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The top food choking hazards for kids

Posted by Dr. Claire McCarthy July 29, 2013 07:00 AM
hard candy.jpgDo you know what food kids most commonly choke on? 

Hard candy.

That's the finding of a study just published in the journal Pediatrics, the official journal of the American Academy of Pediatrics (AAP). Researchers looked at choking-related visits to the emergency rooms that involved food between 2001 and 2009 for children ages 0-14 years. 

There were a lot of visits: more than 100,000, averaging about 12,000 a year. While most of the children were treated and released, 10 percent were hospitalized. More than a third were children under a year, although the mean age was 4.5 years--so choking isn't just a baby and toddler thing. 

This particular study only looked at non-fatal visits--they didn't look at deaths from choking. According to the Centers for Disease Control and Prevention (CDC), every year about 57 children 0-14 die from choking on food. And while we talk a lot about preventing choking on toys (we have all those rules and toy labeling), most (59.5 percent) of the choking that happens in kids is on foods, not toys.

Okay. Here were the top five foods that kids choked on:
1. Hard candy
2. Other candy (like gum)
3. Meat
4. Bone
5. Fruits and vegetables

We talk a lot about hot dogs--but they actually were low on the list (number 11, to be exact). Part of the reason may be that the study only looked at non-fatal choking, and if you get a hot dog slice lodged in your throat, it's more likely to kill you. But part may also be that parents and caregivers have gotten the message that hot dogs are dangerous. That's what so much of this is about: getting the message out, so that parents can keep children safe.

The top choking foods were a bit different depending on age, which makes sense. For babies under a year, the top three were:
1. Formula/milk/breast milk (peak age for this was 4 months)
2. Fruits/vegetables
3. Biscuits/cookies/crackers (beware of those baby biscuits--it's easy to get a big chunk off). 

For children 1-2 years, here were the top dangers:
1. Fruits/vegetables
2. Seeds/nuts/shells
3. Other candy (not hard candy--perhaps people usually know better than to give toddlers hard candy)

Children under 2 can bite stuff off--but don't have the molars to really grind that stuff down. That's why it's very important to give them small pieces of soft foods. 

For the 2, 3 and 4-year-olds, hard candy and other candy had the top two spots, with meat or bone in third. These kids have the teeth to grind--but are still figuring out how to chew and swallow effectively and safely.

Along with choosing safe foods and serving them safely,here are some recommendations from the AAP to help prevent choking on food at any age:
  • Encourage children to chew their food well
  • Supervise meals
  • Insist that kids sit down when they eat
  • Don't allow children to run, play or lie down with food in their mouths

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. 

Three pieces of advice for the royal parents

Posted by Dr. Claire McCarthy July 25, 2013 07:36 AM
royal baby.jpgThe new prince is home now, and Princess Catherine and Prince William are beginning their journey of parenthood. As they do, they are going to get a whole lot of advice. 

There's just so much to learn and do when you are a new parent, and some of that advice may be really helpful. For example, I hope they get some good advice about breastfeeding, safe sleep and carseats. But so much of the advice new parents get is highly ignorable--because what works for one child or family doesn't work for the next.

I've been a doctor and a parent for more than twenty years now. I've given, and been given, thousands of pieces of advice over the years. Of all those pieces of advice, there are three that I think apply to all parents, no matter what:

Trust your instincts. As the famous Dr. T. Berry Brazelton often said, "You are the expert on your baby." Yes, we all need help as we parent, and we all have things to learn (preferably from doctors and other reliable sources). But we are the ones who know our babies best--not just our babies, but our lives and ourselves. Don't ever let someone else drown out that voice in your heart that is telling you what you think is right for you, your baby and your family.

Take care of yourselves. This may be particularly hard for the royal family, who are so public and have so many public obligations. I hope that they take some time alone (now and at regular intervals going forward), get rest, have fun, and treat themselves well. A family needs to have itself at the center for everyone to flourish.

And most importantly...

Enjoy your baby. Of course you should love your baby, and I'm sure they will. But along with loving your children, you should enjoy them. Too often we spend more time worrying and working, doing our best to do our best, trying to get things right, getting distracted by responsibilities and other tasks of day-to-day life...and miss the best parts. Our children are incredible, magical gifts. They may make us crazy sometimes, but they can also be so much fun, and they have so much to teach us. 

I joined in a Twitter chat hosted by ABC's Dr. Richard Besser the other day. It was full of good advice and resources--here is a summary and a transcript. So many good ideas!

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. 

Plan ahead to keep your kids safe in the heat

Posted by Dr. Claire McCarthy July 23, 2013 07:56 AM
sun.jpgLast week we had record high temperatures--it was 99 in Boston on Friday, although the thermometer in my car said 101 when I was driving home. Saturday we decided to spend the day in our air-conditioned living room. We read, did summer math work, and played with toys. 

It felt weird not to be getting my kids out to do some sort of activity on a weekend day. But actually, indoors in air-conditioning is where the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) say you should be when the temperatures climb really high. So that's how we planned our day.

Heat can be dangerous. Besides making you feel sweaty and tired and uncomfortable, it can cause dehydration, heat stroke and heat exhaustion. Heat can kill--and every year there are the horrible stories of babies dying in cars, the elderly dying in hot apartments or hikers dying because they were overcome by heat. And so often, people get caught off guard. They don't expect things to be so bad--and they aren't prepared.

This week has been better, thank goodness.It's been a lovely reprieve. But we are likely to have some more really hot days ahead. Here's how to use some advice from the AAP and the CDC to keep your family safe (and comfortable) when the heat hits again:

  • Read the weather report. I know, I know, here in New England it's often not exactly correct. That's New England weather for you. But it's your best starting place. 
  • Know what is too hot for you and your family. For everybody, once you get into the high 80's it gets uncomfortable, but the very young, the very old and people with some medical conditions may get into trouble before that.
  • If it's really hot, plan to stay in a cool place as much as possible, preferably an air-conditioned place (don't count on a fan to cool you down). If you don't have air-conditioning at home, go someplace that does have it--like a library, museum, or mall. 
  • If you choose to be outside, try to do it earlier or later in the day, not when the sun is at its peak.
  • Dress your kids in lightweight, light-colored clothing. Really, that white shirt can make a difference.
  • If you are outside, try to stay in the shade. Think about this as you plan your outings; some places have more shade than others. Think about bringing your own shade, like a beach umbrella or little collapsible tent.
  • Pack or buy water to drink, and have everyone drink regularly. Avoid sugared or caffeinated beverages--they can end up making you feel worse.
  • Get wet. That might be a pool, beach, sprinkler, fountain or hose if you are outside--or a cool bath or shower when you get home.
  • Know that everyone will feel more tired. Don't ask or expect much from anyone. Cut kids slack if they get cranky (and plan for crankiness).
  • Whatever you do, never leave a child in a car, even if the windows are down. It can get dangerously hot very fast.
None of these is complicated--and each can go a long way toward making sure that everyone is safe and comfortable in the heat. But they may involve some advanced planning--so make that planning part of your summer.
Remember, too, to check on any of your friends and neighbors who might be at risk from the heat, like the elderly or those with medical conditions. If you have air-conditioning and they don't, invite them over; set a good example for your children by teaching them to care for others.

Here in Massachusetts there are lots of state-run beaches and pools to visit to cool off and play. We spend a lot of time at the one near us! 

Thumbnail image for kids at pool.jpg

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. 

We are all Trayvon Martin

Posted by Dr. Claire McCarthy July 22, 2013 08:20 AM
trayvon martin.jpg
In the wake of the Zimmerman verdict, African-Americans all over the country are saying: I could be Trayvon Martin. President Obama said, "That could have been me 35 years ago."

We'll never know exactly what happened between George Zimmerman and Trayvon Martin. But it does seem clear that Zimmerman "profiled" Martin, pursuing him because he was a young black man walking at night. 

This resonates with African-Americans, who know what it's like to have people make assumptions about them based on their skin color. But so many other people don't know what this is like. While they may be angry about what happened, it doesn't feel like their problem.

I think it's everyone's problem.

It makes me think of what Pastor Martin Niemoller said about the Holocaust. There are lots of different versions of his words (one is on the very moving Holocaust Memorial here in Boston), but all are similar to this one:

In Germany they first came for the Communists,
and I didn't speak up because I wasn't a Communist.

Then they came for the Jews, 
and I didn't speak up because I wasn't a Jew.

Then they came for the trade unionists,
and I didn't speak up because I wasn't a trade unionist.

Then they came for the Catholics,
and I didn't speak up because I was a Protestant.

Then they came for me--
and by that time no one was left to speak up.

I don't mean to minimize the struggles of African-Americans; the racism against them is a shameful part of our history and culture, and even, as Robin Kelley wrote in a powerful blog, part of our justice system. First and foremost, we must face and end this. But each one of us has something about us that someone might use to make assumptions about us. Whether it's our race, gender, sexual orientation, the clothes we wear, the jobs we have, the way we talk or act, our political views, where we live or our friends, there is always, always the possibility that someone will judge us--or hurt us.

We need to fight the racism and bigotry and misperceptions that triggered the events of Trayvon Martin's death not just because they are wrong and dangerous, but because any one of us could be next. If we don't stand up for Trayvon Martin, who will stand up for us?

We are all Trayvon Martin.

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. 

Parenting to prevent drug and alcohol abuse

Posted by Dr. Claire McCarthy July 19, 2013 07:43 AM
cory monteith.jpgTwo of my daughters and I are Glee fans, and we are really sad this week. We can't believe Finn--I mean Cory Monteith--is actually dead. I think the fact that he plays a character on a TV show makes it harder; it feels like they should be able to write him back into the script and make him come back.

But they can't. He's dead. And according to news reports, his death was from a lethal combination of alcohol and heroin. 

If your children watch Glee, or even just know who Cory Monteith is, talk to them about his death. Talk to them about how this is an example of just how dangerous drugs and alcohol can be. Sit down with your kids, and use it as a teachable moment. Because when it comes to preventing drug and alcohol abuse, parents are the best defense a kid has. We are, or can be, the anti-drug.

Here are some tips for parents:

Talk early and often. Don't wait until your child is in high school to talk about substance abuse--and to build the skills and self-esteem that will help them stay away from drugs. The Parent Tool Kit has tips for talking to kids of all ages. It even has tips for talking to preschoolers--not so much about heroin, but about how great it is to be healthy, about not eating or drinking things that can hurt them, and about making good decisions. 

At each stage of life, the conversations are a bit different--but from the moment they can talk to you, there are things you can say to help keep them drug-free.

That's the thing: yes, you want your kids to have the facts about drugs and alcohol. But keeping our kids away from them means having conversations about much more than what drugs and alcohol can do to you. It means talking about overall health, about peer pressure, about dealing with frustration and sadness. It means really getting to know them--and doing everything you can to help them feel comfortable talking to you. 

Have rules and expectations. When my eldest two became teenagers, I was caught off guard by how many parents had a "kids will be kids" attitude about alcohol. Don't be that way. Alcohol kills kids, especially when it's mixed with driving. Be strict about drugs and alcohol. Have clear rules--and clear consequences. Follow through on those consequences.

Understand their point of view. This is different from "kids will be kids". This is about understanding that it's hard to navigate peer pressure, that "fitting in" is pretty darn crucial for kids, and that learning to make good decisions is hard. Talk with them about their social and school lives, and what they might hear or see. Talk through situations with them--do some role-playing about what they can say and do if someone offers them drugs or alcohol. Dr. Deborah Gilboa suggests having a code word that kids can text you if they need "out" of a situation. Then you call and say that they need to come home for whatever reason and they get to blame you and they can keep face in front of their friends. Speaking of friends...

Get to know their friends, and their friends' parents. Create spaces in your house where kids can hang out (which may involve buying food and definitely involves giving them some privacy). When you drop off or pick up, take a moment and introduce yourself to parents. These things make a difference.

If your child worries you, do something. Whether it's coming home drunk, or acting strange or depressed or angry, or new trouble in school, or any other event or change in behavior that worries you, react. Don't pass if off as a phase, or a one-time thing, or just teenage behavior. Ask questions, and..

Ask for help. Parenthood is hard, and dealing with things like drugs and alcohol, or mental health, is really hard. Talk to your doctor, or a school guidance counselor, or a mental health professional. Don't let pride get in the way--nothing is more important than your child's well-being.

To learn more, visit the website of The Partnership at

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. 

ABC's hiring of Jenny McCarthy: a decision that could cost lives

Posted by Dr. Claire McCarthy July 15, 2013 04:27 PM
jenny mccarthy.jpgBy: Dr. Claire McCarthy

By choosing Jenny McCarthy to be a host on "The View", ABC made a decision that could end up costing lives--even worse, the lives of children.

Jenny McCarthy believes that vaccines caused her son to be autistic. Never mind that it's not clear that he was actually autistic, none of the claims she has made about vaccines and autism are backed up by, um, any medical evidence. But that doesn't stop Jenny McCarthy from making those claims very publicly. She is a supporter of Andrew Wakefield, the British doctor whose study linking the MMR vaccine and autism was found to be based on fraudulent data. The fact that he has been discredited by the medical community and lost his license doesn't stop her from supporting him.

Vaccines save lives. So many fewer children get sick from polio, diphtheria, measles, chicken pox, tetanus, whooping cough and other vaccine-preventable illnesses. It's getting so that the latest generation of doctors haven't even seen some of these illnesses, these illnesses that used to be common--and sometimes kill. We have done, and continue to do, extensive research on vaccines and their safety. The consensus of the medical community--who care deeply about health, science and safety--is that for the overwhelming majority of people, vaccines are safe.

But that doesn't stop Jenny McCarthy from saying vaccines aren't safe. And the problem is, people listen to celebrities. They shouldn't--it's not like Jenny McCarthy has any kind of scientific training or expertise--but they do. Even though most people realize that celebrities aren't scientists, celebrities get our attention. And when they say things that scare us, well, it can be hard to shake. As my friend Seth Mnookin, the author of the great book The Panic Virus says, it's really hard to unscare people.

Everyone is entitled to their own beliefs and opinions, including Jenny McCarthy. But ABC should know better. ABC knows that people listen to celebrities--and they know Jenny McCarthy's position on vaccines. They had to know that hiring her, and giving her a bigger platform, could end up causing some parents not to vaccinate. 

Have we really sunk so low as a society that ratings, and money, matter more than the health and safety of children?

Arsenic and apple juice

Posted by Dr. Claire McCarthy July 15, 2013 06:37 AM
glass of apple juice.jpgApple juice shouldn't have more arsenic than is allowed in drinking water. That's what the Food and Drug Association said this week, and it makes abundant sense. 

Arsenic is a really common chemical that is found almost everywhere in the environment. Some of it is found naturally, but some of it is there because of stuff we've done, like using pesticides that contain arsenic (which has lead to high levels in lots of rice--check out my post on that). There are two kinds, organic and inorganic. It's the inorganic kind that leads to health problems. Very high levels can kill you, but those sort of exposures are uncommon. Exposures to smaller amounts can damage the brain, nerves, blood, blood vessels, heart and skin--and can cause birth defects and cancer. Not the kind of stuff you want your kid to be drinking.

Here's the good news: the vast majority of apple juice out there doesn't. But when Consumer Reports ran some tests on various different brands of apple juice, they found that some of them had levels that were unsafe. 

At the time, there were no federal regulations when it came to arsenic and apple juice. What the apple juice companies were doing may have been dangerous, but it wasn't breaking any rules. 

The FDA's ruling changes that. Now they have regulations that they can enforce, and if a company makes an apple juice with too much arsenic, they can do something about it.

The FDA did their own testing, too. They found that 95 percent of the apple juice samples they tested had less than 10 ppb (parts per billion) of total arsenic, and 100 percent were below 10 ppb for inorganic arsenic (the dangerous kind). That 10 ppb of inorganic arsenic is the limit for drinking water. 

So, despite all the hype about arsenic and apple juice, parents shouldn't be too worried. It's not a bad idea to check out the test results on the different brands, and choose one that scored well (although it's good to remember that the Consumer Reports folks found that different samples of the same brands had different results). But a cup of apple juice here and there is really unlikely to cause any problems for your child.

And a cup here and there is all they should be drinking anyway--the American Academy of Pediatrics recommends limiting the amount of juice kids drink--or not giving them any at all. Drinking a lot of juice can make kids overweight. The dentists aren't wild about juice either, especially when kids carry it around in sippy cups--it increases the risk of cavities.

So give your kids water to drink. After all, there are regulations about the amount of arsenic allowed in that.

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. 

Medications for ADHD: no guarantee of academic (or other) success

Posted by Dr. Claire McCarthy July 12, 2013 07:33 AM
test taking.jpg

Medications for ADHD can help kids concentrate--but they can't control what they concentrate on. 

That's a really interesting and important message that is emerging from recent studies--and it's a message that parents of children with ADHD need to listen to and understand.

In a recent study out of Canada, researchers looked at kids with ADHD and found that when it came to academic success, being on medication didn't make that big a difference. In fact, some kids on meds actually did worse.

How could this be? Don't the medications help them pay attention? Well, yes, they do. But it's a short-term thing--and, as I said, they can't control what they pay attention to. As one expert quoted in a really great Wall Street Journal article about this said, if a teen with ADHD takes medication and goes to the library to study, and then a friend comes to talk, it may just be that the medication will help him pay better attention to that conversation!

While attention and concentration are crucial for academic (or any) success, academic success is so much more than attention and concentration. Being really successful at a task involves organization and planning and self-control. If you study all the wrong things for a test you won't do well, no matter how hard you concentrate. If you can't plan out your time to get long-term assignments done and end up leaving too much to the last minute, well, ADHD medication isn't going to make the assignment smaller.

Success in school and life also requires family support, self-esteem, and other intangibles that don't fit nicely into medicine bottles.

It's becoming more and more clear that ADHD isn't just a kid condition; it's a lifetime disorder, a chronic disease with effects that can last a lifetime. A while back I wrote about this, and about how parents of kids with ADHD need to be sure that their children are getting regular mental health care, have the best possible school program, and get care from a doctor who knows about ADHD and is aware of all the possible effects it can have. 

What I'd add now is that it's really crucial that parents not think of medication as taking care of the problem. It can be tempting to think: Junior is on medication, we've got that covered. But that's dangerous thinking. Talk to your doctor about all the ways you can help your child and be sure that he has all the skills and support he needs as he grows.

You can learn more at the CDC's ADHD page. And here's a video from WSJ Live that summarizes Shirley Wang's post:

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. 

Do kids really need milk? Maybe not.

Posted by Dr. Claire McCarthy July 10, 2013 06:51 AM
glass of milk.jpgIt's a question I ask parents all the time: how much milk does your child drink?

The answer I'm generally looking for is 2 to 3 cups a day (I even wrote a post about it). But if they say that their child doesn't drink any milk, I'm actually okay with that. In the interest of full disclosure, my youngest son doesn't drink milk (except some chocolate milk at school, something he doesn't get at home). He just doesn't like it.

There are definitely nutritional benefits to milk. It's a great source of calcium, vitamin D (assuming it's fortified--vitamin D isn't naturally in milk) and protein. These are all nutrients that children need. And for many children who are picky about what they eat, drinking milk is a good way to get those nutrients.

But milk isn't the only way to get them. There are cultures all around the world that don't have dairy in their diets--and according to an interesting commentary in JAMA written by my colleague Dr. David Ludwig along with Dr. Walter Willett from the Harvard School of Public Health, bone fracture rates tend to be lower in countries without dairy in their diets, and drinking milk doesn't seem to protect against fractures in adults.

Drinking too much milk can lead to anemia. It can also lead to obesity, and the commentary points out that drinking lowfat milk doesn't necessarily help. Drinking lowfat milk can leave you feeling less full, the authors say--and more likely to reach for more food, like an extra cookie. 

I have many patients who don't tolerate milk because of the lactose in it--they get stomachaches and diarrhea. More importantly, we don't really know all the long-term effects of drinking milk. If you think about it, milk really is meant for humans and other mammals when they are very young--and it has hormones and growth factors to help young mammals grow. What we don't understand fully are all the possible effects of getting those hormones and growth factors for years, long after you are very young.

I don't discourage drinking milk among my patients, as long as they aren't drinking more than 2-3 cups a day (and unless they are underweight, I generally recommend low-fat or skim milk). It is a quick and easy way to get some good nutrition. But if they don't like or don't drink much milk, as is the case with my son, here's what we talk about:

Calcium. You can get calcium from other dairy products (which have some of the same issues, obviously). You can get it from fortified orange juice. You can also get it from salmon, sardines, beans (like black-eyed peas or baked beans), blackstrap molasses, and other food sources.

Vitamin D. Ultimately, this is a sunshine vitamin. Spending time in the sun is the best way to get enough Vitamin D, and that may be a big part of what other cultures do that we don't. Yes, sun exposure can lead to skin cancer, so you do have to balance your risks. But just getting your kids outside to play regularly (which also helps bones, because weight-bearing strengthens them) can make a big difference. You can also get Vitamin D from other fortified foods, as well as from egg yolks, salmon, tuna, cod liver oil and other sources. I often recommend a daily multivitamin for my particularly picky eaters, to be extra sure they get enough (my son takes one!)

Protein. This is easy--you really don't need milk for protein. You can get it from meat, fish, beans, tofu as well as other dairy. The Harvard School of Public Health has some great information about the healthiest ways to get the protein you need.

For more on this topic, check out Deb Kotz's great post. My friend Dr. Natasha Burgert has a terrific post on "alterna-milks", as well. But the best person to talk to about your child's diet is your doctor; together you can figure out what your child should eat and drink to get and stay healthy for life.

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. 

Flat spots on babies' heads: what parents need to know and do

Posted by Dr. Claire McCarthy July 8, 2013 07:43 AM
The good news first: since 1994, when the American Academy of Pediatrics (AAP) started recommending that all babies sleep on their backs, the rate of Sudden Infant Death Syndrome (SIDS) has dropped by 50 percent. That's a lot of lives saved.

baby head.jpg
The bad news, which in comparison to that doesn't seem like a big deal: more babies are getting flat spots on their heads from lying on their backs. In fact, in a study just released, researchers in Canada found that almost half of the 2-month-olds they examined had some of this flattening, called positional plagiocephaly.

The skulls of babies are actually not one bone but lots of them held together by cartilage. This allows the head to squeeze through the birth canal, and it allows for the rapid brain growth we seen in infancy. The fact that there are many bones and that those bones are so able to adapt to change means that they are likely to be affected by position--and end up with flat spots when babies lie in the same position a lot. Usually, the flat spots are noticeable by the time a baby is a couple of months old. 

Luckily, these flat spots don't cause any damage to the brain--and most go away once babies are older and not laying down so much. They can sometimes be permanent, and leave a child with an odd-shaped head, which could lead some some teasing or self-esteem problems. For that reason, if the flattening is severe, we sometimes fit babies for soft helmets that help the head grow into a rounder shape.

The best way to prevent the flat spots from happening in the first place is to change the position of your baby's head regularly, so that he isn't spending 24 hours a day with pressure on the same part of the skull. Here are three suggestions for doing this:

1. "Tummy time." Having your baby spend time on his tummy is also good for building strength in the neck, trunk and arm muscles. So when he's awake and you're watching, put him on his belly. Many parents tell me their babies don't like this, that they fuss and so the parents end up giving up after a couple of minutes and putting the baby back on his back. You can help this by putting fun things to look at in front of the baby (like a baby mirror--babies love those), but the best thing to put in front of Baby is Get down on the floor too, on your belly, face-to-face with your baby. Or put Baby on your chest; you can talk to him, but just being so close to you may be enough to make tummy time more than worthwhile.

2. "Wear" your baby, in a sling or other baby carrier. This can take pressure of the head too. I wore my babies in a sling; I loved having my hands free, and they loved being carried all the time! Wearing your baby may also decrease the risk of colic (or help decrease fussiness in an already colicky baby).

3. Vary the direction your baby's head is facing when he is on his back. Because of the way they usually hang out in the birth canal as they drop down at the end of pregnancy, babies have a tendency to turn toward the right (in the study, more babies had flat spots on that side). When you lay Baby down to sleep, try to alternate sides. If you have a baby that likes to turn to the right, during the day position him so that the more interesting stuff to look at (like you) is on the left.

If you think your baby has a flat spot on his head, mention it to your pediatrician at your next checkup. Together you can decide if a referral to a specialist is a good idea; usually, it's not necessary.

Whatever you do, don't put your baby on his belly to sleep because you are worried about a flat spot. We can so something about a flat spot. We can't do anything if a baby dies of SIDS.

Boston Children's website has a great video that explains positional plagiocephaly--check it out.

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.

Why you should care about somebody else's child care and preschool

Posted by Dr. Claire McCarthy July 5, 2013 05:58 AM
Did you know that during the first 3 years of life, 700 new neural connections form in the brain every second?

It's easy to understand why those years are so crucial: those connections decide what a child will be able to learn, and do, as they grow. The interactions children have with adults during those first three years can literally define the rest of their lives.

What's harder to understand is why we would ever let those years be squandered. And yet, we do: so very many children end up spending those years in situations where the adults don't, or can't, give them what they need.

More than half of U.S. women with children under age 3 are in the labor force, and 6 million infants and toddlers spend time in childcare--but high-quality care is scarce, and too expensive for many families.

The result? By age 2, toddlers in the lowest socioeconomic quintile are behind all other children in measures of cognitive skills and emotional attachment.

We should be ashamed.

There's more we should be ashamed of. Out of the 188 countries that have known maternity leave policies, the U.S. is one of only 8 that doesn't have paid maternity leave (check out this map--it's jaw-dropping).

Even worse: according to UNICEF, among the 29 "rich" countries in the world, the ones who should be able to take care of their children, the U.S. ranks 26th when it comes to child well-being. 26th, folks. Only Lithuania, Latvia and Romania are below us.

Before you shake your head in dismay and go back to whatever you were doing before you read this, happy that your child had or will have a good first three years of life, stop and think about what this means. Because this is about you and your family too.

These children live longer than three years, obviously. Some go on to struggle in school, requiring resources (read: money) to help them learn, resources that could have gone for more teachers, better libraries, new computers, better athletic facilities and other things that would make your child's education better.

When they struggle with school, many of these kids end up dropping out. Some go into low-wage jobs, where they stay the rest of their lives because they don't have the skills to get out. That means that as a country we need to pay for the food stamps, subsidized housing and other things they need to survive with their families. Some get into trouble--and create costs for the criminal justice system. This is money that could have been spent in so many other ways that could help you and your family.

These kids are also our future workforce, the ones that have everything to do with the success or failure of companies and of our economy generally. We need skilled, creative, well-adjusted workers in order to succeed. Remember, too, that they are the future voters, who will help decide who represents you and your family in public office.

Your future, and the future of your children, is connected to the educational and emotional well-being of these children--because all of our well-being is connected. The better they do, the better we all do. we really want to be the country that doesn't take care of its children? Are we really okay with being 26th out of 29? What does that say about us, about each and every one of us? The American Dream is dying; prosperity has become an accident of birth.

The good news is that there is something we can do. We need to put real money into high-quality learning experiences for infants and toddlers, including childcare, Early Head Start, Early Intervention and home visiting. These programs are investments that guarantee tremendous returns, in so many ways.

Come join ZERO TO THREE and more than a dozen national organizations in a virtual rally, Rally4Babies, on Monday, July 8th at 2:00 pm EST. U.S. Secretary of Health and Human Services Katherine Sibelius will be there, as will U.S. Secretary of Education Arne Duncan and other speakers. It's just a half hour out of your day--but what you learn could help children for a lifetime.

Get involved. Sign the petition to urge our elected leaders to ensure that all babies and toddlers get what they need. Don't let any more years--or lives--be squandered.

Do it for them--and for you.

Here is famous pediatrician T.Berry Brazelton explaining why this is so important:

Reminders for a safe and healthy 4th of July

Posted by Dr. Claire McCarthy July 3, 2013 11:59 AM
fireworks.jpgMy kids love the 4th of July--they get to be outside, we go to a parade, there's usually some sort of family party, and, of course, there's the fireworks.

As you plan your day tomorrow, here are a few things to keep in mind to make sure that the only memories you have are good ones:

Please be careful around fireworks (let's just get that one done with). I'm not so worried about the ones we'll go watch in Wakefield. But I am a bit concerned about the ones that our neighbors usually set off in their yard. Thousands of people end up in emergency rooms every year from injuries. Even sparklers can do damage. Use some common sense, folks. The Consumer Products Safety Commission website has all sorts of useful information about firework safety that can help.

Use sunscreen, and reapply frequently. The second part is particularly important. We tend to remember to put it on as we leave the house or arrive at the beach or park, but we often forget to reapply it. Even if you're not swimming, pull it out every couple of hours or so. To check your sunscreen smarts, read my recent post.

Don't forget bug spray. They've found West Nile in mosquitoes in the state, and it's prime time for tick bites too. My post from last year has everything you need to know.

Review safety in public places. Here in Boston we're all a bit anxious after the Marathon bombings, especially since apparently the plan had been to set off the bomb at the Esplanade. We have no reason to think there is any public safety threat to anyone who heads down there for the concert and fireworks, especially given all the precautions the city is taking. But whenever you go to a crowded public event, you need to be careful. Mostly, make sure your kids know to stay close to you, and talk about what to do/where to meet if you get separated (when my kids were little I always dressed them in very bright colors so I could spot them quickly in crowds). Watch out for cars and other safety hazards, and follow all the posted rules. They are there for a reason.

Hydrate. It's supposed to be hot. Drink water, avoid caffeine (even caffeine-free sodas aren't a great idea, as they have sodium which just makes you thirstier). Speaking of drinking...

Make safe choices about alcohol. I know, this is a duh thing. But again, every year there are accidents, some of them tragic. Pick your designated driver, decide and stick to your drinking limits. Keep your family safe and set a good example at the same time.

I know these seem really obvious--but sometimes it's the obvious things we take for granted and don't think about carefully enough. So spend a few minutes thinking about them. You'll be healthier, safer, and happier if you do.

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. 

The passage of time

Posted by Dr. Claire McCarthy July 1, 2013 07:29 AM
There was a family party this weekend to celebrate my niece's return from Australia, along with the birthdays of her brother and parents, and I was really struck by how different everyone looked.

By different, I mean older.

I'm talking about everybody here--kids too. There were lots of relatives there, including children who I last thought of as babies who had suddenly grown tall and become really articulate and funny. But the grownups struck me the most, because, well, I'm one of them. If they are getting older, I am too.

And yet I feel the same.

Not exactly the same, of course. I know that time is passing--I feel it in my bones, and see it in the mirror. But even though I'm approaching my 50th birthday, inside me somewhere is that fantasy you have as a kid, that "growing up" happens to kids but not parents, that life goes quickly when you are young and slows down when you get older. It's not easy to face mortality, let alone the fact that I am headed toward becoming an old lady.

Last night, as I was reading in bed I heard my 7-year-old crying. I went in to the bedroom and sat on the bottom bunk. "What's wrong?" I asked him.

"Things are changing," said Liam. "I don't like it."

Liam has had a terrible time with leaving first grade. He adores his teacher, Mrs. Forrest. He loves his classmates. He is also a creature of routine, and ever since school ended, he's been off kilter. Right before bedtime, it hit him that the fact that his sister had sewing camp in the morning meant he wouldn't be able to play with her--yet another change in his routine. I think that (along with being tired from the aforementioned family party the night before) did him in.

"I want things to stay the same," he sobbed.

No, you don't, I told him. Because if everything stayed the same, nothing would happen. You wouldn't meet any new friends--or new teachers. If everything stayed the same last year, I pointed out, you'd never have met Mrs. Forrest--who will always be your friend. Change brings us new adventures. Change brought us you: you were our surprise baby. 

He nestled in to me, all warm and smelling of soap. Some things don't change, I told him. Daddy and I will always be your parents and always love you, forever. You have your family, and they will always love you too. 

I kissed him good night again and thought: I should listen to myself.

Because, really, I like the passage of time. It's exciting to watch my children grow from babies into toddlers into gangly children and then awkwardly and amazingly into adults. It's fascinating to see how situations and people turn out; it's the passage of time that ultimately works things through. Even though not everything works out the way I hoped, each day is a new chance to make things right, or at least better, and to try new things. And as much as I might complain about gray hairs or the effects of gravity, I am having a wonderful time.

As for being an old lady...once, when my grandmother was 85 and I was 25, she said that she would much rather be her age than mine. She was a tremendous woman, who had lived a very full life, including raising four children, traveling, writing and living through all sorts of joy and tragedy. It was good to be through the hard years, she told me. She liked being old.

I bet I'll like it too--and I have 35 years before I get to 85. All sorts of adventures can happen in 35 years. Bring it on.

A wonderful illustration of the passage of time: my oldest two in 1992--and 2012.

m-z 1992.jpg

m-z 2012.jpg

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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