How can I discipline my child?

From Dr. P's practice

Ms. L comes in to my office with Buzz, her rambunctious 3 year old.

She is distraught. "He is driving me nuts. He only does what he wants to do,

and resists most of my requests. Time out is not working.

Should I spank him, as my mother-in-law insists I should?
I need help, Dr. P. How can I discipline him in a more effective way?"

I get this all the time.

As a start, let's deconstruct Ms. L's question about 'discipline'.

What does she mean by "discipline"? Like most, she really is asking me how she can effectively punish her child. The (incorrect) notion is: "If I just can come up with the right form of punishment, the little guy's behavior will be fine."

However, the word "discipline" comes from the word "disciple" and really means "to teach". Unfortunately, children are unruly disciples, at best. I, for example, have yet to meet the child who looks up to his parent and says, "Thank you, oh great and wise teacher. I will sit here calmly at your feet and learn from your vast wisdom. I will gladly do whatever it is you want me to do. You are my one true guru. I am so grateful!"

So Ms. L is really asking me how she might better teach Buzz the rules of behavior that are important to her and her family and her culture. How might she do so?

To that end, in my office I asked her (and now you) to think of her favorite teacher when she was young. What made him/her so great? Mine was Ms. Allen, my beloved 5th grade teacher. In retrospect, this is what made her so wonderful:

• I knew she liked me (? most important of all).
• She set very high standards. She expected me to work to my potential. No excuses allowed.
• She ran a tight ship. The rules for conduct were very explicit. If you were out of line in class, retribution was predictible and swift and fair. No one messed with Ms. Allen.
• She made the subjects very interesting.
• She had a great sense of humor.
  

(This was in sharp contrast to Ms. Day, my old battle axe of a 3rd grade teacher. She had punishment down to a science, including a long fingernail that she rapped on your skull, often drawing blood, when you were out of line. Although a master of punishment and intimidation, I'm guessing she's made no one's top 10 teacher list.)

My advice to Ms. L then was to think of those characteristics of her favorite teachers and aspire to them when she is dealing with Buzz's difficult behaviors and trying to teach him the rules of the game.

But, you say, that's not enough; that's just the start. I agree. Sorry if I have disappointed you. Disciplining kids is a complex matter with, alas, no magic answers, and I'm going to have to reserve future blogs to complexify the discussion.

In the meantime, becoming more like Ms. Allen and less like Ms. Day when it comes to disciplining your kids certainly wouldn't be a bad start.

Related Topics: Is Your Family Out of Control?, 10 Commandments of Good Parenting

Technorati Tags: childcare, parenting, discipline

Teaching your children: Do as I do, not as I say

Dr. P's favorite quotes of the week

"It distresses parents when children who should obey them,

instead imitate them."
- Unknown

******************************************************************

"Children have more need of models than of critics. "

-Carolyn Coats

(author: Things Your Mother Told You but You Didn't Want to Hear, 1994.)

*****************************************************************

"Education consists of example and love -- nothing else."

-Heinrich Pestalozzi

(Swiss educational reformer. 1746-1827)

*****************************************************************

"People look at you and me to see what they are supposed to be.

And, if we don't disappoint them, maybe, just maybe, they won't disappoint us."

- Walt Disney (1901-1966)

***************************************************************

Dr. P comments

How do children learn how to make sense of and behave in the world?

Sure there is the usual positive and negative reinforcement you always hear about when they are young. And there are fancy toys and extra stimulation (actually, those are pretty useless, but that's another blog). And, of course, peers, school, the media, your wise counsel, even genetics...

But, in the long run, one of the most important ways children learn is through so-called "incidental learning". We humans are great imitators and children just seem to inhale the world around them, incorporating their experiences into who and what they are, and what they become. They are learning on the fly, just when we are least aware of it and don't think we are teaching them anything at all.

I put it this way to the parents in my practice: "The purpose of discipline is to teach and to protect your child. The best way to achieve this, in the long run, is to be the kind of person you would someday like your child to be and to conduct your life in the way you someday hope your child will."

For parents - especially those of the "do as I say, not as I do" school of discipline - that may not be especially welcome news. And it is daunting for all of us to think of the little eyes watching how we act in the world and unconsciously incorporating our behaviors into the way they understand the world and how they act. But, for example, expecting that you can teach your children to be kind to others when you yourself are not, is a forlorn hope and not a great bet.

They tell me, "Physician, heal thyself." True enough, but the same goes for you guys.

Grand Rounds 2:18

Thanks to KevinMD for including me and some of my fellow WebMD bloggers in this weeks' Grand Rounds - a weekly roundup of posts from medical weblogs around the blogosphere!

Technorati Tags: medicine, medical blogosphere

Does having kids make you happy?

Dr. P's Pediatric Journal Club

The study

In 1987-1988, the National Survey of Families and Households interviewed and tested 9,000 people for:

--> Whether they had children (= 3/4) or not (= 1/4).

--> Levels of depressive symptoms.

--> Data on socio-economic status.

What the study found

--> Higher rates of depression were seen at younger ages, in women, in Blacks, in persons with less education, in those not employed full-time, in those with lower family incomes, and in non-married adults.

--> As a group, parents reported significantly higher rates of depression, compared to childless adults.

>> This was especially true of parents with young children.

>> On the other hand, "empty nesters" reported the same levels of depression as childless adults.

What this study suggests

Parents, especially those with young children, report higher rates of depression compared to childless adults.

Dr. P comments

OK, by now you have given up the myth of parenthood being a time of uninterrupted bliss and joy.

More likely, especially if your kids are young, aside from the fun and excitement and good times and joy, it is a time of relentless demands and responsibilities and dilemmas and worries. It's a stressful time - at least to some extent - no matter what your life circumstances might be.

Add to the mix a general lack of appreciation (by partners, families, friends, society) of how hard and how important a job parenting is. Is it any wonder that most parents become depressed some of the time?

I have no pat explanations, except to say that we in the U.S. provide less support for parents (time off work, high quality child care, resources for parents who choose not to work outside the home) than all the other industrialized countries. I wonder: is the level of parental depression in those cultures less than in ours?

Other than moving to Finland, any suggestions that might help? Here are some things I have learned:

>> Children are best served when their parents are living happy and fulfulling lives, whether that means engaging in full time work outside the home or devoting full time as a stay-at-home parent or a combination of the two.

>> Parents often become depressed when they make the mistake of giving up all the things that used to be meaningful to them in their childless days: keeping close friends, working on maintaining and making time for a loving supportive relationship with their partner, keeping up with their long term interests in the world, etc. In short, having a life outside of the kids.

>> Parents may become depressed if they are consumed with the notion of "infant determinism" - a theory popularized by some parenting gurus - i.e., the need to be a perfect parent because every little thing one does with your child is fraught with significance for their long term development. One false move and the child will be an endlessly neurotic, unhappy adult. Since the perfect parent has yet to exist, guilt is inevitable.

>> Parents may become depressed when they view themselves inadequate to provide their child with the skills needed to overcome the new threats to children of the 21st century, threats which were inconceiveable and largely unknown when we were kids (drugs, early sex, early exposure to inappropriate content on the media, etc.)

The good news of this study for you should be a confirmation of your complicated feelings about being a parent. Don't get me wrong, there is (I hope) plenty of joy and fulfillment coming your way. But so too is there almost always a downside, one that parents are rarely given permission to talk about or even feel.

Anyway you look at it, parenting is a tough job. Sure, you get depressed and stressed. But, as this study tells us, you are not alone. In fact, you're not even weird. You're just human.

----------------------x-----------------------

Article cited:

"Clarifying the relationship between parenthood and depression."

Evenson R and Simon R.

Journal of Health and Social Behavior. December, 2005

http://www.asanet.org/galleries/default-file/EvensonSimonJHSBDec05.pdf

Related Topics: How to Be A Positive Parent, Welcome to Parenthood

Technorati Tags: parenting, depression, stress

Self pity in kids

Dr. P's favorite quotes of the week

"The suffering of little children is not what is so intolerable,

but the fact that it is undeserved. "
- Albert Camus

(French existentialist philosopher, 1913-1960)

********************

"Often afterwards, the beloved Aunt would ask me

why I had never told anyone how I was being treated.

Children tell little more than animals,

for what comes to them they accept as eternally established. "
- Rudyard Kipling

(Brtish author 1865-1936, born in India and, at the age of 5,

sent off to live with foster parents in England,

with whom for five years he was "desperately unhappy")

********************

"Children seldom have a proper sense of their own tragedy,

discounting and keeping hidden the true horrors of their short lives,

humbly imagining real calamity to be

some prestigious drama of the grown-up world."

- Shirley Hazzard

Australian author (1931 - )

----------------------------------------x----------------------------------------

Dr. P comments

These quotes remind me of why I love kids so much and why I became a pediatrician.

I have seen children suffer the torments of illness, of unimaginable abuse, of poverty and social disadvantage, of a totally unfair lot in life, all, of course, through no fault of their own.

But never have I seen child full of self-pity. Never have I seen a child who hasn't just tried to move ahead with the business of being a child - with all its attendant challenges and joys and sorrows. Unselfconsciously, sometimes to the bitter end, a kid.

Not a "patient." Not a "victim." Just a kid.

Not a day goes by that a child doesn't teach and inspire me. I wouldn't change jobs for the world.

Related Topics: Life's Major Lessons, Children Are From Heaven

Technorati Tags: pediatrics, children, lifelessons

Your kids: Accept them as they are

Dr. P in P-Town

Over the holidays, my wife and I made our annual trek to Provincetown, Massachusetts. As some of you might know, "P-Town" is a very old whaling town, perched on the easternmost tip of Cape Cod. It also probably has the highest per capita gay population on the planet, which lends it a unique, festive atmosphere.

We were sitting at the bar of our favorite restaurant, awaiting friends to join us for dinner. The young man behind the ancient wooden countertop told us it was his first weekend there as a bartender, so please bear with him.

Now, we are at the stage of life where it's hard to tell how old a young person is. Early 20s? Late 20s? Early 30s? They all look the same (read: real young) to us. We asked him if he had just turned old enough to bartend.

"No," he replied. "I've actually been working in restaurants here in P-Town for 10 years and was a bartender elsewhere for 3 years."

Working 10 years already? Looking at his young face, the math did not compute. We asked him how that could be possible.

He sighed. "When I was 14 years old, living in a small town in New Hampshire, I came out to my parents. I told them that I knew I was gay - always had known, really - and I wanted to share it with them. Long story short: they told me that it was unacceptable, against God's will and everything they believe in. I should pray hard and change my ways. If that didn't happen, I simply couldn't stay with them."

"That week," he continued, "I packed my bags and took a bus to Provincetown, where I heard they would take in guys like me. When I arrived at the P-Town bus station, there was a large sign advising homeless youths to call a number to receive shelter and support. I guess I wasn't the first kid to be in this position."

"I called the number and they put me up with Bill, who had volunteered to take in stray cats like me. As it turned out, Bill became my foster father and I have been living with him for the past 10 years. He had two demands: I had to finish high school and I had to work to earn my keep."

"And so I have. Early on, I decided that the restaurant business was for me. Some day I hope to have my own restaurant here in P-Town. In the meantime, here I am."

We were stunned, horrified, saddened. What parents would banish their 14 year old son from their home? And, for what? A sexual orientation he was born with and had as much ability to change as his being lefthanded? And he seemed such a nice, sweet kid.

Our bartender, on the other hand, was cheerful as he poured our wine. Maybe he had told the story so often it had lost its emotional weight. Or could he really have come to terms with his heartbreaking past?

We asked him if he had any contact with his parents. "Funny you should ask. Last week I went home for the first time since I was banished. It was great seeing my brother and two sisters. Of course, my parents didn't really talk to me; they don't want to know about how I'm living my life and certainly not about my boyfriend. But, to their credit, at least they let me in the door."

I couldn't resist, "Aren't you just so angry at your parents. I have to say, I don't hear it in your voice, but it was such an unfair and cruel thing for your parents to have done to you."

"Sure, on some level. But I've also come to forgive them, at least partly. I've decided that they have about as much ability to change who and what they are as I do to change who and what I am. We'll probably never have a great relationship - maybe not one at all to speak of - but hating them for how they have treated me just doesn't help. I like who I am now, what I have become, and my life. Maybe they deserve at least a little credit for that."

Again, we were stunned, but this time at the level of maturity and wisdom of this young man - a poster boy for resilience in the face of adversity.

We raised our glasses of wine. "God bless P-Town."

"Amen!" he agreed, as he moved on to other customers.

--------------------------------x-----------------------------

As some of you know, I have long counseled that it is your job as a parent to discover - not invent - your child. But what if the human you discover is antithetical to your hopes, your dreams, your strongly held convictions of how a child should be?

I'm convinced that a lot of short and long term parent-child grief emanates from parents who can not accept who and what their child is: not smart enough... not good-looking...too active...too shy...too intense...too laid back...developmental challenges...

Go ahead and add your own pet peeve to the list. Most parents have at least a few. Nature often trumps nurture, and many parents become frustrated and angry at their inability to change unappreciated characteristics of their child.

I'm going to defer my usual "Dr. P's comments" and brilliant suggestions for another blog, and let you ponder this common dilemma: how can you as a parent best handle it when your child has certain traits that just don't fit into your image of the perfect child? When the child you love isn't always the child you like?

Related Topics: Making Peace With Your Past, Sexual Orientation Not Debatable


Technorati Tags: parenting, gayandlesbianchildren, forgiveness, comingout

Back to school: backpacks and backaches

Call me old fashioned, but in my day we measured the amount of homework by the hour. Now it's by the pound.

Backpacks are a great way for your child to schlep stuff back and forth from school. So great, in fact, that many tend to overdo it and carry way too heavy a load. When a backpack is too heavy, the back tends to lurch forward, the muscles in the mid and lower back become overworked, the shoulders stoop, and the neck and/or shoulders and/or back aches (numbness and tingling in the arms and hands is especially worrisome).

Definitive scientific data are not yet in - some studies are reassuring, some a little worrisome - so we don't really know whether such strain in school kids might lead to long term back problems or not.

But I say, hey, let's not wait 10 years to find out, especially when there are a few simple recommendations that seem to prevent the strain in the first place:

• Don't let your child tote more than 10-15% of his/her body weight in the backback.
• Encourage him/her to wear both shoulder straps (to evenly distribute the weight) and to keep the straps tight, so the weight rests against the mid and lower back.
• Buy a lightweight (but, of course, very cool looking) backpack with padded shoulders, padded back and waist strap so that the bottom of the pack sits a few inches above the back of the waist.
• Teach your child to pack the heaviest items in the center.
• Encourage him/her to lighten the load in the school locker during the day.

Dr P's bottom line
Even if you have to talk to your child's teacher or keep an extra set of books at home, keep the weight of your child's backpack at 10-15% of his/her body weight. Teach him her how to evenly distribute the weight. Find a compromise s/he and you can live with between looking cool and acting back smart.

Related Topics: Pain in the Backpack, Few Parents Check Their Child's Backpack


Technorati Tags: kids, backpain, backpacks

Cough medicine and children

Dr. P's Pediatric Journal Club

The study

The parents of 100 children with common colds were asked to rate the frequency, severity, and 'bothersome nature' of their child's nighttime cough for two nights.

On night #1:

--> no cough medicine was given.

On night #2 :

-->1/3 were given dextromethorphan ("DM"),

-->1/3 were given diphenhydramine ("Benadryl"),

--> 1/3 were given sugar water.

(Parents were not aware of which they gave.)

What the study found
- Most kids' coughs improved on day #2.

- There was no difference in the frequency, severity, or discomfort of the cough, whether or not the child had received either cough medicine or sugar water.

- Kids who took DM tended to sleep worse; those who took diphenhydramine tended to be drowsier.

What the study suggests

Two popular over-the-counter cough medicines were no more effective than sugar water in reducing the nighttime cough of children with a common cold.

In response to the scientific evidence of this and other studies, the American College of Chest physicians issued guidelines for treating coughs this week which also spoke to the general uselessness of OTC cough syrups (in part, they believe, because they are given in too small doses to be of benefit).

Dr. P comments

Considering the unbelievable amount of money spent on cough syrups, you'd think they actually would work. This study, as well as others, just confirms what I have seen for a long time: they rarely (if ever) do. Perhaps their only benefit is the (false) sense of security parents feel that at least they are at least doing something for their miserable child!

In a way, it's not all bad that OTC cough syrups are ineffective. When the back of the throat and lungs are full of mucus, coughing is nature's way of bringing it up and out of the irritated areas. Imagine what would happen if your child were not to cough at all: all that gunk would pool in the back of the throat, making breathing even more difficult.

The sad truth is that giving your little one cough medicine will probably be an exercise in futility, not to mention a waste of money. Remember, in this study, most kids' coughs got better on their own. Sure, go ahead and try cough medicine if you must, but 1) don't get your hopes up and 2) don't continue giving it if it clearly is of no benefit.

A vaporizer or humidifier may help to keep the mucus moist and thin, and therefore easier to cough up. Elevating the head of the bed helps a bit. Occasionally a decongestant affords some relief.

Your TLC is always the best medicine for soothing your miserable child and, alas, tincture of time is the only sure cure for the cough of a common cold!

-----------------------------------------------

Article cited:

"Effects of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents."

Paul M, et al. Pediatrics. July, 2004.

Related Topics: Cold and Flu Center, Stopping Germs at Home and School

Technorati Tags: cough,cold,flu,medicine,webmd

Does the U.S. love its kids?

Dr. P's favorite quote of the week

"The test of the morality of a society is what it does for its children."

Dietrich Bonhoeffer (1906-1945)
German Protestant theologian, hanged for a plot to overthrow Hitler

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Dr. P comments

OK, it's my blog and I'm told I get to rant every now and then.

First, here are some of "Dr. P's Unidentifed Flying Facts" about the status of some kids in the U.S.:

• 13 million children live below the poverty line (which, as an example, is a combined family income $19,307 for a family of four).
• 4.2 million white, 4.1 million Hispanic and 3.9 million black kids live in poverty.
• Nearly 10 million children (12%) have no health insurance.
• Food insecurity (defined as inconsistent access to adequate nutrition) is experienced by than 13 million kids.
• Food insecurity + episodes of hunger are experienced by about 420,000 children.
• And, last but not least in this Hall of Shame: The U.S. has the highest child poverty rate of any of the top 17 wealthiest nations.

Let me stress that, unlike many challenges we face as a society, these are fixable and at a price which is pretty cheap compared to what we are spending on... (fill in your favorite blanks). Personally, I'd vote for starting with universal health insurance for kids, more programs to lift their families out of poverty, and more resources put into ensuring top notch public education, starting at age 3.

Of all the stupid ways to save money, there are few stupider than not guaranteeing excellent health care, adequate nutrition, and great educational opportunities for all of our youngest citizens. It's shameful how little we, as a society, seem to value other people's kids, especially if they are poor. I just don't get it (or, even worse, perhaps I do.).

If Dietrich Bonhoeffer somehow came back, I'm not sure we could even look the guy in the eye.

Related Topics: Canada's Poor Healthier than US Poor, Poverty Impairs Problem-Solving Abilities in Children

Technorati Tags: health,education,poverty,children,webmd

Cognitive development in infants

Dr. P's favorite quote of the week

Children are born true scientists.

They spontaneously experiment and experience and reexperience again.

They select, combine, and test, seeking to find order in their experiences -

"which is the mostest? which is the leastest?"

They smell, taste, bite, and touch-test for hardness, softness, springiness, roughness, smoothness, coldness, warmness:

they heft, shake, punch, squeeze, push, crush, rub, and try to pull things apart.

-R. Buckminster Fuller

U.S architect and engineer (1895-1983)

------------------------------------------------------------

Among the joys of parenthood for you, I hope one will be the thrill of observing how your child learns to make sense of the world ("cognitive development").

If you are interested, there is a great book on the subject: "The Scientist in the Crib" by Gopnick, Meltzoff and Kuhl. In it, the authors explain how your infant learns so much so fast:

• S/he has a brain which is ready to solve problems and process information and make hypotheses on how the world works
• S/he has great teachers (that would be you!).
• (Most surprisingly), infants are already born with a good deal of knowledge.

All of this ordinary eternal machinery is our evolutionary heritage. There is no need for extra stimulation: the little scientist will learn to figure things out in the "ordinary expectable environment", with "good enough" (i.e., not 'super') parents.

Of all the motivations for your infant and toddler's behavior mentioned by the gurus, the drive to understand - to make sense of the world - is vastly underrated and neglected. If you realize, for example, that your oppositional 2 year old is really conducting a legitimate social experiment and not being 'terrible', that will go a long way in helping you figure out what is really going on and how to respond in a constructive way.

Children are not little, unformed adults. They make sense of the world in fundamentally different ways than us. Your job as a parent is to discover - not invent - your child. Learn how you can support your little scientist's quest for understanding by learning more about his/her cognitive development.

Related Topics: Milestones for 2-year olds, The Incredible Growing Baby

Tags: babycare, childcare, milestones, childdevelopment, webmd

Antidepressant medications and children

Dr. P's Pediatric Journal Club

"Suicide risk during antidepressant treatment"

Simon G, et al. American Journal of Psychiatry, January, 2006.

-----------------------------------------------------------------

The study

The authors reviewed the computerized medical records (1992-2003) of 65,103 patients for:

- use of antidepressant medications (82,285 episodes of treatment)

- suicide attempts

- death by suicide

What the study found

- The risk of suicide was highest in the month before starting treatment and declined after starting medication.

- The newer antidepressant medications seem to have a lower risk of suicide than do the older ones.

- The risk of suicide attempts was 4X higher in children and adolescents, compared to adults.

What the study suggests

There is not a significant increase in suicide attempts following use of antidepressant medications.

Dr. P comments

In March 2004, the U.S. Food and Drug Administration (FDA) warned physicians and patients about a possible increased risk of suicide with the newer antidepressant drugs. This study suggests this concern was unwarranted and there is no such risk.

In the same issue, other researchers found that antidepressant medications worked extremely well in about 1/3 of patients. (This is consistent with Dr. P's Rule of Thirds: Most treatments work extremely well in 1/3 of patients, so-so in 1/3, and not at all in 1/3.)

So, although the good news is that the newer antidepressant medications seem to be pretty safe, it's also true that they are by no means a cure-all: they are likely to provide significant benefit to only 1/3 and mild benefit to another 1/3 of patients. Is the glass 1/2 empty or 1/2 full?

Medications alone are rarely the answer for depression - certainly I have found that to be the case in children and teenagers. They should always be used in conjunction with ongoing psychotherapy with a trusted, wise professional (which is equally, often more, important).

Dr. P's bottom line

Most parents are understandably reluctant to start their kids on psychiatric medications. While caution is indicated, I feel such a rigid rejection of their use in children and teenagers is a mistake and may deprive your child of a therapy that could help a lot. Used appropriately and wisely, with ongoing follow-up and psychotherapy, I have seen such medications make a huge positive difference lifting a child's mood and improving the quality of his/her life.

If you are faced with the question of starting your child on psych meds, don't reject it out of hand:

• Educate yourself and become an informed consumer.
• Ensure there will be follow-up care.
• Be sure it is used in conjunction with ongoing psychotherapy.

If the medication doesn't work or if unwanted side effects are significant, it can and should be stopped. As a parent, you'll know what is best and can decide if the medications are a boon or a bust for your child.

Related Topics: Bipolar Disorder Treatments

, ADHD in Children

Tags: antidepressants,teens,adolescents,childcare,parenting,webmd

Adolescent immunizations

As many of you know, Dr. P is bullish on immunizations.

No question, the creation of vaccines to prevent illness is one of the great inventions of the 20th century and has saved the lives of countless children. Risks are minimal, especially compared to benefits. Period. End of discussion.

In the U.S., we've done a great job of immunizing and preventing illness in our little ones. (Watch for additional vaccines in 2006 - e.g., to prevent rotavirus, which causes a nasty diarrhea).

The action in vaccines in 2006, however, may be with older kids, i.e., your pre-adolescent and adolescent kids:

• As I wrote in my blog on 12/14/05, it looks like immunity to whooping cough ("pertussis") often wears off after a decade and that your adolescent should get a 'booster' shot with the "acellular pertussis vaccine".
  
  
• Half of all serious infections from a bacteria called meningococcus occur in 15-24 year olds. This is the bacteria that can cause meningitis and is pretty contagious for kids living in close quarters with others (e.g., dormatories). A new, more effective vaccine called quadrivalent conjugate meningococcal vaccine is now approved for children 11 years and older.
  

• (While a concern has been raised about the vaccine possibly leading to a rare neurological problem (Guillain-Barre Syndrome seen in 6 cases out of 2.8 million doses), the risk of a meningococcus infection is far greater. For this reason, the Center for Disease Control (CDC) recommends its administration at the pre-adolescent pediatric visit.)

• A vaccine to prevent "human papillovirus" (HPV) is close to being approved. HPV is responsible for the development of 2/3 of all cervical cancers. Stay tuned for the recommendation that it be added to the immunizations given to kids after the age of 10. If it works and we're lucky, maybe we can make cervical cancer as rare as hen's teeth.

Dr. P's bottom line
Just because your little baby is now taller than you, don't think the risk of illness or the need for immunizations has passed. Keep up with new vaccines as they are licensed and discuss with your pediatric provider giving them to your pre-adolescent or adolescent child.

Related Topics: Immunization Update, CDC Backs Meningitis Vaccine for Adults

Tags: pertussis,HPVvaccine,meningitis,vaccine,teen,preteen,webmd

Bedwetting and Your Child

Dr. P's Pediatric Journal Club

"Bed-wetting and Its Association With Developmental Milestones

in Early Childhood"
Touchette E, et al Archives Pediatric & Adolescent Medicine, December, 2005.

--------------------------------------------------

The study
Data was gathered on 1,666 children in Quebec at ages 29, 41 and 53 months on:

• Bedwetting
• Developmental milestones
  

What the study found

• 10% of children were still bedwetting at 53 months.
• Persistent bedwetting was associated with :
• Slower motor developmental milestones (e.g., sitting up, crawling) in boys.
• Slower language development in boys and girls.
• Increased inattention and hyperactivity in girls.

What the study suggests:
Persistent bedwetting may be due to immaturity of the central nervous system

Dr. P comments
This study helps us understand why bedwetting almost always goes away in time: the connections in the sleeping brain that stop the bladder from emptying are slow to develop. Once they do, the bedwetting stops on its own.

It breaks my heart to see parents get so angry, and then punish and ridicule their bedwetter. It's not his/her fault and all the punishment in the world won't help make those brain-to-bladder connections form. But it will do a good job in increasing the child's shame and lowering his/her self-esteem.

If your child is a persistent bedwetter, have his/her urine checked to be sure there is no medical problem. Try the easy things: restricting fluids after supper and awakening your child to pee before you go to sleep. But don't count on that doing the trick. Similarly, medications like DDAVP can work well when taken (and so are good for sleep-overs or camp), but when stopped the bedwetting comes back.

The most effective treatment for bedwetting - should you and your child want to try to speed the process up - are bedwetting alarms. These probably work by helping to make those connections during sleep. (For some reason, not all pediatric providers are familiar with alarms and continue to prescribe ineffective treatments.)

Bottom line: no punishment for a challenge your sleeping child has no control over. Think about it: if you were to be punished and ridiculed for drooling or snoring when you slept or if you were offered a new car if you didn't, how well would that work?

Related Topics: The Bedwetting Blues, Pedatric Potty Problems

Tags: childcare,babycare,bedwetting,development,webmd