Too Much TV?

The American Academy of Pediatrics recommends limiting a child's television viewing to one to two hours per day.  By ten o'clock this morning, my kids already had their day's fill.  I remember one of my mentors during residency telling a mom that the TV should never function as a babysitter.  He was an older pediatrician, and now that I use the TV so readily when I need a moment to empty the dishwasher or clean up the kitchen after breakfast, I wonder about his words.  Did he ever have to care for his kids by himself?  Maybe his wife dealt with all the child care in his house.  Perhaps he was never left alone with two young children when the hours stretched ahead endlessly.  There are only so many coloring and art projects that I can do.  I also hate to admit it, but I am not the best "player" in the world.  Sometimes I just don't relish getting on the ground to push trucks around and around nor do I love spending hours rearranging furniture in a doll's house.

I am determined, though, not to feel guilty.  There are so many things that make moms feel guilty these days, but I don't think letting my kids watch TV should be one of them.  I know I try.  I spend as much time with my children as a I can, and they know I love them to bits.  If I need the TV to give myself a break every now and then, so be it.  As a pediatrician, I tell moms what the AAP recommendation is for limiting screen time, but I also let them know that for the sake of a mother's sanity, it is only a guideline.

Faking Illness

I saw a little girl in the office today who had been complaining of ear pain at home. Her exam, though, was perfectly normal, and the mom sighed when I told her so.  I thought so, she said; my daughter has learned to say her ear hurts when she doesn't want me to go to work.  Then I have to take time off, she continued, and now I'm just going to reinforce her behavior because it's lunchtime, and she'll love going out to lunch with me.  Take it as a compliment, I told her; she just loves being with you. 

When Sophia complained of a sore throat a few weeks back, I thought she was faking it too.  She started whining about not going to camp, and I sent her to her room to simmer down.  Imagine my guilt when I finally looked into her throat.  Turns out it didn't look normal after all, and Sophia ended up staying at home for a few days.  Sometimes it is so hard to distinguish whether a child really is sick or whether there are ulterior motives involved.  I'm still feeling bad that I didn't believe her.  With this guilt weighing upon me, I've resolved to follow the example of the mother I saw today, even if it did mean an unnecessary trip to our office for her.  But that mother listened to her child, and I hope I'll remember that the next time Sophia tells me something hurts.

It's Flu Shot Time Again

Get your flu shots now!  Flu shots here!  I feel we should post a sign in our office window proclaiming the start of flu shot season.  Most parents don't realize that administration of flu shots can begin in late August when the first shipments come into doctors' offices.  We've already started to give out the intranasal vaccines and are anticipating the arrival of the injectable vaccines any day.  The good news is that the H1N1 strain is included in this year's seasonal vaccine.  That means we won't have to give everyone two types of flu shots like we did last year.

When parents ask me what I think of the flu vaccine, I always tell them that my kids are regulary vaccinated every season, as soon as we get the shots into our office.  Not only is a flu shot safe for most kids (a few kids can't receive it if they have an egg allergy), it can prevent a great deal of morbidity and even mortality.  So call your doctor's office, beat the rush, and get your children vaccinated now.

Activities, Activities, Activities

September is rolling around again, and I've just received an email about potential cooking and art classes for Sophia.  Both Soph and Max are already signed up for soccer on Saturday mornings, and I'm wondering whether Sophia should continue her tennis lessons.  A friend just asked if Max would like to play T-ball with her son.  Another friend is enrolling her son in karate and wondered if Max would do that with him.   Now I just have to figure out when, what, where, and how.

Parents frequently come to our office, frazzled, trying to squeeze in a doctor's appointment between dance or swimming or gymnastics.  I always swore I wouldn't be one of those parents who overschedules her kids.  During well-child visits, I sometimes ask if the child has some time to relax if I get the feeling it's always go, go, go for the poor kid.  Everyone, at every age, needs some down time to themselves.  Truth be told, though, I now know why a mom might plan a slew of activities.  Quite honestly, the thought of entertaining the kids myself during those long empty hours after school is a little daunting.  I think I'm just going to suppress my twinges of guilt by telling myself how much these activites will enrich my kids' lives.

The Gender Divide in Parenting

If a mom can't make it into our office for an appointment, very often her husband will come with a list of his wife's concerns.  He'll hand me the notes to read, to make sure he's not forgotten anything he was supposed to ask.  In a similar vein, when I call a mom back about a sick kid and if the dad answers the phone, many times he'll say, "Oh, just hang on a moment, I'll get my wife on the line."  And while I wait, I'll wonder why he can't describe his child's symptoms to me.  The old feminist in me used to get irritated with such interactions, but being a wife and mom has mellowed me.  Dads are just more relaxed when it comes to their kids.  It doesn't mean that a father loves his child any less than a mother does, but moms do worry more.  Gross generalization?  Perhaps.  But motherhood and my experiences in pediatrics have convinced me of this.  If I were to send my husband with Sophia on a visit to her eye doctor or her allergist, I think I would make a list myself, to make sure he got all my questions answered.  Rob's a physician too, but when it comes to my babies, I want and need to be fully involved, with all my concerns addressed.

A Third Child?

Sometimes I think I want a third child.  Both my husband and I come from families of five, and five strikes me as a really cozy family unit.  But this week I had an epiphany.  While Max was busy at camp on Monday, Sophia and I ran errands, went out to lunch, and had a great time.  But when I'm out with both of them, my stress level invariably rises, with the inevitable fighting on their end, the refereeing on my part, and just having to keep an eye on two kids at a time.  Should I really add a third child to the mix?  When a mom comes to my office with three kids in tow, she almost always looks stressed.  I silently commend her bravery in venturing out with three young ones, but I'm guessing that in most of these situations, she has no choice, with no available sitter who can help.  It takes a calm woman to keep her cool when she's out and about with three youngsters, and I am not one of these women.

I felt like a good mom when I shared some alone time with Sophia as we talked and laughed on our day out together.  I'm afraid there would be fewer moments like that if I were to be stretched too thin if we had a third.  I guess I should just call it a day, recognize my limitations as a parent, and try and do the best for the two kids I already have.

A Message Marked "Personal"

The office staff left a message on my desk today with a note to call Mrs. N. back about a "personal" matter.  Messages marked "personal" never bode well; the parent usually wants to talk about a problem at school, an impending divorce, or worst of all, a recent death in the family.  I called Mrs. N back with some trepidation, bracing myself for some bad news, but it was a wonderful surprise when I heard her voice, brimming with laughter, saying, "I brought something back from Indonesia for you!"  She had remembered our conversation from months ago, about how much we both loved pempek, Indonesian fish patties.  I had told her how my grandma used to make them, and I couldn't have been more touched that Mrs. N had taken the trouble to bring some back for me from halfway around the world.  She showed up later in the day with an enormous bag of food; along with the pempek, she also brought some specialty fish crackers from Jakarta and a homemade sauce of hers to eat the pempek with. 

Somedays I leave the office frustrated or anxious, with challenging cases or difficult parents on my mind.  But today, today was an especially good day, thanks to Mrs. N.  It is gratifying to know that true generosity and kindness really does exist.  Plus, I fried up a batch of that pempek tonight, and it was delicious.

A Weekend In The Hospital

This past weekend I had a patient admitted to the hospital with a cellulitis of his knee.  He needed IV antibiotics for this infection of skin and soft tissue.  A perfectly healthy 2 year old, he had presumably sustained a bug bite a few days prior, and the area around the bite got swollen, hot and tender.  Cellulitis is a run-of-the-mill diagnosis on the general pediatrics ward; it usually takes just a few days of IV antibiotics before the child is able to go home again.  But meeting with the mother at her son's bedside on Saturday and Sunday morning reminded me of how difficult it is for a parent to see her child, small and vulnerable in a hospital bed, hooked up to an IV pole.  I understood exactly what this mother was going through as Max was hospitalized with cellulitis of his arm over New Year's 2008.  That experience of being the parent rather than the physician was an eye-opening one.  I learned first-hand what patience and fortitude it takes to pass long hours in the hospital, praying for antibiotics to work their magic.  And most of all, I gained a true appreciation of the anxiety a parent suffers when her child is sick enough to be admitted to the hospital.  I hope my experience with Max has made me a more empathetic physician.

A Dinner Fight

Ah, the food battles in my house.  Last night Max refused his dinner of a delicious beef stew and pasta.  It took a threat of throwing out his newest DVD and the bribe of ginger ale to successfully get him to eat about eight bites.  I hate threatening him, especially when he cried so pitifully at the thought of his DVD going into the garbage.  But mealtimes can be frustrating, and I find myself losing my temper easily when I see plates of food going untouched by the kids.  I remember reading somewhere that a parent should consider herself lucky if her young child eats one good meal a day, and I know that I really have nothing to worry about as both my kids are growing beautifully.  For the parents who complain to me that their kids don't eat the way they want them to, in most instances I can reassure them by showing them their children's normal growth charts.  It's just a phase, I say; the picky eater you have now will probably become the sushi eater when he's eighteen or the lover of Indian vegetarian cuisine when she's a college student.  Kids' taste buds and palate preferences do mature and change as they grow up.  But as a mom, it's so difficult to lay out a meal and have both children spurn it.  I'm going to strive to be more patient at mealtimes.

Learning To Follow My Own Advice

A mom called last night, frantic and weeping.  Her seven-month old daughter had rolled off the bed.  The child hadn't lost consciousness or vomited after the accident and now seemed fine.  But this poor mother was the one crying even though her baby had calmed down.  I reassured her as best I could, telling her to call me back if the baby developed lethargy or vomiting.  I tried to make her feel better by telling her how Sophia had rolled off our bed at about the same age.  But it's so much easier to tell someone else to calm down; I remember how upset I was when Sophia had fallen.  The worst part about Sophia's accident was that it had been my fault and only my fault.  My husband had been in another room, and I had turned my back for one second after placing Sophia in the middle of the bed.  The guilt that consumed me was only magnified by the fact that I always warn parents never to leave their babies unattended on beds or changing tables or any high surface.  I did not like learning the hard way to practice what I preach.

Newborn Nursery Rounds

I went to the hospital this morning to see a newborn.  The well-baby nursery must surely be the happiest place in the hospital.  The vigorous cries of the babies, the new moms strolling the halls, the flowers and balloons on the ward all contribute to a joyful energy.  There is such promise in the air, of happy homecomings and the anticipation of all that lies ahead for these infants.  I sometimes think back to those first babies I cared for as a pediatric intern.  To think that I had the privilege of examining their tiny bodies before they left the hospital to begin the rest of their lives.  They're teenagers now; what has become of them?  Hopefully they have brought their parents much love and joy.  Back then, during my first year of training, a new mom laughingly told me, "I want you to tell me he's going to grow up and get into a great college and find a beautiful wife and just be happy!"  I hope she'll get her wish.

A Battle With Lymphoma

It's August now, and a special patient of mine will be starting college this month.  This past spring she showed up in my office complaining of fatigue and a lump in her neck.  For the first time in my career, my hands started to shake after I examined a patient.  Not only did she have a large lymph node above her shoulder blade, I also felt multiple, enlarged lymph nodes scattered all throughout her neck region.  I had to compose myself as her mother asked what I was thinking.  I told that the very best diagnosis we could hope for would be mononucleosis; at worst, I was thinking about lymphoma.  I choked on that dreaded word, and the mother's face registered shock as I sent them off to the ER to be evaluated by the oncology team.  By the next day, her diagnosis of Hodgkin's lymphoma was confirmed.  By the next week, she had already begun the first of three rounds of chemotherapy.  What I'll always remember about this young lady was the smile on her face when she welcomed me to her bedside.  While her parents told me they felt like they were living in a nightmare, this girl kept her spirits up.  Her bravery, and perhaps the resilience of youth, helped her through her chemo regimen.  Her prognosis is excellent as her cancer responded well to her therapy.  Now she's off, onwards and upwards, ready to start her freshman year of college.