Curiosity

Do you see my toddler looking at the snail? How cute is he? All crouched down and inspecting the little wonders of the earth. He calls it a “nay”. Everyday we walk my daughter to her bus stop. When he sees one, he starts to trot along eager to reach it.

I try to allow plenty of time to wander in the morning so he can explore some of his favorite things, including snails. Just the other day he crouched down and blew on one. The snail’s head retracted into its shell. He was thrilled! He’s similarly fascinated with light switches. Off. On. Off. On. He’ll poke me and says “Liiii!” he’s so excited to share his discoveries!

I have to admit that I spend a lot of my time squelching and redirecting my child’s curiosity. “What are you doing? Don’t touch that! Get down!” When I ask my older kids just what do they think they are doing they often say, “But I wanted to see what would happen!” I can’t argue with that. I just need to keep them safe while they are exploring!

I know that curiosity is key to their learning. Right now blowing on little snails and playing with light switches are pretty harmless, but the other day I turned around the corner and saw my toddler teetering at the edge of the dining room table. I carefully led him down to safety…kids!

Sheila Cason, MD

Cold and Flu Season: When to Take your Child to the Doctor

It’s late and I just got home. It was another very busy day in my clinic. Everyday I’m educating parents regarding their sick child. Sometimes it’s not always easy to tell when you should go to the doctor. A fever is considered any temperature greater than 100.4 degrees Fahrenheit. kidshealth.org has a good article on fevers.

Here’s what I tell my parents:

Seek medical attention if:
• There has been a fever present more than three or four days.
• A cough has been present for more than 2 weeks.
• A cold or upper respiratory infection has been present for more than a week to 10 days.
• There are focal symptoms such as ear pain, throat pain, chest pain or tightness.
• There is persistent vomiting or diarrhea.
• There is a fever greater than 100.4 Fahrenheit in an infant less than 3 months of age.
• There is a fever > 102 in an infant less than 2 years of age particularly if there are no other symptoms. This could mean they have a urinary tract infection.
• If you have any questions or concerns.

Go to the emergency room if:
• A child looks very ill or lethargic or is difficult to arouse.
• A fever is accompanied by a rash. Particularly if it looks purple or like blood under the skin.
• There is difficulty breathing and drooling.
• An infant/child’s lips are blue or they appear to stop breathing.
• You child has a seizure.
• Your child has a fever and stiff neck and/or severe headache.
• Your infant’s soft spot is bulging.
• Your child is inconsolable.

If you’re unsure whether to take your child to the doctor call your pediatrician. You should be able to talk directly to you doctor the same day. You may have to wait a few hours until they can get space in their clinic but your call should be returned by noon if you call in the morning or by end of the work day if you call after lunch. If your child is ill and needs to be seen that day, they should be able to accommodate you. Don’t expect to be seen the same day if it’s a chronic problem and can wait until the next day.

Sheila Cason, MD

Deceptive Medical Claims

Too often than not, I’m watching TV or listening to the radio and a doctor or other “expert” comes on claiming that XYZ can cure everything from gout to diabetes. These ludicrous claims, that have little scientific backing, are what make people think doctors are quacks. Recently I had a reader ask to clarify what the benefits of colon cleansings are. Colon cleansings! Did I miss that lecture in medical school? Having no more expertise that the average person I did some researching and found that this is one of the numerous deceptive medical claims that are out there on the market. So how do we decipher what is legitimate or a hoax? Well lucky for you, there is Quackwatch.org that can help provide you with some info.

Yep, there is a whole website devoted to debunking deceptive medical claims. Quackwatch, Inc., is a nonprofit corporation whose purpose is to combat health-related frauds, myths, fads, fallacies, and misconduct. Its primary focus is on quackery related information that is difficult or impossible to get elsewhere. Founded by Dr. Stephen Barrett, it now has a worldwide network of volunteers and expert advisors. Because of its rigorous adherence to scientific principles in evaluating medical claims they have received numerous awards over the years regarding their articles.

The future for quackery looks bright says James Harvey Young, Ph.D in his article “Why Quakery Persists”. Many people have suffered side effects from modern "miracle" drugs. This circumstance, added to the over prescribing of antibiotics, tranquilizers, and stimulants, has helped foster a stereotype of our nation being "drugged," thereby giving "natural" healers a promotional boost. In the early nineteenth century, quacks termed the doctor a butcher; today they call him a poisoner.

Be wary of grandiose health promises. It’s like they say, “If it sounds too good to be true, it probably is.” If you have questions then do your own research. Check out what other people and physicians have to say. Ask your pediatrician for their advice or go on to Quackwatch.org to see more info regarding the specific claim. Now as an educated health consumer, you can make your own decision. Oh and what about the colonics? They have lots to say about this as well! Check it out here.

Sheila Cason, MD

Birthday Girl

The uninterrupted time was splendid. We prepared for her party tomorrow, decorated the house, swam … but the true highlight was getting her nails done. My little girl is growing up.

Sheila Cason, MD

My First Born

Tomorrow my first born turns 5 years old. I can’t believe that it’s been 5 whole years since she came along and my life was changed. Sometimes it feels longer than 5 years that I have had her in my life and at other times it was just a minute ago that I was a new mom, feeling happy, scared and ready for anything.

Recently I have some friends that have either just had or will have their first baby and I’m jealous. Never again will I experience it all again for the first time. But as I much as I miss her little baby stage, I’m really enjoying the new stage as well. It’s amazing to discover her personality. She’s a giggler and I love to listen to her and see what is so funny. Tomorrow I plan on taking the day off to be with her and I can’t wait. There will be no school, no work, no other siblings. Just she and I…the way it was in the beginning.

Sheila Cason, MD

The Long Hug

It seems that when the kids start to get past the little baby stage that any embrace gets shorter and shorter. There was a time when all my precious children slept soundly and preferably in my arms. I could hold them all day long if I so desired. Now the cuddles come in the morning and while reading books. The days of the prolonged hold is starting to wan…unless they are sick.

When they kids are sick their regression comes quickly, and I latch onto it knowing that this moment of stillness is something I might not get for a while. Yesterday, my 17 month old, still trying to kick his cold, fell back asleep in my arms after waking from his nap. I was talking to my husband and rocking my little boy when my husband whispered, “He’s asleep.”

I froze. It was too good and I was afraid of spoiling the moment. This hadn’t happened since I stopped breastfeeding 2 months ago. I settled back in my chair gazed at his little face. He was a bigger version of his baby self but just as vulnerable looking. He slept there for a long while, enough for dusk to settle over the house and for me to wonder if he’d be there all night. While I felt terrible that he was sick I was also grateful for the long hug.

Sheila Cason, MD

How to Get Your baby to Sleep through the Night Part Two

Yesterday we talked about how the bedtime routine is the key to getting your child to sleep through the night. Now that you know what to do, here are some tips to help you stay on track! Remember that this is what worked for me and what I recommend. It’s not the only way to get a child to fall sleep on their own. There is no so-called “best” way it’s just my way.

1. Put them in their own room.
Your child needs their own space dedicated to sleep. It doesn’t matter if they share a room with other siblings, but it’s going to be hard to get them to sleep without you if they can roll over and see you.

2. Make sure they are safe and not sick.
Don’t ever let a baby cry it out when they are in a potentially dangerous situation. You need to know they are safe. This means no pillows or blankets or other stuffed animals in their crib. Everyone knows their baby and their cry. Your baby may be ill. Talk to your pediatrician to make sure they are healthy and there is no medical cause for their awakenings such as reflux.

3. Make sure you are ready.
Think hard about why you want your baby to all sleep by themselves. If letting them put themselves to sleep is against your philosophy then don’t do it. There’s nothing wrong with you soothing your baby back to sleep…if that works for you!

4. Make sure everyone else is ready.
Before I decided to embark on “Operation Sleeping through the Night”, I told everyone in the household what I was doing. If anyone had any objections I usually offered that they are the one to get up 5 times a night. Nobody took me up on it so I went through with my plans.

5. Choose the right day
Chose a night where you don’t have a lot of pressing things the next day. It’ll be a tough couple of nights and you’ll be tempted to stop if it gets too hard. Don’t do it when your mom is in town. Trust me, I tried this and it failed miserably!

6. Be consistent.
Once you decide what you are going to do, be consistent. Don’t stop and start, stop and start. It’s unfair to you and your child. I figured that at some point I was going to have to let them soothe themselves. What better time than the present.

7. Expect setbacks.
Once they are sleeping through the night, expect setbacks! When they were sick or we were traveling they all woke up at some point and I soothed them back to sleep. I took that time to enjoy the cuddles and knew that they needed me. When the time was right I let them put themselves back to sleep, and they went right back to sleeping through the night.

8. Be strong.
It won’t be easy. For all of my children, I slept just outside their door so I could be near them if they needed me. I covertly checked on them periodically particularly when they stopped crying.

9. Use your clock.
When you first put your baby down, look at the clock. It’ll feel like forever if your child is crying. You’d be surprised at how relatively short it can be.

10. Ask for advice
If you need help along the way, check in with your pediatrician. They can guide you with your baby’s sleep issues.

Good luck and let me and let me know how it works for you!

Sheila Cason, MD

Previous Article:

How to Get Your Baby to Sleep through the Night

How to Get Your Baby to Sleep through the Night.

Dr. Cason,

I found you! You don't remember us, but you saw my twins and me in SD when they first came home. You showed me how to swaddle my son and turned me on to Happiest Baby on the Block. I have a question, well a problem, I guess. My twins are 8 months old. One, my boy, is sleeping through the night 7P-6a. But the other, my girl is still getting up, sometimes 5-6 times a night!

I tried to let her cry it out a few times, but then I cry or my other baby wakes up. She eats plenty during the day including food, cereal, yogurt, and a bottle before bed. I'm not sure if I should just let her cry it out and deal with her
brother, too. We are in desperate need of help! I'm 6mos. Pregnant, and I’m getting real cranky without my sleep. I'd appreciate your advice.

Thanks and I hope things are going well for you in Guam.

L.K.

Hi L.K.!

I think all parents have this issue at some point in time with one of their children. The key to getting your baby to sleep through the night is their bedtime routine. Some kids will spontaneously start sleeping through the night at about 4 months of age and others need a little coaxing. Parents will think their child wakes up a lot but remember that we all wake up in the middle of the night. We just usually go back to sleep. Your baby is probably arousing at a normal rate but then failing to put her self back to sleep on her own.

Most children who can’t put themselves back to sleep probably have a sleep prop. A sleep prop is anything she requires to help her fall asleep. It could be a bottle or pacifier or just being rocked to sleep. Remember that when we fall to sleep with something – “a prop”- then we need that same prop to be present to fall asleep again. When she wakes up and it’s not there then she’ll start to cry until it is offered again. So you see it’s really not unreasonable for her to be crying. It’s just what she been taught.

I ran across a good explanation once. They explained that it was like us falling asleep with our favorite pillow. If we were to wake up in the middle of the night and find our pillow was gone, we’d be up and aroused looking for it. If someone quickly gave us our pillow when we stirred, we would roll over and go back to sleep. But if it wasn’t replaced then we’d be tossing and turning and really mad. But what if we never went sleep with it in the first place? We’d quickly adapt and soon falling asleep and staying asleep without a pillow would feel normal to us.

So the first thing to do is eliminate the bed time props. For a lot of babies this is a bottle, whether it be held by a parent or placed in bed, an infant gets used to the drowsy comfortable feeling of a full tummy and links this to sleep. To start disassociating feeding with sleeping make sure you don’t give her anything to eat after her bath. Besides you’ll be brushing her teeth and she doesn’t need to have food or milk in her mouth. Then read her a book and put her in her crib while she’s still drowsy but not asleep.

Your night time routine should look like this:

• Dinner
• Playtime (Light playtime – No roughhousing. You don’t want to amp her up!)
• Snack or Bottle
• Bath
• Brush teeth
• Book and Cuddle time
• Bed… night- night lights out!

When she can fall asleep, by herself, in under 5 minutes then you know she has developed the ability to fall sleep on her own. After this occurs, you can let her put herself back to sleep for the rest of the night. Don’t worry about letting her wake up her twin. He’ll get used to it and soon they both will be sleeping through the night. You’d be surprised how quickly kids adapt.

That’s it. There’s nothing special or fancy to it! In reality there is no “best” way to get your child to sleep, there are just different ways. You need to decide what is best for you. Remember it’s a parenting style, not a moral decision. You’ll always find people that agree with your method and others who won’t. All of my children needed help “learning” to sleep through the night. I know it can be anything but easy, so tomorrow I’ll give you tips on how to make it work for you!

Sheila Cason, MD

Geckos Galore!

The island is alive. There are critters galore and so far the kids’ favorite is the little cute gecko. Before moving to Guam, we had never seen any geckos except in the clever Geico commercials. You have to admit of all the reptiles they are small and utterly charming with their large eyes and little bitty feet.

Geckos are the only lizards that have a voice. Some species of geckos make a squeaking or clicking noise that sounds like "gecko," hence their name. Most geckos are nocturnal which explains why for a while there we always saw a little one nightly. Just around bedtime we’d have our gecko “sighting”. We’d be reading books and settling down when all of a sudden someone would cry out, “Gecko!” and you’d hear squeals and the sound of everyone’s feet, including the baby’s, pattering across the floor to say hello!

I have to admit I find the geckos charming as well. They are innocent, harmless to humans and eat mostly insects. What more could you ask for in house guest critter? They are welcome anytime!

Sheila Cason, MD

The Best Laid Plans

Last evening was a bit of a disaster. What started out to be a pretty good evening, complete with striking sunset and good food, quickly decompensated into every parent’s worst nightmare: your child is throwing a tantrum and there’s nothing you can do about it.

It all started when I saw my baby happily munching on a cookie. Not knowing if it had nuts and was therefore “safe” to eat, I broke off a piece and put it in my mouth. He lost it! He started screaming and crying throwing himself backwards on the ground. I started reasoning with him but quickly switched to ignoring him when I saw it was too late. He was so angry and beyond reasoning, that I would have to ride out the storm until it passed. I had no problem with this. After all this was my third child and I was getting used to this behavior. I knew it would be over soon. I went on with my business which included picking up a friend’s infant and cuddling him. My poor baby couldn’t handle it. He started screaming even louder, tears and mucous ran down his red face. When the screaming gave way to vomiting, I caved and went to hold him.

Just as I thought all was calming down the other two started to bicker. I went over to sort it out and soon the mama of all dramas quickly erupted from my three year old. I still don’t quite know what it was all about. It beat out all other tantrums hands down. She started ear piercing wailing and running in circles around the picnic area.

Can you believe it? Two of my three kids had the largest tantrums of their lives and it was on the same night. I think all the parents at the party could relate but the childless couples were viewing it all with a mixture of awe and pity. We did what any reasonable parent would do. We scooped up the kids, made our apologies, and got out of there as fast as we could. Sometimes it’s just the best you can do.

Sheila Cason, MD

Friday Traditions

I recently ran across this great article by Rondi Hillstrom Davis and Janell Sewall Oakes. It encourages us to gather with our friends. I find the more informal it is the better. Tonight we’ll be gathering on the beach to grill tuna and have our own Friday night tradition. The kids and adults alike will get a chance to laugh and play after a week of work and productivity. I’m looking forward to it. I’ll take pictures to share!

Easy Autumn Entertaining; A Casual Dinner with Friends

Gathering friends together around the dinner table becomes a Friday night tradition. As I greeted my friends, each bearing a gift from their own kitchens, I was reminded of the signs of fall.

The signs of fall are unmistakable in my part of the country. Golden aspens shimmer in the crisp breeze and crimson leaves float through the air. Weekend visitors flock to apple orchards, pumpkin patches, and intricate corn mazes that farmers have carved into their fields. Canned food drives and Coats for Kids programs are in full swing. The comforting aromas of warm soup and a crackling fire fill our homes. Just as the animals prepare for colder weather, there is something almost instinctual about our desire to make the most of the last days of temperate weather, stock up on autumn’s colorful offerings, count our blessings, and nurture, not just those we love, but the community as a whole.

Now that we’ve comfortably settled into our school routines, gathering friends together around the dinner table becomes a Friday night tradition. With my friends, this started in late September, when Susan casually mentioned that she’d made a big pot of chili (too much for just her family) and it would save her freezer space if we would bring the kids over and help them finish it. Within hours, there were six adults sharing stories around the kitchen island and nine children planning a circus in the playroom. The next week, Lee called to say he’d just brought home a new fire pit for the backyard and had soup on the stove. Once again, the week’s tensions fell away as we gathered around the campfire, laughing and roasting s’mores.

When our turn came, I knew better than to plan a large meal. No matter how many assurances of, “Don’t bring anything, I have it all under control,” I knew no one would come empty handed. Nancy’s always sure to bring an appetizer or dessert, along with an excuse for going all out. Sometimes it’s a simple collection of cheeses, pears, and spiced walnuts (because, “I bought them at the Farmer’s Market last week and I have way too much.”). To our gathering, she brought her famous lemon bars (because, “The girls really wanted to make them.”). After Susan arrived with a spread made from cannelini beans, sage, garlic, and olive oil, a loaf of good, crusty bread, and an armload of games for the kids, I knew we were in for another memorable evening.

As I greeted my friends, each bearing a gift from their own kitchens, I was reminded of the Children’s folktale, Stone Soup. It’s a story about a group of individuals who don’t have enough to eat but, when they come together as a community, bring all they have to the table to create a sumptuous stew. Our friends are like that. Each of us, with our own personalities and experiences, bring joy and support to one another.

I gazed around that night, feeling lucky to have found such a warm group of friends, and remembered the gratitude wreath my family creates each year for Thanksgiving. We build a wreath of autumn leaves, each displaying a written message about what we are thankful for. Lacking a pile of leaves, I asked my guests to grab a gourd from the centerpiece, gave them each a permanent marker, and told them to write anything that came to mind. When we were through, we filled a glass vase with the gourds and placed it between us on the table. The small pumpkin on top simply said, “Good Friends.”

About the Authors: Rondi Hillstrom Davis and Janell Sewall Oakes are the co-authors of the award-winning book Together: Creating Family Traditions. To check out their website that's jam packed with family ideas, visit http://www.togetherparenting.com

Article re-published with permission from: http://www.togetherparenting.com/archives/articles_goodfriends.html

Have a good weekend and go play with your friends!

Sheila Cason, MD

The Best Chocolate Chip Cookie Recipe…Ever!

Hands down this is the best chocolate chip cookie recipe I’ve ever made. I have no problems with passing it on to you because it was a generous soul who passed it to me. I use the butter flavored sticks of Crisco - yes, I know! Just eat the cookies in moderation. My kids adore them!

Ingredients:

• 1 cup of shortening
• 1 cup of white sugar
• ½ cup brown sugar
• 2 tsp vanilla
• 2 eggs
• 2 tsp baking soda
• 1 tsp salt
• 2 cups all purpose flour
• 12 oz bag of semi-sweet chocolate chips

Mix the first 5 ingredients together until smooth. Combine the dry ingredients together in a separate bowl and then add to the sugar mixture. Add the chocolate chips in last.

Bake in a 375 degree oven for 8-10 minutes.

Sheila Cason, MD

How Much Sleep Does Your Child Need?

Uh… I’m still sick and feeling under the weather. During the day everything seems to go okay but then night time hits and I’m exhausted. Even the early AM time to myself is slept away as I try to get over this illness. Now that my kids are all busy either in daycare, preschool or kindergarten they have also been needing more sleep at night.

Everyone seems to have their own magic number when it comes to how much they sleep need but there are general guidelines. According to The National Sleep Foundation, experts “estimate that preschoolers (3 to 5 years-old) need 11-13 hours of sleep, while school-aged children up to age 12 need approximately 10-11 hours of sleep.” [See table]

How much sleep a person needs will depend on “a person’s basal sleep need – the amount of sleep our bodies need on a regular basis for optimal performance – and sleep debt, the accumulated sleep that is lost to poor sleep habits, sickness, awakenings due to environmental factors or other causes.” If you watch your children closely and see how they perform on a certain amount of sleep you can get a good idea of what their basal sleep need is.

Make sleep a priority. It’ll make a big difference in how you and your child functions!

Sheila Cason, MD

Using Your Nice Voice: How Not to Yell at Your Kids

It’s a struggle not to yell sometimes. Here are some tips I try to use. I didn’t include counting to ten because I never remember to count in the heat of the moment!

1. Eat, sleep and exercise. This is first and foremost one of the most important tips for not yelling. If my needs are being met then I have infinitely more patience for my kids. Make sure that you’ve eaten and slept and exercised a little each day. Yelling offers a physical release for some people. Go for a run instead.

2. Don’t sweat the small stuff. Take a good look at what is important and what isn’t. Learn to ignore the little stuff such as bickering between siblings, nagging and silly questions. Kids are kids and by definition they are noisy and impulsive. Just realizing this can help you be more understanding.

3. Lower your expectations. Read up on what is developmentally appropriate. Remember that even though a two year old understands what you mean when you say no, they have no impulse control. Don’t expect that they won’t touch Aunt Edna’s precious vase – just move it.

4. Model good behavior. Sometimes I yell because the kids are yelling at me. You have to remember who the grownup is. You need to set the example of being in control. This is particularly helpful as the kids get older and are coming to terms with their own anger.

5. Be proactive. Plan for the little things, such as having a snack ready when your toddler all of a sudden gets hungry in the middle of grocery shopping. Keep extra clothes in the car if you know you may need them. It’s easier to go with the flow when you have a plan for life’s little emergencies.

6. Whisper. I like this one a lot because it keeps my blood pressure low. When my kids crinkle their faces and bend close, I can tell them what I want now that I have their attention.

7. Stop the perfection. Remember that “perfect is the enemy of good”. Life is to be enjoyed in all its wonder. When we get strive to be perfect we overshoot good and go straight to terrible. It’s okay to eat pasta two nights in a row. Do you really think your kids care? Skip the baths once in a while if it’s too late and just read books instead. It doesn’t all have to be by the book.

8. Learn to forgive. This means forgive yourself and your kids. There will be times when you just have had it and you yell. Take a step back and tell your child that you’re sorry. This doesn’t show that you’re weak just that you’re human. Chances are your child will appreciate it and it may help your relationship more than if you’d never yelled in the first place.


9. Become happy. Ever notice how happy people just exude happiness? Commit yourself to finding what fills you up! Outside of food, sleep and shelter we all need something that brings us joy. Is your love reading books or photography or playing with the kids? Make sure you do more of those things that bring pure joy.

10. Pretend that they’re not your kids. If you’re still yelling despite all the other techniques then just pretend they’re not yours. I’m serious about this one! I never yell at my patients because no parent would tolerate it and it’s not appropriate. So I just take a deep breath and repeat for the umpteenth, “Please go put your pajamas on.”

I would live to hear what works for you!

Sheila Cason, MD

Yelling: My New Norm?

This weekend my heart broke a little. We had just gotten back from swimming at the slide pool and the kids and I were all enjoying a little lunch. We were happy and tired from swimming. Everyone was quietly munching along, including me, when my oldest innocently between mouthfuls said:

“You yell a lot.”

“I yell a lot?”, I asked her, my eyes widening.

“Yes. You yell a lot on Guam.” And she returned to her meal.

Gulp…I swallowed hard and tears stung my eyes. I have to say this doesn’t come as a complete surprise to me. I am well aware that I yell…sometimes. With three kids I have to raise my voice just so that I can be heard above the noise. I didn’t enter into a discourse about why Mommy seems to be yelling more these days, but some retorts came immediately to mind.

1. I’m not yelling, I’m just talking very loud.

I called my own bluff on this. No one has ever told me I was overpowering them just by my voice alone. It was unlikely that my 4 year old was going to be the first.

3. I yell only because I’m protecting you and I have to get your attention.

Yes it’s true sometimes I yell when there is eminent danger and I have to get her attention fast. This happened numerous times when she was at the pool that day, but in all honesty this cannot be true most of the time.

2. You only think I yell more in Guam because I’m around you more.

This probably comes closest to the truth. Let’s say I yell 5% of the time. If I’m around them for only 2 hours a day then 5% is 6 minutes of yelling. Not too bad. I could do that just trying to get them out of the door in the morning. But if I’m around them for 14 hours then 5 % is 42 minutes. Hmmm…that’s 3 minutes every hour. That’s kind of a lot. I can see what she’s talking about.

It really bothers me that she thinks that I yell a lot. I can justify how it’s really not that much. But this is her perception. “Mommy yells a lot.” I’m not unrealistic. I know that it’s normal for parents to get frustrated and raise their voices but the truth is that it affects my children. So I looked at her and said, “I’m sorry for yelling at you. I’m going to try to use my nice voice.”

Stay tuned for tomorrow’s column. We'll talk about tips you can use to help you keep your cool.

Sheila Cason, MD

Family Outings

We spent this weekend immersed in a little bit of island culture. It was the annual Micronesian Island Fair at Ypao Beach Park, and it highlighted 10 island groups of Micronesia including Guam. My girls were particularly fascinated by the dancers. The music was hypnotic, and they couldn’t help but move with the groove. They kept running in and out of the crowds trying to get closer to the stage. I had to keep running after them. It was exhausting at times trying to balance keeping them safe and close to me and yet letting them explore.

When you have young kids it’s tempting to stay home a lot. After a week of work and school, it’s nice to stay in and have no agenda. I mean, lets face it, sometimes the thought of bringing changes of clothes, diapers, strollers, snacks, drinks, blankies and all the other paraphernalia is too much! I just want to order pizza and open a bottle of wine. I have to fight the urge to do this all of the time though. Kids learn how to behave in restaurants and public places by actually going there, getting it all wrong and being corrected. When we first moved here, my kids went crazy in restaurants. No kidding, I would spend all my time pulling kids out from under the table and explaining why screaming songs from The Little Mermaid was inappropriate!

The more we venture out for little outings, the better we get at it. First and foremost, we’ve lower our expectations. Just getting out of the house for a change of pace is usually our goal. We usually go for outings in the morning before naps or in the afternoon after they wake up from naps. Whatever we do, we only plan to be gone for a couple of hours at a time. And when the crying becomes overwhelmingly consistent, regardless of what we are doing, we start our trek home. All in all it’s getting better, and we’re still having fun!

Sheila Cason, MD

Another Year Another Football Season

For a while now the weekends have been filled with football. Everywhere I turn, loud raucous noise emanates from the TV. My husband talks to me animatedly about all the different teams and their players. I politely listen but I really haven’t a clue. I rarely watch it. I can read a book for hours but trying to sit in front of a football game gets me all jumpy. But even though I don’t watch it I am a football fan. There’s something about having it on and a constant presence throughout the holidays that feels right to me.

Ever since the kids were babies they’ve climbed up and joined their daddy on the couch.
So last weekend when they grabbed their jerseys and snuggled up to him, I grabbed the camera. I knew somewhere on the computer sat last years picture and I couldn’t wait to compare the two.

I was amazed. They look so different and yet along the way the change seemed to happen so subtly. We move a lot so there is no one door with their heights measured and etched in the wood. What we do have is lots of pictures and good memories. I can tell that these football jersey pics will be some of my favorites. They’re so sweet, giggling on the couch and playing each other. I can’t wait to see what next year looks like.

Sheila Cason, MD

Infant Cold Medications

The cold season has hit my pediatric office and our house as well! I’ve been fighting a virus for the last couple of days and now it looks like my 17 month old has it too. This morning, he’s been wandering around with his little pjs on and dragging his blankie. I would normally give him something for the cold but things have changed a little since he was born.

Last year when I wrote about infants and colds I recommended infant drops to help with the stuffiness. Well, I take that back! Yesterday The New York Times reported that infant cold medications have been pulled from the market. The Consumer Healthcare Products Association issued a press release yesterday 10/11/07 listing the infant medications that have been voluntarily removed by their manufacturers. They are as follows:

Manufactured by the McNeil Consumer Healthcare unit of Johnson & Johnson:

Concentrated Infants’ Tylenol Drops Plus Cold
Concentrated Infants’ Tylenol Drops Plus Cold & Cough
Pediacare Infant Drops Decongestant (PSE)
Pediacare Infant Drops Decongestant & Cough (PSE)
Pediacare Infant Dropper Decongestant (PE)
Pediacare Infant Dropper Long-Acting Cough
Pediacare Infant Dropper Decongestant & Cough (PE)

Manufactured by Novartis:

Triaminic Infant & Toddler Thin Strips Decongestant
Triaminic Infant & Toddler Thin Strips Decongestant Plus Cough
Manufactured by the Medtech Products unit of Prestige Brands Holdings:
Little Colds Decongestant Plus Cough
Little Colds Multi-Symptom Cold Formula

Manufactured by Wyeth:

Dimetapp Decongestant Infant Drops
Dimetapp Decongestant Plus Cough Infant Drops
Robitussin Infant Cough DM Drops

The Consumer Healthcare Products Association states: “Potential misuse of these infant medicines, not product safety, is driving the voluntary withdrawal. This withdrawal does not affect cough and cold medicines for children age 2 and older”.

This isn’t too surprising. In January 2007 the Centers for Disease Control and Prevention released their Morbidity and Mortality Weekly Report. In it they “identified three cases of infant deaths in two states during 2005 that were determined by a medical examiner or coroner to have been caused by cough and cold medications” Since this time there has been increasing concern over the safety of over the counter cold medications for infants. It’s not unusual for parents to inadvertently overdose their infant by giving them multiple preparations all containing the same medication.

This move by the manufacturers is a good one for now. Until we know more about the safety of over the counter cold medication in infants, then we should opt for more benign treatments such as a warm bath, nasal saline, a humidifier, and tender TLC.

Sheila Cason, MD

A Baby’s Love

Every afternoon we go down to meet my kindergartner, and I get to watch the excitement of my baby. He is the embodiment of innocence. He stands at the corner and waves to all that passes by. He doesn’t discriminate. It could be a casual jogger or a passenger car. Everyone is his friend and he sends out a cheerful hello. If no wave is returned he just keeps on waving. His feelings aren’t hurt he just figures you didn’t see him.

He’ll stand at the bus stop and patiently wait for her big yellow bus. He usually takes this time to discover everything in the immediate vicinity, but as he hears the bus round the corner his findings are forgotten. He starts to clap and jump up and down. Pointing at the bus he yells, “Buu..! Buu…!” He begins to wildly wave at the school bus, its driver, everyone getting off the bus and even those that are still on it. By the time his sister approaches he breaks free of my restraint and tackles her. He wraps his little arms around her waist and welcomes her home. It’s as if they have been apart for years.

I marvel at the pure uncensored love that radiates from my baby. You can’t help but smile when around him. He teaches us what all children teach us: to be good and kind and to welcome the world with open arms.

Sheila Cason, MD

Redirection

Since I started work last week it’s harder to get out of the door in the morning! Seriously I get up an hour early and somehow I’m running around at the last minute trying to get three kids out of the door. I definitely think it’s harder now than when the kids were babies. At least then you could strap them safely in their car seats and go. When they get older they have their own agenda!

With only a few minutes to spare in the morning I usually ask my oldest to go brush her teeth. I ‘m amazed when I pause to watch her and see the manner in which she gets distracted on the way to the bathroom. I can almost hear her thoughts, “oops, I dropped my sock…oh what’s that on the floor… oh it’s my dolly, well she needs to go for a nap before I go... hmmm… I wonder where her clothes are?” And on and on it goes until I find her rummaging in the closet for her dolly’s clothes.

The funny thing is even if I’m standing next to her while she’s brushing her teeth she gets distracted. By the nature of their young age, kids will need to be redirected. I try to remember that kids can’t be nagged to death. They hear several hundreds requests per day. By the end of the day - or in my case by the beginning of the day – kids can tune out a parent’s voice. Sometimes talking isn’t the best answer. Often using gentle friendly reminders help; put the toothpaste on the toothbrush and hand it to her.

Between gentle reminders and streamlining the process, I know it’ll get better. One mom I know used to have her kids go to sleep with their school clothes on. Some might think that’s overkill or at the very least ridiculous. Me? I think it’s positively brilliant!

Sheila Cason, MD

Parenthood: An Awesome Responsibility

“Mommy!! If you don’t give me something to eat… then I’m not eating!”, my daughter said it forcefully, with a little pout and anger in her voice. It seems I had become distracted and she’d been waiting for breakfast a little too long. Guilt washed over me and I rushed into my kitchen to put some food in her tummy.

Our child’s complete and utterly dependence on us is shocking at times. They depend on us for everything. If I don’t feed them they don’t eat. If I don’t bathe them they don’t get clean and if I don’t watch them they don’t stay safe. Besides basic survival skills they also need us to help them negotiate the confusing nature of life. The other day I had to try to explain a spirit to my child. That was a challenge. What we teach them is critical in helping them grow into responsible good human beings. If you’re anything like me you sort of knew what you were getting into but when it came down to it you really had no clue.

To parent effectively we have to be a relatively stable healthy individual. No matter how sorry you feel for yourself at 2:00 am you have to just get up and do what needs to be done. You can’t be whiny and throw a pity party every time they impinge on your schedule. You’re allowed to get cranky, even go a little crazy but you gotta hang on. There are times when I feel overwhelmed and not up to par. I’m not saying all this is easy. Lord knows that I’ve been really angry, unreasonably so at times. During the heat of the moment rational thought isn’t always accessible. For this reason self forgiveness is something you should get comfortable with.

I’ve learned through the rigors of medical school and residency not think too hard about the really tough times but to just schedule little breaks and keep putting one foot in front of the other. I think the same thing goes for parenting. When it’s a long sleepless night, I just tell myself that it’s all right. I hold an image of a hot steamy mug of coffee in my mind and know that the desperate feeling will pass. It always does. It also helps to find other couples with kids. These people will be your lifeline. They will offer you support, humor, perspective and make this crazy beautiful world of parenting a little easier. Would I do it again? A thousand times over. Wouldn’t you?

Sheila Cason, MD

Manila Bananas

Living in the tropics you get used to seeing banana trees around. We have one such tree in our back yard right next to the window, and the kids have spent months watching its fruit ripen. “Oooohhh…bananas!” they would point out nearly every day. They took a while to grow and the wait seemed long but finally they were ready.

The most unique aspect of this banana is how it looks. They’re fat and yellow with little brown scattered freckles. They plump up and ripen so much so that their skin splits down one side and begs to be eaten. I almost cut them up but eating it pure and unchanged from the way nature made them seemed preferable. Cutting it up would change the texture and therefore the experience.

Remember the episode on M*A*S*H when Hawkeye had corn on the cob sent in from the states. He talked about it so much that he had the camp all worked up. By the time it arrived they were reminiscing about lazy summer days and you could almost taste the sweet corn. You could hear its crunch when you bit into it and taste the butter as it dripped off your fingers and you pulled little corn kernels from your teeth. So when Private Igor Straminsky, the mess tent assistant, turned that beautiful corn on the cob into creamed corn, you groaned along with everyone else in disappointment. They just couldn’t leave well enough alone!

Taking food and twisting it into a completely other dish is delightful sometimes and at other times it’s downright criminal. For now I’ll leave the little cute sweet bananas alone and eat it in its natural state. The kids like it better this way too. It’s nature’s healthy snack. They taste sweet but with a little tang, lemony almost. I’ll eat them like this for a while because I’m still new to the Island and filled with banana wonder.

Sheila Cason, MD

Daddy’s Kids

Last weekend Daddy and his little girl put her bike together. Poor thing she’d been waiting since we moved here and other things always seemed to take precedence. One day she just piped up… right in the middle of the football game. He couldn’t resist. Soon all the tools and her bike were strewn about and all three kids jumped at the chance of a project with Daddy. I thought the kids would scream and fuss and fight but they managed beautifully… without me.

I’m always amazed at the differences in parenting and I get myself in trouble when I think it has to be done my way to be correct. The secret to a couple successfully parenting together is respecting your differences and going with the flow. It’s reasonable to expect that if it isn’t done by you it will be different. But it isn’t necessarily wrong. A great article in Psychology Today talks about the father’s role in parenting their children.

Here are some of the highlights:

“[A fathers’] …more playful, jocular approach carries major consequences for
developing children. Where the "average" mother cushions her baby against
irritating stimulation, the "average" father heaps it on, consistently producing
a broader range of arousal. The resulting ups and downs force children to
"stretch," emotionally and physically.”

“This emotion-stretching dynamic becomes more pronounced as father-child relationships enter into their second and third years. When playing, fathers tend to be more physical with their toddlers--wrestling, playing tag, and so on--while mothers emphasize verbal exchanges and interacting with objects, like toys. In nearly all instances. fathers are much more likely "to get children worked up, negatively or positively, with fear as well as delight, forcing them to learn to regulate their feelings." In a sense, then, fathers push children to cope with the world outside the mother-child bond. Fathering behavior also seems to make children develop emotional communication skills.” They do this in three steps.

“First, children learn how to "read" their father's emotions via his facial
expressions, tone of voice, and other nonverbal cues, and respond accordingly.
Is Daddy really going to chase me down and gobble me up, or is he joking? Did I
really hurt Daddy by poking him in the eye? Is Daddy in the mood to play, or is
he tired?”

“Second, children learn how to clearly communicate their own emotions to others. One common example is the child who by crying lets her daddy know that he's laying too roughly or is scaring her. Kids also learn to indicate when interactions aren't stimulating enough; they'll show they've lost interest by not responding or wandering off.”

“Finally, children learn how to "listen" to their own emotional state. For instance, a child soon learns that if he becomes too "worked up" and begins to cry, he may in effect drive his play partner away.”

“The consequences of such emotional mastery are far-reaching. By successfully coping with stimulating, emotionally stretching interactions, children learn that they can indeed effect change both on internal matters (their feelings) and in the outside world (their father's actions). In that regard, links have been found between the quality of father-child interactions and a child's later development of certain life skills, including an ability to manage frustration, a willingness to explore new things and activities, and persistence in problem solving. As important as learning to regulate the emotional intensity of their interactions is children's ability to master the larger interactive process, the give and take that makes up social communication. Kids who learn how to decode and encode emotions early on will be better off later when it comes to any social encounter.”

Wow all that huh? Who knew? Daddy’s projects with the kids almost always go smoother than I thought it would. There’s something about watching your husband with your kids that makes you appreciate a different method of parenting. But if you micro manage the way he interacts with them you’ll find this discourages his involvement. If you can welcome your differences your family will flourish. The article reminds us of this when they later say that families “…should take advantage of the difference[s] between men's and women's parenting approaches. Since fathers' boisterous antics seem to help prepare children for life outside the family, mothers shouldn't cancel this out by intervening or being overly protective.”

I didn’t intervene… this time… and the bike got put together. And she loved it. She hopped right on and proudly puttered around the patio.

Sheila Cason, MD

Naptime

Nothing makes me madder than having just gotten all three kids to nap and aghhh... some inescapable noise threatens to wake my children. It’s naptime at the Cason’s and not a sound is peeping. Nothing, nada, zip. Except for an alarm that is currently going off in our quiet, secured, no alarm necessary neighborhood.

I’m protective of my kid’s naptime. It’s a well needed rest for all of us. When I was childless- a lifetime ago- I thought people were a little too strict with naps. I used to wonder about the moms who’d tape a stern note to the door –

“Attention do not ring door bell… Children napping!”

What it really meant was:

“Warning! Children inside napping and mom going to lose it if you up wake her child."

Of course now I get it. I mean what mom wouldn’t understand?

Once I had kids my perspective shifted. Now when the phone rings at an ungodly hour – 2:00 pm - I lunge toward it.

“Hello”, I whisper a little too crankily.

“Oh I’m sorry were you sleeping?”, they usually reply.

“No.”

Most times I add “I’m about to take a shower.”

Sometimes I add “I’m about to clean the bathroom.”

And occasionally I add “I’m about to do some sit ups.”

But it’s not unusual for me to skip the shower, the bathroom and the sit ups altogether and go straight for the most procrastinated task. Seriously now, I have to go. The kids are sleeping, and there’s laundry to be folded.

Sheila Cason, MD

Child-Pet Relationships

As you may remember we have two dogs, Abbot and Cameo. They are two bouncy, boisterous, sweet Labrador Retrievers that will love you till the cows come home. They’re in Kentucky with relatives while we’re here in Guam, and things just aren’t the same. When the doorbell rings I brace myself for the barking, and I’m startled to find things eerily quiet. When the baby drops food to the floor I look for our canine vacuum cleaners- they’re nowhere to be found.

Of the three kids, my middle girl seems the most shaken by their absence. You wouldn’t notice it all the time. But she wants to pet every dog we come in contact with and when yesterday we got a big black stuffed lab she called him Abbot and wouldn’t leave him all night. At random times in the middle of a crying meltdown she wails, “I miss my puppies!”

It shouldn’t surprise me. In 2000 Dr. June McNicholas and Dr. Glyn Collis published their paper in the journal Child Care Health and Development titled "Children's Representations of Pets in their Social Networks” They interviewed 338 children between the ages of 7 and 8 years of age. They found that child-pet relationships were characterized by affection, trust and an absence of conflict. They also found:

• 90% of children list their pets in their top 10 special relationships.
• 40% sought out their pet if they were upset
• 40% looked for their pet if they were bored
• 85% regard their pets as a playmate
• 53% watched TV or videos with their pet
• In some cases pets are first above all human relationships – e.g., confiding secrets, comfort when ill.
• Though pets were not as important a relationship for children as parents, they were a valuable source of support, especially for comfort, self-esteem and sharing.

A publication called Children and Pets: A guide for parents, teachers and therapists' is available at the Society for Companion Animal Studies. The guide discusses the influence of pets on children's development and health. It also talks about how to be a responsible pet owner and selecting the right pet.

Until we can have our dogs back we’ll have to settle for the stuffed animals! Currently the dog is asleep under blankets in my kids’ room. I know how they feel. I miss my puppies too.

Sheila Cason, MD

Making Friends

This is my conversation with my kindergartner a couple of nights ago.

“I saw Timmy today.”, she whispered

“Oh… where?”, I replied

“In the cafeteria.”

“Is he in your class?”

“No… he’s older. Not little like me. He’s in 3rd grade.”, she said.

“Oh?”

“He sat next to me in the bus.”

“When? Today?”

“I don’t know” …pause… “He makes me laugh”, and she erupted into giggles.

“I saw him in the cafeteria today. He did this…” – she smiled the tiniest of smiles. I almost missed it. “And I did this…”- she again smiled the tiniest of smiles.

Throughout her conversation I was trying to follow what happened and then slowly it started to make sense. Near as I can figure, she met a boy on the bus and then recognized him in the cafeteria amongst all the other kids. He recognized her too. He smiled in acknowledgement, and she smiled in acknowledgement back.

Isn’t that amazing? She’s making friends all on her own. I don’t know about you but it’s hard for me to watch my kids make friends. I have to fight the urge to “manage” her relationships at such a young age. Say hello. Be polite. Don’t be rude. Every time I even begin to worry or start to say something, I am reminded that she’s okay and somehow it all worked out.

Sheila Cason, MD

Paper Helicopters

I admit it. My children have an excess of toys. When all of our stuff was moved out of our house in San Diego, I had a chance to see their imagination at work. With a paucity of toys they started to create their own playthings. No kidding, my hair clips became alligators and shoestrings were snakes as they ran around the house trying to scare each other. When they tired of that, they actually started playing with air. They would cradle imaginary little baby dolls in their arms as they sang and danced with them. I was fascinated.

It was no wonder that when we actually moved in I was embarrassed by the surplus of toys. I took advantage of the smaller house and donated a lot of them. They didn’t even notice. Like most kids they like the novelty of new toys but are soon playing with the boxes they came in. This flighty fascination is why making your own toys is so enjoyable and affordable. After experimenting with the origami last week, I was inspired to make a paper helicopter. After an easy download from paperairplanes.co.uk we were soon spinning little paper helicopters to our hearts delight.

Sheila Cason, MD

TV and Children Under the Age of Two: Part Two

As we saw in yesterday’s article there is evidence that allowing your baby to watch TV may hinder their language. Our cheapest babysitter may be our most expensive. It’s funny now that I’m researching TV and children, I certainly have been more aware of its use in my house. But what about the parents who don’t know? If you thought that TV was giving your kids a head start wouldn’t you want to know if research found it to be otherwise? Should Baby Einstein have a label on its videos warning parents that the American Academy of Pediatrics recommends no TV under the age of two? The Campaign for a Commercial-Free Childhood says yes.

The Campaign for a Commercial-Free Childhood (CCFC) made up of health professionals, educators, advocacy groups and concerned parents filed a complaint with the Federal Trade Commission in 2006 against Baby Einstein, Brainy Baby and BabyFirstTV. They state that these companies make false and deceptive claims that they cannot substantiate.

“They are likely to deceive a consumer acting reasonably under the circumstances.” “The number one reason parents allow babies to watch television and DVDs is the belief that the programming is educational and/or good for brain development.”

After the latest study regarding delayed language in children who watched TV for an hour was published in August 2007 the CCFC issued a press release reaffirming their stance. “This important study is the clearest indication yet of potential harm caused by the false and deceptive marketing of television programming and DVDs that target babies. Previous research suggests that television is not a good medium for teaching language to babies. Now we see that infants (ages 8-16 months) who watch baby videos have a slower rate of language acquisition than infants who do not. Not only is there no evidence that baby videos do any of the things the baby video industry claims they do, but these media may actually be undermining the development of the very skills they claim to foster.”

But maybe Baby Einstein, Brainy Baby and BabyFirstTV isn’t all to blame. I have a feeling that with or without a label on the video or websites, babies under two will still watch TV. The Kaiser Family Foundation in their 2005 study stated that “…it appears that the primary reason many parents choose to bring media into their children’s lives is not because of the educational benefits it offers kids, but because of the practical benefits it offers parents: uninterrupted times for chores, some peace and quiet, or even just an opportunity to watch their favorite shows.”

If it’s true that our primary reason to allow babies to watch TV is for our convenience, then maybe we need to develop some strategies for how we’re going to get that shower in or dinner cooked. But remember you don’t have to parent perfectly. Even if you tried you wouldn’t get it all right. But as long as you’re trying it won’t be all wrong either. I tell parents what the AAP recommendations are so they can make an “educated” decision. So now you know and the decision is yours. As for me? For now my older kids can watch some TV. But none for the baby. He has a whole lifetime to develop a taste for television.

Sheila Cason, MD

TV Under the Age of Two - Part I