Dr. P's Top 10 Back-To-School Tips

"BACK TO SCHOOL" - 3 words certain to fill your children's hearts with despair and yours with joy. It's an annual rite of passage and a good time to take stock: How can you help your kids to make this school year academically productive, socially fulfilling, and safe as can be?

Here, in no particular order, are my top 10 suggestions. Feel free to share your own.

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1. Get organized! Plaster a monthly/yearly school calendar on the refrigerator to highlight upcoming events, deadlines, etc. Figure out and agree on morning routines: when to get up, bathroom rules and time, getting dressed, eating a decent breakfast, etc. in a "no nagging required" environment.

2. Talk things over. Arrange a "planned discussion" with each of your kids to talk about his/hers and your academic goals for this year. Is there anything she is particularly anxious about? Be sure you include your expectations for performance - just make sure they are appropriate (perhaps a tad high) and fair, linked to his/her talents and potential. If she's a brainiac, then good grades are reasonable to expect. If an average student, don't set the bar so high she is sure to fail. Remind her that what you really expect is for her to try hard and do her best, no matter what her final grades may be. Discuss expectations for completing homework. Construct positive (hopefully) self-fulfilling prophecies about the year. Reassure her that a lot of kids are anxious at the first day of school, but you know she'll handle this just fine, as she usually does. Remind her about the good things that happened last year.

3. Talk some more. What are his/her social goals? Is he looking to make new friends? How might he best accomplish that? What might be some of the social challenges this year? Ask about what's important for social status in school this year (it changes on a dime). What kind of clothes, shoes, backpacks, hair styles are in? It's important to give this some sort of adult perspective but - make no mistake - social status is very important to all of us, and your kids are no exception. So don't belittle their feelings and desire to fit in, rather help them to achieve that within the values and aesthetics and monetary constraints of your family. Allow him/her to pick his/her own school supplies and clothes, but within an agreed-upon budget and your veto power in extreme circumstances (like too-sexy clothing). Click on the above image to read the very funny Onion parody of necessary school supplies.


4. Discuss and rehearse walking to school safety. Have your child walk (with or without adult supervision, depending on his age) to school if possible. It's great low-tech exercise and a wonderful time to socialize with friends in the great outdoors. Find a couple of reliable pals to walk with each day. Review pedestrian safety. Take a rehearsal walk or two, noting potential dangers along the way. Find a direct, safe route with the maximum crossing guard support. Be sure she always crosses at a crosswalk (or at least a corner). Be sure she understands to look for a green light and walk sign. Be sure she knows to stop at the curb, look left and then right and then left again (unless you're British), and listen while crossing all streets. Beware parked cars or other obstacles blocking vision of the street.

5. Go over appropriate response to strangers. Role play: What if a nice stranger came up to you and asked to help him to look for his poor, sad, missing dog? What if he offers you a ride on a rainy day? How about some candy, little girl? Does it matter what he or she looks like? You don't want to make your kids abduction fearful, just stranger wise.

6. If your child is taking a bus, the biggest danger is getting on and off. Go for a bus ride together and show him how to wait at the curb 10 giant steps away from the bus for the driver to stop, how to be in clear view of the driver at all times (don't walk behind the bus!), how to be very careful and make sure all oncoming cars have stopped and the driver has signaled it OK to cross. Be sure to pick a safe spot in the neighborhood for boarding and exiting the bus. Go over your expectations for conduct on the bus. Encourage him to feel safe to discuss any bad experiences on the bus (like bullying or teasing).


7. Don't overdo the weight in the backpack! Don't let your child tote more than 10-15% of his/her body weight in the backpack. 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. In a pinch, rolling backpacks are catching on (but are tough in the snow).

8. Go over potential bullying experiences with your child. Remind him this happens, but is mean and unacceptable and not to be encouraged. Tell him/her if it happens to TALK: tell the bully you don't like what s/he has done and that it isn't nice or fair, and WALK: Walk away. Bullies like victims who are passive and come back for more, and SQUAWK: Tell the teachers or parents. Bullies prefer kids who keep silent so they can go about their nasty business without consequences. As a parent, get the school involved in teaching about bullying.


9. Discuss the unmentionable: toileting in school (if you don't who will?). For a surprising number of kids this is the most anxiety-provoking part of the school day. In great discomfort, they'll hold it all in rather than face what might await them in the bathroom. Remind them you expect them to ask to go in school whenever they need to go, and to tell the teacher or you if there are any problems in the bathroom. Role play what they might do if someone makes fun of them or offers a cigarette (or worse) in the bathroom.


10 . Whoops, can't think of a #10, so I'll resort to my usual:

Enjoy your kids! Enjoy the ride! Some day soon you'll wonder how it all went by so fast and why you didn't appreciate it more as it was happening.

Related Topics:

• Back to School in a Wired World
• WebMD Video: Tips to Get Your Kids Out of Bed and Off to School

Technorati Tags: back to school, safety, pediatrics, health and wellness

The Toy Recalls and the Long Sorry Story of Childhood Lead Poisoning

By now you surely are aware of the latest fiasco in children's toys. If not, here's a quick summary:

• - Mattel Toys has just recalled 18.6 million toys worldwide (1/2 in the U.S.) because they were coated with lead paint or were held together with magnets that could detach and be swallowed by a toddler.
  


• - On August 8, Schylling Associated recalled 51,000 Thomas & Friends, Curious George, and circus tops coated with lead paint.
  


• - On June 13, RC2 Corp. recalled 1.2 million Thomas and Friends wooden railway toys for the same reason.
  

All of these toys were made in China.

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Lead is Bad News

You also certainly know that ingesting lead is very bad for kids. It preferentially enters the growing bones and brain and other organs, where it can cause significant disruptions and damage, such as learning problems and ADHD at relatively low levels; seizures, brain damage and even death at high levels.

As it turns out, this latest wrinkle is part of a long, fascinating, tragic and disgraceful story: how and why the U.S. was so late in taking steps to prevent lead poisoning, a totally preventable, devastating childhood affliction.

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A Brief History of Getting the Lead Out

As we humans have for 6,000 years, you gotta love lead and its wonderful, seductive properties. Lead has a low melting point and is easy to fashion into objects. It holds pigments beautifully. It's quite weather-resistant. It makes paint brighter, stickier, longer lasting, mildew-resistant. And it is cheap.

Rich ancient Romans especially loved lead objects, so that lead poisoning was common and perhaps one reason so many Roman emperors (like Caligula, Tiberius, and Nero) were complete nut jobs. Hair analysis has shown that Beethoven probably succumbed to lead poisoning. Tragically, no Beethoven's 10th.

Although many had been suspicious (including Ben Franklin), it wasn't until 1892 that childhood lead poisoning was recognized by the scientific community. As a result, lead paint was banned in Australia (the site of the study) in 1914.

Despite thousands of subsequent reports on occupational lead poisoning and at least 35 on childhood lead poisoning, it wasn't until 1970 that a statute was finally passed banning lead paint in residential homes in the U.S. (lead continued to be added to paint for another 8 years, so only paints manufactured after 1978 are uniformly safe). Not until 1990 was lead banned from gasoline (? more proof we Americans love our cars more than our homes and our kids).

Why, you may ask, were we 55 years behind Australia (and much of Europe) in banishing lead paint, leading to millions of U.S kids being unnecessarily lead-poisoned?

To be fair, some of it was due to scientific ignorance about the effects of low level lead exposure. But mostly - big surprise - it had to do with greed. Lead in paint meant more profits. Additionally, in the 1920's it was found that adding tetraethyl lead to gasoline boosted its octane rating, allowing for the development of high-compression engines. (One executive of a General Motors subsidiary gushed "our continued development of motor fuels is essential in our civilization" and called lead "a gift of God.")

So powerful corporate interests of the lead, gasoline, paint, varnish, banking, and real estate industries lined up behind pressuring congressmen not to pass any legislation and to spread the word: The evidence is inadequate to warrant such a drastic solution. Not that many kids are being poisoned. Their developmental problems preceded the lead ingestion. Lead in the body isn't really that bad. The economy will suffer, jobs will be lost. And a brazen lie: We aren't even adding lead to residential paint anymore.

Additionally, who got lead poisoned? Mostly poor kids, who are notoriously short on lobbyists and political clout. And because of the poor scientific studies (for example, the comparison groups were also lead poisoned by current standards), the deleterious effects of lead on IQ and school performance were attributed to lousy parenting, not to the lead. So there was little countervailing pressure until the scientific evidence became undeniable and the moral imperative to do something overwhelming.

Did banning lead work? It has proved one of the most effective public health measures ever. In 1970 the median lead level of kids in the U.S was 13.7 micrograms/deciliter. In 1994 it was 3.2 (anything over 10 is now considered a potential problem). But there are still pockets of old lead paint in the U.S. and it is estimated that 310,000 kids age 1-5 years still have elevated lead levels (greater than 10).

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The Good News

Here's the good news: China is under fire now - what with the contaminated pet food and toothpaste and now this. They will fix the problems soon because of the potentially devastating economic effect of the world viewing their products as unsafe.

In the U.S. everyone who allowed these toxic toys into the country has major egg on their faces and are scrambling to make restitution. Watch for the Consumer Product Safety Commission to issue much more stringent safeguards before these kinds of goods enter the country. Watch for the toy companies to do their own testing and to have huge "Guaranteed Non-Toxic and Lead-Free!!" logos plastered all over their toy boxes.

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What does this mean for you?

• DON'T PANIC. There has yet to be a case of lead poisoning reported from these toys. I suspect most kids will have no lead ingestion. A few kids may have had a low level exposure, but severe poisoning from the toys alone is pretty unlikely.

• If your child has one of these toys, see how the paint looks. Any missing or thinning? Does your child mouth his/her toys?

• When in doubt, call your pediatric provider and get a simple blood test done to check for lead in the blood. (Send the bill to the toy manufacturer if your insurance balks at paying. I dare them not to reimburse you.)

• Keep up with future alerts. You can go to the Consumer Product Safety Commission's excellent website (http://www.cpsc.gov/cpscpub/prerel/prerel.html) for current and past recalls. If you're really paranoid, you can sign up with them for email alerts.

• 70% of toys in this country are made in China. They need to feel the economic pain of this outrage. Why not pay a little extra and look for toys made in the USA this holiday season?
  

This scare will soon fade but childhood lead poisoning from old paint will remain a problem for decades to come, all because in the not-too-distant past we ignored our sacred responsibility to protect our kids and succumbed to the propaganda and pressures of greedy corporate interests. I wonder if we have learned our lesson.

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Sources for history of lead poisoning:

"History of Childhood Lead Poisoning"
Herbert Needleman

"Childhood Lead Poisoning: The Tortuous Path from Science to Policy"
David C. Bellinger and Andrew M. Bellinger

Related Topics:

• 1/3 ADHD Cases Linked to Lead, Smoking
• Prevent Lead Poisoning

Technorati Tags: toy recall, lead, China, consumer product safety, childrens health

Should You Feed "Friendly Bacteria" to Your Infant and Child?

Here's an unidentified flying fact for your consideration: There are 100 trillion (100,000,000,000,000) bacteria - weighing 4 pounds - happily living in your intestines. That's ten times more bacteria than there are cells in your body, more bacteria than the number of stars in our galaxy, more bacteria than the number of humans who have ever lived (estimated, by the way, at 100 billion) ... You get the picture. There are a lot.

Now that I've completely grossed you out, know this: without these guys, you'd be dead. Some scientists even consider our bacterial inhabitants to be an essential body organ because without them your intestines couldn't properly absorb nutrients, the tissues would be thin and easily torn, your immune system would be compromised, you would become vitamin K deficient, you would be unable to digest certain foods. No wonder, then, that most are called "friendly" (probiotic) bacteria.

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Probiotic bacteria and your infant
When your baby was born her intestines were was completely free of bacteria. Over the first weeks, as she swallowed milk and saliva, various germs entered her gut and took up residence.

Interestingly, these bacteria are different whether a breast- or bottle-feeder, and whether born by C-section or not. Breast-fed and vaginally-born infants are colonized by more of the friendliest guys of all: bifidobacteria, while bottle-fed, C-section delivered infants have far fewer. These bifidobacteria seem especially good in promoting intestinal growth and function, helping the immune system to develop, and playing a role in preventing allergies.

By 12-18 months of age, the bacterial flora (as they are picturesquely called) look pretty much the same no matter what the manner of birth or feeding.

Formulas with friendly bacteria?
Perhaps another reason "breast is best" is because of this effect. That's why you are now reading about infant formulas containing these "friendly" bacteria. Is it a good idea? Should you buy it?

Although the evidence is pretty thin at this point, I'm saying yes to supplementation (much like a vitamin) in the first year of life with bifidobateria and lactobacillus in formula-fed and/or C-section delivered infants. Here's my reasoning:

• Since your infant's intestines are going to become home to lots of bacteria anyway, why not try to duplicate what generally happens in nature (i.e., in a breast-fed, vaginally-born infant).


• Bifidobacteria seem to be very safe; there have been no reports of significant medical problems in infants who ingest them. And there seems to be increasing evidence of their positive role in early infant health.

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Other uses of probiotic bacteria in children?
The best evidence for the therapeutic use of probiotic bacteria is during a diarrheal illness (especially rotovirus), where they seem to cut down on the severity and duration of the symptoms. Probiotic bacteria have also have been shown to cut down GI disease in sick, premature infants. Other, less proven, uses have included to prevent infections of the genitourinary tract, to treat irritable bowel syndrome, and to help with preventing and treating eczema in infants.

Again, based on their safety and that it seems to make sense (at least to me), I often recommend using supplements of probiotic bacteria for kids during and after:

• Infectious diarrhea.


• Taking antibiotics for any reason.


• In the care of sick, premature infants (to prevent necrotizing enterocolitis).


• Symptoms of irritable bowel syndrome.


• Cases of severe eczema


• Recurrent urinary tract infections

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Look for supplements containing bifidobacteria and lactobacillus. (There is some debate if yogurt alone can do the trick. Personally I'd count more on the supplements you can buy at your drugstore or health food store).

But beware the exorbitant claims made that these bacteria can prevent cancer and cure other illnesses, which seem pretty dubious to me. Here's what the Harvard Health Letter had to say about this issue (2002):

"Probiotics have been oversold. The claims are that seductive pills, powders, and solutions containing 'friendly' bacteria will boost the immune system, prevent cancer and perform other assorted health miracles...But that doesn't mean it's based on total fiction...The evidence suggests that probiotic therapy could be useful some day as a form of preventive medicine - and not just for diseases affecting the gut."

And since preventive medicine is often best started in infants and children, I'm cautiously coming down on the side of their use, even though the scientific evidence is by no means well established (this is about as "fringey" as I get).

I'm curious: are any of you going down this road? What do your pediatric providers think about this controversial area?

Related Topics:

• WebMD Video: Good Bacteria
• Food for Thought: Breastfeeding and Bottle-Feeding

Technorati Tags: probiotics, supplements, infants, pediatrics, health and wellness