Privilege Withdrawal

Well…Unfortunately I don’t think I’m going to win the “Mom of the Year Award!” The other night I was having power struggles with the kids and gradually the praises and pleading gave way to punishments. Before I knew it I’d had it up to here!! That was it!! “I’m done! No more talking! Tomorrow all privileges are withdrawn! That means no TV! No playing with dollys! No coloring. No reading. Nothing!!” They just looked at me blankly as I turned around and headed back to bed hoping they magically stayed in theirs! They did by the way. Maybe they were just so confused. Is something wrong with mommy?

Apparently I missed the memo that says privilege withdrawal isn’t an effective method of punishment at this age! They are a little young and it was too far removed from the incident. The baby was, of course, exempt. All three followed me throughout the house. Yeah the baby just wanted to be with me too. I mean who wants to play alone when everyone else is helping mommy? We made breakfast, cleaned up, did the wash and made the bed. We ran errands and even made bread! After lunch it was nap time! From then on it was coasting until dinner time.

Some psychologists report that revoking privileges is cruel and unduly harsh. I’m not convinced that this is so. But I’m also not convinced that it did that much of anything! They didn’t seem to mind not playing and just being with me! Funny thing was, all in all, it was a really good day. No-one screamed or fought. They all got along. The house was the cleanest it had been in a while! I was happy and they were happy! Hmmm…I think I need to schedule more cleaning and helping time with mommy. Not everyday needs to be a free play day!!

Sheila Cason MD

Hello Kitty Backpack

The only backpacks available at the Navy Exchange were Hello Kitty backpacks. The Exchange - for all you non military folk - is the general merchandise store located on the military base. The items can be significantly less expensive than that found elsewhere. Back home it’s probably not a big deal. But in Guam the stores are limited. They do have “The World’s Largest K-Mart”. But - get this - is too expensive!! So I don’t shop there!! So anyway the only backpack was a Hello Kitty one. I looked and peered around. I thought we need to get something different. You know… something a little less Paris Hilton.

I kept looking for something cute and unique. Of course my soon to be kindergartner was all about the Hello Kitty Backpack!! She was insistent. “No mommy this is good.” “Well honey let’s see if they have anything else”. Around we went until it hit me! Ah Hah!! I forgot! Kids don’t want to be unique! Being different is tantamount to disaster!! Kids want to conform! It makes them feel safe and similar if they look and act like their friends.

I’m itching to tell her all the things that make us different also make us special. For now, I think I’ll save my “it’s okay to be different” speech for when it really counts. I bought the backpack. Now I need to make sure she doesn’t lose hers amidst the crowd of Kittys!!

Sheila Cason MD

Coin Ingestion

What’s the most common foreign body ingestion in kids? Coins!! And yep you guessed it: my little 16 month old swallowed a penny a couple of weeks ago. As a pediatrician I’ve seen this plenty of times but of course when it’s your own child it’s different!! I watched it go into his mouth and instead of politely asking if I could have it -like I have always done - I said NO! And I then tried to go after it. After much screaming and then choking and then coughing he gulped it down! I just froze. I thought now what do I do?

You go to the ER. Regardless whether a child has symptoms or not an x-ray needs to be obtained. The x-ray will show whether it passed into the stomach or got hung up somewhere! Occasionally the coin can hang out in the esophagus and cause problems such as esophageal erosions if they are not removed. If the coin is in the stomach then it will likely pass without incident. Most children will pass the coin in a few days. Examine the stool to make sure it has passed! If it hasn’t passed you’ll need to get follow up x-rays.

What about inducing vomiting? Good question. I wouldn’t recommend it. The baby could then choke on it again and this time he can get it into his lungs!! Just get the x-ray. My child happened to keep that coin in his stomach for a good two weeks and then got a hold of some Chamorro hot sauce. – I swear we really do watch our child! We happened to have an ER doctor friend with us. Who, after our baby was frothing and vomiting from the hot sauce, peered into the mess on the ground. He softly inquired, “Do you see a penny in there?” It wasn’t there but it did successfully move it from the stomach down to the intestines!! It passed two days later!

This was a trying incident to be sure, but one that reminded me to keep all small things away from young children. If it can fit inside an empty toilet paper roll then it’s too small. Ironically I was ridding the house of all teeny weeny things when the coin incident occurred! When something does happen make sure you’re ready. Get CPR certified. And if something does happen and if your child is having difficulty breathing or looks likes he’s in distress, call 911!

p.s. Check out the coin in the photostream. I cleaned it all up and saved it! What can I say…I’m a packrat at heart!!

Sheila Cason MD

Hafa Adai from Guam

The wicker basket by our front door is our flip flop resting spot and it’s a small but visible indicator that my life has really changed! Can you believe it! Just a short time ago I frantically was balancing being a wife, mother, and pediatrician in sunny San Diego! But compliments of the US Navy we now call the beautiful tropical island of Guam - Home.

I’m a full time mom now as I await my medical license and enjoy my three children. They, by the way, have adjusted remarkably well. We weren’t at the airport for 10 minutes before they were playing duck duck goose with the local children!

I miss my friends and family in the states but I relish the time with my children. Now that I am home I’m struggling with a brand new set of challenges. How do I keep my patience? How do I maintain a balance of what I need and what they need? What about the house – how do you get anything done when there is all day to do it? And what’s this about dinner? Do I really have to cook again? I think about this and many other things all day long but in the meantime I haven’t heard anyone crying for a long time about why I have to go to work! I know these kids right here need me too, and I’m blessed because I can give them what I now have …time.

Sheila Cason MD

Comment for Dr. Cason: "playing house"

Dr. Cason,

My nephew is 12 and my great-niece is 7. They were being babysat by his mother and me playing video games and such. They got to playing house (this comes from my sister having a conversation with both of them very calmly after she walked in on him laying atop of her--both clothed). They said they were playing house and kissing and then it got carried to a next level of touching and then they went about their business playing and the "wife" sent the "husband" off to a baseball game (still playing house). My sister immediately called the girl's mother and told her what had happened, but her mother freaked out and now they've called the police and we don't know what is going to happen. I read a small blip that you posted about having a hard time knowing what is an abusive situation vs. play. Can you offer some resources that I can offer to both parents to read to help them understand whether this should be a police/CPS matter or a disciplinary, sit your child down and discuss matter? I truly do NOT believe in any way that this boy was trying harm this 7 year old. - Anonymous

Dear Anonymous,

Thanks for your question. I sympathize with your situation it must be hard for everyone including the children to understand what is going on.

It's a fine line to understand what is "abuse" verses innocent but nonetheless "inappropriate touching". Surely many factors need to be considered including the age of the children and the extent of the touching. You say with your great-niece and nephew it got carried to the next level of touching, so I'm left to assume that there was more involved. If any of the private areas - those normally covered by a bathing suit - are involved, then it is certainly inappropriate.

Most definitely both children need to be sat down with their respective parents and talked with. Having an open honest discussion fostering trust and receptiveness is imperative. Scaring the kids at this point and having them feel shameful and secretive is not likely to be helpful. It's a confusing world for children these days. Playing house and acting out situations are normal. Television and the media, in general, show very explicit material at times and it would be easy for a child to simulate what they see. How many times have we seen children pretending to "kill" each other and lie "dying" and then run off giggling to themselves? It's uncomfortable for me as a parent to watch that but completely understandable. I don't really believe that they are trying to hurt each other just as you don't believe that your nephew had ill intentions! But children need supervision and guidance. Your sister did the right thing in talking with the children immediately. And though the 7 year old should know that degree of touching is inappropriate, it's the twelve year old that bears more burden of responsibility. Remember that the two children are at different developmental stages and a twelve year old will have different curiosities. He really needs to know what is okay and what is not.

Having said all that, what you do now that the incident has occurred is varied. It’s the parent’s prerogative whether to call the police or Child Protective Services (CPS). But remember that if one of the parents goes to their pediatrician or tells someone of authority – such as a teacher - that person is required by law to contact CPS if they have reason to suspect abuse. Often this isn’t a question that is easily answered and hence why another impartial party needs to be involved. However scary it is to have CPS investigating the case, it’s their job to decide if there is anything to worry about. It’s helpful because it relieves the burden from the parents about making that judgment call. I’ve had many situations that I have referred turn out to be nothing and the case was closed. For more information on child sexual abuse or other forms of abuse, write to the National Committee for Prevention of Child Abuse, PO Box 2866, Chicago, IL 60690.

I wish you and your family good luck. Please let me know if there is anything else I can answer for you.

Sheila Cason MD