Category Archives: Community

Tips for Managing Screen Time

Maybe I am harping on this a little too much. But I do not think so. I believe that screens are detrimental to the healthy development of human brains. It seems that the American Academy of Pediatrics agress with me. But too my surprise, it seems that a lot of parents agree too. In a recent article in the NY Times, Bruce Feiler surveyed parents about what they do about their kids screen time. He found that the majority of parents have rules governing their kids screens. Here sre some of the things he learned in his survey of parents and some of my suggestions added in.


  1. Parents need to be examples and put their phones down. More and more we are all becoming addicted to our screens.
  2. Delay getting a first phone until kids really need it. You may need your child to get a phone by the time they are in middle school for communication needs. But it does not have to be a smart phone. It can be a dumb phone to call and text only.
  3. When your child gets a phone or tablet, set up strict rules for them. No internet during the school week, and only 1 hour a day of screen time! Set up a contract and monitor use from the start. Yes, you will be a mean parent but you will be in the majority with other parents.
  4. Homework needs to be safeguarded. Yes, more homework is online. But other communication and apps need to be limited to decrease distraction. Have kids do homework in common areas. Check in on them. Your presence turns off cheating on rules. And no social media during homework time.
  5. No phone use 1 hour before bedtime. Screen use has been shown to hinder normal sleep patterns. Also communication through texting interrupts sleep. Check phones into a common charge area at night so phones are charged for daytime when you need to communicate.
  6. Make rules for teens that they must answer your calls or texts within three tries. The excuse about not having reception is no excuse. You need to be able to reach them.
  7. Meal times should be screen free times. Eat together and talk.
  8. Limit social media accounts. Younger kids do not need facebook, snapchat and other accounts. Each account drains time from your child. Use a common ipad for their accounts so you can monitor what is going on.
  9. Punish kids with device removal. Check in regularly. Adjust house rules as you need to. Read some random texts. Read them aloud to embarass them. These are ways to have some control of what they do in this open arena we call the internet.
  10. Family time is very important. Interaction is the only antidote to screen time. Have game nights. Cook together.  Get outdoors together. Have parent-child date nights. Any fun you can have without the screens is good fun and interactive fun.
  11. Don’t give up the fight. Screens are a privilege for kids to have not a right for them to have. You have control and pay for the screens. Turn off your router if you must.         Good luck!

Where Are Our Heroes?

Children look up to heroes. Young children look at fairy tale or fictitious heroes. Harry Potter, Superman, and Batman –  we can name hundreds of heroes in fiction. But as children  grow, they graduate to real heroes. These could be sports stars  or people in the news. This is a sad time for children since we  have so many fallen stars. Barry Bonds, the biggest home run  hero of our time, cheated by using steroids. An American  cyclist, Floyd Landis, came back to victory in the Tour de  France only to have his victory clouded under doping  allegations. Our President is usually an obvious choice of a  hero yet our last two Presidents failed our children. Clinton  is famous for his cheating on his wife and Bush made up reasons  for war and has made America famous for torture. Hollywood  props up movie stars as heroes but then we hear about their  drunk driving or their prejudicial remarks or both.  Unfortunately, there are only a few Tom Brady’s around. We hope  that our newly elected officials live up to there promises and  reputations, though we are losing faith.

Kids need heroes. But more importantly, they need adults  that they can look up to and respect. I once heard in a  parenting conference that what children need is an “influential  adult” outside their family who becomes their local hero. These  “influential adults” can be teachers, coaches, or community  leaders. They aren’t famous heroes because over time kids turn  away from their infatuation with distant heroes and turn their  attention to real tangible, respectable adults who are involved  in their lives. To that end, adults in every community need to  respond to this era of poor examples of heroes at the top. We  have to become the heroes on the bottom. Every adult in every  community needs to evaluate how he or she is demonstrating him  or herself as an example to young adults. What child will look  up to you as an “influential adult” in their lives? At home,  are you there for them or do you disappear too often to ensure  you have your fun? Do you provide examples of good community  work? Do you volunteer or donate time or money? Do you expect  returns for your good works or is it truly given like real  heroes do? Do you simply act in kindness so children see and  live kindness around you?

You can’t ask “what is happening with kids today?” without  asking what is happening to heroes for kids today? We, the  adults, can make a difference inside and outside of our homes.  We need to start in our small communities. Do good work in your  community. Donate time to worthwhile projects. Work with food  pantries, or help the elderly. Don’t expect praise but let your  children and other kids witness your good acts. Be kind. Live  a well-valued life – especially those of us that work with  children. If we start at home and in our communities we can be  heroes for our children. They need them. We can build a  community of “heroes” pitching in and helping each other. Maybe  over time local heroism will filter up to where we need them for  our children the most in the high visible places of our country.

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 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.

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.

Tough Times for Teens and Their Parents

When I do workshops for parents of teenagers I see many shaking heads when I say, “it is a tough time to be a teenager!” Everyone in the audience recognizes this  statement as fact. Few adults can picture growing up as a teen now. School demands  are higher. It is harder to get into college. College costs add a burden. A high school  diploma doesn’t help your career very much. And now, with the economic crisis, the  future looks tougher still. There is only one thing tougher than being a teenager, and that  is being a parent of one!

Teens are exposed to so much so early that they seem to be growing up too fast.  Media-We know the risks that they may encounter but it seems that they do not. We  worry for them. And the freedoms that they demand from us so early make it difficult for  us to stay in control. How are we to parent our teens today? Where else can we turn?

The Too Busy Family

The family dinner is on its way out. Families are too busy. They can’t seem to be in the same room together for too  long much less have a meal together. The commitments have  grown. Schools need volunteers. The sports need coaches and  supporters. Aging relatives need your help. Kids have too many  activities and desires. It is no wonder that families are too  stressed. How can we calm this spiral of family commitments?

This is a difficult question for families to answer. It is  hard to fight the pressures we face. To calm down our family  commitments it means that a parent needs to say “no” to  somebody. This, in turn, may lead to disappointment, anger or  guilt. But nonetheless it may be necessary if a family gains  some sanity in the process.

Many families have choices to make regarding their  commitments. Do kids really need to be on two baseball teams or  two hockey teams? Let your kids focus on one sport and one team  a season. In fact, one extracurricular activity per season may  be sufficient. If there is more than one in a season at least  have one activity limited to once a week. Our kids really don’t  need to be so scheduled.

Some families don’t have the luxury to sign their kids up  for activities to be overscheduled. Many families have two  working parents. Some have divorced parents trying to balance  custody arrangements along with work and school commitments.  Yet other families have single parents who balance work and home  schedules. What constitutes “over scheduling” may be very  specific to family makeup and family health. There cannot be a  “one size fits all” prescription for family activity. It is  important for all families to look at what they can do to  support everyone’s interests while balancing what is realistic  for the family to be committed to.

In light of this, parents need to recognize that there are  pressures for us to keep up with other families. If other  players are on two baseball teams, should your son play on a  second team as well? If your neighbor’s daughter is going to a  summer ballet program, should your daughter too? This pressure  continues through high school so much so that you can be made to  think that you are ruining your child’s chances for a good  college or even a good life if you do not keep up with other  families. Of course, this is not true. We do not have to keep  up with other families!

Families need to look at the calendar together. Discuss  what is necessary and fair. All members need to be involved in  the family schedule. Someone’s activity may have to be  sacrificed in favor of another’s. Sometimes a practice, game or  party may have to be missed for the sake of family sanity. This  is blasphemy in today’s family but should not be.

Coaches, teachers and parents need to chill out. Everyone  wants commitment to the team, the class or to the social group.  But with families committed to death, people need to recognize a  family’s excuse as a legitimate reason to miss a practice game  or event.

Families should rely on community supports without guilt.  We all need help from other parents, extended family or a hired  babysitter. Don’t let others make you feel bad if you cannot  always be at the game or volunteer for the class. Be there when  you can. Get support where you need it and let go of the guilt  that others put on you. We all need help and support. We can’t  do it all.

Something has to give with this helter skelter family life  that people are experiencing. We need renewed commitment to  time at home to relax with the family without a scheduled event.