New Year’s Resolutions

Sean Palfrey, MD & Robert Sege, MD

Boston Medical Center & the Massachusetts Chapter of the American Academy of Pediatrics

One year ago, the country was stunned by the shooting at Sandy Hook School. Many of us spent the shattered holiday season trying to make sense of how such a tragedy could happen here and what we should do about it. One year later, we have gained little insight, have argued over many possible solutions but agreed on few, and have done little of substance to reduce the possibility that such an event could happen again.

But there are important resolutions we can all make this New Year to our families, our communities and our country in memory of the 20 children killed in Newtown and the thousands of other children killed by gun violence since then across this country.

The first resolution is to make our own families safer. Most parents safety-proof their homes when their children are small, putting knives away and getting poisons like drain cleaners and rat poisons locked up or out of the house. But as our children grow, explore, experiment and act, sometimes impulsively and sometimes intentionally dangerously, we have to continuously upgrade our safety measures. We need to store all potentially life-threatening things, such as guns, bullets and explosives, far out of reach. For greatest safety, they should be out of all homes and out of our daily lives.

The second resolution is to help all members of our community be safe. Homes, schools and workplaces can all be very stressful. Many people at risk of harming themselves or others may seem calm much of the time, but they may not be inside. We know normal children can be naughty and teens will act in risky ways, but we can all  recognize when someone crosses the line and shows truly dangerous behaviors – bullies, challenges, insults, hurts people, harms animals, is a mean drunk or surrenders to drugs that destroy their self-control. Each of us, their families, friends, teachers, and doctors must have the courage and wisdom to identify and help these people on the edge before they strike out and hurt anyone, or many. Professionals are available and waiting to help.

The third resolution is to make our country safer. We have the power and responsibility to speak out to our legislators and ask them to help us build a safer country. Since the Newtown massacre a number of states have acted to require background checks before gun sales and ban military-style assault weapons, but other states are moving in the opposite direction. These are issues that need broad state and national action, and it is the job of our legislators to act on our behalf. Let them know that the lives of our children and friends really matter to us and that they must act to safeguard them.

In memory of the children who died this past year we can at least make these basic New Year’s resolutions to save the lives of our children in coming years.

Let’s Co-Opt Powerful Food Marketing Strategies to Help Parents Raise Healthier Eaters

By Natalie Digate Muth, MD, MPH, RD, FAAP

When my son turned 3, we took a big gamble for his birthday “treat” at preschool. We didn’t bring cupcakes, brownies, or cookies. We didn’t even bring 100% fruit popsicles or juice. Instead, the night before his birthday my veggie-hating child and I sat down together, cutting up pineapple, broccoli, and cherry tomatoes; arranging blackberries, blueberries, and black olives; and generally having a great time getting ready for his birthday together. I smiled big but secretly fretted. Was I setting my son up to be the laughing stock of his preschool? Would he even eat his own birthday snack?

Our concoction turned into a beautiful array of Sesame Street characters – a blueberry and blackberry Cookie Monster, pineapple Big Bird, cherry tomato Elmo, broccoli and olive Oscar the Grouch. The experiment was a success. The three- and four-year-olds, my son included, were eager to gobble up their Sesame Street friends. This test capitalized on what even the most novice food marketers know well – the way to a child’s mouth is through his heart – in particular with beloved characters, sure to make any given food more exciting.

Unfortunately, this insight typically goes towards marketing unhealthy food, with 98% of food ads for kids consisting of pure junk. A recent report from Yale Rudd Center found that in 2012, the fast food industry spent $4.6 billion marketing mostly unhealthy product to kids. Unlike other developed and wealthy nations, the U.S. has done disgustingly little to regulate manipulative advertising to kids, and despite bold promises to self-regulate, the food industry has done a lousy job.

In an effort to counter junk food marketing, last month Let’s Move joined with Sesame Street to announce a campaign to promote fresh fruits and vegetables to kids. Starting in mid-2014, the Produce Marketing Association and its growers, suppliers, and retailers will get to use the Sesame Street characters’ likeness to promote fresh fruits and vegetables!

My own mini-experiment and real peer-reviewed research suggest that this strategy will work! For example, one study showed that simply placing an Elmo sticker on an apple doubled the number of kids who would choose an apple over cookies. By rearranging vegetables and fruits in a way that appeals to kids’ imaginations, an “I-won’t-touch-anything-green” kid eagerly reached over to take a bit of the dirty, grouchy, and oh-so-loveable broccoli Oscar at my son’s birthday party.

As pediatricians and vocal advocates in the media and online, we need to not only continue to push for commonsense restrictions on advertising to kids and put pressure on celebrities, corporations, and organizations who engage in tactics to get our kids to prefer junk but also support efforts to promote healthy foods, such as Let's Move's partnership with Elmo and Rosita.

Natalie Digate Muth, MD, MPH, RD, FAAP practices general pediatrics at Pediatric Medical Associates in Vista, California and is Healthcare Solutions Director at the American Council on Exercise. She is author of the book “Eat Your Vegetables! and Other Mistakes Parents Make: Redefining How to Raise Healthy Eaters” (Healthy Learning, 2012) which aims to help empower parents to set their kids up for lifelong healthy habits, without the mealtime battles.

Attack of the Hand Held Devices

Mary Ian McAteer, MD, FAAP

Private practice pediatrician

Indianapolis, Indiana

I am all for establishing screen time rules for children, but how about screen time rules for parents?  Every day I see instances where my families have their devices situated between themselves and real life experiences in front of them.  They are busy texting as they walk into the office. They ask me to “hold on” while they take a more important call. Occasionally, they even Google a diagnosis or medication while we are discussing it in the exam room.

It is not just children that are glued to their devices. Parents seem equally unable to disconnect.  The image of a family walking through the park talking to each other and taking in the scenery has been replaced by a baby in the stroller tapping away at his iPad, a parent bent over a phone balanced on the handles, the other parent walking beside them chatting away on a Bluetooth. 

Our children learn to communicate by watching and imitating their parents.  It is heartbreaking to see a family out for dinner, what should be a shared family experience, and instead, everyone is intently interacting with their own personal device. This is a missed opportunity both for shared family time but also to teach and model appropriate social interactions for a child. Conversations are difficult enough without being distracted by a smartphone and interrupted by devices beeping, ringing and vibrating. 

Children first learn the rules of polite social interactions from their parents, but even older children and teens need these behaviors reinforced. Unfortunately, it seems that for many parents having a quiet child at a restaurant is the goal and if that is more easily achieved by handing him a smartphone or an iPad many parents see that as a “win.”

But, these same parents are surprised and frustrated when their children don’t know how to sit quietly in the pediatrician’s office while their parents try to have a conversation with their doctor. Or, they don’t know how to look a person in the eye when they are asked a question.  Yet, is it really surprising? How should these children know how to interact if those modeling behavior for them seem constantly distracted by a device and don’t look them in the eye when speaking.  Couple this with the fact that almost all of their opportunities to learn and practice social interaction have been eliminated or smoothed over by handing them a device?

I would argue that even on long car rides or tournaments, where these devices seem very handy, that it is in fact better to use these opportunities to engage each other in creative conversation or word games to pass the time -- together.

As a member of the older generation of pediatricians, I accept the positives of constant connectedness and the relationship building potential of social media.  I am getting used to it and enjoy connecting with more people than ever, even with cool emoticons.  But I see the need to encourage our younger generation of parents to slow down a little and use trusted ways of teaching communication and social development.  They should take the time to enjoy the spontaneity of childhood, dedicate time to fully participate in face-to-face discussions, turn off distractions when a task needs to be accomplished or an experience simply shared.  This can be a slow, sometimes painful process, but it needs to be prioritized in this fast paced, glamorous world of multi-media society.

Social Media Makes Me A Better Pediatrician

Heidi Roman, MD, FAAP

About two years ago I started writing more regularly- reflections on being a new mom, thoughts on my changing perspective as a pediatrician. I kept a notebook that quickly filled with musings that occurred to me during clinic, questions parents asked, things that came up with my son. I realized that a lot of other parents had the same kinds of questions I did. They too were Googling questions and looking for credible sources of information. So, I started actively creating and curating child health information via social media. I'm still a neophyte compared to many online pediatricians that I respect and follow. Nonetheless, I'm a relative veteran compared to most of my colleagues. I’m often asked about how and why I do this. When I answer that I think being online is making me a better pediatrician, I get some curious and quizzical looks. I admit that I  didn’t expect it when I started all of this, but being involved in social media is shifting the way I think about medicine and ultimately making me a better doctor. Here’s how.

•          I write more. I write, on average, a post a week. Writing has made me a better doctor and mom, in many ways. When a parent asks a question on a topic I’ve recently researched and written about I can direct them to useful resources without a moment’s hesitation. And, writing makes me read more too. I now have a set of go-to sources for quality child health information that I am well acquainted with and that I can use quickly in clinic or to research a topic.

•          I think more. Writing makes me think. Insightful comments from readers make me think. Listening to the amazing online community of patients makes me think. My point of view is challenged. My mind is opened. I’m a better doctor.

•          I make more connections. After I started blogging, I joined Twitter. I thought it might be a good way to share my work. But, I’ve found that, for me, Twitter is so much more. For me, Twitter is about the thoughtful, generous, intelligent community of people that I follow. Every day, they bring me the latest information in medicine, child health, parenting, and general news. They enable me to say to my patients’ parents, yes I did read that study on sleep that just came out and here are some thoughts. Or, there are some new car seat regulations and here’s what you need to know.

•          I am a more effective child advocate. By being more connected, I am both more aware of the current policy issues affecting kids and more effective at spreading the word.

•          I’ve started to become more “digitally literate.” There is no debating that this is where healthcare is going. It’s good to be in the thick of it.

•          I have more hope for healthcare. Thanks to social media I have met,people both online and in real life who are working every day to make healthcare better. People with innovative ideas and incredible drive who I am excited to join. People who give me hope that, with the help of new technology and hard work, we will improve our broken healthcare system.

Sure, there are limitations to social media. Nothing replaces face-to-face communication. I’ve also learned to take breaks now and then. Regain perspective. I’ve learned to dip in and out of the social media stream and not worry too much about missing something. If it’s important or compelling, it’ll come around again. I’m certain that the ways we share information will continue to change and evolve. Perhaps, this will all sound quaint in five years. But, for now, I think all of this communication and knowledge sharing is a good thing for patients, their families and for me.

Editor’s Note:  For AAP Members, the Academy has a wonderful webpage entitled, “Making the Most of SocialMedia” This resource is full of helpful tips and advice so login and check it out.

National Immunization Awareness Month

WHAT EVERY PARENT NEEDS TO KNOW ABOUT VACCINES

JoANN C. ROHYANS, MD, FAAP

August is National Immunization Awareness Month.  As summer vacation winds to a close, parents should be aware that they need to check their child’s vaccination record.  Vaccines (or immunizations) are recommended for people of all ages (from newborns through adults) and are the best way to keep children and adults healthy.  Through social media and television, we are all bombarded with tons of “quasi” medical information.   Unfortunately, parents don’t always know to whom to listen.  Not only are there doctors on television talk shows, news programs, Twitter, Facebook and blogs, but there are also celebrities and broadcasters who feel compelled to offer their advice regarding the immunization program. 

The best advice should come from a trusted medical source, primarily your physician.  The Institute of Medicine (IOM) has released two very important reminders.  One is that the MMR vaccine is NOT associated with autism and the other is that the current vaccine schedule (2013) is SAFE and best to be given on the schedule as it is written. 

Parents often ask if we can change the vaccine schedule to give fewer shots at each visit.  This is not recommended. Very good research shows that the number of vaccines given at one time does not increase side effects.  Instead, by using “alternative schedules,” parents leave their children vulnerable to very dangerous diseases. 

It can be confusing to parents since both the media and some doctors often speak of alternative schedules as if they are actually approved alternatives.  However, parents should be aware that there is only one official vaccination schedule.  This vaccination schedule is recommended both by the American Academy of Pediatrics and the Center for Disease Control.

It is also understandable that many parents feel overwhelmed and confused by the increase in the number of vaccines children and adolescents receive these days.  By age 2, a child can receive up to 24 injections and 2-3 doses of an oral immunization.  Luckily, combination vaccines can significantly reduce the number of injections without decreasing their efficacy.  But even so, it certainly does sound like a lot until you realize that we are able to protect against 16 diseases, all of which can be serious -- often causing hospitalization or even death. Because the vaccine program has been so successful in decreasing the incidence of many of these diseases, vaccine discussions in the media today often loose sight of how serious these diseases or their sequela can be.

This can lead to parents feeling ambiguous as to whether or not they should vaccinate their children.  It is not uncommon in my practice for a parent to ask, “Why does my child need a vaccine if the disease is almost eliminated from the U.S.?”   Unfortunately, diseases can have resurgences and when that happens the disease can spread quickly between countries and infect unvaccinated individuals. For example, in England in the late 1990s, parents chose not to give their children the measles vaccine.  Over the next 7-10 years, the incidence of measles increased dramatically especially in those unvaccinated.

What the vaccine discussions in the media and on-line often lack is a sense of what the world would be like without these vaccines. I saw many of the diseases now considered vaccine preventable when I was a child and more recently during medical school, residency and in my pediatric practice.  I have seen infants and children die of varicella (chicken pox) and its complications, which can include severe skin infections, blood stream infections and even central nervous system infections.  Before the rubella (German measles) vaccine became available, infants born to mothers who had rubella during their first trimester of pregnancy had a 50% chance of being born deaf, blind or having heart disease. 

I remember vividly a call from a mother on a Sunday morning saying that her child had developed a fever during the night, woke up having a seizure and was admitted to the hospital with meningitis and subsequent severe brain damage due to the Haemophilus influenza bacteria (HIB). This was just a few months before the HIB vaccine became available.  I also remember a young nurse with a chronic cough.  Her ill five week old was later admitted to the hospital and placed on a breathing machine.  It turns out her chronic cough was pertussis (whooping cough) and she had passed it to her baby. 

The diseases that we vaccinate against are real and serious. So as we enter August and prepare to go back to school, check that everyone in your family -- children, adolescents and adults -- is up to date on all their immunizations and booster shots. Furthermore, if you have any questions about vaccines, your doctor is a far better resource for medical information than the media.