Cell Phone Use in the Doctor's Office

When a mom's cell phone rings in the middle of an office visit with me, she's usually apologetic.   But I tell her to answer it, especially if she's got other kids.  Don't feel bad, I say, the school might be trying to get in touch with you, or maybe your husband is.  I understand; I've had to answer a call in the middle of a visit to my doctor before.  But yesterday, I had one mom whose behavior really amazed me.  I walked into the exam room, and she was deep in the middle of a conversation.  I eventually gathered that her call was not of a very urgent nature, because I got to hear the next five minutes of it.  She smiled at me, as I talked to her five-year old for the duration of the call, but she made no attempt to get off the line until she finished chatting.  I like her, and maybe she feels so comfortable with me that she didn't feel like she needed to get off her phone.  Maybe she felt it was a good opportunity for me to converse with her child.  But ultimately, I think such behavior was just rude.  I would never have dreamed of continuing a call with my doctor or dentist waiting for me, and I hope that most people out there will continue show some respect when it comes to cell phone use.

Let The Baby Cry, or To Ferberize or Not to Ferberize?

Friends of mind have a nine-month old baby who isn't sleeping well.  For the sake of anonymity, I'm going to call them Rich and Grace.  They are first-time parents, and like all new parents, their world has revolved around their little girl from the minute she was born.  She's been rocked to sleep every night and for every nap, and now she can't go to sleep without being held by mom or dad.  She wakes every three hours or so and protests loudly when she discovers that she's in her crib and no longer in those warm arms of her parents.  To get her back to sleep, they give her a bottle of warm formula; then she's rocked in a parent's arms again before they gingerly put her back into her crib.

Rich and Grace are exhausted.  They remind me of my sleepless nights with my first child.  At Sophia's nine-month well-visit, my partner, Dr. Katz, asked me how she was sleeping.  I admitted that I was still up every few hours and confessed that I couldn't ignore her cries at night.  He looked at me quizzically, and said, "Come on, you know what you have to do.  Put her down when she's still awake, so that she gets used to soothing herself to sleep, and don't rush to her room when she cries in the middle of the night.  And God forbid that you feed her every time she wakes up!"  I knew he was right, although that didn't stop me from feeling affronted when I read what he wrote in Sophia's chart under the "Sleep" column: "Still wakes at night; Mother can't ignore." 

But I have to admit Dr. Katz had a point.  We finally approached sleep the way the famous Dr. Ferber championed.  By ignoring Sophia's cries in the middle of the night, we trained her to sleep.  It took hardening my heart and shutting my ears to ignore her pitiful cries, and I spent some nights with my pillow over my head when I heard her crying for me.  But the torture paid off, and she learned to sleep well.  For Rich and Grace, I would tell them to place the baby in her crib when she's awake so that she learns to put herself to sleep.  For the first week, they can allow themselves to pick her up when she cries in the middle of the night.  But by no means should they continue feeding her through the night.  And after that first week, they shouldn't even go into the room.  Some pediatricians would advise going into the room every ten minutes of so just to pat the baby on the back, but I always found that showing up in Sophia's room without actually picking her up made her cry even harder.

The crying is so hard to hear, but it really doesn't do the baby any harm.  And when it does stop and the baby learns to sleep through the night, it's a blessing for everyone involved.  Imagine how good it feels to sleep through the night, I always tell parents.  Well, a baby reaps the benefits of a solid night's sleep as well.  I hope Rich, Grace and their little girl get some good sleep soon.

Ear Infections

I was on call last night, and I spoke to a grandmother of a nine year-old who had fever and ear pain.  Her low-grade fever had just begun; the grandmother wanted to know how much Motrin to give.  I discussed the dose and told grandma to give the child lots of fluids, but I also told her that the child would have to be examined before any antibiotics were prescribed.  The grandma understood, which was a relief to me, because at the first twinge of ear pain, some parents think that their child needs an antibiotic immediately. 

On examinatin, thick, cloudy fluid behind the ear drum or a red, bulging drum suggests middle ear infection, or otitis media.  Clearish fluid behind a slightly red ear drum is more suggestive of a concurrent upper respiratory tract infection, most often caused by a virus.  When a child has an examination consistent with a viral etiology, I tell the parent that an antibiotic is not the answer, that watchful waiting is prudent.  Sometimes, depending on the exam, I do give a "safety-net antibiotic prescription," explaining that many ear infections clear on their own, but if the child's symptoms were to worsen, the parent should then fill the antibiotic.  Antibiotics are overused.  Waiting 24 -48 hours to see how a child's symptoms evolve can prevent unnecesary medicine use and halt the development of further resistance to antibiotics.  I've found that just having a prescription reassures the parents, especially since they won't have to bring the child back to the office if the pain worsens.  But in most cases when I give the "safety-net" prescription, I am happy to report that the child doesn't eventually need the medicine.