Passing of an Expert & Friend

It's with great sadness that we announce that Dr. Steven Parker died unexpectedly this morning. Dr. Parker was an example of the passionate practitioner who brings not only knowledge but care to patients and readers. As WebMD’s expert pediatrician, he provided information and support to countless expectant and new parents. Our hearts go out to his wife, Karen, his family and friends. You can share your messages of condolence and support here.

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Who Are Your Children's Role Models?

I am shocked - shocked! - that Michael Phelps smoked dope at a fraternity party. Who does he think he is? Doesn't he know he is a role model to our kids? I wanted my kids to be him and then he goes and pulls this stunt!?

Actually, what I am really shocked about is the ridiculous brouhaha this has generated. Let's face it, his behavior is not at all unusual for his age (in the only phrase from George W that I've appropriated: "When I was young and foolish, I was young and foolish."). Of all his potential misdeeds, this seems a minor transgression indeed.

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And, anyway, who says he is (or should be) a "role model"? The dictionary defines a role model as "a person whose behavior, example, or success is or can be emulated by others, especially by younger people."

Let's face it folks, your kids have no chance of becoming Michael Phelps, unless they too have a body like a torpedo, outsized hands and feet like a pizza pie, the wherewithal to swim for 13 hours a day, 7 days a week, a coach who will devote his life to their success, etc.

I work in the inner-city of Boston. Who are the role models of many of the kids I see? Mostly rappers and basketball players. Yet the odds of actually making it in life as one of those is zero. It's completely unrealistic and misguided in its values and what they can accomplish in life. Why their heroic 6th grade math teacher is never mentioned is a source of great sadness to me because, with some hard work and motivation for school success, they could actually become that math teacher.

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Here‘s where you parents come in. Much like talking to your kids about what's on TV and what values it promotes, so too do you need to address this question of what kind of people we admire in life and why.

Sure, Michael Phelps did a very cool thing and loves his mother, but what about someone who has devoted her life to helping others, someone who started a successful small local company, someone who is really smart and worked hard in school to succeed, someone who teaches.

You get the idea. If you don't push for alternative role models, who will? Surely not the media who are financially committed to hawking celebrities as the royalty of our culture.

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I want to close this screed on a scary note.

I do know with 100% certainty at least one or two people who, no matter what, will surely serve as important role models in your kids' lives. That would his/her parents. Yes I am talking about you!

Many parents think they are teaching their kids by their discipline methods or rules of the house, etc. But we humans - and that includes your kids (at least most of the time) - learn mainly from what is called "incidental learning," that is, learning on the fly, learning by observing and interpreting and making meaning of what is going on around them all the time.

Be afraid, be very afraid: your kids are observing you and eventually will judge what kind of a role model you are based on how you behave, your relationships with others, how loving and caring you are, and how mean and selfish.

Some of you lucky ones will be 100% positive role models for your kids (don't count on it), some will be 100% negative (I hope not), but most of you will be a mix of good and bad, with some traits that your kids will want to emulate and carry on to the next generation and some that your kids will reject and be glad not to pass on to their kids.

So the next time you are thinking about Michael Phelps and his bong, better to think of your own behavior and what lessons your kids are deriving from it day after day, year after year, generation after generation.

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Faith Healing and Children

Some stories just break your heart on every level, like this tragic one. But most don't also make you so mad you could spit. Here's what happened:

Kara Neumann, 11 years old, was getting progressively, inexorably sicker. Despite a powerful thirst and hunger, she seemed to be wasting away to nothing. Over time she was becoming weaker and weaker. Despite nutritious food, she continued to fail. Eventually she was too weak to get out of bed. She became confused, then lethargic, then comatose. Then she died.

Many of you probably recognize the classic symptoms of untreated diabetes and diabetic ketoacidosis. It's an easy diagnosis to make and, had she been properly diagnosed, she would have been treated with fluids and insulin, and gone on to have a nice long life.

But that is not what happened. Instead, her pious parents - who strongly believed that only God and prayer can and should heal - never brought her to medical attention, even as they profoundly and urgently and continuously and lovingly prayed for her recovery.

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Now the state of Wisconsin is prosecuting the parents for "reckless endangerment." Each .faces up to 25 years in prison. Apparently, the critical legal issue is whether the parents knew it was a "life-threatening" condition (really, how could they not?). Their lawyers contend the state is unjustly violating their right to religious freedom.

To put this in context: Over 300 children (that we know of) have died in the past 25 years because of medical neglect due to parental religious beliefs.

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On two occasions during my pediatric training, I cared for Jehovah's Witness kids who required major surgery. Turns out this was a fairly common event and we knew just what to do. Parents were informed that surgery could only be done with the option of a blood transfusion if needed. They refused. We then went to a local judge and got a court order / permission to transfuse blood if need be. Surgery went ahead.

I have to say, on both occasions I got the impression the parents were relieved to cede authority to us to save their child's life. They didn't have to violate their religious percepts - after all, Dr. P was the one who would go to hell if blood products were administered! But neither did they have to worry that their child would die for want of blood.

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What's your take on this? Isn't this a free country? Wasn't it founded on religious freedom? How can we then deny parents their right to practice their religion in the way they choose? How dare the state intervene into the lives of families in such an intrusive way?

Here's my view. As an adult you have the right to believe anything you want and, as long as those beliefs don't impinge on the rights or well-being of others, you have the right to freely act on those beliefs. You can act against your own self interest, even do things that are clearly self-destructive. That is your right, boneheaded as you might be.

But you do not have the right to use those values and beliefs to harm a child - especially your own - who cannot decide for herself. You do not, for example, have the right to impose cruel physical punishment, even if your beliefs dictate you should do so. You do not have the right to have your child avoid all educational programs in the hope of isolating her from the temptations and misguided beliefs of this wicked world.

And, most assuredly, you do not have the right to endanger her health and well-being and very life to conform with your beliefs.

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In short, as a parent you have the right to make a martyr of yourself, but you do not have the right to make martyrs of your kids.

I feel bad for Kara's parents. I really do. They have lost a child - the very worst thing that can happen in this life, At the same time, if I'm honest, I want to throttle them for their reckless, stubborn abandonment of their ever weakening child. Jail or no, now they will have to live with the awful knowledge that her death was their fault.

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Read the entire New York Times' article, Trials for Parents Who Chose Faith Over Medicine.

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• Type 1 Diabetes - When To Call a Doctor
• WebMD Video: Nurses Study the Faith-Healing Connection

When Your Child has the Misery

It's a sight sure to pierce the very heart of any parent.

Your little bundle of joy, Pookie, is sick: snorting, spewing, coughing, miserable. She looks up at you with those big, limpid, trusting, bleary, red eyes: What's wrong with me, Mommy? Help me! Fix it!

Then, when miraculous relief is not forthcoming, reproach: Why aren't you making me feel better? Why are you letting me down when I love and trust you so? What kind of a Mommy are you?

The urge is overwhelming: Don't just stand there, do something!

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But what, exactly?

How about a cold medicine? Whoops, no go. Cough and cold preparations are no longer prescribed for children under 4 years because of rare but potential significant side effects. And, to be honest, they never did work well anyway. Scratch the cold medicines.

How about good old Tylenol or Motrin? Well, no. They are only useful for pain and fever, neither of which Pookie has. They wouldn't do anything useful (except to give the illusion of doing something to make things better).

I've got it! Good old Vapo Rub! Great idea. Except, as you probably just read, there was a recent case report of a problem with an 18 month old infant who was hypersensitive to camphor oil and had breathing problems because of its administration under her nose. Plus, the stuff is pretty useless, except to stink up the joint.

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Here's the sad, hard, inconvenient truth: there are some negative experiences in life from which you will be unable to protect your kids - the misery of a bad cold being one of them. The desire to do something - anything - is strong but, as we've learned, that can sometimes lead to side effects that are far worse than the 'disease'.

As physicians, we take the vow: "First do no harm." That goes for you parents also.

Actually, I'm not convinced this is even bad news. Like all of us, children need to learn to cope with adversity, to feel lousy but then to endure the misery and emerge unscathed, perhaps even stronger, on the other side. That successful sense of mastery will serve your child well when other adversity strikes (as it inevitably will) and she instinctively knows: I will get through this OK!

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But there is an even more important lesson that is often learned: the magical healing love and support of wonderful caregivers. Perhaps Mom was ineffectual at making it better right away but, during my miseries, she provided me with a powerful, comforting cocoon of warmth, of support, of care, of love.

When we ourselves have the misery, who among us - no matter what our age or station in life - doesn't ache for Mommy to soothe a fevered brow and offer hot soup and a knowing hug and a sympathetic gaze, just as she so memorably and lovingly did all those years ago.

For many, the tender ministrations of our parents during illness is one of the most enduring and beautiful and powerful of our childhood memories. Be sure your kids have a bunch of them and you will, in fact, have really done something of earthshaking importance during their misery, something that far transcends the quick fix of an ineffectual medication, something that cuts to the heart of a parent's love.

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• WebMD Slideshow: Treating Your Child's Cold or Fever
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Dr. P's Top 10 Pediatric Stories of 2008

Is it possible another year has passed? Here, in no particular order, are 10 pediatrics stories that caught my eye in 2008:

1. New recommendations for lipid screening and treatment in kids.
Perhaps in response to the epidemic of childhood obesity, the American Academy of Pediatrics has significantly revised its recommendations on the screening and treatment of kids for high cholesterol and blood lipid (fat) levels.

Basically they are recommending that your pediatric provider order blood tests for these levels starting at age 2 years, and then every 3-5 years thereafter if you have a positive family history for high lipid levels or early heart disease, or if such history is unknown, or if your child is overweight. That turns out to be a majority of kids!

However, what has generated a lot of controvery was their recommendation that - if diet and exercise fail to lower the levels to an acceptable range – cholesterol and lipid-lowering medications be used in children, as early as age 8 years. As you might guess, I have an opinion on this New Cholesterol Guidelines for Kids. Stay tuned for where all this goes in the next few years.


2. Cough and cold medicines get the axe for infants and toddlers.
I've long contended that cough medicine is essentially useless and cold medications are not much better. What I wasn't aware of until this year were the numerous incidents of these over the counter cough and cold preparations causing harm to infants and toddlers (often due to giving too high a dose. After all, "If a little is good, a lot is better", right?). Here are my appreciative comments on this change: The FDA and OTC Cold Medications for Infants.

So it's now no longer recommended to use any of these medications for children under two years of age. Stick to old stand-bys: a humidifier/vaporizer, elevating the head of the bed, honey after age one year for cough and, of course, chicken soup and TLC.


3. New ways to lower the risk of SIDS
Earlier in the year I alerted you to a study showing that pacifier use seems to significantly cut the risk of Sudden Infant Death Syndrome (SIDS). Now comes another potential low-tech way to decrease the risk even more: running a fan in the bedroom. In this study, a fan in the bedroom seemed to also cut the risk of SIDS by 70% (perhaps because it prevents the baby from sleeping too deeply).

So now the list on how to decrease the risk of SIDS includes "back to sleep", pacifiers, a fan in the bedroom, not too soft mattresses, no dolls in the crib, not too hot a temperature in the bedroom, and, I'm sure, more to come. I so would love to see the last of SIDS in the world. It is such a cruel event.


4. Probiotic "friendly" bacteria safe in pregnancy and for infants
It's always nice when research confirms what you have been preaching. In 2007, despite scant evidence, I came out for giving infants and kids "friendly" probiotic bacteria under certain circumstances.

This year another study showed that feeding normal infants these bacteria was safe and also seemed to increase resistance to respiratory infections during the first 2 years of life! During the 6-month intervention, antibiotics were prescribed less often than in the placebo group (23% vs 28%) and respiratory infections occurred less frequently in the friendly bacteria group.


5. Honey is the best cough medicine.
OK, if cough medicine is useless, does anything help? A neat little study this year showed that good old buckwheat honey did help in children over 1 year of age. Try it.


6. Eating breakfast reduces weight gain in adolescents
Could my (and everyone else's) mother have been right? Is breakfast the "most important meal of the day"? I don't know about that, but a recent study did show that adolescents who eat breakfast aren't nearly as overweight as those who skip breakfast. The reasons for this association are not clear.

Given this study and others showing children who have breakfast are better able to concentrate at school, let's go with mom on this one: have a good breakfast! (Timlin MT et al. Breakfast eating and weight change in a 5-year prospective analysis of adolescents: Project EAT (Eating Among Teens). Pediatrics 2008 Mar; 121:e638.


7. On the road to a malaria vaccine
I hate mosquitoes, but for the wrong reasons No doubt, so do you. The most important reason to loathe mosquitoes is their transmission of malaria, arguably the worst disease on the planet. Every year over 500 million people contract malaria and 1-3 million die, the majority of whom are children in sub-Saharan Africa.

But just a few weeks ago, a vaccine with about 50% efficacy to prevent malaria (not great but much better than anything else) was reported. You know how much I love vaccines. Now it looks like we may soon be getting the upper hand on banishing this horrid disease from the lives of the world's poorest children.


8. Stem cells created from normal skin cells
2008 was a great year for stem cell research. Two research teams were able to take skin cells from patients suffering from a variety of diseases and reprogram them into stem cells. This may avoid the need to use the controversial embryonic stem cells all together.

The newly created stem cells can hopefully then be induced to assume new identities and serve as major tools for understanding how diseases arise and develop. Eventually, when scientists master cellular reprogramming so that it is more finely controlled, efficient and safe, patients may someday be treated with healthy versions of their own cells.


9. Five-in-one vaccine developed
The first "five in one" vaccine ("Pentacel" - diphtheria, tetanus, pertussis, polio, hemophilus influenza) has been developed. This means fewer shots and less cost. And, yes, combination vaccines have been shown to be just as effective and no more prone to serious side effects than the single, double or triple vaccines were.

Pentacel still has to be administered in four separate doses, three times between the ages of 2 and 6 months, then again between 15 and 18 months - but it cuts down by 30% on the 23 injections toddlers under 18 months normally receive.


10. Prenatal maternal blood test for Down Syndrome
A new genetic test may be able to pick up Down syndrome in the fetus with a simple blood sample from the mom-to-be. Because small amounts of fetal DNA enter the mother's blood stream, the test is designed to detect abnormally elevated levels of chromosome 21 in the mother's blood, which would indicate a baby with the syndrome. This would be a far less invasive and safer way to diagnose this common parental concern.

11. Enjoy your kids! All the best from Dr. P for a happy and fulfilling 2009 for you and your family!

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