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The 5 Best New Year's Resolutions for Parents

Posted by Dr. Claire McCarthy December 30, 2013 08:32 AM
2014.jpgIt's New Year's Resolution time--and as a pediatrician who is always talking to families about ways to live healthier and happier, I can't let the opportunity pass. 

My advice is kind of obvious. I get that. But as someone who spends an awful lot of time listening to how families live their daily lives, well, just because something is obviously a good idea doesn't mean it automatically or even frequently happens. We all have some room for improvement.

And that's how you should think about it: as room for improvement. So many New Year's resolutions don't get kept--mostly, I think because people get too ambitious, set goals that aren't really practical, and then give up. With each of my suggestions, all you really need to do is lean into them. Try things out. Make small changes. They add up. 

It's worth making these changes, really. Because each one of them is about habits that can make your child--and you--healthier and happier not just for now, but for life. So here are my top five:

1. Give your family a healthier diet. There's lots of ways to do this, obviously. But the best things you can do are to add more fruits and vegetables, cut back on sweetened beverages, and limit junk food and fast food. Like...pack water instead of juice for school snack, and swap out an apple for those chips. Get in the habit of including a fruit or vegetable with every meal, even if only a few bites are eaten. Do some meal planning on weekends, and maybe put together a casserole (with no-cook noodles, making lasagne ahead of time is wicked easy) so you're less tempted to grab fast food on the way home.  The Healthy Family Fun and websites have lots of great recipe ideas. 

2. Get your children active. The goal is an hour a day of physical activity; anything toward that goal is great. And really, "active" is the key word. Active play is fine, although running around the house (which is what lots of parents point to when I ask about activity) may not quite be enough. Playing outside is better--and really, you don't have to hibernate all winter. Layer up and go outside! There are lots of indoor things to do, too--like swimming lessons, martial arts classes, indoor rock climbing (my son loves that!), roller blading or basketball. The Healthy Family Fun website has information about things to do in the Boston area. Check out your local YMCA and city recreation department, too. 

3. Be more thoughtful about media and screen time. Notice I'm not telling you to shut the screens off--I get that they are here to stay. But we could all do a better job of being more thoughtful about the kinds of media our children interact with--and how much time they spend with them. Take a hard, honest look at your family's media habits. Limit violent or sexual content for everyone (it truly has effects you don't want)--and for little kids, try to limit media in general, especially fast-paced cartoons, as they can mess up learning and behavior. The Common Sense Media website has great ideas and reviews that can help parents make the best decisions--and find media that can be good for kids. If you have tweens or teens, talk to them about social media, and help them make good choices about how they use it. 

4. Make sure your children have time and space for creativity, relaxation--and independence. Too many children are overscheduled--and have too many decisions made for them. This is another place where parents need to take a hard, honest look at their lives and habits. Children need to play, use their imagination, choose their own activities...and make their own mistakes. It's really crucial for their mental health--and overall success in life.

5. Spend more time together as a family. Have more family dinners (with the TV off)--they lead to better nutrition, better school performance, and better teen behavior, it turns out. Game Night is another way: I had a blast the other night playing Anomia with my daughters--and our Apples to Apples game on Christmas Eve was pretty funny (even the 8-year-old enjoyed it). Exercise together--take walks, go to family swim. Build a snowman together. Visit a museum (check out the museum pass program at your local library for discounts). Try to do something once a week. You might just be surprised how much fun you have. The connections you make with your family can make all the difference--for your child, and for you.

Happy New Year--may 2014 be a really great one for you and your family.

How Santa almost ruined Christmas Eve: when good ideas go bad

Posted by Dr. Claire McCarthy December 27, 2013 07:12 AM
Screen Shot 2013-12-27 at 5.38.05 AM.pngBecause of Santa Claus, my youngest child was certain that he was going to ruin Christmas for everyone.

Somehow, I don't think that's how it's supposed to work.

Liam is 8 and believes firmly in Santa Claus. It's very sweet. His four older siblings think it's sweet too, and help by doing things like talking about hearing hoofbeats on the roof, or hiding Amazon boxes, or weaving stories to answer Liam's innumerable questions. Michaela, 22, got the NORAD app on her phone so that Liam could track Santa on Christmas Eve.

"It says that he usually comes between 9 and 12," she told him. "But he only comes when everyone is asleep."

Almost immediately, Liam got anxious. "Everyone needs to go to bed," he told us. "We've got time," said Michaela. "He's in Brazil."  Liam was not convinced.

I put Liam to bed. When I went up with his sister a half hour later, he was still awake, and getting worried. "What if I can't fall asleep?" he asked. "You will," I told him.

An hour later, he called me up. "I'm still awake," he said. "Don't think about sleeping," I said. "Make up a story in your head or something." I got the Christmas presents out with the help of the older kids (my husband was working the night shift) and at 11:25,  just as I was putting the last of the candy in the stockings, Liam's head peered around the corner. "I can't sleep," he said.

I dove on him and pulled him out of the room, thanking God that he left his Coke-bottle glasses upstairs, and brought him back to bed. I climbed in with him; his face was wet with tears. "If I don't fall asleep," he said, "Santa won't come and nobody will get presents."

"Oh, sweetie," I said, "I'm sure he will." "No, he won't," sobbed Liam.

I shut off the lights downstairs and brought Liam into bed with me (he said that might help). He looked at the clock: it was 11:38. "There won't be any Christmas presents," he said through tears. I held him and stroked his head. "Santa will come after midnight if you're not asleep," I said. "You don't know that," he said. "You don't know what Santa will do." But I do, I thought. "He always comes, honey," I said, but it didn't help. 

Right about then, my 21-year-old son decided to finish up his handmade gifts and wrap them. For reasons that were not fully clear to me, this involved lots of opening and closing doors--directly beneath my bedroom. Liam tossed and turned every time the doors closed. I texted Michaela to tell Zack to stop, but he didn't. I turned the clock so that Liam wouldn't see that it was 11:53; he was crying so hard he was shaking. Finally, I climbed out of bed, went downstairs and told Zack off in a, well, not very Christmas-y way. "I'm wrapping presents," he said reasonably. "Not here you're not," I snapped back, completely unreasonably, and stomped off.

As I got back in bed and held the trembling Liam close, I thought: this is ludicrous. The gosh-darn presents are under the tree. My younger son is a mess, and I just reamed out my older son on Christmas Eve for wrapping presents....because of Santa?

Like I said: not how it's supposed to work. How is this a good idea? And on top of everything, Santa gets all the credit for the presents. Totally ludicrous.

Liam settled, finally, and drifted into sleep. He woke in a panic on Christmas morning; he ran downstairs and came back to tell me that Santa had come after all. "I told you he would," I said. "He almost didn't," said Liam.

It all passed, of course. Liam forgot all about it once he opened the Star Wars toys Santa brought, and I apologized to Zack, who was very gracious and understanding about the whole thing. But I'm kinda feeling like after 23 Christmases with children I might have hit my Santa wall. We might just need to have a talk with Liam before next Christmas rolls around.

Although, as I think about how completely excited Liam was to see the bootprints of ash Zack made outside the fireplace...well, we'll see. Another year or two might not be terrible. 

As long as we get to bed earlier.

My Christmas wishes to you

Posted by Dr. Claire McCarthy December 23, 2013 10:11 AM
xmas tree.jpgIt's nearly Christmas. In our house, we are making the last-minute preparations: the last-minute food shopping, the search of all the hiding-places to find those things we could have sworn we bought but now can't find, the quick trip out for more tape and wrapping paper (and to buy those things we can't find--or completely forgot to buy). It's a scattered, stressful time--but the kids are so excited that we can't help but be excited too.

And as we do all those down-to-the-wire things, I just wanted to pass on my Christmas wishes to each and every one of you.

May everyone be well--may nobody get sick, or hurt. (I am sick right now--I am quarantining myself and hoping for the best. Last year Natasha had a fever throughout Christmas...that was a drag).

May there be minimal arguments (it's rare for a family to have none, but may they be small and brief) and may people be (mostly) pleasant to each other. 

May the food you cook turn out the way you want it to. At least some of it. 

May people like the presents you got them (or fake it really well)--and may you get at least a couple of presents you like (and may there be gift receipts or really great re-gifting possibilities for everything you don't). 

May the tree stay upright (I'm still amazed our Bernese Mountain Dog puppy hasn't toppled ours over) and nothing (of value) get broken. 

May everyone (or at least enough people) chip in with the cooking, cleaning up and other chores.

Most of all: may you find happiness in the people around you. May you have at least one moment (hopefully many) where you look at the person next to you and think: this is good. I am happy

Merry Christmas to all. 

Rethinking antibacterial soap

Posted by Dr. Claire McCarthy December 19, 2013 08:04 AM
soap.jpgWhen it comes to staying healthy, it turns out that washing with plain old soap is a better idea than washing with antibacterial soap.

This sounds counterintuitive. After all, bacteria are germs, and we want to get rid of germs--wouldn't something "antibacterial" be a good idea?

Not so much, says the Food and Drug Administration (FDA). Apparently studies show that antibacterial soaps don't prevent illness any better than regular soap. And (this part is scary), some of the chemicals in antibacterial soaps, like triclosan and triclocarban, may cause health problems if used over years--they may have hormonal side effects.

There's also the pesky problem of microbial resistance. When we use a lot of chemicals specifically designed to kill bacteria, what can end up happening is that we kill off a lot of the weaker strains of bacteria--leaving the stronger strains to multiply and take over. Not only that, many of those "weaker" strains actually help keep us healthy--when we wipe them out, we mess all sorts of stuff up. 

I should say that it's different for hospitals, where being really germ-free is crucial. It's also different if you have a newborn, or if you or someone you live with has a problem with your immune system. In those situations, you want to use plenty of hand sanitizer--and talk to your doctor about what soaps you should use to wash. 

As with so many things in life, it's about finding the right balance between risk and benefit, both when it comes to bacteria (some are good, some aren't) and soap. The best way to keep anything in balance is to not go to one extreme or the other, and the same is true of washing. It's not a good idea to skip washing--washing your hands regularly is the best way to fight infection. But when doing that washing, it's not a good idea to use strong chemicals.

Plain old soap and water, like we used when we were kids, will do just fine.

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. 

Don't drink unpasteurized milk!

Posted by Dr. Claire McCarthy December 16, 2013 08:22 AM
raw milk.jpgIn these days of alarming news about how food gets made and processed, as we hear about antibiotics and pesticides and hormones, I can understand how people might think that drinking raw milk is a good idea. If it's "raw", that must mean that it's more natural, free of anything bad and good for you, right?

Wrong. Big time.

Nutritionally, raw milk and pasteurized milk are the same. One is not better than the other when it comes to protein, calcium, milk sugars or anything else. But there is one important way that raw milk and pasteurized milk are different: raw milk can make you sick. 

Think about it. As the milk comes out of the udder, it touches the animal's skin. And while some barns are incredibly clean, well, it's not like cows (or goats) use toilets and wipe carefully. The milk comes into contact with the hands (or gloves or clothing) of the person milking, or the machine that does the milking, and it's unlikely that any of those are bacteria-free. It sits in containers that aren't bacteria-free either. Insects are known to hang out near animals, and sometimes they get into milk.

Even if you could make all that perfectly clean, or you could drink it straight from the (wiped clean) udder, it's possible that the milk itself could have germs. After all, milk is a bodily fluid; infections get passed into it. As with people, you can't always tell when an animal is sick--especially if it is early in an illness.

According to an article just published in the journal Pediatrics, between 1998 and 2009 consumption of raw milk or milk products in the United States resulted in 93 illness outbreaks, 1837 illnesses, 195 hospitalizations and 2 deaths. Most of these illnesses were from Escherichia Coli, Campylobacter or Salmonella bacteria.

That's why the American Academy of Pediatrics (AAP) strongly recommends that pregnant women, infants and children not consume any raw or unpasteurized milk or milk products. (They can be dangerous for anyone of any age who has problems with their immune system, too). The AAP also endorses a ban on the sale of raw or unpasteurized milk or milk products throughout the United States.

Many states do have bans--but the majority don't. Here in Massachusetts raw milk can't be sold in stores, but it can be sold from farms. There are some regulations and requirements around storing and testing it, but none of the regulations and requirements can make the milk as safe as it would be if it were pasteurized.

When milk is pasteurized, it is heated up to at least 161 degrees for greater than 15 seconds, and then rapidly cooled. This goes a long way toward killing the dangerous germs that can get into milk. 

Some people argue that the good bacteria get killed along with the bad. That may be true--but it's really easy to get "good" bacteria into your system in other ways, like by eating yogurt with active cultures. You don't need to risk infection to get good bacteria.

As for the argument that drinking raw milk helps prevent allergies or asthma or autism, well, there's just no scientific data to show this to be true--and allergies, asthma and autism are things we have studied, and continue to study, very closely. 

I'm all for diets that are full of natural, unprocessed and organically grown foods (although you don't have to give your kids all organic foods--see my post from last year). But food safety is just as important. When it comes to dairy products, pasteurization is the way to go.

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. 

Let's not let more children be shot

Posted by Dr. Claire McCarthy December 13, 2013 08:35 AM

I can't believe it's been a year since the Sandy Hook shooting. If I close my eyes I can see the footage again, and feel exactly how I felt when I heard the news. It was a tragedy that hit me particularly hard, as my youngest was in first grade--in a classroom right off the school lobby.

Did you know that gun injuries to children, teens and young adults cause twice as many deaths as cancer, five times as many deaths as heart disease, and fifteen times as many as infections? Did you know that they are the second leading cause of death for our youth?

Did you know that the number of children killed in one year by gun-related injuries could fill 134 classrooms?

After the Newtown tragedy, it actually seemed like we were going to get something done. There was something about the sheer horror of twenty first-graders being gunned down that seemed to break down the walls between us. People stepped off their soapboxes and began to work together to prevent another tragedy, to keep children safe.

And then, it fell apart. Not entirely--there has been some progress, and six states have passed legislation. But much of that legislation is being challenged. We are back to being polarized.

I don't have the answers. But as a parent, pediatrician and citizen, I know that we have to do something. In memory of all of those children--the ones at Sandy Hook and the hundreds of others who have died from guns since--we need to come together and keep children safe. Yes, we can and should teach gun safety--but it's going to take much more to make a dent in a public health problem this big.

I agree with the American Academy of Pediatrics. Here's what they recommend:

  • Stronger gun laws, including an effective assault weapons ban, mandatory background checks on all firearm purchases and a ban on high-capacity ammunition magazines.
  • Research into the causes and prevention of gun violence.
  • Strengthening the quality of mental health care and access to services for children.

Check out this powerful video. Together, we can make a difference. We can save lives.

Let's be like Gisele: Share your breastfeeding pictures

Posted by Dr. Claire McCarthy December 11, 2013 07:46 AM
Screen Shot 2013-12-11 at 8.27.53 AM.pngI never expected to say this, but I'm grateful to Gisele Bundchen. 

I'm grateful because of a picture of her--not a fashion picture, but a picture of her breastfeeding her daughter while getting her hair done that she sent out on Instagram. As she described it herself, she's multitasking: getting ready for a shoot, and feeding her baby. She makes it seem totally ordinary. Well, it's hard for anything to seem entirely ordinary when it's Gisele Bundchen, and most of us don't have "beauty squads." But in the picture, it's totally no big deal that her breast is exposed and her baby is on it. She's just feeding her baby.

That's exactly what we need. 

This picture wouldn't cause a stir at all if she'd been feeding Vivian with a bottle. But because there is an exposed breast involved, well, it has caused a stir. That's the part that is a problem in our society. Seeing the picture made me feel like part of a sisterhood with Gisele. ( I never expected to say that, either.)

I breastfed all my children--and sometimes, I would be out and about or simply just not alone one of them needed to be fed. So I would pull up my shirt and feed my baby. And while there weren't many times that anybody actually said anything to me, there were lots of times when people gave me funny looks or made it clear that having me expose a breast was not so okay with them (especially when the baby was distracted and pulled off from time to time, leaving my nipple exposed). I would always try to do things discreetly, but it kind of bugged me that I had to rush to cover exposed skin. After all, I was just feeding my baby. 

I persevered and breastfed in public (my youngest daughter refused to take bottles, so I had no choice). But many women don't persevere--or just feel too self-conscious and uncomfortable about breastfeeding in front of others. So they pump breast milk and give it through a bottle, or give formula. From a breastfeeding standpoint, neither is as good as feeding a baby directly from the breast--that's the best way to ensure a good milk supply, and ensure that the baby doesn't get lazy and start preferring a bottle nipple. Our societal discomfort with public nursing is a real reason many women breastfeed less, or stop, or never start at all. 

Women shouldn't have to feel that way when they are just feeding their baby.

I think we should start a movement. I think we should join Gisele in her social media endeavors. I think breastfeeding women everywhere should post pictures of themselves breastfeeding their babies while doing their ordinary, day-to-day stuff (their equivalent of being made up by a beauty squad.) We could use the hashtag #justfeedingmybaby. I don't think I have any of myself from those days, but I'll happily retweet and like and otherwise promote other moms' pictures--as I hope other people will do as well.

Let's say loud and clear that breastfeeding is just that: feeding. Not every woman chooses to breastfeed, or can breastfeed, but if they do, they should be able to do it anywhere without feeling any discomfort or judgment. It's not a political thing. It's not about sex. It's just feeding a baby. It's wonderfully ordinary.

Go for it: #justfeedingmybaby. 

Thanks, Gisele. 

4 Must-Do's for (Regret-free) Holiday Toy-Buying

Posted by Dr. Claire McCarthy December 10, 2013 08:34 AM
toys.jpgMy youngest informs me daily just how many days there are until Christmas. It's raising my blood pressure--because I am nowhere near done with shopping.

I'm not the only one in that boat. It's crunch time: we are all hitting the stores. But as you do, here are some things to keep in mind to be sure that what ends up under the tree is safe, not just a colossal waste of money--and maybe even good for your kid.

Safety First. As the yearly U.S. Public Interest Research Group Trouble in Toyland report points out, toys can be dangerous--even lethal. To make sure your child plays safe, here's what you can do:
  • Read labels. If it says it's not meant for kids under 3, don't buy it for your 12-month-old. 
  • Be aware of choking hazards--not just for the child who is getting the gift, but for others who have access to it. If you have an everything-in-the-mouth 15-month-old, it might not be the year to get that 1000 piece Lego set for your 10-year-old.
  • Stay away from magnets. Bad stuff happens when they get swallowed--and for all sorts of interesting and puzzling reasons, even big kids swallow them.
  • Projectiles aren't a good plan either. They don't always go where they should. 
  • Don't buy crib toys. There's simply no need, and it's asking for trouble.
  • Careful with anything with strings attached. They can end up around little necks.
  • Check the Consumer Products Safety Commission website for recalls and info about toys that have lead in them.
  • Save the mad scientist stuff for your teen. Chemistry experiments can go bad (my friend Katie and I exploded something once in her basement. We cleaned the glass and stinky stuff up really quickly. I'm still amazed we didn't get hurt.)
  • Be aware of noise danger. Apparently some toys, like the Chat and Count Smart Phone, are so loud they might actually be bad for your kids' ears. And here we were thinking that ear damage from noise was just an iPod and rock concert thing. Sigh. 
Avoid frustration. 
  • Again, read labels. It's not just about safety, but what's age-appropriate. If your kid can't do it, or can barely do it, it's not much fun. Yeah, maybe your kid is extraordinary, but if the Lego set is meant for an older kid, there could be a really good reason.
  • Speaking of Lego sets...back to that 1000 piece set...don't do it unless you've got a patient kid who will keep track of every darn piece until it's done. Keep your child's temperament and personality in mind as you choose a toy. Just because your friend's kid liked it doesn't mean yours will.
  • Read the fine print (eg "some assembly required".) Read reviews (I love that we can do that now--there are many toys I wouldn't have bought my older kids if I'd been able to read reviews). Amazingly, not everything is as easy and fun as the package and commercial might make it seem. 
Look for toys that foster interaction. This is especially true for young children, who really need that back-and-forth with you and other caregivers, but in general it's great to have toys that encourage play with others. Buy a board game everyone can play. Buy books to read to your children. Buy a toy your child can play with her friends. Not only can it be more fun, but it's just plain old good for your kid to interact with others sometimes. And it's plain old good for your family to interact with each other sometimes too. 

Look for toys that make your kid think. That would include toys that aim to teach, like educational software, but I'm actually talking more about ones that make them use their imagination (indeed, that's thinking too!). Like...dollhouses. Or building sets you can build anything with. Or paint and paper. Think about giving your child the starting point of play, instead of the end point.

Two more tips for holiday sanity (and perspective):
  • Use the holidays as an opportunity to clear out some toys that aren't being used anymore. Any chance to de-clutter is good...and kids may be less upset if they know new stuff is coming.
  • While buying for your child, pick up something for a child in need--or even better, donate to a worthy cause, especially one that helps children. Involve your child in choosing the cause. It helps reorient to what the holidays are theoretically supposed to be about.
Happy shopping...may what you want be in stock (and on sale)--and may the lines be short!

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. 

FAQ: how do I know if my child is really sick?

Posted by Dr. Claire McCarthy December 6, 2013 08:03 AM
sick baby.jpg
It's a question all parents ask themselves at some point as they hold a sick child: is my child really sick? Not just kind of sick, but dangerously sick?

Kids get sick all the time. In an average winter, for example, an average kid might get six or more colds--and at least a couple of them could be bad ones. Illnesses are especially common among young children in daycare or school--as much as we try to wipe noses and clean shared toys, germs have a way of spreading. If one kid starts coughing or vomiting, chances are more will too in a few days.

Luckily, with some rest, fluids and TLC most kids weather illnesses just fine. It's rare that they get very sick--but it's important that parents be able to recognize it when it happens. Here are seven signs that parents should watch for:
  • Any trouble breathing. By this I don't mean a really stuffy nose, or a cough that comes and goes. I mean a really frequent cough, or fast breathing, or sucking in around the ribs, or difficulty talking (or crying, in an infant), or looking pale.  
  • Lethargy. We docs get worried if a child is excessively sleepy or weak--not just taking long naps, but hard to wake, hard to get to move or do anything. We also worry if they seem confused, or have trouble doing normal stuff like walking or using their arms and hands.
  • Bad pain that doesn't get better. Babies and toddlers might show this by being inconsolable. If cuddling and some acetaminophen or ibuprofen don't make a difference, that worries us docs.
  • Vomiting everything. If kids can't keep anything down (especially if there is diarrhea as well), it can lead to...
  • Dehydration. You can tell a child is dehydrated if they are urinating much less, have a dry mouth or no tears when they cry. 
  • A high fever (102 or more) that won't go down with medication. For any baby less than three months old, we worry about any fever 100.4 or higher, whether or not it goes down, and some children with medical problems might need to see a doctor for a lower temperature than 102 (check with your doctor). But in general, it's the persistent high fevers, the ones that either stay high or keep coming back that worry us. 
  • Any rash that looks like a bruise. If the spots are dark red or purple, no matter what the size, that warrants a call to the doctor. 
These are all signs of a serious illness--or serious complications of a minor illness. Call your doctor if they happen; if you can't reach someone quickly, go to an emergency room. 

If something your child does--or doesn't do--really worries you, even if it's not on this list, call. Over the years, I've really come to respect a parent's instincts. We doctors are always here to help, but parents know their children best.

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. 

Making the most of the social life of health

Posted by Dr. Claire McCarthy December 4, 2013 01:32 PM
keyboard and stethoscope.jpgWe are getting seriously social about our health--especially those of us with chronic health problems--and it's time we not just realize this, but make the most of it.

Last week Pew Internet released yet another fascinating study about how Americans use the Internet. According to their interviews, adults with chronic conditions are more likely to look up information about medical problems, treatments and drugs than adults who don't have any conditions. They are also more likely to read online reviews about medical treatments (and providers)--and more likely to read or watch information about the health experience of other people. 

People with chronic conditions are also more likely to check in with their doctors about what they find on the Internet. When people with chronic conditions "self-diagnose" from Internet info, 60 percent check that diagnosis with a doctor, as opposed to 48 percent of healthy people who self-diagnose. Part of that reason may simply be that they see their doctor more often.

You could argue that they don't need to self-diagnose if they see their doctor often--but it doesn't bother me at all. There is so much information out there that can be incredibly helpful to patients and families, and it's simply not possible for me to know all of it. People come to me all the time with information they've found online. Sometimes it's something brand new or different that I didn't know about, and we learn together. Sometimes it's something I do know about that I don't think is a good idea--but by talking about it, we still both learn: they learn more about their condition, and I learn more about them and what they think and worry about.

The Internet does something else I can't do: it connects people. As much as I'd like to connect people with the same diagnoses, between patient confidentiality and not knowing who wants to connect (or would connect well), it's not something I can do easily. And yet these connections and relationships can make all the difference for families facing tough diagnoses.

For this, along with the incredible access to information it offers, I am grateful to the Internet; it helps me take better care of patients and families. That's why I think we need to do a better job of making the most of it. We should be suggesting sites, suggesting searches, suggesting questions to answer together.

There are other ways we need to make the most of it, too. One worrisome part of the study was that overall, people with chronic conditions were less likely to be on the Internet than healthy people--and that's after controlling for things like age and income. The researchers called it "the diagnosis difference": for some reason, some of the people who most need the Internet aren't using it. We need to understand this diagnosis difference, and fix it.

We also aren't using technology anywhere near as much or as well as we should. While the study showed that people with chronic disease were more likely to track things about their health (like their weight, blood pressure or blood sugar), and said that the tracking helped them, most of them either track with pencil and paper (43 percent) or keep track of things in their heads (41 percent). A measly 4 percent use apps, and the same percentage use a computer or spreadsheet. 

Given what tech can do, this is a real shame. Those pieces of paper tend to stay at home on the kitchen table instead of making it to my office, and we all know that information doesn't always stay perfectly in our heads. I would love to do more prescribing of apps, but I don't know enough about what's out there to do it. Just the other day, I wished I had a good app I could recommend for tracking headaches (does anybody know one?)--but didn't have time when I was with the patient to search for one. We have the capacity for patients to track things in real time and send the info to their doctors, which could revolutionize the care we are giving, especially for patients with chronic conditions; we just need to make the technology more accessible, both to patients and to doctors.

This our new reality: health, and health information, is moving online and getting social. The sooner we get our act together and make the most of it, the better.

The tightrope of parenting tween girls

Posted by Dr. Claire McCarthy December 2, 2013 08:57 AM
crop 2.jpg

My 12-year-old, Natasha, loves all things fashion. In an attempt to move this obsession into the realm of concrete and creative, I signed her up for sewing lessons. It turns out she has an aptitude for sewing--and now she wants to be a designer. She is even more obsessed with fashion, and what she wears, than before.

Yet another example of a well-meaning effort gone wrong.

There are times when parenting feels like a tightrope walk, all about high-stakes balance. These days, in a society that is all about beauty, media and tech, it feels like there is nothing more tightrope-y than parenting a tween girl. We need to get the messaging right as parents, to combat the sexualization and bullying and help prevent eating disorders. It's scary stuff.

Even though I'm a pediatrician, and even though Natasha is my fourth child to reach adolescence (and my third girl), there are days when I feel like a novice tightrope-walker.

Natasha is more challenging than my others were at this age. She is more social, more intuitive, more connected to and affected by media. She is an uncomfortable mix of awkward and elegant; she is silly and young at one moment, full of attitude and swagger the next. She is pretty and popular, yet shy, uncertain and eager to please...just the kind of kid who can run into trouble with peer pressure.

As a pediatrician, I tell parents that we should de-emphasize physical beauty. That sounds incredibly sensible and straightforward--but sometimes I wonder how exactly to do it. If I tell her she looks pretty, does that make it seem like pretty is important? If I don't tell her she looks pretty, will it hurt her self-esteem? If I suggest we try a different cream for her pimples (I remember being mortified by every pimple I had at that age, and want to help if I can), does it draw attention to them? Would it be better to ignore them? It sounds silly, but every comment or compliment related to her appearance feels tricky and laden.

Food is another hard topic. I go out of my way to relate food to health and not weight, which is what I tell parents to do as a doctor--but is that enough? I limit junk food and sweets, because that's what I think parents should do, but the folks at Boston Children's who work with kids with eating disorders say that if you are too strict it can backfire and feed an eating disorder. Again--more tricky and laden conversations. 

I talk with parents about the importance of teaching media literacy to kids, about helping them understand how it manipulates and distorts. I do this with Natasha, too, but I'm not sure it sinks in. I showed her the really great Body Evolution video (I included it below), but even though it is a perfect illustration of how so much of what we see in the media isn't real, I can't help wondering if it only reinforces the idea that she is supposed to look a certain way. Can a 12-year-old really understand that it's not physically possible to look like Barbie?

It's just so hard to know what to say and do. And I honestly think it's harder than it used to be. There's nothing like media, and social media, to magnify the social drama, body image issues and other side effects of puberty that have always been intrinsic to middle school.

Ultimately, I guess, all I can do is love Natasha and talk to her a lot--especially about her good grades and her ability as a swimmer and her kindness and sense of humor and everything else about her that is strong and good and rises above the drama. That's all any parent can do in any situation, really. We do our best--and hope for the best.

After she finishes the dress she's making, she wants to make a snuggly blanket. Maybe I'll try moving her into quilting instead of fashion. At least for now.

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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