You Can Do It! A Pep Talk for Parents During Cold & Flu Season

Of course there are suggestions for avoiding colds and flu, but even with all of these preventions, sick days are almost unavoidable.

Dear Parents,
‘Tis the season. The season for lost mittens and hats, frigid walks to the bus stop, and – oh, yes – mornings where you look at your partner and ask, “Who can stay home with her today?”
According to the CDC, adults will have two to three colds per year, and children will have even more. If those colds are bad enough to cause you to keep yourself or your child home one day each time, we’re talking about up to eight sick days for a typical family of four – and we haven’t even talked about stomach bugs and the dreaded flu.
Of course there are suggestions for avoiding colds and flu and also some good suggestions on when you keep your children home so they can adequately recover and you don’t share it generously with all of the other families in town (please, please don’t push the limits here). But even with all of these preventions, sick days are almost unavoidable.
Between handing out tissues, cleaning the toilet, and catching up on the emails you missed while you were gone, you might find yourself asking, “How the #$%@ do parents do this??”
I don’t have all the answers. In fact, after seven years, I still ask the air (or my husband) that same question about a hundred times a year. But I have found a few strategies that help us cope.

Part 1: Prepare for it

Don’t live in denial. You know that cold and flu season is coming. As with most things in life, an ounce of preparation can go a long way when it comes to sick days.

Be prepared when it comes to taking sick days at work

Know your leave policies and review them before the season starts.
How many days do you get?  To whom do you need to report to let them know you’re taking a day? Does your workplace have a “pool” for those dealing with extended illnesses who need to borrow sick days from others? (Yes, this actually exists in some places). Can you take a half-sick day and just report a few hours?
Consider talking to your boss or colleagues as cold and flu season begins to make sure you are on the same page. How will you fill in for each other?

If you have a parenting partner, discuss how you’ll handle sick days

If you are both working parents, how do your sick time policies compare? Who has more flexibility? If equal, how will you make the decision each time? If you’re a stay-at-home parent, what will happen when you get sick?
As soon as it looks like a child is getting sick, prepare your contingency plan. If you don’t end up needing it, you’ll be ready for next time. My husband and I have a routine of checking in on each other’s schedules for the upcoming week and putting major commitments on shared calendars so we have an idea of what each of us is up to. If an illness comes up, a quick glance at the calendar can determine who will be staying home.

Prepare your house

Are you stocked up on tissues? Do you have tea and local honey in the house? Do you have a bucket to place by your kid’s bed and an extra bed pad that can be thrown on at night? Do you have an emergency stash of chicken soup? A humidifier? Children’s Tylenol?
Add anything that comforts your family during an illness to the list. If you don’t have these items in the house, go shopping today. There’s nothing worse than running to the pharmacy just before their 10 p.m. closing time in single-digit weather or snowfall because your child isn’t sleeping well.
When you use these things, put them on the list to be replaced before the next round.

Part 2: Embrace it

You are home sick and bed-ridden, or your child was vomiting all night. If it’s bad enough to stay home, then for goodness sake, stop pretending you can do everything. Let me repeat – you are taking a sick day. In the words of Jon Kabat-Zinn, “Wherever you go, there you are.” And right now, you are home sick or with a sick kid.
You are not taking a “work on that project for my boss between naps” day or a “get all my work done even though my child has diarrhea” day or even a “now I can do the laundry and clean the kitchen” day. You need rest and recover, or help your child rest and recover. Engage your away status, call in the reinforcements as needed (because you’d do it for them), and hit the pause button.

Part 3: Get a little strategic

One strategy for embracing a sick day with your children is to involve them in the plan. Go over a list of the things you want to “accomplish” that day (i.e. we need to sleep, read, watch a movie, go for a short walk, take a shower, and take our medicine). Then discuss the order in which they want to do things.
This helps avoid the “I want to watch TV all day” syndrome that convinces kids that every day should be a sick day – unless that’s truly all they can manage.
You can also create a “menu” for the day (like the B.R.A.T. diet for diarrhea or the Chicken Soup-and-lots-of-fluids diet for a cold) so that they know that they have a choice of foods that will help them get better even though they might be restricted from some things.
Your child might be so sick that a plan is not necessary and they will spend all day in bed, but I find that phenomenon rare. A list they can check off will remind you all what today is all about and increase your chances that it won’t repeat for too long.

Part 4: Remember, you can do it!

Here’s the thing, parents – you’re pretty awesome at juggling a million things at once. You work (at home or in an office), take care of your kids, balance your budget, clean your car, put food on the table, and somehow manage to clean yourself, too.
Your challenge with a sick day is to stop doing almost all of those things and just focus on getting you and your family back on track. That will be easier if you prepare for the inevitable sick days and even easier still if you embrace them when they come.
So, you got this.
Take those sick days in stride knowing you can handle anything that comes your way. Who knows, maybe you even need those sick days to give yourself an excuse to slow down.
Sincerely,
One Who Has Been There
(and is in fact there again today, but I promise, I’m just editing during nap time!)

If You're in the Throes of Colic, Just Hold On

It was, quite simply, awful. Dreadful. Wretched. But you know what? It passed. Colic passed. And I lived to tell the tale.

Oh, my friend. Your baby has colic. That’s what your doctor tells you, even if she can’t quite tell you what exactly that means. The Internet isn’t clarifying things, either. Is it indigestion, tummy troubles, gas? Is it simply the “witching hour”? Is it acid reflux?
All you know is that your baby cries. Every day. For hours at a time.
You don’t know how to help. You can’t make it stop.
I imagine you’re tired. If your baby is crying in the evenings, you probably feel like you’d do just about anything to help him go to sleep. You’ve tried swaddling. You’ve tried sleep sacks. You’ve tried Harvey Karp’s “5 S’s” method. You’ve tried white noise and alpha music.
You’re even considering taking your mother-in-law’s advice and offering some rice cereal at bedtime, despite the fact that your doctor says it’s a no-no and your online friends say it didn’t work for them. MIL says it helped her kids to sleep, so maybe it’ll help yours?
If your baby is crying in the middle of the night, I imagine you’re groggy and desperate. There’s nothing worse than getting woken from your own broken sleep by the cries of your needy newborn. Again.
There’s nothing worse than knowing that you, no matter how hard you try, are simply not enough. Not enough to soothe. Not enough to induce sleep. All you want is to go back to sleep yourself.
I imagine you’re sad. Maybe even depressed. There’s nothing so heart-wrenching as listening to your baby sobbing night after night. It doesn’t matter that it’s not your fault. Your baby is sad, distraught, devastated. And you can’t fix it. There’s no worse feeling than knowing that all the snuggles in the world can’t help your little one feel better.
I imagine you feel guilty. Sometimes, at least. Someone posted in one of your parenting forums that they discovered that their little one had been suffering from GERD for months, and that once they got her on reflux meds, she immediately started sleeping six hours at a time every night. Maybe your little one, too, has severe heartburn?
Someone else shared an article positing that tongue tie is intrinsically connected with colic. Suddenly, you’re ashamed of refusing to get your little one’s anterior tie clipped or lasered or whatever. Sure, it would have hurt short-term, but would it have prevented these regular nighttime fussies?
Or maybe, on the other hand, your child doesn’t have tongue tie. Does he? Did the doctor or lactation consultant or anyone even bother to check? Is it too late to find out now?
What about probiotics? You read on a blog somewhere that gut imbalance is the root cause of colic. Maybe you’re now wondering if thrice-daily doses of probiotics are the answer. What’s the best brand? Can you even afford it?
Maybe you’re thinking shamefully of your cesarean, medically necessary or not. Haven’t studies shown that babies born via c-section have different gut flora than babies born vaginally? Is this all your fault because your baby wasn’t birthed ‘naturally’?
I imagine you’re angry, at least some of the time. After all, depression and anxiety often manifest as anger. Chances are, there are times you’ve felt on the verge of snapping at your baby. You want to yell at her. Maybe you put her down on the changing table a little rougher than necessary. You’re tempted to just plop her into her swing and walk away, to let her cry her little heart out because you just can’t take it anymore.
You used to laugh incredulously at campaigns to stop Shaken Baby Syndrome – those ridiculous billboards and ads in parenting magazines and the flier the hospital sent home with you. Who would ever shake their baby that hard? you wondered to yourself or aloud to your partner. How ridiculous.
Now you know. Now, you fully understand.
I imagine you’re fed up. Haven’t you tried everything? You’ve cut dairy and gluten and broccoli and every possible irritant you can think of out of your own diet. Didn’t help.
You’ve tried snuggling the baby in a ring sling every night, pacing and bouncing and trying desperately to soothe him. Didn’t help.
You’ve tried diluted lavender oil on her feet, even though you’re a little wary of this essential oils stuff. Didn’t help.
You’ve even picked up an amber necklace on Etsy, hoping the succinic acid or whatever the description said it was will help ease any unidentified pain. Didn’t help.
You’ve been to the pediatrician’s office several times in between normal well-baby checks, only to be told that it’s normal. There’s nothing you can do.
The good news is, there’s a light at the end of this tunnel.
In most cases, colic passes on its own. Remember how it appeared out of the blue one day? Well, it disappears in the exact same way much of the time. You might get a day here and there at first, when your little one goes to bed easily, at a normal time, and you realize that there were no long bouts of crying that day.
For just this one night, you feel like you can breathe. Sure, your baby is still up every hour or two or three all night, but she actually goes back down easily. You get some real sleep in between. The next morning, you actually feel refreshed – for the first time in weeks.
Sure, the crying starts up again the next night, but somehow, you feel better equipped to handle it. You’re a little more patient, a little more loving. That night of relative rest shored up your defenses.
After a week or so, you get another respite, and another a week or so after that. Maybe two blessed crying-free days in a row. You’re on a roll!
Before you know it, the haze of colic has lifted. You’re having more good days than bad. A few more weeks pass, and suddenly, you can no longer remember when you were last up until 2 a.m. with a baby who wouldn’t sleep.
Sure, you’re still exhausted; you have a small baby, after all. But it’s normal new parent exhaustion. The kind you can adjust to. You no longer feel frazzled and on the edge. It’s amazing how good you feel now that your infant is no longer screaming into your face on a daily basis.
Believe me, friend, I’ve been there. For three awful months, my own baby, my second-born, had colic. It started a few weeks after we brought him home from the hospital. At first, it was just a day here and there, but then it really set in. For months, I was rarely in bed before midnight.
I tried everything I could think of. I had his tongue tie clipped. I offered gripe water. I did probiotics. I bounced and swayed and wore him. I swaddled him. I went gluten-free for about two weeks. We spent hours every night in the bathroom, because sometimes the white noise of the bathroom fan soothed him – and when it didn’t, it at least masked his wailing so that everyone else could sleep.
It was, quite simply, awful. Dreadful. Wretched.
But you know what? It passed. Colic passed. And I lived to tell the tale.
It’ll pass for you, too. You’ll emerge on the other side, tired and worn down, but with a baby who is at last willing to be soothed.
Just hang in there, my friend.

Navigating My Daughter's Speech Delay, Embarrassing Words and All

Our daughter’s speech delay is just one of the many things about her. She’s more than just her ability or lack of ability to talk.

“You do realize she’s saying ‘tits,’ right?” our friend asked us.

We sighed. Yes, we do.

It’s our three-year-old daughter’s word for everything. It’s what she says when playing and in pretend conversations with her stuffed toys. It’s the sounds of cars and trains. It’s also what she says while lifting her fingers in the air and asking for more.

And yes, it sounds a lot like “tits.”

But it’s a sound. A consonant and a vowel sound. And as I’m learning about the intricacies of speech and language that I’ve taken for granted up to this point, consonant and vowel sounds together are good. They’re important: the beginning building blocks to speech. It just so happens that my daughter’s consonant and vowel articulation sounds a lot like “tits.”

For the last few months as we’ve gotten into the routine of speech therapy, we’re hanging onto every sound our daughter makes. We listen for new sounds. We cheer when she says a word. We work with her to say sounds close to the words she should be saying. We shorten words to just their vowel or consonant sounds. As long as it’s some sound from the word she’s saying or asking for, we’re excited.

“Mmmm” becomes more.

“Teee” becomes tree.

“Oooo” becomes open.

“P” becomes please.

“Eee” becomes eat.

And then there’s “tits.” We’re not sure what that becomes.

Nothing cues my mama-anxiety more than social interactions with people who don’t know my daughter. She’s three and has a speech delay. She’s also tall for her age, so most people think she’s about four and expect her to talk. They ask her questions and wait for answers. She’s a personable and outgoing toddler. She loves people. They are drawn to her and then they expect her to answer questions.

“What’s your name?”

“How old are you?”

“Is that your baby brother?”

Sometimes she’ll act shy, burrowing her face in our bodies. Other times she’ll chime in with her sounds and words. At the library the other day, she brought her baby doll. She held her baby very protectively. The librarian excitedly greeted us and said, “Oh, is that your baby?! What’s her name?”

To which my daughter replied, “Tits.”

How do you recover from that?

I just kept smiling and casually shared that her baby doesn’t have a name.

There’s such an innocence about my daughter. She loves being with other kids and playing. Somehow it works for her and the other kids, the language barrier doesn’t impede their playing. Yet I do wonder what the other kids think – if they wonder about why she doesn’t talk. Many times I’ll translate for her, interpreting her hand motions and sign language for others. Yet if I’m not around to see her signing “please,” others won’t know what she means and that she’s asking politely for the toy that they’re holding.

Our daughter’s speech delay is just one of the many things about her. She’s more than just her ability or lack of ability to talk. Yes, we do spend a lot of time and energy getting her to repeat sounds. We spend a lot of time in the car driving to and from speech therapy. We spend a lot of time waiting and listening during her sessions. My husband and I are good at shortening words and isolating the sounds. Our daughter is quick to pick up on certain sounds although others come with difficulty or a blank stare. Lots of times we’ll simply say, “Good trying.” I listen intently to her speech therapist and try to repeat what she says.

Ultimately, when we look at our daughter, we don’t see a girl with a speech delay. We see a girl who works hard and plays hard. We see a girl who loves her brother. We see a girl who lights up a room with her smile. We see a girl who has great fine motor skills, who loves to color and paint and turn screwdrivers with her dad. We see a girl who watches everything. A girl who laughs, loves, and joyfully plays.

I have a feeling we’ll be involved in speech therapy for the foreseeable future. We’ll keep celebrating the sounds and words she makes. We’ll keep pushing her. We’ll keep learning. She’ll have to work harder at speech than most kids her age. Sometimes we’ll just marvel at her, our precious daughter. We’ll listen to her, the sounds of tits and all, and we’ll give thanks.

An Academic Medical Journal Wants to Hear from Parents

Has your child had an experience that helped change your pediatrician’s practice? If so, now you can help doctors learn from your family’s experience.

Has your child had an experience that helped change your pediatrician’s practice? Have you advocated for changes at your local hospital after a particularly bad or particularly good visit? Does your pediatrician have excellent online resources that have saved you panic at three a.m.? Have you identified any “gaps” in your caregiver’s knowledge of a particular medical condition, or even social issues that affect medical care?

If so, now you can help doctors learn from your family’s experience.

Pediatrics, the journal of the American Academy of Pediatrics, is already a useful resource for parents because of its clear language and easy-to-follow format. Now Pediatrics is making even more connections between the academic and parenting worlds by asking for parents’ stories.

The new section, Family Partnerships, is calling for submissions that “reflect the joint perspective of patients, families, and health care professionals taking care of the family or child.”

Two previously published Family Partnerships articles were co-authored by parents and doctors who turned personal tragedy into new knowledge and even newer hospital programs.

In one Family Partnerships article, a mother, a pediatrician, and a neurologist share how a child’s death from Sudden Unexpected Death in Epilepsy Persons (SUDEP) has changed their medical practices.

Before four-year-old Henry’s death from SUDEP, his pediatrician had never heard of the condition. Even Henry’s neurologist, who was treating him for epilepsy, did not understand that SUDEP could affect kids without additional medical complications. As a result of Henry’s death, these physicians have changed their medical practices, both to better prepare parents for the possibility of SUDEP and to help prevent it.

Another Family Partnerships article describes how a hospital created a new program to resolve issues raised by one dedicated parent.

After two-year-old Declan’s death from a complication of an undiagnosed genetic disease, his mother reviewed her own detailed records of his visits with 10 specialists and identified the various missed opportunities his doctors had to make the correct diagnosis. She advocated for a “medical quarterback” at the hospital, who would coordinate the care for all patients with undiagnosed complex medical conditions. Wake Forest Baptist Health now has that quarterback and more: the Declan Donoghue Collaborative Care Program began in April 2011.

Although the above examples stemmed from two families’ personal tragedies, submissions to the Family Partnerships section can cover any topic. Suggested topics for Family Partnerships articles include “shared decision-making, use of the Internet or other technologies to improve care, family-centered rounds, health care disparities, or issues related to medical education.”

The journal editors stress that these are only examples, and they will consider any manuscript as long as it includes multiple perspectives from families and medical professionals, and uses personal experience to make a broader generalization or argument about pediatric care. Submissions can also include the perspectives of the patients themselves, if those patients are old enough to communicate their own experiences.

The submissions should not be personal narratives about what happened in a particular child’s case. Instead, they should be broader arguments about how your experiences could affect how healthcare providers improve patient care.

Read the Family Partnerships submission guidelines for more details. If you have questions about a possible article for Family Partnerships, contact Pediatrics’ editor-in-chief Lewis First at lewis.first@uvm.edu.

If Childhood Aggression is Genetic, What Can We Do About?

You can play a positive role in reducing your child’s aggressive behavior. Here are some ways parents can do this.

Aggression in children is common, especially in toddlers. Children are developing mammals and, as part of that, they have aggressive impulses that they may even develop in play.

This was quite shocking to me when I first became a parent. At the time I strongly believed in the social-learning model in which children are largely shaped by their home environments. Then I was pinched by my firstborn and had to reconsider my point of view. My child had certainly not learned that behavior from observing me.

Aggression in young children can often be a source of conflict in mothers’ groups. If your child is a biter or hitter, the responses from the group can be such that you may want to stop attending. Mothers who want to protect their babies have strong reactions to criticism of their offspring. Aggression in children may be feared, judged as a sign of abusive home life, or viewed as a sign of future behavioral problems.

A recent study by the Université de Montréal studied aggression in children and how that may change as children age. Stéphane Paquin led a study on 555 sets of twins that examined proactive and reactive aggressive behavior. (Proactive aggression is the psychological term that means physical or verbal behavior with the intent to dominate or obtain advantage. Reactive aggression refers to a defensive response to a perceived threat.) Proactive and reactive aggression are, for the most part, closely related although some children may only exhibit one or the other.

The study’s cohort of twins included 223 sets of twins with an identical genetic code and 332 sets of fraternal twins. The closeness of genetics in identical twins is ideal when studying the interplay of genes and environment. In this case, using twin children allowed researchers to separate whether the individual differences in proactive and reactive aggression were due to genetic or environmental factors. Teachers provided reports of children’s aggressive behavior at ages six, seven, nine, 10, and 12.

Paquin found that at age six, both types of aggression have most of the same genetic factors. Aggressive behavior reduces in most children as they age. Between ages six and 12 years, environmental factors rather than genetics were responsible for increases or decreases in aggression.

“Too often we forget that aggression is a fundamental part of a young child’s social development,” said Paquin. “Human beings show the highest levels of aggressive behavior towards their peers between the ages of two and four. As children grow, they learn how to manage their emotions, communicate with others, and deal with conflict. They are able to channel their aggressive impulses, whether proactive or reactive.”

The study paves the way for looking at how to help parents and teachers shape aggressive behavior. “Our findings also corroborate those of other studies, demonstrating that programs designed to prevent reactive aggression should focus on reducing experiences of victimization, whereas those meant to counter proactive aggression should be based on the development of pro-social values.”

What this means for parents

If your child is using aggressive behavior, the environment you provide is important. This means you can play a positive role in reducing your child’s aggressive behavior. Here are some ways parents can do this:

  • Provide a low conflict home.
  • Manage dominance conflict and prevention via supervision between siblings to ensure victimization does not occur. Sibling fighting and competition is normal, but if it involves one sibling regularly dominating the other, parents must intervene.
  • If your child is bullied at school, ensure that strategies are put in place to protect your child.
  • If your child is aggressive, work on pro-special behaviors such as friendship skills, valuing others, sharing, and the like.
  • Model prosocial behaviors in your day-to-day life and reduce your own use of aggression.

If you have an aggressive child in your playgroup, keep in mind that while prevention is important, excluding children won’t help them develop prosocial behaviors. A better solution is to encourage better supervision and behavior redirection at high-risk times.

It’s good to know that we can all play a role in reducing our children’s aggressive behaviors.

Is an Emergency Department Visit Necessary? Probably Not as Often As You'd Think

Roughly half of children being seen in the emergency department don’t need to be there. How can you avoid being one of those parents?

There are many costs to using the emergency department for non-urgent care.
There’s the literal cost of care, given that emergency room visits generally have higher co-pays than clinic visits.
There are also plenty of figurative costs. Bringing your child to the emergency department when she does not have a serious illness or injury is likely to lead to a long wait, because she will be triaged behind the actual emergencies. After that long wait, you’re likely to receive an unsatisfying diagnosis and/or treatment: a Band-Aid for a cut, a directive to drink fluids for a run-of-the-mill cold, etc.
These experiences may erode your trust in the emergency department, especially when you receive the bill. It’s hard not to feel snubbed, like your child’s pain doesn’t matter, even when you are being told that your child is medically fine.
If you and your not-so-sick child are in the emergency department all night, both of you might miss out on a good night’s sleep, and, as a result, school and work tomorrow. While logging all that time in the waiting room, you and your child are also susceptible to hospital-acquired infections from all of the other sick patients.
Visiting an emergency department for a non-emergency can also have longer-range consequences. Taking a child to the emergency room for common ailments like ear infections can harm continuity of care, argues a recent review article in the The Journal of Pediatric Health Care.
When parents seek treatment for such issues at the ED, their children’s primary care providers (PCPs) might not receive valuable information about different illnesses. Without knowing how many ear infections or cases of strep throat a child has had, a PCP will not know whether or not to recommend interventions, like tympanostomy tubes or tonsillectomies.
All of these consequences focus on your child, but there are consequences for other people, too – including the truly sick children whose care may be delayed by overcrowded emergency departments or by overstretched hospital staff.
Given all of the negative consequences of bringing children to the emergency department for non-urgent conditions, it’s surprising that so many parents are doing it. A study of 31,076 emergency department visits from 33 different pediatric practices found that nearly half of those visits (47 percent) were classified as non-urgent by hospital staff. In other words, roughly half of children being seen in the emergency department did not need to be there.
Why are so many parents bringing their children with non-urgent conditions to the emergency department? How can you avoid being one of those parents?

It’s rarely a matter of life and death

The ED is for acute medical problems that may kill or maim if left untreated, which is why many hospitals around the country use the Emergency Severity Index to triage patients. The ESI’s triage algorithm is easy to read and worth parents’ time, because it shows exactly what a triage nurse or other healthcare professional will be asking when evaluating your child’s case.
The ESI flow chart begins with one easy question: “requires immediate life-saving intervention?” A “yes” answer leads to an ESI score of 1, and hasty attention in the ED.
A “no” answer leads to another set of questions. If the situation is not high-risk, the triage score will be somewhere between 3 and 5, depending on how many resources will be required to help a patient. If a patient does not require any resources (say, for a cold or flu), then the patient will be scored a 5. Many parents who bring their children to the ER for non-urgent categories will get a 4 or 5.

Why parents head to the ED

If their children are not at serious risk, why are so many parents heading to the ED?
One recent study found that parents’ tended to rate their children’s conditions more severely than medical professionals did. The hospital staff determined that of 381 visits, 298 (78.2 percent) were non-urgent cases.
In other words, just over two in 10 patients actually needed emergency care. However, almost 40 percent of parents asked to rate their children’s conditions reported that their children needed emergency care.
One explanation for overuse of pediatric emergency services is that parents, who are, on the whole, less experienced medical providers than doctors and nurses, are simply not good at evaluating whether or not a medical condition constitutes an emergency.
That explanation, however, fails to account for the nearly 40 percent of parents in the study who brought their children into the ED knowing that they had a non-urgent condition.
One way to better understand why parents bring their children to the emergency room is to simply ask them. Two different interview studies have done just that, questioning parents who took their children to the ED for non-urgent conditions. Both studies took place on weekdays during normal work hours, in order to determine why parents chose the emergency room over a PCP.
In the first study, researchers identified three main reasons for choosing the ED over the PCP. Some parents indicated that they chose the ED because their PCP recommended it, either after an in-person visit or after a phone call.
Another group of parents chose the ED because of problems with their PCPs, including impolite staff, confusing directions from the PCP, or even a PCP whose accent was confusing to parents. Parents also saw advantages to the ED, which was available for walk-ins and might be closer to home.
The second study found similar reasons for ED use, but went a step further in matching those reasons to parents’ health literacy. Researchers found that parents with lower health literacy tended to seek care for a diagnosis and treatment, while parents with average health literacy usually came to the ED with a diagnosis in mind but seeking reassurance from a trusted source.
Both groups feared “getting it right” when it came to their children’s diagnoses. In that sense, the ED operated as a space to reassure parents that they were providing good care to their children.
The most interesting finding of this second study was that all parents heard alarm bells over some symptoms. No matter how much health literacy they had, nearly all parents in the study panicked about fever. Parents feared ear damage, brain damage, and other consequences frequently misattributed to fever, and took their children to the ED even when it was not recommended by their children’s PCPs.

What’s the best way to keep your kids out of the ED?

Boost your own health literacy.
What’s clear from the interview studies is that parents with stronger health literacy are better assessors of risk, better able to distinguish between non-urgent, urgent, and life-threatening situations.

1 | Learn to identify true emergencies

You’ll probably know a true emergency in the unlucky case you see it, but if you need reminders, the American Academy of Pediatrics’ Healthy Children site for parents offers a useful list of situations that count as emergencies.
Although medical emergencies come from the whole alphabet, remembering just the Bs is a good start: behavior changes (like disorientation), bleeding, breathing problems, broken bones, burns, and button batteries (only if swallowed). All of those things will be considered high priority in an emergency department, because they are either life-threatening, high-risk, or causing severe pain.
When you’re on the fence about whether or not emergency care is right for the situation, your child might be better served by urgent care. Many lacerations, for example, are urgent but not life threatening, and therefore do not require a trip to the ER. In fact, they may be more quickly resolved at an urgent care center.
Some hospitals, like the Mayo Clinic, operate both emergency departments and urgent care centers, which makes it possible for parents who are unsure about the severity of a condition to be redirected by the hospital staff.
If you don’t have a combination ED and urgent care center near you, and aren’t sure which of the two to go to, check out Colorado Children’s Hospital’s helpful quiz to train you to distinguish between urgent and emergency situations. Actually, if you have time to take the quiz, you probably have an urgent care need and not an emergency.
Many other terrifying-looking medical issues, like a high fever in a child over three months old or even febrile seizure, do not require urgent care and can be handled through follow-up with your child’s PCP, which is why the next step is so crucial.

2 | Develop trust in your child’s primary care provider

Try to see the same PCP for all of your child’s well visits. Doing so can help you build trust in that person’s judgment, which you can lean on when making middle-of-the-night healthcare decisions.
Your child’s PCP is there to monitor your child’s health, but also to educate you about how best to care for him. Make sure you are receiving the resources you need, including, for example, information on urgent versus non-urgent situations.
Many PCPs operate phone services for health questions. These hotlines are different from the insurer hotlines you might call to find out about health coverage. Instead, these hotlines put you in touch with a healthcare professional, often a nurse, who will help you determine how serious your child’s health issue is. That person can also contact your PCP to get further advice about how to proceed.
If your pediatrician does not have a triage after-hours phone service, ask why not. If you don’t trust your primary care provider, get a new one.

3 | Ask what you’re buying with an emergency department visit…and where else you can buy that

The hardest part of deciding not to go to the emergency department with a sick or injured child is probably not a medical issue. It’s a philosophical one.
One possible explanation for the overuse of emergency departments for common childhood illnesses is that parents are seeking reassurance more than they are seeking medical care. Although training yourself to identify true emergencies, developing trust with your child’s PCP, and cultivating a list of after-hours resources will all help you make better decisions, what you need most is to develop trust in yourself as a parent.
If you review the above studies about the ages of children brought to the ED, you would notice a distinct drop-off after the first few years of life. That’s not because young children are necessarily any more vulnerable than preschoolers or kindergarteners. It’s because parents of one-year-olds don’t trust themselves to identify and resolve their children’s health problems.
For the first three months or so, no new parents know what they’re doing. This is also the time period when some issues, like fever, are considered emergencies. So you might choose to follow an informal three-month rule, erring on the side of caution and making frequent calls to your child’s PCP until you can start to separate urgent from non-urgent.
As you begin to learn these distinctions, and develop your health literacy, start to trust as much in yourself as in your child’s medical staff.

4 Research Skills That Explain Why Not to Panic About Arsenic in Baby Formula

If you know arsenic to be poisonous, you were probably shocked to learn that the food you’re feeding your baby contains it.

The Clean Label Project recently released a study of more than 500 infant formulas and baby foods representing 60 brands. The results, which the CLP published as an infographic, look terrifying:

  • 65 percent of baby food and 80 percent of formula contained arsenic.
  • 36 percent of baby food contained lead.
  • 58 percent of baby food contained cadmium.

Myth-busting Snopes was on the case almost as soon as the CLP published its results. The CLP did not publish its findings in a peer-reviewed journal. It did not provide any data to support its conclusions. It did not disclose any conflicts of interest. The Snopes investigation also identified previous controversies with Ellipse Labs, the company that did the product testing for CLP.
This is not the first time critics have addressed methodological problems and conflicts of interest at the CLP. When the organization published results about pet foods earlier this year, its methods drew a great deal of criticism, including a lively Reddit Ask Me Anything in which two of the researchers answered very little.
All of these are reasons enough not to trust the CLP’s findings about baby food and infant formula. But that debunking isn’t necessarily helpful to parents who want to avoid being taken in by the next headline-grabbing “study” of a baby danger.
Here are four research skills to help you digest the CLP’s study of baby food and prepare yourself to be a more critical reader of the next big baby scare.

Just because something sounds dangerous doesn’t mean it is dangerous

The CLP finding you’re most likely to hear about in the news is the shocking conclusion that eighty percent of infant formulas contain arsenic. That’s bound to stick with you, because arsenic is probably the most famous poison.
If you know arsenic to be poisonous, you were probably shocked to learn that the food you’re feeding your baby contains it. The problem here is that many foods contain arsenic, especially rice, which just so happens to be a component of many baby foods. It’s also present in another kid favorite, juice.
The CLP’s arsenic finding is one of many variations on the same rhetorical strategy: name a scary-sounding ingredient, identify a non-food purpose for that ingredient, and voila! You’ve made viral news. It’s the same approach that has worked for the Food Babe countless times…
Subway is feeding you yoga mats! Macaroni and Cheese is stuffing your kids with the same stuff you use to power your car! 
The CLP benefits from our collective chemophobia, such that it can merely mention the name of a scary-sounding chemical in order to stoke fear. Take, for example, the CLP’s finding that 10 percent of its samples tested positive for acrylamide, which, according to its infographic, “is a chemical created during manufacturing linked to brain damage, cancer, and reproductive harm.”
Let’s take those claims one at a time. Although it’s technically true that acrylamide would be created during the “manufacturing” process of some baby foods, that’s only true because “cooking” is part of the manufacturing process. Acrylamide is used in the manufacture of paper, ink, and other materials, but that’s not the use we’re talking about in baby food.
Acrylamide is created during the cooking of starchy foods like french fries and potato chips, as well as some types of crackers. Although the CLP does not name the products that tested positive for acrylamide, it’s reasonable to assume that they were fried or otherwise cooked with very high heat: teething biscuits, puffs, and other crispy snacks.
The second claim, that acrylamide has been “linked to brain damage, cancer, and reproductive harm,” is another one of those true but not true claims. Acrylamide was unfairly maligned as a cancer-causing agent in the early 2000s, but it was found to be a natural part of the cooking process not necessarily linked with human cancers.
Takeaway: If a chemical sounds scary, find out all of its uses before deciding it is scary.

Beware of inappropriate comparisons

Let’s return to arsenic for a moment. It may be true that 80 percent of baby foods tested by the CLP contained arsenic. That finding, however, is not evidence that these baby foods pose danger to children.
The CLP did not compare its results to any arsenic level standard. Instead, it tested for the presence of arsenic and compared products to each other. Because arsenic is naturally present in many foods, it’s reasonable that some products tested positive for arsenic, and that some would have higher levels than others.
Imagine Baby Cereal A and Baby Cereal B. Cereal A was found to have 50 parts per billion (ppb) of arsenic. Cereal B was found to have 100 ppb of arsenic. Is Cereal B dangerous? Not according to the FDA, which recently proposed a limit of 100 ppb for all rice-containing baby cereals.
The CLP, however, would call Cereal B more dangerous, because it places products on a spectrum. Those with less detectable arsenic are “better” than the ones with more detectable arsenic, even if all of the products tested meet the FDA guidelines. The CLP could also claim that the “worse” cereal has 100 percent more arsenic than the better cereal, which makes that cereal sound absolutely terrifying.
Takeaway: When you see scary numbers in the news, look for the comparisons. Beware of dangerous items compared to each other instead of to a standard.

Always search for a methods section

The CLP describes its “unique” methods for obtaining its data as follows: “We do not make assumptions for product recommendations based on manufacturer supplied data, peer-reviewed research reports, or data from other consumer advocacy groups.”
Assuming that “make assumptions for product recommendations” means something like “we don’t allow the following sources to influence our product recommendations,” it’s both reasonable and ethical that neither manufacturer-supplied data nor consumer advocacy group data was included in the study.
Wedged in between those two groups, however, is “peer-reviewed research reports.” The entire notion of scientific knowledge is that it is built, piece by piece, upon the work of previous science. If you aren’t identifying yourself within a particular field, and you’re not building your work on the publications of others in that field, you’re not doing scientific research.
It’s possible for a research method to be “unique,” but the methods section of your study should not be. Researchers include detailed methods sections in their research so that other researchers can replicate those findings. That replication is essential to demonstrating a phenomenon actually exists.
Takeaway: If you can’t identify the methods the researchers used, you can’t reproduce their results. If you can’t reproduce their results, it’s not scientific research.

Ask if the researchers are trying to sell you something

The most concerning issue here is that the CLP is telling parents what to buy.
There is nothing wrong with consumer-advocacy groups recommending one product over another. There is nothing wrong with groups like Consumer Reports or even blogs like The Sweet Home offering detailed reviews of their products. There is a problem when a group claiming to be doing “independent” research is profiting directly off of the results of its research.
The CLP’s website features “buy now” links to all the products included in its reviews. It’s possible that those links represent an undisclosed conflict of interest. The CLP could be a part of Amazon’s Affiliate marketing program. If so, the CLP would earn four percent from the Amazon sales of all its recommended products. The CLP happens to recommend more expensive brands more highly, therefore, with each click of a CLP five-star product, they would be earning more than they would if they had highly rated a cheaper product.
Even if the CLP is not an Amazon affiliate, it has not disclosed sources of funding or possible conflicts of interest, which has been a source of controversy for the organization before.
Takeaway: If the same people conducting the research are also trying to sell you something, be suspicious. If they aren’t telling you how they earn their money, be even more suspicious.

Stop Hitting Her: The Things I Did and Didn't Do as a Witness to Domestic Violence

It’s not enough to pull over and be a bystander to a cycle of violence that will continue unchecked. We have to do more.

I wanted to think it was a joke, that the young couple was just horsing around. But as I looked closer, my heart started to race. This was real.

I stopped the car short and rolled down my passenger window.

“STOP IT!” I yelled. “STOP HITTING HER!”

The man looked up. He was crouched over the woman, his arm cocked. The woman’s hands were over her face.

“I’M GOING TO CALL THE POLICE!” I yelled.

“Do you hear that?” the woman said. “She’s going to call the police.”

The man spoke to me, so politely it was jarring.

“We’re okay, ma’am. There’s no need to call the police.”

“Do you want me to call the police?” I asked the woman.

I watched it happen, watched him intimidate and shame her.

“Do you want her to call the police?” he said quietly.

She was silent for a moment. Her posture was still defensive, but she seemed to relax ever so slightly.

“No,” she said.

I felt desperate but I hoped my voice was calm.

“There are places you can go for help,” I said to her. “There are people who will help you.”

He turned to me again, unflaggingly polite and terrifying.

“Thank you, ma’am,” he said. “We know that.”

I pulled away.

In the movie, this is the part where the camera pans out. It pans out to reveal two children: one, a small boy, standing next to the violent man. The other, a small girl, in the back seat of my car.

Domestic violence statistics are staggering. Estimates by the National Coalition Against Domestic Violence indicate that as many as a third of women and a quarter of men have experienced physical abuse by a partner in their lifetimes. Not only that, “1 in 15 children are exposed to intimate partner violence each year, and 90% of these children are eyewitnesses to this violence.” In other words, out of the six percent of American children who are living in an unsafe home, nearly all of them actually see or hear this violence perpetrated. So that little boy is not alone – far from it.

What effect does witnessing this violence have on small children? The authors of a 2011 British study scanned the brains of a group of children, with results revealing that those living in violent homes responded differently to images of angry faces. These children showed an increased level of activity in two particular areas of the brain, the anterior insula and the amygdala. Brain scans of combat soldiers exposed to violence in battle also show increased activity in the anterior insula and the amygdala, areas of the brain associated with threat detection.

The authors suggest that “both maltreated children and soldiers may have adapted to be ‘hyper-aware’ of danger in their environment. However, the anterior insula and amygdala are also areas of the brain implicated in anxiety disorders. Neural adaptation in these regions may help explain why children exposed to family violence are at greater risk of developing anxiety problems later in life.”

As a society, we are just beginning to reckon with the toll of battle on veterans of combat and finding ways to help former soldiers adapt to civilian life. It turns out that some of our children have never had a chance at civilian life.

In the short term, young children may experience symptoms that are far more quotidian. UNICEF’s Behind Closed Doors campaign tells us that behavioral issues among small children who witness domestic violence can include “excessive irritability, sleep problems, emotional distress, fear of being alone, immature behavior, and problems with toilet training and language development.” By the time they’re in elementary school, these kids may have difficulty focusing or concentrating, and as a result often struggle with schoolwork. As they get older, issues can include substance abuse, teen pregnancy, and, ultimately, criminal acts.

Perhaps most frightening on a societal level is that the cycle has been proven to perpetuate itself. An American study that drew on data from the Notre Dame Adolescent Parenting Project (“an ongoing prospective longitudinal study investigating the effects of adolescent parenting on child development”) showed that “witnessing violence and victimization prior to age 10 predicted delinquency and violent behaviors.”

This makes sense. On the one hand, violence has been normalized for these kids. On the other hand, resorting to violence themselves is a way of exerting control since their own home lives are so far out of control. For some, the pattern will continue into adolescence and adulthood, not because they are violent themselves, but because they seek out or accept violent partners. And when children arrive on the scene? The entire cycle repeats itself.

The numbers are discouraging. The outcomes are tragic. So what do we do?

I know where to begin, and the only reason I know is because I did something wrong: I didn’t call the police. And it haunted me. I drummed up a lot of reasons not to call. I thought the man would flee. I thought the woman would lie when the police came. I didn’t want her to be punished further by the man when he inevitably talked his way out of a charge (a big assumption, yes).

But mostly, I didn’t want to involve my daughter more than I already had. And yet I had two excellent reasons to call the police: the woman being abused and the child watching. Add to that a third reason: I need to set an example for my daughter that when someone needs our help, we help. My friends encouraged me. “Good for you for pulling over,” they said. Sure, it was a start. However, it’s not enough to pull over and be a bystander to a cycle of violence that will continue unchecked. We have to do more.

I know where to begin. I’m sharing these resources in the hopes that you’ll join me. The first thing I did was to put this number – 800-799-7233 – in my phone under “Domestic Violence Hotline” where I can easily find it. In the same contact, I put the number of the local YWCA Domestic Violence Program.

My next step is to write these numbers down on index cards and leave a few in my purse and a few in my glove compartment. I hope I never see another woman being beaten, but if I do, I will call the police and I will give her these numbers. Beyond that, there are so many ways to be of service. I plan to go down the list.

Here areStop Hitting Her: The Things I Did and Didn’t Do as a Witness to Domestic Violence other resources you can use if you ever need to help someone get out of a terrible situation:

Abusers stay in the picture by exerting their power. It’s time I exerted mine.

Invisible Disability: Close Your Eyes and See My Son

Autism can be invisible. This fact is a double-edged sword. It will help my son in life, and it will hurt him at times.

My son’s autism is invisible. When I first expressed my concern that Henry was two and had only spoken two words and had stopped saying them months ago, our pediatrician told me Henry looked just fine to him. Yes. A pediatrician. While it’s frightening that a medical professional, one I love and respect, could not see past the invisibility of my son’s disability, I can’t fully blame him. This is human nature. For many of us, seeing means believing. And not seeing, not knowing, terrifies us. We can find the worst parts of ourselves when we are faced with the unknown. I am guilty of the same well-intentioned, yet harmful misconceptions.

Perception vs reality

Before my son was diagnosed, when I first moved into my current home, there was a man who walked by my house, a lot. Back and forth, he walked past my house. My instinct was to lock my doors. Weeks passed and I began to see the man walking everywhere, all around town. I remained cautious. A few months later, Henry received his diagnosis, and I began to learn all about autism spectrum disorder.
One day, as I drove down my street and passed the man pacing my block, it dawned on me. Maybe he is autistic. Maybe his repetitive behavior that soothes him is walking. What if one day Henry finds comfort in long walks? What if someone sees him, misunderstands his behaviors and judges him? What if they are afraid of him? I began to look on this man with compassion. I began to look upon him with the same kindness that I can only pray that others will bestow upon my son. I haven’t seen the scary man surveying my neighborhood in a long time. However, I quite often do see a man who minds his own business and enjoys long walks around my neighborhood.
Autism can be invisible. This fact is a double-edged sword. It will help my son in life, and it will hurt him at times. The fact that one cannot see his autism spectrum disorder, will at least impact how people will judge him. It will also leave him vulnerable to misunderstanding and unsolicited judgments. So much of how we deal with situations and people is based on our perceptions. Sometimes our perceptions are born from experience, knowledge, and our personal ideologies. But sometimes they are born from fear, misunderstanding, and ignorance.

One person with autism

How do we reconcile these conflicting motivations from our perceptions? We can begin ceasing our efforts to identify the disability. Education is wonderful, and I’m all for it. We should all educate ourselves about disability. But even a thorough education can be insufficient in identifying certain invisible disabilities. You could not possibly identify every disabled individual’s personal symptoms, traits, idiosyncrasies, self-regulating, and repetitive behaviors.
Autism spectrum disorder can be a great example. It is an umbrella diagnosis, meaning it encompasses a wide range of symptoms, and each individual’s coping mechanisms for these different symptoms is unique. In other words, it’s a mixed bag. And they don’t say “if you know one person with autism, you know one person with autism” for no reason.
So if we cannot possibly learn how to identify each individual’s invisible disability through self-education, then what can we possibly do? Instead of looking for the disability in others, look for the humanity you share. When you see someone who looks different than you or even someone who looks the same as you, and you don’t understand them and your instinct is to run away, or stare, or judge, try not to. It’s that simple.
Instead of looking for someone’s disabilities, look within yourself for what we all share. Compassion, kindness, acceptance — they are all at your at your disposal. There is something even more fundamental than education in life: humanity. Sight can be one of our least reliable senses. Our hearts, however, are fully equipped to see what our eyes cannot. Close your eyes, open your heart, and you will see more than an invisible disability — you will see people. Beautiful people.
This article was originally published on TheMighty.com.

This Is What Happened When I Said Yes to Every Offer of Postpartum Help That Came My Way

They say it takes a village to raise a child, but it’s rare that we actually trust our village to come through for us when we need them to. What if we did?

There’s a few things I need you to know before I begin.
I was in labor for three hours with my third child. Besides a few initial squawks upon arrival, she never cried the entire time we were in the hospital. Her first night, she slept a glorious four hours in a row.
I need you to know these things, because it’s important to note that not everything was terrible those first few months. With such a smooth beginning, I wasn’t expecting everything to fall apart. But a few days later it did, and I found myself trust-falling into my community.
My postpartum string of bad luck started with a slow recovery. The cramping and bleeding refused to slow down for weeks. With a hernia to boot, I could barely walk for weeks after delivery. Even lifting the car seat proved to be too much.
Ten days after delivery, I developed a bad ear infection that would last well over a month through multiple rounds of antibiotics and several different types of ear drops. I also got not one, but two stomach bugs, the latter of which landed me in urgent care with an IV hooked to my arm. At one point in the postpartum haze, I even shattered my iPhone.
The crowning moment, however, was when we totaled the minivan we had just bought before it even made it home to our driveway. A few days later, we all came down with colds – even the newborn – and I prayed that was our rock bottom.
At some point in this string of unfortunate events, I realized we couldn’t do this on our own. I decided that I would say “yes” to any offer of help that came my way.
My mom had already agreed to stay with us for the first several weeks after the baby was born. When she offered to take the kids in the morning and let my husband and I go back to sleep, the answer was a resounding “yes.”
We gladly devoured meals that were dropped on our doorstep. When a friend texted to say “do you need anything?” I asked if they could pick up a gallon of milk the next time they were at the store, or swing by and entertain my older kids for an hour. One friend even delivered my ballot to the courthouse on Election Day.
Shifting a few everyday tasks to other’s plates helped reduce my mental load tremendously. But as grateful as I was to receive the help, I felt uncomfortable admitting we needed it. In other times of stress, I had always met “Let me know if you need anything” with a “Thanks, but we’re doing good!” I worried I was inconveniencing my friends and family by actually accepting their offers of assistance. Our friends, however, seemed genuine in their desire to lend a hand.
It would have been easy enough to shut the door, feed the kids nothing but frozen fish sticks, and post cute baby pictures on Facebook that would make it look like everything was going wonderfully. But I knew pretending would only make things more difficult in the long run.
The months after my first two children were born, although not quite the tragicomedy we were currently living, had also been stressful. I struggled to adjust to motherhood, how to get my premature son to latch, and of course, with sleep deprivation. But more than anything, I was lonely in only the way that a new mother who is never alone can be.
Perhaps that is why, this time around, I was so desperate to accept any offers assistance. I ‘m sure I could have survived without friends cooking meals or family members stopping by to rock the baby. But what I needed most was not the cup of coffee that my friend was dropping off. Rather what I truly needed was the opportunity to connect with someone for a few minutes. Those brief moments of pleasantries reminded me that there was a world outside our own little turbulent bubble, and that we would eventually return to it.
They say it takes a village to raise a child, but it’s rare that we actually trust our village to come through for us when we need them to. There is no honor in doing everything on our own, and no shame in admitting that we can’t.
I now have a gigantic pile of Tupperware sitting in the back of my car. Every time I try to give it back to my friends they all reply the same way: “Oh it’s fine. I don’t need it back.” My own Tupperware drawer is pretty full as well. So when the newborn dust settles, I know exactly what I’m going to do with it – start feeding my own village. You never have to look too far to find a parent who could use an extra hand.