a chemical that is used in the production of many plastics. In particular, you can find it in the linings of food and beverage containers. It is one of the most widely produced chemicals in the world. Important for parents is that it is used in many baby bottles and sippy cups. It also lines the metal containers that liquid infant formula is sold in. There are also small amounts in the containers for powdered formula. 

There is currently a significant amount of controversy regarding the safety of using BPA in food and beverage containers. A recent study reported in the Journal of the American Medical Association (jama.ama-assn.org/cgi/content/full/300/11/1303) found associations between higher levels of BPA in the urine and cardiovascular disease, diabetes and liver changes in adults. Prior studies had suggested  that BPA might cause mild levels of brain damage producing such symptoms as attention deficit problems. Other studies suggested it may act to some degree like estrogen and cause premature pubertal changes.

On Oct. 30, a subcommittee formed by the U.S. Food and Drug Administration presented a review of a prior FDA report concerning BPA. The prior report had concluded, based on the available literature, that the use of BPA at the levels normally seen is completely safe. However, this new subcommittee basically came back to the FDA and contradicted the prior report – saying that the earlier report was inaccurate and that current available data is NOT adequate to conclusively determine the safety of BPA. The subcommittee noted several small studies that the FDA did not include in the original determination as well as some studies performed after the early report by the FDA. More research is needed on the effect on humans.

Where does this information leave the harried parent? The American Academy of Pediatrics released a statement in light of the contradictory information (www.aap.org/new/bpa.htm).  The important points for parents that wish to take precautions are:

1. Clear plastics and plastics with the number “7” imprinted on the recycling code are most likely to contain BPA. Use opaque plastic bottles instead.
2. The most likely ways to increase exposure, if you Do use containers containing BPA, is by heating them or using them with scratched inner surfaces. So you can reduce your exposure by not heating these bottles or using bottles with scratched surfaces.
3. Formula is still the safest alternative to breast-feeding by far for infants, but you can reduce your child’s exposure by using powdered instead of ready-to-feed formula.

As always consult your physician.

I had a conversation with my son Kellen this morning, and he expressed a desire for me to share his comments with the rest of you.  So here’s how it went:

Kellen:  “Mom, I’ve having a really hard time understanding this whole Daylight Saving Time business.  What’s up with that?  For my entire life, time has always been the same.  Seven o’clock in the morning is always seven o’clock in the morning, you know?  And now you’re telling me that all of a sudden, it’s six o’clock?  I don’t get that.”

Me:  “I know son, it can be a little confusing at first...”

Kellen:  “A little!  I mean, how do you expect me to adapt to this when I can’t even tell time?  All I know is that my body gets tired when it gets tired…and it wakes up when I’m not tired.  But here you are telling me that I can’t go to bed at 6:30 at night and that I’m waking up too early.  What do you expect a kid to do??”

Me:  “Calm down, son.  I’m just trying to tell you how the system works.  You’ll get used to it eventually, like your big sister.”

Kellen:  “Ha!  You’re telling me that she’s used to it?  Have you noticed how incredibly crabby she’s been ever since Sunday morning, when we both had to wait an extra hour to go to church after we woke up and it got our whole nap schedule out of whack?  Whose brilliant idea was it to schedule family pictures that afternoon, anyway?  Isn’t her nonstop whining driving you crazy by now?”

Me:  “No, of course not.  Don’t you know that Mommies have hearts of gold and the patience of saints?   Mommies never mind a little whining and inconvenience.”

Kellen:  “So then you don’t care if I keep waking up at six o’clock every morning, even if that’s an hour earlier than you need to wake up?”

Me:  “No.  That has to stop.”

Kellen:  “Sigh.  Maybe you can write a letter to our new president about this whole time change business, and how it really doesn’t work for little kids.”

Me:  “We’ll see.  Keep in mind that his campaign slogan was ‘It’s time for change.’ He probably likes Daylight Saving Time. But I’ll see what I can do…”

***Disclaimer***  

As most of you probably realize, my son is only five months old…so he did not actually “say” these exact words.  But I’m pretty sure that I have interpreted his babbling correctly.  My part of the conversation may have been slightly embellished.

The American Academy of Pediatrics in conjunction with the National Institutes of Medicine recently recommended doubling the daily recommended dose of Vitamin D from 200 IU (international units) to 400 IU for children from birth to18 years old.

The recommendation is based on research that shows most Americans do not get enough Vitamin D. There have also been a number of studies suggesting Vitamin D may play a role in preventing certain inflammatory and auto-immune disorders such as juvenile rheumatoid arthritis, diabetes and possibly even leukemia. Vitamin D primarily regulates calcium in the body. If you have enough Vitamin D, your body pulls calcium out of the food you eat. If there is not enough Vitamin D, your body pulls the calcium out of your bones potentially creating weak, brittle and painful bones, a condition known as rickets.

There are essentially three ways to obtain Vitamin D. The first is sunshine. If you’re a blond-haired, blue-eyed kid in San Diego, then running around in your bathing suit for 10 to15 minutes around noon three or four days a week will probably give you enough. If you live further north or have darker skin, sunshine is much less reliable as a source of Vitamin D. Thus you have to get it from your food. There is enough Vitamin D in 32 ounces of milk or formula to meet the new requirement. 

There are also significant amounts of Vitamin D in cod liver oil, salmon, tuna and cod. There are also small amounts in eggs. If fish and milk are not regularly a part of your diet, all vitamins available for children have 400 IU per dose.

Breast-fed children are an interesting question. The AAP recommends supplementing all breast-fed infants with a vitamin containing 400 IU of Vitamin D as there is not enough in breast milk to maintain adequate levels in infants. Several Web sites I’ve perused lately say that it is not necessary. I think that, in light of recent data demonstrating the importance of good vitamin levels and the lack of harm, that breast-fed infants should receive a vitamin supplement. Formula-fed infants and older children should get three to four cups of formula or milk daily.

Finally, everyone should get some outside time as regularly as possible while avoiding sunburns and the risk for skin cancer. Turns out, outside time is good for the heart, the soul and now, for the bones!

Now that cold season is here, I often hear the same concern: “Doctor, the drainage is green. I’ve always been told that means an infection.” Grandparents have been telling us that one for years. The other common grandparent advice is that if a child has a fever, he or she has an infection.

The funny thing is, in the broadest sense, both of those statements are true. The problem is that many of us forget that viruses are infections!  The common cold is caused by a large number of viruses. Each of these viruses has multiple strains. Because of the wide variety of types and strains, none of us seems to ever get completely immune to the common cold. Children have it the worst because their young immune systems have been exposed to far fewer of these various types of viruses than most adults.

Many viral upper-respiratory infections (colds) start with a clear runny nose and cough and a feeling of the “blahs.” Sometimes fevers are associated with them, even temperatures up to 103 degrees. Most of the time, the drainage from the nose turns green about day No. 3 or No. 4 and stays that way for about 7 to 10 days. Around that time, the cough seems to turn deeper and “junkier.” There’s more looseness to it.  That allows us to cough up the phlegm. I love when the cough finally turns very loose, because that usually means I’m closing in on the last days.

Symptoms of a cold that last longer than 14 days or fevers for longer than four days are suggestive of a sinus infection, bronchitis or pneumonia. This is especially true if you “feel” sick. Children tend to never stop running and wrestling and causing trouble. If they do stop, then they are more likely to have a bacteria that may respond to an antibiotic. Time to call your doctor. Increase the fluids, increase the rest, try honey for the cough in children who’ve had their first birthday, run a humidifier in the room and lift the head of the bed at night and you’ll find that, even though it’s green, this too shall pass.

In our unsettling economy, I am always looking for ways to save money for my family.  Over the past year or so, I have become a regular on “Craigslist,” the Internet site where you can view ads for gently used items in your own community, then arrange to pick them up.  It’s kind of like eBay, without the shipping charges and wait time.  It’s great for parents of young children (who tend to outgrow clothes, toys and gear before you even get a chance to take the receipt out of your wallet), since you can find stuff that’s practically unused for a lot less cash!  That said…here is one scenario that could happen when you use Craigslist instead of just going to the nearest store.

You could notice one day that your five month old is bored with his jumperoo and that what he really needs is an exersaucer with lots of cool toys on it…and he needs it right away.  So, you look online to see how much a cool new one would cost from a retail store.  Yikes!  Then you look on Craigslist and see that there is a really cool exersaucer for sale in a nearby community for much less money, so you e-mail to see if it is still available.  It is!  The sellers offer to throw in another baby toy, and you make a deal for $55.  They need exact change.  No problem.  Next, you decide that it would be a good idea for the whole family to take a drive to pick up the exersaucer after eating Mexican food for dinner, so that you can all spend more time together.   Great idea!  Three minutes into the drive, you remember that the baby hates his carseat…especially when it’s dark.  Despite the screaming, you carry on…because a good deal is hard to pass up these days.  Dad turns into a bank to get cash out of the ATM.  Wait a minute!  The bank is shut down?  Forever?  Gee, you guess the economy is as bad as everyone is saying.

Plan B is to stop at the closest grocery store to get cash back from a debit card purchase.  That will work better, since you need exact change anyway.  But that means you have to buy something while Dad circles the parking lot with a still screaming (louder) baby.  No biggie…you needed more milk anyway.  Once you have the milk and the $55, you are once again on your way.  To simplify (and quiet) things, you decide to climb into the back seat to make a bottle and feed the baby.  You temporarily forget that you have a tendency to get carsick in the back seat.  After a brief scuffle to try to find directions that seem to have disappeared into thin air (and end up being on the floor board behind the driver’s seat), all is calm and quiet and good.  You are almost there.  Then, moments after Dad informs you that he thinks he needs glasses, you realize that he cannot read any of the street signs in the dark, foreign neighborhood…and that you are no help from the back seat.  After turning around (several times), you finally reach your destination.  Hooray!  (You always say that you enjoy exploring new places, anyway.)

The exersaucer is just as cool as it looked on Craigslist and in great shape!  And the extra toy is an even cooler added bonus!  The baby will love crawling around in it soon.  You and Dad head home feeling very proud of yourselves for making a smart buy.  Uh-oh.  You suddenly aren’t feeling so good.  Is it getting really warm in the car?   Even though the baby has started screaming again (since stopping the car always wakes him up) you crawl back into the front seat to try to regain control of your senses.  It is no use.  You look around for the nearest “container,” and the next thing you know you are barfing into a plastic grocery bag, while your son is trying to break a record for the loudest cry ever and your husband is calmly listening to John Mayer in the seat next to you as if this kind of chaos is becoming normal for him.  All you can think is, “Thank God the ATM was closed so that I had to buy milk, or I wouldn’t have had this bag…”  And then your three year old pipes up from the back seat, “What is that stinky smell in the air?”   “Don’t worry about it,” your husband tells her.  “It’s just enchiladas verdes.”   LOTS of enchiladas verdes.

Does that possibility make the prospect of saving a few bucks on Craigslist worth it to you?  Well, I guess it depends on the final outcome.  In my case, (yes…this actually happened to me) we got home, threw away the barf bag, the baby stopped hyperventilating, and our three-year-old daughter could not have been more excited to see her brother’s new toys.  And as she played the music on one of the exersaucer features and did a little dance around it, Kellen (our baby) started laughing.  As in, “ha-ha-ha” laughing…which is something that he has only done once or twice before…briefly.   I feel as if I have waited forever to hear that sweet little laugh!  For 10 minutes, Kellen laughed out loud at his big sister as she entertained him with his new toy.  And for that 10 minutes of wonder and delight (for all of us), I wouldn’t trade any of the drama that led up to it (except maybe I wouldn’t have had the enchiladas verdes). 

Craigslist exersaucer…priceless.

With all the conflicting reports in the media regarding the condition known as ADD (Attention Deficit Disorder), I thought I’d take a few moments to look a little more closely at the condition. On a recent evening, the issue was brought to my attention during my last appointment of the day.

“Why are you here today?” I asked.

“I’m just here to get my shot and go home,” she said, rather irritated that I had asked.

Well, as many of you know, pediatricians don’t “just give a shot” and send you home. We want to know how you’re doing. Do you have any health concerns? Have there been changes to your regular routine that can make a healthy difference? As it turns out, her grades were suffering. “You have to understand,” she said. “For me, getting a C is like getting an A for other kids.”

I was dumbstruck, yet I’d heard comments like this before. I hadn’t seen this young lady in about five years, so we probed further. It turns out that she has trouble completing her work, that she can’t remember what it is she’s supposed to be working on, that she is very easily distracted and has trouble returning to the task at hand. She often ends up with incomplete on work that she’s actually done -- she just didn’t get it turned in because she forgot or it was lost in the book bag. The worst thing is she thinks she’s dumb! She is upset by her poor grades, she’s tired of being nagged by her mother and she’s tired of being different than all her friends. She knows there’s something wrong, but she entirely blames herself and gives up because she’s dumb.

The truth is, in order for people to organize their thoughts, stay attentive to their work and play, and complete tasks, they have to have adequate amounts of dopamine, serotonin and norepinephrine in the frontal portion of their brains. These chemicals are messengers or communicators from one brain cell to the next. If there are not enough of these messengers, some brain cells never receive messages.

For example, imagine two lines of people stretched over 500 yards. One line has a person every 10 feet; the second has a person every 30 feet. Now start a message at one end of both lines. Which line is most likely to get the message all the way to the other end? Now add a lot of background noise. This is how a child with ADD feels in a room of 20 or 30 other kids. He or she might have done just fine in a quiet room, but once you add the noise, their brains just aren’t’ passing the correct messages. They get distracted, they take forever to complete tasks, they may never complete the tasks and they may get lost in the process of completing a task.

While there are many opinions regarding the reality of ADD, the scientific evidence has clearly demonstrated that there is a group of kids -- with a certain group of symptoms -- who desperately need help and support. They may need medication. They may need behavioral modification. There is a very small possibility that diet and discipline may help. What’s very clear is that these symptoms are very real and they desperately need our help in a variety of ways.

As always, if parents have questions, they should consult their physician.

As a working mom, I worry a lot about missing the milestones that happen in my new baby’s life.

Since I stayed at home for 18 months with my first child, Anna, I was always the one who was there with her when she “did stuff” for the first time.  I was right beside my little girl when I placed her in the sitting position, and for the first time, she didn’t fall over!  I was the one who walked into her nursery and saw her standing up in her crib for the first time.  I was the first one to feel the sharp little nub that would become her first tooth, and I was the one who let go of her hands when she took her first steps.  Each moment was such a big milestone in her little life, as well as mine, and I couldn’t imagine not being there to witness them.

Now, with Kellen in daycare, I constantly wonder if his “teacher” will be the one who will see those “firsts” instead of me.  He has been super close to rolling over lately…and every day for the past week, I awaited news that he had started doing so at daycare. 

Saturday morning, I was pleasantly surprised when my husband woke me up to say, “Come downstairs to see what your son is doing!”  And there was our little butterball, rolling all over the family room floor.  Kellen is now officially mobile, and he had just figured it out!  I was SO excited to watch him display his newly acquired skill all weekend long.  And I am so relieved that even if I wasn’t the first one to see him do it, at least my husband earned that title…and I was right there to come in a close second.

Many thanks to my son for waiting until the weekend to achieve a major milestone!  And many thanks to his teacher, in case by chance she DID see him roll and chose not to tell us.  When it comes to “missed” milestones…what we parents don’t know will never hurt us!

What is it about kids?

I ponder this question often. Why would I even ask such a question? Aren’t children a gift from God, always to be cherished? Aren’t they the twinkle in our eyes? Aren’t they the center of most parents' conversations? Wouldn’t we put ourselves in front of a run-a-way big rig to protect them?

Yes, but aren’t they also the source of many a lost night of sleep? Aren’t they the root of many disagreements in many home? Don’t they just test every last shred of patience you could have sometimes?  It is true: Our kids are the source of both our greatest joys and our deepest sorrows.

Think deeply about this sometime. Busy mom Kate has told us about her adventure in Chicago and about the grossest thing a kid can do. At the time, she was probably horrified!  Now she can tell stories and laugh about it. In the office, a two year old will have an absolute fit and refuse to let me look in her ears and throat and almost nothing her parent and I do will change that. In spite of that, I haven’t hung up my hat and said, “I quit.” After being screamed at by the fourth or fith child in a row, I at least consider it though. Then, as I drive home, I realize how much I mean to these families and children and commit to being screamed at yet another day.

Children are our hopes. They bring us great joy in their successes. When their love is freely given, it is absolutely precious. While they are busy refusing to do their chores, while our internal thermometer rises, we can still look at them and wonder, “just who is this child going to become.”  Then, of course, there is the child you see quietly sleeping in their beds (at least, I hope they’re in their own beds and not yours!). If you ever have trouble remembering why you parent, look at your child sleeping and your heart will completely melt!

I have a picture in my office of my daughter that I think most of you can relate to that describes this well. She is looking up at the camera with this sly little grin, her hands clasped behind her back. The smile is all sweetness, but the pose is entirely something else. It is as if she is saying, “Daddy, I know you know what I just did, but I also know that you really don’t want to do anything about it.”  And you know… I really don’t want to do anything about it.

That’s right…I said “bonk,” not honk.

It’s because I recently noticed how that one four-letter word…so rarely used by grown-ups…is one of the favorite verbs of every three- and four-year-old kid that I know (not just my own daughter!)  The way I have come to understand it, “bonk” has a variety of uses.

“Mommy, I bonked my elbow on the table!”

“Aunt Kate, Anna took my flashlight and then she bonked the dog with it!”

“First I climbed up the ladder, then I went down the slide and bonked off the bottom…”

Anna, do you want a banana with your cereal?  “BONK!”  Does that mean yes?  “BONK!”  Are you being silly right now?  “BONK! BONK! BONK!”

Sadly, this all-encompassing word has now become a permanent fixture in my own lexicon.  I find myself using it even when there are no kids even around.  For instance, this morning I stubbed my toe coming into work.  In my head, I heard myself say, “Ouch!  I bonked my toe!”  Not stubbed…not bumped…I bonked my toe.  My next thought was, “How old am I again?”

Somebody just bonk me on the head.

Ah, the joys of parenthood. Kids are always a challenge and always a joy. I have yet to fully figure out how they can manage both.

The other night, I’m home with the kids and my wife is out doing her thing. I walk in, my wife walks out: “Dinner’s on the stove. Bye!” It’s a little late for dinner, so I assume the kids have eaten. Silly me. “Hey, kids? Have you eaten yet?”

“No,” they reply in unison from the basement where they have been playing PlayStation.
“Come on up then. Let’s get moving.” I go to my room to drop off my stuff from the day. I come to the kitchen… No kids!  “Kids, I said it’s time to come up for dinner!”
“OK!!!  You don’t have to nag us!”
 We finish dinner. The two go back downstairs while I clean up. “Anyone have any homework?” I ask.
 “No,” they answer, again in unison. We go about our evening, getting a couple of more things done. My son gets in a little piano practice, my daughter her reading.

“It’s time to brush teeth and get ready for bed.”

The usual evening scramble begins. I try to keep the kids focused on their evening chores. Things seem to be moving well enough. My son is in bed doing his bed-time reading.  My daughter is in her room doing something. I stop in to check. “What is that??!”

She has math work out, just as I was about to tell her to turn out the lights. “My homework,” she answers.

“What do you mean, homework?! You’ve been fooling around playing video games all evening. I asked earlier about homework. What happened?”
 “I forgot…” and her tears start pouring out.

Now, if you don’t have a daughter, you might not know what I mean when I say the tears started pouring out. If it were my son, he’d just get mad at me or fumble out some lame excuse, but never tears. My daughter’s tears are a knee-jerk response when Dad is upset about something she’s done. Now, I’ve blown it. And since I never have understood the tears, I grow even more impatient. I’m thinking about how we will have to back up, resettle, get the homework done and somehow get to bed.

So much for a nice, smooth-flowing evening. I should have known the evening had been going too smoothly.

A dear friend of mine recently found out that she is pregnant (surprise!), and plans to deliver her baby in the same hospital where I had Kellen, SSM St. Joseph Hospital West.

In light of that information, she has been very impressed with a new obstetric (OB) training tool that the hospital has been able to purchase.  The tool’s name is Noelle.  She is (in layman’s terms) a pregnant robot.  Noelle has a baby in her uterus that she can deliver again and again…as in, through the birth canal.  Or via C-section.  And she can scream!  And talk! And bleed!  It is one of the coolest things that I have ever seen.  Apparently, my friend and I are not the only ones who think so, because Noelle has been all over the news lately.  (Click on the following links if you’d like to see some of the stories).

Fox2 News St. Louis (video):

http://www.myfoxstl.com/myfox/pages/Home/Detail?contentId=7451189&version=1&locale=EN-US&layoutCode=VSTY&pageId=1.1.1

St. Louis Post-Dispatch (print & video):

http://www.stltoday.com/stltoday/lifestyle/stories.nsf/healthfitness/story/3E213597EC172FBA862574B4007421F7?OpenDocument

Suburban Journals (print):

http://stcharlesjournal.stltoday.com/articles/2008/09/24/news/sj2tn20080923-0924stc-baby0.ii1.txt

The OB physicians and staff at St. Joseph Hospital West will be using Noelle to train for the emergency scenarios that they don’t see very often, like shoulder dystocias or prolapsed umbilical cords.  As someone who just had a baby, and will probably have at least one more, that makes me feel really good. And I know it makes my friend feel good.  You just never know what’s going to happen when you go in to deliver a baby.  Neither do the doctors and nurses.  Everything could go perfectly through your entire pregnancy and labor, and if the baby’s shoulders get stuck in those final moments of delivery, it is a serious situation.  It’s awesome to know that caregivers are going to be able to use a tool like Noelle to get more hands-on experience practicing the maneuvers to work that baby out, in real time, instead of having to just read about it out of a book…or “practice” on an actual patient.

I think that every labor and delivery hospital would benefit from having a tool like Noelle!  I understand why most don’t, since she is so expensive.  But I’m also really glad to know that my friend’s baby…and any more that I have (YEARS from now)…will be in the hands of one of the most skilled teams in the St. Louis area, thanks to a pregnant robot.

So what exactly are all those vaccines doing?

I’m going to address a very simple (for me) subject next:  the vaccines themselves and how they work. It seems that a lot of the misinformation out there comes from a misunderstanding of what vaccines actually do when they get into the body.

Vaccines come in two forms. The first form is made up of little tiny parts of the bacteria or virus that we hope to protect you from. When these little tiny parts are put into the human body, the body generates what are called immunoglobulins. Since there is enormous variation in immunoglobulins, the body eventually finds one of these proteins that actually “fits” the tiny bit of bacteria or virus.  Once this protein matches (“recognizes”) the tiny part, it “sticks” to it.

Sticking to the particle allows the protein to then send out a signal to the body’s infection fighting systems to make lots more of these proteins that “fit.” Signals also are sent out to attack anything that fits that particular protein now or in the future. For example, a small piece of tetanus (the bacteria Clostridium tetani) is put into the body, a protein recognizes it, the protein sends out signals to make a lot more of that protein and also to fight off anything looking like that small piece of tetanus. This makes the body MUCH more responsive to tetanus the next time the body sees it and allows the body to fight it off before it becomes a full-blown infection.

The second form of vaccine is live virus. Measles, chicken pox and rotavirus vaccines actually have the whole virus instead of a piece. These whole viruses have been modified however, so they are unable to create full-blown disease in a person. Just like with the tiny pieces, the whole virus activates a similar response making the body much more sensitive to the virus and allowing it to fight it off in the future. Once the body learns to make the necessary protein the first time, it can make vast amounts of it in the future in a very short time frame which is how a tetanus shot can prevent illness for 10 years or longer. This process has been demonstrated to occur even in the very youngest of our children. Some tiny bits of virus or bacteria cause a more robust response in older children and some require a carrier protein to create a good response. This would be why some vaccines are given very early (hepatitis B) to young people, some are bound to special proteins (HIB vaccine) and some are given later (the meningitis vaccine).

My daughter just did it!  Just when you think that you have seen it all, your kids will come up with new ways to surprise you. 

Anna is three and a half years old now, and generally takes her baths with “in-and-out” supervision.  That is to say, we wash her hair and then let her play for a few minutes with the door open, as we do little household tasks in the near vicinity and check on her as we walk by.  She is very capable of washing herself, as well as getting out of the tub if she needs to get a toy or a washcloth, then getting back in.  You would think that she would use that same ability to climb out when she needed to go potty.  Oh, you would think…but you would be wrong.

About a week ago, she went “number two” in the bathtub.  Then she started crying.  Then I was freaking out, as I watched the wet, slimy culprits floating around and wondered how I was going to get all the shampoo out of her hair before yanking her out of the germ-infested water.  Needless to say, she got into trouble for that. 

Last night, my stern admonitions of “no more pooping in the bathtub” must have been resonating in Anna’s head when she felt a sudden, urgent need to go to the bathroom.  She called for Daddy.  He was running the water for Kellen’s bath in the other room and didn’t hear her.  She yelled for Mommy.  I had decided to vacuum the family room really quick, and didn’t hear her either.  Anna panicked.  And I guess in that moment when push comes to shove (so to speak), she did what any non-logically thinking three year old would do:  She pooped in her hand.

Suddenly, from above the roar of the vacuum, I heard commotion coming from the second floor.  Anna was screaming.  My husband was yelling, “Put it down! Put it down!”  What in the world was going on up there?  I ran up the stairs to see my adorable little curly top gripping a handful of the most disgusting brown “stuff” that I have ever seen…with a look of absolute terror on her face.  I think once she did it, she immediately thought, “What have I done???”  And while she wanted to get rid of it, she simply didn’t know how.  She was paralyzed.  My husband, holding a naked, wet, slippery baby, was trying to get her to deposit “it” into the commode, but she just couldn’t seem to make the connection.

Quickly sizing up the problem, I rushed into the bathroom, grabbed Anna’s hand, reached over and flung the “stuff” into the potty.  I then proceeded to wash and sanitize Anna’s slimy hand and everything else in the bathroom.  And the entire time, we were both crying:  Anna, because of the horror of what she had done; me, because I was laughing so hard that I almost couldn’t breathe.  It was at once the most disgusting and the funniest thing I had encountered as a parent.  I couldn’t even scold her.  There was no need to tell her what a poor decision she had made.  She was well aware.  Eventually she stopped crying and started chuckling with me.  It was one of those moments that we will probably laugh about for years to come.  (And if she chooses to “block it out,” you can bet that I will remind her!)

For me, this was yet another reminder that parenthood is often a dirty job.  We should all get to wear sashes covered with merit badges from each disgusting rite of passage.  Then we could compare and congratulate each other on a regular basis.  “Oh, you’ve got the ‘Cleaned Poop Out of the Bathtub’ badge too?  I’m hoping to get my ‘Vomit in the Car’ badge next!”  But alas, there are no badges.  Only blogs.  And thank God for those!  I don’t know what I’d do without a good sense of humor and the ability to share!

In my last blog post, I discussed the safety of our vaccine supply with regard to brain damage. The available reputable scientific studies demonstrate that our vaccines are not causing  brain damage, ADD, autism or learning disabilities. But what about other problems?

Each vaccine comes with a Vaccine Information Sheet. These sheets are
put out by the Centers for Disease Control and are updated as new information
becomes available. Your doctor is required to make these sheets available
to each patient receiving a vaccine. These sheets include the name
of the disease being vaccinated against, a description of the disease,
the possible complications of getting the disease and the expected side
effects of the vaccine. Most of my patients ignore these sheets. I wish
they wouldn’t. These sheets are chocked full of information, as well as
references for obtaining more information, including access to the scientific
studies regarding safety.

Most of our vaccines are not live. These vaccines can cause fevers, rashes,
fatigue, and muscle aches, what most people would call flu-like symptoms.
One or two of them have been known to cause quite high fevers. In particular,
the pertussis, or whooping cough, vaccine has a higher incidence of fevers.
Unfortunately, five percent of infants and toddlers will experience
a febrile (fever-related) seizure at some point in their lives. If they
get a high fever from the vaccine, that could be the trigger for a febrile
seizure.

These seizures are very frightening. The whole body shakes rhythmically and the infant or toddler is unresponsive for some period of time. Usually these seizures last only a couple of minutes, but they feel like they last forever. During these fevers, stay calm, comfort the child as much as possible, make a clear space around the child for safety and don't put a stick between teeth as has been recommended in the past.  If the seizure lasts a full five minutes, call EMS.  Studies have made it abundantly clear that simple febrile seizures do not cause lasting brain injury.

Some vaccines -- for measles, mumps and rubella and the chicken pox, in particular -- are “live” viruses. That means that there is some likelihood of getting a weaker form of the disease and even a very slight possibility of the disease’s complications. If a child gets a mild case of measles from the vaccine, for instance, they would develop a fever and rash a week or two after the vaccine is given. The number of children getting a measles rash with the vaccine is less than 1/100. The number of children getting encephalitis, the worst complication of measles other than death,
is 1 in a million or less.

Needless to say, vaccines are not without side effects. What is very clear,
however, is that these side effects are either less harmful than catching
the disease, or far less common than they would be if you caught the disease.

This has just been “one of those weeks.”  Nothing really bad has happened…yet I am ridden with “Mommy guilt” and the feeling that I’m just not doing a good job of keeping the “balance.” 

The scale has been tipping more toward my job lately.  While I love my job, being a “good employee” doesn’t give you quite the inner contentment as knowing that you’re a “good Mommy.”  Twice this week, I’ve arrived home after 7 p.m.  Scenario:  I walk through the door, throw down my bags, kick off my shoes…and immediately my daughter asks, “Mommy, will you come play with me?”  And of course I want to play with her!  But I also want to get out of my work clothes.  And snuggle with the baby.  And say hi to my husband.  And eat dinner.  Usually I just skip the dinner.  And husband-time can wait until the kids go to bed.  So then my dilemma is how do I cram “quality” time with BOTH of my kids into the hour and a half left before bedtime?  The baby doesn’t like crawling around in makeshift blanket “tents” and setting up tea parties…but that’s all Anna wants to do.  And anything that currently amuses Kellen is way too BORRRING for Anna. 

Typically, my husband and I trade shifts with each of the kids throughout the night.  So I spend 20 minutes playing grocery store, then 20 minutes blowing raspberries and making clicking noises with my tongue.  Twenty minutes giving Anna a bath, then twenty minutes giving Kellen a bottle.  And the whole time, I’m constantly thinking, “Is this enough?  Is the time I’m spending with my kids enough to let them know how much I love them?  Does Kellen even KNOW I’m his Mommy…or am I just ‘that lady’ who puts him to bed every night?” 

I wonder what our kids are able to process and remember at such a young age.  Am I being too hard on myself?  I remember thinking that having a Mommy on bed rest was going to cause permanent psychological scarring to Anna, since I couldn’t do anything “fun” with her for such a long time.  But now, just a few months later, it doesn’t seem like she even remembers that time at all.  Maybe she won’t remember that Mommy had some long days of work when she was small.  Maybe ALL she’ll think of are the times we played games and colored and read books…even if it was crammed into an hour and a half each night.

Maybe.  I just wish I knew for sure.

My recent interview on KSDK-TV news was far too brief to go into any detail regarding vaccines.  With the recent surge in news coverage on the safety of vaccines (and, yes, Kate, they do hurt some when given), I thought I’d expand a little on the topic. This will be a short series of blog entries that I hope will address questions you might have.

Vaccines really are one of medicine's most important contributions to public health. Second only to clean water, vaccines have saved an enormous number of lives. If they save lives, why are so many questions being raised?

The No. 1 reason is the accompanying rise in the number of our children with multiple forms of brain dysfunction. The rates of ADD/ADHD, learning disabilities and autism are on the rise. The rise appears to parallel the trend in mass vaccinations. If there is a link, several theories have been put forth to explain it.

The most well-known theory links these disabilities with MMR (measles, mumps, rubella) vaccine. Proposed by a physician in Great Britain and published in a British medical journal in the mid 1990s, this theory is based on finding antibodies to the vaccine type of measles in a number of his autistic patients. The physician claimed that was a link and there has been a great deal of misinformation ever since.

The scientific community responded by demonstrating in large-scale studies that this link could not possibly be true – the studies compared communities that had been vaccinated and those that had not. In both communities, the number of brain disorders was climbing at the same rate. The original author, in light of the weakness of his study and the strength of subsequent studies, retracted his article. Unfortunately, the damage has been done. Some people are refusing to be vaccinated in Europe and the rates of measles have jumped markedly there.

A second popular theory blames thiomerosol, a mercury-containing preservative, for causing the brain damage. The theory goes like this: Since mercury is neurotoxic, it must be the source of brain damage in our little ones. Studies in California, the first state to mandate mercury-free vaccine, have shown that the incidence of brain disorders continued to rise despite the mercury-free inoculation.

 The CDC and FDA monitor the safety of our vaccine supply. Vaccines that show some significant level of harm are taken out of circulation. The smallpox vaccine is not publicly available. The first vaccine for rotavirus was pulled from the market. Certain vaccines are only recommended for very high-risk patients. It is fairly clear that our current vaccine supply is as safe as is possible and is very life saving. I’ll write more about that in my next post.

Did I just hear someone shudder when you read that title?  Yes, last weekend we took the kids on our first road trip as a family.  We traveled to Chicago to celebrate Mommy’s 30^th birthday.  And no, it wasn’t that bad.

My husband and I are very idealistic (and apparently very brave) souls who love to travel and dream of doing “educational” activities like backpacking across Europe with our preschoolers in tow.  We had such a great time in London and Paris last year (by ourselves, mind you), that we were actually thinking of taking the kids to Ireland next fall.  It’s a good thing that we had a five-hour car ride in between to teach us that we are CRAZY!

Here are the lessons that we learned from this trip:

ð            The baby HATES his car seat.

ð            Cloth napkins, candles and three year olds do NOT mix at the dinner table.

ð            When you tell a preschooler to go “check out the fountain,” expect that she will check it out very closely, and will in fact come away soaked to the bone.  You’d better have an extra change of clothes on hand…or be prepared to walk a mile back to the hotel to get them! (We did the latter.)

ð            Even after three hours in the car, the baby will STILL hate his car seat, and will not “just accept” the fact that he is not getting out anytime soon.

ð            When a preschooler says she has to go to the bathroom at a major tourist attraction, you should look for the “fast lane” designated for small children…but there won’t be one.  And when you finally make it to the doorway of the bathroom, she will probably let loose with the most pee you have ever seen in your life, splashing the shoes of everyone around you.  You’d better have plenty of wet wipes and an extra pair of undies.  (Actually, this one was our cousin’s kid, not ours.  But it was still a lesson learned!)

Ahhhh…the memories.  But you know what?  Plenty of things went right too.  We got to introduce our kids to the wonder of skyscrapers, and fulfill Anna’s desire to visit a beach where she could “feel the warm sand between her toes.”  We saw dolphins and whales and Sue the Tyrannosaurus Rex.  We saw the night lights of the city from 150-feet up in a Ferris wheel and we got to watch fireworks while eating ice cream at Navy Pier.  All in all, I’d say that our first family road trip was a success.  (But we won’t be taking the kids to Europe anytime soon!)

Little Girl, Big City

These are skyscrapers, Baby Brother...

On the topic of “sniffles,” I just have to chime in and say that they have already arrived at my house.  It caught me a bit off guard. 

The other day, I woke up little Kellen from his much-loved sleep and was surprised to find his face covered in crust.  If you’ve ever been around a small child, I’m sure that you know what I’m talking about:  that delicious-looking crust that fills their nostrils and lines the corners of their eyes, almost sealing the eyelids shut.  Poor kid.  He did NOT enjoy me trying to get it all off!

Then, after I fed Kellen his morning bottle, I held out the towel to catch the normal round of spit up that typically follows his burps…and I looked down to find a giant loogie instead!  If you’re not familiar with the term “loogie,” I have taken the time to look it up for you on urbandictionary.com:  “A loogie is a large slimy glob of spit, mixed with nose snot, that is formed by coughing up and hocking what’s in your throat.”  Lovely.  Yes, that is exactly what my three month old offered up to me…with a look that said, “Mommy…what is going on here???”

As hard as it is on us parents, it must be even tougher on our little ones when they catch those yucky colds, and don’t really understand why it has suddenly become harder to breathe and eat.  Luckily, Kellen’s sniffles didn’t seem to turn into a full-blown cold this time around…but I will definitely try some of Dr. Barton’s tips for easing his discomfort the next time the loogies show up at our house!

The weather is starting to get cooler. Kids are in school. Day care has picked up for parents who had the summer free. This all means kids are closer together and are sharing more than their lunches. It’s cold season again.

Colds are caused by hundreds of viruses that all of us are in contact with on a regular basis. They cause fevers (usually of less than 102 degrees), stuffy and runny noses, coughing, sore throats and feelings that all is not well. Symptoms usually last 10 to 14 days whether you're an adult or child. Babies, with their very small air passages and intolerance for inconvenience, are struck particularly hard.

Unfortunately, no one has come up with the cure for the common cold. Antibiotics do not help. Recent studies have proven that over-the-counter cold medicines don’t help the cough or congestion or shorten the duration of illness. So really all we can do is try to make our kids feel better. Raise the head of the bed. Let little ones sleep in their car seats. Humidify the air in their bedrooms. Make sure they are drinking plenty of fluids (doesn’t matter if they drink formula or milk). Try nasal saline to relieve congestion. In children older than one year, there is some evidence that a spoonful of honey can help with coughing. In adults, there is a small amount of evidence that zinc lozenges taken frequently may shorten the duration of a cold.

The other thing to not lose sight of is that the average infant or toddler will “catch” 8 to 10 colds a year with most of those being in winter. That usually means that many toddlers are well only a few days before they catch the next cold.

Finally, the best treatment is prevention. The best ways to prevent the cold are to frequently wash your hands well and clean the toys your child sticks in their mouths or frequently shares with a friend.

It’s 7 a.m. on a Friday morning and my phone rings.  Now you have to understand, in my house, 95 percent of the phone calls are to my wife and the other 5 percent are to my kids. I never pick up the phone. But at 7 a.m., the most common call to my house is a partner letting me know that one of my patients is in the hospital and needs to be seen. So I pick up the phone.

“Hello?”
“Hello. May I speak to Mr. or Mrs. Barton?”
“This is Mr. Barton.”
“This is Mrs. So and So, your son’s Horizons teacher…”

Several thoughts go through my head very quickly.  The most pressing one is, what has my son done now. You see, my son has a history of having teachers and administrators call us at home, and usually not for the wonderful, caring, charming child that he is. He’s been in trouble for a wide variety of issues. Now I’m getting an early morning phone call, from the school, on the third day of school. Couldn’t he at least have waited until he’d been in school for a couple of weeks?

Why is it that, so often, when we think of our kids, the worst things come to mind? A phone call from a teacher or administrator brings the fear of misbehavior. A scream from the yard to “come quick” and we worry about broken bones (or windows).  I’ll walk into an exam room and a child is very upset and I think, “Oh no, not another screamer.” The neighbor calls and says, “I think we need to talk.” Our first thought is never, “I’m about to hear how great my child is doing.” Nor is it, “poor kid, I wonder how I can help him or her feel better.”

One thing I’m trying to do more in the office is to see the kids from their own point of view. I’m not so good at it. I’m 42 years old. Seeing things through the eyes of a screaming 15 month old is not so easy for me, but it can make a difference. It helps us to make decisions about how to respond to the behavior we see in our children. It also tempers how strongly we react.

By the way, the teacher was calling to say that our son needed to be moved up a couple of levels in math… much better than I was thinking. Next time you find yourself in a situation with a child and you start thinking the worst about your child, try turning it around and think the best that you can about your child. You might be very pleasantly surprised.

People keep asking me “How’s the baby?”  Up until the past few days, I have had absolutely no complaints. 

I keep telling everyone, “Kellen is such a good baby!  He smiles all the time, he rarely fusses and he sleeps all night!”  At that point, most people gasp and tell me how lucky I am.  Trust me…my first daughter was colicky and didn’t sleep on her own until she was a year and a half old…I know how blessed I am to have a baby like Kellen!  

However…after enjoying full, uninterrupted nights of sleep for the past seven weeks, my husband and I are scratching our heads over the fact that Kellen suddenly seems to be having newborn flashbacks and has woken up hungry for the past three nights.  Last night, I even made him wait a bit longer for that last bedtime bottle, and he scarfed a full eight ounces right before going to sleep.  I thought for sure he would sleep soundly all night long.  But nope…around 3 am…WAAAHHHH!

Now, I enjoy those “middle-of-the-night” snuggles for what they’re worth.  I never really mind getting up to feed Kellen when he’s hungry.  But…it does make it a bit harder to function as a “working woman” (or man) the next day when you’re bleary eyed and bumbling due to lack of sleep. 

My question is:  Is this something we should be concerned about?  Is it normal for babies to suddenly change their sleeping habits like this?  I keep thinking that Kellen may just be going through a growth spurt, and simply needs the extra nutrition.  On the other hand, I worry that if this goes on too long, we will be fostering a bad habit by getting him up for a middle-of-the-night feeding.  Does anyone have any advice to share?

I was trying to decide what to write about in my first post to this blog. Should it be medical or personal? Should I look at a disease or the ordinary day-to-day stuff? I was enjoying the Summer Olympics and thinking about Kate’s newborn and my older kids when it hit me. One of the biggest reasons that parents parent, teachers teach and pediatricians doctor kids: potential.

The funny thing about the potential of our kids is that we don’t often think about it.  In the day-to-day hustle and bustle of life, it gets forgotten. We rush from one activity to another because that’s what we have to do. Our kids are making us crazy fighting with each other, asking us questions, getting into some other kind of trouble and we forget.  Deadlines, ill parents, preparing meals, vacations, life in general keeps us from stopping and thinking about what our kids will be in the future.

Take a moment as you watch the Olympics or watch your own kids to think about their potential. Fifteen to 20 years from now, that sweet or wild child will be representing your country at the Olympics, designing the newest video game, working out diplomacy with another country, figuring out how to solve our energy crisis, or discovering the cure for the latest avian flu.

That child may also be comforting a friend in need, making sure the gaskets in your engine are lined up just right, designing home interiors, reporting the latest news for a local paper, or just running a household.

You see, one of the biggest reasons parents, teachers and pediatricians take their jobs seriously is because they realize that these children will be taking over our responsibilities as we get older. Take a moment today, the next time your child is completely exasperating you, to remember that you are raising the future.

My three-year-old daughter, Anna, has recently started dressing herself.  This was a process actually initiated completely on her own; I rather enjoyed picking out my little girl’s cute little outfits everyday.  It hadn’t even crossed my mind yet that she might want to start choosing her clothes for herself. 

Then one day I walked upstairs to help her to get ready to go somewhere, and she stopped me at her bedroom door.  “No, I need to help you get dressed,” I chided her, sure that she didn’t realize why I had followed her.  “No, mommy…I can do it by myself,” she informed me with uncanny confidence.  “I’m a big girl now.”  I stood there blinking as she gently shut me out of her bedroom.  From the other side, I heard the words she has so often heard from me.  “I need a little privacy, please.”

For me, it was one of those small but profound moments of parenting when I realized that the process of “letting your kids go” starts much earlier than I first thought.  It’s not something that you do cold turkey one day when your 18 year old heads off to college…it’s a process that lasts a lifetime.  With every new milestone…every school year completed…every parental “need” no longer needed…we let them go, one small step at a time.

Do I get some measure of satisfaction knowing that Anna thinks that a “good” outfit is being dressed in different shades of green from head to toe, and still needs a little help coordinating?  You bet!  I’ll help her every chance I get, knowing that even my fashion advice won’t be needed – or appreciated – for much longer. 

Maybe I’ll wait a few years before I teach her to tie her shoes…

        You have to be cute to pull off green socks with green crocs!

Several months ago, I never would have dreamed that I would feel comfortable taking my kids to someone’s home for daycare.  My daughter had gone to “regular” daycare centers since I returned to work when she was about one and a half.  I always liked her “schools” and the socialization and education they provided.  She has had some wonderful teachers!  Plus, after spending years as a TV news reporter and telling too many stories of child abuse, I really liked the “accountability” factor of the larger centers.  I think it’s much rarer for a crying baby to be shaken in a typical daycare setting than at someone’s home, where it can be easy for a caregiver to feel isolated and overwhelmed.

Keep in mind that as I write this, my two precious children are at their current daycare…in someone’s home!  And I’m not worried about them in the least.  In fact, I feel blessedly assured that they are receiving safe and loving care.  It’s so crazy how things just fall into place.  We had been planning to send Kellen to Anna’s daycare center, and even visited the infant room with him one day to meet his teachers.  There was nothing wrong with the place; yet, I wasn’t looking forward to taking him there.  I looked at the rows of cribs lining the wall and the tile floors, and everything just felt so cold and clinical.  I couldn’t picture him rolling around on the floor or taking a nap with the lights on.  Every time I thought about returning to work and having to drop my baby off, I would get a lump in my throat.

Then my sister-in-law started interviewing in-home childcare providers for her new baby, and showed up at our house one day to tell us that she had just interviewed our next-door neighbor.  We were stunned!  We had just moved to the neighborhood, so we didn’t know she was a childcare provider.  My husband and I went over to speak with our neighbor that night, and immediately decided to take both the kids there instead.  And what a blessing it has been!  We have found someone that we really trust, with similar values and religious beliefs, who is accountable not only because she’s full of integrity…but let’s face it…she can’t escape us!  We have peace of mind knowing that our kids are safe, and the kids get the comfort of a big home where they can roll around on the carpet, play with the puppy, eat lunch at the kitchen table…and get the individualized attention that comes with being two of only a handful of kids.  Plus…I can’t lie…it also saves us a lot of time and gas money not having to drive to and from daycare!  Now instead of spending an extra hour in the car everyday, we get to spend that time enjoying our kids.

I guess the bottom line is that you have to make the childcare choice that’s right for your family, at each phase of your lives.   The situation that fits your needs this year may not work out next year.  After three years of parenting, I’m getting pretty good at following that gut feeling that tells me when something is “right.”  And the peace of mind is priceless!

First of all, I’d just to say that I can’t believe how quickly this week has flown by!  Now that I am back at work, it seems there just aren’t enough hours in the day.  Each work day is over before I know it, and then the precious few hours I have with my kids before they go to bed are gone in an instant.

Those moments with the kids seem even more special to me and my husband now that there are two of them, and we get to watch them interact.  We were always hopeful that Anna would be a good big sister, and not be resentful of the new addition to our family…but she has exceeded even our wildest dreams with her sweet, nurturing personality.

She has taken “Baby Brother” under her wing, and seems to think of herself as his “other” mommy.  It amazes us that she is so gentle, and seems to know exactly how to touch him (without hurting him).  She assures us that “he likes to be petted.”  Our little three year old already knows the difference between Kellen’s “I need attention” cry and “I’m hungry” cry.  She is always ready to step in to help entertain him when needed.  And it’s so sweet how his face just lights up when she starts talking to him.   Every day I hear her tell him how much she loves him, and all the things she is going to teach him when he gets “big like her.”  I really feel like she must be the best big sister ever (although I know I am biased).

Puff Daddy and I feel very blessed indeed to see the friendship that is blossoming between our two children, and hope we can continue to nurture this camaraderie into the future.  Hooray for siblings!

Anna and Kellen in June

Anna "pets" her brother.

We love each other (at least for now)!

Kellen had his two-month old check-up with the pediatrician yesterday.  I absolutely love our doctor.  He does a great job of explaining where the kids should be developmentally and answering any questions or concerns that we have.  Kellen sat in my arms and listened attentively (comprehending all, I’m sure); cooperated for his measurements (he achieved the 80^th percentile for weight and height); and then pooped (to show the doctor that he’s good at that too).  The verdict:  we have a perfectly healthy little boy!  In fact, everything went smoothly until he had to get those first vaccines.  Four of them! 

That is such a hard thing to watch as a parent.   I know that the vaccines are good for him and could potentially save his life, so it’s not that I wish he didn’t have to get them.  I guess I just wish that I didn’t have to be there for it.  Just as I’m really starting to build a solid level of trust with this new little person, I have to stand by and “betray” him as some stranger jabs four pointy sticks into his chubby little thighs.  He looked right at me as his little eyes welled up with tears and he let out a gut-wrenching scream that might as well have been, “Mommy, how could you?”  I felt so terrible!

The nurse said that usually the babies stop crying as soon as it’s all over…but not Kellen.  Even after she left the room, he continued his pitiful little wail, with tears streaming down his face.  I don’t think it was his legs that were still hurting.  I think it was his feelings!  He did NOT want to be comforted…especially by me!  I eventually won him over with a bottle and he sniffled himself to sleep.  But even later in the evening, as I cuddled him and tried to redeem myself, I kept catching a look from time to time that read (in my guilty mind), “I can’t believe you did that to me.  I thought you were sworn to protect me!” 

Poor kid.  What a traumatizing experience…for both of us.

Ahhh…it’s my fourth day back at work, and in a sense it feels like I’m “home.”  I have really missed this place, and all the friendly faces that smile at me as I walk down the halls.  People keep doing a double take when they see me, which is usually followed by a boisterous “Welcome back!”  I guess they figured I had disappeared forever.  Six months is a long time to be out of the office!!  So many things have changed around here, except for the most important thing (to me):  I still really enjoy my job.

My big fear was that I wouldn’t enjoy working when I returned from maternity leave because I would be missing my kids too much…especially the little, needier one.  (I mean, how could my 9 week old possibly be expected to survive without his Mommy?)  Do I think about them both constantly and wonder what they’re doing?  Yes.  Do I have their pictures plastered all over my office and carry them around in my badge holder?  Of course.  But is it making me miserable to the point where I don’t like being here?  Nope.  I’m having fun getting back into the swing of things in the office…then once the clock strikes five, I rush to my “other” home and scoop my babies into my arms and enjoy them all night long. 

It’s strange how much they have grown in the past four days.  Plus, my 3 year old seems to have gotten even smarter and funnier, and Kellen has definitely gotten even cuddlier.  I guess it’s true what they say:  absence really does make the heart grow fonder…even when your heart was bursting with fondness to begin with!

I have learned one important new lesson since Kellen has been born:  when buying baby formula for a newborn, keep the receipt. 

We have been through four different types of formula in the past six weeks, and are now settling back on the one that we started with.  Since most small cans of powdered formula cost around $14, and the large cans cost around $25, you want to be able to return those suckers if you haven't opened them yet!  I can think of a lot of things I could do with an extra 25 bucks...like buy six gallons of gas.  But that's another blog entry...

So why all the formula-hopping, you ask?   Well...in the beginning, we started supplementing my breast milk with the traditional Brand A Lipil formula.  While Kellen would eagerly drink it, he was spitting up A LOT, and often seemed uncomfortable while eating.  He would gulp down the first ounce or so, then after that it was always..."Suck-suck-suck-WAAH!  Suck-suck-suck-grimace-grunt-WAAH!  Suck-suck..." and so on.  So then we decided to try Brand A's formula for fussy, gassy babies.  That didn't seem to help much.  Next, we called the doctor's office and they suggested that we try Brand B Lipil, to see if that brand worked any better for him.  Nope.  Then we moved on the most expensive formula on the face of the earth...Brand A Nutramagen.  It is for babies with colic symptoms due to a milk protein allergy.  We didn't know if Kellen HAD a milk protein allergy, but the doctor's office told us to try it for a few days to see if it made any difference.  The difference turned out to be that he vomited more in those three days then he had in the weeks prior, and was much fussier while eating (actually causing us to breathe a huge sigh of relief, since Nutramagen costs $25 a pop for the SMALL cans)!  Yet we were also pulling our hair out, wondering what in the world we were going to be able to feed our kid without causing him pain.  So we went back to the original Brand A Lipil and scheduled an actual doctor's office visit.

On Monday, Kellen had an Upper GI Scan done at SSM St. Joseph Hospital West, which determined that he does have acid reflux.  (For those who don't know, that's when acid from the stomach backs up into the esophagus...otherwise known as heartburn).  The poor kid probably gets that from his dad, who had horrible acid reflux as a baby and still takes prescription medication for the problem to this day.  So Kellen is now two days into a Prevacid prescription that seems to be helping him already, much to our relief.  He is still spitting up some, but is fussing much less while drinking...and actually seems to be drinking more than he had before.  I sure hope the agonizing formula dilemma has finally been solved!

Our little man has no idea how hard we work to make sure his world is as perfect as it can be.  And that's good.  We wouldn't have it any other way.

After four weeks out of the womb, my son just spent the first night asleep in his crib, in his own bedroom, all by himself. (Well, that is to say…the time he spent asleep was spent in his crib.) It was the first time that my husband and I have been able to sleep soundly, at the same time, in weeks. It was terrific...and terrifying.

There are so many things we have worried about since we brought Kellen home from the hospital, but the biggest thing has probably been what might happen to him while he's asleep. What if he cries and we don't hear him? What if he spits up and chokes on it? What if he stops breathing? Like all new parents, we have poked him plenty of times "just to make sure."

At first, we couldn't fathom the thought of laying him down in a different room. To be perfectly honest, we could hardly stand the thought of letting him out of our arms. During his first two weeks, Kellen spent plenty of nights (and naps) sleeping on the chest of whoever was taking the "sofa" shift. (Somehow, it seems like the most natural thing in the world to let your newborn fall asleep in your arms, even though you KNOW you're not supposed to do that). He spent the rest of the time sleeping in his Papasan swing, which cradles him perfectly and is very snug and secure. But...we knew neither of those sleeping spots would be a long-term solution, and both required us to take turns camping out in the family room at night, which doesn't make for very good rest.

So then we transitioned to putting Kellen to sleep in his bassinet, which is right next to our bed. We were pretty proud of ourselves for starting our boy on the path to being able to sleep lying down, and he actually did a really good job with it. We would lay him down while he was still awake, and he would typically fall asleep within five minutes. The only problem was that he is a VERY noisy sleeper. He grunts constantly. And whines. And whinnies. You feel like you're either sharing a room with a pony or a fighter jet. Ranhrrrrrrrrr....Eh-eh-eh-eh-eh-eh. Even though those noises don't mean anything is wrong, they constantly wake you up throughout the night. So even though my husband and I were technically getting to sleep "more," we both felt even less rested than when we'd each spent half the night in the family room. Perhaps you've noticed I didn't write at all last week? That's because anytime I had a free moment to do so during the day, I was dozing off instead.  I was exhausted!

The big scary move to the crib, therefore, had become a matter of necessity. My husband was the first to take the plunge. He turned on the nightlight and some baby jazz and laid Kellen between his wedges so he wouldn't roll. Then we passed out in the quiet of our bedroom. And you know what? The boy did great. He slept like a champ until he was hungry, and then he made himself heard. There was no way we could miss it. He didn't choke, and we're pretty sure he breathed all night.

I'm sure you're not surprised. After all, babies have been sleeping fine in their cribs for generations. I mean, we're all here, aren't we? Yet somehow it's still a big relief to know that our kid has joined the club of successful crib sleepers...even if it's only for two hours at a time.

I know that everyone in America is familiar with "maternity leave." That’s the wonderful policy that allows working women like me to take time off from their jobs to recover from childbirth and bond with their newborns. I am certainly enjoying my maternity leave, and couldn’t imagine being able to function without it.
But I think I’m enjoying my husband’s paternity leave even more!

That’s right…my husband works for a wonderful company that provides new fathers with six weeks of PAID paternity leave! Could anything be cooler than that? I had never heard of such a policy until I married him. But I’m telling you, it is the BEST!!

From the minute our son was born, we have been able to spend every minute of his precious young life getting to know him together. I don’t have to call my husband at work to tell him about the sweet new things his son is doing, because he is right here to share those moments with me. He is also here to share all the duties…diaper duty (we’re tied in the number of times we’ve been peed on), feeding duty and "the night shift."

Even though Kellen is a pretty good sleeper, he still has his days and nights mixed up a bit. When he wakes up to eat at night, he always seems to be saying, "What’s up, parents? I’m ready to party!" Since neither Daddy nor Mommy wants to be known as party poopers yet, we take turns entertaining our boy on the night shift. That way, we each get at least a half night of uninterrupted sleep. When you have an older child who wants to play all day long, I can’t imagine handling the nights any other way. Even with two parents sharing responsibilities, we’re both pretty much in a constant state of "tired." If my husband weren’t here to help me right now, I would be utterly exhausted!

So I would just like to say HOORAY for paternity leave! And kudos to every company that realizes how important it is for fathers to fully share in the first weeks of a new child’s life…and gives them not only the time, but the financial means to stay home with their families. What a blessing!

Yes, I meant to spell it "weight." That’s what I keep reminding myself, two weeks after the birth of my son. "My stomach isn’t going to feel like the Pillsbury Dough Boy forever. This extra weight will come off eventually."

Of course, I think the question for every postpartum woman soon becomes…how long will it take??

While it feels SO good to not be pregnant anymore, I still feel like I’m living in someone else’s body. It just doesn’t feel like "me" yet. Now, I know I can’t expect to get back into my regular jeans just two weeks after giving birth, but that didn’t keep me from trying them on with a wish and a prayer…and feeling really disappointed when they wouldn’t even rise past my thighs. I could hear my three-year-old daughter’s recent words echoing in my head. On Mother’s Day, of all days, she had most innocently informed me, "Mommy… Daddy is the BIG boss, and you’re the FAT boss." Of course, I was REALLY pregnant then, but it still hurt! No Mommy wants to be known as the "fat boss."

Unfortunately, I am not one of those women who only gains 20 pounds when they are pregnant. With Cocoa Puff (my daughter) I packed on 60 pounds, and this time I gained 50. I couldn’t tell you how much weight I have lost so far, because I honestly haven’t stepped on a scale yet. (I can tell by the jiggling that the number isn’t yet one I can deal with). So I imagine that I still have my work cut out for me.

As soon as I get the go-ahead from Dr. Young, I’m eager to start working out again. I love being active, and I haven’t been able to do that in a really long time. Plus, I’ve noticed that the frequent "milking" seems to be shrinking my tummy much faster than I remember from before. SO…I can say that I’m freaking out about the extra weight much LESS than I did the first time around. Like I said, it’s just "weight a while." Eventually, that first 60 pounds came off and my old body returned. And if it happened once, it can happen again. In the meantime, I’m just trying to focus on enjoying my beautiful children. Even if one of them keeps poking me in the belly and saying, "Smooshy." 

After two full days at home, we could not be more in love with our beautiful new son.  Despite his questionable behavior in the womb, he has turned out to be an absolute dream of a baby.  He eats well, he sleeps great and he is the best snuggler on the planet!  Here are some pictures of sweet little Kellen and his adoring family.

Mommy and Kellen

Kellen and Dr. Young

Our perfect little guy!

Seriously…if you’ve been following this blog, did you really think this pregnancy could have ended without a good story to tell?  Impossible!  Lucky for everyone…it’s a story that has a happy ending…and I can’t wait to share it with you!

In my last blog entry on Wednesday, I gave Special K an ultimatum.  I (kindly) let him know that he had to be out by that night, or he was going to be “evicted.”  In other words, since I was walking around with contractions at 4 cm dilated, Dr. Young had scheduled an induction for that evening.  Surprisingly, for once, my little rebel actually did what I wanted him to!  I started contracting seriously on Wednesday morning, and soon Puff Daddy (my husband) and I decided it would be best to head to the hospital earlier than planned.  We arrived around noon.

I was a bit more dilated when we arrived at the hospital, though not much.  In short order, I had been given a FANTASTIC epidural (thank you, Brad), and Dr. Young broke my water.  When I still wasn’t progressing super quickly, Dr. Young said I could have a little “nudge” of Pitocin at 5 pm.  At that point, I was 5 cm dilated.  An hour and a half later, after a lovely little nap, I was told that I was 10 cm dilated.  The room quickly filled with nurses and mothers and sisters.  It was suddenly…shockingly…time to push! 

That’s when things started to get a little dramatic.  I pushed for about 10 minutes.  Really, that’s not very much time to try to shove a watermelon through a keyhole.  But toward the end of the 10 minutes, I started to sense there was some urgency to the situation.  Even though I already felt like I was pushing twice as hard as I had when my daughter was born, I kept hearing words like “harder,” “more” and “right now!”  I couldn’t feel a thing, but it’s still exhausting work.  Just when I thought I wasn’t going to be able to keep up, Dr. Young put my hands on something wet and slimy, and I helped to pull our little son onto (and OUT OF) my belly! At 6:54 p.m. on May 14, Kellen David (Special K’s real name) entered the world!  Wow.  Seeing your child for the first time is one of those amazing “freeze frame” moments that you know time will never erase.  However, this moment was somewhat terrifying as well.

I quickly realized what Dr. Young already knew…that Kellen was blue and that his umbilical cord was not only wrapped around his neck, but looped back around his body as well.  In other words, he was completely tangled.  In addition, he had come out face up…which is NOT the right way to be born.  But he had plunged down the birth canal so quickly that there wasn’t time to turn him around.  So needless to say, he was having some issues.  After just seconds, Dr. Young whisked Kellen back off my belly and cut him out of the web he was caught in.  Then the baby nurses took over and I watched as they tried…and tried…and tried to get him to cry.  He started to turn pink, but that stubborn (and stunned) boy of ours was so frighteningly quiet.  I was really starting to get worried as I watched the nurses lift up his little arms, which he would then let fall limply back on the table.  It was SO unlike the kicking, screaming and flailing I remember from Cocoa Puff’s birth.

The nurses soon decided that Kellen needed to go back to the Special Care Nursery for more treatment.  I was able to give him a quick kiss on his way out, but didn’t get to have that initial “bonding” moment that you always plan for.  In fact, hours went by before I was able to see my son again.  It was such a surreal experience.  While I was calm, knowing that he was in good hands with the experts in the nursery, I did start to question whether or not I had REALLY just given birth.  It was weird to be just sitting in bed watching American Idol with a flat (relatively speaking) belly and no baby in sight. And boy, did I start to feel GUILTY for wishing him “out” so soon!

To skip to the end of this already long story, Kellen later made a FULL recovery!  Thank God. His lungs are functioning at full capacity, and all his other systems are perfect. His head is a bit bruised and misshapen from his rocky entrance, but that will soon go away.  He had to stay in the nursery until 3:30 on Thursday morning, but what a pleasant surprise when the nurse wheeled in our baby, ready to cuddle with his mom and dad.  I am sure that we are biased (as most new parents admit), but we just think he is adorable!  I will have to post some pictures soon!

There is so much more I want to say about little Kellen, but he’s just as dramatic when he wants to eat…so I’ll have to save it for another day.  I will say that my heart is just overwhelmed with joy right now, and I can honestly declare that EVERY single minute of suffering throughout that pregnancy…both physical and mental…was worth it.  I wouldn’t change a thing (except maybe my complaining).  I am so thankful that God doesn’t listen to whiny pregnant women who beg for their children to be born before they are ready.  With the issues Kellen did have, I’d hate to think what it would have been like if he had been born prior to 38 weeks.  I am also SO THANKFUL for my incredible doctor, Doug Young, who once again saved the day and rescued my son from his moment of distress.  We could not have asked for a better physician throughout this challenging pregnancy.  I am also grateful for the wonderful nurses who have taken such good care of me and Kellen at SSM St. Joseph Hospital West.
 
Thank you, thank you, thank you for all the thoughts and prayers!  They have been answered in our little 7 pound, 6 ounce bundle of joy.  Kate’s baby is here!  Hooray!

Kate's eviction notice has finally been received. Special K was born on Wednesday, May 14th. He weighed in at 7 lbs 6 oz. He did not require any outside influence as he must have listened to his mother. I think he did leave some of his hair in the shower because he is follicularly challenged/hair deficient. This is difficult to tell because of his blond locks. However, being the Drama King he is, Special K decided to make a somewhat eventful arrival out of his former residence. To those of you faithfully following this blog, this should not surprise you that special K has continued to be....well...SPECIAL! In all seriousness, such a wonderful child could not have been bestowed to two such genuinely nice people. I believe pictures may be forth coming......stay tuned.

Dr. Young

When you first discover that you are pregnant, you are SO excited to be sharing your body with a new little stranger.  “I can’t believe there is a LIFE inside of me,” most of us gush at some point.  “Of COURSE I will share my womb with you!” we tell our budding little embryos.  We can’t wait until our new cohabiters actually start to make their presence known (in ways other than making us vomit).  We want to SEE the baby growing and FEEL the little bumps under our skin…to know without a doubt that we are no longer “alone.”

Nine months later…it’s like being at the end of a very long college semester with the roommate who snores, leaves hair all over the shower and wakes up by listening to the same (obnoxious) CD every single morning.  You’re still friends, but you try to think of ways to politely tell her that you can’t stand the thought of living with her one more day.  You even research other housing options for her to make the transition more appealing.  It’s a tough conversation.  There aren’t enough Hallmark cards that say, “I love you, but you’re making me miserable.”  

Well, Special K…here’s the deal.  You have a great nursery with a comfy crib all set up and waiting for you.  You have a bassinet next to mommy and daddy’s bed.  You have a Moses basket that your big sister loved and a pack-n-play set up in the basement family room.   You also have two swings…including one of those cool new Papasan swings that sways from side to side (and I wish they made in my size).  I really don’t care which of these places you choose to make your favorite snoozing spot.  We can rotate you all day long if you’d like.  I just think it’s time to give up your favorite placenta pillow.  I want my body back.

As you know, I had been giving you the option of leaving at a time that was convenient for you.  I know moving can be pretty stressful.  However, things have recently changed.  If you are not out by tonight, my doctor has agreed to help me evict you.  I just want to give you fair warning.  I hope there are no hard feelings about this.  It’s been fun sharing, but I simply think it’s time you moved on to bigger and better digs.  I promise that you’ll love life “on the outside.”  We’ll both be so much more comfortable…you’ll see!  I’m looking forward to seeing you, son.  Now get out!

Hugs and kisses,   

Mommy

I didn’t write much last week.  A lot was going on, and I wasn’t really in the mood to share while I was still in the thick of it.

The week started off with a bang.  It’s Monday morning at 3 a.m. and the still of the night is broken by, “WAHHHHH!   Mommy, Daddy, I threw up all over me!”  Cocoa Puff could not have made a truer statement.  (She still doesn’t know to sit up when she feels sick in bed, so she erupts like a geyser.)  So we went in and got her all cleaned up, as good parents do…and then she threw up all over me.  Good times.  After another round of vomiting on Tuesday morning, my three year old and I spent that day at the doctor’s office and hospital (she had to get an X-ray due to a long history of tummy trouble).  I was rather relieved to find out that this time the problem seemed to be nothing more than a flu bug.

Then Wednesday came, Cocoa Puff seemed better, and I was finally able to get some work done.  Although now I wasn’t feeling quite “right,” and I was afraid to eat or drink much.  By mid-afternoon, I was really feeling nauseated…but I’d started having contractions too.  As in, lots of contractions.  And they were getting stronger and closer together with each passing hour.  I started to think, “Could this be it?  Could I actually be in labor?”  I remembered that some of my friends said that they got “sick” right before they had their babies.

I was afraid to get my hopes up, but when my husband got home and watched me writhing (and vomiting) for a few minutes, he decided that this had to be the “real deal.”  He called Dr. Young.  We drove to the hospital.  They hooked me up to the monitors.  I was still feeling sick.  My contractions were strong and less than two minutes apart.  Both of our families filled my hospital room, with eager anticipation hovering in the air.  And you know what happened next???

Nothing. 

It turned out that all the nausea was from Cocoa’s fortuitous flu bug.  Duh!  And all the contractions were from being dehydrated…which according to Dr. Young, can cause your body to act like it’s in labor without actually doing anything productive (i.e., changing your cervix).  I have never been more disappointed in my life. 

I had to spend the night in the hospital, hooked up to an IV, getting bag after bag of fluids and medication…knowing that I would not only be going home pregnant, but SICK and pregnant. Then I spent the next two days recovering on my couch, so weak and tired I could barely move.  I didn’t feel like myself again until Saturday.  So week 37 definitely goes in the books as one of the lowlights of this pregnancy.

The good news is that we’re now on to week 38.  So far, no one has thrown up.  That bodes well for us.

At 37 weeks and counting, I am now MORE pregnant than I was when I delivered my first child…which after 13 weeks on bed rest has come as quite a shock.  We prayed all along for a healthy full-term baby, and yet I had prepared myself for a bit of a preemie.  Now, judging from the ever-increasing amount of time it takes me to roll myself off the couch, I don’t think this baby is going to be so small after all.  Gulp!

Can I just say that this “waiting for labor” business STINKS?!  I don’t like it at all.  I have no control over when this happens.  It makes me feel so helpless and unorganized.

Last week, when we went in for the cerclage removal and were so sure we were coming home with a baby, I was VERY prepared.  Maybe not mentally…but at least my house was clean, my bag