Cosmetic Surgery for Toddlers

On Mothers Day, a new book called My Beautiful Mommy will be (self) published by a plastic surgeon. It's a picture book for young children that explains the ins and outs of Mommy's impending tummy tuck and nose job.

This book has generated a lot of controversy and got me thinking about children's notions of physical beauty. It also led me to a brilliant idea, which I unveil here for the first time.

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First, let's consider toddlers' views on what makes a person beautiful. Let's be honest, isn't it annoying how clueless they are of true standards of beauty? All children seem to think, for example, that their moms are beautiful, even if she has a big nose or sagging skin...or worse.

I ask you: is this a healthy viewpoint? If we don't teach our toddlers otherwise, won't they take this misguided view of beauty into later childhood, even adulthood? Imagine the consequences to society if everyone was considered beautiful in his/her own way.

And should we be praising toddlers for how they look, when they invariably possess offensive pot bellies and gross rolls of 'baby fat'? Give me a break. Who really likes a big fat stomach on any human of any age? You don't like one on yourself, why should you on a child? Imagine the let-down in store for them when their cherished jelly bellies become objects of ridicule by their peers!

No, far better to 1) to teach them the real standards of beauty from early on (hence: My Beautiful Mommy), and 2) at the same time help them to achieve that ideal of beauty with the help of modern medicine (hence: my brilliancy).

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As I thought more about this book, I realized that there's simply no excuse in this day and age for you not to be a beautiful mommy or for you to have a pug-ugly toddler. Welcome to Dr. P's Spa for Toddler Cosmetic Surgery, offering a full range of beautification services for the little ones:

• Liposuction to tuck in that protruding stomach! I have already spoken of the long-term horrors of the jelly belly.


• Hair transplants for that wispy hair. Your toddler isn't an old man. Why should his hair look like it belongs to one?


• Nose jobs (a "mini bob"). True, most toddler noses haven't yet achieved their full offensive size and shape, but there are numerous asymmetries and improper angles. A little tweaking could render them absolutely perfect.


• Shaving a few inches off thunder thighs. This also promotes walking without inter-thigh friction, which can cause unsightly rashes and an unsteady gait.


• Male member enlargement. As a man, I find toddlers' tiny weenies to be disgraceful.


• Implants (saline, not silicone - I am all about health) in girls for their pathetically undeveloped breasts. Eventually she will have to deal with womanly breasts - why not learn to manage them well before the inevitable shock of puberty?


• A butt lift. Let's be honest, on whom does a big butt ever look good? And diapers only add to their apparent heft!


• Botox to make their eyes larger. Nothing is worse in my book than beady-eyed toddlers. They look so untrustworthy.

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The benefits of my modest proposal will already be obvious to you. It will, for example, be easier for parents to love a cosmetically perfect child than a flawed one, so parent-child bonding will be enhanced. Other kids will admire and respect your surgically perfected child, whose social cache will skyrocket. And proper values will have been instilled from an early age.

So, watch for the grand opening of Dr. P's Spa for Toddler Cosmetic Surgery. In my humble opinion, sure to be the next great 21st century advancement in pediatric care.

Related Topics:

• Moms Influence Kids' Body Image
• Building a Healthy Body Image for Children

Technorati Tags: cosmetic surgery, plastic surgery, toddlers, pediatrics, healthy children, My Beautiful Mommy

Booster Seats Until 57 (Inches, That Is)

In my home state, legislation was just passed that mandates booster seats for all children less than 8 years old (or shorter than 4 feet 9 inches). I have to tell you, not every one is happy about this. "It's more evidence of the Nanny State - the government telling us how to raise our kids," some have objected.

I am not unsympathetic to this kind of libertarian view when it comes to adults. After all (although I don't subscribe to the view), why should the government force me to wear a seat belt if no one else is hurt but me? Don't I have the right to get my own fool self killed unnecessarily if I so choose? Hey, next the Nanny State will fine me for not wearing sunscreen because I might get skin cancer.

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But - vive la difference - the rights of kids and the rights of adults are not equivalent.

As the laws concerning kids have frequently (and wisely) reiterated: Adults may have the legal right to make martyrs of themselves, but they don't have the right to make martyrs of their kids. That's why, for example, courts order life-saving blood transfusions for kids whose parents object on religious or other grounds.

I'm 100% supportive of the government taking this on as a way to keep kids safe. Of all your priorities in raising your kids, ensuring they survive their childhood (and your parenthood) must be at the top. I'm not trying to be funny here. I can't tell you how many parents I know who obsess about the color of their children's poop, but leave them improperly restrained in the car.

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Here's why appropriate car restraints are the number one way for you to safeguard your child's well-being:

• Nothing - repeat nothing - is more likely to cause your child to die than a motor vehicle accident.


• Properly used car restraints cut the chance of death in an accident by 60%.


• Improperly fitting seat belts (most commonly seen at age 4-8 years) greatly increase the risk of intra-abdominal, spinal cord and vertebral injuries during an accident. The reason is that the seat belts tend to ride on the belly and not the hips (booster seats correct this). In case of an accident, serious injury to the abdominal organs or spine is more likely to occur. **


• Booster seats improve the chances of survival over seat belts alone by 28% ***


• States with expanded booster seat laws see a 39% rise in the appropriate restraint of a child ****

In one way, the objecting parents are right: Don't wait for your state's law to tell you what to do. Law or no, keep your kids in booster seats until they are 4 feet 9 inches tall.

If they object, tough. They're kids and our #1 priority is to keep them safe, whether they like it or not. In my book, a parental job well done is for them to live long enough to some day complain to their shrinks about how overprotective you were.

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* For more info on how to use car restraints with your kids:
http://www.aap.org/family/Carseatguide.htm

** For the story on seat belt injuries:
http://www.sciencedaily.com/releases/2007/08/070809172130.htm

*** "Effectiveness of child safety seats vs seat belts in reducing risk from death in passenger vehicle crashes." Elliott et al. Archives of Pediatric and Adolescent Medicine. 2006
http://archpedi.ama-assn.org/cgi/content/full/160/6/617

**** "Effect of booster seat laws on appropriate restraint use by children 4-7 years old involved in crashes". Winston, et al Archives of Pediatric and Adolescent Medicine. 2006
http://archpedi.ama-assn.org/cgi/content/full/161/3/270

Related Topics:

• Child Car Seats
• Protecting Kids in Side-Impact Car Crashes

Technorati Tags: car seats, child safety, booster seats, pediatrics

Caution: The Hospital May be Hazardous to Your Child's Health

It's my third and final year of being a pediatric resident. I'm the supervisor of the interns on the inpatient ward and we are at morning "x-ray rounds." My intern urgently grabs my arm, drags me to the back of the room and, ashen-faced, says "I think I just ordered 10 times the dose of insulin for Bobbi that I should have."

Let me explain. Because of her short stature, Bobbi is undergoing a "growth hormone stimulation test," in which we purposely give her a low dose of insulin to see if it will stimulate the normal production of growth hormone. Ten times the recommended dose will lead to dangerously low blood sugar levels which, among other things, could cause brain damage, even death to this happy, healthy, normal, short kid.

We race up three flights to the inpatient floor. I grab a syringe full of concentrated sugar (dextrose) and barge into her room where, to our great relief, she is chatting comfortably with her father, an attorney who - I am not making this up - sues doctors for malpractice.

I infuse her IV with the glucose, all the time asking her "How do you feel...How do you feel?"

"Anything wrong?" her father asks with just a touch of concern.

"Oh, no," I say, breezily. "Just a routine part of the test."

Having calculated the dose of sugar need to offset the overdose of insulin, she remains blessedly conscious and oblivious to my terror. Her blood sugar eventually dips only a little and the test is completed uneventfully.

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Scary. I still have nightmares about it, all these years later.

But, as a new article in the journal Pediatrics shows, apparently this is still not all that unusual. These researchers carefully looked at the medical records of kids admitted to 12 different Children's Hospitals. They found that about 7.3% (1 in 14 kids) experienced an "adverse drug effect" (ADE) of some sort - mostly a drug side effect. (By the way, the most common medications causing ADEs were pain killers (50%) and antibiotics. )

OK, 1 in 14 is a lot but before you panic, let's do the math:

1. Keep in mind that 13 of 14 (93%) had no reported problems of any kind with medications.


2. 97% of the ADEs were 'mild and temporary.'


3. Of the 7% who experienced an ADE, 1 in 5 was felt to have been "preventable."
   
4. That works out to 1 in 70 hospitalized children who will experience a medication error of some kind, which is way, way too high (and this probably underestimates the problem because some are never reported).
   
   

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Why do we make medication errors?

I could be flippant and say it's because we're human and that would be partly right. Also, I think it's easier to make a dosage error with children because the amount of medication given is often calculated on a "per weight" basis. That means the dose of a common medication could vary 50 fold between prescribing it for a 4 pound premature infant and a 200 pound teenager. So it's easier to get confused and harder to spot the error.

Additionally, there is the old "look alike/sound alike" mistake, whereby the pharmacist substitutes one medication (e.g., hydralazine) for another (hydroxyzine), either through my error or illegibility in writing it or the pharmacist's error in reading it.

But I've seen that most errors can be prevented by recognizing to err is human and by implementing appropriate safeguards to prevent us from screwing up. In my hospital, for example, all medication prescriptions are run through the computer to be sure the dose is in the usual range (and not, for example, the most common 'factor of 10 mistake' of my intern) and to warn of potential drug-drug interactions. Additionally, nurses check and double check that the dose ordered is the dose given, and that the right patient is getting the right meds.

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I'd like to empower you to play an active role in preventing medication errors to your (and others') children. Here's what you can do:

In the pediatric office:

1. Look at and review all prescriptions written by your pediatric provider.


2. Be sure the Rx is easily legible and clearly written.


3. Read it aloud to your pediatric provider.


4. Ask if the dose is the usual dose.


5. Ask your pediatric provider what hospital precautions are in place to prevent medication errors.

If your child is in the hospital:

1. Ask the staff the same question about procedures for preventing medication errors.


2. Look at all medications being administered to your child.


3. Be sure your child's name is on it.


4. Ask the nurse if the dose is the usual (if you're very ambitious check out all doses on the web to be sure they are in the normal range).

Will you be perceived as a pain in the butt by the medical staff? Absolutely, but, I hope, in a good way. After all, we all need to work together to ensure the inexcusable doesn't occur even one in a million times.

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Article cited:
"Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to Identify Medication-Related Harm in US Children's Hospitals"
Takata G, et al. Pediatrics, April 2008
http://pediatrics.aappublications.org/cgi/content/full/121/4/e927

Related Topics:

• WebMD Video: Fewer Perscription Errors
• WebMD Video: High Tech IV Pump to Catch Medical Errors

Technorati Tags: pediatrics, childrens hospitals, medication errors, healthy children

A License to Parent?

Recently I was discussing a few well publicized parenting outrages with a colleague. "I'm sick of kids being neglected and mistreated!" he said passionately and angrily. "I've decided we should make all parents earn a license before they are allowed to become parents. After all, everyone thinks it's OK for the state to mandate basic requirements before it allows us to drive a car."

"Why not then," he continued, "for the most important job of all to get right - that of being a parent? Then we could provide child development and child rearing classes to everyone before they actually had kids to raise. I'm convinced we can diminish the amount of child abuse and neglect in this country through this measure."


My colleague cited a book he had just read on the subject. I don't think I can really represent the position fairly, so if you'd like to read a more detailed rationale for the granting of parenting licenses, read the author's own words: THE RATIONALE FOR LICENSING PARENTS by Jack C. Westman, M.D.

Sounds like a good idea, right?

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I hope not. To be honest, the idea horrifies me, although I must admit I agree with the sentiment behind his modest proposal and that prospective parents should learn about child development and what constitutes basic parenting skills. Frankly I don't understand why these aren't part of the basic curriculum taught in all schools to all kids. And, alas, it is true (albeit rarely) that some parents just shouldn't keep having kids (as with a patient of mine whose first five kids are in foster care due to neglect and now she just had her sixth.)

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But even if we wanted to, could we really weed out those who will become rotten parents? I have been surprised so often I highly doubt it. Take Millie who was a stone cold neglectful cocaine addict when her child was an infant and who, against all odds, turned her life around and got clean and has been a great mom to her four kids since. Or Sally who, after doing OK with her first, had a second child who somehow sent her into a tailspin that turned her into an impossibly neglectful, depressed mom.

Secondly, can adequate parenting skills be taught? Or more importantly, can inadequate parenting skills be overcome by a simple course in child development? I wouldn't bet on it. Can we teach someone not to abuse their kids? Would that it was so simple! Can we teach parents to love their kids? Just what would taking a course for the license ensure anyway? Just what would it teach?

Thirdly, who gets to decide who shall bear children and who shall not? And just where would you draw the line between acceptable and unacceptable future parenting skills? I would bet the bias against poor and minority families would especially play out here, as we denied them the right to parent in far greater numbers than we would economically advantaged parents.

Finally, just how would we as a society enforce the lack of a parenting license? The ways to do it seem to me to be too intrusive and horrible to contemplate (forced adoption? jail time?).

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Some human rights seem more untouchable to me than others, and the right to procreate without government interference has to be close to the top, even if you are unlikely to be a candidate for mother-of-the-year.

Extreme cases tend to lead to bad ideas and a license to parent is another one of them. Far better to devote enough resources to help families in trouble: high quality early child care and public school, universal health care for children, opportunities for economic self-sufficiency, more programs to help hopelessly inadequate parents, and more safeguards for kids who are exposed to such parents.

But "No" to authoritarian government intrusion into the lives and reproductive biologies of all families.

Related Topics:

• WebMD Video: Daddy Boot Camp
• 10 Commandments of Good Parenting

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