All posts by Brian Orr

Whatever Happened To Sportsmanship

I am a sports fan and enjoy watching games like many  Americans. In October, I was thrilled when the Red Sox won  the World Series. I am enjoying the Patriots season, and am  interested in how the Celtics can rebuild. As I revel in  Boston’s great sports world, I have become very concerned  about the environment and what we are teaching kids about  sportsmanship.

Just think about the images of sportsmanship that were  on display in the last six months. During the playoffs and  World Series we saw objects thrown onto the field, police  in riot gear lining the stands, overzealous celebrations  leading to burning cars and a couple of deaths. No sooner  do we turn the page on that season when we witness NBA  players fighting with fans during a game. These are the  images that come to mind when you get away from the idea of  who won and focus just on sportsmanship.

We may want to rationalize our thoughts about  sportsmanship. I have heard phrases like, “well, a series  with the Yankees is always like that” or “what do you  expect, we haven’t won in 86 years” or “there always have  been bad examples of sportsmanship”.

But think about sportsmanship even at the high school  level. I have been embarrassed by some of the behavior of  parents in the stands at some high school games. We have  had murders caused by our “friendly” competitions between  rival towns. And on the field, some players have not  learned how to be good sports. Where can our children get  good examples of sportsmanship? How can we teach our kids  sportsmanship so the next generation of fans won’t be worse  than this one? Here are some suggestions.

1. Increase access to “pick up” games. These are games  where kids decide on the teams and referee themselves.  It is in these settings that kids have to set the  rules, be fair, and respect each player for their  worth. Perhaps some “leagues” should serve this role.  Get the coaches and parents out of the way and let the  kids learn through this valuable learning tool – pick  up games.

2. Parents and coaches need to recognize the diversity  of skills. Our culture of focusing on star players  demonstrates an overemphasis of personal athletic  prowess versus team play. All players should have a  role on the team. After all, that is how the Red Sox  and Patriots have won their championships!

3. Point out, criticize and punish displays of poor  sportsmanship – even by star players. Have the player  sit out a game. There should be clear rules for  sportsmanship on every team at every level. And those  rules need to be enforced. Many high schools have  players read and sign a sportsmanship pledge. Parents  should read it and agree to it as well.

4. Recognize, praise, and encourage displays of good  sportsmanship. Everyone likes it when you see an  opposing player help their opponent off the ground.  Good sportsman should receive high praise and rewards  at the end of every season.

5. Parents – Be Cool. Cheer your child on. But get  over the idea that your child’s accomplishments are a  reflection on you. Their accomplishments are theirs  – not yours. They don’t need to have extra pressure  from you to keep their level of accomplishment high.  They don’t need a second “coach” in the stands. It is  your child’s game to succeed or fail in. Be there to  share the joys or the sorrows. But please keep it in  perspective. It is their game not yours. Overzealous  parents are an embarrassment to the player and the  team.

6. Parents and coaches need to remember that it is only  a game. How we act towards the sport is the greatest  way for our children to learn sportsmanship.

7. Emphasize sportsmanship especially with rivalries.  I love the fact that we can have “United We Stand”  bumper stickers on our cars but don’t take this to  heart when our children are playing a rival town. We  all need to keep a perspective that we are united  despite having a rivalry. If both sides work on it we  could keep all rivalries “friendly”.

8. Competition is valuable. It teaches our kids to work  hard and earn what they receive. But sportsmanship is  more important than competition. Because if we don’t  learn sportsmanship, we as a society will never learn  to embrace peace.

What TV Teaches Our Kids

Have you ever wondered why your child can’t have their attention held for more than two minutes on anything but TV?

The answers to these questions may be “yes” and here  is the reason. In April 2004 the Journal of Pediatrics  published a report that said in short that children who  watch TV before age 2 (even “educational” TV) are more  prone to difficulties in paying attention then those kids  who do not watch TV. That’s not all.

There are many studies that demonstrate the negative  effects of TV and technology. Some studies show a tendency  towards more violent behavior and desensitization to  violence. Other studies show a decrease in helpful and  positive behaviors in kids. There is a link with obesity  and TV use. And still other studies show that heavy doses  of TV and technology decreases children’s ability to read  and decreases their grades in school.

Of course we have to ask “is there anything good about  TV?” Most parents tell me that, for a time, it gives  parents a rest. It occupies their children while parents  cook, shower, and do other chores. It is well known how TV  serves as short term babysitters for children across the  U.S. This “positive” aspect of TV should not be totally  discredited. Many parents need to use TV in this manner.  But, when weighing the positives and negatives of TV and  technology use, it is becoming very clear TV and technology  is bad for kids.

Knowing this, why is it that most American families  remain hooked to their screens? Well, there is speculation  that it is “habit forming” or “addictive”. Add that to the  list of negatives!

For the sake of our children we need a mass effort to  wake families up to the negative effects of TV and  technology. Schools need to initiate “Pull the Plug”  campaigns. Families need to have standards for screen use  at home. Here are some rules for families.

Minimize use of TV as a babysitter.

No TV for all children under 2 years old.

One hour of “screen time” per day or 7 hours total per  week. That “screen time” should include computer, IM,  game boy or play station time.

Reading time should exist at home.

Homework time should exist separate from reading time.

Videos and movies also should count as screen time.

Don’t fear changes away from screen time. The  positive changes in your home will far outweigh the  negative.

Come to my workshop on TV and technology at Cape Ann  Families 6 PM on April 4th to discuss more about what we  can do about TV and our kids.

What The Tsunami Should Teach Us

The devastating tsunami in Asia has an impact on all  of us. We cannot look at these images without recognizing  that these hurt people need help. That help comes to those  Asian communities by having those in need increase their  circles of helpful communities. The whole world recognizes  this – some countries faster than others. We are hearing  phrases in the press such as the “world community” or  “community of nations” in discussions about the response to  disaster, and so it should be. None of the local  communities in Asia will fix themselves without the aid  from the world community.

I am personally hit with the images of this disaster.  I have worked in different areas of the world and know how  poor communities receive the brunt of natural disaster. In  1998 a hurricane devastated Honduras. I visited the  country months after Hurricane Mitch flooded communities,  caused mudslides, and washed sections of plantations away.  As part of a medical team assessing the status of medical  relief, I could see with my own eyes that poor communities  got hit the worst and that Honduras would not recover  without years of aid from the world community. Today,  Honduras is better, (though still impoverished) largely due  to the aid it received from many countries. It will take  years for the Asian countries to recover with aid from  around the Globe as well.

Each disaster I witness reminds me of lessons learned  from previous disasters. Many of these lessons are basic  and logical. It is a wonder why we don’t listen and take  these lessons to heart between disasters. These lessons  should serve to guide us in decisions both personal and  communal. Here are the lessons I have learned.

1. It is easy to break things down.

2. It is harder and more costly to build things up.

3. It takes cooperation to make things better.

4. To make things better, we must rely on a community of  people to be sources of aid.

5. We hold human life in high regard. Human life is the  greatest value we have and we feel this most with  tragedies and unreasonable unexpected deaths.

6. We respect those who help others the most. Unselfish  people are great blessings.

7. Tragedies lead us to times of unselfishness.

Think about these lessons for a moment. These lessons  are applicable to many situations. Whether we are talking  about the war in Iraq, the tsunami in Asia, or the deaths  of family members in an auto accident, these lessons hold  true. These are really rules of life that everyone should  heed, not only in times of tragedy but all days of our  lives.

If we thought of these as a basic of how we live our  lives, we would work to build better communities. Better  communities would be in better position to withstand  difficult times. Better communities would help support  stronger families. Today, as we live in a society which  emphasizes “ownership” and the individual, we need to step  back and listen to the lessons of the tsunami. Rather than  emphasizing the achievement of individuals, our society  needs to emphasize unselfishness, cooperation, and  community.

What’s With Those Boots?

Almost every week I see a child in my office with a  pair of funky boots on. The boots are usually rubber with  easy to pull handles. The toes are decorated with a face  of an animal – perhaps a duck, frog or ladybug. The day  might be bright and sunny, but the child comes clomping  into the room with their rubber boots proudly on their  feet. I often ask them “What’s with those boots?” To  which the mother sheepishly responds, “She wants to wear  them everyday and I just don’t want to battle her.” The  fact of the matter is that all parents have to choose their  battles and there are some battles just not worth fighting.

So how should parents choose their battles? We all  know, as parents, we have to confront our children over a  number of issues. Too many parents feel like they are  battling their children all day. How do we know when to  put our foot down and when to let them wear their boots?  The answer is somewhat personal. It depends to some degree  what is truly important to the parent. But as a young  pediatrician, I was taught that there were some guidelines  about battling with children. As I became a parent, I  found that these guidelines were helpful. Here are those  guidelines and some others I have added.

1. You cannot control whether your child eats or not.  You can control what food is put on the table. A  child can be given a choice before the meal such  as “Do you want PB & J or Tuna fish for lunch?”  Once a choice is made stick with it. The child  can eat or not eat!

2. You cannot control your child’s choice of friends.   You can control how much time those friends spend  at your house. Children often choose friends  that are unlike themselves. You may consider  them a “bad influence”. But you cannot impose  control over your child’s choice. You will be  very frustrated if you try to choose your child’s  friends. You should only control what you can –  perhaps the time available outside of school for  your child to be with that friend.

3. You cannot make your child go to sleep. But you can establish and control a bedtime. Many  children are made to be in bed but stay awake for  a time before drifting off to sleep. Your job as  a parent is to enforce the time for your child to  be in bed. Your child can choose between being  awake and going to sleep.

4. All parents need to win the battles over safety.  Kids cannot run out into the street, must wear  seatbelts and ride bikes with helmets on. Safety  is the area where parents have a right to battle  their kids.

5. Hygiene is another worthwhile battle. Baths need  to be taken, hands washed, teeth brushed and noses  left alone – at least in public.

6. Choice of clothing is a famous morning battle.  Clothes should be put out the night before. But  as with the choice of foods, once the clothes are  put out, don’t open the choices up for debate  again. The child can choose between the two sets  put out the night before and only those two sets.  To force a choice, move to the next phase of the  morning – breakfast or even leaving the house.  Many children need to finalize their choice for  clothes in the car!

7. Parents often feel pressured into battles because of time. We know that deadlines exist but kids  don’t care. So when we want to get our kids  ready, we often pressure them to dress, eat,  and get their things ready. Of course as they  resist our pressure, we get more upset. The key  is not to pressure the kids because of our time  consciousness. Just be clear on what they need to  do, give five minute warnings for each step they  need to make, and set a “drop dead time” when –  ready or not – half dressed or partially fed – you  are out the door! The next days you will see more  cooperation during your 5 minute warning periods.

The major issue with the battles we have with our children  is that parents may sense a loss of control. If you are  feeling controlled by your child over an issue, then you  need to decide what your child has control of and what you  need to control. You control the choice of foods; your  child controls how much they eat. You control the choice  of clothes; your child chooses between the two sets in the  morning. You set the bedtime; your child decides to sleep  or not. By allowing your child some sense of control then  you can be better choosing your battles. And then it might  be okay if your child chooses her boots everyday too!

What Our Reactions Teach Our Children

You are spending a beautiful day at a park with your kids. While fixing a zipper on your older child’s jacket,  your toddler falls on a walkway. Apparently unhurt by the  fall, you see your two year old on the ground peering  around for you. Another mother helps him to his feet and  he smiles up at the friendly woman. Then he catches your  eye and bursts into tears as if hurt. Is he hurt? Has he  learned to cry with falls? Is he expressing emotion to  test your reaction?

This is a small example of how our reactions can teach  our children behaviors. Parenting is an interactive  process. Both parent and child may develop behaviors in  response to the others reaction. When a child first falls,  we may react with worry and concern about injury. We may  run to the child’s aid most often to discover minor  scrapes. Nonetheless the child cries – perhaps not with  injury but responding to our reaction of fear for injury.  Thus a pattern of behavior for both parent and child begins  mostly due to our reaction.

This is not about falls. Certainly some falls can be  hurtful and need sympathy but a grand majority are not.  The point is that children can subconsciously manipulate  our behavior patterns just as we can subconsciously  manipulate their behavior patterns. This can happen in  many areas. Food battles often occur as children wait for  their choice of food to arrive while watching a parent  worry over their refusal to eat. Bed times can be delayed  as children use fears to make us come for multiple curtain  calls. Sometimes kids know how to put on a face or an  emotion that pulls on our heartstrings and gets them the  reaction they want from us. Some kids learn to get  attention from parents by behaving badly. They establish a  pattern early and learn to get parent’s reactions to bad  behavior.

So what are parent’s to do? How do we measure our  reactions? How do we analyze what we are doing that is  resulting in behavior patterns we don’t like in our kids  and in ourselves? These questions are what make parenting  one of the most introspective experiences in our lifetimes.

Think for a moment about some areas of parenting where  you react strongly. Ask yourself a few questions. Do you  have some unrealistic fears that make you react to your  children? Are you afraid they will starve? Do you worry  about them getting hurt? Do you think our kids can’t  manage without you? What is so important in situations  that make you react strongly? What assumptions are you  making? Do these assumptions make sense? Or are they  false assumptions drawn from your history or heritage?

Do you take everything your child does as a reflection  of you as a parent? Do you respond to your children in an  effort to control them? What children do is a reflection  of them not you. And as much as you try to control them  they will have to assume control of themselves for  themselves.

Answer these questions for yourself. Recognize why  you have strong reactions to some of your children’s  behaviors. If we can understand our reactions and where  they come from, we can start to temper our emotions in  different situations. You will see your children  responding less in behavior and tempering themselves as a  result. As we control ourselves, many times our kids will  become better in behavior. It seems so basic but is very  difficult to see and understand when you are in the midst  of battles. It just seems to happen that the more self  aware parents are, the more self aware their children will  become.

What Is Praise, Anyway?

In our country we have developed a culture where rewards come too easily. I have seen children’s sport  leagues where everyone gets a trophy. I have heard of  birthday parties where siblings got “birthday” presents so  their feelings weren’t hurt even though it wasn’t their  birthday! So how can children get real praise and  recognition for their true skills in this culture of  ubiquitous rewards? If rewards come so easily, how can  children get a true sense of themselves and what they are  good at? We live in the “age of don’t disappoint”. As a  result we are raising children of excess. Whether they  earn it or not they receive it. Whether it is their turn  for recognition or not they get it. So in this world of  ubiquitous reward and recognition, what is true praise?  When is it deserved? What should we be trying to achieve  for our children with praise, recognition and rewards? In  other words, what is praise anyway?

Praise is something said to another in recognition for  a true skill, or achievement that comes from that  individual’s ability. It is important for children to hear  praise because it supports them in building an identity  around their true skills. When praise works well in young  childhood we see the development of confident individuals  who have a good sense of their skills. They feel good  about themselves and know what parts of their inner being  they should value. So how can parents work towards giving  their children truly deserved praise?

Parents need to be keen observers of their children.  All children are different and have different skills. It  is important for parents to have openness towards their  children to hear and see their individual skills. It is  amazing what kids show us when they know there is an open  acceptance of their ability.

Open observation needs to be combined with acute  perception of what they really enjoy doing. We tend to  pigeon hole boys (and now girls) into certain sports and  girls into cheering or dance. But, especially in younger  years we need to look for what brings a flicker to their  eyes or a joy to their hearts. Young kids need to be  exposed to different areas that include singing, music,  dance and arts. It is sad but true that school programs  won’t be enough to bring out these interests in children.

We need to recognize our children’s accomplishments –  even relatively small ones. Showing courage and overcoming  a fear, showing poise, or even controlling negative  reactions all need acknowledgement from parents.

We must allow for periods of disappointment. We  shouldn’t falsely bolster a talent or interest where there  isn’t any. This can set up a harmful dynamic where  children keep participating in an activity just to please  the parent. If a child has the drive for that area of  interest, they will naturally overcome disappointment. In  either case, children need to sort out their feelings over  effort, interest, achievement and failure.

Once we see their true interest, we need to help  provide opportunities to foster that interest. We can’t  necessarily assume that opportunities to use their skills  will present themselves. Some skills will be developed in  school and play. Others need to have specific activities  in order to develop their talent. Lessons, teams and even  hobbies serve the purpose of skill development outside of  school.

Through all of this, children need praise for both  general achievements and specific skills. Getting off to  school on time, helping around the house or even taking  care of a pet needs praise. Everyone is capable of these.  But acknowledgement of your child’s contribution is  important. Specific praise is needed in areas of  particular skill. “Boy you are great at building with  legos” or “You are great at organizing things with your  friends.” These kind of comments let children know that  you are noticing them for their skills and for who they are.

Parents need to think positive. We tend to emphasize  the negative and correct our kids too often. Kids need  praise from us. It is important to their growth in  character. With a little effort we can learn to be keen  observers and give our kids genuine praise. With that our  kids may still live in a world of excess but at least they  will learn what is of value to them as individuals.

What Is a “Time-Out” Anyway

You’re in a supermarket and your kids get into  trouble. You warn them, “If you don’t stop you’re going  to get a “time-out” when we get home.” They don’t get  better so when you get home you enforce a “time-out”. You  direct them to respective chairs where they sit. They  say they are hungry. You tell them, “You’ll have to wait  until “time-out” is over.” You ask them what they want  for lunch. After you finish making their lunch you say  their “time-out” is over and they may come to eat. Was the  “time-out” effective? Did they learn anything? Did they  feel anything? What is a “time-out” and how do you give  one to your child?

A “time-out” is a period of isolation you purposely  give to your child where they do not get any attention from  you and they don’t control you. It doesn’t matter where  they are, or whether they have a “time-out” place. The  action is louder then words. The key points are personal  isolation and lack of control. Nobody is willing to  continue behavior that yields isolation and control of  nothing.

Let’s think about this a moment. What should a child  get for a positive behavior? If a child helps at the store  or cleans their room he or she receives praise and a  positive response from their parent. They receive  attention and control their parent’s response for that  moment. So what should children receive for a negative  behavior? Certainly not the same attention from the parent  and controlling their parent’s response! We should  consistently give negative behaviors a rapid response but  that response should involve little attention and a  controlled reaction from you. This is the reason “time-outs” are introduced as a tool for parents.

So when your child misbehaves, give them a quick  correction. Then isolate them with coldness. Don’t  respond to them at all. If you can’t ignore them where  they are (if they are screaming, crying or tantruming) then  put them someplace else or go somewhere else where you can  ignore them. During this entire time stay firm but in  control. Don’t let them control your response. You  control it. Through being isolated while you are in  control your children get just punishment for negative  behavior. Over time they will have no motivation for  continuing that behavior.

In the scenario I started with, the parent warned  about a “time-out” while in the store. But negative  behaviors need more immediate consequences. Then when  arriving at home, the “time-out” was really a peaceful  interactive time together while waiting for lunch. When  being punished kids need quick, stern correction followed  by a feeling of isolation from their parent while the  parent stays in control. A “time-out” is then properly  done. A “time-out” is not a thing to be warned about and  given to a child later. It is an action done rapidly  without warning after negative behaviors. As parents we  have a right to respond to behaviors that we do not want to  see. If ”time-outs” are done right, kids learn over time  that positive behaviors get a better response and naturally  gravitate towards them.

What Is A Good Playdate?

Ah, remember those days when we, as kids, ran out and played in the neighborhood with other kids. I remember  running inside to tell my mother I was hungry so I could  gobble down a sandwich just to get back outside for our  game. Dirty sneakers, muddy pants, smudged faces, and  sweaty heads were the norm after school and on weekends.  Bats, balls, gloves, ice skates and sleds are in every  picture from my childhood. Play was arranged by stepping  out the front door. Arranging a playdate? My mother rarely  had to face this parenting challenge. Today, parents need  to decide about playdates regularly.

I recognize that some neighborhoods may still have the  community environment that allows spontaneous play, but  most families today face the problem of separation between  friends which then require parents to arrange playdates.  What is a good playdate? How can we arrange a playdate so  that we are comfortable about safety, diet, and  constructive play?

Playdates are very important for children. From the  time children are three years old and recognize that there  are people their age on this planet, they want to interact  with playmates. Children develop their brain power through  interaction with people. So playdates are a necessity in  this increasingly isolating society of ours. A good  playdate is one where children play actively with each  other sometimes causing conflict and solving it together.  Battles over legos, homemade forts, or who plays what role  leads to problem solving skills, compromise, creativity,  and use of the imagination. We know that creativity is all  but erased in computer games. Imagination is stifled by TV  and movies. Kids can get enough of those without wasting  time with a friend with screens in front of them.

Good playdates take more than the type of play.  Supervision is necessary even for the closest of friends.  Someone needs to be there to be sure conflicts don’t get  out of hand or to help support the friends’ activities. An  adult can also be sure that kids don’t snack  inappropriately between play. Good snacks are increasingly  important and can be easily accepted when provided with a  little creativity.

Obviously, good playdates take some work. Parents  need to talk to one another – not just about scheduling the  playdate. Good playdates really depend on communication  between parents. Meet the parents of playmates. Stop in  at drop-off and observe a little of the play environment.  Parents need to make sure the other parents know your  expectations. Be explicit about your expectations over TV  and computer time. Ask about outdoor time during playdates  if the weather permits. If you are the host parent, be  available for some supervision. Be true to the other parent  and enforce agreed upon rules for the playdate. Many  parents want to hear that parents have the similar opinions  about play. It is wonderful to find good playmates and  families that carry out similar values in playdates. This  is important even as your children enter middle and high  school.

If a playdate doesn’t work out to your liking take  control of the playdate. You can require that your child  and that friend play together at your house. If you don’t  approve of play between your child and their friend, veto  the playdates or minimize their time together. You do not  have to debate your decisions with your child. You have a  right to agree or disagree with playdates!

A discussion of playdates cannot ignore the ever growing sleepover nightmare. More and more I am hearing  about sleepovers that include very late nights, children  awake later than parents, unsupervised TV and internet use,  and the post-sleepover “hangover” where parents deal with  over tired children on a day reserved for homework or  family time. It is amazing that parents are pushed to give  into these sleepovers without restriction. Parents have a  right to put restrictions on sleepovers – especially in  later years. Even teens can have a lights out time. Time  restrictions on computer and internet use are important.  There are good reasons to limit their use after certain  hours.

If sleepovers and their aftermath get out of hand  (moodiness, decrease in school work) a parent needs to  say ‘no’ to them. Your child will not suffer because  “everyone else is going to be there”. Your child can be  picked up at 11 and sleep at home. They won’t miss much  and they’ll sleep better.

Parents need to be aware of what happens in playdates  and sleepovers and exert some influence over them. Bad  playdates and sleepovers are not helpful to your child or  to your family’s functions. Keeping your child’s  interactions with friends as healthy as possible is a  worthwhile concern for all parents. Parents need to feel  empowered to exert their influence even into teen years.  Your child will be better off for it.

What The Newborn Nursery Won’t Tell You About Your Baby

Newborn nurseries are magical places. Wonderful people care for new babies and their nervous mothers. Before the pair go home to experience new life together, nursery nurses are able to teach a number of essential tasks to make the first few months go well. They teach mothers how to feed, and bathe their infant. Mothers learn how to monitor for signs of illness in a baby. With these important functions to teach it is no wonder that nurses don’t cover less important worries that new mothers have. Fortunately, that is where I come in. As a pediatrician I get to teach new mothers about their babies too. And in the first visit with me, mothers are often perplexed about many simple things that we as practitioners in medicine take for granted. Over the years I have made a list of worries other than feeding that mothers have at their first check up at two weeks of age. Here they are.

1. How do I stop his hiccups?

Many mothers experience hiccups in their babies even before birth. But it is more disturbing to us to see a baby’s little body shake with hiccups. Fortunately, we don’t have to do anything about them. Hiccups occur as a natural reflex. This reflex tends to subside as babies grow. It may be hard to watch. But remember, babies aren’t bothered by hiccups. We are, but they are not. Just leave them be. They’ll be fine.

2. My baby sneezes and coughs. Is she sick?

Oh, those immature reflexes! They haunt babies for months. Sneezes and coughs are also reflexes that are a bit hyper in babies. These, too, will decrease in frequency over the first several months.

3. My child sounds congested.

Congestion is not a reflex. Congestion is a blockage in the nose that makes it hard for babies to breathe. But babies often sound congested without even having any blockage. Why is this? Babies have narrow nasal passages with loose mucus membranes. Air moving through a narrow space makes a noise. In musical instruments air makes a pretty sound. In babies’ noses, air makes a congested noise as it moves along those vibrating mucus membranes. So a parent only needs to be concerned about congestion they see – not a congested noise they hear. With congestion you see, a few drops of saline solution usually helps clear their little noses.

4. My baby is fussy and hard to console sometimes.

All babies have fussy periods. These occur with more frequency and for longer periods of time at six weeks of age. Babies usually settle down and are less fussy at three months of age. Even though it goes away, that doesn’t make it easy to deal with while it is happening. Keep your baby close, support his belly and have extra people around to help out. That’s how to get through the fussy baby times.

5. My baby has so much gas! Is that normal?

Whether your baby is fussy with gas or not, it is normal for babies to be gassy. It is a natural process for our bowels to develop a flora of bacteria that creates gas in their bowel. Only a small percent of babies have fussiness caused by this gas.

6. What about this green poop he has?

Stool color changes with time even when the baby’s diet does not. Nursing babies progress from brown muconium stools to yellow watery stools to yellow seedy stools to green stools. Bottle fed babies change more rapidly through these color stools and end up with the typical brown stool faster than nursing babies. It might be hard for a pregnant woman to imagine being concerned about the color of poop. But…you will see. It is amazing how much talk there is about poop once you have the baby.

7. Besides pooping the only other things my baby does is eat, sleep and pee! And he sleeps a lot! When will he wake up and interact a little?

For the first few weeks after birth most babies just eat, sleep, pee, and poop. This can be surprising to parents who expect an expressive baby. Many parents start longing for more interaction. It becomes difficult to be at the service of an infant and get little of the warm and fuzzy things in return. The interactive time will come. By two months of age babies are usually focusing on parent’s faces and smiling back at them.

8. Well, before two months what is my baby seeing?

It is hard for babies to tell us what they are seeing. However, physicians have studied the visual preferences babies have in the first few months of life. At first babies prefer sharp contrasts between light and dark objects. This is likely due to the fact that the color interpreting cone cells of the eye develop over the first month or so. After the first month babies prefer to look at oval objects similar to the general shapes of faces. This leads to the focusing on particular faces by two months of age. By four months babies will be able to see across a room. And by six months any stray object that you didn’t see such as a small toy or a bit of fuzz will be picked up and thrust into their mouths.

9. When do they stop burping, gagging and spitting up?

Babies are messy little creatures. They drink and gulp their meals. Belch frequently. They gag on almost anything at the beginning. And often spit up or throw up what seems like half their meals. It sounds awful but is quite natural. Since most of their food is liquid and taken in by sucking, burping is a natural consequence of this form of feeding. If babies didn’t burp they could become more bloated and more gassy. Burps will come if they need to. Not all babies burp after all feedings. Spitting up happens with burping. It is of no consequence so long as the baby gains weight on the amount of food they keep down. And gagging is helpful for babies to protect themselves from aspirating their liquid food. Due to a baby’s gag reflex, it is rare for any baby to actually aspirate food into their lungs. So even though these issues are messy, they help our babies stay healthy. They do become less frequent after nine months of age.

10. My baby breathes in a funny way. Sometimes she even stops breathing for a second. Is that okay?

Babies do breathe in a funny way. They can breathe ten times rapidly, then take a deep breath and not breathe for five seconds. If we traced newborn breathing patterns on paper we would have nothing but squiggly lines. Their breathing patterns smooth out and become more regular at three to four months of age. Until then, their irregular respirations can startle parents until they recognize how normal their baby’s abnormal breathing is.

These are the most common normal body habits of babies that disturb new parents. Some of these cause real fear and concern for first time moms and dads. Having some knowledge about these nuances of newborns can help parents relax. And that is good for parents, good for baby and good for the new family. It would be nice to hear about all these issues in the newborn nursery but it would just be too much to handle at that special time. Having some reference for these issues after you go home is more appropriate. So it is with that in mind that this was written for expectant parents.

I hope you can relax and enjoy your new baby.

Trends In Pediatrics

As I look back over twenty-three years of practicing Pediatrics I see some dramatic changes in the health of our children. Most of the practicing clinicians I know look  back at their years of training with fondness. It was during those years that our minds  were absorbing all kinds of new information about the care of children. Twenty years  ago during my training I was taught how to screen children and babies for serious blood  infections called bacteremia and serious brain infections or meningitis. During my early  years of practice, hardly a day went by without at least one spinal tap being done. Spinal  taps for meningitis and blood cultures for blood infections were two relatively common  procedures for practicing pediatricians. Today, thanks to new vaccines babies suffer  these unpleasantries much more rarely. Two vaccines, one for pneumococcus and one  for hemophilus bacteria have changed children’s health in a very real way to me. These  have allowed me to keep spinal taps in my mind mostly as a memory.

Though changes in medicine have helped children’s lives there are other changes in  children’s health that are not so promising. In fact, the rise of some health and mental  health issues should be the concern to all of us.

Over my years of practice I have seen a dramatic growth in four types of illness. Asthma  cases have risen. Childhood obesity is an epidemic. Attention Deficit Disorder with and  without hyper-activity continues to rise. And mental illness particularly depression in  children and teens is reaching crisis proportions. There are good reasons why we all need  to be concerned about the increase in these illnesses. Let me explain my reasons with  each type of illness.

Asthma is a disease where a person’s lungs become more reactive to viruses or allergens  making the bronchi go into spasm. This makes it more difficult for that person to  breathe. The typical symptoms include cough, night cough, difficulty breathing and  coughing with exercise. Nobody knows why we have had an increase in asthma cases  over time. Perhaps we have more allergens (things that cause allergies) or maybe we  have more allergic people. Perhaps our air quality has something to do with it. Others  say we are diagnosing it more easily than we used to. No matter what the reason,  we all should have concern for this negative trend in children’s health. We could all  work harder to improve air quality. We can avoid second hand smoke–producing it or  receiving it! We can know the early warning signs of asthma-persistent cough, cough  at night, or cough at play. And finally we should seek care early because, on the bright  side, our treatments for asthma have improved as the cases have increased. We are better  at taking care of asthmatics now than we were years ago.

Obesity has been in the news a lot in the past few years. Practicing pediatricians saw  this trend coming long before the lay press put it on the front page. And even with the  publicity given to this problem, people are not doing enough. We need to make sure our  children don’t have a sedentary lifestyle. They need exercise daily. And a balanced diet  eaten daily with lots of fruits and vegetables is essential. We need to model and teach  good diets starting very young. If you are excusing your child’s poor eating habits, stop  right now and put him on a good diet. I often shock people by telling them some stories I hear from parents about how their children eat. Yet despite obvious diet issues many  parents fail to intervene and make changes. We, the parents need to take control of the  choice of foods, our children will not. There is too much temptation in our society. We  need to help them make the right choices. This is imperative for our future generation.

Attention Deficit disorder is a problem where children cannot sustain attention on any  one subject for very long. Again it is not clear why this has risen to such a high number.  Some say we are too quick to diagnose and treat. Others say schools have too high  expectations for all kids to conform. Many of the practicing doctors I know feel the trend  towards more ADHD is real. Many children and families are helped by treatment. Many  children go from failing grades to straight A’s. Parents need to think about this diagnosis  with any child who has trouble in school. Seek help from a professional. It may make a  world of difference.

Depression can be a serious mental illness that can have catastrophic results. Few  psychologists, psychiatrists or pediatricians doubt the rise in this illness. Parents need  to know the early warning signs of depression: withdrawal from friends and activities,  increased sleep, failing at school; and loss of interest to name a few. Seek professional  help early. It can save a life.

The trends in ADHD and depression are extremely worrisome to me. Certainly these  need to be treated and managed. But I question whether there is something cultural that  we need to face to decrease these cases in the future. Are our children learning to change  their focus rapidly and often while playing on the screens they watch daily? Are they  failing to learn how to interact well together due to decreased interaction with people as  they grow side by side with technology? These are hard questions to answer. But it is  important for parents to recognize that children’s mental health development depends a  lot on personal interaction. So it may stand to reason that we should be limiting screen time not just to reduce obesity but to optimize children’s personality development. If our  kids are away from screens and facing each other, they learn a lot more about conflict resolution, empathy and caring then they do in front of a screen.

Suffice it to say there have been wonderful gains over the past 20 years in  children’s well being. There are new vaccines against devastating illnesses. New  medicines work better than old medicines against many illnesses that we are seeing larger  numbers. Yet we need to continue to move forward in our children’s health and well  being by looking at the new trends in pediatric illness and question why they are  happening. By increasing awareness and having more minds questioning, perhaps we  will find reasons for these negative trends. Once reasons are found then we hope these  trends can be reversed so the health of our children can be improved once again.