Peds to Parents

by Steven D. Blatt, MD

“Steven, don’t talk with your mouth full of food.”

“Michael, take your elbows off the table.”

“Ed, finish eating your vegetables.”

Not great conversation.  When I was growing up, my brothers and I did hear those types of things at our dinner table.  We also talked about what we did during the day and our parents talked about what they did at work.  We talked about our friends, school, sports, politics,…stuff that was going on in our lives.  We did that every day of the week.  We always had dinner together.

In my house, we don’t have dinner together every day.  A lot of the time it’s my fault because I come home late from the hospital.  I’m fortunate my family is understanding about my time away from home to care for patients.   At other times, one or more of my kids would have a late practice, a game, a school project or something to get in the way of eating dinner together.  I’m glad my kids have things to do, but our schedules and activities make it hard to eat together.  My family is like a lot of other families, maybe like your family…it’s difficult to get everyone at the table for dinner time.

There are many reasons I wish we ate together more often.  First, there are the practical reasons.  If you eat with your kids, you can prepare and serve their food, and have more input into your children eating a healthy diet.  Once your kids leave your house for the day, they will be making the decision as to what they actually put in their mouths. When you are at the table with them, you have an opportunity to guide their choices and develop good nutritional habits.

Dinner time should be more than just food.  Dinner time should be fun.  Do you like your family?  I hope so.  Eating a meal with them is a great time to talk with your kids.  Any time with your kids is also a time to teach.  Study after study has shown the benefits of families eating together. Children from families that have meals together have less involvement with drugs and alcohol, better performance in school, and better nutritional habits.

Go to a nice restaurant during lunch and you’ll probably see some tables where there is a “business lunch” occurring.  Why conduct business over lunch?  People are more agreeable when they eat; it relaxes them.  They have to sit at the table, and in between bites of food, they can talk.  People aren’t going anywhere, so they are a captive audience.

Have a “business” meal with you kids.  Here are some suggestions for having a “business” meal with your kids.

• These family meals don’t happen by accident.  You need to plan.  Make meal time a habit.  You may not be able to eat together every night, but try to develop a routine so everyone expects to eat together.
• Serve healthy food.
• No electronic devices.  No texting. No phones…the phone won’t break if you don’t answer it.  No television.
• Talk about things that you care about and things your kids care about.  That might be school, work, sports, books, friends, family, the weather….You know what you care about; you don’t need me to tell you what’s important to you.
• Talk about things you REALLY care about.  You don’t want your kids to smoke cigarettes?  Use drugs?  Drink alcohol?  Tell them.  At dinner they are sitting at the same table with you.  I know it’s hard, but only when you start.  The more you talk, the easier it is to share this information.
• Talk about things that you REALLY, REALLY care about, but are difficult to talk about…SEX!  Every parent I have ever met has an opinion about “sex” and their children, yet many never talk about it on a regular basis.  Your children look to you for advice and guidance. Have discussions with them about important topics.
• Try to have discussions, not lectures.  Express your thoughts, but just as importantly, let your children express their opinions.  Everyone at the table should feel free to say what they think and ask questions about what you think.

Your kids shouldn’t talk with their mouth full of food, but more importantly they should talk with you at the dinner table.  Enjoy your meal!

by Steven D. Blatt, MD

I’m tired.  I stayed up too late last night reading.  Ok, I was reading while I was watching the football game.   Anyway, I went to bed too late and got up too early resulting in only 6 hours of sleep.   Ironically, my colleague at the Golisano Children’s Hospital, Dr. Zafer Soultan just spoke about sleep disorders in adolescents at Grand Rounds.  Dr. Soultan didn’t disappoint us; this was an excellent discussion on the importance of sleep, a topic that is often overlooked.

During his remarks, Dr. Soultan, an expert in pediatric pulmonary medicine and sleep disorders, noted, “The only thing that replaces sleep is sleep.”  I tried to replace sleep with a football game and a book, but there was no way to make up for my “lost sleep.”  What about our kids, how do they fare with lost sleep?

Data shows our kids don’t get enough sleep.  In my neighborhood, the high school bus comes at 6:50 am.  Although some kids will roll out of bed at 6:35 and make the bus, many more will be up before 6 am.  Too many won’t even get breakfast.  After school, there are so many activities; sports, jobs, and dinner that must be juggled.  Undoubtedly, these students will stay up late at night doing homework or some other activity.

Even if your adolescent makes it into their bedroom at a reasonable time, there are impediments to your child getting proper sleep.  The National Sleep Foundation (NSF) found in 2006 that the average sleep duration was 7.6 hours for 14 year olds, decreasing to 6.9 hours for 17 year olds.  That’s about 1.5 hours less per night than their parents had in the mid 1970’s.  97% of adolescents have at least one electronic device in their bedroom including 57% with a TV.  Today, many kids sleep with an iPad or smart phone in their bed, watching TV on the device, texting, accessing Facebook, and listening to music.  Up to the second news from their friends.  Light from the screens.  Music, beeps, vibrations (isn’t this what an alarm clock does?).  It’s no wonder they can’t fall asleep.

When I got to work after that night of watching football, the first thing I did was make a pot of coffee, which is a bad habit I learned as an overworked resident.  Drinking coffee does not replace sleep, but it may keep me up during the day.  Our kids have adopted the same habit.  In the NSF 2006 poll, 75% of adolescents reported drinking at least one caffeinated beverage and 31% had two or more.   Additionally, there are now non-caffeinated energy drinks to keep us up.   It may seem to help a little, but remember what Dr. Soultan said, “The only thing that replaces sleep is sleep.”

Ok, it’s clear that our kids don’t get enough sleep.  We also know that caffeine helps a little, but not a lot. Does it really matter?  The NSF 2006 survey found that 28% of students fell asleep in school at least each week. On top of that, 22% fell asleep doing their homework each week.  When they looked at the relationship between sleep and grades they found that those with more sleep had better grades.

While bad grades are one thing, risking a child’s life is another. In fact, 58% of High School seniors reported driving while drowsy 15% of each week.  That is pretty scary.  Just like using a cell phone while driving or driving while intoxicated, sleep deprived drivers are involved in an increasing number of motor vehicle accidents.

What should parents do?  Parent.  Parenting can be difficult, especially with teens, many of whom don’t want to be told when to go to sleep at night.  Your adolescent needs you and your skills.  Most teens will not pay attention to their sleep patterns, so you need to help them.  Discuss this topic with them during dinner.  I know, many families don’t eat dinner with their kids.  Everyone is too busy.  Parents should take the time to eat with their kids to allow conversations about important things, like sleep!

How does a parent tell their child to sleep more?  That’s a hard question and the answer will be different for every family.  It will take more than one short discussion.  It will be something to address over time.  Sleep is a habit and lack of sleep is a bad habit.  Bad habits are hard to break and you must work at it.

Remember, sleep is free, it’s organic and it has no side effects.  It can help your child get better grades in school and make him or her a safer driver.  Keeping our children safe and healthy… sounds good to me!

For more information, please talk to your pediatrician.  The website for the National Sleep Foundation is http://www.sleepfoundation.org/ .

by Steven D. Blatt, MD

“Dr. Oz Investigates: Arsenic in Apple Juice”

“Bachmann (Presidential Candidate Michele Bachmann) claims HPV vaccine might cause ‘mental retardation”

It seems that every day there is a new medical claim in the news. Dr. Mehmet Oz shared with his television audience his concerns about apple juice concentrate, 60% of which comes from China. Dr. Oz found that apple juice in this country contains higher levels of the poison arsenic than is considered safe. The US Food and Drug Administration called this claim “irresponsible”.

Congresswoman Bachmann claimed that HPV vaccine is dangerous and could lead to mental retardation. The American Academy of Pediatrics characterized these statements as false. For the record, I am a member of the AAP and completely agree with my pediatric colleagues. More than 35 million doses of HPV vaccine have been administered. There is no data that has ever suggested it causes developmental delays or mental retardation.

How does a parent or a patient determine who is correct? How do we figure out who to believe? Where should we get our medical information? Dr. Oz seems like a nice guy and a pretty smart doctor. In fact, I’ve occasionally seen a few minutes of his show and he seems like a smart doctor to me. His advice seems to help a lot of people. Shouldn’t I believe him?

I don’t know how TV personalities, even TV personalities who are doctors, decide how to interpret medical information. How about a Congresswoman or a Senator? They must have access to good medical information. Their medical information should be right also. Or should I believe my nurse and pharmacist and doctor? They’re medical people. They should have the best information, shouldn’t they?

People approach medical decision making differently. There are cultural influences, family traditions, economic considerations, and a set of beliefs that we all have about ourselves and the world we live in. Many of us look to others for information to help us make these decisions. How should we manage the information that we encounter from TV shows, the internet, our family and friends, our doctors….this website?

“Evidence Based Medicine” or “EBM” is the concept that we should base medical practice and medical decision making on the available medical evidence. Oftentimes, the evidence is incomplete or contradictory. All too often, the “evidence” seems to change. For example, 20 years ago, the evidence suggested that children with possible ear infections should be aggressively treated with antibiotics. Since then, we have learned that most ear infections resolve on their own and overuse of antibiotics leads to resistant germs, such as MRSA. Now the evidence suggests we use antibiotics only for those more severe ear infections. So, if the evidence is going to change or is incomplete, what should a parent or a patient do? Should one even bother reading about new medical information if there’s a good chance it will be incorrect or eventually turn out to be wrong?

After reading the literature, you, the patient or parent, either believes exercise is a healthy endeavor, or you don’t. After hearing someone speak on TV, you believe that lowering the bad cholesterol is good for your health or don’t. After gathering information, you believe you should get that vaccine or you should take that vitamin or supplement or this medicine will help you or this treatment is safe, or you don’t. In other words, you learn what you can and then you have to decide what to do with the information. One way or the other, we all have to make decisions.

Here are my recommendations for handling the medical information that is available to us:

• Recognize that there are a lot of decisions to be made; not making a decision on medical treatment is a decision.
• For many things in medicine, we never know the answer to “What is the best thing to do?” Recognize that even with incomplete information we may still have to make a decision.
• Read about medical topics from sources that are reliable. Reliable websites include:
  • Medical Organizations: American Academy of Pediatrics, American Academy Family Practitioners, American Medical Association, American Congress of Obstetricians and Gynecologists. These websites often end with “.org”
  • CDC, FDA, Department of Health. These websites often end with “.gov”
  • Medical schools such as Upstate Medical University. These websites often end with “.edu”
  • The Upstate Family Resource Center (FRC) at the Golisano Children’s Hospital is staffed by medical librarians who can assist you in your search of health information for children and adults. You can reach the FRC by phone 315.464.4410 or by email frc@upstate.edu. This service is free and confidential.
• Use your common sense and instinct. If something doesn’t seem right, keep looking for more information. Does it make sense to you that apple juice has arsenic or that a vaccine makes teenagers mentally retarded? If not, look for more information.
• Look for hidden agendas. Is something being said or written for shock value, to raise ratings, win a vote, or to push an agenda? If so, then there’s a good chance the information isn’t valid.
• Discuss your thoughts with people in your life who you trust and who have given you good advice in the past.
• Discuss what you read or what you hear with a trusted health care professional. Bring the article in question to your doctor and discuss it in detail.

The internet is a great source of information, but interpret it wisely.

by Howard L. Weinberger, MD & Steven D. Blatt, MD

From time to time we hear stories on the news about toys or cosmetics having lead paint in them. If you are old enough, you may remember that gasoline was once “leaded” but federal legislation led to its removal in the 1970’s. Many people know that paint in old houses contains lead. Since 1978, house paint has been lead free. It may seem we no longer have to worry about lead exposure. Why is it still important to prevent lead poisoning and how can you keep your child safe from lead poisoning?

Lead can harm the body in many ways. If there is a lot of lead in the body, it can cause developmental delay. That is, it prevents the brain from developing as it normally would. Fortunately, we can identify children who have been exposed to lead and prevent the lead levels from getting high enough to cause serious damage.

The only way to know if your child or an adult has been exposed to lead in the environment is by a test to measure the amount of lead in the blood. New York State requires physicians to test all children with a blood lead test at one and two years of age. In many pediatric offices, the doctor will order this test at the one and two year Well Child Visit. If your child is found to have an elevated blood lead level, don’t panic. For most children, no medical treatment is necessary. Whenever a child’s blood lead level is even mildly elevated, the source of the exposure needs to be identified and eliminated.

If your child does have lead in the body, where did it come from and what do we do about it? Even though house paint bought at the store no longer has lead in it, three out of every four houses in Central New York were built when paint did have lead it. That means if your house was built prior to 1978, it most likely has lead on its walls, both indoors and outside. When the paint chips get in the dirt on the outside of the house or in the dust inside of the house, lead may eventually find its way into the child’s mouth. Children often put their hands or toys covered with “leaded-dust” into their mouth or may actually eat paint chips. Chipped paint, especially on window frames and railings are common sources of lead.

Your local county Health Department can help you identify the sources of exposure in your house and make recommendations for making your home safe. They will help even if you are renting the home or apartment. The lead in house doesn’t have to be removed. It would be impossible to remove all the lead from all the houses in Upstate New York. The practical approach is to ensure that the lead in the house paint stays on the walls. If your house has chipping paint, it needs to be corrected safely.

Rarely, some children are found to have high blood lead levels. These children will be offered medical treatment to help the body excrete the lead quickly. This is called chelation. Most children will never need this treatment.

As an adult, you may be at risk for exposure to lead especially if you are a pregnant woman, if you participate in certain hobbies which use lead (fishing sinkers, lead solder, stained glass, and jewelry work), or if you work in certain industries.

In our pediatrics office, we follow New York State requirements and do a blood test for lead at one and two years of age. When you take your child for his or her checkup, your child’s doctor should do the same. If not, ask for a lead test. Tell the doctor you want to be sure your child does not have lead exposure and you can only be certain by doing a blood test.

by Steven D. Blatt, MD

“It’s only the flu.” 

“It’s no big deal.” 

“Everybody gets the flu.” 

“The flu shot will make me sick.” 

“I got it once.  Why do I need it again?” 

These are just a few of the responses that people say when offered a flu vaccine.  What are the facts and how does one decide if they should get the vaccine?

First, what is the “flu?”  Patients often use “flu” interchangeably with “viral infection.”  For example, someone will say, “I was home sick for three days with a stomach flu.” That is not the type of flu we are discussing.   Flu vaccine protects against Influenza.  There are many different varieties of Influenza and ways of categorizing them.  There are Influenza A and Influenza B.  Influenza A has different subtypes based on two proteins “H” and “N.”  For example, the strain that caused “swine flu” in 2009 was a strain of H1N1.

The flu vaccine comes in two forms, the “shot” and the nasal spray or “mist.”   The shot is an inactivated or killed vaccine.  During the manufacturing process, the virus is killed and purified.  It is impossible to get Influenza from the shot.  This formulation is approved for anyone older than 6 months of age.   The nasal spray vaccine is made from a live virus that is weakened.   This vaccine is only approved for healthy people, aged 2-49 who are not pregnant.  Individuals with respiratory illnesses, such as asthma, or who have diabetes should not receive this vaccine.  Since flu vaccine manufacturing process involves chicken eggs, those with a severe allergy to eggs should not be vaccinated.  If your child has an egg allergy, tell your doctor before receiving the vaccine.  Both vaccines are safe and both work well.  Surprisingly, the one without the needle, the nasal spray, works a little bit better.

Each year, scientists review surveillance data to predict which influenza strains are likely for the coming year.  This information is used to determine the components of that year’s flu vaccine.  For 2011-2012, the strains in the vaccines are an H1N1 virus that emerged in 2009, an H3N2 virus, and a B virus.  This year’s vaccine is made specifically for this flu season.  Manufacturers try to make just enough for the year.  Unused vaccine will be discarded at the end of the year.  Flu vaccines are available from your physician, flu clinics, and more recently, pharmacies.  They become available in September, but early on, the supply may be variable.  For those that delay, there is still value in getting the vaccine as long as flu is in the community.  There was still significant flu activity in New York State in April 2011.  Getting the flu vaccine in February still provided protection.

When you’re done reading this, please schedule your flu vaccine, for you and your children.  We don’t know when flu season will begin, so the earlier the better.  The more people in your family who are immunized, the less likely you can spread the flu to someone else.  Remember, the primary way to prevent the spread of any infection, including the flu, is with good hand washing, covering one’s mouth and nose when coughing and sneezing, and staying home from daycare, school or work for 24 hours after a fever is gone.  An excellent website to learn more about the flu is from the Centers for Disease Control and Prevention or CDC website at http://www.cdc.gov/flu/