Private discussions with the pediatrician

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Every once in awhile a parent will tell the nurse that they want the child out of the room to discuss an issue with with the doctor privately. This is usually something they perceive as a negative thing for the child to hear, such as the child being overweight or having behavior problems.

While I understand the parent's intentions, I find this to be disruptive and counter productive. As much as I try to find an excuse to have a child leave, it is usually obvious that the nurse keeps them out longer than needed.

If we have the child leave the room, he knows something is up. We are talking about him. But not sharing with him. What could possibly be so bad that we won't talk to him about it? (How do you feel when you suspect people are talking about you?)

Then there's the issue of any patient needs to know what the issue is so we can address it. My guess is most of these kids already know what the concerns are. They need help working on them. If they are overweight, we need to talk about what they eat, how they exercise, and how they sleep. If it's behavior problems, they need to give insight into how they feel and what leads to the behaviors. They need to be a part of the plan to fix the problems. If they aren't on board, they won't change their habits. I can talk about weight (or behavior, or drugs, or whatever the concern is) sensitively and in an age appropriate manner with the child. The kids at school are likely talking about it in a not-so-sensitive manner, so it's best to not make it worse by secretly discussing it.

If a parent really wants to let a physician know specific points without the child present, find a way to do that outside of a visit with the child.

Send in a letter or secure electronic message with your concerns before the appointment. Be sure it's at least a few days before the appointment so the doctor has a chance to review it!

Schedule a consult appointment for just parents to come in without the child.

Call in advance to tell the phone nurse your concerns so she can pass it on to the physician.

Don't bring siblings to an appointment where you want to discuss a private matter about another child.

All of these means allow the physician (or other provider) to know your concerns without blatantly kicking a child out to talk about something privately.

 

What kids need to be able to do to leave the nest...

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It's graduation season, which has me thinking of all the ways our kids grow over the years. They're born, then just a few years later they are in kindergarten. In just a blink of the eye they get a locker in middle school. Then high school is over. The world awaits...

Where does the time go?

I have one who will be starting high school next year, and have spent a lot of time reflecting about at all he's learned and what he needs to learn to be successful, independent, healthy and happy.

I have never really thought that school is about learning the actual subjects. It is more about learning how to learn. How to organize. How to be responsible. I have always told my kids I don't care what grade they get as long as they learn what they need to and do their best.

Home life is also a process of learning. We learn how to live healthily and respectfully with others. We learn to take care of ourselves. We learn to be responsible with money. Ideally we learn to argue a point without losing control of our emotions or being hurtful.

In all of this reflection, I came up with a list that I have shared with my kids, and I invite you to share it with yours.

Things you should be able to do independently before leaving home:

Good hygiene habits

• Brush teeth twice daily. Floss once a day. 
• Shower or bathe daily. Wash hair as needed for oil control. 
• Wash hands often. 
• Shave as needed. 
• Flush.
• Brush hair at least daily and get a hair cut regularly. 
• Clip and groom nails regularly, fingers and toes. 
• Use personal hygiene products correctly, including: deodorant, facial acne cleansers, etc. 
• Wear clean clothes and change underclothing daily. 

Healthy habits

• Get adequate sleep to wake fresh and ready for the day. Set an alarm and get up on your own. 
• Eat healthy foods and limit junk food and sodas. Be able to prepare simple healthy meals. 
• Take vitamins daily. 
• Understand common over the counter medicine indications and how much to take.
• Understand why you are taking medications (if you are), how to take them, and what is needed to get more -- is it over the counter or a prescription medicine?
• Know your medical history, including any allergies and chronic health care problems.
• Know how to take care of common injuries until they are healed. 
• Exercise regularly, at least 3 times a week. 
• Develop healthy strategies to handle stress. 

• Journal 
• Prayer or meditation 
• Sketch or other artwork
• Talk to someone openly—don’t hold bad feelings in! 
• Take a long bath 
• Think before speaking 
• Deep breathing 
• Laugh 
• Exercise 
• Schedule down time 
• Think about the problem from different points of view 
• Break big projects into small parts to be able to complete in parts 
• List the good things going on and be positive 
• Avoid overscheduling
• Learn to say "no"

• Enjoy social interactions as well as alone time. 
• Exercise the brain by doing puzzles or reading.

Things to learn

• How to cook a healthy, balanced meal. 
• How to grocery shop on a budget to incorporate nutritional balance.
• How to properly clean dishes and tidy up the kitchen after eating.
• How to balance a check book, make a budget, and pay bills on time.
• How to do easy repairs around the house.
• Understand health insurance plans - how to get them, what they cover, what is excluded.
• Basics of money investment, retirement planning, savings.
• What to do in case of a road side emergency.
• Important numbers (doctor, dentist, insurance, etc).
• How to do laundry.
• How to clean a bathroom, use a vacuum, and dust.
• How to sew basic clothing repairs (buttons, hems, etc).
• How to get help when needed.
• How to apply for a job and build a resume.
• Choose words carefully: they can build someone up or crush someone down. 
• Drugs and alcohol should be treated with respect and used only with good judgment. This judgment should take into consideration laws and safety. Our brain does not fully develop until the early/mid 20s and early use of drugs or alcohol increases the risk of addiction.

Be a good friend and responsible family member

• Be clear with plans: Look at the family calendar when making plans. Get permission from all parents involved; let family know where you will be and when you will be home. 
• Keep a phone available to be able to call when needed. Answer calls/texts from parents! 
• Treat everyone with respect: family, teachers, friends, and strangers. 
• Require that others treat you with respect. 
• Do random acts of kindness occasionally. 
• Volunteer regularly.
• If you feel unsafe, leave the situation. Tell a trusted adult as soon as possible. 
• Do only things you and your parents will be proud of. 

Things to do to show you are getting ready to leave the nest...

• Complete assigned homework and chores without reminders or nagging. 
• Keep your room picked up and clothes off the floor. 
• Hang your towel to allow it to dry between uses. 
• Clear dishes from the table. 
• Clean up after projects or play. Return all things to their proper place after using them. 
• Throw all trash in the trashcan. Recycle things that are recyclable. 
• Responsible use of cell phone, computer, and other electronics. Turn off before bedtime to allow uninterrupted sleep. 
• Spend and save money responsibly. Never spend more than you can afford. Use credit cards wisely.
• Take pride in your work: schoolwork, chores, job, and helping others. Do it to the best of your ability and ask nicely for help as needed. Recognize that work is not always fun, but necessary. Doing tasks with a good attitude will help. 
• Time organization skills: Do not procrastinate until the last minute. Plan ahead and do big projects in small steps. Be prepared with all materials you will need for a project and ask in advance if you need help acquiring items. Use tools (apps, calendar, check lists). 
• Take care of your things. Keep them in proper working order, clean, and put away. 
• Drive responsibly. 
• Accept consequences with grace. 
• Earn trust. 
• Know when to trust and follow others and when to take your own path. Make independent decisions based on your own morals. Have the courage to say "no" if something goes against your beliefs.

It's All In Your Perspective: Read Critically

As a mother of two middle schoolers, I know that school attempts to teach kids to read critically, but I don't think the population as a whole really catches on.

Headlines amaze me. I know they are trying to sell a newspaper or become the # 1 rated program on tv, but they spin stories so much it is sad. More than sad. They take advantage of our gullibility. They enrage people or get them riled up and then people share misinformation. This has happened time and again with many health issues. Just watch Oprah or Dr Oz. (For those who trust Dr Oz, see the bottom for links expressing my concerns.)

Recently some parents (more than one family, don't think I am singling anyone out here) have read a recent headline and want to stop a lifesaving drug for their children. No joke. They worry more about the drug that their child is thriving on because of one headline.

Asthma drug may stunt growth permanently is the title of a NBC News story.  Makes you think the poor asthmatic kids will never be able to perform in life because they are too short. Personally I would rather my child breathe comfortably while running, playing, and living regardless of how tall he/she will be, but really you need to look more closely than the title. (And many people only read headlines, so wouldn't read that the total difference was 1 cm = 1/2 inch. Not 1/2 foot or anything that really is significant in my humble opinion. Few jobs will require another 1/2 inch of height.)

Medscape is an online medical journal I follow. The title of their story about the same research: Pediatric Corticosteroids Have Minimal Effect on Adult Height.  If you are a headline reader, you will have a much different opinion about this life-saving asthma prevention medicine.

No wonder sometimes parents worry so much about things that we as physicians seem to "ignore" or not understand your concerns. We aren't concerned based on the way we have interpreted the research. Hopefully we can explain why we are not concerned, but often times emotions scream louder than statistical analysis information. I have blogged on this before in Decisions Parents Make: Use all the facts.

Please read information critically on your own. Think over what you read. Get additional information from other sources if it is a big issue to you. Think some more. Then make a decision you can stand firm in and not regret. Please.

For more:
Science-Based Medicine's blog: For shame, Dr. Oz, for promoting Joseph Mercola on your show! and Dr. Oz promotes quackery... again