Summer safety (part 2): Practice safe sun!

I know, I know. For many of you, this mundane topic belongs in the DUH! category of pediatric advice. But consider this:

• 50-80% of our lifetime sun-exposure occurs before age 18.
• Many parents use only 50% of the optimal amount of sunscreen and often neglect to reapply it as the day goes on.
• Early sun exposure is related to aging skin, wrinkles, and the later development of skin cancers. The most deadly, melanoma, has continued to increase over the past decades, perhaps because:
• NEWSFLASH! It is now felt that exposure to UVA ultraviolet rays may be more important in causing later skin cancer. Many sunscreens do not provide adequate protection against UVA!
  

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First, a brief primer on sun-exposure

• The sun contains three kinds of ultraviolet (UV - light with very short wavelengths) rays: UVA, UVB, UVC. (UVC rays are apparently the most dangerous but, at least for now, are blocked by the ozone layer and don't penetrate the earth's surface.)
• UV rays interact with and are absorbed by your skin's pigment cells (melanocytes) . More UV --> more melanin to protect the surrounding skin from burns --> suntan.
• However, there is no such thing as complete protection from UV rays.
• The sun's rays are strongest in the summer, especially between 10am and 4pm. (Use the "shadow rule": when your shadow is shorter than you are, the UV rays are most intense.)
• UV rays reflect off water and snow, increasing exposure.
• 2/3 of UV rays penetrate clouds and can cause unexpected sunburns.
• The "SPF" (sun protection factor) on sunscreens estimates how well the UV rays are blocked from reaching the skin. A factor of "15" means that sun exposure of 15 minutes is equivalent to about 1 minute exposure without sunscreen. An SPF of 10 blocks about 90% of UVB, a SPF of 15 blocks 93%, and an SPF of 30 blocks 97%.
• However, SPF refers to the ability to block UVB, not UVA!
  

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I hope I've convinced you that this is a big deal and one of the important preventive measures to obsessively follow with your kids. Here are Dr. P's Tips on protecting your child's skin from harmful rays.

• Wear sun-protective clothing. Look for summer clothing with Ultraviolet Protection Factor (UPF - similar to SPF in sunscreen) of 15 or greater on the label. (These can lose effectiveness if wet, stretched, or too tight.)
• Wear caps/hats with broad bills that shade the face, head, neck and ears.
• Use sunglasses with both UVA and UVB protection (Cataracts as an adult may, in part, be related to early unprotected eye exposure to UV rays + kids look so cute with shades!).
• Play in the shade. Bring an umbrella or pop-up tent along to avoid direct sun.
• No sunbathing! Remember: tan skin is damaged skin.
• Use sunscreen liberally. There is no evidence at all that sunscreen is harmful to children. (Despite the absence of data, the American Academy of Pediatrics doesn't advocate its use until 6 months of age. Recently they've said that if direct exposure to sunlight can't be avoided, it's probably fine to use it on the small parts of the body that will be exposed).
• Pick a PABA-free "hypoallergenic" sunscreen that offers both UVA and UVB protection.
• All sunscreens block UVB , but not all do a good job with UVA. Read the label: the best UVA protectors contain a chemical-free sun "blocker" (like zinc oxide, titanium dioxide) and/or the sunscreen avobenzone.
• Use a sunscreen with an SPF of 15 or more whenever your child is exposed to the sun.
• An SPF of more than 30 is not necessarily better, as the increased concentration of suncreen is more likely to cause skin irritation while offering very little extra protection (e.g., increasing SPF from 30 to 40 requires 25% more sunscreen with only 0.8% more protection).
• Apply sunscreen liberally and let dry about 30 minutes before exposure.
• Don't forget the nooks, crannies, and high-exposure areas (ears, feet, lips, noses).
• Remember: "water resistant" means it lasts about 40 minutes in the water; "water proof" means it wears off after about 80 minutes in the water. So, reapply, reapply, reapply (every 2-3 hours, or right after swimming or sweating a lot), as the day wears on.
• If you read the labels, you'll see there isn't much difference (except cost) in sunscreens marketed for kids. Don't feel obliged to use them, unless one especially appeals to your child.

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OK, you (or your independent child) blew it. What to do in case of sunburn?

Sunburn is caused by the high energy of the UV rays directly burning the exposed skin. It usually shows up 2-6 hours after exposure and peaks in severity at about 24 hours. Alas, no treatment (except avoiding further sun exposure) has been shown to reduce the extent of the damage or the time of healing.

For comfort, here are some tips:

• Take a cool bath (some find adding baking soda or oatmeal to be soothing).
• Gently apply cool, wet compresses.
• Rub on soothing aloe vera gel.
• Use a fragrance-free moisturizing cream (not petroleum-based) to rehydrate the skin.
• If severe, 1% hydrocortisone cream may offer some relief (although, alas, it usually doesn't in my experience).
• Give a pain reliever which also reduces inflammation (such as ibuprofen).
• Drink plenty of fluids.
• While rare, if the sunburn is especially severe and/or accompanied by other symptoms (like severe pain, horrible blisters, nausea, confusion, headache, looking infected over time), seek medical attention!

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I've spent a long time on this because one of the real gifts you can give your kids is healthy, non sun-damaged skin. It's worth the effort!

Related Topics: Summer Skin Care, WebMD Video: Safe Summer Tan?

Other Summer Safety Tips from Dr. P: Mosquitoes


Technorati Tags: pediatrics, skin cancer, UVA, UVB, SPF, sunburn, sunscreen

Summer safety (part 1): Mosquitoes be gone!

I just noticed that the Weather Channel web site now provides information entitled: "Mosquito Activity Forecast." Worse, in my town today's report reads: "HIGH. Be on the lookout! Lurking mosquitoes likely to be busy."

And, in case I wasn't already sufficiently bummed out, they feel compelled to remind me that "female mosquitoes require a blood meal from time to time." (for the protein to nourish their eggs, which is why the male mosquitoes don't bite).

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Loathsome creatures

I have to admit, I detest mosquitoes above all creatures. Consider the following Unidentified Flying Facts about these loathsome insects:

• There are estimated 1,000,000,000,000,000,000,000 (1,000 trillion) mosquitoes on planet Earth!
• They've been around for 30 million years, perfecting their ability to detect your heat, light, body odor, and carbon dioxide. All the better to eat you with, my dear.
• Once you are bitten, the proteins in their saliva sets up an immune response -- swelling and itching.
• Mosquitoes are the world's most dangerous creatures:
  - The diseases they spread have killed more people than all the wars in history.
  - World-wide, mosquito-spread diseases kill 2 - 3 million people/year by infecting an estimated 200 million/year with malaria, filariasis, yellow fever, dengue fever.
  - Fortunately (?), in the U.S. mosquito-spread disease is rare; only West Nile Virus and various kinds of encephalitis are of any concern.

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Avoiding mosquito bites

I know it's just a matter of time before stories of West Nile Virus and encephalitis hit the news stands and my WebMD Message Board lights up with parental panic. So let's discuss how to avoid mosquito bites for you and your kids (adapted from the CDC):

• When possible, wear long sleeves, long pants, and socks when outdoors.
  
• Place mosquito netting over infant carriers when outdoors.
  
• Consider staying indoors at dawn, dusk, and in the early evening (peak mosquito biting times).
  
• Install or repair window and door screens so that mosquitoes cannot get indoors.
  
• At least once or twice a week, empty water from flower pots, pet food and water dishes, birdbaths, swimming pool covers, buckets, barrels, and cans. And limit the number of places around your home for mosquitoes to breed by getting rid of items that hold water, such as old tires, tin cans, buckets, drums, bottles, clogged rain gutters, and trash containers.
  
• Check with local health authorities to see if there is an organized mosquito control program in your area. If no program exists, work with your local government officials to establish a program.
  

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Insect repellents

Short of going outside in a bubble, applying an effective repellent is the best way to avoid mosquito bites. The most effective insect repellents contain deet (N,N-diethyl-m-toluamide, also known as N,N-diethyl-3-methylbenzamide).

Is deet safe for kids?

• The risk of adverse reactions and illness from deet, when used prudently and as directed, appears to be very low.
• There is no specific data on the worry of skin absorption of deet in children. However, data on similar chemical suggests that after 2 months of age, there should be no increased soaking through the skin. Therefore, deet is not recommended for use in infants under 2 months of age.

Special tips on applying insect repellent on kids:

• The concentration of deet in products may range from less than 10% to over 30%.
• The major difference relates to how long they are effective. Products with concentrations around 10% are effective for periods of approximately two hours; a concentration of about 24% affords an average of 5 hours of protection.
• Select the lowest concentration effective for the amount of time spent outdoors.
• Deet should generally not be applied more than once a day.
• Apply repellents only to exposed skin and/or to clothing (as directed on the product label).
• Do not use under clothing, on cuts, wounds, or irritated skin, nor on the eyes and mouth.
• When using sprays do not spray directly onto the face; spray on your hands first and then apply to face.
• Do not allow children to handle the products. Do not apply to children's hands.
• When using on children, apply to your own hands and then put it on your child.
• Do not spray in enclosed areas to avoid breathing it in. Do not use near food.
• A heavy application is generally unnecessary for effectiveness. If biting insects do not respond to a thin film, then apply a bit more.
• After returning indoors, wash treated skin with soap and water and wash treated clothing before wearing them again.
• If you suspect that you or your child are reacting to an insect repellent, discontinue use, wash treated skin, and then call your local poison control center. If/when you go to a doctor, take the repellent with you.

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What about "natural" insect repellents?

Other insect repellents that are used in children include those made with Citronella and soybean oil. However, these are not nearly as effective in warding off mosquitoes, do not last as long, and do not protect against most stinging insects, including wasps, bees, and fire ants. Remember, "natural" does not necessarily mean "safer."

Newer repellents

Picaridin. A new repellent contains the chemical picaridin. Consumer Reports (Dr. P's bible) found it as effective as deet and states it is "worth a try...if you need just a few hours of protection and if you don't like the odor or feel of repellents containing deet." Apparently, picaridin has been used world-wide since 1998 and the World Health Organization regards the proper use of picaridin as "safe".

Oil of lemon eucalyptus. The Centers for Disease Control and Prevention announced that it considers oil of lemon eucalyptus, like picaridin, as effective against mosquitoes as deet. I haven't had any experience with it and safety data is lacking.

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Dr. P's bottom line

These new preparations may turn out to be effective, but none have been as well studied as deet for effectiveness and for potential side effects. For now, I'm sticking with deet.

Remember: A skeeter bite-free summer is a happy summer. Take care!

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Want yet more info? Check out the CDC's Website.

Other Summer Tips from Dr. P: Summer Sun Protection

Related Topics: Mosquito Repellents: What Works, Are You A Mosquito Magnet?

Technorati Tags: mosquitoes, insect repellent, West Nile Virus, deet

Give that baby a pacifier!

OK you blogsters, you want real controversy, people coming to blows, marriages in shambles, World War III? Let's talk pacifiers.

Here's my contention:
Every human infant on the planet should be offered a pacifier.

Aside from my copious stock options in binky companies, here's why:

There is pretty good (but perhaps not quite definitive) research to show that infants who suck on a pacifier have a significantly lower risk (perhaps as much as 45-90% less, depending on the study) of dying from Sudden Infant Death Syndrome (SIDS). (Yes, thumb-sucking also had a protective effect in at least one study, perhaps a 50% decrease).

The reasons for this association are not clear (especially since we really don't know what causes SIDS in the first place). Some wonder if the pacifier changes the airway in an important way, perhaps by moving the tongue forward or keeping the mouth open. Others speculate the sucking reflex stimulates the brain so it doesn't 'forget' to breathe or to sleep too deeply.

Who knows? (Really, who cares if it does the job?)

But them's fighting words. There are vociferous opponents - haters, really - of pacifiers, mostly because of the concern that their use will interfere with the initiation of breast feeding (although studies generally do not support this) or hasten weaning (which a few studies do suggest). Also pacifier use is associated with a small increase in ear infections in the first year.

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Soooooo, let's take stock: on the one hand, potentially less time breast feeding and/or ear infections, on the other decreased risk of DEATH. Really, is this a tough call?

Even the conservative American Academy of Pediatrics recommends the use of pacifiers for the first 12 months or so, with the following provisos:

• A bottle-fed baby can be offered a pacifier right away.
• Wait until breast feeding is well established to offer the pacifier (remember peak of SIDS is not until 2-4 months of age).
• Use it for all sleep and nap times.
• No need to keep putting it back in the mouth should it fall out.
• Don't use sweeteners on the nipple.
• Keep them clean!

The nice things about a pacifier (which the British call a "dummy", perhaps because it was first used only by the lower classes) is that you can get rid of it whenever you want (unlike the thumb). Since dental misalignment is not a concern for 4-5 years, you have plenty of time to decide when you are ready to face your infant/toddler's wrath at its banishment.

I only wish there were other as simple, effective, inexpensive and relatively risk-free public health interventions! Maggie Simpson has got it right. Power to the Pacie!

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Articles cited:
Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis.
Hauk F, et al. Pediatrics, October 10, 2005.


Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome: population-based case-control study.
Li D, et al. British Medical Journal. December, 2005.

Related Topics: Nutrition During Breastfeeding, Infant Formula, Parkinson's Tie Probed

Technorati Tags: pacifiers, infant care, pediatrics, SIDS

Pediatric Grand Rounds

Pediatric Grand Rounds is a roundup of some of the best blog posts written by pediatricians, parents and others concerned about pediatric issues. The latest is just out and includes my discussion of the prescription of antipsychotic medications for young children. There are also posts about newborn testing, Asperger Syndrome, autism and more.



-Dr. P

Technorati Tags: PGR, pediatric grand rounds, pediatrics

Father's Day: Nice work, guys

Talk about an under-appreciated group of humans!

Happy Father's Day to all you hard-working dads out there.

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Here are some of Dr. P's favorite quotations about fathers:

Perhaps my fave:

"Sherman made the terrible discovery that men make about their fathers sooner or later... that the man before him was not an aging father but a boy, a boy much like himself, a boy who grew up and had a child of his own and, as best he could, out of a sense of duty and, perhaps love, adopted a role called Being a Father so that his child would have something mythical and infinitely important: a Protector, who would keep a lid on all the chaotic and catastrophic possibilities of life. "
- Tom Wolfe, The Bonfire of the Vanities

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"He didn't tell me how to live; he lived, and let me watch him do it. "
- Clarence Budington Kelland (American author)

"Henry James once defined life as that predicament which precedes death, and certainly nobody owes you a debt of honor or gratitude for getting him into that predicament. But a child does owe his father a debt, if Dad, having gotten him into this peck of trouble, takes off his coat and buckles down to the job of showing his son how best to crash through it. "
- Clarence Budington Kelland (American author)

"There are three stages of a man's life: He believes in Santa Claus, he doesn't believe in Santa Claus, he is Santa Claus. "
- Author Unknown

"When I was a boy of fourteen, my father was so ignorant I could hardly stand to have the old man around. But when I got to be twenty-one, I was astonished at how much he had learned in seven years."
- Mark Twain ("Old Times on the Mississippi" , 1874)

"If the new American father feels bewildered and even defeated, let him take comfort from the fact that whatever he does in any fathering situation has a fifty percent chance of being right. "
- Bill Cosby

"It is admirable for a man to take his son fishing,
But there is a special place in heaven for the father
Who takes his daughter shopping. "
- John Sinor (American author)

Nice work, guys!

Children and antipsychotic medications

Are antipsychotic medications overprescribed for children?

Dr. P's Pediatric Journal Club

The study

The researchers extracted data from a national survey of doctors' office visits during 1993-2002, looking for the use of "antipsychotic medications" in children and adolescents (under the age of 21 years).

What the study found

• 18% of visits to a psychiatrist resulted in a prescription for an antipsychotic medication.
• In 1993, 201,000 prescriptions for antipsychotic medications were written for children under 21 years of age. In 2002, 1,224,000 prescriptions were written.
• This adds up to about 14 per 1,000 children and adolescents receiving these medications ( compared to about 2.75 per 1,000 in 1993), about a five-fold increase.
• These meds were mainly prescribed for Disruptive Disorders (38%), Mood Disorders (such as childhood bipolar in 32%), Pervasive Developmental Disorders or Autism Spectrum or Mental Retardation (17%), and Psychotic Disorders (14%)
  

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Dr. P comments

The plot thickens in this highly debated area of the psychiatric care of our children.

I've blogged before about the increase in ADHD (Attention Deficit Hyperactivity Disorder) and antidepressant medications over the past 15 years (neither of which I'm going to discuss again here). So it comes as no surprise that the newer generation of 'atypical' antipsychotic medications (such as Risperdal, Clozaril, Zyprexa, Seroquel, Abilify **) are being used with increasing frequency in the younger age groups.

So (you appropriately ask), is this a worrisome trend or is this good news?

The potentially worrisome part:

• While safer in most cases than the older antipsychotic medications (such as Haldol, Mellaril, Thorazine), these meds are not without side effects. Significant weight gain and elevation of fat in the blood, at the very least, are quite common.
• Since these medications are relatively new on the scene, their long-term use has not been well-studied, especially when started in childhood. Could there be unexpected side effects (negative or positive) that will show up in a decade or two?
• "If all you have is a hammer, everything looks like a nail." There is no question these medications can be very beneficial for some children. But might their effectiveness and relative safety short-circuit attempts to first try to solve behavior/psychiatric problems with slower and more labor-intensive environmental interventions? Are we too quick to default to medications as the first line of treatment? Could this trend reflect an easy way out for a society facing a critical shortage of mental health professionals for children?
  

The positive side:

• There are an increasing number of studies and lots of clinical experience showing these medications often really help some children (especially childhood bipolar disorder and disruptive disorders in children with developmental disabilities).
• So far, aside for the weight gain and elevation of fat levels, the medications are usually well tolerated and appear to be reasonably safe.
• While imperfect, these medications do represent an important advance in treatment for many children. Over time, even safer and more effective medications are going to emerge.
  

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A case from Dr. P's clinic

Try to put aside your opinions for a second and let me present to you a case from my own practice. I'll tell you what I have done, then you can decide if you agree with it or not.

When I first met him 3 years ago, Billy (not his real name) was an exceptionally hyperactive two and a half year old. Even more remarkable, he would occasionally go for 72 hours without any sleep! He was bright, cute, but could be very aggressive and unmanageable. His intense tantrums could last for hours. Babysitters refused to care for him more than once. He was expelled from his day care. As you might guess, life with Billy was incredibly difficult.

Despite being unsure of his diagnosis, I decided - at the tender age of 3 years - to start ADHD stimulant medications + a medication for sleep. These did help for about a year or so, but began to lose effectiveness when he was four.

Because of his extreme symptoms and a positive family history, I had always been suspicious that Billy was manifesting, at an unusually young age, symptoms of Childhood Bipolar Disorder. So, reluctantly, I started Risperdal (one of the newer antipsychotic medications).

His mom described the difference as 'miraculous'. Billy's hyperactivity, aggressiveness, and disruptive behaviors became quite manageable. Now he loves to go to preschool where, instead of being constantly punished and berated for his misdeeds, he proudly reports his many successes. His learning is at age-level. Baby sitters are now happy to give mom a break. He's gained a lot of weight but otherwise seems a healthy and much happier little boy.

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So, was I right to start an antipsychotic medication in a boy who is only four years old? What were/are the risks of using - or of not using - the medication?

Frankly, I struggle with these questions every time the issue of using psychiatric medications comes up (which is more and more often!). I don't see any easy, pat answer to the good news/bad news question. For better or for worse, I take it case by case and weigh the pros and cons as best I can.

Anyway, I hope I've at least highlighted for you the complexity and importance of what is at stake. This is an issue and a debate only likely to grow in intensity and importance over the next years. Your thoughts?

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Article cited:

Archives of General Psychiatry, June 2006

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** I'm using the trade names for these medications, instead of the actual drug names, since these are names most people know them by and since you can't get generic brands for them as yet anyway.

Related Topics: Bipolar Disorder: Recognize the Symptoms, Bipolar Youths May Misread Faces

Update: Welcome Pediatric Grand Rounds readers!

Technorati Tags: antipsychotic medication, pediatrics, childhood bipolar disorder, ADHD, depression

Your 21st century child: Raise a lover of science

My #3 strategy to raise a happy and successful 21st century child?
Raise a lover of science.

OK, I realize I really have my work cut out for me on this one. That's because many of you 1) hated science class when you were students and 2) don't respect science as a way to understand and appreciate the beauty of the natural world and how it works.

If that sounds like you, here's the rub. It's not a news flash that many of the good jobs available to your 21st century child will be in the science and technology sectors. If your child follows in your footsteps, s/he may get left behind as our world and the job market continue to evolve in unexpected ways due to new scientific discoveries.

Truth be told, we Americans are already falling behind in this area.

Here is what the prestigious National Academy of Science has to say: "The committee is deeply concerned that the scientific and technological building blocks critical to our economic leadership are eroding at a time when many other nations are gathering strength." They made this statement for these (and other) reasons:

• We are relying more and more on foreign-born scientists: 38% of the PhD scientists and engineers in the U.S. were born abroad. In 2003, foreign students earned 59% of the engineering PhDs awarded in the U.S.
• The U.S. share of global high tech exports has dropped from 30% to 17% in the last 20 years.
• U.S. students finished 27th in a recent international mathematics test.
• 2/3 of chemistry and physics teachers in U.S. high schools did not major or have a teaching certificate in the subject. The same is true for 1/2 of the grade 5-12 math teachers (some of whom are physical education majors).

You can read the entire article and their recommendations (website below) for changing our school system. But while they lay out how we as a society should respond, they don't address what you as a parent might do to interest your kids in a career in science.

It turns out this is a critical question. Just last week, the journal Science published a study in which over 3,000 8th graders had been asked "what kind of work do you expect to be doing when you are 30 years old?" They were then followed for their career choices years later. Here's what the study found:

• 10% of the 8th graders listed science as their career choice.
• If an 8th grader had expressed an interest in a career in science, 34% of those graduating college achieved a science or engineering degree.
• If an 8th grader had not expressed an interest in a career in science (even with above average mathematics scores), 19% of those graduating college achieved such a degree.
• The study concludes that having an interest in science by the 8th grade - even more than a talent for science - often guides later career choices.

How to interest your child in science?

It really shouldn't be that hard to encourage an interest in science. After all, we are born as "little scientists" (see the wonderful book "The Scientist in the Crib" by Gopnik A, et al). In the first years, we conduct endless scientific experiments (e.g., "Hmm... What happens if I smear jelly all over this wall?" "How will Mom respond if I refuse her request to go to bed?"). That's one way we learn how to make sense of the world.

But this wonderful curiosity is often dampened by boring lessons and rote drills and parental indifference to all things science. Just as damaging, in my opinion, is an anti-scientific bias many U.S. parents seem to have. "I don't care what the scientific studies say, immunizations are bad for kids." "If a medicine is 'natural', it must be safe. I don't need scientific proof."

In the interest of full disclosure, I view scientific endeavors as one of mankind's crowning achievements. A life without appreciating the beauty and importance of scientific theories and methods and discoveries is one that misses out on a key part of modern life, one that is likely to become even more relevant and important to your child in the 21st century.

So how can you help to promote an interest in science, in general, and perhaps a career in science, in particular, for your child? Here are a few suggestions:

• There's a pretty good website on this topic: http://www.teachspace.org/scientist.html
• Watch the science channels on TV together and discuss them.
• Visit and join the science museums in your community.
• Discuss with your child how things work and why events turn out as they do.
• Teach your child about the scientific method of proving or disproving what people say is true.
• Buy your child a chemistry set, a telescope, a microscope, an ant farm, etc and play together with them.
• Children's interests are best stimulated when they associate the activities with quality time spent with a beloved parent. It's never to late for you to become a science geek!
• Be sure your child's school has an excellent science curriculum.

As usual, I'm better at laying out the challenge than the solution. I'd love to hear how you approach this with your kids!

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Articles cited:
"Career Choice: Enhanced Planning Early for Careers in Science"
Tai RH, et al. Science 26 May 2006; pp. 1143-1144

"Rising Above The Gathering Storm:
Energizing and Employing America for a Brighter Economic Future."
National Academy of Sciences, 10/05
http://fermat.nap.edu/execsumm_pdf/11463

Related Blog Entries:

• Raise a bilingual 21st century child
• Your 21st century child: Raise a book lover

Technorati Tags: 21st century child, parenting, science, technology

Your 21st century child: Raise a book lover

#2 on my list of strategies to raise a happy and successful 21st century child? Raise him/her to be a book lover.

There are, of course, clear benefits to being a good reader and to enjoying books:

• Reading skills are one of the best predictors of academic success. (However, cause and effect are not clear since good students tend to be good readers and vice versa but, as we say in the trade, honing your child's reading skills wouldn't hurt).
• Despite inborn differences in how skillful a reader a child will become, as a parent you can work to ensure that s/he comes to enjoy the experience of reading. A good book is one of life's great pleasures, affording a lifetime of entertainment, knowledge, new experiences, insight.
  

Those are pretty obvious, but I also have a few more subtle advantages in mind.

First, let me state that I'm not at all a TV, media, computer opponent (for example, I thought the Academy of Pediatrics was ill-advised to forbid TV for kids under 24 months), as long as they are used in moderation and with close parental attention to the content. The electronic media will certainly be a fact of life for your kids and, hopefully, a positive one.

Having said that, these omnipresent 21st century TV and computer-based experiences have three qualities that worry me:

1. Everything moves at a fast pace. Even the great Sesame Street has taken some heat for promoting short attention spans as their lessons fly by at a dizzying pace (and they are the good guys). Most TV images are fleeting: BIF! BAM! BOOM! Process it quick and move on to the next image.
2. These experiences are essentially passive ones. Everything is laid out for the watcher, unlike books or even radio. We don't have much work to do; mostly we're along for the ride. (I love Harry Potter, but I was sorry they made the movies. It was heartwarming to see children so excited about reading, each with his/her own image of Hogwarts and Harry, fueled by imagination. Now the need for that creative leap is gone - the movies have done all the work for us and it's hard to imagine Harry as anything other than the actor who plays him.)
3. There are no long, complicated stories, no slowly developing narrative flow, no time or need to anticipate and guess what is coming next. Our kids are being raised on a diet of short stories instead of novels.
   

Could such experiences have unintended long-term consequences?

These issues are not well studied, so I admit there is little or no scientific evidence (yet), but my fear is that we may be raising a generation of kids with shorter attention spans, a passive stance to taking in information, and little ability to follow or create a complex story.

If I'm right, reading might just be the antidote. The story evolves slowly. Your child has to do creative work, to create characters, to anticipate possible plot twists and predict what might happen next. It is an incredibly active experience rather than an incredibly passive one.

How to raise a book lover?

About 17 years ago one of my Developmental Pediatrics fellows started a program called "Reach Out and Read". (http://www.reachoutandread.org/ ) in which pediatricians give out books to kids at every visit, starting at the 6 months, to encourage an early love of books.

It's been very successful and is now in thousands of pediatric offices. There is good research to show it improves interest and appreciation of books in all kids, but especially those from disadvantaged circumstances. Parents love it, kids love it, and pediatricians love it (it's a lot more fun to give a child a book than a shot!). And we've learned a lot from the program.

In my blog of 12/05/05, I advised you to read aloud to your kids, giving them books to chew on and to enjoy from early age. The key is for them as infants and toddlers to associate a book with your attention and love. Later on, when you can read them a story or book before sleep, creating a wonderful shared experience.

Keep lots of things to read in your house -- it doesn't have to be great literature. The key is for them to read and to enjoy the printed word, any printed word (well, almost any). Of course, do this in a second language and you've got a twofer of raising a bilingual lover of books - a Dr. P dream come true!

Well, this blog is already long enough. Really my intention has been to explain why it might be a good idea to raise a booklover. I'll save more of the how for another time and, anyway, I'd love to hear your suggestions, especially with your older kids.

(In my next blog, I'll opine on my #3 best strategy to help raise a happy and successful 21st century child. Stay tuned!)

Related Blog Entries:

• Raise a bilingual 21st century child
• Your 21st century child: Raise a lover of science
  

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