T shirts

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Often, the difference between success and failure is a willingness to accept and learn from failure.

A few weeks ago a teenager caught my attention with a T shirt that read, “I am not done until I have won.”  Stepping to the side, I watched him walk away and wondered if he understood those complex words.  Few of us have the opportunity to experience one day, one month or one year without the taste of failure.

Every child fails. Whether it is a dance step, a spelling word or the swing of a bat your child must learn how to recognize, respond and accept failure.  Parents are tempted to shield their child from mistakes, loss and lack but this is a false victory.  Children raised in a staged world are tempted to forget the power of sadness.  Sadness, anxiety, fear and grief although difficult to see in the eyes of your child are emotions that teach resiliency and the authenticity of life.  Children, teens and young adults who tip-toe through life are blinded to the limitless power and freedom found within unsuccessful exploration and experimentation.  Your support allows your child to become gracious in defeat and willing to try again no matter what the odds.

Every toddler must learn to accept and expect falling before learning to walk.  When your child takes that first wobbly step he says to the world:  “Here I come!”  Falling and failure are your concern not his.  As he falls to the ground he looks to you for support.  By responding with love and satisfaction rather than fear of failure your child will try again and again.  Attuned to your response your son or daughter focuses on doing and not on achieving.  Falling teaches your child the world is safe not dangerous and fear of failure is replaced by a willingness to explore.

Children are frequently faulted for not trying hard enough or long enough. They grow up believing success is the only goal in life.  Such teaching becomes a learned response and is not a sign of character or fortitude.  Rather than teaching success is the Holy Grail to be sought and achieved, we must teach children to believe in themselves and the process of trying.  Mastery of this belief depends upon authentic encouragement and approval from those they love.  Such support allows your child to pursue ever more challenging explorations inspired by resilience and broadened by independence, judgment and insight.

Never forget life’s greatest learning opportunities come not from what we do right but from what we do wrong.  Living is about learning and growing and not about winning.  Acceptance of our failures makes winning and losing both gifts.

Anaphylaxis Due to Food

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Anaphylaxis is dangerous. Up to 1000 people die each year in the US due to anaphylaxis. Foods are the most common cause. 30% of the time the trigger is a food allergy, and 90% of the time it is due to peanut or tree nut exposure. These reactions are difficult to predict since the severity of an allergic reaction to food cannot be predicted by history or by skin prick or allergen-specific IGE level testing. 25% of the time the first episode of anaphylaxis has not been preceded by any prior food reaction.

The most common symptoms are skin, respiratory, gastrointestinal, and cardiovascular symptoms.  Skin symptoms include hives, itching, flushing of the skin and swelling of the lips, tongue or uvula. Respiratory symptoms include shortness of breath, wheezing, stridor or a low oxygen level in the blood. Gastrointestinal symptoms include crampy abdominal pain and vomiting. Cardiovascular symptoms include fainting, collapse, low blood pressure and urinary incontinence.

Injection of epinephrine into the thigh is the best treatment. The dose is .15 mg for persons less than 55 pounds and .3 mg for those weighing more. Having two doses available is important since 20% of the time a second dose is required. Many people do not know that in 20% of the cases there is a biphasic pattern to symptoms with symptoms returning after initial treatment success.  Other treatments include placing the child supine on the ground with legs elevated or in a position of comfort. Oxygen and intravenous fluid therapy may be needed. Antihistamine treatment with a medication like Benadryl only treats skin symptoms and has no cardiovascular benefits.

Management of food-induced anaphylaxis at school is very important. School staff must be aware of food-allergic children and an emergency action plan for treatment must be in place. Medication must be available and staff must be trained to administer the medication and notify emergency personnel.  Safe food practices must be maintained with only designated foods being available and surface and hand washing before and after meals.  No food sharing is allowed. Prevention strategies are age and maturity dependent.   In the US children with a diagnosis of anaphylaxis are protected by the American with Disabilities Act that prevents discrimination based on disability. Children with food allergies are often bullied due to issues with social isolation brought on by food limitations.

The majority of people who have a severe episode of anaphylaxis also have asthma.  Exercise and alcohol also increase the severity of anaphylaxis.

Breastfeeding is Best

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Breastfeeding is best for both mom and baby. Everyone knows breast milk is the best nourishment for a newborn infant. It protects your infant from infection, is easily digested, makes your baby smarter and lowers your child’s future risk of developing asthma, allergies, diabetes, obesity and Sudden Infant Death Syndrome. Benefits are not just for the infant.  There are also clear benefits for the mother who breast feeds. It decreases a mother’s risk of heart disease, high blood pressure and diabetes as well as lowering your future risk for developing breast, uterine and ovarian cancer.

Besides these physical benefits there are cognitive and developmental benefits for both mother and baby.  Mothers who breast feed experience a physical and emotional union with their child. This fosters secure attachment, supports self-regulation and healthy eating patterns and enhances maternal fulfillment and emotional satisfaction. Babies who are breastfed have a developmental advantage over formula fed infants.

Another benefit that is easily overlooked is the benefit to the father. Fathers who learn about breastfeeding and become a true partner with their spouse strengthen their relationships with both mother and baby and improve the success of breastfeeding.

The more you know and learn about breastfeeding prior to delivery the more successful the breastfeeding experience will be for both you and your child. Including your spouse in this discovery and learning process is also beneficial.  Breastfeeding is natural but it is also a learned behavior.  Support from family, friends, workplace and your social and healthcare networks are vital but the most important advice is to always expect the best.  Guidance and advice can help you eliminate fears which often lead to anxiety and breastfeeding difficulty. Taking a breastfeeding class, joining a breastfeeding support group and seeking consultation with a lactation consultant or your pediatrician all are helpful. Tailoring your support to your individual needs prepares you best.

During the first hour after delivery it is important to initiate breastfeeding. The nursing staff will be there to guide and support you. Skin to skin contact with your infant is important as is body and head position.  In the days following delivery your milk will come in and your nipples will become less tender.  You and your infant will discover one another. You will become comfortable with making sure your infant rests her chin and nose on your breast and opens her mouth wide with lips turned out. You will learn how to recognize a good latch and watch and listen for rhythmic and deep sucks with interspersed bursts and pauses. Listen for deep swallows rather than sharp clicks and make sure her cheeks are not sucked in. Patience and support are the best therapy.

After discharge make sure you have a breastfeeding toolkit nearby when you nurse. It should be packed with all the important items you might need including water, burp cloths, clean baby clothes, cleansing wipes, nursing pads, fresh diapers, petroleum jelly, plastic disposal bags, hand sanitizer, a soft blanket and pillow, healthy snacks, a music player and lanolin. Drink plenty of fluids and eat healthy.  Nurse on demand and do not watch the clock.  Learn to recognize your infant’s cry, movements and facial expressions. Exercise, adequate sleep and stress reduction techniques all help. Exclusive breastfeeding is best but if due to medical concerns you are unable to breastfeed then remember formulas are nutritious, safe and healthy and you should never feel shame or guilt for not nursing due to medical or personal considerations.

Exclusive breast feeding through 6 months of age is best. At 6 months complementary feeding can start. Most parents begin with infant cereal mixed with breast milk and then progress to vegetables, fruits and pureed meats. Complementary foods are not meant to substitute for breast milk. Continuing breastfeeding through age one to two years and beyond is best.  Providing breast milk for your child is one of the greatest gifts parents can provide.

The Fruit Stand

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Do you listen to your inner voice?

The young girl turned towards me and asked, “What can I get you?” “A bag of corn,” I replied. The sack was overflowing with a dozen fresh ears just picked this morning.  I grabbed the bulging bag with two hands to prevent the plastic from tearing and turned towards a pair of bicyclists standing near the fruit stand. “Where have you come from?” I asked.  “California,” the man answered. “Where are you heading?” “Boston,” he replied. I told him I would pray for a safe ride and tossed my corn in the back of the car and headed off.

As I drove off I hoped there would be no rain for the cyclists that night.  Something, however, told me to stop. I checked my mirror and headed back to the fruit stand.  Both riders were straddling their bikes that were covered with well-worn gear. The man was studying a laminated map on his handlebar bag and the woman was patiently waiting with her bike pointed towards Buffalo, 80 miles to our right. I pulled up next to him and leaned over the corn on my passenger seat. “I live about 20 miles ahead if you need a place to stay for the night?” I said.  He looked at me and nodded. “Turn left at the first road past twenty-mile creek and go through the gate. My wife and I live in the green house.”  He nodded and answered: ”We would like that.”  We exchanged names, and I gave him my cell number.  “If you see a sign saying entering New York State you missed the turn.” He nodded again.

Later that day my wife and I were outside working in the garden when I heard someone call out, “Joe?”  I stood up and took off my hat and work gloves.  Ann reached out her hand: “Thank-you for offering us a place to stay.”  Walt came over and after introductions to my wife we headed inside. Later that evening after several hours of rest and relaxation we talked about their 51 days on the road and our chance meeting at the fruit stand. I explained how an inner voice had told me to turn around and invite them for the night. He said his wife had asked if he had a good feeling about me. He said yes and after eating they decided to take me up on the invitation. We shared stories and dreams over dinner and ate as much of the corn as we could. This was their second bike trip across the US. Walt was a retired National Park Ranger and Ann, a retired teacher. We watched the sun set, promised to meet again and headed off to bed.  I woke early the next day and headed to the hospital for morning rounds while my wife cooked them breakfast. She offered another rest day but they said yesterday was just what they needed. A light rain fell as they turned east on Route 5.

When was the last time intuition spoke, and you remained silent.  Heroes who save the lives of another are often asked why they reacted as they did. They seldom have an answer.  Each of us must find the courage of awareness to see and listen within. We are models for our children who must learn never to dance in slow motion. Listening and responding to our inner voice strengthens us and enriches the lives of others.

On that mid summer day, something about Walt spoke to me and me to him. A fleeting moment changed our lives and was captured forever.  Walt and Ann, ride safely.  You will be remembered.

The Movie Trailer

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Movie trailers and shopping malls have something in common.  When walking through malls I frequently see parent and child interactions that remind me of movie trailers. Why does a screen filled with fleeting loud and emotional scenes heighten our awareness and willingness to return for more?   This past week, while walking through an outdoor mall, I saw a parenting trailer called: “The Growl.”

Standing outside a store I was startled by a young mother speaking to her child with a voice filled with anger. With a clenched jaw she pointed at her four year old son.  “Get in that stroller now!”  She shouted.  Standing silent and invisible, I said to myself: “What are we teaching our children?”

Overwhelmed parents often behave counter to their intention and such actions are long remembered by a child. Feelings of anger, sorrow and fear heighten a child’s awareness and influences future behavior.  Emotionally laden behaviors often teach children what we do not want them to learn. Our intentions are right but the outcome is wrong. Stress and a lack of emotional mastery cause this negative outcome.  Although parents desire to teach cooperation and respect, anger, fear and regret are often substituted and remembered.

Parenting responsibilities are endless. They are continuous and not diminished by lack of sleep, illness, time and financial constraints. In fact, such constraints often increase the rate of parenting decisions.  Parents are forced to act with limited time for thought or advice. Whether a child does something right or something wrong a parent must immediately decide how to respond. The response must be direct and memorable.  We are taught to foster and respond to positive behaviors yet negative behaviors heighten our emotions.  Caught in an emotional traction beam we frequently resort to punitive or negative responses and become a parent we do not recognize or wish to be.

Threats are short term solutions. They teach anger, aggressive behavior and avoidance. When we rely on threatening looks, harsh or scary tones and body or hand gestures a child shuts down.  A vicious cycle of tension, failure and aggressive or acting out behaviors often result. Our words and manner of response become the lesson we teach as our intention disappears. Such negative emotional energy is seldom forgotten and is replayed over and over in the coming years by both parent and child.  Like the movie trailer emotions bring the parent and child back for more.

What trailer will you show your child?

Lyme Disease

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Lyme disease is a tick-borne disease.  A bacteria called Borrelia burgdorferi is transmitted to humans by the bite of certain ticks. Early symptoms include fever, headache, fatigue and depression. A unique circular skin rash that is described as being a “bull’s eye” rash is also common. This infection and the symptoms can be eliminated through early treatment with an antibiotic.

Most tick bites are harmless and most are difficult to detect since tick bites do not hurt or itch. Prevention is through limiting environmental exposure and having frequent skin checks. The use of topical DEET or Picardin and using tick repellant (permethrin) on clothing are both helpful. DEET or Picardin last about 3-8 hours and can be applied daily. DEET is safe for infants older than 6 months. A 5-10% DEET concentration should be used and there is a rare risk of allergic skin reactions. Showering after coming inside is a good idea. The use of permethrin on pants, cuffs, socks and shoes is also helpful.

Choose playground sites that are away from trees and lawn edges.  Hats, socks, long sleeves and long pants can be helpful if walking through high grass and beneath trees and foliage.

Always check your child closely behind the ears, on the scalp, behind the knees, around the belly button and between the toes. For small deer ticks that are the size of a large poppy seed use a fingernail or credit card edge to scrape it off.  For larger wood tics place a small cotton ball that has been soaked with liquid soap over the tick. After a minute remove the cotton ball and often the tick will be stuck in the cotton. Another option is to use a tweezers and pull softly to remove it. Any remaining tick parts can be managed as if it was a wood splinter.

If the tick has not been in place for over 24-36 hours the risk of contracting Lyme disease is very low.  If you live in an area where Lyme disease is common prophylactic treatment for all children with a single dose of doxycycline can eliminate the risk. Talk to your doctor if you have concerns.

Keeping Your New Baby Safe

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A new infant in the family brings added responsibility to a parent.  The delivery is tiring for both parents and fatigue is often accompanied by poor decision making. Take time before you leave the hospital to rest and catch up on your sleep.  Consider allowing your infant to stay in the nursery while you take a nap and send dad home for a shower and a nap. Post-delivery time is also a good time for parents to discuss a parenting budget and develop a plan to share responsibilities and caretaking so both parents are able to rest. Tired parents are also prone to illness and this is a risk to a newborn.

Breastfeeding is the best way to keep your infant safe. Breast milk is the best nutrient for your infant and breastfeeding is also good for the mother.  By providing support and advice to parents breastfeeding success and duration can be increased.  Make sure you ask for lactation advice both before and after delivery. Avoiding pacifiers and supplemental formula is best. Both of these can be considered after the mother’s milk is in and the infant has become accustomed to breastfeeding.

Babies need to be placed on their backs for sleeping. This “back to sleep” position has been shown to decrease the risk of sudden infant death. Begin this immediately after delivery and continue this positioning after discharge.  Clothing should be in layers and only one thin layer more than you need. A hat should be used if the temperature is below 60 degrees.

Car safety is always important. The infant car seat should be rear facing and a LATCH system should be used. An infant should never be placed in the front seat. Middle rear seat is safest but many cars require back side positioning to use the LATCH system. An appointment should be made with a Child Passenger Safety (CPS) approved technician to inspect your installation if you have concerns. Make sure your car seat straps are at or slightly below shoulder level and the fit is snug. Check the seat angle to make sure your infant’s head and chin do not roll forwards and cause breathing obstruction. Clothing layers should be thin so the straps can fit correctly. Place a blanket over your infant after she is strapped in if the temperature warrants.

Make sure your crib meets the 2011 crib safety guidelines and the mattress is firm and fits properly. There should be no loose objects in the crib and any bumper pads or positioners.

The changing table should be sturdy with guardrails on all four sides. The base should be concave to decrease the risk for your infant rolling off and a safety strap should be used.  Never leave your infant unattended and keep all cleaning materials within easy reach but out of reach of the infant.  Hand washing hygiene is important as is diaper disposal. Baby wipes can save a great deal of time but should be tested on a small area of your infant’s leg first to see if any allergic reaction occurs. Often, wipes do not need to be used for every changing if your child has only urinated. Apply a generous amount of Vaseline to the entire diaper area with every diaper change. This prevents diaper rashes and keeps your infant more comfortable as well as making diaper changing easier.  Bathing time can be challenging. A flat area near the floor is best and be careful about slipping on water. Bathing is often only needed every other day.

When walking around the house with you infant consider using an infant body carrier. With small infants make sure head and neck position do not interfere with breathing. Tripping over pets and other unexpected obstacles that often accompany the arrival of a new baby should also be avoided. Steps are risky and handrails do help. In the kitchen be careful about fumes and hot liquids that could injure your infant.  Proper food preparation and handling and hand washing are always important. Make sure your smoke and carbon monoxide alarms work and are in the right places. Have a practice fire alarm drill so you know who goes where and who gets whom.

For friends and family ask anyone with an illness to stay away. Contact with young should only be with adult supervision and hand washing and hand sanitizer use is essential to prevent the spread of respiratory and gastrointestinal infections.

A new baby in the house is a time for joy.  A safe home and car environment protects both you and your new infant.

Recognizing Allergies in Children

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Allergies are very common. Over fifty million people in the US have some type of allergy and thirteen million adults and four million children have asthma.  If you have asthma you have an 80% risk of also having allergies. Most asthma symptoms begin after exposure to specific allergens and in children viral infections are the most common cause of an asthma episode.  Itchy and watery eyes or nose, sneezing, coughing and wheezing are the most common symptoms. Skin rashes including hives are common as are gastrointestinal symptoms. If one parent has a history of allergies a child has a 25% risk of also having allergies. If both parents have allergies this risk increases to over 60%.

In addition to general discomfort other consequences to allergies include an increased risk for infection, school absence and work loss. Life threatening consequences due to anaphylaxis although uncommon are also possible.

An allergy is caused by an overreaction of the body’s immune system. The immune system functions to fight off infection. In the case of allergies it becomes activated to a harmless substance called an allergen.  Antibodies (IgE) are produced that cause a cascade of events leading to the release of many chemicals such as histamine from allergy cells in the body. An allergy is not a disease. It is a reaction to something eaten, breathed, touched or injected.

The most common reactions include wheezing, skin reactions like hives, contact or atopic dermatitis, eczema, food allergy and hay fever. Common airborne allergens are pollens such as trees, grasses and weeds or molds, dust mites and animal dander. Food allergens include cow’s milk, eggs, soy milk, wheat, peanuts and tree nuts, seafood and shellfish. Medication, chemicals and the saliva from stinging insects are also common allergens.

The most serious reaction is anaphylaxis. After allergen exposure there is a rapid onset of skin, gastrointestinal, respiratory and cardiac symptoms that can lead to death if there is not rapid intervention with epinephrine. This is done through the use of an EpiPen or a Twinject.  An antihistamine like Benadryl is also given. In children the most common causes are peanuts, tree nuts, cow’s milk, soy, eggs, fish and shellfish. Insect stings from bees, wasps, hornets and fire ants can also cause anaphylaxis.

For mild to moderate symptoms avoidance and environmental accommodations are best. The best treatment is to determine the cause of the allergy symptoms and then to focus on avoidance measures. Options include vacuuming and dusting, carpet avoidance, the use of air conditioning, damp mopping, a HEPA filter and humidity control. Dust mites and molds thrive in a moist environment.  Indoor plants, smoke and pets can also cause allergy symptoms.  Working with your doctor and close observation are essential to develop the best action plan to treat your child.  Mild symptoms can often be managed with avoidance and over the counter antihistamines. For chronic or moderate to severe symptoms further allergy intervention including skin testing, prescription medications and immunotherapy (allergy shots) are often needed. Treatment is available. The proper intervention can alleviate or eliminate life threatening reactions and symptoms that make your child’s life very difficult.

Too Much

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I always rode a girl’s bike. My two older sisters shared two bikes. We called them red and blue. The red bike was much smaller and had solid rubber tires. The blue one had big balloon tires and was easier to ride with no hands.  Sharing bikes meant I always rode a girl’s bike and being smaller than my sisters I mostly rode the red bike. I loved that bike. Riding down the street doing tricks or leaving long rubber streaks on the concrete from spin outs were our X Games events. Two bikes and three children provided me some of my most important lessons about sharing. Deciding who would run next to the bikes, trading off riding and riding double is my first memory of taking turns.

Most of our friends shared bikes, and I was so happy we had two.  They were our magic carpets.  We spent our days playing board games, kickball, tag, climbing trees or building forts.  Many days we just rode our bikes.  We shared sandwiches for lunch and played on porches if it rained. Summer seemed endless.  Trips to the beach and drive-in movies were the salt and pepper of those magical summer days.

Playing together we learned how to give and share and although we never got everything we wanted, we did get everything we needed.  Summer was filled with games, new discoveries, smiles and laughter.

Many parents attempt to give their child everything they wished for but did not have. They fill their child’s life with objects, activities and opportunities they only dreamed of and forget the power of shared imaginative free play.  Schedules and responsibilities act as magnets drawing us in and tempting us to take control of the lives of our children.  Limiting our child’s independence hinders the development of free choice, imagination and sharing.  Driven by our own unconscious feelings of lack we are stealing from our children opportunities for acts of giving and sharing.

Is your child given more than he or she needs?  Are you fulfilling your own dreams through your child?  Are you the manager of your child’s schedule?  If the answer to these questions is yes, it might be time for a change.  By supporting exploration through unscheduled and independent free play a world of creativity and relationships is visible to your child. Act now.  It is never too late.

The Question

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I turned off my reading lamp and wondered if I had made a bad decision. It had been raining all day, and the room was lit by my reading lamp and two basement windows. The room was nearly empty except for a cot, a desk piled high with books, a suitcase and two old leather chairs my father had been given when he opened his law practice just before enlisting in the navy at the start of World War II. I remember saying to myself, “At least it’s cool.” Listening to the rain I was about to doze off when I heard a squeal of tires and a loud thud. Barefoot and wearing jeans and a white T-shirt, I ran up my back stairs and out into the street.

About fifty people were standing around a car stopped in the middle of the street. Several women were crying but mostly it was quiet. The synagogue across the street had just finished services, and I wondered if there had been an accident. I slipped through the crowd and saw an elderly man curled up on the ground. He was on his side moaning. His back was leaning up against the right front tire of an old sedan. I could see the driver pacing to the side and heard him telling some men: “I never saw him.” This is when I asked the question.

In the years since I have often wondered: “Which is more important, questions or answers?” The answer to this question is elusive since the power and success of an action often depends on questions asked. With experience I now believe the choices we make are fueled by the questions we ask, should have asked or could have asked.

I asked the man next to me: “Did someone call an ambulance?” He shook his head, raised his hands and said: “I don’t know?” This is when I asked the question. “Has anyone checked him for injuries?” “Who are you?” he asked. “I am a medical student.” I answered. With those five words my life changed. Everyone turned toward me and stepped back as if I had parted the sea. A woman kneeling next to the man waved me forward. I thought to myself, “I am in big trouble.” The only emergency medicine I knew was learned from television, movies and boy scouts. I had completed only three days of medical school and this woman was looking to me for help. Kneeling down, I checked his pulse and placed my hand on the woman’s shoulder. I asked her if she was his wife. She nodded and began to cry softly. I told her his pulse was strong and help would arrive soon. She thanked me and squeezed my hand against her shoulder.

The police had been called and an ambulance arrived after the two longest minutes of my life. I helped transfer him onto a stretcher and waved to his wife as she climbed into the ambulance. I turned and began to walk home. A woman touched my shoulder. I turned to her and she said, “Thank you.” Standing there, shoeless in my wet shirt and jeans, I shook my head and said, “I didn’t do anything.” She squeezed my hand and said: “Yes you did.”

That wet and rainy night, absent of knowledge and filled only with desire I discovered the meaning of comfort and why we should never stand quiet. The next time you have the opportunity to help someone check your pulse and follow your heart.