This week there is a story making national headlines. It concerns women in their late seventies and early eighties having plastic surgery (http://bit.ly/qd5dDd). The article I chose to quote attributes this to "toxic social pressures." These same social pressures occur in teens, as manifest by the growing number of teens opting for bariatric surgery to assist with weight loss. Toxic social pressures can actually occur as early as first or second grade.
How do parents deal with the effects of all this negative pressure? How do we prevent it?
As with most things, prevention is the best policy. We prevent this with grass roots efforts. It starts at home. We all need to take responsibility for this. We need to teach our children to look beyond physical appearance. Picking on someone for how they look is bullying. They need to understand that bullying isn't just fighting or physical threats. Words can hurt just as badly as fists. We've all been hurt by the words of an acquaitance or coworker. As adults, we find it disturbing or even painful. As children, we simply aren't equipped to deal with this.
I would also talk to your children about their self-image. What do they feel good about, concerning themselves. What bothers or scares them about themselves. Then ask them the same things about their siblings and close friends. Then, ask them about classmates and other children in school. Ask about the children who stand out, both as favorites and as outcasts. Why are they favorites or outcasts? Is it because of their appearance or their personality? Children can pick out the favorites and outcasts by 3-4 years of age. These conversations are excellent opportunities to help them develop personal values. It can make them stronger individuals and help them develop integrity.
If you can, arrange play dates with classmates who are outcasts, as well as favorites. This will enrich your child's social experiences, as well as your own. The invited child may be an outcast due to his or her personality. Such a situation will require close monitoring by adults, but can be safely done. Keep in mind that "hurt people hurt people." The child may be lashing out due to unwitnessed abuse or lack of parenting at home. That child may need you more than you could possibly know.
As you educate your children in this manner, they will learn the joy of helping others. This is one of the greatest joys of being a person. They will become empowered, which will help their self-esteem. These simple things can greatly improve their happiness.
A much more difficult question is what to do once bullying has occurred. Schools in the US are being challenged to deal with this problem, and it has become massive. Few programs have proven their efficacy. The KiVa program (http://bit.ly/oeJICh) is one exception. Some Kansas schools will be rolling out this program soon. For those parents whose school is not in this program, get involved. Get involved with your school to battle bullying before you become aware of a problem. Help create in your childs' school(s) an atmosphere of nurturing. Children who are outcasts or victims of bullying have much more difficulty concentrating on schoolwork.
Let's stop teaching children to condemn one another or themselves. A healthy self-image in childhood will lead to greater self-confidence and a healthier self-image as an adult.
Just trying to change the world.
Nanette Nuessle, MD, FAAP
House Call Pediatrician
Overland Park, KS
http://FiresidePediatrics.com
www.PersonalMedicine.com
Tuesday, August 23, 2011
Tuesday, August 9, 2011
Cosleeping
Cosleeping is finally out in the open. For years, this has been a topic taboo for parents to discuss with their friends, coworkers or even, sometimes, their pediatrician. Last week there was an article published (http://bit.ly/nw955n) that stated cosleeping is not as dangerous as we previously thought. This statement got a lot of press and people are speaking out.
The most important thing that I can say is this: cosleeping is a decision that each family must address individually. The answer isn't the same for every family, or even for every child within a given family. You have to do what is right for you and your baby. Yes, I just said it. I spoke out against current recommendations. It is not the first time I have taken this stand on this issue. The bottom line is that you get to choose. Do what is right for you and your child.
Cosleeping is also called bedsharing. It is the norm in most parts of the world today. It was the norm in the US for over a century. I don't really know when it lost popularity here. The 21st (and late 20th) century imposes many difficulties on childrearing. (Another one is the daycare-driven idea that all children should be potty trained by age 2). To say that no child and no parent should cosleep is unrealistic and unproven by research.
There are many benefits to cosleeping. For mothers and infants who are breastfeeding, the advantages are pretty obvious. It makes breastfeeding easier and more efficient. Cosleeping babies breastfeed more often and longer. There are also studies that show moms sleep as deep as usual, but babies do not. This may make them less susceptible to SIDS. It is known that SIDS is less common in countries where cosleeping is the norm, but a causal effect has not been proven. Finally, there is a lot of interaction that occurs between mother and child during sleep (http://bit.ly/q6WaP8).
There are also disadvantages to cosleeping. The most obvious is that the parental bed is no longer the sanctity of a couple. When I talk about cosleeping with new or prospective parents, many fathers picture 2 or 3 children in their bed and no longer having private time with their wives. If this were the case, how did they get the 2nd and 3rd child? Seriously, though, having 3 children in your bed is seldom the case, and not something I am recommending. Having a baby is a huge change in your family dynamics. Talk to each other about this before, during and after your baby's birth. Start having a regular date night, if you aren't already doing that. Get help if you are struggling with the transition. Don't automatically blame cosleeping. However, cosleeping is a choice. It may not be for you, and that's okay.
The other disadvantages have to do with safety concerns. If your baby is cosleeping, make sure they sleep on their back or side. Discourage your child from sleeping on their tummy. Don't cover baby's face or head with bed linens. Avoid pillows, stuffed animals and other fluffy things. Some infants have gotten injured by having their head get caught in the headboard. Check your headboard and make sure this can't happen. Also, make sure baby can't get trapped between the mattress and the bedframe. Don't allow toddlers and older children in the same bed with an infant. They simply aren't mature enough to show awareness of the baby while they are sleeping. The same goes for parents who are under the influence of alcohol or drugs that cause drowsiness: they may be less aware of the baby's presence. This could lead to someone rolling onto baby and suffocating him or her. Infants exposed to cigarette smoke are more prone to SIDS. If you smoke, don't cosleep. In fact, if you smoke, please quit. It is unhealthy for parents and for children of all ages. If you cannot do it alone, help is available. Never leave your infant alone in the parental bed. Naps without mom or dad will need to be in a bassinet, play yard or crib.
What about transitioning infant to his or her own bed? Well, that is a lot like weaning your baby. It has to be a mutual decision between parents and child. Many children transition to their own crib quite well between 5 and 9 months of age. Others aren't ready for that transition until grade school. Most are somewhere in between. My oldest child coslept the first 3-4 months of her life, then went into a crib without any fuss. My youngest was the polar opposite of that. He was born while I was in training and on call (in the hospital) every third night. When I was home, he wanted me all to himself for the first hour, and in the middle of the night. By 5 months, he was sleeping in a play yard next to our bed. He would wake up around 2:00 and cry until placed in our bed. At 9 months, we put him in a crib. He would still wake up and cry to be put in our bed around 2:00 am. By 13 months, he was climbing out of the crib and coming to find us. This meant he didn't wait until 2:00. He would come to our bed as soon as he sensed we were asleep. The more we tried to put him back in the crib, the more he fought it. He needed to know we were available to him. At all times. Finally, we gave in and let him decide where he wanted to sleep. (As if we really had a choice. He could climb out of the crib!). He would start out in his crib or bed, and when he became lonely he would come to us. Once he realized he was in control, he started coming to our bed later and later each morning. Eventually, he was climbing into our bed 10 minutes before the alarm went off. The anxiety level in our home dropped considerably and everyone slept better.
Newer studies show there is no emotional or psychological damage cause by cosleeping. I am still waiting for someone to study the psychologic advantages of cosleeping. However, I am not holding my breath.
In summary, there are advantages and disadvantages to cosleeping. Some of the "disadvantages" have recently been debunked. Most importantly, cosleeping is a decision. It must be made individually by each family based upon the needs of their baby.
Nanette Nuessle, MD, FAAP
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
The most important thing that I can say is this: cosleeping is a decision that each family must address individually. The answer isn't the same for every family, or even for every child within a given family. You have to do what is right for you and your baby. Yes, I just said it. I spoke out against current recommendations. It is not the first time I have taken this stand on this issue. The bottom line is that you get to choose. Do what is right for you and your child.
Cosleeping is also called bedsharing. It is the norm in most parts of the world today. It was the norm in the US for over a century. I don't really know when it lost popularity here. The 21st (and late 20th) century imposes many difficulties on childrearing. (Another one is the daycare-driven idea that all children should be potty trained by age 2). To say that no child and no parent should cosleep is unrealistic and unproven by research.
There are many benefits to cosleeping. For mothers and infants who are breastfeeding, the advantages are pretty obvious. It makes breastfeeding easier and more efficient. Cosleeping babies breastfeed more often and longer. There are also studies that show moms sleep as deep as usual, but babies do not. This may make them less susceptible to SIDS. It is known that SIDS is less common in countries where cosleeping is the norm, but a causal effect has not been proven. Finally, there is a lot of interaction that occurs between mother and child during sleep (http://bit.ly/q6WaP8).
There are also disadvantages to cosleeping. The most obvious is that the parental bed is no longer the sanctity of a couple. When I talk about cosleeping with new or prospective parents, many fathers picture 2 or 3 children in their bed and no longer having private time with their wives. If this were the case, how did they get the 2nd and 3rd child? Seriously, though, having 3 children in your bed is seldom the case, and not something I am recommending. Having a baby is a huge change in your family dynamics. Talk to each other about this before, during and after your baby's birth. Start having a regular date night, if you aren't already doing that. Get help if you are struggling with the transition. Don't automatically blame cosleeping. However, cosleeping is a choice. It may not be for you, and that's okay.
The other disadvantages have to do with safety concerns. If your baby is cosleeping, make sure they sleep on their back or side. Discourage your child from sleeping on their tummy. Don't cover baby's face or head with bed linens. Avoid pillows, stuffed animals and other fluffy things. Some infants have gotten injured by having their head get caught in the headboard. Check your headboard and make sure this can't happen. Also, make sure baby can't get trapped between the mattress and the bedframe. Don't allow toddlers and older children in the same bed with an infant. They simply aren't mature enough to show awareness of the baby while they are sleeping. The same goes for parents who are under the influence of alcohol or drugs that cause drowsiness: they may be less aware of the baby's presence. This could lead to someone rolling onto baby and suffocating him or her. Infants exposed to cigarette smoke are more prone to SIDS. If you smoke, don't cosleep. In fact, if you smoke, please quit. It is unhealthy for parents and for children of all ages. If you cannot do it alone, help is available. Never leave your infant alone in the parental bed. Naps without mom or dad will need to be in a bassinet, play yard or crib.
What about transitioning infant to his or her own bed? Well, that is a lot like weaning your baby. It has to be a mutual decision between parents and child. Many children transition to their own crib quite well between 5 and 9 months of age. Others aren't ready for that transition until grade school. Most are somewhere in between. My oldest child coslept the first 3-4 months of her life, then went into a crib without any fuss. My youngest was the polar opposite of that. He was born while I was in training and on call (in the hospital) every third night. When I was home, he wanted me all to himself for the first hour, and in the middle of the night. By 5 months, he was sleeping in a play yard next to our bed. He would wake up around 2:00 and cry until placed in our bed. At 9 months, we put him in a crib. He would still wake up and cry to be put in our bed around 2:00 am. By 13 months, he was climbing out of the crib and coming to find us. This meant he didn't wait until 2:00. He would come to our bed as soon as he sensed we were asleep. The more we tried to put him back in the crib, the more he fought it. He needed to know we were available to him. At all times. Finally, we gave in and let him decide where he wanted to sleep. (As if we really had a choice. He could climb out of the crib!). He would start out in his crib or bed, and when he became lonely he would come to us. Once he realized he was in control, he started coming to our bed later and later each morning. Eventually, he was climbing into our bed 10 minutes before the alarm went off. The anxiety level in our home dropped considerably and everyone slept better.
Newer studies show there is no emotional or psychological damage cause by cosleeping. I am still waiting for someone to study the psychologic advantages of cosleeping. However, I am not holding my breath.
In summary, there are advantages and disadvantages to cosleeping. Some of the "disadvantages" have recently been debunked. Most importantly, cosleeping is a decision. It must be made individually by each family based upon the needs of their baby.
Nanette Nuessle, MD, FAAP
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
Tuesday, August 2, 2011
Fall Allergies
It's time to talk about fall allergies. I know it seems early, with daytime temperatures over 100 degrees. However, fall allergy season starts in the last half of August. If you have family members with allergies, it is time to prepare.
The best way to deal with allergies is to prevent a reaction. This is done first by avoidance. Don't go out into fields, if you have a lot of fall allergies. That makes sense, but some people are not able to do that. These individuals can lower their risk of an allergic reaction by taking antihistamines and by keeping their homes as allergy free as possible.
Keeping your home allergy free is not easy if you have multiple allergies. For seasonal allergies, it is important to keep your house closed up. Resist the temptation to open the windows and turn off the air conditioning as temperatures drop. If you also have food allergies or indoor allergies, you may have to be more vigilant during this time. Exposure to multiple allergies can add up and make you really miserable.
Let's talk a little bit about antihistamines. I realize that much of this information may be review for some people. Antihistamines block histamine. Histamine is released by our immune systems in response to a trigger. Some people react to one trigger, and some to another. Some people's trigger setpoints are more sensitive than others. Since antihistamines work by blocking release of histamine, they work best when taken before the allergic reaction starts. For the fall allergy season, that means taking medication from August 15th until the first hard frost. (Where I live, the first hard frost happens sometime between Halloween and Thanksgiving). That seems like a lot of medication for a long period of time. I agree. Clearly, not everyone with fall allergies has severe enough symptoms to warrant this regimen. However, if you have allergies that trigger asthma or eczema, this can be life-changing. The newer nonsedating antihistamines (eg. fexofenadine, loratidine) allow us to treat you for extended periods of time without drowsiness. Diphenhydramine is more effective in many people, but is also associated with drowsiness in most people. Grade schoolers given diphenhydramine at bedtime showed an inability to concentrate that lasted until about 3:00 pm the following day. Many pediatricians are getting away from it's use for this reason.
For individuals with moderate to severe allergies, this may not be enough treatment. If you continue to have itchy eyes, stuffy nose and sneezing despite the above advice, there is more you can do. For itchy eyes, there are several over the counter (OTC) eye drops that are very effective. Follow all instructions on the label and do not use for more than 1 week without your physician's input. Nasal steroids can help with nasal congestion and sneezing. Like antihistamines, they work best if started prior to allergy season. They can be associated with headaches, nosebleeds and colds, so do not take them without first talking with your provider. However, they can be very helpful in individuals with asthma triggered by allergies. We know that if we control the upper airway (nose), it is easier to control the lower airway (lungs).
Some people take drugs called "mast cell" inhibitors, such as montelukast. There seems to be a lot of confusion about when and how to use these. To explain this, I would like to back up a bit. The allergy response (an allergic reaction) is called a cascade. This is because it is a series of chemical reactions that in turn cause more allergic reactions. A good visual is to think about playing pool. When you "break" in pool, the cue ball hits one or two balls, which each hit 2-3 balls, etc, scattering all the balls over the table. A cascade is similar in how one reaction causes several other reactions. Antihistamines work on 2/3 of that cascade, and mast cell inhibitors work well on the other third. Because of this, mast cell inhibitors should always be used with an antihistamine, and never instead of an antihistamine. Do you follow? I hope I made that clear. It's a difficult concept.
In summary, fall allergy season will be starting soon, and there is much you can do to relieve symptoms. Avoidance is the best treatment. Don't open up the house when the weather cools off, as this introduces allergens into your home. Antihistamines and other medications work best if taken before the allergic reaction starts. Medications may need to be taken from August 15th to the first hard frost. I hope that you have a better understanding of how and why certain medications are used. More importantly, I hope you have a happy and healthy fall season. For more questions, contact your Personal Medicine provider.
Nanette Nuessle, MD, FAAP
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
The best way to deal with allergies is to prevent a reaction. This is done first by avoidance. Don't go out into fields, if you have a lot of fall allergies. That makes sense, but some people are not able to do that. These individuals can lower their risk of an allergic reaction by taking antihistamines and by keeping their homes as allergy free as possible.
Keeping your home allergy free is not easy if you have multiple allergies. For seasonal allergies, it is important to keep your house closed up. Resist the temptation to open the windows and turn off the air conditioning as temperatures drop. If you also have food allergies or indoor allergies, you may have to be more vigilant during this time. Exposure to multiple allergies can add up and make you really miserable.
Let's talk a little bit about antihistamines. I realize that much of this information may be review for some people. Antihistamines block histamine. Histamine is released by our immune systems in response to a trigger. Some people react to one trigger, and some to another. Some people's trigger setpoints are more sensitive than others. Since antihistamines work by blocking release of histamine, they work best when taken before the allergic reaction starts. For the fall allergy season, that means taking medication from August 15th until the first hard frost. (Where I live, the first hard frost happens sometime between Halloween and Thanksgiving). That seems like a lot of medication for a long period of time. I agree. Clearly, not everyone with fall allergies has severe enough symptoms to warrant this regimen. However, if you have allergies that trigger asthma or eczema, this can be life-changing. The newer nonsedating antihistamines (eg. fexofenadine, loratidine) allow us to treat you for extended periods of time without drowsiness. Diphenhydramine is more effective in many people, but is also associated with drowsiness in most people. Grade schoolers given diphenhydramine at bedtime showed an inability to concentrate that lasted until about 3:00 pm the following day. Many pediatricians are getting away from it's use for this reason.
For individuals with moderate to severe allergies, this may not be enough treatment. If you continue to have itchy eyes, stuffy nose and sneezing despite the above advice, there is more you can do. For itchy eyes, there are several over the counter (OTC) eye drops that are very effective. Follow all instructions on the label and do not use for more than 1 week without your physician's input. Nasal steroids can help with nasal congestion and sneezing. Like antihistamines, they work best if started prior to allergy season. They can be associated with headaches, nosebleeds and colds, so do not take them without first talking with your provider. However, they can be very helpful in individuals with asthma triggered by allergies. We know that if we control the upper airway (nose), it is easier to control the lower airway (lungs).
Some people take drugs called "mast cell" inhibitors, such as montelukast. There seems to be a lot of confusion about when and how to use these. To explain this, I would like to back up a bit. The allergy response (an allergic reaction) is called a cascade. This is because it is a series of chemical reactions that in turn cause more allergic reactions. A good visual is to think about playing pool. When you "break" in pool, the cue ball hits one or two balls, which each hit 2-3 balls, etc, scattering all the balls over the table. A cascade is similar in how one reaction causes several other reactions. Antihistamines work on 2/3 of that cascade, and mast cell inhibitors work well on the other third. Because of this, mast cell inhibitors should always be used with an antihistamine, and never instead of an antihistamine. Do you follow? I hope I made that clear. It's a difficult concept.
In summary, fall allergy season will be starting soon, and there is much you can do to relieve symptoms. Avoidance is the best treatment. Don't open up the house when the weather cools off, as this introduces allergens into your home. Antihistamines and other medications work best if taken before the allergic reaction starts. Medications may need to be taken from August 15th to the first hard frost. I hope that you have a better understanding of how and why certain medications are used. More importantly, I hope you have a happy and healthy fall season. For more questions, contact your Personal Medicine provider.
Nanette Nuessle, MD, FAAP
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
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