New Year’s Resolutions

I love the New Year. It feels like a clean start. It’s like it just rained and you woke up to a scrubbed brand new day. But change requires introspection and analysis about what is and isn’t working. This past year brought me the blessing of my baby boy but now with three children my life has been more stressful and chaotic. So along with eating healthy and exercising, this year I will try to create calm in my life despite the pandemonium.

So if you are up to the challenge try something new this year. Try a resolution that will bring another kind of transformation for you and your family. Talk with your children. No doubt they have things they want to work on as well. Creating goals together increases accountability for both parties. You can encourage everyone by setting small rewards for the incremental changes you accomplish!

Three steps to help you succeed are:

1. Plan your work and then work your plan. This includes writing a timeline for what you want to accomplish.
2. Set realistic goals and baby step your way to success.
3. Be flexible. You don’t have to be perfect; just set a goal and keep your mind open to the possibilities that follow.
   

Good Luck and Happy New Year!

Dr. Sheila Cason

Read Books To Your Children

We just got back from the bookstore with the kids and I couldn’t be happier. It’s one of my favorite ways to spend a day with my children. Because I was read to as a child, I learned to love reading. Not only did it help me tremendously in school, it gave me an appreciation for stories and characters! I stopped reading for pleasure during my medical training. I was so time deprived that I read only to increase my knowledge base. Once I had children I began to look for books that I loved as a child, and it reawakened my love of a good story. I now make a conscious effort to turn the TV off and pick up a good book. My children see this and often imitate me. They sit for hours with books all around them and will look at the pictures and pretend to read!

How do you get your children to love to read? First and foremost you need to read to them. The American Academy of Pediatrics recommends that you start reading daily to your child at 6 months of age. I didn’t know a lot about reading and kids when I first started reading to my baby. She was all over the place and I was frustrated! She never let me finish the story. And when she did she wanted to hear the same book over and over again. I now know that that’s normal. Reading with your child is supposed to be enjoyable. You can embellish the story with sounds and funny noises. Don’t feel like you have to read every single word. Spice it up and pay attention to which part that your child likes. My 2 year old has trouble focusing so I play games with her. Sometimes in very detailed books such as Richard Scarry’s “What Do People Do All Day” I pick one character, such as the little worm, and see if my kids can pick him out on each page. I ask them to tell me a story about what he’s doing.

Read to your child at least 15 minutes a day. A bedtime story is a wonderful way to connect with your kids and helps them wind down from the day. The American Academy of Pediatrics has a great reading guide on their website (http://www.aap.org/). It’s called “Read Me a Story”. You can use this guide to help evaluate your children’s progress. It also gives suggestions on how reading skills can be developed. Reading to your children is one of the most important things a parent can do with their children. I read to my children to help them open their mind not only to information but to the wonders of other worlds.

Dr. Sheila Cason

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Children and Dogs

Our family dog is sick. We have two Labrador Retrievers and it is our oldest, a 10 year old yellow female, that is not feeling well. Her illness has been unexpected this holiday season and we still don’t know if she will be okay. We’ve had our dogs before our children were born and they are definitely part of the family. I can’t imagine our lives without them.

Children and dogs can be a wonderful combination! There are studies that indicate stress reduction in a person when they are around pets. If you want a family dog then you need to do some investigation and choose your pet wisely. Labradors in particular have excellent reliable temperaments. I chose them because of this reason. Dogbreedinfo.com has a list of dog breeds and ranks them according to their compatibility with children. Some dogs are naturally excellent with kids and others need to be raised from a puppy to be good around kids. But no matter how good a breed is kids need to be taught how to behave towards dogs.

• Kids need to be encouraged to give love, attention and respect.
• Children should never tease or poke a dog.
• Kids need to know to never approach or touch a dog without their owner’s permission.
• And especially don’t antagonize a dog when they are eating, sleeping or hurt.
• Always supervise children around dogs and seek medical attention if your child is bitten.

If you keep these tips in mind, then your dog can be an enjoyable addition to your family!
As our older dog is recuperating I have begun to talk to the kids about her illness. I know sometime in the future she won’t be around and that opens a whole new conversation. In the meantime we are saying a prayer for her health and enjoying our time with her.

Dr. Sheila Cason

Traveling with Kids

Well, we’re back home again! Yep! A 28 hour drive with a 4 year old, a 2 ½ year old and a 7 month old was just a little too much. What were we thinking? We turned around at the 11 hour mark. It was actually the baby who had the roughest time. He was crying nearly the entire time! That much time in the car made me realize the little things that can make a trip go smooth:

1. Leave early in the morning! You can place PJ’d kids in the car before sunrise and they can nap for a few hours. When they awaken you can all stop for breakfast.

2. Bring snacks. I brought them out when we all needed a diversion.

3. Plan breaks accordingly. Stop before everyone is melting down! Kids will have a harder time recuperating when they are pushed beyond their limits.

4. Carry a portable potty with you if your children are young. Telling your 2 year old and 4 year old to wait 10 minutes is unreasonable. More than likely they have been waiting anyway and are telling you when the accident is imminent. Just trust me on this, because I know!

5. Stop and eat some real food once in a while. It will do wonders for your sense of well-being.

6. Bring fewer toys not more. Books and coloring books all travel well. Lap oriented toys work great.

7. Bring an empty bucket. Yes, we also had to deal with carsickness! It can serve as a trash receptacle at other times as well.

8. Clean out the car when you stop. It’ll help in the long run to keep the car tidy.

9. Don’t carry your whole wardrobe with you. Pack three days of clothes per person and plan on doing laundry.

10. When you stop allow them to play and run. They need to get their energy out.

11. Plan on returning early with a few days to spare before you have to go back to work. It’ll help you put your world back in order.

12. Lastly when things aren’t going well, be flexible and adjust accordingly.

The last tip of course is what we learned the most. It was a hard decision but one that was best for the kids. So now we’re back home and celebrating Christmas in town. It’s weird to have spent all that time driving just to be back where we started. Next time I’ll look into flying in the off-season or renting an RV. In the mean time it’s evening and the kids are all down to sleep and no one is crying. Ahhh …it’s nice to be home!
Happy Holidays!

Dr. Sheila Cason

Car Seat Safety

Well the time has come to pack up the kids and drive excessively long hours to celebrate the holidays with family. It’ll take us 28 hours to get to our destination! Believe it or not it doesn’t sound that bad to me. I have good memories of long trips as a kid. But travel has changed a lot since we were young and sprawled out everywhere in the car. The following recommendations are taken from the National Highway Traffic Safety Administration website (http://www.nhtsa.gov/) and The American Academy of Pediatrics website (http://www.aap.org/).

1. Everybody needs a child safety seat, booster seat, or safety belt!

2. The “best” car seat is the one that fits your child and can be installed correctly.

3. All infants should ride rear-facing until they have reached at least 1 year of age AND weigh at least 20 pounds.

4. Children age 12 and under should ride properly restrained in the back.

5. A child should stay in a booster seat until the adult seat belts fit him correctly. This is usually when the child reaches about 4' 9" in height and is between 8 and 12 years of age.

6. Your child can graduate to a booster seat when she reaches the top weight or height allowed for her seat with a harness. (Her shoulders are above the harness slots and her ears have reached the top of the seat). Remember that a booster seat needs to be used with a lap and shoulder belt.

7. The car safety seat needs to be replaced if it was in a moderate or severe crash. The seat does not automatically need to be replaced if the crash was minor. A crash is considered minor if:

· The vehicle could be driven away from the crash.
· The vehicle door closest to the car safety seat was not damaged.
· No one in the vehicle was injured.
· The air bags did not go off.
· You can't see any damage to the car safety seat.

8. Make sure your child is buckled into the car safety seat correctly. You need to use the correct harness slots, keep the harnesses snug and the plastic harness clip needs to be at the underarm level to hold the shoulder straps in place.

9. If you are using a seat belt to secure your seat, then you need to make sure that the seat belt is routed through the correct belt path and the seat belt is buckled tight. It’s not tight enough if you can move the seat more than an inch side to side or toward the front of the car.

* If you’re going to be flying instead of driving remember that The Federal Aviation Administration (FAA) and The American Academy of Pediatrics (AAP) recommend that when flying, all children until 4 years of age should be securely fastened in a car safety seat. After 4 years of age, they should be secured with the airplane seat belts. Most infant, convertible, and forward-facing seats are certified to be used on airplanes. Booster seats and travel vests are not certified to be used on airplanes.

Making sure that your kids are safe during your travel will make the trip more enjoyable. Happy travels! I’ll see you on the other side of the country!

Dr. Sheila Cason

Diarrhea and Dehydration

It is diarrhea season and my office is packed with parents needing advice! Diarrhea is one of the most common winter illnesses. The classic abrupt diarrhea illness lasting about a week is often caused by a virus. In 2004, The Journal of American Medical Association reported that dehydration is one of the leading causes of illness and deaths in children throughout the world. This is because replacing lost fluids in a child can be problematic in countries with limited access to intravenous fluids. As a result, The World Health Organization (WHO) adopted Oral Rehydration Therapy (ORT) in 1978. This treatment of viral diarrhea is still the most effective treatment of mild to moderate dehydration. ORT consists of giving children electrolyte solutions by mouth frequently to combat their loss of fluids.

Children will often clear diarrhea themselves without much intervention. But one of the most important things to remember is that, while they are healing, they need to have fluid and electrolytes replaced. Don’t give plain water to children! Oral rehydration solutions such as Pedialyte, Infalyte and Rehydralyte are the best solutions to replace their losses of salt, sugar, potassium and other electrolytes. Don’t worry about their drop in appetite – it’s normal. As they begin to recuperate, they will get their appetite back. You should allow your child to drink as much as they want. However keep in mind that some diarrhea illnesses have a degree of vomiting with them. Because of this it’s better to give your child sips of liquid every 20 minutes.

Parents should keep oral rehydration solution in their home at all times. I keep some in an emergency bag in my car as well. Replacing fluid losses with rehydration solutions is appropriate for mild to moderate dehydration. Only your child’s doctor can assess the degree of dehydration your child may have and advise you with specific recommendations. Call your doctor if your child has:

1. High fevers and bloody stools
2. Frequent vomiting
3. Frequent diarrhea
4. Abdominal pain
5. Dry mouth
6. No tears when crying
7. Less than 6 wet diapers per day
8. Lethargic
   

Don’t forget to wash your hands!!

Dr. Sheila Cason

Delaying Gratification: The Marshmallow Experiment

If someone offered your child a marshmallow would they eat it? What if they were told they could get two if they waited for 15 minutes? In this age of “I want it and I want it now!” mentality, it’s hard to imagine a child waiting. I can hardly get my children to wait 5 seconds. It seems that this concept of delayed gratification might be an advanced skill. A skill that you might ask of a group of high schoolers or at least middle schoolers right? But research shows that this skill can be learned at a young age. And most importantly delayed gratification can have greater ramifications for the future than we think.

I see a lot of children where delayed gratification is a foreign concept. They quickly choose to forego college because money is greater and faster going straight to work than continuing with school. But it’s hard for kids to see beyond the big picture. They are concrete thinkers. What’s here and now in front of me is stronger than an imagined good in the future. Therefore it’s our job to show them the benefits of waiting. Part of this is actually setting limits and boundaries and saying, “No. I know you want it but you need to wait and here’s why.” In order for kids to be accustomed to this gratification delay, it needs to start when they are young and the choices aren’t as life altering. This pattern of thinking sets the groundwork for their life. In 1960 psychologists at Stanford University told a group of preschoolers that they could have one marshmallow immediately or if they waited, they could get two. 14 years later they followed up with these children that resisted temptation. These children scored on average 200 points higher on their SATs and they showed better adaptability to stressful situations. This ability to wait for the things we want when we are young translates into real world success.

Our job is to prepare our children for the world and help them learn crucial life skills. Whether we like it or not we are teaching our children in everything we do. It’s essential that we teach them that things worth having are worth the wait. So I ask you…. if your child was given the choice: one marshmallow or two.....which would they choose?


Dr. Sheila Cason

Tips for Dry Skin

Did you know that the skin is the largest organ in the body? It serves an important role in a child’s overall health and needs some special care at this time of year. Our skin gets parched because the indoor heating, cold air and low humidity strips moisture away. Often people think they should cut down on their kid’s baths. Not me! I don’t know about your kids but mine are grimy at the end of the day. I am not giving up the routine of a nightly bath. It’s particularly good at bedtime because children get sleepy when their temperature drops after a bath. What a great preparation for sleep! Just remember to moisturize when they get out.

If your child’s skin is persistently red, irritated, and dry, he may have eczema. Eczema can be a chronic skin condition and may be caused by many things. Ask your pediatrician for their expertise in understanding your child’s skin. Eczema a.k.a. “the itch that rashes” can be helped tremendously by avoiding triggers, keeping the skin moist, and controlling the itching. There was a study that took people with inflamed eczematous skin and put them in plaster casts. It was no surprise that when the casts were removed the skin under was healthy and beautiful. Because they took away the ability to scratch, their skin healed!

So just because the cold weather can wreck havoc with your little one’s skin doesn’t mean that they have to be uncomfortable! A little bit of preventative care can go a long way. General tips include:

1. Avoid harsh soaps.
2. Avoid very hot water for prolonged periods of time.
3. Put a thick moisturizer on their skin within a few minutes of getting out of the bath.
4. Apply a thick moisturizer several times a day.
5. Put a humidifier in their rooms to replace moisture in the air.
6. Drink plenty of water

Dr. Sheila Cason

The Fussy One Month Old!

Nearly every day I look into the bleary eyes of a sleep deprived parent and hear their chief complaint: “fussy infant”. They look at me confused, and say “she was great!” They add, “She slept whenever and wherever. But now she’s crying all the time! There must be something wrong with her!” This is a common complaint and one of the most important visits you can have with your pediatrician. First and foremost, always call your pediatrician when you’re concerned about your fussy infant. After we rule out medical reasons for their fussiness, we can talk about ways to help your baby and you calm down.

After reading countless baby books, seeing hundreds of patients and having three babies of my own, I believe that most of these babies are overtired! At one month, they’ve reached an age where they haven’t learned to settle themselves, and they need your help. So when this little infant comes to me, I take a thorough history and do a complete physical exam. Once I’m confident that the baby is healthy, I immediately ask for a blanket and proceed to burrito-wrap the infant. Often the parent says, “Oh we’ve tried that but she fights it!” I then ask, “Does she sleep and then startle herself 10-20 minutes into her nap?” “Yes!” They reply, “How did you know?” I nod sympathetically and say “I’ve been there…” and I go ahead and wrap them anyway.

Remember the startle reflex is still prominent at one month of age and is often the culprit of a baby’s sleep disturbance. The following method was developed and perfected by my husband. Standing up, I take this little wrapped baby and encircle them in my arms holding them snug. With their head on my left upper arm I place a pacifier in their mouth and roll them slightly in toward my chest. This helps keep the pacifier from slipping out, and I can watch their facial expressions. Even if they seem upset and they are crying a lot, I keep them in the same position. I rock the two of us back and forth patting their bottom and back rhythmically, all the while saying “shhh shhh shhh” over and over. Ninety-nine percent of the time this cranky baby stops crying, begins sucking on their pacifier and then slowly drifts off to sleep. My visits nearly always end with the baby having to be woken up to be put back into the car seat so they can all go home.

A crying infant is a common and stressful event. Your pediatrician can help give you advice to help you through it. Unfortunately, sometimes in the midst of baby’s crying jag, even the most well-intentioned parent can lose their cool and shake their baby. Never shake an infant! The National Center on Shaken Baby Syndrome states: “In America, every year an estimated 1,200 - 1,400 children are shaken… Of these tiny victims, 25 -30% die as a result of their injuries. The rest will have lifelong complications.” So I encourage you to seek help when your baby is crying. If all else fails and you feel like you’re becoming angry it is safer to put your baby in her crib, and then take a shower and calm down than try to “wait” it out! There are many great books on how to soothe babies. They all give similar advice. The one I most recently read and liked was Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer by Dr. Harvey Karp.

Remember that soon this will be a distant memory. So when it’s late… and you’re holding your baby… and they finally fall asleep... Smile and savor the moment.

Good Luck!

Dr. Sheila Cason

Meditation - A Calm Approach to Caring for Yourself and Your Children

Are you all as busy as I am? Are you just surviving the day? Do you spend all your time ruminating about the past or dreaming of the future? I am often amazed at all the thoughts scurrying through my head. While feeding the kids their dinner and discussing the day’s events, I am also thinking about the washing machine that is full of wet clothes and how I need to go to the bank. This monkey mind is a hard habit to break and sometimes not so practical. By the time I get home from work it’s late, and I have to multitask to get everything done!

We have heard that living with this stress chronically can be unhealthy but western medicine still doesn’t know a lot about the mind-body interaction. The National Center for Complementary and Alternative Medicine (NCCAM.org) has been looking at the connection between the mind and health for many years now. When we are stressed the sympathetic nervous system (i.e., part of the autonomic nervous system) activates the fight-or-flight response. Physically it causes the heart rate to elevate as well as the breathing. The blood vessels narrow and the muscles tighten. This is helpful when we are under attack because it mobilizes us for action. But what if we’re just busy? We are not preparing to fight a war or run from a lion; we’re just trying to balance family and work and our own needs. It is thought that meditation helps with stress by activating our parasympathetic nervous system (i.e., the other part of the autonomic nervous system) and helping our body relax. This is the rest and digest response. The heart rate and breathing slows and the vessels dilate. Our bodies relax and enter a state of calm.

This state of calm brings enormous benefits to us as well as our children. Author Sarah Napthali reminds us in Buddhism for Mothers: A Calm Approach to Caring for Yourself and Your Children: “The more healthy, positive and kind our minds are, the more happiness we can experience and the more benefits for our children”. It’s a great book and a good place to start if you’re interested in meditation and the benefits with regards to parenting. I will talk more about this and the mind-body connection in future columns. Until then relax….

Please e-mail me if you have questions or comments…


Dr. Sheila Cason

Breastfeeding

Mother’s Milk

When you’re a new mom and the topic of breastfeeding comes up, it can all be overwhelming! Sometimes I find the advice to be a little black and white. You need to take breastfeeding in stride. Some of the strict advice is unrealistic, such as: “never give your baby a pacifier, never give formula, and never go more than 3 hours without pumping at work”. I’ve seen too many moms give up entirely because they couldn’t do it the perfect way they were advised! Remember, there are no absolutes and you need to find what is best for you. Here are some things I advise my patients.

The sucking reflex is very great in some babies and if your little one wants to stay latched on every moment of the day it is okay to give them the pacifier. If you want to introduce a bottle, try doing so around two weeks to a month of age. Personally I like the two week mark but do it as long as the baby is very proficient at drinking from the breast and isn’t struggling with nipple confusion. I like parents to use pumped breast milk because some babies can get very gassy and constipated when switching between formula and breast milk.

About a month before you are going back to work start storing up milk. In the morning after some sleep, you will feel fuller so this is a good time to pump and actually get extra out. Feed your baby in the morning and then immediately pump out that which she didn’t take. Store it in the freezer and then feed her when the next normal time would be. Remember that the more you pump out the more your body will make. If you do this every morning you’ll have a ready supply when you return to work. Now about pumping at work... Early on a physician friend reminded me that it was okay not to pump exactly when I would be feeding her. You can pump two hours apart particularly in the morning and get a good amount, and then later in the day go five hours without pumping. This is the schedule I worked out for myself. Feed your baby in the morning (let’s say 5 or 6 am) then pump immediately afterwards for the extra. Then in a couple of hours go to work and pump immediately again (or pump right before you leave if you don’t have a long commute). Then pump at 12:00 noon when you have lunch. By now, between pumping and feeding the baby, you’ve expressed milk four times in six hours. You can then wait until 5 or 6 pm to feed her when you get home. Nurse her again before her bedtime and pump again before you go to sleep. You can see this takes some dedication, but this routine has worked for me. Above all try your own schedule and trust yourself! Some people want only to nurse their baby in the morning and evening and give formula all day. This is also okay. Your body will soon adjust and make enough only for these times.

If your supply drops whether through decreased pumping or your baby goes through a growth spurt, try pumping after every time she feeds. Your body needs to be told to make more! I do this on the weekends. If you’re drinking and eating then your supply will rise again by the following week. Remember that to make milk you need to be drinking 8-10 glasses of water a day, eating and sleeping.

Finally, I suggest getting a car adapter as well as a battery operated pack for your pump. You’ll be happier to pump in a car with a blanket over you rather than in a bathroom stall!

Dr. Sheila Cason