A Working Parent's Guide to Being There

As a working mom myself, I have at times struggled with the guilt of not being around for every new milestone, class party, or other occasion.

There are the stay-at-home vs working mom "Mommy Wars" that I don't want to get into because these options are unique to every family. I know that working is the right choice for me on many levels. I like that my kids have two hard-working parent role models that also spend quality time with the family.

Do things always flow smoothly?

Of course not. We have a crazy, hectic life. Every stage has had it's own problems to conquer, and once we get into a routine it settles for a bit. Then the life stage changes and we adapt. At this point I thought my life would be less crazy (my oldest is away at college and my youngest drives), but it's still crazy aligning schedules.

When my children were younger, it was really hard to get home, get dinner on the table, and get them to bed on time for a good night's sleep. Young children need 11-12 hours of sleep, and when we get home at 6:30 pm, it's really hard to do anything. I became the queen of 15 minute meals and love my crock pot. My quick cooking is probably even healthier than fancy casseroles because it's a basic heated frozen vegetable, stovetop cooked chicken or a quick fish, and noodles or rice. No fancy cream sauces or cheesy goodness weeknights. Sometimes my kids ate leftovers from the previous night so they could eat within minutes of getting home. Whatever worked at the time to get dinner served quickly so the bedtime routine could start was what happened.

We only have two kids, and are fortunate to have two parents, but sometimes we still needed help from friends to get kids to scheduled activities on time. I am a big believer in being there at games or shows, but it's impossible with more than one child and overlapping schedules to be at everything. We tried to alternate which child's activity we do, though my husband went to more hockey games and I went to more dance activities because, well, we're human and he can only watch so many dances and I had a hard time watching my son get thrown against the boards.

It is important that kids know parents are there for them, even if they aren't physically able to be there all the time. The best way to do that is to show kids. When you're together, really be together. Don't keep checking your phone. Make conversation. Make eye contact. Have fun.

Sneak in quality time any way you can, even if it's just a minute or two.

• Talk on car rides. Make routine trips no-screen rides. On longer trips consider an audiobook that you can all listen to and discuss along the way.
• Make eye contact when your kids ask for your attention. Even if you're busy making dinner or doing the dishes, be considerate enough to look at them when you're speaking to them. So often we get upset by our children's manners, but we forget who they're modeling after. 
• Bed time. Definitely at bedtime make the time to connect. Those night time stories, back rubs, and cuddles are the perfect time to bond. Even when your kids can read, take time to read to each other.
• Find quick games to play after dinner. Many games list the time it takes to play right on the box. No one has time for Monopoly after dinner if they plan on getting the kids to bed on time, but family games are a great way to connect, and kids learn many skills from playing. 
• It sounds silly, but kill two birds with one stone. Have a family "clean time"- and make it fun. The house needs to be cleaned or picked up regularly and if everyone pitches in with age-appropriate chores, it gets done more quickly. Brag on your children's effort and build their confidence. 
• Try to be at activities as much as possible. If they're in a recital, they want you there. If they have a big game, they want you to see it. Even if they say, "it's okay" when you can't go, they want you there. I know it's not possible to be there for everything, especially if you have more than one child and you need to alternate between which activity you go to, but try to be at as many things as you can. Even when it's painful to watch the first season of kid-pitch baseball. And if you must take a pain reliever before going to the band concert for your 4th grader. Still go. 
• Make the time with them with them. Turn off your cell phone. Don't check e-mail. Set a good example and talk with the people you're with. So many studies are being done that show parents ignoring their kids due to electronics. You have time to check email after your kids go to bed when they're young. When they're older and their bedtime rivals yours, you can find time when they're doing homework or when they're at an activity. No need to ruin family time with work, social media, or other things that can be done when you're alone. I cannot stress the importance of this. Don't miss your real life and your children's lives by wasting time on screens.
• Family meals are important. Study after study shows benefits. Take the time to talk. Turn off the tv. Keep the phones away from the table. If your family gets stuck with conversation, try some conversation starters or the story game where someone starts with a sentence, then the next person takes it from there.
• Slow down. So often we have a list of tasks we know we must accomplish, but our kids can sense the rush. Take a deep breath and enjoy the moment with your kids.
• Take 10 minutes to do whatever your child wants. Read a book. Run outside. Color a picture together. Just 10 minutes a day can make a difference. Make it a tradition, something your child looks forward to every day.
• And finally, remember that no one is perfect. Some days just won't work out as planned. That's okay. Just don't let every day become that over-rushed day.

I see far too much guilt in parenting. Guilt because you choose to give baby a bottle. Guilt because you want your baby to sleep through the night. Guilt because... it never ends. I think one big driver of guilt is social media. We see into other people's lives on Facebook, Pinterest, Instagram or Twitter and compare it to our own. The posts are usually the best parts of their life, but we forget that everyone has the parts they aren't showing. Everyone wants to be like someone else on some level. We all have dreams and aspirations to improve. Great. Keep bettering yourself. But don't suffer from guilt of choices you've made. If they are working, great! Keep them. If they aren't working, investigate other options and make a positive change. In 4 S's of Being a Confident Parent, Dr. Escalante discusses the trials parents face and errors parents make and why that's okay.

I came across this great post on the problems with Attachment Parenting. I think that when people have such strong opinions about anything, it is a set up for failure. Attachment Parenting can lead parents to feel guilty because they aren't always there for a child. You know what? It's healthy to have alone time. Parents need to do things with other adults and leave the kids with a trusted adult or mature teen babysitter. It's just healthy. If you don't take care of yourself, you won't take as good of care of your family as you can if you are healthy in mind, body, and spirit.

Enjoy time with your kids. They won't be little forever. Make the time to be present in their lives.

One last thought... Here's an old song that I always think of when I think of busy lives: Cats in the Cradle from Harry Chapin. 

Lead by example

We've all heard the saying: kids will do what they're shown, not as they're told.

It is so true. Think about all the times your kids are watching you. They are learning from you. 

What can you do to help them have healthy habits?

• Eat your vegetables.
• Get daily exercise.
• Wear your seatbelt. 
• Stop at stop signs.
• Don't use your phone while driving.
• Wear a life vest near a lake or river.
• Maintain your composure during times of stress.
• No phones at the dinner table.
• Don't tell lies- even little ones.
• Get enough sleep.
• Be kind to others.
• Call home- your parents and siblings would love to hear from you.
• Don't permit violence in your presence.
• Give your time and talents to others.
• Take care of your things.
• Limit screen time.
• Brush your teeth at least twice a day and floss daily.
• Wear a helmet when on a bike.
• Don't mow the lawn without proper shoes. 
• Make time for family.

Learning and Behavior Series Part 1: Labels - Why should my child be diagnosed?

This is the first in a series of posts about learning and behavior I will do over the next several months.

I see a lot of children with various behavioral and learning issues. Teachers and parents often first think of ADHD with any problem, but that isn't always the problem, or at least the primary one. It is simply one of the most common diagnoses. Since it is so common, I will focus on this topic often, but it can mimic other problems and it often co-exists with other issues.

I firmly believe that kids with learning and behavioral problems cannot just "work harder" to fix the problem. When I am sleep deprived, I cannot focus as well. I cannot read and comprehend what would typically be easily understood and retained. I lose track of things. I lose my temper more easily or get upset about the little things that usually wouldn't phase me. I must put extra effort into everything, which is even more exhausting. I liken this to how some people feel most of the time. How can we possibly expect them to just try harder without professional assessment and treatment?

One reason parents don't want to have their child diagnosed with ADHD or any other learning or behavioral problem is that they fear a label. What is a label? It is not a diagnosis, but the way we are perceived. Think about how many judgements and labels you make in a day. I try really hard to not judge because it's not my place, but those thoughts sneak into my mind all the time:

That person is rude. 

That's my shy (hyper, loud, smart, active, loving, etc) child.

That was a dumb statement. 

That group of giggling girls is too loud and out of control. 

I don't say anything with these thoughts most of the time because it's usually not my place. I often mentally rebuke myself for having them, but I still have opinions. The truth is that we all make judgements all the time. And when a child acts out a lot, he is judged and labeled. If a child never seems to be organized, she is judged and labeled. If a child falls behind academically, he is judged and labeled. It happens with or without a diagnosis. The label is there.

Wouldn't it be better to get a professional's evaluation and treatment? With proper management, your child might lose the negative labels and be able to succeed!

One of the problems with diagnosing many learning and behavioral disorders is they are difficult to test for since there is a continuum of symptoms of normal and atypical and there are so many variables (such as sleep) that can affect both learning and behavior. Even though ADHD is common, studies vary and disagree as to exactly how common it really is. Some experts think people are under diagnosed. Others claim too many are over diagnosed. The same goes for treatment: too few kids are medicated or too many kids are medicated. I think that all stems from the fact that the symptoms of ADHD are common to any neurotypical person, just to a larger degree, and symptoms often overlap with other disorders -- making a correct diagnosis difficult. There are still many people who think behaviors and focus problems are due to bad parenting. If it is a parenting issue alone, how would a medicine help? Probably in part due to this stigma, parents worry about how the diagnosis will reflect on the child and family more than any other diagnosis I know. If a child has an infectious disease or  a chronic condition such as asthma, there is much less hesitation to assess, diagnose, and treat the illness.

There are many reasons for parents to be hesitant to begin an evaluation when their kids are showing signs of a learning or behavioral problem. Some think it's just a phase. Many wonder if another few months of maturity will help the child. Some think the child is just misbehaving, and stricter rules or harsher punishments will help. Others think the child is just looking for attention and giving more praise will help. Some parents think it is because of the other children around -- you know, "Little Johnny is always messing around in class so my Angel Baby gets in trouble talking to him."

While I am all for looking for things on your own that can help a child's behavior and optimize their learning, I also think that avoiding the issue too long can lead to secondary problems: academic failures, poor self esteem, depression, drug/alcohol abuse, and more. Working with the school and seeking professional help outside of school can help your child succeed. If a parent is not wanting to start medication, there are other things that can be done that might help the child succeed once the specific issues are identified.

Why wouldn't you want to start a treatment that works? Asking a child with ADHD to just focus harder is like asking someone with nearsightedness to just focus harder. Without the help of glasses a person with nearsightedness can't see well. Without a medicine to help, some people just can't focus. If a child needs glasses to focus parents rarely say they'll just make the child try harder. They get glasses for the child. Without the glasses a child may have more injuries from not being able to see. He might have physical symptoms, such as headaches, from the eye strain. His grades might fall because he can't see the board. People see the vision issue as a medical one, yet when a brain has trouble with neurotransmitters causing focus problems, they often resist the medical treatment. Untreated ADHD also has consequences. The children suffer from poor self esteem because they constantly are reminded that their behavior is bad. They have a harder time doing tasks at school because they lose focus. They get distracted and miss important information. Children get in trouble for talking inappropriately, acting out or for invading other's personal space. They lag behind peers with social skills and often have a hard time interpreting how others react to their behaviors. Their impulsivity can get them into dangerous situations, causing more injuries. Older kids might suffer from depression and anxiety from years of "failures".

If you still worry about labeling your child with a diagnosis, think about what the root of your worry really is. Remember that the diagnosis is only a word. It doesn't define the best treatments for your child, but it opens the doors to allow investigation of treatments that might help your child. In the end most parents want healthy, happy kids who will become productive members of society. How can you best help them get there?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

• ADHD: CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am on the board of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!
• Anxiety: Many parents are surprised to learn how much anxiety can affect behavior and learning. The Kansas City Center for Anxiety Treatment has support groups for their current and former patients.  

• Autism: The Autism Society has a list of resources 
• Dyslexia: Dyslexia Support Group for youth with dyslexia

• Learning Disabilities: Learning Disabilities Association of Kansas
• Tourette's Syndromr and Tic Disorders: Tourette's Syndrome Association is a great resource for people with tic disorders. They have an active local chapter.
• General Support Group List: List of many support groups in Kansas: Support Groups in Kansas  (I found the search function to work best with the bottom option.)

I'll be writing a lot on this general topic over the next few months, so let me know if there are any specifics you'd like addressed!

More Quest for Health blogs on ADHD:

• Why get diagnosed?
• Who's Who in ADHD Treatment
• Nutrition, Elimination Diets, and Vitamins
• Alternative Treatments
• Medications
• Generic Methylphenidate HCl ER (for Concerta)
• Red Dye #40 and Hyperactivity
• Homework Battle Plan

Screen time: Do you have a love - hate relationship with it?

Screen time. Parents often have a love - hate relationship with it. We've all heard the warnings that it is bad for our kids, but we've experienced the benefits of it keeping our kids occupied while we get things done. And some programs and games have an educational component -- do we group those in the same category as purely entertaining ones?

Most parents by now have heard the recommendations that kids under 2 years should have no screen time. At all. And older kids should have no more than 10 hours / week total.

Most parents are also fully aware that their kids exceed those guidelines. Some by a little. Others by a  lot. There are all kinds of reasons parents have for allowing this. Some are good reasons, others are not.

To be honest, there is still a lot we don't know about screen time. Research continues. When I was a child, television and movies were just passive watching. Thankfully there wasn't much offered, and with a limited number of channels, we usually stuck to watching tv only on Saturday mornings. Other times we played outside. Shows were not as action packed and overstimulating as those of today. Compare Mr. Rogers to pretty much any show designed for kids today with quick scene changes, music in the background and motion everywhere. Now there are interactive games, many of which are educational, or at least they seem to be teaching letters, counting, or other skills. There's even Wii and Kinect that use whole body movements to get kids off the couch. One can get a good workout with some of the games, but Wii bowling is nothing compared to real bowling.

So how do you count educational and active game time? Should it be included in that 10 hours/ week, or should you allow extra time for it? Are e-readers a form of screen? They often allow interaction like a computer and many can show videos and offer games.

Short answer about counting total screen time: We don't know.  Experts can give thoughtful opinions, but really at this point it's all educated guesses.

Some studies show that kids learn better when things are presented on a computer or video format. Maybe it keeps their attention better than a paper workbook. I love the ability to hold my finger on a word in an electronic e-reader and have the pronunciation and definition pop up. How many times as a young reader did I simply skip over words I didn't know? My daughter likes to increase the font size so only a sentence or two are on the screen. She feels like she reads faster because she "turns the page" more often. Does this build her confidence reading? Does it actually slow her down? I don't know. But she's happier to read and it seems to work for her. (This does drive me nuts if I pick up the Kindle after she's changed the settings... but I can change it back to my preferences easily.) Are kids losing the ability to find things in alphabetical order, such as using an encyclopedia to look something up, since they just hit "search" and find the answers? Does it matter?

Parents must really pay attention to what kids are watching and playing as well as how much time they are spending on a screen. For every minute they are on a screen they aren't interacting with people to work on social skills, they aren't outside playing games and getting exercise. If the games they are playing help develop thinking skills, strategy, math, reading, and more, then some screen time every day can benefit. If the content has violence or other age inappropriate material, it can be very detrimental. If they are online playing against other people, dangers multiply. While I can see kids who hate to read actually not notice how much they must read to play a game on a computer or tablet, are there better ways to get them pumped into reading a book?

There's a time and place for everything. The dinner table and bedroom are never a good place for online/screen time. Watch and play with your kids. They will love the time with you and you can better supervise what they're exposure is and modify it as needed.

More information:
Media Resolutions Every Family Should Make in 2014 has some tips to help monitor and limit screen time.
For information on internet safety, check out YourSphere for Parents.
American Academy of Pediatrics Media page.

Developing healthcare responsibility in your children

I am writing this fully knowing I am at risk of upsetting some parents. But this is the time of year we see more school aged kids for their annual physicals, so it is the time of year I think about how parents could help their kids grow into independent adults or hinder that growth by trying to be a good parent.

source: Shutterstock

I read an article recently (The Overprotected Kid) that really hit home with me about how parents try so hard to keep their kids safe that we sometimes prevent them from learning about real life. Although the article is based on allowing kids to roam and play with things that haven't been engineered to keep them safe, it did touch on the fact that parents hang around to answer for kids and speak up for them.

I find that parents often try to help their children during visits to my office by answering questions about their health, sometimes even what they are feeling. I'm sure they want to be sure I know their (parent) perspective. Maybe they are just trying to speed up the visit so they can leave and do the other things on their to do list. But it usually ends up taking longer, because I then spend more time trying to talk to the child.

When a question is directed at the child, let the child answer. If I need parental clarification, I'll ask for it. Obviously a pre-schooler needs more help than a high schooler, but if the teen has never had the opportunity to answer for himself, he might not have the skills and confidence to do it.

Sometimes a parent will start asking their child questions or tell them to tell me about .... I'm sure they are thinking that it is helping me, but it doesn't. (I'm not talking about the parent reminding the child to tell me something they previously discussed, I'm talking about the parent who in response to something I've asked tries to draw the child into conversation-- that's my job.) I have a set amount of time to assess a child's physical exam as well as other factors, and I have a process of evaluating all the points I must consider.

When I ask a child a question, I'm not only looking for the answer they are giving, but I'm also gaining valuable information about the child. Can they speak clearly? Do they understand a question that is age appropriate? Do they make eye contact? Are they developmentally mature for their age? Do they understand how their habits effect their health?

So often well intentioned parents pipe up and answer questions directed at the child. It doesn't matter if I'm looking directly at the child, the parent answers. Even if the child starts to answer. I will often redirect to the child for clarification and the parent still answers. Some of the kids roll their eyes. Others take it in stride without much of an expression at all, as if they're used to their parent taking care of everything. Some simply turn back to their hand held game and play, ignoring the grown ups in the room. Ugh! How does that help me get to know the kid?

Sometimes I wonder how the parent makes it through the day when the child is at school since they can't be there to speak up for the child all day there. It can be that bad.

I really worry about the older school aged kids, especially those in high school, who have parents answer for them. How will they be able to assume their healthcare responsibilties once they turn 18? If they don't know about their past medical history, allergies, and family medical history how can they eventually establish healthcare with a new physician without a parent? If they can't give a clear and concise summary of what their symptoms are for an illness, what will they do when you're not there?

And yes, I see parents piping up for their high schoolers.

I guess it's a learned behavior for all. Parents get used to answering the questions for pre-verbal kids, and they keep doing it.

Please stop.

Let kids in elementary school be prepared to order off the menu when the waitress comes to the table -- after discussing their choice before she gets there if they need help deciding on a healthy item. Have older elementary kids speak up at the store to ask for help when they need a dressing room or if they need a price check. Let them talk to their teachers first if they question a grade or need help learning a concept. Let them give their own health summaries at the doctor's office. You can be there for support along the way, but offer less and less as they get older and more experienced.

If your child has true inabilities to do these things there might be an underlying problem, such as anxiety or developmental delay. Those should be addressed. But by far and away most school aged kids can do these things. Let them.

They need to do these things to be able to one day live independently. Trust me, they will appreciate it some day! Too many college kids call home for parents to "fix" things that the young adult should be able to handle. But they can't jump into the deep end of the pool without learning to swim along the way.

Private discussions with the pediatrician

photo source: Shutterstock

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...

photo source: Shutterstock

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.

Stepping outside my comfort zone

Getting ready to start in our party scene!

This past week I was on vacation from my day job to be an active parent.

Sometimes we need that.

I really had to step outside of my comfort zone for this parenting act -- being in the cast of Clara's Dream (a version of The Nutcracker).  Parents often do things we never thought we would for our kids.  We intentionally put our nose to a probably dirty diaper to be sure it needs to be changed. We forego sleep to take care of kids. We take care of their needs before our own routinely.  They change us in many ways for the better.

For years my daughter has loved to perform on stage for theater and dance. She has asked on several occasions for me to audition for "family shows" where they allow parents of students to be in the cast. Each time she has asked, I answered with a firm "No".  I have never acted or danced. I prefer one-on-one conversations, not large groups - and definitely not the stage!

Several months ago she asked and I actually considered it. I had already requested vacation for that week due to show week always getting crazy with time constraints. Rehearsals were later in the evenings, so they wouldn't interfere with work. As I thought about it, I considered the joy of being an active part of her favorite activity and put away my fears of being on stage.  (Of course the fear returned each time we were called backstage to line up for the scene- but it was too late to turn back then!) It was an act of faith because I had never seen the show and knew little about what I was signing up to do.  I figured parents would mostly be "background" people and didn't realize we would learn dance steps and actually be a part of the scene. No, I didn't have to do ballet - just a Victorian ballroom style dance.

It was fun to be a part of my daughter's life in a way that will always have a special memory. Call it working mom guilt, but I want to make special memories in addition to daily quality time.  Quality time is not spent watching tv with kids, but doing things together.  Some things are small, like taking a walk or playing a game. Some things are more memorable because they are unique.

Not only did I get some great times with my daughter, I also met a number of fun people in the process.  Spending so much time with other parents of dancers was a great bonding experience in itself. And I got to know some of the students and teachers my daughter works with on a regular basis at dance classes.  It is always a good idea to know the people that hang out with the kids!

So when your kids ask you to do something and your first thought is "no way", take a moment to think about it. You might just change your mind and grow with your child!

Bow time... my "German son" is blocking me.

To be in your children’s memories tomorrow, you have to be in their lives today.  – Anonymous

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

Ear Wax: Both Good and Bad

Ear Wax Removal NOT Recommended

We make ear wax, also known as cerumen. Many people are annoyed by wax buildup, but it has a purpose! Wax grabs all the dust, dirt, and other debris that gets into our ears. It also moisturizes the ear canal ~ without it our ears become itchy. It even has special properties that prevent infection. That's all good stuff, so don't be too frustrated with a little wax!

Most often the wax moves from the inner part of the ear canal to the outer edge of the canal on its own.  It is amazing to me how our bodies are put together so perfectly: it is designed so the wax is made deep in the canal, then skin cells and wax migrate to the outer edge of the canal, taking with them debris! Some people naturally make dry wax, others make wet wax. This can be due to genetics and other factors. The important thing to remember with this is how your wax tends to build up and how to best keep it from building up.

If wax builds up it can cause pain, itching, ringing in the ear, dizziness, decreased hearing, and infection.  Inappropriate cleaning with hard and/or sharp objects (such as an cotton swabs or paperclips) can increase the risk of infection or even perforation of the ear drum.  Even special cotton swabs made "safe for ears" can push wax deeper and cause a solid collection of wax plugging up the canal.

How can parents help babies and kids keep their ears clean?

Routine bathing with clean warm water allowed to run into the ear followed by a gentle wiping with a cloth is all that is needed most of the time. 

Ear drops made for wax removal with carbamide peroxide can be put in the ear as long as there is no hole in the ear drum or tubes.  The oily peroxide acts to grab the wax and bubble it up. Then rinse with clean warm water and a soft cloth (see syringe tips below). If there is excessive buildup, daily use of drops for 3-5 days followed by weekly use of the drops to prevent more buildup is recommended. (For particularly stubborn wax, using drops 2-3 times/day for 3-5 days initially can help.)

Make your own solution of 1:1 warm water:vinegar and gently irrigate the ear with a bulb syringe.  

Mineral oil or glycerin drops can be put in the ear. Let a few drops soak for a few minutes and then rinse with warm water and a soft cloth. 

Occasional use of a syringe to gently irrigate the ear can help. Using the bulb syringe:

• First, be sure it is clean! Fungi and bacteria can grow within the bulb ~ you don't want to irrigate the ear with those!  While they can be boiled, they are also relatively inexpensive and easily available, so frequent replacement is not a bad idea.
• Use only warm water /fluids in the ear (about body temperature or just above body temperature is good). Cold fluids will make the person dizzy and possibly nauseous! If using drops first, put the bottle in warm water or rub it between your hands a few minutes (as if rubbing hands together to warm them, but with the bottle between the hands). Don't overheat the fluid and risk burning the canal!
• Have the child stand in the tub or shower.
• Pull up and back gently on the outer ear to straighten out the canal.
• Aim the tip slightly up and back so the water will run along the roof of the canal and back along the floor. Do NOT aim straight back or the water will hit the eardrum directly and can impact hearing. 
• Don't push the water too fast ~ a slow gentle irrigation will be better tolerated. If they complain, recheck the angle and push slower. If complaining continues, bring them to the office to let us do it to be sure there isn't more to the story.
• Refill the syringe and repeat as needed until the wax is removed. 
• Use a soft cloth to grab any wax you can see and dry the ear when done. Some people like to use a hair dryer set on low to dry the canal. Just be sure to not burn the skin! 

If wax continues to be a problem, we can remove it in the office with one of two methods:

After inspecting the ear canal carefully with an otoscope (or as I call it with the kids: my magic flashlight), we can use a curette (looks like a spoon or a loop depending on provider's preference and wax type) to go behind the wax and pull it out.  This is often the fastest method in the office, but is not always possible if the wax is too flaky or impacted into the canal leaving no room for the curette to pass behind the wax.  It should only be done by trained professionals... don't attempt this at home!

If the wax is plugging up too much of the canal, the canal is very tender, or if the wax is particularly flaky and breaks on contact with the loop, we will let the ear soak in a peroxide solution then irrigate with warm water. This process takes longer but is better tolerated by many kids and they think it is fun to "shower their ear".  We often must follow this with the curette to get the softened wax completely out. 

My biggest tips:

Not Safe!

• Never use cotton tipped swabs, pipe cleaners, pencils, fingernails, or anything else that is solid to clean the ear! (Note: I still don't recommend them if the package says "safe" ~ they aren't!)
• Don't put liquid in the ear canal if there is a hole in the ear drum (tubes are included in this). Pus draining from the ear is a sign that there might be a hole.
• Ear candles are not a safe solution. Burns are too big of a risk!
• The ear canal is very sensitive, especially if wax buildup has been there a while and has caused an infection of the skin in the canal.  Anything put into the ear can increase any pre-existing pain. 
• If the skin is friable from prolonged wax and/or infection there is often bleeding with cleaning. If you notice this at home, your child should have the ears evaluated in our office. We will look for holes in the ear drum, scratches on the skin in the canal, and signs of infection needing antibiotic.
• Some people who suffer from itchy ears can help themselves by NOT cleaning their ears so much!
• Earwax usually can be left alone. Only try to clean it out if there are signs of problems with it (ear pain, ringing in the ears, decreased hearing, etc). If kids don't tolerate removal with the methods above, bring them in for us to take a good look. There might be more to the story that needs to be addressed. 
• If there is significant ear pain, pus or bleeding from the ear, or an object in the ear, bring your child in to the office to have us assess and treat.

UPDATE:

In January of 2017, the American Academy of Otolaryngology-Head and Neck Surgery Foundation issued updated AAP-endorsed guidelines regarding wax buildup. Check out this list of Do's and Don'ts from the guidelines.

Parenting when you're angry: Keep Cool

Picture Source: Shutterstock

One of the biggest problems I've had disciplining my kids is letting them see I'm angry. And from talking with many parents over the years, I know I'm not alone. It is only natural to lose your temper and yell when mad, right?

The problem is obvious. We all see it. When we yell, other's yell back. That is also natural.

So if you yell, the kids yell. Or otherwise show you they are angry. It can get pretty ugly, right?

One of the best things I ever did when I was losing my temper and my husband wasn't around to give me a reprieve: I put myself in Time Out. I went to my room, closed the door, and sat on my bed. The kids (who had been fighting with each other) worked together outside my room, talking about what was happening nicely and quietly with each other. They bonded instead of fighting. They were a little scared and very confused. I got some peace and quiet while they worked through their problem. It was wonderful. I only did that once or twice, I'm not sure why I didn't do it more often.'

Everyone gets angry. That is okay. It is human and natural. How we react to the anger and what we do about it is what makes a difference. Yelling, hitting, belittling, blaming others, or otherwise mismanaging anger can have devastating consequences and generally makes the situation worse. No one can think when angry, and showing anger typically makes the others involved angry.

So what can we do to keep situations under control without showing anger?

• Time Out. This is typically given to the child in trouble, but certain circumstances might help if everyone gets a time out, as above.  Time away from talking, glaring, or otherwise communicating can give everyone time to simply calm down.
• Change the situation. If appropriate, changing the activity is a simple way to get everyone in a better mood.
• Take deep breaths. Exaggerate the deep breathing. This physiologically helps your mood and gives you time to sort your thoughts, and also shows the kids that you are trying to manage your anger. This modeling can help them to remember to take deep breaths when they are angry too.
• Count. This draws attention to the problem once kids realize that you count when they need to change choices and gives everyone time to problem solve.
• Take turns. If you have someone else who can take over (spouse, parent, friend) when you are losing control, find a way to ask for help. My husband and I would relieve each other a lot when the kids were younger. Sometimes simply having the change of person would calm the child. Because this parent was not already angry with the situation, they were better able come up with a solution.
• Lead by example. Choose words carefully. Don't hit. Don't name call. Don't blame. Keep voice level neutral. Speak in a calming voice. Avoid gestures or facial expressions that show anger or distain. Take deep breaths to "think." Show your child how to handle bad situations without poor behavior.
• Get their attention first before giving directions. Get on eye level with your child. Ask that they look at you when talking. Put a gentle hand on their shoulder. Don't yell for attention, but calmly wait a few seconds for it before speaking. Sometimes a whisper gets attention better than a yell.
• Use humor if appropriate. This DOES NOT mean to make fun of your child. That is horribly damaging to self esteem. It means to try something funny to get your child's attention. 

Make a baby doll "talk" about what is going to happen next: "I'm going to splash in the bath." or "Look at me brush my teeth."

Put pajama pants on your head and ask the child to show you what you're doing wrong. They just might get dressed to show you!

Come up with a silly stress dance to shake out the worries and stress. 

• Think about the root of the problem. When kids act out it often isn't just because of the action itself. Are they tired or hungry? In need of attention? Sad about a loss? Being bullied? Afraid of failure? Or is their behavior really okay but you are stressed and sleep deprived and over reacting? Addressing the root problem will typically help the day to day issues.
• Talk through your thoughts out loud. "Those words you just said hurt my feelings. I am now sad." If you are frustrated at another person when your kids are around, model good behavior of handling a negative situation without yelling or fighting. 
• Smile. It really works. Smiling can actually change your mood and relieves stress, as described by Karen Kleiman in this article.
• Apologize if you make a mistake. It is okay for a parent to admit fault in a situation. Saying something as simple as "I'm sorry I yelled. I was very disappointed in your choice but I should not have yelled and lost my temper." This will earn respect from your kids and teach them that they can apologize when they are wrong too!
• Keep a journal. This often can help us see our own situation more clearly. What triggers our anger and what can we do? It is easier to think about this when we aren't mad and come up with a plan for the next time the situation arises.
• Family meetings are a great way to talk about behavior in a non-threatening manner and at a time that everyone is in a good mood. You can discuss situations that have happened and ask kids what they think they could have said or done differently to change the outcome. (One rule with this: they can only change themselves, no one else!) Roll play situations that come up frequently, such as sharing toys or getting a chore done. Let them figure out good ways to handle common problems, don't give answers. Talking about what's happening the following week, such as a dentist appointment and soccer practice, helps kids get a perspective and internally plan. 
• Make a list of appropriate things to do when angry. 

The list might include many options, such as: Yell into a pillow. Squeeze a stress ball. Pray. Deep breaths. Whatever comes to mind that might help.

Keeping the list in an easily accessed area can help older kids and parents find ways out of their anger. (It's hard to think when angry, so the list really does help!)

• Choose words carefully. Starting sentences with "I feel" instead of "You" are less hurtful. "I feel sad when I see toys on the floor when no one is playing with them because they weren't put away," instead of "You left your toys out again and that makes me sad." Hear the difference? Same general point, but much less inflammatory and judgmental.
• And never forget prevention of problems! Routines are important, especially eating regularly and sleeping adequately (kids and parents). Tired, sick, and hungry is a recipe for disaster! Praise the positives. It is easy to see problems, but be sure to give kudos when due, even for the small stuff. Never underestimate the power of praise and attention!

Decisions Parents Make: Use all the facts

Parents struggle with decisions

I was recently asked to clarify a comment I made on facebook, and the comment deserves more than a quick facebook blurb.


The original post:

If you ever plan on having kids, PLEASE make sure you educate yourself about this!

Myths about Circumcision You Likely Believe | Psychology Today

www.psychologytoday.com

CIrcumcision does great harm to babies By Darcia Narvaez, Ph.D....

My reply:
This is one way to use "studies" to distort facts. This article has so many inaccuracies I don't know where to start. 

One of the great things about our country is we have freedom of speech.  I highly support everyone being able to state their opinion, including those who disagree with my opinion.  But I also think we all need to look at opinions as opinions, not as hard fact.  Read articles critically and form your own opinion. Read articles from both sides of the line before you draw your conclusion.  When authors have an agenda (which is why most writers write, including myself here) you must be able to see when they are able to share both sides of a story and when they are simply stating the facts that support their cause.  I am not saying that it is wrong to just state your opinion, just that readers must know how to filter the information. I personally dislike/hate when an argument is actually based on emotion and fears, but comes off as science.  Too many parents are made to feel guilty because they have made a choice for their child that differs from a friend or relative. They read something that differs from what they did and they feel like they made the wrong choice. Regret is a dangerous thing, and is often misplaced.

The intent of my facebook comment above is not to support or discourage circumcision, but rather to warn that when authors have a strong agenda, the methods of persuasion often cause doubt and guilt in readers. I do not find this to be helpful in any way. Data and statistics can be used to distort reality, especially when studies are hand picked to only discuss the ones that support your cause and the ones supporting the contrary are omitted. This includes not only circumcision, but also breastfeeding, vaccines, home schooling, discipline, religion, government, and many, many other topics. 

The first clue that this is an article with a cause is the title and subtitle: “Myths about Circumcision You Likely Believe  CIrcumcision does great harm to babies”.  Simply reading this title alerts the reader that the author is going to persuade you that circumcision is a bad thing.  Their argument is one side of the circumcision debate, but you need to read the counter point from someone who supports circumcision before you make a decision.  

As a disclaimer and credentials for why I feel I can give an educated opinion:  I am a pediatrician who has performed many circumcisions during my 13+ years of private practice. I let parents make the decision to do or not do the circumcision and do not try to sway their decision in any way. I invite parents to watch every time, and nearly half of boys have one or both parents present. Typically parents are impressed by the overall brief procedure. Many have commented that it wasn’t as bad as they thought it would be. I have never had anyone comment how bad it was and have never had anyone (parents, nurses, medical students, or nursing students) become physically ill from watching. I admit that it could be awkward for a parent to express negative comments, so they could simply keep their thoughts to themselves, but experience tells me that when people are upset about things, they tend to complain.  So the many positive comments without any negative comments supports that parents have a generally good feeling about their decision even after watching the procedure.  Note: parents are self selecting here. The parents who don’t want a circumcision in the first place don’t agree to the procedure, and the parents who don’t want to watch are not able to comment on the actual procedure.

Starting with myth 1.  The foreskin is the distal skin of the penis and is removed during the circumcision. It is true that it is adhered to the glans of the penis in a newborn, and there are several means to break these adhesions. This is the most painful part of the circumcision in my opinion (but with adequate pain relief, this pain is diminished/eliminated-- see #3).  As for the surface area of the foreskin in an adult male, I do not see how that accounts for anything about a newborn’s circumcision. A newborn does not have 15 square inches removed. Adult males have wide variation in penile size, and therefore foreskin size.  What has been documented is the more foreskin surface area, the more likely a male will suffer from sexually transmitted diseases:

• Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis: Tobian A.A.R. et al. (2009) 

• Foreskin surface area and HIV acquisition in Rakai, Uganda (size matters) 

• Foreskin surface an  HIV acquisition  

Myth #2.  Procedures hurt, but that doesn’t mean pain isn’t managed. I agree that anesthesia helps, and this has been shown by several studies. The small study by Lander the author mentions shows that the best form of pain control is with the ring block, which injects lidocaine around the base of the penis. However the only form of anesthetic mentioned in the Myth article is the dorsal block, stating that it is the most common. In reading the article by Narvaez, it is stated that one patient in Lander's study suffered a seizure. Reading Lander’s summary, it appears the baby had apnea and loss of tone in the limbs. While this could represent a seizure, it could also be a choking episode, which is common with newborns feeding or crying. I have seen these in many newborns not associated with any procedure. It is difficult to presume it was a seizure from this documentation, and the conclusion of a direct cause/effect from the procedure cannot  be certain. The small sample size of the study limits the validity and generalizability of any findings, including problems encountered. I personally use sucrose pacification (sugar water on a parent or nurse finger or a pacifier) plus a ring block. Neither of these were mentioned by the author. Sucrose pacification has been shown to help with painful procedures the first 4 months of life. I use it to decrease the pain associated with the injection of lidocaine for the ring block and throughout the procedure. I find that babies tolerate the procedure very well the large majority of the time. What also wasn’t mentioned is that there are many types of circumcisions. Training of the physician typically dictates method used, but they each have their own risks and benefits and pain scores.

Myth #3.  See also #2. I do not know where the 45% of doctors using anesthesia number comes from. In my geographic area at the 4 hospitals in which I take care of newborns, anesthesia of some sort is used by all physicians doing circumcisions to my knowledge. In my area it is typically the pediatrician who performs the circumcision, and few obstetricians do it, not OBs.  As for it taking 30 minutes to achieve anesthesia, I have no idea where that number came from.  Local anesthetics have rapid onset once injected. Lidocaine takes 0.5-1 minute, prilocaine 1-2 minutes.  Topical preparations do take longer and should be placed at least 30 minutes prior to the procedure, and they are much less effective in general than injectable anesthetics.  

Myth #4. I cannot understand how this can be reliably tested. The process of birth itself is traumatic. The large majority of boys in the United States are circumcised, but I do not need to treat the majority of boys for Post Traumatic Stress Disorder. The choice of pain relief by Taddio in his studies (referenced in the Myth article) was a topical anesthetic, which is not as effective as other forms of anesthesia. This highlights that you can formulate the methods of your study to get the answer you are looking for, not necessarily the whole truth of the matter. If Taddio really wanted to prove that anesthesia made a difference, the choice of anesthesia should have either included several types ~ or at least the most efficacious, not the least.  Linking long term effects to a single newborn experience would be impossible in my humble opinion because there are too many confounding factors and it is impossible to isolate a single cause/effect relationship.  This is simply a ploy to get parents to regret a choice they have made for their children. This is horrendous in my opinion. We have many opportunities to feel guilt, please do not try to make parents feel guilty about a choice they have made that can impact the health of their son.

Myth #5. Yes, some babies sleep comfortably during the procedure. I have many parents that can agree with this statement after watching their sons undergo the circumcision.  Their babies did not cry themselves to sleep or go into a shock state. They were just sleepy babies. Most do not sleep ~ after all we are stimulating them by moving them around, washing the area, and otherwise touching them.

Myth #6. There are risks to all procedures. A physician should discuss the risks and benefits prior to the procedure. Parents have the right and responsibility to make choices for their children.  Of the complications listed, these are not unique to circumcised males. 

• Meatal stenosis is a narrowing of the urethra that both boys and girls can have, not necessarily after circumcision.  It can be a complication of circumcision from irritation, but is rare.

• Adhesions are NORMAL.  I mentioned above (Myth 1) that they must be broken to remove the foreskin. Without a circumcision they tend to release by 6 years of age. Some circumcised boys re-attach the foreskin without any need to do anything since they typically release on their own by 6 years of age. This is especially common if the pubic fat pad pushes the skin of the penis up and buries the penis (see next item).  While some physicians recommend breaking these adhesions, I have found that it is not required to break these attachments in most cases. This has been validated by Ponsky et al at Penile adhesions after neonatal circumcision. Rarely boys develop bridging adhesions which are different, and these do need to be repaired. 

• Buried penis is common when infants have a thick fat pad at the base of the penis. This happens in both circumcised and uncircumcised boys. It has nothing to do with the amount of foreskin removed. The worst I ever saw was in an uncircumcised toddler. He suffered complications to the point where he needed a circumcision as a preschooler to resolve the problems. This required general anesthesia which involved greater risk than neonatal circumcision.

• Infections are possible any time the skin is broken, yet I have never seen an infected circumcision. It is a risk that should be discussed prior to the procedure so parents know how to identify it early and seek help.  Poor sterile technique has been associated with infection and has made the news earlier this year. If done in a hospital setting with proper technique this risk is minimized. Those having a bris should find a qualified mohel with a good record for safety and proper hygiene.

• Death is very rare. Risk factors, such as family history of bleeding disorders should be discussed prior to the procedure. Vitamin K should be given prior to procedures to decrease risk of bleeding. After the circumcision the site should be routinely checked by trained persons to assess for bleeding. See also infection risk above.

Of course no mention of benefits was made by the author. This unbalanced view does not allow a full disclosure of both sides. 

• A significant decrease in sexually transmitted diseases has been shown among circumcised men. 

• Urinary tract infection risk can be decreased in infants. 

• Phimosis and balanoposthitis are infections caused by improper cleaning of the uncircumcised foreskin. I have seen phimosis once when working as a nurse assistant in a nursing home. It was painful and a horrible consequence of care takers not knowing how to care for the uncircumcised penis. Can this be prevented? Yes. But in our country where most men are circumcised, it is not common knowledge. 

• Improved hygiene in general is easier in circumcised males. I have instructed many families on how to care for the penis, but find that many boys don’t care for themselves properly as they become independent in the shower. Parents need to discuss this with their uncircumcised sons often!

• A decrease in penile cancer risk after circumcision.  

My intent on writing this is not to support or condemn circumcision, it is to simply show how only looking at one side of any conflict can lead to confusion and misinformation.  Learn to look at both sides of an argument to make a better informed decision that is right for you! Don't judge others for their decisions, and don't feel regret for decisions you made based on the information you had!