Acetaminophen and Asthma

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Although acetaminophen has been used for many years there is evidence to suggest the liberal use of it is not healthy. It can lead to the development of wheezing disorders and can exacerbate wheezing and asthma symptoms in children known to have asthma.

Some drug manufacturers point to the association of viral infections with the use of acetaminophen and say the respiratory problems are due to the viral infection and not the medication but studies do not support this.

At the present time it is best to avoid using acetaminophen by all children with asthma or at risk to develop asthma and use an alternative medication such as ibuprofen when possible. In general, for all children over age 3 months who do not have an allergy to ibuprofen the substitution of ibuprofen for acetaminophen is reasonable.

Future studies will provide more information about the safety of acetaminophen. Until then, caution is the best policy as is limiting the use of acetaminophen to clinical situations where no alternative is available.

A Christmas Birthday

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What does your birthday mean to you?

It was the week before Christmas, and we were making construction paper Christmas cards for our parents.  Glitter, glue and crayons were scattered across the table-top. Sister Marie Rene walked over to my table, put her hands on my shoulders and announced to the class, “Joey’s birthday is on the most special day of the year, Christmas!”  “Do you get extra presents?”  My friend sitting next to me asked.  “No,” I answered.” “So why is it so special?” He countered.

It took me many Christmas birthdays to realize love was the reason my Christmas birthday was so special. My birthday, forever paired to Christmas became a time of giving, sharing, receiving, acceptance and love.

Have you wondered why children only ask for food, warmth, love, comfort and protection yet are often worshipped with favors and material gifts? As perfect beings children do not ask for bows, ribbons, cakes, candles, birthday parties or gifts. What they ask for is love.

After birth infants require love, attention and affection. By age one freedom, encouragement and respect are added as every child develops a sense of self-worth. By the mid elementary years a child learns to give, share, be non-judgmental, accept others and tell the truth. Birthdays come and go, lessons are learned and love is given and received. These lessons are the greatest birthday gift every parent can give a child.

As parents we are prone to forget the simplicity of parenting. We over-engage, indulge and worship rather than teach our children. As we fail to set and enforce boundaries and limits, behavior problems become increasingly apparent.

Many children today drown in a sea of plenty. Your child’s birthday is the perfect time each year to remind yourself and your child about the transience of material gifts and the simplicity of love. Make your child’s next birthday about the essence of Christmas. Be a model for your child. Teach your child the difference between needs and wants and live a life based on giving not receiving. When you teach your child to listen, to touch, to give and to heal you will also be teaching the meaning of love.

Happy Holidays and a Merry Christmas to all!

The Greatest Gift

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What are your three wishes?

“If you had three wishes for anything in the world what would you wish for?” The eight year old looked at me with a puzzled look. “Take time to think,” I told him. His gaze drifted to the ceiling and his breathing slowed. His eyes lowered and met mine. “I want my dad to be okay,” he answered.  “Where is he?” I asked. “Away in the army,” he answered. There was something about his determined look that prevented me from turning away. “You love him very much, don’t you?”  He nodded and his eyes shimmered without tears. “Mom told me he will be coming home soon,” he replied. “You and your dad are my heroes,” I said to him. “I am so proud of you.” The boy nodded and wiped his cheek.

The gleaming eyes of children taught me the gift of gratitude is the greatest gift one person can give to another. I saw how a kind word, a pat on the back, a push on a swing or a bounce of a ball made gratitude visible. Young children do not hide gratitude. They hug, they smile, and they sing to us. They wear it loose and visible like a scarf and often leave it behind without regret. We as adults are the ones who forget to show gratitude for what we have and for what we are given by others as gratitude, our greatest gift, is replaced by material acts of giving.
Gratitude empowers and refreshes all who experience it. It comes from the heart and freely given, enriches everyone. It awakens joy, breeds satisfaction and inspires giving. Gratitude built upon humility, acceptance and trust is the ultimate gift. It helps us to understand, accept and love others.

During the coming holiday season make gratitude your greatest gift. Give it to others freely. Don’t hide it. Display it proudly and watch how others become inspired. Show your gratitude for having the opportunity to wake another morning, take another step, and sing another song or blow out another candle. Make every day a new day, a new chance and a new opportunity. Show gratitude for the love of others near and far. Give thanks for what you have already received. Hear the music. Feel the vibration. Reach out to another and dance. Allow gratitude to become your greatest gift.

The Fussy Baby

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Every infant will have strengths and weaknesses but each one is perfect. Some infants easily self soothe while other so called “difficult infants” are slow to settle. In addition, some infants experience colic. You know your infant better than anyone, and you are in the best position to understand and respond to your child. Infants who have difficulty settling require more time and attention. If you invest the extra time and attention and limit the sensory distractions that bombard new infants and lead to unsettled behavior, you will reap major benefits.

Colic is the name given when an infant has fussy or extreme cranky periods usually in the evening. During these periods all attempts to soothe and settle the infant fail. These episodes can occur anytime during the day and for some infants they occur throughout the day. Most often the peak period is between 6pm and midnight. These fussy periods begin at two to four weeks of age and peak at about six weeks of age. They can last for up to 3 hours and gradually taper to one to two hours by three to four months. About 20% of all infants develop colic. It is normal and does not mean there is anything wrong with your infant. During these prolonged crying episodes infants may cry or scream inconsolably, bicycle their legs and pass gas. They often swallow air and their stomach becomes painfully distended.

Although there is no known cause of colic recent findings support colic being an indicator of a child being at risk for the future development of migraine headaches. Colic is felt to be due to a delay in the ability of the nervous system to self-regulate. Infants with colic appear to be oversensitive to environmental stimuli and have difficulty being consoled. The inability to self-soothe leads to constant crying and associated behaviors.

If you feel your child has colic talk to your doctor. There are several medical reasons for behavior that appears to be colic. These include food sensitivities and gastro-esophageal reflux.  These problems are treatable.

After delivery babies need to learn how to live in a new environment. Sounds, smells and visual sensations abound. Your infant is no longer living in the tight, warm and quiet environment of the womb. Your heart rate is no longer the primary sound your infant hears. This change in environment disrupts many babies. Allow your infant time to deal with the frustrations associated with this change. By providing ongoing unconditional love and support your infant will adjust to the new surroundings.

If you have a fussy baby it is important you remain calm and relaxed. Your infants can sense your emotions and negative emotions can heighten and exacerbate your infant’s behaviors. If you are tense or anxious consider asking someone to give you a break. A brief break allows you to find a positive balance.

Make sure a fussy infant is not cold, wet or hungry. Checking on all “comfort needs” is always the first step in the response to a crying baby. Some infants cry when they need to be burped. If you have concerns that your infant is sick check for a temperature and call the doctor.

If all comfort needs have been met and there is no sign of illness it is time to pursue common interventions for so called high needs babies. Walking with your infant provides a calming swaying movement. Make sure you do not over-feed your infant and consider skin to skin contact. Breastfeeding is always best. Stomach distension can make your infant uncomfortable so make sure to burp your infant. The use of a pacifier can also be very helpful. Sucking lowers your infant’s heart rate, evens out breathing patterns, encourages relaxation, decreases stress and promotes the onset of sleep. Sucking also decreases the risk of SIDS. Distractions such as making shushing sounds, playing soft music or softly stroking your infant’s head from the forehead to the back of the head are other ways to settle your baby. Always try to limit distractions and make sure the room is not too warm or too cold. Infants should always sleep on their backs. It is alright to try some tummy time if this position helps soothe your infant but you must remain in the room and watch your infant. Never leave a sleeping infant on his or her tummy to sleep. This increases the risk for SIDS.

Cry it out (CIO) approaches are not appropriate for infants. It is always best to respond right away to a crying infant and if you notice pre-crying behaviors such as anxious facial expressions, breathing pattern changes or jerky arm and leg movements it is best to pick up and try to soothe your infant.

Role of the Father

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A Father must take an active role prior to the delivery of their new child. The paternal-maternal relationship must be supported and flourish prior to the delivery. The most visible roles of the father have included economic and physical protection. Yet roles of equal importance include the fostering of social-emotional, cognitive, language and motor development.

Fathers must be competent and caring role models. They must be attentive and responsive to the needs of their child. The quality of interaction is just as important as the quantity of interaction and it is important paternal involvement be supported and encouraged prior to and at the time of delivery to prevent fathers from disengaging from the care of their child.

Mothers and fathers can both experience post-partum depression. The added responsibilities, obligations and stress that come with a newborn can lead to depression. Intervention must be sought for post-partum mood changes. Two-way communication between parents and the sharing of feelings are the first steps in the identification and management of post-partum depression.

Although generalizations oversimplify gender patterns of support there are two types of support infants and children must receive. This support may come from traditional gender relationships or from non-traditional gender relationships. Gentleness and security are typical maternal support patterns while independence and confidence building are typical paternal support patterns. Fathers often provide a “rough and tumble” approach to life experience. They teach children how to manage aggressive impulses and how to learn how to control emotions. In this way fathers teach their children how to make their way through the rigors of the outside and often unforgiving world. These skills enable a child to develop the discipline to control emotions and frustrations. This leads to personality traits that support empathy, respect of others and the importance of genuineness.

Fathers must provide a secure, safe and supportive environment for their child. This must begin early in the child’s life and must be linked to the building of emotional competence. Emotional competence allows a child to recognize, respond to and understand emotions and leads to increased self-esteem and self-worth. The life skills that result from this training and modeling foster the development of social confidence and competence. Fathers who teach these skills to their child improve their child’s ability to initiate and maintain friendships throughout their lives.

When fathers engage in vigorous play intellectual development is supported. Children learn how to use their bodies to solve problems and learn the importance of exploration and risk-taking. Fathers support the use of more challenging language and focus on the importance of social communication and teamwork. Vigorous play improves motor skills for both large and small muscle groups, improves hand-eye coordination skills and encourages both one on one and team directed activities. Such activities encourage and support independent thought and behavior for a child.

Fathers are the model of so many important behaviors for children.  The goal of every father is to share what they love with who they love.

Birthmarks in Infants and Children

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About 1% of newborns are born with congenital nevi or moles. These are brown or black in color and may be raised or flat with the skin. They grow with the child and are safe if less than 2-3 inches in size.  Children can also develop acquired nevi or moles following delivery. These are common in Caucasians who have an average of 10-30 pigmented nevi or moles. They often develop after age 5 years.  Warning signs for neoplastic changes include asymmetry, border irregularity and color change. If a nevi or mole “looks different” from neighbor nevi it needs to be evaluated by a doctor.

Sun freckles are common and increase with sun exposure. These dark spots are flat and run in families. They are more prominent in the summer. If your child is prone to freckles then sun protection is a must. Children with fair skin are prone to freckles as well as having an increased risk for skin damage due to unprotected sun exposure and have an increased risk of skin cancer and malignant melanoma.

Hemangiomas are raised red or reddish blue bumps. They are caused by the growth of blood vessels that cause an abnormal amount of blood vessels to grow. They are seen in 2% of infants and often develop after 1-2 months of age. Treatment usually is not needed but depends on size, rate of growth and location. Locations around the mouth, eye, and nose and in the throat raise concern for treatment. If multiple hemangiomas are present then there are concerns about internal hemangiomas on various body organs.

Flat angiomata are called “stork bites or angel kisses”. They are seen on the face an on the nape of the neck. They become more visible when an infant cries or becomes hot. No treatment is needed. They usually fade by school age.

Port wine stains are rare and often indicate an underlying medical condition. This type of birthmark can be seen on the face and limbs. They are large in size and dark red to purple in color. They are not raised.

Tips on Baby Basics

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  • Be attuned and responsive to the needs of your infant by watching, touching and listening.
  • Always provide love, attention and affection to your infant.
  • Breastfeeding through one year of age is always best. Longer is better.
  • Breast feed your new infant every 1-2 hours until your milk comes in.
  • If your infant is urinating 6 times a day and the urine is clear and copious your infant is not dehydrated.
  • A double electric breast pump that is adjustable provides speed and efficiency benefits.
  • Breast milk can be kept in the fridge for four days and in the freezer for 3-6 months.
  • Always thaw breast milk overnight in the fridge or by immersing in tepid water.
  • Keep visitors to a minimum during the first few weeks of life.
  • Safety at home, in the car and out of the home is very important.
  • Dress your infant in layers to help with temperature regulation.
  • Always follow the “Back to Sleep” rules to decrease your infant’s risk of SIDS.
  • The use of a lubricant such as petroleum jelly in the diaper area after every diaper change prevents diaper rashes.
  • Consider giving your infant a soft full body massage with olive oil, coconut or Neutrogena bath oil twice a day to prevent skin dryness.
  • Infants startle due to sudden noises or an unexpected touch or body movement. This is normal.
  • Infants under 6 months of age cannot be spoiled.
  • The use of a body carrier helps both mother and baby.
  • Co-sleeping does have risks associated with it.
  • The best ways to calm a baby include walking or swaying, sucking on a finger or pacifier, upper body swaddling and making sushing sounds.
  • Watch a You Tube video about how to swaddle your infant. Leave the legs loosely wrapped but supported. This helps to prevent hip problems.
  • Infants who swallow excess air often feed less well
  • Three burping positions are the throne and shoulder positions, the belly flop on lap position and the walking strut with baby facing away.
  • Diaper changing stations need proper safety, set-up and hygiene.
  • Chewing, rubbing, cold and rare pain medications are the best ways to decrease teething pain.
  • Avoid cereal and pureed baby food before 4-6 months of age.
  • Never leave an infant alone in a tub and always check the water temperature.
  • Baths 1-2 times a week are often enough.
  • Tummy time can become fun time but it often takes practice and patience.
  • Always look for snooze clues such as eye rubbing and cranky behavior.
  • Sleep schedules are often irregular through 4-6 months of age.
  • After 4-6 months most infants benefit from scheduled naps twice a day.

Grandparent Boundaries

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Grandparent wisdom and advice can benefit your child.  By the year 2030 30% of the US population will be over age 65.  Although many things have changed since grandparents raised children many things have not.  Grandparents can be the best models, mentors and memory keepers for a family. They can also be intrusive, rash and judgmental. Every parent must recognize the perils of this generation gap while at the same time understanding the wisdom and experience grandparents provide.

Whether you are a parent or a grandparent your goal is to keep your child safe.  It is important for parents and grandparents to avoid confrontations that can lead to resentment. Advice from grandparents often feels judgmental. Grandparents must be cautious not to intrude or interfere in the decisions their children make about raising their own child. Many times useful information is presented in ways that cause friction and wounds that are difficult to heal.

Parents must take the time to explain to their parents why they want things done differently in the past. Choose your battles carefully and focus on what is important rather than engaging in a battle for control. By explaining why you want something done differently you will be better able to engage your parents in a dialog concerning the care of their grandchild. This dialog will allow you to address the concerns of the grandparent rather than just telling them what you want done. Always seek middle ground and compromise on minor issues. On important issues always focus on the health and safety of your child and stand firm about the boundaries you set and the decisions you make.

Parents and grandparents must both learn how to suppress their egos. Many Grandparents view parents as children rather than as adults worthy of respect and parents view parenting advice from grandparents as intrusive and interfering. A parental “it is now my turn” mentality leads to discord and inevitable differences in opinion and prevents the development of reciprocal respect.

Parents must be flexible and at the same time set clear boundaries concerning the care of their child.  Grandparents must find the balance between sharing their experience and wisdom while not interfering and avoiding rash judgment and hostility. When parents and grandparents recognize each has a unique perspective to share the value of personal opinions increases.

Some things that need to be discussed include safety issues, discipline and technology. Smoke avoidance is very important. Infants and children of all ages should not be exposed to tobacco smoke. When placed in a crib a “back to sleep” position should always be used. Infants must not be overdressed since overheating increases the risk for sudden infant death syndrome (SIDS). The crib should be free of all toys and bumper pads are not needed. The mattress should be firm and there should be no loose cords that could lead to entanglement and strangulation. Baby powder and fragrances should be avoided and breastfeeding is best.  Supplemental food should not be introduced until 6 months of age. A rear facing car seat is best until age 2 years and a bedtime bottle should be avoided. Infants under 6 months of age cannot be spoiled. If an infant under this age is crying a cry it out (CIO) approach is not appropriate.

Eating patterns have also changed. Portions should be small and never encourage children to clean their plate if they are no longer hungry. A better response is to decrease future portions.  For discipline positive redirection and antecedent management have replaced negative punishment. Finally technology is moving forward rapidly. Technology is now imbedded within the lives of children. The focus should be on setting healthy boundaries concerning the use of technology rather than on avoidance and negative comments about the hazards and dangers of technology.

A Simple Word

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Why is it so hard to say, ”No?”

I picked up my afternoon schedule and nodded yes. My secretary had just asked me if she could add two patients into my afternoon schedule.  Every slot on the day planner was filled, and I wondered how I was going to find time to fit everyone in. I tossed the schedule on the desk as the phone rang. “Dr. Barber your first patient is ready.” Head down, I took a deep breath in and walked out of my office.

Life is an emotional winter storm, chaotic and overfilled with promises and responsibilities. Minutes, hours and days are consumed by endless duties, lists and negative emotions. Parents are overwhelmed by fatigue and limited by time and opportunity. As responsibilities grow hopeful dreams fade, and parents stop living. Frozen and overwhelmed by shame, guilt, anger and fear parents silently accept the next demand, the next responsibility and the next chore.

Your brain is a wonderful instrument. Billions of synapses allow you to debate, disrupt, judge and detail what needs to get done. The brain drives us all to act or not to act, to think or not to think and to perform or not to perform. It becomes the storyteller of acceptance and excuses and the enforcer against saying the word “No.”

Excuses allow parents to say no when the brain is overpowered by inadequacy and negative emotions. Each of us is hardwired not to say “No.”  We want to be powerful and well-liked. We want to be change agents and competent models.  Responding with an excuse rather than the word “No” justifies rather than explains and shrouds us with avoidance rather than acceptance and communication. Excuses are a passive and protective stall tactic that bury our emotions and allow us to hide from and avoid our own feelings.  They harm us physically and emotionally and must be replaced with truth.

The best way do this is to recognize, understand and respond to your own needs and take control of your life by using the word “No.”  This word must be practiced and cultivated. It empowers both the speaker and the listener and allows you to disengage while encouraging the speaker to seek and find another solution. “No” informs the listener you are willing to give up control and makes the listener the agent of change. This heartfelt , mindful and trust filled act informs the listener that you do not have the desire or ability to take on one more task or responsibility and are confident that they do have the ability to find their own solution.

This act of saying “No” is the foundation of self-care. Self-care creates prosperity for all and increases your generosity and future ability to give. It eliminates the need to make excuses for self-neglect and supports responsibility for your own needs. Self-care enriches two-way communication and provides the energy to live an inspirational life filled with love, passion and good health.

Until my quadruple bypass 12 years ago I was an expert excuse-maker.  I always said “Yes” without pause or hesitation looking out and never in. Blind to self-neglect, stress and fatigue I was lost in a storm buried deep within my heart.  That day I woke up. You can too. It starts with a simple word.

Sibling Rivalry for the School-Aged Child

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School-aged children must learn how to name and accept conflicting feelings about a sibling. These children must learn that they will need to cross many small streams during their lives, but they must always be aware that even a small stream after a heavy rain can become perilous to cross. By being aware of this danger most severe sibling rivalry issues can be avoided.

Learning how to recognize, understand and respond to jealousy and competition allows the school-aged child to learn how to build positive and supportive relationships. Learning how to name conflicting feelings is the first step to head off sibling rivalry. By responding to these feelings the older child is also preventing emotions from developing into unconscious drives that result in unhealthy and even risky behaviors. Unconscious drives can easily evolve into destructive behaviors such as tattling, physical or verbal aggressive behavior or the destruction of personal property.

The goal of every parent is to build lifelong positive and supportive relationships between all of their children. By being fair, not having favorites and not comparing children parents are setting a strong positive example of behaviors they support and endorse. This is done by focusing on individuality and not equality. By learning how to give and share in a non-judgmental and accepting fashion, children will be ready and able to reach out not only to sibs but also to others they meet and desire to develop positive relationships with.

Parents must paint a realistic picture of both the fun and less than fun aspects of having a new infant in the family. Infants are fussy, cry often, require constant attention and even require “smelly” diaper changes. By starting early and preparing the school-aged child for the work ahead you are more likely to find a partner in this endeavor rather than an adversary.

Parents who do not set a positive example run the risk of accelerating negative rivalry issues and supporting the evolution of negative behaviors. Parental responses must focus on being fair and never comparing children. There can be no favorites and unconditional love and support must be provided daily if your child is to have a secure sense of security. Weekly family meetings where the importance of love, unity, trust and positive self-worth are discussed can also be very helpful. It is essential all participants understand that everyone is entitled to an opinion and no one has the right to change or control the behavior of another. Parents must learn how to listen during these meetings, acknowledge the feelings of participants, sum up the situation and then support the development of a dialog between the participants. This is done by asking for solutions rather than providing solutions. Criticism must be avoided and positive behaviors supported.

The aim of a parent is to focus on prevention of rivalry rather than directing blame on a specific behavior or child. By learning how to arbitrate rather than judge parents are less likely to be drawn into a conflict where there is no right or wrong. This also prevents alienation and supports the ability of every child to resolve conflicts in a respectful fashion.