Sexual abuse

Recent news about a well known person repeatedly sexually abusing children over many years has many parents angry, confused, and simply aghast.

Many of us feel like we do all we can to protect our kids and our kids aren't at risk, yet statistics show that any child could be a victim.  Studies reveal that about 20% of women and 10% of men experienced sexual abuse as children.  Sexual abuse crosses all socioeconomic groups, all racial groups, all ethnicities, and all neighborhoods.  Often the perpetrators are the least suspected: a family member, a coach, a neighbor.

Signs of abuse in kids can be subtle.  They are often attributed to something else.

If kids do try to talk about feeling scared or not safe with someone: LISTEN.  They don't make this stuff up!

I appreciate the organizations that require background checks on all adults around kids.  I have had my background checked on many occasions:  job related, coaching my daughter's cheerleading squad, volunteering at my children's school, and volunteering at a local children's theater.  I was never offended by these requests and always supported these checks, but some parents grumble.  I suspect they just don't understand.  Many schools, sports organizations, and scouting organizations require teachers and volunteers to have routine background checks.   Does yours?

Do you ask if the adults supervising your children have had background checks?

Most do not.  

I am not even sure how I feel about this.  I suspect it gives a false sense of security, knowing that many abusers have many victims before being caught. They would have normal background checks.  They are often personable, friendly, someone who grooms victims and their families to gain trust. 

If background checks aren't full proof protection, what should a parent do?  I believe that the best protection about abuse is to show love to your children, educate yourself and them about abuse, and frequently talk with them.

Knowledge is Power!  

• Teaching kids about proper boundaries is important.  Let them know that their swim suit area is private, and no one should be able to look or touch there without permission from mom or dad.  
• Young children should learn their full address, phone number, first and last name (and first/last names of parents).  
• Remind kids that there are no secrets between kids and their parents.  They can tell you anything.  They can keep your birthday gift a surprise though!  Secrets that scare them are especially important to tell!  They will NEVER get in trouble for telling about a scary secret.
• Know your children's friends, their friend's parents, teachers, coaches, piano teachers, etc.  Offer to help as much as possible at school and activities. 
• Be sure there are no secluded areas in the places your child goes.  Kids should always remain in a group with adults.  A minimum of two adults is safest.  
• For your protection, if you must take other kids to a public restroom, stand in the main door with it open and let the kids go into stalls alone.
• Teach kids that adults will never need help from kids to find a missing puppy.  Adults can ask other adults, not kids, for directions if lost.  Give examples and role play. 
• Caution kids when they wear shirts with their name clearly posted on the outside that strangers will "know" their name.  Stay especially close when your kids have their name displayed.  It is easier for a stranger to trick them:  "Johnny, your mom told me to come get you.  She is hurt. Come with me."  What kid wouldn't question that???
• Question about new toys or gifts.  Kids might earn token gifts from coaches or teachers as a reward system, but if your child is getting bigger, more expensive gifts, that is a cause for alarm.
• If kids are lost, have them find another child to ask for help.  Usually the other child has a safe adult with them that can help. (Plus kids are less intimidated talking to other kids when they are already scared and lost.) 
• Parents of today need to learn about protecting kids on line.  Bullying now does not stop in the safety of one's home.  On line threats, photos, and comments follow kids everywhere and are very dangerous.  Keep computers in public areas, monitor cell phone use, teach kids to never give identifying information on line, and use a computer monitoring system.
• Abusers often target kids who are feeling unloved.  They groom those kids (and their families) by befriending them, making them feel special, and giving them gifts.  The kids start to deeply care for that person, and then the confusion of feelings does not allow the child to easily tell on the person.   Show your kids love in many ways: time spent one on one talking and playing (not watching tv), show interest in your children's activities, give good touches (ruffling hair, pat on the back, hugs), and build your child's self confidence.  

Building confidence in kids is tricky.  Be careful in how you word things... it is always okay to say "I enjoyed watching your game," whether your child was the star player or had a horrible game.  You can say something about how proud you are of the effort they put into something even if the outcome wasn't good.  Try to avoid saying "better next time," since that means they didn't do well this time.  Praise frequently and honestly from the heart.

• Create a safe environment at home. If kids witness fighting among parents, or parents don't treat others with respect, the children will learn that this is acceptable behavior.  They have a strong potential to get seriously injured at home or to enter abusive relationships as adults.  Seek help if your home is not safe!  Use a public computer if yours might be monitored and click here or call 1.800.422.4453 (1.800.4.A.Child) from a safe phone.
• Learn more about protecting against abuse and what to do if you suspect it.  There are on line resources, such as TheSafeSide or PreventChildAbuse, and locally The Sunflower House to learn about abuse.  GetNetWise and NetSmartz411 have information about keeping kids safe on line.

Chores for kids become chores for parents?

As a parent I see the great value of chores for kids.

• Anyone can learn the satisfication of completing a task, improving self confidence.  
• Young children can improve self care competence such as with bathing and dental hygiene. 
• Older kids can learn money appreciation and management if they are paid and expected to save some and share some of their well-earned money.  Learning to save for a large ticket-item and not spend frivolously is a great life lesson many adults missed.
• Older kids can establish a great attitude about work and learn real-world skills such as laundry, cooking, and cleaning.  
• Kids might even gain self esteem by the positive intrinsic reward of a job well done.  
• They learn responsibility.

The downside?

Chores for the kids often make work on the parents harder.  (Who said parenting is easy?)

Parents must decide what tasks are able to be done by children at various stages of maturity.  There are on-line resources available to help guide parents.  This is one place I disagree with the WebMD list because they say a 10 year old can mow the lawn--not recommended by the AAP until 12 years!

Some good lists: Workingmom.com, Focus on the Family, Chores-Help-Kids

Parents must make sure the chores are completed or set a means of monitoring what is done. Ideally chores would be accomplished without fighting and whining, but how?  Verbal praise and acknowledgment is always a winner.  If parents choose to reward chores with stickers, gifts, or money, there must be a way to track when a task is complete.

Consistency is key in any form of discipline, and this includes the tracking of chores.  The biggest reason chores fail in my house is we (the parents) forget to check the lists to be sure the kids did them.  Having a consequence for not doing the expected chores versus getting a reward for doing the list... behavior experts disagree on these points.

Many behavior experts recommend to not remind kids to do chores.  They feel that the negative consequences of not doing the chores will teach the lesson better than the constant nagging to do the chores.  I have found that without reminders the chores are simply not done, but this does not mean I must always directly remind.  Praising the initiation ("I'm glad you are getting your homework done early tonight!"  "I see you remembered to sort your laundry, that's the hardest part!") is often an effective way to get kids to complete the task.  There is a fine line between nagging the kids to do the expected things and letting the chores slip by without being completed.

Over the years we have had many means of keeping track of chores in my family.

• When the kids were young, we first tried a dry erase board, but that got erased too easily.
• We then found a simple paper chart each week that had lists that could earn stickers. I liked the format because it separated tasks into the general categories below, but we often forgot to mark things off at the end of a busy day, so there was little reinforcement for the kids to do the chores.  The categories of chores:

• Self: included things such as brush teeth, bathe, get dressed 
• Home: included things such as pick up toys in living room
• Room: included things such as pick up room, make bed
• School: included things such as help a friend, homework, pack backpack

• One of my favorites was a system called 10-20-30Go! that friends developed.  It was wonderful because it is based on the kids taking full responsibility for marking down what they did. It is simple and includes a strong family and faith base.  It was one of the longest running systems that worked for us, but as all systems, it also faded in follow through.   A big reason was that we often had activities that interfered with the family meeting night, no matter what night of the week we tried to do it.  (Family meeting nights are still a great thing, but difficult in a busy house!)  We also found that the kids didn't look forward to their allowance, so it was little reinforcement to do the tasks.  They might have been too young at the time.
• Another favorite system of mine due to ease of use, cost (free), and kid -centered responsibility is MyJobChart.  It works well for kids who can use the internet fairly independently.  My kids can log in to their account and mark the chores as they do them, or once a day.  They earn points, which they can choose to share (with pre-determined charities), spend (on items I help pick), or save (for the future!)  I like many features of this system, but it still has periods that my kids forget about it for weeks, then periods that we all remember again.  They still do their chores (or they have no clean clothes the following week... or whatever natural consequence follows the forgotten chore) but they don't always mark them down for credit.

What do you find helps to keep your kids up to date on their chore list?

New SIDS Prevention Guidelines

As pediatricians we practice a lot of preventative medicine.  Our patients are generally young and healthy... and we want them to stay that way!  One way we do this is to discuss safety at well visits.  We try to share safety tips on our facebook page, website, and here.

A big safety issue is the sleep position of babies.  Most parents by now have heard that it is safer to put babies to sleep on their back, not belly.  Occasionally we hear of young babies sleeping on their stomachs because parents have realized they sleep longer that way, and they do.  But this is dangerous. Babies don't wake up as much when on their stomach, this is true.  Some babies simply don't wake up.  Please put your babies on their back to sleep!

Parents often want to sleep with their babies because it also is associated with longer sleep time for the baby and more convenience for the parent (especially the breastfeeding mother).  Despite ease and convenience, this is not a safe sleeping arrangement for babies. Arguments that this is safe because world wide many families share beds is not often a valid argument. Americans tend to sleep on a bed with a headboard and bedding.  Babies can get their head stuck between the mattress and headboard (or wall).  They can suffocate from the bedding.  Parents can roll over in their sleep and smother the baby.  There are simply safer options for all to sleep better.

Recently the American Academy of Pediatrics (AAP) released new Sudden Infant Death Syndrome (SIDS) prevention guidelines.  AAP SIDS prevention Guidelines that are based on strong evidence:

• Back to sleep every time.
• Use a firm sleep surface covered with a fitted sheet.
• Room share without bed share (put the baby in a crib or bassinet near the parent bed).
• Keep soft objects and loose bedding out of the crib.
• Pregnant women should receive routine prenatal care.
• Avoid smoke exposure during pregnancy and after birth.
• Breastfeed.
• Consider a pacifier at nap and bed times, but do not attach it to the infant or infant's clothing or stuffed toys.
• Avoid overheating.
• Do not use home cardiorespiratory monitors as a strategy to reduce SIDS.

Other recommendations based on limited evidence:

• Immunize in accordance with the AAP and CDC guidelines.
• Avoid commercial devices marketed to reduce the risk of SIDS (postitioners, co-sleepers, wedges).
• Supervised, awake tummy time is recommended to help development and reduce the risk of  positional plagiocephaly (a misshapen head from laying on one side routinely).

Other issues addressed:

• Co-sleepers are not recommended.
• Absolutely no bed sharing the first 3 months.
• No bed sharing at any age if a person in the bed is a smoker.
• No bed sharing with anyone who is excessively tired.
• No bed sharing with someone who is using medications that increases drowsiness or impairs alertness (pain medicications, alcohol, illicit drugs, certain antidepressants).
• No bed sharing with anyone who isn't a parent. This includes no bed sharing with siblings or other children.
• No bed sharing with multiple persons.
• No bed sharing on a soft surface (waterbed, old mattress, sofa, armchair)
• No bed sharing on a surface with soft bedding, including pillows, heavy blankets, quilts, comforters.
• Because of the high correlation with SIDS and suffocation on couches and armchairs, infants should not be fed on these when the parent is extremely tired and at risk of falling asleep.
• When choosing a crib, be sure it has not been recalled and all the parts are put together properly.
• Use only mattresses designed for infants.  Do not add any comforters, quilts, pillows, or other soft bedding to the sleep area.
• Bumper pads are not recommended.
• Infants should wear clothing that will keep them warm (not excessively hot) and that will not cover the head/face.
• Keep dangling cords or window coverings away from the sleep area.
• If infant slings are used, it is important to keep the infant's head up and above the fabric so the face is visible (unless currently breastfeeding).  
• Infants should not routinely sleep in car seats or other sitting devices (strollers, carriers, or backpacks/slings).

NOT safe!!!!!!
Picture actually taken to show the person who gave the comforter and bumper pad set, then it was put away. 

Keep your baby safe by placing her in a safe place at all times.  It only takes one accident to have life-ending consequences.  To say that you've always slept with your babies and they are fine, so it's not a problem for babies to sleep with their parents is like saying you never wear a seatbelt and haven't had any problems.  Just wait until that first crash...

Complimentary and Alternative Medicine

Complimentary and Alternative Medicine (CAM) means many things to many people, but the truth is  that many people use it to try to help a broad range of ailments without much guidance from their physicians.

Why?  Reasons vary.  Some feel that "natural is better."  Others feel that mainstream medicine is not working.  Many people see CAM as a lifestyle choice.  Some don't have access to (or money for) a doctor visit, and CAM is readily available at many locations.  There are many other reasons that people use CAM.

Is it safe? Is it reliable?  Depends on the CAM.

What is CAM?

CAM includes any form of medical treatment that is not a part of mainstream medicine.  It has gained popularity because it is holistic, and people like the idea of treating the whole person and not simply one condition.  It includes many categories of treatments, including natural products (vitamin supplements, herbal medicines, minerals, and probiotics), homeopathy (diluted substances that would typically cause symptoms used to treat those symptoms), acupuncture and manipulative treatments, Oriental medicine (energy fields), and mind-body medicine.

What are potential problems with CAM?

• Homeopathic medicines and natural products are not regulated by the FDA.

• Some therapies have been shown to be contaminated with heavy metals (such as lead)
• Products have been shown to be inconsistent in the amount of active ingredient from bottle to bottle
• Studies to show the appropriate dose have not been done in most instances 

•  Studies to show effectiveness have not been done in many cases

• Many don't share CAM use with their physicians.  Why?

• Don't want to admit in case doc disagrees

• Don't think about it and aren't asked specifically 

• Don't think it will make a difference

• Many docs don't know how to advise about CAM.

• If parents ask about herbs, spinal manipulation, or other CAM treatments, physicians often don't have the answers.  
• Physicians are taught to advise based on an evidenced based platform.  If studies haven't shown a treatment to benefit, we are less likely to recommend it. For many complementary and alternative medicines studies have not been done to show safety and efficacy.  
• Studies that have been done typically were done in adults, not children.  Children handle medicines and therapies differently than adults, but research is often not done on them. 

• CAM information does not often make news in medical journals and is not typically discussed at conferences, the places at which your physicians learn. 

Do I recommend CAM?


While there are many CAM treatments that I am not comfortable recommending, I often recommend things that are CAM.

The first and foremost form of alternative medicine I recommend to everyone is healthy diet and lifestyle.  This is widely accepted among mainstream medical doctors.  Healthy diet and exercise helps prevent many health problems, treat some health problems, and even helps mental focus and overall mental health.  

I believe there is solid research supporting fish oil, probiotics, and other vitamin supplements.  The American Academy of Pediatrics recommends Vitamin D for all children. 

I think that relaxation techniques, biofeedback, yoga, prayer, and meditation can all be beneficial and I cannot see how they would be detrimental if used properly.  

In the category of manipulative medicine, I have not been trained specifically, but I refer to physical therapists and sometimes chiropractors.  Massage therapy is a growing field, and has been recommended for children with muscle tightness affecting gait and for those with sports injuries.

Other CAM therapies are difficult for me to recommend.

Herbal therapies might be beneficial, but there is also potential risk of interactions with other therapies.  They are not regulated by the FDA and have been known to be contaminated with things such as lead. There also have been reports of the strength of the supplement to vary widely from what is listed on the bottle and non-listed ingredients to be in the supplement.  This can lead to unknown interactions and consequences.

Most studies of CAM therapies have been done on adults.  Children are not little adults.  Therapies such as lifestyle changes are safe, but those with herbal or homeopathic medications might not be.  There simply is not enough scientific data to support the use of these in children.

Studies do show that about 50% of children have used complementary or alternative medicine (higher numbers if you include vitamin supplements).  Unfortunately most of the time the physician is unaware of these treatments.  Many of the kids using these therapies are those with chronic conditions for which there is no traditional medical therapy that manages the condition well.  This means that more research is needed to show if they are safe or effective.  Are they worth the cost? Is there something better? Should physicians recommend them because they do work?

Why would parents use a treatment that isn't proven? They just want to help. Many parents think "natural" is better.

My answer to that: I would never give my kids organic marijuana to stimulate their appetite.  It is natural.  Organic even.   And it does stimulate the appetite, so it might work.  But I know there are risks to marijuana.  We've all heard those because it is a well known (and unfortunately misused) substance.  Many herbs and other treatments aren't as well known.

How to improve the safety of CAM use in your children:

• Discuss any therapy you are using with your health care provider. If you have more than one provider, be sure all know each treatment you are using.
• If you use a CAM provider, be sure to check the education and training of that person.  Are they licensed to practice?  Be sure they have experience with the age group of your child.  (This actually goes for any health care provider you choose!)
• Ask your pharmacist if there are any known interactions with the supplements and medications you are giving your child.  Be sure to list all prescription, over the counter, and supplements given.
• Store all medications, supplements, and vitamins out of reach of children.
• If you notice any ill effects that might be related to CAM or other treatments, be sure to discuss with your provider!

Resources:

AAP News 2008; 29;1
PEDIATRICS Volume 120:1, July 2007
PEDIATRICS Volume 125:2, February 2010
National Center for Complementary and Alternative Medicine (NCCAM)