Early childhood educators wear many hats. Not only do they teach, but are often called on to give medical attention to their students. Last week we shared with early childhood teachers at the Delaware Valley Association for the Education of Young Children's 2012 Early Childhood Conference the signs a child is in respiratory trouble. Although we focused on asthma, these signs of respiratory difficulty may be present in a variety of illnesses such as pneumonia. 

My youngest child clambered off the bus Friday afternoon with a fixed grin across his face.

 "What are you doing here?" he asked curiously. Usually, I am not home in time to greet the afternoon bus.

"I came to walk you home from the bus stop and then go for a run," I said beaming, and kissed him on the forehead.

As my son stiffly kissed me back, the strange fixed grin remained on his face.  Then I noticed his hands were behind his back. With a sly glance, I saw he clutched a crinkled brown paper bag. I smiled. Hidden crumpled paper bags close to Mother's Day mean only one thing — a "surprise" gift.

"Don't you want to go running now?" my son asked as we walked up our driveway, carefully rotating his body so that he continued to face me.

"Yes, good idea" I said, and resisted the temptation to look back.

As I jogged through the neighborhood, I mused over the upcoming holiday and what it meant to be a "happy" mother on mother's day. Last week I had gained some insights after participating on a panel at Brown University's Women's Leadership Conference. The topic of the discussion was “Happy Kids/Happy Parents: What's the Secret Sauce?” The talk was lively, and since it was a women's conference, discussion focused on motherhood. Ultimately the conclusion made by moderator Clare Hare was "There is not one right way to parent," but, perhaps, some good guidelines. Here are some ideas to think about:

On the dilemma of working outside the house vs. working full time as a mom at home: As a mom it is easy to give, give, and give so much of yourself to others that you can lose a little (or a lot) of your own self-identity. By maintaining a self-identity you become a more confident mother. Some women draw confidence from forging a career outside the home. Others draw from organizing local community-based activities. A mom ultimately needs to feel at the end of the day that she raised her own child, no matter how she does it. Stop comparing yourself to others and do what is right for your own family. In an economy where it is often not financially feasible for one partner to stay at home, working outside the home may be less of a choice and more of an obligation; however, the crucial point remains— if you are not the person you want your child to see, then become the person you want her to see.

On helicopter parenting: Worried that you are too much of a helicopter parent? Know where to draw the line. Use the "cry now or cry later" philosophy. If you know your child will be crying in 30 years when he is obese and diabetic because you didn't insist on a healthy diet with limited “junk”, stand your ground and let him cry now and you refuse him a second helping of cake. If you know your child will NOT be crying in 30 years because you didn't insist that he continue piano lessons, let it go.

On keeping you and your child sane during the college admission process: Yes, statistically it's tougher than ever to get into colleges- this is a matter of demographics. There are more college-bound seniors because of population growth, and hence more applicants per spot. But the pressure for students to overextend themselves in multiple activities is imposed by parents and the kids themselves, not by the admission offices. In the years preceding applying to college, encourage your child to concentrate on excelling in specific areas—think quality not quantity. Do what comes from the heart. When your child seems overwhelmed, as Dr. Kardos and I always say, insure basic needs are met — eat, sleep, drink, pee and poop. And don’t forget to leave time for play and relaxation.

On ignoring hype:  Be willing to change your opinion in light of data. Use evidence, not hype, to drive your actions. Despite data showing teens naturally awaken later in the morning than younger children, one audience member recounted how she still encountered many difficulties when she advocated for later high school start times in her school district. 

All thoughts to nosh on.

You never realize the soaring magnitude of your own mother's love until you meet your child. No matter your approach to raising children, we wish you "happy" as you remember how you felt when you were the child who brought home a brown crinkled paper bag to surprise your own mom. And again "happy" as you feel gratitude and awe for the privilege of now receiving the surprise.

Dr. Kardos and I wish you a Happy Mother's Day.

Naline Lai, MD

Special thanks to my fellow panelists: Clare Hare, Principle of Clare Hare Design; Jill Hereford Caskey, Director, Alumni College Advising Program, Office of Alumni Relations, Brown University; Judith Owens , Director of Sleep Medicine, Children’s National Medical Center; Peg Tyre, Director of National Advocacy, Edwin Gould Foundation, author of The Trouble With Boys and The Good School.

© 2012 Two Peds in a Pod®

Today we bring you more advice from the Atlantic Regional Osteopathic Convention 2012 Adolescent session, where Dr. Amanda Manning updated us about adolescent vaccines. As always, be sure to review with your child’s doctor any contraindications as well as reasons to vaccinate early with all of these immunizations. 

The meningitis vaccine, or “quadrivalent meningoccal conjugate vaccine”:  Pediatricians routinely give this vaccine to tweens. New recommendations add a booster dose at age sixteen years. If the first dose was not given until age sixteen, a booster dose is not needed. Read our earlier post for more information about this vaccine and the disease it prevents.

HPV vaccine: This vaccine protects against Human Papillomavirus (HPV), which causes cancer of the cervix, vagina, penis, and throat. HPV also causes genital warts. Most people who are infected pick up the virus unknowingly during their first two years of sexual activity. In fact, eighty percent of women by age 50 are infected with some form of HPV. Luckily, the majority of infected women do not develop illness. The Pap tests that women receive at their yearly gynecology visits screen for cervical cancer caused by this virus. Here are common questions parents ask about the HPV vaccine:

I have a confession to make.  Two of my kids still have not had their blood cholesterol checked. You see, according to the National Heart, Lung and Blood Institute (NHLBI), kids with risk factors for heart disease (in my children’s case, a grandfather who had an early heart attack) should have their cholesterol level checked.  But I’ll be getting my kids to the lab soon.  New research shows that although heart attacks and strokes are rarely seen until adulthood, atherosclerosis (cholesterol plugs) in blood vessels, which is a precursor for heart disease, can be seen as early as during fetal growth. The concern is so great for heart health that guidelines were recently revised: EVERYONE, regardless of risk factors, should be screened twice during childhood.

For those WITHOUT risk factors, your child’s doctor can order NON-fasting total and high-density lipoprotein-HDL (aka “total cholesterol” and “good cholesterol”) levels for initial screening.  Routine screening should occur sometime between 9-11 years and again between 17-21 years.

For kids WITH heart disease risk factors like mine, the American Academy of Pediatrics recommends a nine to twelve hour fasting “lipid panel.” Lipid panels usually measure low density lipoprotein (LDL) “bad cholesterol” and triglycerides in addition to total and HDL cholesterol. For kids with risk factors, screening should occur when the risks are discovered. 

Pediatricians start asking for a family history of risk factors by three years old.  Risk factors include: a parent, grandparent, aunt/uncle, or sibling with a heart attack or evidence of heart blood vessel damage less than 55 years in males or less than 65 years in females, or a parent with high cholesterol or triglycerides. Other risk factors for your child include having medical conditions such as diabetes, high blood pressure, obesity (Body Mass Index/BMI ≥95th percentile) and smoking cigarettes. Ask your child’s doctor for a full list of qualifying conditions.

The easiest way to time a “fasting” blood draw is to give your child dinner at his regular time, send him off to bed, and go to the lab first thing in the morning. Bring a snack with you so you can feed your child immediately after his blood is taken.

Because drinking water will not affect the lab results, have your child drink plenty of water before-hand and throw a sweater on him. The extra fluid will plump up the veins and the warmth from the sweater will dilate blood vessels, making it easier for the lab technician to draw blood.

Worried about calming down your kids’ nerves before a blood draw? Use techniques discussed in How to take the sting out of injectible vaccines.

For the full NHLBI report check out http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm . For guideline analysis look at this link from the  American Academy of Pediatrics.

Naline Lai, MD with Julie Kardos, MD

©2012 Two Peds in a Pod®

We're back from a Jersey Shore medical conference where we moderated the adolescent session of the Atlantic Regional Osteopathic Convention. In the next few weeks, we'll be posting you advice gleaned from talks on teen depression, vaccine updates, fatigue in adolescents and worrisome teen drug use trends.

Today we start with advice based on Dr. Melisa Lai Becker’s talk, Trendy Tox Teen Behaviors:

How do I know if my kid is high? Your tween or teen wanders in late on a Saturday night and acts like he is in slow motion. “I’m just tired,” he claims. Is he high, you wonder? To answer the question, have him look you straight in the eye as you talk to him. Even if he is lying, the truth will be in his eyes. More specifically, it’s in the size of his pupils (the black part of his eyes). Too big (nearly covers the colored part of his eyes) or too little (like pinpoints) is a sign he is currently high.

Alcohol: Parents, beware. The type of alcohol in your beer, ethanol, is the same type of alcohol in your morning mouth wash and perhaps in your medicine cabinet. The difference is that mouthwash contains more alcohol than beer. Beer typically contains up to 5 percent ethanol, wine up to 14 percent ethanol, and liquors usually up to 40 percent ethanol. Compare this to Original Listerine with 27 percent ethanol and Nyquil Nighttime Cold/Cough with 25 percent ethanol (and you wonder why it helps you fall asleep?!).

How can you tell if your kid is drunk? Again, look at his eyes- if he is drunk you may see pupils dancing in small circles. The dancing eyes give the sensation of “dizziness” to drunk individuals.

Pharming: We teach our children that medicine is not candy, and yet Pharming—consuming prescription substances to get a high—is a big problem among teens. Since 2003, according to the Centers for Disease Control, more overdose deaths have involved painkillers like Vicodin and Percocet than heroin and cocaine combined. Among teens, medications prescribed for Attention Deficit Hyperactivity Disorder are the most popular pharmed drugs. Don’t unwittingly contribute to a pharming party where kids raid medicine cabinets, deposit pills into big bowls and randomly ingest them. This upcoming week, April 28, is National Prescription Drug Take-Back Day . Make it a spring cleaning priority.

The most important phone number parents (and doctors) can know? The U.S. National Poison Control Center hot-line: 1-800-222-1222. Experts available 24 hours per day tell you what to do if you suspect your child might be poisoned. They can supply information about the toxicity of any substance, both legal and illegal. This phone number is not only for parents of toddlers, who ingest medication accidentally, but for parents of teens who may knowingly ingest medication for the purpose of getting high. We urge you to enter this number into your phone now.

Melisa Lai Becker, MD, is chief of Emergency Medicine at the Cambridge Health Alliance at Whidden Memorial Hospital campus in Everett, Massachusetts. She also serves as Director of Medical Toxicology of the Cambridge Health Alliance and as a Harvard Medical School instructor. 

Naline Lai, MD and Julie Kardos, MD
©2012 Two Peds in a Pod®

Squeezed through the birth canal, many babies are born with pointy, cone-shaped heads. Others, delivered by caesarian section, start off life with round heads. No baby begins with a flat head. But as parents put babies on their backs to sleep in accordance with Sudden Infant Death Syndrome prevention guidelines, babies are developing flat heads. 

Called positional plagiocephaly, a young infant's head flattens when prolonged pressure is placed on one spot. Tricks to prevent positional plagiocephaly all encourage equal pressure over the entire head. Because babies' heads are malleable, parents can easily prevent and treat the flatness. In fact, the flat shape begins to correct itself after six months of age, when babies spend less time lying down and more time sitting and crawling. Additionally, increased hair growth hides some of the flatness.

"What will happen if your grade drops from an "A" to a "C"?" I sometimes ask during a check-up. 

Many kids shrug and say, "Try harder next time, I suppose." Others look shocked and anxious about the possibility and are speechless. 

Still others will point at their parents and say,"THEY would kill me." 

Observe a toddler learning a new skill. You will see him repeatedly try to fit a ball into a hole until he is either successful or wanders way. He is not anxious or afraid of failure. He is not "stressed" about trying to learn. Although all children start this way, too often toddlers become big kids who end up in my office discouraged and worried about school performance. Today's guests Principal Mr. Leonard Schwartz and Vice Principal Michael Testani, based on the work of Dr. Carol Dweck, discuss ways parents can influence their children so that they embrace learning. 

– Drs. Lai and Kardos

Researchers under the leadership of Dr. Carol Dweck conducted a survey of parents of school aged children. The majority of parents thought it was necessary to praise their children’s intelligence in order to give them confidence in their abilities and motivate them to succeed. Instead, this approach can lead to fixed mindsets in children. Kids with fixed mindsets believe "my abilities are what they are." 

Instead, the most motivated and resilient students demonstrate a growth mindset. They are the ones who believe their abilities can be developed through their effort and learning.  These students are resilient and persevere when tasks become challenging.

A study of students' brain waves revealed students with a fixed mindset were interested in whether they got an answer right or wrong, but when they were wrong, they paid little attention to the correct answer. Students who were praised for their intelligence later lied about their scores. They felt the errors were so humiliating that they could not own up to them. The students failed to persevere, believing they were no longer "smart," and therefore unable to meet academic challenges. 

Students with a fixed mindset typically think it is best if they:

• Don’t make mistakes – "I’m too smart to make mistakes."
• Don’t need to work hard –"I’m smart and learning comes naturally to me."
• Don't try to repair mistakes- "I was wrong, and that is the end of it."

Students with a growth mindset generally:

• Take on challenges
• Work hard
• Confront their deficiencies and correct them

How should parents talk to their children in order to develop a growth mindset?

• Wow, you got 10 out of 10 right! What strategy did you use to get a perfect score?
• What can you learn from this mistake that will help you do better next time?
• I am proud of how hard you worked on this project and look at how your hard work paid off!
• The strategies you used last time didn’t work. Let’s take a look at them so I can help you figure out better strategies to use next time.
• You’re becoming such a good learner!
• Smart is not something you are; it’s something you become. Let’s figure out how you can become smart at this assignment.

What is your child’s mindset?  Ask yourself, what is your own mindset?  Have a conversation with your child as you discuss your child’s report card.  Use any upcoming parent teacher conference to examine outlooks, attitudes, and strategies that are or are not supporting your child’s academic progress.

• Where applicable, praise your child’s positive skills and attributes.  Celebrate instances you observed that contributed to positive indicators.

• When necessary, examine areas of poor performance and strategize with your child about how he or she can turn a weakness into a strength.  Again, you may revisit situations you observed this past grading period in which your child took shortcuts, provided incomplete work products, or did not do his or her personal best.

• Make your expectations very clear in terms of why you value attributes or traits of resiliency, and how they can and will develop into habits that will serve your child well.

Grades are a distant second to the level of effort a child invests in personal learning in any setting.