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Ideas for a happier and healthier Thanksgiving

Posted by Dr. Claire McCarthy November 27, 2013 09:49 AM
turkey thing.jpgThanksgiving: it's a mixed-blessing kind of holiday.

Yes, it's great to have family time, and Thanksgiving is a big holiday for that. It's also great to eat yummy food, and Thanksgiving is, more than any other holiday, about food. But we Americans have a way of overdoing things, and whenever you get families together, or travel, stress is possible. So as a pediatrician, here are some thoughts on how to keep a bit healthier, and keep a bit of perspective, as we all start cooking and/or driving:

Actually think of some things you are thankful for. Yeah, I know, it's corny. But hey, it's actually called Thanksgiving--we can't let the opportunity pass. So give some thanks--and make your kids do it too. Whether it's before dinner, or first thing in the morning, or before you go to bed, spend some time saying out loud what you are grateful for. As I've written in lots of blogs before, we are never anywhere near grateful enough--and reflecting on good things can help a mood made grumpy by cooking, driving or problematic relatives. 

If you have to drive, play the games you used to play growing up. Most Thanksgiving travel is by car, with more than half driving at least 100 miles, so there's time to kill. Instead of relying on electronics, play some games together. Like I Spy, or License Plate Bingo. My father and I used to have fun pretending that the letters on license plates were acronyms. YJL could be Yellow Jumping Llamas. QST could be Quick Short Tumblers. You get the idea. We used to have a blast (this is one that works for older kids as well as younger ones). Make up stories with each person adding something, or sing songs (I'd steer away from 99 Bottles of Beer On The Wall--bad messaging and really boring).

Enjoy eating, but stop short of gluttony. The estimates I've found for how many calories each person consumes on Thanksgiving range from 2500 to 4500....whatever the exact number, it's too many. The idea shouldn't be to eat as much food as possible--that rarely works out well. Be healthier, and set a good example for your kids: keep quantities reasonable, and make sure there are veggies on your plate (preferably a lot, but any is good). Speaking of setting a good example...

Don't just sit around all day. Go for a walk. Play an active video game if it's too cold for that, or clear some space on the floor and do some family dancing. Just get moving somehow, and make sure your children do too. As for other good examples to set, and your mental health...

Remember that the success of a relationship, or a family visit, can sometimes be measured by the number of bite marks on your tongue. Take a deep breath, and let it go.

Don't drink and drive. In my researching of Thanksgiving facts, I found one claim that the Wednesday before Thanksgiving beats out New Year's and Christmas for alcohol consumption. I have no idea if that's true (does the anticipation of the holiday really drive us to drink?), but given all the driving that happens on that Wednesday, it made me nervous. Please, be safe. 

Celebrate traditions--including untraditional ones. Traditions can be comforting, and can bring people together. Easy is best. My kids love watching the Macy's parade in their pajamas--and watching a movie after dinner with their cousins (when everyone is too full to move). My husband and I like listening to Arlo Guthrie's "Alice's Restaurant" while we cook. If it's not a fun tradition, ditch it. Do what makes you happy--there's no point in repeating things that don't. Which ties in nicely with my final bit of advice...

Cut yourself slack. Yes, you want to make things nice for your family and guests. But ultimately, I don't think anyone really cares if your house is spotless, if your kids are dressed perfectly or if the mashed potatoes have any lumps. If anyone does, that's their problem. Enjoy yourself and your family. That's about the very best example you can set for your children. 

Have a happy, healthy and safe Thanksgiving.

Scary new statistics about ADHD

Posted by Dr. Claire McCarthy November 25, 2013 06:30 AM
info-4.jpgMore than 1 in 10 children in the United States have ADHD. 

That's astounding--and frightening.

New statistics from the Centers from Disease Control and Prevention (CDC) show that 11 percent of the children ages 4 to 17 in the US have been diagnosed with Attention Deficit Hyperactivity Disorder, or ADHD. This is up 41 percent since 2003, when 7.8 percent had the diagnosis.

Some of that increase is that we are more aware of ADHD and are therefore diagnosing it more. (We are also diagnosing it early; half are diagnosed by the time they are 6 years old.) But some of that increase is real. 

The majority of the kids with ADHD (69 percent) are taking medications. While it's good that they are getting treatment, a study earlier this year showed that taking medications didn't necessarily help kids academically or any other way. Medications can help kids concentrate, but they can't pick what kids concentrate on. Behavioral therapy can make a difference, especially when kids get to learn the life skills they need to manage their ADHD, but not everybody gets therapy or life skills training.

And life skills are what they need, because ADHD is not just a condition of childhood. Another study published this year showed that it often persists into adulthood, and people who had ADHD as children were more likely to suffer from other problems such as alcohol or drug abuse, anxiety, depression or other mental health problems. They are also more likely to try to commit suicide.

I guess that's what's freaking me out about these statistics. This isn't just about a few more active and distracted kids who struggle in school and with friendships and with keeping out of trouble. This is about the adults those kids will grow into: adults who are likely to struggle in many ways too, and whose struggles are likely to affect those around them in just as many ways.

Because there is collateral damage when it comes to ADHD. I watch it play out in families, in the stress it puts on parents and marriages and siblings. It plays out in classrooms, too: these numbers translate into at least two kids with ADHD in every classroom, which can affect everyone's learning. It costs our health care and educational system millions of dollars. Adults with ADHD, besides possibly being perhaps not the best spouses, parents or employees, can end up needing real resources to help them, and those resources cost money too. The ripple effects of 11 percent of children having ADHD could be staggering.

More and more, it's becoming clear that ADHD is a public health problem--like obesity or heart disease or HIV. We will never succeed in tackling it if we don't start thinking of it that way, and give it real attention, thought and resources. But unlike with other public health problems, we don't really understand all its causes--or the best way to treat it. Which makes fighting it hard. It's not just a matter of eating healthy and getting exercise; ADHD is complex, and each person with it is different.

That's why I'm feeling so upset about this report. When it comes to most public health problems, I know what to say as a doctor, community member and mother. When it comes to ADHD, I don't. I can help individual patients and families, but I don't know how to even begin to make a dent in the overall problem.

That's what needs to change. We need to take this problem seriously, as seriously as we've taken cancer or asthma or influenza. This isn't a problem of a few badly-behaved kids; this is much bigger and more dangerous. We need to find better ways to prevent and treat it.

There are lives that need saving. Let's not wait any longer. Let's get started.


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. 

Five Things You Need to Know About Antibiotics

Posted by Dr. Claire McCarthy November 21, 2013 06:59 AM

getsmart-logo-600px.jpgIt's Get Smart About Antibiotics Week! 

Antibiotic resistance is one of the biggest public health problems in the world. Bacteria want to survive, just like any other living thing--and the more they get exposed to antibiotics, the more chances they get to adapt and become resistant. Because of the way we have been using--or rather, misusing--antibiotics, many of them just aren't working as well as they should.  That means we don't have all the weapons we need to fight infections, some of which can be deadly. 

That's why the Centers for Disease Control and Prevention (CDC) really wants to be sure that people know the important facts about antibiotics and their use. Here are five things everyone should know:

1. Antibiotics don't cure all infections. They only work (when they work!) against bacteria--they don't do anything against other germs such as viruses, which are the cause of the common cold and the other upper respiratory infections so many people get each winter.

2. Antibiotics have side effects. As with any medication, things can happen when you take them. Stomach upset and diarrhea are common, as are rashes, but more serious side effects are also possible. In fact, among children the majority of the Emergency Department visits for bad reactions to drugs are for reactions to antibiotics.

3. Up to 50 percent of the prescriptions written for antibiotics (both inpatient and outpatient) aren't necessary. Far too many people go to the doctor with a cold--and leave with a prescription for antibiotics. Yes, this is in large part the doctor's fault (the CDC is working on that, too)--but it helps if people don't go to the doctor expecting that prescription. 

4. You should never take antibiotics that were prescribed for someone else--or antibiotics that are left over from a previous infection. This isn't like taking Tylenol; antibiotics should be prescribed by a health care provider for a particular person for a particular infection. 

5. If a doctor prescribes antibiotics for you, it's really important that you take them exactly as prescribed. It's always good to question whether or not you really need an antibiotic. But if the doctor says you do, take it and take it all. If you don't, not only might you stay sick (which is a bummer), but you could increase the chances of resistance.

To learn more about smart use of antibiotics, visit the CDC's Get Smart About Antibiotics page--and check out their PSA video:

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. 

My plea to the Massachusetts Legislature: don't hurt kids as you reform welfare

Posted by Dr. Claire McCarthy November 18, 2013 08:21 AM
welfare.jpgHere in Massachusetts, our House and Senate are in the thick of figuring out a welfare reform bill. A version was passed in both the House and Senate, and they are working out their compromises as I write this--it may even have been worked out.

I'm nervous.

I'm all for being sure that taxpayer money is spent wisely. There's just not enough money for any to be wasted. We want to do everything we can to be sure that the people who are getting benefits really need them, and that we fight fraud and get people back to self-sufficiency as soon as possible.

But as we make changes and reforms to reach this worthy goal, there's something really important to remember: there are children involved.

Thousands of children in Massachusetts rely on welfare benefits for their food, housing, heat and clothes and other basic needs. Their families rely on that money for day-to-day survival.

We don't know what the final bill will look like--or if it will pass. But in reading about what's been discussed, here are some parts that worry me and others who care for poor families:

  • Work requirements should be reasonable and fair for parents with disabilities. Anyone who can work should work, plain and simple. But many parents with disabilities can't--and the way the bills are written now leaves things very vague in a way that could put many families at risk of losing their benefits. It needs to be clear, and it needs to make medical sense.
  • Job search requirements should make sense. Of course people should look for a job. And given how little welfare actually pays, most people I talk to would way rather have a job than be on welfare. But it can take time to look for a job--and you need childcare, and a way to get to interviews. Not that people can't figure this stuff out. But we need to be realistic and fair with families. 
  • Rules for reapplying for welfare should make sense too. If people need to reapply for benefits after being off them, we should look at their current situation, not their situation when they were on benefits before. Things change. That's why they are reapplying.
  • Education and training are crucial. That's how people get off of welfare, so it's a worthwhile investment. Which is why...
  • Getting a college education should count for something. It can be a family's ticket out of poverty--and off of benefits--forever. Yes, lots of people work while they are in school--but when you have kids, that gets harder. It will cost us less in the long run if we support poor parents while they get a degree.
  • We shouldn't make pregnant women work longer than is safe. Both versions of the bill are a bit unclear as to how long a pregnant woman has to work. That should be very clear--and ultimately decided by the woman's doctor.
  • The families of legal immigrants need somewhere to live too. There are provisions that could stop some lawful immigrants from applying for public housing. These are people who have played by the immigration rules--we should play fair too.
It's easy to say, and mostly true, that we should pull ourselves up by our bootstraps--but we need boots first. And whatever your stance is on bootstraps, it's our responsibility to keep our children safe and well.

My advice for head lice: comb them out.

Posted by Dr. Claire McCarthy November 15, 2013 08:20 AM
head lice combing.jpgI've been seeing and hearing a bunch about head lice recently. I'm not sure why; maybe it's because school is back in full swing and the weather has grown cool enough that more kids are wearing and possibly sharing hats.

Whatever the reason, there have been a bunch of itchy kids and freaking-out parents. My advice to them? Buy a good comb, and get ready for some quality time together.

It's totally understandable to want a quick fix when it comes to the creepy crawlies. My entire family got infested about a decade ago, and I still itch when I think about it. But when it comes to head lice, quick fixes are hard to come by. These are hardy buggers. 

I think it's fine to use the over-the-counter creme rinses, which are generally permethrin or pyrethrin. They can help, and they may even get rid of a mild infestation. I always recommend giving them a try. But I would caution against stronger treatments such as lindane or malathion; they have real possible side effects. And when something as side-effect-free as combing can do the trick, I can't see why anyone would risk using pesticides on a child's head.

Another positive for combing is that it gets rid of nits, the eggs laid by lice. Even though most nits that are an inch or more out from the scalp are empty and/or dead (which, along with the fact that lice don't jump or fly, is why No-Nit policies don't make sense), school nurses, other parents and friends can get alarmed when they see them. Combing them out saves you all that headache.

Here's what you need to know to make combing work for you:
  • Buy the right comb. You need one with long metal tines that are very close together. The LiceMeister is a good example, but there are various ones out there that will do the trick. Do not rely on the one that comes with the lice treatments.
  • Set time aside for combing every day. Whether it's quick or long depends on how much hair your child has. At the beginning, when there's more to get out, it will take longer; after a few days, it should go faster.
  • Have good lighting, and a cup of water (or sink) nearby for cleaning the comb after each swipe.
  • The hair needs to be tangle-free or the comb will get stuck. You can put conditioner on and do it in the tub, or use detangling spray.
  • Separate the hair into sections, and comb from the scalp out. The nape of the neck and behind the ears are where lice are most likely to hang out.
  • Use distractions, like a video, while you comb. Or make up stories together. 
  • Keep combing every day until you've gone 8-10 days without finding anything--that's how long it takes for an egg to hatch. 
It's a good idea to comb everyone in the house, to be on the safe side. And speaking of the house...lice don't live very long off of people (and don't fly), but there are a few things you should do:
  • Make sure everyone has their own brush and comb. No sharing allowed.
  • Wash all hats and clothing in the hottest water possible, and forbid any sharing until the infestation is over.
  • Wash bedding regularly in the hottest water possible. If things can't be washed, put them in the drier on the hottest setting possible (this is a good way to deal with stuffed animals).
  • Vacuum furniture regularly. Don't buy the anti-lice furniture sprays--they can be toxic, and vacuuming works just fine.
If things aren't getting better, talk to your doctor for advice. But most of the time, with patience and perseverance, you can get rid of head lice--without any chemicals. And while most of us would rather have a different sort of quality time with our children than combing out lice, any excuse to spend extra time together is, in my opinion, not a bad thing.

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. 


PG-13 movies and the weapons effect: parents, take action

Posted by Dr. Claire McCarthy November 12, 2013 11:06 AM
pg-13.jpgHere's a scary fact: Since 2009, PG-13 movies have contained as much or more violence as R-rated movies.

It's true, according to a study published in the journal Pediatrics. Violence in all films has doubled since 1950--but the increases in films geared for youth is striking, and disturbing. Gun violence in PG-13 movies has more than tripled since 1985. 

When we think about PG-13 movies, we generally think of them as being fine for youth. Maybe not really young children, but certainly fine for older kids. But that really may not be true.

It has to do with something called the "weapons effect". It turns out that the mere presence of a gun can make people more aggressive. In a study done in 1967, researchers had subjects give electric shocks to people (accomplices of the researchers) to evaluate them on tasks. On the table in the room were either two guns, badminton equipment, or nothing at all. The subjects were told that the objects were left over from another experiment and the researchers forgot to put them away. They were told to ignore them, but they didn't; if the guns were in the room, subjects delivered bigger and more shocks than they did if there was badminton equipment or nothing at all.

Yes, 1967 was a long time ago--but there have been lots of studies since that have shown the same thing. The mere presence of guns makes people more aggressive. Even seeing the word "gun" has an effect.

So what does it mean for this generation of children, growing up with so much depiction of violence in the media?

It's not just the psychological effects of guns. As the study authors point out, youth learn how to solve problems by watching how others solve problems. Too often, what they are seeing is that the way to solve problems is through violence.

This has real and frightening implications for the behavior of our youth--and the well-being of our society in general. This is something we need to react to. 

I don't think it's possible to stop our children from being exposed to violence. I think that ship has sailed. But I do think that we can try to limit it. I think that parents can be more thoughtful about what movies their children see; at least when they are young, parents can exert control. We've all had the experience of going to violent movies only to see young children there--that's just unnecessary. Somehow, we need to do a better job of getting the message to parents that ratings are there for a reason. 

But also, I think parents have to have more conversations with their children about the violence they see. We need more processing and debriefing. Violence has become so common that it's easy to just let it pass--but that's a mistake. We need to talk to our kids about how it makes them feel, about why violence is bad, and about how there are better ways to solve problems. If we don't say anything, we let media violence do the talking for us.

So think about it. Do your homework before letting your child see something--read reviews (Common Sense Media is a great site for this) and find out exactly what's in the movie. Think about whether it is a good idea for your child to watch it. Help youth make good choices (or make better choices for them), and if you haven't already, start talking.

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. 

Talking to children about Typhoon Haiyan

Posted by Dr. Claire McCarthy November 11, 2013 08:23 AM
typhoon.jpgThe reports are coming in about the destruction in the Philippines from Typhoon Haiyan, and it is staggering. Thousands are dead. There are stories of children being ripped from their parents' arms by the storm, and corpses on the streets.

As much as we might like to keep horrible news like this from our children, unless your children are very small, it's hard. Even if you manage to keep your house media-free (including newspapers), other families don't--and children talk to each other. 

Here are some thoughts on what parents can do:
  • Be careful and thoughtful about the media images your children are exposed to. The images with the most devastation and horror are the ones that are likely to get picked up by TV and the Web, and those are exactly the ones that are toughest for children to see (toughest for anyone, really), especially video images. As mesmerizing as it might be, it's best to look at those images without your children--or keep their exposure really brief.
  • Be truthful in your explanations of what happened, but keep it brief and leave out gory details. There was a very bad storm that hit the Philippines. Many people were hurt or killed, and and it destroyed a lot of buildings. Lots of people are doing everything they can to help.
  • Focus on the heroes and helpers. There are always stories of ordinary people saving lives, and of all sorts of people doing extraordinary things to help. As those stories come in, talk about them more.
  • Reassure children that events like these are very rare. This was an extraordinary storm. The Philppines, too, as a country of islands with lots of small and lightly constructed houses, was particularly at risk for destruction. This is not the case for us here in Massachusetts. Yes, we are on the coast and yes, bad storms happen. But what happened there is really unlikely to happen here.
  • Talk about all the ways that people work to keep them safe from natural disasters--and talk about ways that they can keep themselves safe. The Centers for Disease Control and Prevention has information about preparing for a hurricane--you can use that as something to talk about.
  • As a family, choose a way to help. Three organizations that are on the ground helping already are The Philippine Red CrossThe World Food Programme (you can also text the word AID to 27722 to instantly donate $10--I did it, it works) and UNICEF
Hug your children. Hug your partner. Call your mother. I feel like I say this all the time in lots of different blogs, but we are nowhere near grateful enough for what we have.

Going back to school after a concussion: what parents need to know

Posted by Dr. Claire McCarthy November 7, 2013 08:06 AM
school after concussion.jpgWhen an athlete gets a concussion these days, we have rules and guidelines to help us decide when it's safe and healthy for them to go back to sports. But when it comes to going back to school (for athletes or non-athletes), well, it's a lot fuzzier.

We keep kids out of sports after a concussion both to prevent a second concussion (we know that getting another shortly after the first can lead to worse or permanent brain damage) and because physical activity after a concussion makes symptoms worse and can make recovery take longer. It turns out that the same is true for "cognitive activity", things like reading, writing, concentrating, watching videos or even thinking. Lots of stimulation by light and noise and activity can also be hard for someone who just had a bad bump to the head.

It's also just plain old hard to do schoolwork if your head hurts, you feel dizzy, you have trouble concentrating or you can't sleep at night. It's not really fair to ask a kid to do it, let alone expect them to do well at it. 

That's why the American Academy of Pediatrics came out with a clinical report to help doctors, parents and schools take the best care possible of children after concussions. Here's what parents need to know and do:

  • First and foremost: see a doctor. This should go without saying, but it's common for parents to think that if there's no blood involved and their kid is acting more or less okay, they don't need to see a doctor. But any headache after a head bump that is more than a mild one, and any headache that comes with dizziness, vision changes, sensitivity to light or noise, trouble with memory or concentration, or sleep problems warrants a visit to your doctor or an emergency room.
  • Kids shouldn't go back to school until they feel better and are able to concentrate and work for at least 30-45 minutes (which is about the length of the average lesson). This is important: they don't need to feel perfect, they just need to feel better and be able to get something out of school, even if it's just for part of the day and with built-in rest periods. While doctors can help figure out when to send kids back to school, ultimately parents are the ones who need to make the decision, because they know their kids best.
  • Parents, doctors and the school need to work as a team to figure out the best school program for a child who has had a concussion. The school team should have people involved in both academics and physical activity. It's really important that all team members communicate well and often.
  • The amount of work and homework a child gets should be increased slowly, making sure they can tolerate it. This is where the communication becomes really important!
  • If symptoms last more than 3-4 weeks (most get better by then), the child should see a concussion specialist (talk to your doctor about this) and there should be more formal changes made in the child's school program. 
  • Kids should be back to their academic baseline before they go back to full physical activity or extracurricular activities. This is one recovery you really don't want to rush.
I've found that most schools and coaches are really good about helping kids get back on their feet after a concussion. But not everyone knows what to do--and because kids can look and act pretty normal, it's easy for people around them to think they are back to normal when they're not. If you feel your child isn't getting the support her or she needs, talk to your doctor.

For more information on brain injury and how to treat and prevent it, visit the Concussion page of the Centers for Disease Control and Prevention website.

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. 

Telling vs. asking: the trickiness of vaccine discussions

Posted by Dr. Claire McCarthy November 4, 2013 09:18 AM
Thumbnail image for baby getting shot.jpgIf doctors want more kids to get vaccines, it turns out that it's better not to ask parents if they want the vaccines. It's better to just tell them the kids are getting them.

These days, there is a big push in medicine toward shared decision-making. We want patients and families to understand and own their health care decisions--and we doctors want their help in being sure we are making decisions that work for them and their lives.

But in a study of videotaped doctor visits just released in the journal Pediatrics, researchers found that when doctors took a  "participatory" approach to talking about vaccines ("Would you like Joey to get vaccines today?") rather than a "presumptive" one ("Joey is due for vaccines today"), parents were more likely to resist getting them. Like 17 times more likely. 

And when parents resisted, if docs persisted with a Joey-needs-his-vaccines response, half of the parents who had resisted went along with the vaccinations. 

While I am a big proponent of vaccines, this makes me a little uncomfortable.

This study really struck a chord with me, because I am more likely to take the Joey-is-due-for-vaccines approach myself (as were 74 percent of the doctors in the study). I am always happy to talk about any worries parents might have, and I firmly believe that when it comes to any medical treatment, including vaccines, parents are in charge. They should do what they think is best for their children.

But I worry that if I start out with a Would-you-like-Joey-to-get-vaccines approach, parents might think that I'm not sure about vaccines, and I am sure. I worry, too, that it might feel like I am putting all the onus on parents, which could make some of them anxious. Many people would rather have something bad happen "by accident" (like getting a vaccine-preventable illness) than as a result of something they did (like say yes to a vaccine). The risks of complications from a vaccine-preventable illness are always higher than the risks of a vaccine, but being a parent is scary stuff sometimes.

One part of the study that worried me was that in those taped visits, doctors only asked if parents had questions about vaccines a quarter of the time--and talked about why we give them, and possible side effects, a third of the time. That's not okay--and yet at the same time, I get it. Sometimes it feels safer to keep conversation about vaccines to a minimum. 

We have got to find a better way to do this. We have to be able to talk about vaccines, about their importance, about the questions and worries people have, about their risks and benefits and how the decisions families make affect other people around them. 

What do you think? What have you liked, or not liked, about conversations you've had with your doctor about vaccines? What could we do better? How can we docs keep children and communities safe from vaccine-preventable illnesses, and still be supportive and keep the lines of communication open?

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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