January 4, 2018
It’s sick season. That means, in pediatrician offices across the country, there are lots of congested, coughing kids (and lots of worried parents). I’ve compiled some parenting tips on how to get through the sick season with your kids.
I’ve officially joined the ranks of all those snot-covered, sleep-deprived moms and dads this month (I’ve been part of the toddler tantrum crew for months –– for help on those, get our free guide here). Four weeks ago, my littlest came down with Croup and spent three nights hacking away like a baby seal. I came home from work to her lying on the rug in my living room, curled up in a tiny ball, clutching a stuffed animal while my husband rubbed her back. Then, New Year’s Day, she wound up in Urgent Care after waking from a nap with a 103 fever and labored breathing, bless her little heart.
Needless to say, the mama inside me outweighed my medical degree both of those evenings. I had to force my mind to “think like a pediatrician.” I also had to take a deep breath and try NOT to think about all the work I would inevitably miss, the wasted childcare dollars I would no doubt forfeit and the sleepless nights I was bound to encounter before she recovered from her respiratory illness.
It made me think, as I reminded myself to stay objective, of all the sick kid parenting pearls I try to share with my patients’ parents in clinic week after week, but especially during sick season:
If you are worried about your child, call someone. Make an appointment. Get them in front of a medical professional. You know your kid best so, if they seem off to you, listen to that little voice inside your head telling you to take action. Pediatricians aren’t irritated when a parent wants their child to be seen “just to be sure everything is okay.” Actually, we would much rather that than the alternative – a serious condition gone unchecked. Kids tend to rally well at first with sickness but then can crash pretty fast. It’s better to get the parenting tips you need early on so you don’t get to a more critical point.
If you’re a new parent, that may mean you call as soon as your child gets a small cough. No problem. Your doctor or their nurse can guide you through what to expect and what to do- consider it your sick kid mini-education. As you get more and more experienced, you’ll gain confidence, you’ll know the basic ways to handle minor illnesses and you likely won’t need as much assistance.
Whenever possible, you want a medical provider caring for your child who really knows their stuff – someone trained specifically in pediatrics (obviously, if you are on vacation or in an emergency situation, that’s not always realistic). When you do have a choice, choose pediatric-trained providers so they can get the most accurate medical history possible and can provide the most up-to-date care.
If your child has had a fever for one day or for five days, those are completely different situations, each of which triggers different levels of testing and medical interventions, depending on age. As I sat in the urgent care clinic with my daughter last week and watched a practitioner shrug a little when I said she had just developed her fever, it was tempting to try to sell how bad her illness was. Sometimes, I know, it feels like elaborating a tiny bit to get the attention of medical providers will help when it comes to a sick kid, but that can backfire. You don’t want your child to have extra bloodwork, imaging (X-rays, etc) or medications when they don’t need them. It can lead to unnecessary and sometimes harmful side effects and even hospitalizations.
I cannot count the number of times someone has brought their febrile child into my office, completely miserable, so that I can see how sick they really are. No fever-reducers on board, the poor kids and their parents must have had a horrible time on their car ride over to clinic. But there’s no need to show us your child at their worst. It’s fine to give your son or daughter acetaminophen or ibuprofen (these medications can be age- and condition-dependent – check with your health professional if you’re not sure) before your doctor’s visit. In fact, the best way for medical professionals to accurately assess how your child is doing can be to see them WITHOUT THE FEVER when possible, since they sometimes look worse than they actually are when febrile.
Sometimes, a parent will seem disappointed when I tell them their child has an upper respiratory infection (aka a cold) and doesn’t need antibiotics. Remember, it’s a GOOD thing if there isn’t a need for extra medicine. You don’t want antibiotics unless you really need them.
Every drug has side effects and, if we give antibiotics for colds, the medication:
It’s hard to wait out a viral illness, letting the storm pass until the sun comes out again, but it’s worth it to concentrate on comfort care if your doctor prescribes it versus fighting for an unnecessary medicine.
When we see you in the office, we’re catching your child at a moment in time. We hear about what has happened so far and we base our diagnosis on our exam that day. It’s one data point. Often, though, an illness can change within hours or days and, without a crystal ball, it’s impossible to predict which direction a sickness will go. It’s not surprising to us when we need to schedule a re-check appointment to make sure things are improved or when a parent calls us back to say a child is still sick. That’s why we give so many contingency after-visit instructions. Most of the time, we can solve an issue with one evaluation but it can take a bit more complex problem-solving with multiple visits at other times.
Part of my job as a pediatrician is to make sure I translate all the medicalese for my patients and their parents, assuring they leave with a solid understanding of what’s wrong with their child and what they can expect as they recover. I know it is sometimes terrifying (or sometimes just super inconvenient) to have a sick kid and that parents need answers and explanations. I’m used to it. ALL doctors are. So, ask away. Clarify. Pull out the list of worries. Let us know the underlying issues (like, “When will my child be better and when will I be able to go back to work?”). We’re all ears and, in the end, it’s easier for all of us to be on the same page from the get-go than to let frustration or confusion play a role in your child’s illness.
I’m not gonna lie – having sick kids is one of the most challenging parts of modern parenting. The schedule re-arranging, the miserable little one, the scary unknowns of illness – it all adds up. Remember, pediatricians know how hard it is to care for sick children (I do it myself all the time!) and we want your child to get better as fast as possible, too. Access the resources you have, get the answers you need. Above all, follow your gut – if you’re worried, get help (or just peace of mind). ’Tis the season for sickies and sickness and you’re not alone in just checking to make sure everything is alright.
Want more resources for caring for your kids and for yourself? Click here to get our free toddler and mommy self-care guides.
December 22, 2017
December 22, 2017
Last year at this time, I was freaking out. My daughter, bless her soul, started having some major outbursts and I didn’t know why. Tantrum after toddler tantrum (by the way you can check out our free tantrum guide here), day after day, night after night. We watched her go from absolute sweetheart to total terror at the drop of a hat. She wouldn’t eat, complained she “just didn’t feel good” and started shying away from school, dance, and friends- all things she had previously loved.
It took over a month to figure out what was going on. After weeks of tears (on our part and hers), we finally got a handle on the issue. In the end, it turned out she had a case of nasty PINWORMS. She also had an exaggerated dread of potty training that culminated in a huge mess of a situation. (I am gonna spare you the details because even I gagged a little when it all went down.)
The point is, I spent a lot of time last year racking my brain as to what the heck was happening to the little sensitive soul that lives in my house. She had always been unique but this was on a whole different level, even for her.
It came to my mind today as we were driving home from her grandma’s house. I looked back in my rearview window and saw her quietly humming along, looking out at the leaved trees passing by her car window. It was the perfect picture of peace and contentment. It brought me back to that “aha” moment when we eventually figured out what was (literally) bugging her so much. To the grateful look in her eyes when we finally explained what was keeping her up all night and what had made her act like a completely different person. To that huge wave of relief I saw passing over her as she listened to us say that, if she took some medicine, she would be herself again.
The car ride also was a good reminder to look for her real self in the relatively common moments she still, as a function of her age or her circumstances (tired, anxious, missing a snack), goes back intermittently to that scary state. It can be easy for us to forget when our children are acting out or are out of sorts. We can forget that they may have a very good reason for it. That there is something we need to detective out (or wait out).
I can’t count the number of times I’ve had to either 1. Sing James Taylor’s “Fire and Rain” under my breath as I wait for my child’s toddler tantrum to pass or 2. Act like the scientist I am and try to think objectively through the situation to find a root cause. I’ll admit, the Pinworm thing was quite a challenge since it presented in a totally off way and it’s something that, in retrospect, I probably would have caught faster if I hadn’t been trying to catch it in my own kid (yes, she does have a pediatrician – don’t worry- it just all snowballed pretty quickly).
It’s true for the parents of the wayward, rebellious adolescent who one day “snaps out” of the angry teenage phase. It’s true for the mom of the suddenly inconsolable six-month-old who eventually pops a tooth. We all deal with the feeling that our kid is not themselves sometimes. It tempts us to forget the core of who they really are. We get scared that the phase will never pass, that this could be our new normal.
In our family, we learned a lot last year about how to get mindful and about how to get outside help when we needed it. (Note: if you are in a situation where you really can’t figure out what’s going on with your child, ask your doctor for help so they can come along side you to rule out anything major.)
We understood better in the end about trying to see every one of the people we come in contact with as products of nature (the genes we’re born with, the way we’re wired) AND nurture (the product of the environmental stressors or positives that surround us).
Our kids are so often trying their hardest but coming up against factors they just cannot control or understand themselves. It’s up to us as parents to help them navigate, to give them the space and support they need, and to love them no matter what. We need to believe that their true selves are just waiting to be found. We just need to look in their, sometimes less obvious, hiding places.
December 22, 2017
I love good food. Like, homemade pasta with seasonal veggies and quality meat, paired with the crispest, coldest Italian wine. That kind of love. So, of course, I hoped that my daughters would absolutely love good food, too. That, as adults, they would appreciate the complexities of flavor from different regions of the world. That, as toddlers, they would not “ruin” my life by only trying three things on any given menu.
I meet a lot of kids in clinic who are that way. Picky eaters to the core. Where they have a family meal together, the only things the kids will touch are bread, butter and pasta with cheese. Hardly any vegetables. Hardly any fruit. Absolutely no sauces. It would take an Act of Congress to get those kids to eat anything with pepper or spice. Their parents are often, understandably, at their wits’ end.
About 50% of my patients’ parents say they have a hard time with pickiness. At first, it all went well. As a baby, their child would take anything they gave them. But slowly, over time, they became more resistant.
A lot comes back to temperament. For easy-going kids, their experience at the dinner table can also be easy going. For stubborn children, the dinner table can be another opportunity for a power struggle (if you’re looking for behavior help at home or away, sign up for our toddler tantrum guide here).
But, even taking temperament into account, even the most laid-back kids and parents sometimes butt heads when it comes to food. While there is no easy answer for dinner-time (or lunch- or breakfast-time) battles, there are some steps parents can take to encourage adventurous eating and to avoid head-on collisions with their kids in this sometimes-challenging area.
What To Do:
There are no “adult” flavors and “kid” flavors, just kid and adult consistencies. Why not offer mushrooms, eggplant, artichokes, kale, yams or onions? The American Academy of Pediatrics recommends starting solid foods at four to six months, closer to six months if possible. They also recommend waiting two to three days between new foods to observe for allergic reactions. But, starting at six months, there are no limitations on what these foods can be (except no honey until one year of age for Botulism risk and no cups of cow’s milk until 11 months old), just on watching out for choking risk. In fact, the American Academy of Allergy, Asthma and Immunology now recommends even highly allergenic foods like shellfish, dairy and eggs be introduced earlier versus later.
We know that food preferences start even within the womb. The foods that pregnant women and lactating women consume strongly affect the palate of their offspring. It makes sense, then, that giving our kids a variety of healthy foods from an early age also influences their willingness to eat them later on.
An expression of disgust does not predict a life of hatred. My daughter’s first food was avocado. We have pictures of her sweet little face just covered in it at six months, with a look of utter displeasure. She spit that food out as fast as we could get it to her lips. Of course, I didn’t force it on her that day, but every week I re-introduced a small amount as part of the other foods I offered. At one year of age, we have another picture of her face covered in a green gooey mess, this time with a look of complete glee. Avocado became and still is her favorite food to eat. Experts say it can take 20 to 30 exposures before an affinity develops for a new flavor.
Does it ever strike you as odd that, even at a relatively nice restaurant, the children’s menu has the most unhealthy options available? Chicken strips, french fries, buttered noodles – this is the stuff we are offering our children? At the grocery store, in brightly-colored packages, are sugary cereals, salty crackers and juice boxes – foods that would make us tired and cranky if we ate them all day. Instead, offer the food on your plate to your kids.
That might mean adjusting what food is on your plate. It won’t work to have you order a cheeseburger and a soda every time you go out as a family if you want your kids to do the opposite. You may need to take stock of what you are consuming. If you do attempt to order or eat healthy foods yourself, sharing what you have allows your children to see quality food as normal. Dads are especially important when it comes to setting a healthy eating example.
There will come a time when almost every child becomes a somewhat picky eater. They are supposed to. This is the way we protect ourselves evolutionarily. In a toddler’s mind, green = poisonous plant = bad. So, if you have a toddler and this is your reality, this is the moment you’ve been preparing for. The mantra you’ll have to tell yourself? Roll with it.
As a parent, your responsibility is to provide healthy options for your child in consistent intervals during the day. As a child, your responsibility is to choose how much of any given food you eat at any given time. If your child decides they don’t want the green beans tonight? That’s okay. Let them eat what they want off the plate. Just don’t offer a replacement food when they won’t eat them and DEFINITELY don’t use them as a reward for dessert. You can read more about division of responsibility when it comes to food in Fearless Feeding, my favorite book about pediatric food psychology.
Finally, remember that, like all things parenting-related, most kids and parents hit jags every once in awhile. Our goal is not to have perfectly-trained kids who eat everything you want them to all day every day, just like our goal is not to have perfectly-behaved children at all times. Instead, let’s focus on helping our little ones become adults who love great food. (Note: if you’re having a particularly hard time with picky eating and you’ve tried all of my tricks above, ask your pediatrician for more help!)
I hope my kids will share my enthusiasm for Italian (and French and Japanese) cooking, but I hope even more that they don’t have complicated hang-ups about what they eat and don’t develop a rebellious attitude toward food. Let’s raise individuals who savor what they consume, who use it as fuel to drive their lives and who have the freedom to enjoy it fully.
Want more help raising toddlers? Click here for our free resource guides.
December 22, 2017
Four years old is kinda magical. Imaginations are running wild and free.
I love watching my daughter orchestrate an entire wedding event in her playroom at the drop of a hat. Someone needs an archaeologist to find all the dinosaur bones in the bathroom? She’s all over that. But four years old brings its challenges (and tantrums), too.
My most recent testing zone of patience and grace? The zoo. The zoo is actually one of my favorite places to go with my kids. We get fresh air, my baby is all excited to see that there are elephants in REAL life, too (she throws her arm up in the air like a trunk going “Pffffffffff…”” every time one walks by). It’s an amazing place to learn about nature and it’s also an amazing place to learn some manners.
The other day, with one kid strapped to me and the other one bouncing along in a stroller, I braved that place like a boss. I packed all our own snacks, made sure we had sunscreen and worked hard to set expectations before we left.
“When we get to the zoo there will be other children going to see the exhibits,” I said. “You’re bringing your zoo key (a little piece of plastic shaped like a key you can insert into a machine that plays an educational recording about the animal in front of you). There might be other children who want to use their key to listen, too. If they’re using the key station before you get there, wait quietly for your turn. There’s no need to let them know that you’re waiting – they see you there. If you’re using a key and a child says that they would like to use it, just let them know with your polite words that you’ll be just a minute.”
Most importantly, I said, “And remember what happens if we throw a fit over using the zoo key machine or waiting for our turn to use it?”
“Yep, I get the zoo key taken away. If I do it twice, we leave the zoo.”
Feeling extremely proud of my expert pediatrician and parenting forethought, we entered the gates enthusiastically. It seemed like for the first two zoo key stations, we were doing just fine. Everyone was sharing and there were tons of please and thank-yous. But, about one hour in, once the shine wore off, I saw those manners start to fade. Even though we prepared with good rest and a good meal before we started on our adventure, things started to unravel. I turned to grab a toy that fell out of my baby’s hand and looked up to see a full-on brawl about to ensue (by the way, if you’re in need of toddler tantrum help, we have a free guide here).
My little girl was red-faced and sweaty, holding her hands over her inserted zoo key while another boy asked her if he may have a turn listening about how flamingos stand on one foot, too.
“NOOOOO! It’s mine! It’s MY turn!” In, what seemed like an instant, she was screaming.
The boy stared at her, a bit dumbfounded, not sure what to make of this reaction to his simple request (it turns out he had asked for a turn but also motioned to put his key in instead of hers, which is what set her off. If only I had prepped her for every possible scenario when things don’t go her way, I smirked).
Yep, I took that zoo key right away and I let her know that our time at the zoo was done for the day if it happened again.
The second was more offensive.
The mother of that little boy proceeded to give my child the biggest stink eye I have ever seen. She glared at my daughter long and hard…And then she raised her eyes and glared at me. “Wow, nice,” she said.
The mommy shaming was UNREAL.
Now, I am a pediatrician. I see all types of behavior issues in clinic every day. There are some behaviors that really ARE a result of poor parenting practices. I’ve had times when I guide a parent to shift their approach with their kids and they see immediate, amazing results. But that’s not always true. Parents are only half (or sometimes less than half) of the behavior equation. There are external pressures and stressors, there are temperament factors and then there is the reality that kids cannot be completely controlled.
Like in all of our interactions with other human beings, we are responsible for our behaviors, for setting limits and appropriate boundaries and (for our kids) for providing fair consequences when lines are crossed. Our kids are in charge of their sometimes less than desirable reactions or responses to that guidance.
If we have a solid child development understanding, are setting expectations and are following through on them consistently in a loving but firm way, we’ve got to be okay with the idea that sometimes the cards will fall how they may. We can’t feel so bad when our children’s behavior doesn’t always reflect all the effort we are putting in.
That can be so tough. But why? I’ll speak for myself and for most of the other parents I know: it’s because sometimes we are really embarrassed by the behavior and because we know that other people are watching us with pretty unforgiving eyes (obviously, if you see someone blatantly being verbally, physically or emotionally abusive to their kids, shame away and stick up for those young souls. I’m just talking about people up on their high horse when they see a little tantrum).
That’s just life.
I’ve decided to put my blinders on, as much as possible, to the mom shaming I see all around me. Haters gonna hate. Let’s focus instead on loving on our kids, doing the best by them and raising them up to be their best selves long term, however long it takes.
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