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Ten tips for a hurricane day home with the kids

Posted by Dr. Claire McCarthy October 29, 2012 07:37 AM
Last night, my youngest (aged seven) really wanted us to turn off the television. He did not want to watch any more coverage of Hurricane Sandy. "This is scaring me!" he said.

"We're going to keep you safe," I told him. And although he wanted to believe us, I could see that it didn't entirely make him feel better.

I grew up on the north shore of Long Island (I'm kind of glad I'm not there now). We had lots of storms--and lost power all the time. It was years before I felt comfortable having an electric alarm clock; growing up, I always had a wind-up one. But for Liam, this concept of storms is new and scary. They've called off school, so for him, that's a sign that this is going to be Bad.

Here are some ideas for things you can do with your child today both to calm nerves and pass the time:

1. Get the flashlights ready together. There's nothing like a flashlight to make you feel better, I think. You know you are going to see. Since losing electricity is a big kid worry, put the batteries in together, test them, and put them in an easily accessible place. They are also really fun to play with, especially in tents made of sheets.
2. Plan out the day--and include activities that don't require electricity. A big blank day can be a bit worrisome all around (especially if you are like me and need to get some work done). Put the stuff that definitely requires electricity (like watching a movie or baking cookies) early in the day, before the wind is due to pick up. Check out the game closet, pick out some to play together.  and put them in a stack to be at the ready.
3. Think of games that don't involve any props at all--like Charades, or Guess What I'm Thinking. Kids really love these games. Actually, what they really love is playing with you. So do it.
4. Plan out the menu. Include some sweets or silly stuff, and have a plan for meals that don't require electricity (that was one of Liam's biggest worries, oddly enough). 
5. Stay in your jammies. How often do you get to do that? 
6. Check in for hurricane updates, but don't have the Weather Channel on nonstop. It will freak out your kids. And get in the way of Charades. They don't have much new to say usually anyway.
7. Get out sleeping bags and blankets. They go well with jammies, and are comforting.
8. Spend some time doing arts and crafts. Paint, draw, make collages out of pictures from catalogs and magazines. Most families don't do that kind of stuff hardly enough these days. 
9. Look at photo albums together. It's really fun to reminisce and tell family stories--and it's a great way to take your mind off of things.
10. Hug, and snuggle. We never, ever do that enough.  

Why I'm a Halloween Grinch

Posted by Dr. Claire McCarthy October 29, 2012 07:14 AM
Call me the Grinch, but I'm not all that sad that it's looking like Hurricane Sandy may put a damper on Halloween.

Part of the problem may be that I've just had too many Halloweens as a parent. This year will be my, um, twenty-second year of having trick-or-treating kids. It's just a lot of years of dealing with costumes, candy, trick-or-treating routes, curfews--and all those middle school kids who come to your door dressed in regular clothes expecting you to put candy in their pillowcases (which I usually end up doing, if only because I don't want to have any leftovers). Small annoyances get bigger over the years.

I think that my biggest annoyance is the excess. As with all things, we Americans can't seem to stop ourselves from supersizing anything, and Halloween is no exception.

Like the candy. Don't get me wrong, I like Halloween candy. Especially candy corn, peanut M and M's, and anything Reese's. But it's unclear to me why the goal of my children (and all their friends) is to get absolutely as much of it as possible. They are on a mission. Goodie bags must be adequately large. Routes are planned for maximum number of houses, being sure to include the houses that give the Best and Most Stuff. They don't want to stop and chat with the neighbors--that would slow them down in their quest for More.

Or the costumes. We have a toyroom full of old costumes and various other dress-up options--and I'm a reasonable seamstress. But what my kids and their friends want are new costumes from the store, the latest and coolest with the best accessories. There have been years when I've been able to get them to compromise, but there is always way more convincing involved than I like (Natasha was not happy when I said no to the $60 dress at iParty). The costume gets worn once or twice max, and mostly in the dark, often with a coat on. Why can't we be a bit more low-key about it?

Or the decorations. I love carved pumpkins with candles inside; my father used to get incredibly artful in his carvings, and my husband is of the same ilk. A few lights or decorations or a spooky noise is fine. But the hanging zombies, the yards covered in spiderweb, gravestones, fake blood and bones--excess when it comes to death and gore and scaring people doesn't feel like a great idea to me.

I know I sound downright curmudgeonly. Hey, I've already admitted to being a Halloween Grinch. But it just seems to me that the only age that gets it really right is preschool. They are happy with whatever costume you give them or make for them, and have fun showing it off to the neighbors. They are content with a short trick-or-treating walk and a small bag of candy (which they usually happy to share). They like homemade, not-so-scary decorations and love carving pumpkins. That works for me. That's fun. 

I guess that's it in a nutshell for me: Halloween doesn't feel fun. Excess has a way of ruining things.

But in the face of a hurricane, excess isn't possible. There's no school today, so we can do some more pumpkin-carving--and the candles inside will work whether or not we have power. We can build a fire in the fireplace and tell ghost stories; we can get sheets from the closet and pretend to be ghosts ourselves, or make cookies, or make decorations out of construction paper. We can get out photo albums and look at pictures of Halloweens past (Natasha loves the picture of her as a baby trying to get her Eeyore hat off). It's likely to still be raining on Wednesday--but maybe, if we do some at-home things before then, it won't be so bad to have a short trick-or-treating route--and stopping to visit with the neighbors will have real appeal, because it will get us out of the rain.

It might just be enough to make me less Grinchy.

Preventing cheerleader injuries

Posted by Dr. Claire McCarthy October 26, 2012 06:25 AM

Did you know that cheerleading accounts for two thirds of all catastrophic injuries in high school female athletes over the past 25 years?

From my personal experience, I believe it. I'll never forget being tossed in the air at Madison Square Garden as a college cheerleader (an embarrassing number of years ago). We'd practiced the stunt lots of times and I'd landed safely, but in the exuberance of the moment they threw me higher than usual and I lost my bearings, coming down really hard on my heels. Luckily the diagnosis in the Emergency Room that night was just "bone bruises" and nothing more serious, but I was on crutches for a bunch of winter break. 

Stunts like that one, as well as pyramids and other ways that people end up high in the air (often on top of other people) are the cause of half of the cheerleading injuries--and essentially all of the concussions. There have even been injuries that have caused paralysis, brain injury and death. And since cheerleading has become more competitive, daredevil stunts have become more common. Cheerleading isn't just jumping up and down with pom-poms on the sidelines of a game anymore. It's full of complicated athletic stunts now. While the overall rate of injury from cheerleading is low, the rate of bad injuries is high.

A big part of the problem? Cheerleading isn't considered a sport in all states. Which is silly, given the amount of hard work and athleticism it takes to do it consistently and well. But more importantly, being a sport means you're entitled to things like trained coaches (something our informal squad was remarkably lacking in), good practice facilities, access to certified athletic trainers, mandated sports physicals (so we doctors get to weigh in and warn), and a system of keeping track of injuries.

Here's what the AAP recommends to keep cheerleaders as safe as possible:
  • Cheerleading should be designated as a sport in all states, allowing for benefits such as qualified coaches, better access to medical care and injury surveillance.
  • All cheerleaders should have a pre-season physical, and access to qualified strength and conditioning coaches.
  • Cheerleaders should be trained in all spotting techniques and only attempt stunts after demonstrating appropriate skill progression.
  • Pyramid and partner stunts should be performed only on a spring/foam floor or grass/turf. Never perform stunts on hard, wet or uneven surfaces. Pyramids should not be more than two people high.
  • Coaches, parents and athletes should have access to a written emergency plan.
  • Any cheerleader suspected of having a head injury should be removed from practice or competition and not allowed to return until he or she has clearance from a health professional.

The latest on organic foods--five things parents need to know

Posted by Dr. Claire McCarthy October 23, 2012 10:58 AM

One of the questions I’m most commonly asked as a doctor, and one I ask myself often as a mom, is: should I buy organic foods?

It’s not an easy question to answer, because there is a lot we don’t know about the health benefits of organic foods—or the risks of conventional ones.  It would be an easier decision if organic foods weren’t more expensive—but they are, and for lots of families buying all organic just isn’t an option. This week, the American Academy of Pediatrics came out with a clinical report to help us figure out what to do as we stand in those grocery aisles.

Here’s what they said:

1.    It’s not clear that organic foods are more nutritious. They might be, but so far there isn’t the scientific evidence to prove it—in part because there are so many variables like humidity, soil quality or how the food is harvested that affect nutrition. If you are making your decision purely from a nutrition standpoint, organic doesn't seem to be necessary.

2.    Organic produce has fewer pesticides. Nobody is arguing this point—this is part of what defines organic foods. What is tricky here is that we don’t know if the amount of pesticides in conventional foods is dangerous or not. There are studies that suggest that exposure to pesticides during pregnancy can lead to learning and behavior problems in children—in general, it’s babies and children we worry most about. They get a higher dose because they are smaller—and chemicals can be dangerous for their developing brains and bodies. But the truth is, we just don’t know what’s safe at any age. 

But before you cancel your cable so you can pay for all organic produce, not all produce is the same when it comes to pesticides. Conventionally grown corn on the cob and onions, for example, don’t have much at all—but apples and grapes do. There’s some great information available from the Environmental Working Group (including a great app called Dirty Dozen) that can help you decide when buying organic makes the most sense. 

3. Organic meats have fewer resistant bacteria in them. Conventional farms give animals antibiotics to make them bigger. And whenever you use antibiotics a lot, you kill off the weaker bacteria and leave the resistant ones, like MRSA (methicillin-resistant staphylococcus aureus), that are causing all sorts of really tough infections these days.

There isn’t really much risk of catching one of these infections from making burgers, especially if you cook the meat well and wash your hands. But by buying meats from companies that don’t use antibiotics you can help fight the superbug problem. And that’s a good thing. 

4. You don’t need to buy organic milk (or organic infant formulas). Pesticides really aren’t a problem in milk, so you don’t need to worry about that. What most people worry about is hormones—but it turns out that we don’t really need to worry about that, either. Yes, cows are given bovine (cow) growth hormone, and it gets into their milk—but besides the fact that it gets broken down by pasteurization and our digestive systems, it’s a cow hormone; it doesn’t affect humans. Cows are also given estrogen, but the amount that gets into milk is too small to cause any trouble (another reason to drink lowfat or skim milk: the higher the fat, the higher the amount of estrogen). 

5. Organic farming is better for the environment and for sustaining our resources. It leaves a better earth for our children, and that’s important. By buying organic foods, we encourage more farmers to use organic methods for making our food—and to find cheaper ways to do it, something the AAP says is absolutely possible if we set our minds to it. 

In making the organic-or-not decision at the grocery store, remember that the most important thing is to eat a healthy diet full of fruits, vegetables, whole grains, low-fat dairy and lean meats—whether or not they are organic. Having five servings a day of conventional produce is healthier than one serving a day of organic produce. There’s also way more to overall health—like exercise, getting enough sleep and immunizations. As with everything in life—and especially in parenting—it’s crucial to keep some perspective.

Some more resources:

Information about organic foods and labeling from the US Department of Agriculture

Consumer Report's 2008 article "Fruits and Vegetables, When to Buy Organic", a great website with everything you might want to know about food safety.


6 tips for potty training success

Posted by Dr. Claire McCarthy October 20, 2012 09:14 AM
When I was new to doctoring and parenting, I thought of potty training as very straightforward--and very cookie-cutter, very one-size-fits-all. Twenty one years later, I know better. It's not that potty training is the hardest thing you do as a parent--there's lots of stuff that's harder (teaching your kid to drive, for example--much more risky, for starters). But it's not necessarily straightforward, and it's definitely not cookie-cutter.

So here are the tips I've learned over the years:

1. Do it when your child is ready. To be ready, your child should have the motor skills needed to get his pants down (and back up), to sit on the toilet (or stand in front of it and not get pee everywhere), and wipe. He also needs to be able to communicate with you that he is about to pee or poop. And, last but not least, he needs to be interested in doing it. If he's not even vaguely interested, it's not going to work very well.

Most kids are ready between 18 months and three years. It's not always easy to know for sure if your child is ready (sometimes you have to try it out to really know), but it's important to look for signs of readiness before you buy that potty.

2. Do it when the other people in your child's life are ready. If your child is ready but you just had a new baby, or just moved or started a new job, or your daycare really can't help you out just yet, then don't start. Hold off. Things will go much better if everyone is on the same page.

This actually works the other way, too. If you're on the fence about your child's readiness but the daycare is potty training all the kids in the class, or you have some time and energy to devote to it that you aren't going to have in a couple of months, I say give it a try. You can always stop if it isn't working.

3. Tailor your approach to your child's temperament. The basic principles are the same no matter what: introduce potty, have child sit on it, try to get them on it when they tell you they need to use it (or when you think they need to use it). But how and how quickly you do that, whether you use the potty or toilet, when you start using much depends on your child. If you have a child who hates change, you might want to take it slowly, and start with reading potty training books together even before you try out the potty. If you have a child who is bold and loves to try new things, more of a cold-turkey approach might work. This is a really crucial part of potty training that I didn't understand at the beginning. But having now potty-trained five children and helped countless other parents potty train theirs, I have come to understand that every child and every family is different, and each has their own best way.

4. Use rewards. We all are more likely to do things if we get something out of it. The biggest reward should be praise, of course. But stickers or other little prizes can make a big difference (Matchbox cars did it for my youngest)--as can earning an extra story at night or a special trip to the park or museum with you. Try not to go overboard with rewards, though. Not only could it get expensive, you could end up setting a precedent that comes back to bite you.

5. Be patient. Chances are your child won't go to high school wearing a diaper. There are kids who have special challenges (more on that below), but the vast majority of them figure this stuff out. It may be quick, or it may take months. If your child seems really upset by it, you're probably better off stopping for a while and trying again later. Don't worry if you see other kids the same age already potty trained--remember, every child and every family is different. And remember that accidents at night are really common through at least six years.

6. Ask for help. Definitely talk to your doctor ahead of time if your child has any physical or developmental issues that might get in the way of potty training--but even if she doesn't, talking to your doctor is a good idea. I try to bring it up with all families at the 18 month visit so I can answer any questions and we make a plan together. You should also ask for help if your child is having trouble or if you're feeling frustrated--and if your child is still in diapers at her fourth birthday.

For more information and tips, visit the Toilet Training page of the Boston Children's Hospital website.

Lessons from losing a child

Posted by Dr. Claire McCarthy October 17, 2012 10:26 AM
Today is my dead son's birthday.

He died a long time ago--sixteen years ago. He was born with a severe brain malformation that left him very disabled, with lots of seizures and other health problems. He died a few days after his first birthday.

I miss him, but not in the raw, longing way I used to. That passed years ago, as I came to peace with the fact that living was very hard for him and would only have gotten harder. He lived the lifetime he was meant to live. He is healed now in ways he could never be healed on earth.

claire and aidan 2.jpg

My grief now is different. It's in my marrow, in my bones, surfacing at sometimes unexpected moments, in ways that are often out of my control. There is a part of me that will always be gone--that's what happens when you lose a child. It has always seemed to me that my loss should be visible, like a scar across my face, because I am forever different. I am and always will be the mother of a child who died.

Even more than that, Aidan's death has left me with a deep, uncomfortable understanding of our vulnerability, of how all and everyone that we hold dear can be taken from us in an instant. Nothing is guaranteed; the world doesn't work that way. It never has.

Living with that knowledge fills me with panic on a regular basis--especially in the fall, the season of Aidan's birth and death. Flashes of something terrible happening to one of my other children, or my husband, grip me and nearly shatter me without warning. It is all I can do sometimes to pull myself together and keep moving forward.

But over the years, living with the knowledge of our vulnerability has also taught me to be deeply grateful for each and every day, for each and every moment with those I love. I am unaccountably blessed--by the privilege of being Aidan's mother, by my other five children, by my wonderful husband, my family, my friends, my colleagues and my patients. As much as I am panicked by the possibility of losing someone again, I am overwhelmed and humbled by what I've been given.

That is how I will honor my son today. As we do our remembrance at the cemetery, letting balloons go and watching them wind their way to Heaven, I will hold my loved ones close. And I will hold Aidan in my heart and thank him--for helping me understand that my life, and everything in it, is a gift.

Prescription for better school performance: an earlier bedtime.

Posted by Dr. Claire McCarthy October 15, 2012 10:52 AM
One extra half hour of sleep can help your child do better in school. Just one half hour.

That's the message of a study just released in Pediatrics, the official journal of the American Academy of Pediatrics. Researchers found 34 kids ages seven to 11 who were all healthy, didn't have behavioral problems, and were getting what we generally consider "enough" sleep: eight and a half to nine and a half hours a night. For five nights in a row, they asked half of the kids to go to bed an hour later and the other half to go to bed an hour earlier. They asked the parents to rate the kids on their sleepiness, and asked the kids' teachers (who didn't know what group they were in) to rate the kids' behavior--specifically, how moody, restless or impulsive they were. These are behaviors that directly impact a child's ability to pay attention and learn in school.

There were no big surprises in the group that was asked to go to bed an hour later. The kids were sleeper, moodier, more restless and more impulsive (we can all relate, I'm sure--I know I act that way when I get less sleep). But the results with the group that was asked to go to bed early were interesting.

The kids didn't actually sleep a full hour more. It's not easy to fall asleep earlier than you are used to; on average, they only slept 27 extra minutes. But those 27 minutes made a difference: not only did their parents of those kids say they were less sleepy, but their teachers found them to be less moody, restless and impulsive than usual. And remember, these kids were theoretically getting enough sleep before!

Parents, please pay attention to this study.

We all know that sleep is important. We all know, too, from personal experience, that when we don't get enough we are cranky and don't concentrate or perform as well as we usually do. More and more studies are proving that this is true in kids, too, showing behavioral and learning problems in kids who don't get enough good sleep. Not getting enough sleep is also linked to health problems like obesity.

And at the same time, as a pediatrician I'm seeing kids I'm seeing kids getting less and less sleep. It's worst with the adolescents; just recently I had a high school student tell me that between extracurricular activities and homework, there was simply no way for him to get more than six hours of sleep. Even the ones who don't do much after school are staying up late because they are spending so much time texting or on the Internet. Younger kids are texting too, and so very many of my patients have televisions in their bedrooms that are on until late. Few families have calming routines in the evening; it seems like life goes at a breakneck pace until the moment the lights go out--and parents wonder why the kids don't fall asleep. 

It's true that we don't know exactly how much sleep kids need, and that some kids need less--or more--than others. But this study underlines the fact that getting more sleep can help a child behave better--and learn better.

Try it out at your house. Send the kids to bed an hour earlier. It will likely take some rearranging of routines as well as cutting back on TV, Internet and texting. But if it helps your child succeed in school, it's worth it. Think of it as an investment in their future.

The end of public kisses: leaving a part of parenthood behind.

Posted by Dr. Claire McCarthy October 10, 2012 12:45 PM
My seven-year-old son and I had a milestone moment this morning.

I was dropping him off at the before-school program. As we approached the classroom, he stopped me. He stood in front of me, gave me a hug, and reached his face up for me to kiss.

It took me a second to realize what was happening. "You want me to kiss you goodbye here, not in the classroom?" I asked. Liam nodded. So I took a breath, kissed him, and brought him into the classroom where he dumped his backpack and ran to his friends, not looking back.

I know where this goes. It's happened to me four times before, with my older children. Self-consciousness sets in, the need to be cool...and the need to separate. Not completely--I'm sure Liam will still be snuggly when we read a book tonight--but we have turned an important corner. It's not a surprise, of course--I've been lucky to get public kisses this long. 

But he's my last. I'm leaving a part of parenthood behind forever.

I like having older children, don't get me wrong (my eldest two are 21 and 20). It's exciting and fascinating to watch their lives unfold, and to begin to have new and different relationships with them, to be friends in ways that weren't possible when they were younger. And although it feels very strange to say this, I'm looking forward to having grandchildren (in case Michaela or Zack is reading this: I can totally wait a few years, guys). 

And young children can be plain old exhausting. There is so much they need you to do for them, and while lots of it is fun, lots of it isn't (like diapers and generally cleaning up after them). As each of my children has grown older and more independent, it's been a relief.

But there's something lost.

This morning when I went to wake Liam up, I climbed in bed with him just to smell his sweet smell and feel his luscious warmth. His arms unconsciously reached for me, his eyes still closed; he was more baby than boy. There is such magic in that--and in the marvelous time of childhood when real and imagined mix, when silly dancing in the store is totally fine and puddles are expressly for jumping in, when curled up in my arms is the best place in the world to be.

I will miss that terribly.

How safe is your teen driver?

Posted by Dr. Claire McCarthy October 8, 2012 07:50 AM
There was some good news last week about teens and driving: according to the Centers for Disease Control (CDC), the number of teens who report drinking and driving has come down by half in the past decade from two in ten to one in ten.

While that really is good--great--news, it doesn't change the fact that motor vehicle crashes are the leading cause of death for US teens. In 2010,  every day seven teens died in motor vehicle crashes--and 770 were treated and released from emergency rooms. If you don't want this to happen to your teen, it's important that you know the risk factors for teen crashes--and talk to your child about them.

Drinking. As I said above, the numbers have gotten better here--but still, one in ten is a lot. And even if your teen knows better than to drink and drive, he or she may not always be the one driving. Make it really clear to your teen that drinking and driving are a lethal combination--and that you will always come get them, no matter what, if they find themselves facing that situation.

Speeding. Teens are more likely to speed. You need to talk about this a lot, and have a zero tolerance for it. If you catch them or otherwise find out they've been speeding, take the keys away. Teens naturally take risks--their brains are still developing, and they don't fully understand the consequences of their actions. Sometimes you need to understand things for them.

Being male. Not much you can do about this, but be aware that male teens are more likely to speed and get into accidents than females. I'm usually very much against treating one gender differently, but data is data. Talk a lot to your sons--and make sure your daughter understands this about her male friends (and boyfriends).

Not wearing seat belts. For whatever reason, teens have a tendency to not wear seat belts--in 2011, only half of high-schoolers reported always wearing a seatbelt when driving with someone else. Maybe they just aren't cool. But cool or uncool, they absolutely save lives--and your teen absolutely needs to wear one. It's the law here in Massachusetts--they could get their license suspended if they are a junior driver. 

Driving together. The risk of fatal crashes goes up the more kids are in the car together. It doesn't need to be a car full--risks go up when you add even one or two passengers. This will make sense to anyone who has ever watched teens together--they have a way of distracting and goading each other. Driving with a bunch of friends is about the least safe way for a teen to get anywhere. Always know how many people will be in the car. 

Distractions. Texting is the one we talk about a lot now--and despite the media coverage, and laws in many states (including Massachusetts), a third of teens still admit to texting while driving. It is not physically possible to look both at the road and your phone. Using your cell phone bill, you should be able to see when your child texts. If you find any when you know he or she was driving, that's another reason to take the keys away.

It's not just texting, though. Anything that takes your eyes or attention away from the road can cause a crash. That could be as simple as changing the radio station or turning to talk to a passenger or reaching for a sip of coffee. Anything. Make sure your teen understands this.

Experience. As with anything, practice matters. Teens are most likely to get into accidents in that first year or so after getting their license. So spend a lot of time in the car with your teen. Make sure they get lots of time on the road with you before and after they get their license--don't just leave it to the Driver's Ed instructor. When they have their license, start things out gradually. Be sure they are comfortable and capable before you  give them additional privileges. 

If you do all this, I can pretty much guarantee that your child will get annoyed, even mad. There will be a whole lot of eye-rolling, a whole lot of I-know-all-this!, and you will be accused of being overly strict and not trusting them. Ignore it. Stand firm.

You may just save their life.

For more information, check out the Teen Drivers page of the CDC website.

Why Marissa Mayer's (nonexistent) maternity leave might actually be good for women

Posted by Dr. Claire McCarthy October 4, 2012 07:34 AM

Like most of the social media universe, I was feeling pretty angry with Yahoo CEO Marissa Mayer for going back to work a week after giving birth. What was she thinking? She was setting a crummy example, I thought, and making it harder for working women who want protected time at home after giving birth. I imagined employers saying: hey, Marissa Mayer can do it. What's your problem?

But then I read my friend Wendy Sue Swanson's take on it. "I suspect Ms. Mayer is making decisions in the context of what is right for her family," Dr. Swanson wrote. My tail went right between my legs. She's right. We shouldn't be judging--or forcing our ideas or stereotypes on others.
And more--most--importantly: Marissa Mayer got to make her own choice.
I still don't agree with that choice. There's all sorts of medical and emotional and parenting reasons for staying home after having a baby--for longer than a week. I don't think this is great for her or her baby--but as Dr. Swanson pointed out, Ms. Mayer is a smart person. She knows the health and other risks of what she's doing. I am sure she weighed them against the benefits of doing it. And she did what she thought was best.
I'm hoping it's really that way. I'm hoping it's not that she felt that she really didn't have a choice, that she had to go right back if she was going to be successful in this still largely man-powered world. We'll likely never know.
But rather than second-guessing her, rather than bashing her and questioning her parenting (while I'm still a bit stunned by the crowdsourcing of her baby's name, there have certainly been worse approaches), we should see this for what it could be: an example of a woman making the parenting choice that works best for her and her family. That's worthy of celebration, not derision.
It shouldn't just be people with ample financial resources that get to do this, though. That's our challenge as a society. Just recently a mother in my practice had to go back to her minimum-wage job when her baby was three weeks old in order to pay for food and rent. That's not fair--and what made me most sad was the mother's resignation. It didn't even occur to her that she and her baby might deserve more. They do. Every mother and child deserve to have what's best for them.
Marissa Mayer's choice challenges us, too, to think outside the box when it comes to parenting. I have no idea what her husband's role is going to be, but wouldn't it be cool if he were going to be a stay-at-home dad? Why is it that we get so easily angry with her--but don't get angry with fathers who go to work the day after their babies are born? Why is it that we think more of women who cut back on work to care for their children--but less of men who do the same?
So, Ms. Mayer, please accept my apology. I was wrong to think what I did (and send the Tweet I did). Instead, I should be congratulating you on the birth of your healthy son--and thanking you for pointing out very publicly and bravely that our life choices should be just that: ours.

Seven tips for a successful parent-teacher partnership

Posted by Dr. Claire McCarthy October 3, 2012 08:00 AM
Over the past couple of weeks I've gone to three school open houses: one at Liam's elementary school, one at Natasha's middle school, and one at Elsa's high school. At this point, with two kids in college, I can't even count how many I've been to.

As I sat in them, it got me thinking about how much I've learned over the years as both a mom and a pediatrician about partnering with teachers and how important those partnerships are. I mean, think about it. There are days when teachers spend more time with our kids than we do. They have so much power in their lives--and offer so much possibility.

So here are a few hard-learned tips when it comes to partnering with teachers and working as a team. Some may seem obvious, but if there's anything I've learned over the years it's that the obvious is worth stating when things are important. And your child's education is important.

Go to the back to school nights. They set the stage for the year--you get an idea of what the teacher is like, learn about expectations, meet other parents, see the actual classrooms your child sits's a crucial opportunity that you shouldn't miss. It's almost always a real stretch for me to rush from Boston to get to the school in time, and you'd think at this point I'd remember to pack myself dinner, or at least a snack...but it's worth it.

Communicate with teachers. Let them know when you are seeing things that worry you--and when you see things that make you happy! Don't wait until things are really bad--the earlier you give them the heads up about a problem, the better you'll be able to work together to fix it. When I hear about school problems in my patients, I'm surprised by how often parents haven't talked with the teachers about them. But as you think about communicating, remember to...

Communicate with teachers the way they ask you to. If they want notes, don't send an email. If they give you a different email than the school one, use that one. Not only does it encourage mutual respect, it's most likely to be effective, as that's the way they are expecting to hear from you.

Don't ambush preschool or elementary teachers at school drop-off or pick-up. Most of us don't do so great when we are caught off guard and distracted by chaos around us, and teachers are no different. Plus, there may be things that they don't want to say within earshot of others. It's fine to let them know that you'd like to talk, and set up a time and way to do so, but don't launch into your concerns unless it's something they really need to know that day--like "Jimmy cried himself to sleep last night because of something Johnny said to him and I had to drag him here today", or "Jenny said she felt like throwing up this morning but I decided to bring anyway". That kind of stuff the teacher might like to know.

Give teachers the benefit of the doubt. There is always another side to the story; what your child or his friend's mother tells you may not be, well, everything there is to know. Always bring concerns to the teacher first, and try to phrase it along the lines of "Jimmy was very upset about his grade on the project. Could we talk about it?" as opposed to "You didn't grade Jimmy fairly." I've been burned personally on this kids sometimes leave little bits out, like something was late, they didn't follow the instructions, etc.

Talk to the principal if communicating with the teacher isn't working out. Sometimes you need a neutral party. Sometimes the chemistry between a teacher and a kid, or a teacher and a parent, just doesn't work out. I've had that experience too--and I've mediated some of those situations as a pediatrician. Which is another point I wanted to make:

Remember that your doctor can help. Over the years, I have had countless conversations with teachers and principals, helping kids and families get what they need--and helping them understand what teachers and principals are trying to tell them. My job is to look after all aspects of a child's well-being--and their education is absolutely part of their well-being.

That's the point, really: you, the school and your doctor are all a team. You are your kid's team--and you do our best work when you do it effectively, and together.

Kids and the secondhand (background) television problem

Posted by Dr. Claire McCarthy October 1, 2012 07:48 AM
On an average day at your house, how many hours a day is the TV on? Not necessarily being watched--just on?

According to a study just released in the journal Pediatrics, the average US kid is exposed to four hours of background TV a day. This is on top of anything they might actually sit and watch. For kids eight months to two years, that number is five and a half hours a day.

This is really worrisome, because contrary to what many parents think, background TV affects kids. Research shows that background TV:
  • Distracts kids from their play, which means that they don't learn to pay steady attention to what they are doing, a skill that is reasonably crucial in life.
  • Distracts them from tasks that help them learn--like homework!
  • Gets in the way of the parent-child relationship--nothing messes up interactions like one or the other of you turning away to watch TV
In the study, the kids who were most likely to have lots of background TV in their lives were African-American, living in homes that were low-income, with parents who had less formal education or with one parent. This is unfortunate, because these kids are already at high risk of problems with "self-regulation" (attention and social skills) and obesity. Background TV makes this worse.

But even for rich kids with highly educated parents, the TV was on in the background for two or three hours a day, more than is good.

So...a few suggestions:
  • Please, don't leave the TV on. So many families do this out of habit; it's like white noise to them. If nobody is actually sitting there watching something, shut it off (watching it less is a good idea too...)
  • Get TV's out of kids' bedrooms. Having a TV in the bedroom isn't just associated with more background TV exposure, but with more TV viewing in general (with all those downsides) and sleep problems.
  • Being home with a small child can be boring and lonely sometimes if you are alone with them day after day--but turning on the TV isn't the best solution. Play with your child instead--it may end up being more fun than you think. And if you are craving some adult interaction (or just more to your day than Peek-a-boo and Dora The Explorer), there are other options besides TV. Invite friends over. Look into parent-child classes, or community parent groups, or babysitting collaboratives. Many gyms have childcare--lets you be around grownups and get some exercise too! 
TV is not necessarily evil. There are some good shows, and it can be a nice way to spend time together. As long as your kids are getting some active and imaginative play and don't spend more than a couple of hours a day in front of the TV, I think it's fine. But we do need to rethink our TV habits.

If there isn't  a really good reason for it to be on, turn it off.

About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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