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6 Things I Wish All Parents Knew About Sleep

Posted by Dr. Claire McCarthy May 31, 2013 07:49 AM

Thumbnail image for sleep.jpgAccording to a study just released, the number of hours kids sleep at night is more affected by genetics than by bedtime or how quiet or dark it is. While daytime naps can be affected and changed by messing with the environment, nighttime sleep is a more wired thing.

This doesn’t surprise me at all, actually. For years I’ve been hearing from parents about how much their children sleep, and there is remarkable variation. Some kids sleep a lot at night and a lot during the day too, while others truly barely sleep at all—and yet, for the most part, they seem to get the sleep they need. It’s hard to explain this variation to parents, who understandably think that all kids of a certain age must need roughly the same amount of sleep.

That’s just one of the conversations I seem to have again and again about sleep. When I read the study I thought: this would be a great opportunity to write a blog about the things I wish all parents knew about sleep. So here they are:

Every child needs a different amount of sleep, as the study points out. It depends on age, to some extent, but it also depends on genetics, what they do during the day and all sorts of factors we don’t understand yet. So instead of counting hours, look at your kid. Are they generally tired or cranky during the day? If so, they may need more sleep. If they are healthy, act rested, have enough energy, get along with others (and are doing okay in school if they go to school), they are probably getting enough sleep.

Calming routines before bedtime are a good idea.  Nobody can go from active, exciting or stimulating things to being fast asleep right away. Yet lots of families try to make their children do just that…and wonder why it doesn’t work. Video games are not a good plan—a recent study suggests that any video (including TV) may not be a good plan, not just because it can get kids riled up, but because the blue light emitted messes up melatonin and our body's sleep cycles. My general advice to parents: start winding down at least an hour (an hour and a half is better) before bed. Do a bath or shower. Turn off the screens. Read books or do other quiet activities. It helps.

Routines in general are good. I once had a mother complain that her child wouldn’t go to sleep on school nights—but on further questioning, it turned out that on weekends the whole family stayed up very late (to at least midnight) doing things together. I suggested that they try to keep the child’s bedtime more or less consistent even on weekends, and the sleep problems went away. I'm not saying you have to be a slave to routines--flexibility is important in parenthood and life--but having a regular bedtime (and a regular waking time) can help kids get enough sleep.

Safe sleep is important for babies. Everybody approaches sleep a bit differently (and I am personally a sleep softie), but there are a few things that all parents should know about safe sleep for babies:

  • The safest place for a baby to sleep is in the parents' room, but in their own sleep space.
  • The safest position for a baby to sleep is on his or her back (we used to say back or side, but now we say just back).
  • Mattresses should be firm. No waterbeds or featherbeds, and sleeping on a couch is a bad idea too.
  • Bedding should be kept to a minimum. Cooler is better for preventing SIDS, and babies can smother or get tangled in extra bedding.
  • There should be nothing extra in the sleep space--no crib bumpers, pillows or stuffed animals.

Snoring is bad. A little bit here and there with a cold or when the child is really tired is probably okay, but any regular snoring should be reported to your doctor--especially if the child seems to have trouble breathing. It can lead to health, behavioral and learning problems.

Most sleep problems can be fixed (or at least helped). Genetics may play a role, but that doesn't mean that there's nothing you can do if your child's sleep routine is wreaking havoc with everyone's sleep. Even the study found that at 18 months the genetic influence wasn't quite as strong, giving parents and caregivers a possible window of opportunity to make changes. So talk to your doctor if exhaustion is common at your house. Your doctor may have ideas, or may refer you to a specialist (at Boston Children's we have a Center for Pediatric Sleep Disorders to help families). Really--it is possible for all of you to get enough sleep.

I don't really mind having these conversations again and again with families. After all, sleep is important for health, and my job as a doctor is to keep my patients healthy. So talk to your doctor if you have any questions about sleep; we are here to help.


Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post. 

Could your child have a motor delay? How to help your doctor find out.

Posted by Dr. Claire McCarthy May 28, 2013 07:45 AM
Thumbnail image for toddler sitting.jpgAs a pediatrician, I always want to find developmental problems earlier rather than later. When I do, I can get children and families the help they need earlier, which can make a big difference--especially if the developmental problem is caused by something that needs medical treatment.

The problem that I--and all doctors--face is that it's not always as easy as you might think to pick up on problems. Babies and toddlers aren't always happy to come to the doctor, and don't necessarily, um, cooperate--or show me everything they can do. So sometimes I'm not sure if what I'm dealing with is a problem--or a scared or furious kid.

And while parents are the experts on their kids and usually do know when there is something going on, that doesn't always get communicated as well as it could. Sometimes parents, especially first-time parents, aren't sure about their concerns and decide not to say anything. Sometimes denial plays into it, sometimes parents get intimidated, sometimes doctors don't ask the right questions and sometimes we plain old run out of time at a visit. 

This week, the American Academy of Pediatrics (AAP) published some guidelines to help pediatricians pick up on motor delays--that's when there's a problem with how children use their muscles, especially their arms, hands, legs and feet.

The clinical report, entitled "Motor Delays: Early Identification and Evaluation," lays out a whole process for doctors to use. The well child visits they want doctors to especially concentrate on are the 9 month, 18 month, 30 month and 48 month visits. 

At the last two, the 30 month and 48 month visits, doctors are mostly supposed to be looking for anything they might have missed earlier--and assessing for school readiness at the latter visit. But at the 9 month and 18 month visits there are very specific things they are supposed to look for--and parents can look for them too.

At 9 months, babies should be able to:
  • Roll to both sides
  • Sit well without support
  • Use both arms, hands and legs equally (without preferring one side)
  • Grasp objects and transfer them from hand to hand
At 18 months, toddlers should be able to:
  • Sit, stand and walk independently
  • Grasp and manipulate (play with, pick up, move around, etc) small objects
If your child can't do any of these, talk to your doctor. Make sure that he or she listens, and that you have a plan for not only figuring out why (if you don't know already) but for getting your child help.

There are also four questions that doctors are encouraged to ask parents--and that parents can also ask themselves:
  • Is there anything your child is not doing that you think he or she should be able to do?
  • Is there anything your child is doing that you are concerned about?
  • Is there anything your child used to be able to do that he or she can no longer do?
  • Is there anything other children your child's age can do that are difficult for your child?
Think about these questions. If the answer to any of them is yes, talk to your doctor. Again, make sure that he or she listens--and that you have a plan for figuring out and helping if after talking about the questions there does seem to be a problem.

Children under the age of 3 years with developmental delays may qualify for services and support through a program called Early Intervention. What many people don't know is that parents can call Early Intervention themselves and ask for an evaluation; a doctor doesn't need to do it. You can find listings of programs here in Massachusetts at the Family Ties of Massachusetts website.

You can also find more information about developmental milestones at the website of the Centers for Disease Control and Prevention. 

Get informed, and speak up. That's what I always want the families of my patients to do--because it helps me be a better doctor to them.

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.

8 Ways to Give Your Child a Safer Diet

Posted by Dr. Claire McCarthy May 23, 2013 07:58 AM
snow-white-poison-apple.jpgFood: It's supposed to keep us healthy. But these days, sometimes our food makes us sick.

I'm not just talking about bad potato salad. I'm talking about more insidious risks, the kind that build up, and cause problems down the line--such as cancer. That's what makes these hard: you feel fine after eating or drinking this stuff. 

As parents, it's particularly important that we make our children's diet is as safe as possible. Not only are we responsible for their well-being, but the fact that they have so many years ahead of them means that toxins have many years to build up in their bodies.

It's nearly impossible to avoid all toxins these days--they are truly everywhere. But here are 8 things parents can do to at least make their child's diet safer (not necessarily in the order of importance):

1. Limit processed foods. Yes, processed foods make life simpler. But they simply aren't as healthy as food you make or cook yourself. As much as you can, buy whole grains and fresh produce and fresh meats. Make big batches of recipes and freeze some. MyPlate has a great Pinterest board with tons of healthy, easy recipes.
2. Buy organic--wisely. The pesticides many farmers use can be poisonous and increase the risk of various diseases. However, it's not absolutely necessary to go totally organic. Some foods just have more pesticides than others. The Environmental Working Group has two great lists: The Dirty Dozen and The Clean Fifteen. Check them out--there's even an app you can use while you shop.
3. Wash your produce. Really well. All the time. You lower all sorts of risks that way. Originally in this post I said to wash meat, but I was appropriately corrected; the USDA says not to do that, because of the possibility of cross-contamination.
4. Be aware of mercury. Mercury can harm the developing brains and nervous systems of unborn babies and children--and there's mercury in a lot of seafood these days. Thick fish like tuna and swordfish (my favorites, sigh) have particularly high levels. To find out exactly what is safe (and what isn't) for children and pregnant women, check out the Fish Consumption Advisories page of the website of the Environmental Protection Agency.
5. Limit rice and rice products. Turns out that the rice plant is really good at sucking things out of the ground--like arsenic. The Consumer Products Safety Commission published a scary report last year that suggested we should all be cutting back on the amount of rice and rice products we ingest (I summarized it in a blog I wrote last fall). Rice isn't the only food with arsenic in it--a recent report found it in chicken, too--but it's important to know about.
6. Watch out for BPA. BPA, bisphenol-A, is another ubiquitous chemical, found in all sorts of plastics, the linings of cans, and even cash register receipts. It can affect the reproductive system, may affect behavior and can increase the risk of cancer. To limit exposure, use fewer canned goods (I've been using dried beans more--takes advanced planning but worth it) and don't serve or eat foods in or on plastics with the numbers 3 or 7 on them (limiting plastics in general is a good idea). You can read more at the National Institute for Environmental Health website.
7. Keep to real colors. This is part of #1, really, but if the color of the macaroni or the drink you are giving your chid is, well, not a color you've ever seen in a food (or in nature), that's not a good sign. Not that all food coloring is toxic. But some of it isn't good for you--and chances are that the food or drink isn't healthy for some other reason. Speaking of drinks...
8. Keep drinks to the healthy three. Kids really should be drinking milk (or a healthy alterna-milk--my friend Dr. Natasha Burgert has a great post about those), water or 100 percent juice (although, keep juice to no more than a cup a day or so). Nothing else.

If I'm forgetting something, please chime in!

It's really important, too, to stay informed. Talk to your doctor. The various websites I've linked to have lots of great information, as does the American Academy of Pediatrics website for parents and families. We learn new things every day, so check in frequently to learn the best ways to keep your family healthy.

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.

New report says 1 out of 5 children has a mental disorder

Posted by Dr. Claire McCarthy May 20, 2013 08:03 AM
img4_sm.jpgIn your average classroom of 20 children, four of them have a mental disorder.

That's the finding of a report published by the Centers for Disease Control and Prevention (CDC). It's the first report to describe the number of U.S. children aged 3 to 17 years who have specific mental disorders. Using information from various different sources covering the period 2005 to 2011, they came up with estimates for what percentage of children currently have mental disorders. The "currently" part is important: when they say that up to 1 in 5 children have a mental disorder, they mean that up to 1 in 5 have it--and need help--now.

The report is sobering. Here are the top five:
  • ADHD: 6.8 percent, or 1 in 14
  • Behavioral or conduct problem: 3.5 percent, or 1 in 28
  • Anxiety: 3.0 percent, or 1 in 33
  • Depression: 2.1 percent, or 1 in 50
  • Autism spectrum disorders: 1.1 percent, or 1 in 100
You child knows these children. You child may be one of them. 

The report also had numbers for the percentage of adolescents with substance use disorders or cigarette dependence in the past year. These aren't the kids who occasionally get drunk or smoke a cigarette or a joint--these are the kids who use them enough to have a real problem:
  • Illicit drug use disorder: 4.7 percent, or 1 in 20
  • Alcohol use disorder: 4.2 percent, or 1 in 25
  • Cigarette dependence: 2.8 percent, or 1 in 36
Again: your teen knows these kids. Your teen may be one of them. 

And the report found that in 2010, suicide was the second leading cause of death among youth ages 12 to 17. You really don't want your teen to know one of those--or be one of them.

That's the thing: this does, or could, touch all of us. And not only are many mental disorders chronic diseases that children will battle for a lifetime, when they start in childhood they often bring family problems, school problems and social problems that can shape a child's life forever.   This isn't just about children; this is about tomorrow's adults. This is about who we will be as a society.

It's also about what we will pay as a society. The report estimates that $247 billion is spent each year on childhood mental disorders. Add to that the costs of caring for them as adults, and  lost productivity, and this becomes an extremely expensive problem.

So what can we do? The good news is that many childhood mental health problems can be prevented, or at least improved, by giving children the support and nurturing they need--and acting early and quickly if there is a sign of a problem. As a country, we need to be sure that there are enough mental health resources, and that everyone can afford them. But there are also things that each one of us can do.

Parents: It's really important to be aware of the signs of possible mental health problems--and to ask for help if you see them. It's also a really good idea to learn as much as you can about positive parenting; being a parent is really hard, and we all have something to learn.

Teachers, coaches, and others who work with youth: Learn the signs too. Speak up. Reach out. Work with families and mental health care professionals--do everything you can to help kids get what they need.

Health care professionals: Never dismiss a parent's concern--and always act on any concerns you might have about a child. Sometimes parents just don't realize what is going on--or are waiting for you, or anyone, to say something and help.

Teens: if you are feeling angry, sad, anxious or some other feeling that feels bad or hard, let someone know. You don't have to handle it alone.

The CDC's Mental Health page has more information and lots of links. Check it out; find out what you need to know--and what you can do.

Here's an infographic from the CDC:


One way you can--and should--spy on your teen driver

Posted by Dr. Claire McCarthy May 16, 2013 08:19 AM
texting while driving.jpg

I'm not big on spying on teens generally. I think that privacy is important. And by the time they are teens, in most cases we need to trust that at least some of the stuff we've said for years has stuck--and we need to let them learn to be independent and make choices without us.

That said, if you have a teen who drives, there's some spying I suggest, assuming you pay for your teen's cell phone (if you don't, I'm really jealous): check to see when your teen is texting. More specifically: check to see if he's doing it while he's driving.

I have Verizon, and it's really easy. With our online account, I can see every call or text anybody makes. I can't see the text itself (or, if I can, I haven't figured out how), but I can see when they do it. It's not even so much spying, because really, you own that information.

Now, you may not know exactly when your teen is driving. This is not a perfect system. But you might catch something--and the fact that you are checking might be enough to make your teen think twice before texting behind the wheel.

A new study in the journal Pediatrics says that half of US teens 16 years and older report texting while driving in the past 30 days. To be fair to teens, we adults aren't setting much of an example: according to the Centers for Disease Control and Prevention, a third of adults text while they drive.

We all know it's dangerous...but some of us do it anyway, perhaps thinking that disaster will happen to someone else. And that's just the thing about teens: they are wired to think that disaster will happen to someone else. Their brains are still developing, and the last part to mature is the frontal lobe, the part of the brain that controls our impulses and gives us some common sense. From an evolutionary standpoint, it's good that adolescents are willing to take risks; as you start out in life, it's good not to be afraid of your shadow. But that risk-taking can sometimes play out badly--and often does, when they text and drive. 

The same study showed that teens who text while driving are also more likely to do other risky things while driving--like skip the seat belts, drive with someone who has been drinking alcohol or drive while drunk themselves. There's probably technology to figure that out, too, but it's not quite as easy as checking your cell phone bill. 

If you do discover that your teen has been texting when driving, there should be consequences. At a minimum, there should be a loss of driving privileges. Driving truly should be a privilege, not a right--teens need to understand really clearly how their lives, and the lives of those around them, can be on the line every time they drive. 

So set rules for safe driving--and enforce them. And while you are at it, follow them too. Please, don't text and drive.

This UK PSA from 2009 is very graphic (it's four minutes long but feels like an eternity, it's so hard to watch) but it really, really drives the point home. If you watch it with your teen, neither of you will ever think that it's no big deal to text and drive.

Parents: Let's Keep Some Perspective About Youth Sports

Posted by Dr. Claire McCarthy May 13, 2013 08:41 AM
soccer.jpgAt my son's soccer game the other day, a parent kept yelling very loudly at one of the players on the other team, giving various directions as to what the player should and shouldn't do. When I say "very loudly", I mean so loud--and harsh--that it startled me each time.

The kids were first graders.

The mother of one of my son's teammates (who was wincing along with me) told me how at her daughter's soccer game earlier that day, the coach of the other team was berating the players, telling them what a terrible job they were doing and calling them names.

Those kids were sixth graders.


Now, I get that these are extremes. But with five kids, I've been to a lot of sporting events, and have listened to a lot of parents and coaches pushing--in good ways and bad ways--kids to achieve. And while achievement is generally a worthy goal, I'm not sure it's the best goal for youth sports. 

Often, when I talk to other parents, I hear stuff about hoping for athletic scholarships. I've got two kids in college now, and so know first-hand how outrageously expensive it is and how every little bit helps. But only about 2 percent of high school athletes get athletic scholarships to college--and very few of them are full rides. The chances of "going pro" are even smaller: about 0.03 percent for basketball, 0.08 percent for football, for example. Basically, unless your kid is extremely gifted and extremely lucky, he's not getting any money out of sports.

Here's what your kid can get out of youth sports:
  • Exercise. With a third of US kids overweight or obese, we need to get more kids moving. Not only does exercise help kids now, it builds healthy habits for a lifetime.
  • Friendships. Sports can be a great way to build relationships and social skills. 
  • Positive self-image. Feeling strong and learning skills can make a kid feel really good about herself.
  • Involvement in positive activities. Sports are a way better way to spend your time than video games or hanging out on the streets; for many kids, sports are what keep them on a good life path.
  • Time management skills. Athletes, especially high school athletes, need to learn to get homework and other things done around practice.
  • Fun! With the right approach and attitude from the athlete and the coach, sports can be a lot of fun.
They are, however, not fun when you are being yelled at--or pushed all the time to achieve. Which is probably why the majority of kids drop out of sports before high school--and miss out on all the benefits entirely.

So, parents, let's keep some perspective. When you are at the sidelines, let the coach do the coaching--if you are going to yell anything, make it encouragement. If you see coaches treating kids badly, speak up--and find a different team if it continues. Don't push your kids to achieve--we should always try to do our best, but it's not always the point of everything. It's certainly not the point of youth sports.

Sometimes it's good enough--better, even--to show up, play the game and have fun. 

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.


For the Women Who Dread Mother's Day

Posted by Dr. Claire McCarthy May 10, 2013 07:37 AM
Everywhere you look--or listen--there's something about Mother's Day. There are ads for gifts, reminders to buy flowers, sentimental blogs, stores stocked with cards. It's all so lovely and sweet...unless you really don't like Mother's Day.

There are lots of good reasons to not like Mother's Day--the mere fact of how commercial it has become is probably enough. But for some of us, the reasons are, well, harder.

For me, Mother's Day is hard because I am the mother of a child who died. It's not that there aren't good things about Mother's Day, but it's definitely a trap-door day for me and all the mothers who have lost children, including children who had yet to be born.

It's a hard day for those who have lost mothers.

It can be a bitterly sad day for those struggling with infertility, or those who for other reasons don't have the children they hoped for.

Mother's Day can be painful, too, for those who are estranged from, or have difficult relationships with, their mothers or their children. It's a day when it's hard to escape or ignore that your relationship isn't what you what you want it to be.

And it's not always easy for the mothers of disabled children, the mothers who aren't going to get those homemade cards, or ever hear "Happy Mother's Day" from their child. Again--it's a day that so idealizes the mother-child relationship that anything less, or different, feels not good enough--even though these women are among the heroes of motherhood.

We are a sisterhood, all of us who just want the day to pass. We are a sisterhood of women who have learned so much the hard way, who know that life doesn't hold guarantees, who in our better moments understand that love isn't about what you get, but what you give.

There's no way to make the day go away. It hurts, no matter what. But for me, part of what helps is acknowledging that it will hurt--and planning for it. I run in a Mother's Day race that I really enjoy. I spend time with people I love. I eat food I like. I take care of myself.

That is what I hope for each of you in the sisterhood with me: that you take care of yourself. Do something self-indulgent. Eat only ice cream all day if you feel like it. Buy yourself a gift. Spend at least a few minutes of the day being beholden to nobody but you.

And--any of you who know one of us, reach out. Let us know you are thinking of us--it helps. Give us a call, or a hug. Send a text. We'll need them. 
Sisters, you aren't alone. There are vast numbers of us. Maybe that's what we can do, too: reach out our hands to each other--in real ways, in cyber-ways, in any way--and say: I understand. I stand with you. This day shall pass, life goes on, and there are always, always reasons to be grateful.

holding hands.jpg

FAQ: What can I do about my teen's acne?

Posted by Dr. Claire McCarthy May 8, 2013 09:38 AM
Thumbnail image for Thumbnail image for acne .jpg
Acne: it's part of life for most teens. And maybe because it's so much a part of life, it's easy sometimes for parents to minimize or ignore it. After all, it's going to get better, right?

It's true that it usually does get better. But living with it is no fun. To have pimples at a time in your life when what matters most to you is what people think about you...yikes. Also--some parents don't think about this--when acne is severe, it can leave scars.

Luckily, there are some effective treatments for acne. In fact, the American Academy of Pediatrics just published recommendations. Here's what they say:

First, the lowdown on washing: acne is not a hygiene problem. Too much scrubbing, especially with harsh products, can actually make acne worse! Use a mild, soap-free cleanser. You can try toners, which may help reduce oiliness, but stop if they irritate the skin.

Most cases of acne will respond really well to some combination of:
  • Benzoyl peroxide. This comes in strengths from 2.5 percent to 10 percent, without a prescription (stronger isn't necessarily better--sometimes stronger can irritate the skin and make things worse) and should be the first thing you try.
  • Retinoid cream or gel (tretinoin, adapalene or tazarotene). These are only available by prescription. The best way to use them is to spread a pea-sized amount over the area with pimples, rather than trying to get it on each pimple.
  • Antibiotics. While antibiotics can sometimes be helpful when put on the skin (especially if combined with benzoyl peroxide or a retinoid), they are most helpful when taken by mouth. This, too, requires a prescription. 
For more severe cases, your doctor might consider:
  • oral contraceptives (for girls). There are a few types that can help make acne better. Oral contraceptives can have risks and side effects, so you should discuss this carefully with your doctor.
  • Isotretinoin. This is a retinoid in a pill form, and it can make a big difference. However, teens who take it need to be monitored closely for side effects and need regular blood tests. It can cause birth defects if taken while pregnant, so girls who are taking it need regular pregnancy tests. There is also a possible risk of depression, so parents need to watch their teens closely for this (but given how depressed severe acne can make a teen, this risk may not seem so bad).
The bottom line: acne doesn't have to be a necessary evil of adolescence. There's lots that you can do. Talk to your doctor.

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.

Study: Parents Are Really Distracted Drivers

Posted by Dr. Claire McCarthy May 6, 2013 08:20 AM
kids in car.jpgAs someone who has been a parent for 22 years, I know firsthand just how hard driving kids around can be. When they are little they cry, as they get older they ask a million questions and fight with their siblings, and when they get older there's the whole issue of the radio, not to mention the chaos of friends in the car. But a study just released suggests that when it comes to parents and distracted driving, it's not just an "Are we there yet?" problem.

Researchers from the University of Michigan surveyed more than 600 parents about various common driving distractions. They asked them whether, in the past month, they had talked on the phone (handheld or hands-free), done child care (fed a child or picked up a toy), done self-care (grooming, eating), gotten directions (via a navigation system or a map), fiddled with the entertainment system (changing a CD or DVD), or texting/surfing the Internet. They also asked them if they did it during less than half the trips, more than half the trips or every trip.

The results (which, sadly, probably won't surprise most parents) were worrisome. Here's the rough breakdown of how many said yes to each: 
  • Phone calls: 75 percent (20 percent every trip)
  • Child care: 70 percent (25 percent every trip)
  • Self-care: 70 percent (10 percent every trip)
  • Directions: 50 percent (10 percent every trip)
  • Entertainment: 50 percent (5 percent every trip)
  • Texting: 15 percent (1 percent every trip)
Now, not all of this is necessarily awful. I don't know that it's that dangerous to munch on a cracker or listen to the nice GPS voice telling you to turn right in 30 yards while you drive. But some of it is dangerous; while  there is a general and understandable uproar about texting and driving (thank goodness the numbers in this study were lowest for that), the truth is that anything that takes our eyes or minds off the road can lead to disaster.

And that's what the researchers found, too. Parents who used phones while driving were more than twice as likely to have had a previous motor vehicle crash. Those who did child care, self care or got directions were about twice as likely, and those who fiddled with the entertainment or texted were about one and a half times more likely. 

Multitasking is an intrinsic part of parenthood. It's hard to imagine parenthood without it--I'm certainly someone who has done some pretty extreme multitasking. But I think that there are some times, and some places, when we just have to stop ourselves from multitasking. When we are driving our kids somewhere, well, that's one of those times.

Try pulling over to make phone calls (and certainly to text or use the Internet). Eat before you go--or stop and eat if it's a long ride. Make sure there are plenty of toys within reach for long car rides. Know where you are going before you leave. If they don't like the music or the movie, tough--unless you have someone with you who can change it, or until you can pull over. Try setting car rules and creating a culture of safety; it will lessen the arguments.

When we drive our children, let's treat them like the precious cargo they are.

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.

Was your child near the marathon bombings? He might need his ears checked.

Posted by Dr. Claire McCarthy May 3, 2013 03:18 PM

We've been reading in the news about all the people who have had hearing loss from the bombs at the Boston Marathon. Some of them didn't go to the doctor until days later, when they realized that they just weren't hearing right.

The thing is, kids might not realize that.

ears.JPGThat's what the ear specialists at Boston Children's Hospital, where I work, are worried about. Children, especially small children, may not understand what's going on when they lose hearing. And they may not be able to explain what it is they are experiencing.

So--if your child was within about 300 feet of either blast (especially if not shielded by a building), if your child was with you and either of you needed any medical care afterward or if your child has any signs of a hearing problem, talk to your doctor about getting an ear and hearing check.

Signs of a problem could include:

  • Ear pain (and obviously any bleeding or fluid coming out of the ear)
  • Ringing in the ears (a younger child may complain of hearing something)
  • Not responding normally when spoken to
  • Not paying attention
  • Asking people to repeat what they say
  • Turning up the volume on things like the TV

Really young children might be more clingy or irritable than usual, and be less interactive.

Some ear problems from the blast may get better by themselves--but some may need treatment, and if there is a permanent hearing loss, the sooner you know, the better--hearing loss can cause lots of problems for children. So talk to your doctor if you have any worries at all. The Audiology department at Boston Children's offers hearing tests in various locations in the Boston area--you can call 617-355-6461 for more information.


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FAQ: What causes warts--and what can you do about them?

Posted by Dr. Claire McCarthy May 2, 2013 08:32 AM
There is something about warts that makes them seem icky and embarrassing, although I'm not sure why; I think we have some odd associations with them (like with frogs and witches) that these skin growths, which aren't dangerous, don't deserve. They are incredibly common--up to a third of school-age children may have them--which means I have a lot of conversations with worried parents about warts.

Here's what people ask--and what I tell them.

What causes warts?
Warts are caused by viruses in the human papilloma virus (HPV) family. These are incredibly common viruses that can be easily passed between people (which is why warts are so common). They can also spread around the body.

Pools (and the showers associated with them) have traditionally been associated with warts, but a recent study suggests they've been getting a bad rap for no good reason--kids are much more likely to get them from family members and school friends. They grow really slowly, so it can be hard to figure out where you got them from.

I thought warts stuck out of the skin--how can those flat things on the bottom of my feet be warts?
Warts on the bottom of the feet are called plantar warts, and they do appear flat--but they can grow inward (or get pushed inward when you walk) and be painful.

Thumbnail image for wart.jpg
How can we make warts go away?
This is what people most want to know--and they want to know how to make warts go away quickly. That's hard, because, well, warts don't go away quickly. Patience is key. And actually, patience alone can sometimes do the trick; most warts will go away by themselves, if given enough time.

But if you'd like to hurry them along, there are some things you can do:
  • Salicylic acid. This is the most common treatment, and it's widely available in different forms (liquid, discs or a solid stick like a glue stick) without a prescription. I suggest to parents that they rub the wart gently with a nail file before using the medication (soaking it in warm water can help too). It still can take weeks or months for them to go away--like I said, these things don't go away quickly.
  • Freezing. Warts don't like being frozen, and this can help them go away a bit sooner (again, not quickly). There are freezing treatments you can buy without a prescription, and they are certainly worth a shot--but for more effective freezing treatments, you'll need to see your doctor or a dermatologist.
  • Duct tape. If you stick the tape over the wart and change it every few days, it may help by taking off the top layer of the wart. The cool colors of duct tape now available may make this a more appealing option to kids--and not only does it cover it from view (although they may have to explain why they have duct tape on them), by covering it, you can help prevent the spread.
  • Other home remedies. I've heard about people using all sorts of stuff on warts, like garlic, vitamin E, aloe and even carrots. I don't think there are any good studies to know if any of these actually work--I would try the other remedies first--but I don't think they can hurt.
There are other treatments such as cantharadin that can be done in a doctor's office--and in rare cases, sometimes we even do surgery to remove them. If the wart isn't going away, or if you aren't entirely sure that what you are dealing with is a wart, call your doctor.

How can we prevent warts?
The people who can do the most to prevent warts are the people who have them: when warts are covered, they are far less likely to spread. So if your child has one, keep it covered! Washing your hands regularly is always a good idea to prevent all sorts of infections, not just warts. The HPV vaccine can help prevent genital warts, but it doesn't prevent all warts. 

Bottom line: they aren't dangerous, you can't really prevent them--and they will go away. Which, compared to lots of other health problems, makes warts something parents really shouldn't worry about.

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.

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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