May 14, 2013

Growing Safety: Planting The Seeds For Nonviolent Conflict Resolution


Jeanine M. Swenson, MD, FAAP, FACC, LMFT

First we have the recent school shooting at Sandy Hook Elementary School in Newtown, Connecticut that caused a large wound in our national sense of safety and security.  It is still hard to accept that this has happened because it is so atrocious and violent.  Twenty innocent children and six dedicated school professionals are dead, along with the perpetrator’s loving mother, and we will probably never know the complete story or the basis for this heinous crime.  Now we have the Boston Marathon and its aftermath. These horrific events throw our rational, secure world completely out of whack.

Each person’s grief process will be unique, depending on your proximity to the people and events, but I find myself looking for hope and ways to enact change in the aftermath of these tragedies to move beyond the crisis.  I have two dreams here.  One is that we can somehow make some kind of lasting change to slow the rate of these events from happening.  Each tragedy affects countless families and has reverberating effects for generations. Can we, as a nation, move from the initial steps of feeling and debate, to the next phase of action and motion?  And second, and this is a big wish, is that I would like my children to live in a world that is slightly less violent than the one we are experiencing today.   

We care deeply about children and families in this country and yet despite this are still unable as a Nation to work together to discuss ways in which we can enact change to bring about a safer, less violent society. Passionate people quickly join the debate and reflexively pick the well-worn and polarized sides of a rehearsed debate.  Just like a married couple, each entrenched position spouts off their rehearsed responses to gun violence (for or against) or terrorism. They don’t even need to listen to the other’s positions or concerns.  They almost know what the other side is going to say as they have heard it hundreds, or thousands of times before. And once again, we have deadlock and nothing changes as each side recharges for the next episode.  It is an endless positive feedback loop of more, more, more. And surely there will be a next episode because nothing was resolved and nothing was changed.  As pediatricians and as parents, we need to take a step back and try to end this loop.

How do we tone down the activated emotions, just a little, to let complexity and reason enter the discussion?  Notice that I said discussion, not debate.  Debates have winners and losers, and discussions can be much more fruitful with each person feeling a benefit.  How do we get this engaged but deadlocked couple to relax so listening, empathy and ultimately change can happen? 

My suggestions for nonviolent or “fair” fighting involve four straightforward issues. First, it may be helpful to point out that it is not about winning or competition. This is not a battle; it is a discussion and a relationship that involves completely different rules and guidelines. Starting at some level of agreement is extremely helpful.  A slow and purposeful language shift away from any adversarial words that invoke strong feelings needs to take place (important notice: this is the opposite of what generally happens in the press as some use feelings and strong vocabulary to encourage engagement). 

Thus, the number one pillar is no hurting, stay away from direct criticism, character annihilation, or areas of previous hurt. 

Pillar number two is about listening openly and quietly so all perspectives can be expressed and heard.

The first two pillars can be supported by the third, the learned habit of providing balanced feedback. Feedback can convey appreciation for the other’s opinion.

And lastly, staying in the conversation and working toward an end, conclusion or action is the final step. We need to keep the end goal in mind and to stay on topic just long enough that both sides feel that their thoughts and feelings have been heard and that some negotiation or agreement has been reached.  If we can focus on the end goal of building a safer, less violent society rather than trying to win the debate, we can as a Nation move forward.  This is a big wheel and big wheels turn very slowly, so patience to persevere in the face of minor disappointment is paramount to see things through to a positive end.

We as pediatricians, communicators and parents need to lead by example in these discussions to help move them forward.  We need to push for these debates to become discussions both at the local and National level.  It is only when we can break this loop that we can begin to find areas of compromise and change because one thing we can all agree on is that a safer, less violent society is something we would all like for our children.

April 23, 2013

6 Ways to Moderate Screen Time in your Home



Melissa Arca MD, FAAP

The upcoming week, April 29th to May 5th, is National Screen Free week. We can encourage parents through our practices and through the media to use this week as an opportunity to make a media use plan, set guidelines, rules and expectations as to how their family will use media and screens for the rest of the year.
We’re living in a media world. No doubt about that. In fact, media follows us wherever we go these days. And our kids are honestly the most savvy among us. They get the hang of navigating iPhones and the various apps faster than you can figure out what your password is.
Media is here to stay and for the most part, it’s a great thing and has led to greater efficiency, communication, and sharing of valuable information.
But we knew there would be a down side. Our children are as fascinated and addicted as ever. We absolutely must moderate their media consumption and make sure the good outweighs the bad.
This is something my husband and I struggle with on a daily basis. We certainly don’t want them magnetically connected to some form of electronics for a good part of the day. So we have rules. Not always easy to enforce, but important and well worth the effort.

Set timers
I have found this to be the best and least confrontational way to set time limits on my kids’ media time. Whenever they sit down with one of their favorite TV episodes or need to hop on Dad’s iPad for a quick Minecraft game, I set a timer. I tell them ahead of time how long the timer is being set for (usually 20-30 minutes) and when it goes off, we move on to another activity.
Aim for no more than 2 hours total screen time per day. When you think about it, that’s actually a lot during a busy week of school, homework, and extracurricular activities. To help getting them to bed on time…turn off all media 1 hour before bedtime. Studies have shown this will help everyone get to sleep (and stay asleep) faster.

Get involved
Know what games and shows your children are playing/watching. Be sure they are age-appropriate and not filled with violent acts. Check Common Sense Media whenever you’re in doubt as you can find just about any movie, show, game, app, or book to determine age-appropriateness.
Play with them too. What about a game of bowling on the xBox or watching their favorite show with them? Being able to take part in something they enjoy will be a great time of connecting, instead of feeling disconnected.

Go outside
When everyone starts complaining that they’re bored, and why can’t we play our favorite video game?…head outside. It’s the best cure I know for whining, grumpiness, and complaints of boredom.

Be a good role model
Want your kids to spend most of their day screen-free? Well, I hate to break it to you, but then you must too! I am so guilty of constantly checking my phone for new emails, almost to the point of obsession that it gets to be ridiculous.
Put down that mobile media. Turn off the TV. And practice what you preach.
As a bonus, do your best to spend the weekends off social media. When I started doing this…wow…it was amazing how much more quality time I had with my family and more time to get to some much needed household chores.

Have screen-free zones
No TV’s or other electronics in the bedrooms. No screens (including, or especially, phones) at the dinner table. I am so adamant about these screen-free zones that just the other day I scolded my husband for bringing his iPad into our son’s room while we did some bedtime reading.
 I do not budge on this rule.

Be flexible
Rules are good but it’s also good to have some leeway. So, while I’m pretty strict about our screen-free zones, I’m pretty lax about the amount of screen time our kids (and us) get on the weekends. We love Friday night movie night and waking up Saturday morning watching cartoons, drinking coffee, and reading the paper.

Rules are great…but sometimes, they really are meant to be broken.

February 4, 2013

A New Year’s Resolution – Phone Etiquette For Our Children


Cori Cross, MD, FAAP

It seems that every year it becomes more common to see younger and younger children walking around with cell phones.  Seeing six and seven year olds with an iPhone is hardly a novelty nor is watching older tweens and teens totally ignoring the world around them while they text like it is an Olympic sport.

One blogger mom took a novel approach when she gave her 13 year-old son an iPhone this Christmas.  The present came with a set of rules and conditions. She laid out what was expected of him and even more importantly she gave him guidelines for proper etiquette.

But what is proper etiquette? For my generation, having good manners was something that parents were expected to instill in their children and everyone knew what good manners were.  We were taught to look someone in the eye when speaking, to give someone your full attention, to not interrupt, to keep quiet if you don’t have something nice to say, and not to gossip or spread rumors.  We were also taught to be modest, not to brag, to respect others privacy, and to be on even better behavior when we were out to dinner or in a public place. 

It seems that for many parents the addition of cellphones into the family paradigm has allowed all semblance of good manners to vanish.  It may be that today there is no universally accepted standard of proper etiquette. This causes many parents not to realize how rude certain behavior is until their children have adopted it. Even worse, when trying to extinguish this behavior in their children, parents often become uncomfortably aware that they are in fact modeling that same behavior.

It may be that as a society we are in desperate need of an Emily Post. Someone to clearly state a set of rules that parents can enforce with their children so that as families and as a society we don't become experts at interacting in a virtual world but inept when it comes to knowing how to behave in the actual world.  For me as a mother, that list would look something like this:

  • ·      Don't answer your phone while in the middle of a conversation with an actual person. You can call the person back. You don’t need to be accessible at every second. If it is an emergency, then say so to the person to whom you are speaking, “Excuse me. I hate to be rude but my mom is calling and I really should answer it.”
  • ·      Look at a person when talking to them.  Don’t carry on a conversation while you continue to text or stare at your phone.
  • ·      Leave your phone in your pocket or bag when out to eat. Don’t place it on the table as if someone more important than the person in front of you may call at any instant.
  • ·      Don’t even think about bringing your phone to the dinner table when you’re at home.
  • ·      Turn the ringer off when you enter a restaurant or other quiet public place. This is why the phone has a vibrate feature.
  • ·      If you need to take a phone call while out to eat, step outside. This is more polite and will remind you that you are there with someone else who is waiting for you.
  • ·      Don’t forward along hurtful or gossipy information or photos.
  • ·      Think before you speak, text, post or forward anything.
  • ·      Don’t post every mediocre accomplishment or thought you have during the day. 
  • ·      Lastly, a word of advice, spend your time actually doing things, don’t waste it documenting your life for all to see as if you are some B-list reality star. 

January 7, 2013

Television in the Bedroom


Nan Nuessle, MD, FAAP

Do your children have a TV in their bedroom? Many children do. In fact, 30% of children under the age of 3 have a television in their bedroom, and the percentage rises with age. By the time they are teens, many kids have a television with a cable or satellite box, a computer, and a mobile phone charger in their bedroom.  A 2008 study showed that when a child has a television in his bedroom, he is at a higher risk of poor school performance, sleep disturbances, obesity and smoking.  New studies have shown that devices such as computers, DVD players, game consoles and mobile phones have similar effects. The good news is that the above study showed that the health problems and poor school performance improved if the electronic devices were removed from the child’s bedroom.
When a television is in a child's bedroom, his television viewing increases dramatically. Some studies show a seven-hour increase, from 21 hours to 30 hours of TV a week. Parents may or may not know the content that their children are viewing. Furthermore, each hour viewing TV is an hour spent not exercising, not conversing with family members and, frequently, not attending to homework. An hour not exercising is felt to contribute to obesity. An hour not conversing with family members can stunt a child's social development. An hour watching TV instead of studying, or while studying, can interfere with academic success. Additionally, once a television is in a child's bedroom, parents find it difficult to remove it.
Here are some interesting statistics. By 5th grade, half of all children have a TV, DVD player or game console in their bedroom. Over 20%, have a computer in their bedroom and over 15% have a mobile phone. What does all of this do to their sleep? 57% of these children admit to using electronics after bedtime, with over 25% engaging in 3 or more such activities after they were supposed to be asleep. Just this lack of sleep alone can contribute to academic failure and to obesity. Even when an electronic device isn’t being used at night it can still cause sleep disturbances. Electronic devices emit a blue light. This blue light is particularly important in sleep disturbances.  Blue light affects melatonin, a chemical in our brains that tells us to sleep. Thus making it more difficult to fall asleep. Some investigators claim that even if you do fall asleep having a blue light source in the bedroom while you are sleeping will decrease the quality of that sleep.
What should we do with this information? First, realize that you are not alone. Next, remove televisions, DVD players, computers and game consoles, and smart phones from all bedrooms. Your children and teens may resist this, but stand firm.  Allow them to use these devices in a family setting where the content can be supervised. Then, consider setting up a central charging area in your home for laptops, tablets, readers and mobile phones. Finally, now that your children are watching less television, playing fewer video games and spending less time on their mobile phones, get active and do fun things together as a family.
Points to remember:
1. TV and other electronic devices in the bedroom are associated with many medical problems and with poor school performance.
2. Blue light emitted from these devices can affect sleep quality.
3. Removing these devices from the bedroom can help correct these medical problems and improve school performance.

December 20, 2012

Once Again


Don Shifrin MD, FAAP

In a week where we saw tragedy followed by the automatic parsing of rhetoric by almost everyone in the viewing public, a James Baldwin quotation comes to mind. "Not everything that is faced can be changed. But nothing can be changed until it is faced."

OK, first let’s chat about we are not facing. After Aurora came the liberal, centrist, and conservative commentaries about whether more deaths should or even could be attributed to the availability of guns. With 30,000 firearm deaths a year in the US (half suicides), is it not common sense to ask ourselves why we are not facing this? Each new episode brings us back to this déjà vu discussion: how could another Columbine, Virginia Tech, and now Aurora be prevented? Debate points include outlawing purchases of higher capacity magazine clips, renewing assault weapons bans, better background checks, limiting assault weapon ammunition purchases, taxing hollow point bullets, flagging new orders for multiple assault weapons, yada yada yada.

OK, here’s where any logic goes off the rails: background checks for gun purchases in Colorado spiked 41 per cent in the four days following Aurora. After the Gabby Giffords’ shooting, gun sales in Arizona spiked 60 per cent for "self-protection" handguns and military style weapons. As Dave Workman, editor of TheGunMag.com stated, "distance does not matter when people are concerned about personal protection."

Validating Mr. Workman, several media sources reported that, once again, gun owners are convinced that if they were there - and armed - Mr. Holmes would have been stopped before his rampage became more deadly. With all that smoke and chaos I can only shudder at the collateral damage that would have ensued.

I, perhaps I alone, am mystified as to how this latest round of gun purchases, and the media attention focusing on gun violence, is being translated in the minds of our children and teens.

Media researchers have tried for years to have the public accept that viewing media violence will engender three responses:

- violence is an acceptable and even necessary solution.

- viewed violence produces desensitization to actual real life violence.
and proven by the spike in gun sales

- viewed violence produces the belief that we live in a mean and dangerous world.

F Scott Fitzgerald was quoted stating that the test of a first rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function. So Americans, can you ‘intelligently’ explain to your children that you apparently abhor violence, but then tolerate it by not creating societal or legal barriers?

It is commonly accepted that you will violate your first amendment's right to free speech by yelling "fire" in a crowded theater. So why is it legally acceptable for the second amendment to prohibit you from purchasing fully automatic weapons, but still allow you to amass an arsenal of semi-automatic weapons and ammunition that could create even more
carnage than your voice?

OK, TV networks, cable, print media, radio, and maybe even schools.  I am putting you on notice. Other than the usual volley of op-eds, who wants to take a crack at explaining that our nation’s children?