Does Your Kid Have Constant Heel Pain? It Could be Severs Disease

Sever’s disease, also known as Calcaneal apophysitis, is the most common cause of heel pain in children.

I felt like the world’s worst mom. My sixth-grade son had been complaining about pain in his heel since starting soccer a month earlier. We were new to the area. He was shy and not overly interested in athletics. I thought he was just trying to get out of it, so I pushed him on.

It took his tears and a coach’s concern to wake me up.

That was the beginning of his battle with Sever’s disease, a condition that took him out of sports and out of gym classes for more than three years. His case was acute, far worse than most. Many kids can continue with athletics after therapy and treatment, but not him. He had to wait for the disease to run its course.

Along with the physical pain, he fought ignorance and the social repercussions of invisible illness. A substitute gym teacher accused him of faking it. His peers were too young to understand what they could not see. He needlessly suffered through medical boots, casts, and expensive orthotics ordered by a doctor who went by the book instead of treating our son as an individual.

It didn’t have to be so hard. Like many parents, we’d never heard of Sever’s disease. If we had been more educated, his experience might’ve been less painful, physically and socially. The more we learned, the more surprised we were at how common Sever’s disease is and how little most parents and coaches know about treating it.

Sever’s disease, also known as Calcaneal apophysitis, is the most common cause of heel pain in children. It’s not really a disease. It is an overuse condition that usually occurs during the growth spurt of adolescence, about two years before the onset of puberty. For most kids, that’s between the ages of eight and 13 for girls and 10 and 15 for boys.

This is how it happens: Children who are still developing physically have plates made of bone surrounded by cartilage on their heels where their Achilles tendons attach. Picture that piece of bone as an island in a sea of cartilage. The pain occurs when the tendon repeatedly yanks on that growth plate, causing inflammation in the cartilage. The only permanent cure is time.

Eventually, the cartilage turns to bone and the pain is gone for good. The worst pain usually lasts only a few weeks or a few months, but flare-ups can happen any time during the 18 months to three years it takes the cartilage to solidify. Knowing the root cause is essential in deciding how to treat it for the long-term. We didn’t know that.

The most popular articles that popped up in my internet searches addressed only the acute stage, as did our doctor, a sports podiatrist who came highly recommended by friends. We had no reason to doubt the doctor or question his approach to treatment. So when he recommended casting, we did it. When he recommended a boot, we did it. When he encouraged our son to return to sports with a duller version of the pain, we agreed.

Each time it flared up, this doctor prescribed the boot, again and again and again. Nothing seemed to keep the flare-ups at bay. The doctor’s final solution was an expensive pair of orthotics that did nothing.

It was an exercise in frustration and it led to confusion for us, the school, our son’s coaches, and his peers. Our son was becoming depressed, especially after we hit the two-year mark and the pain with activity was no less intense. We found no real relief until we ditched our doctor and found an orthopedic surgeon at the University of Rochester, who was known for thinking out-of-the-box.

What we learned is that not all cases of Sever’s disease respond to the same approach. There are several potential causes of the condition. Overuse in sports, a tight Achilles tendon, and bio-mechanical problems such as flat feet and high arches are common culprits, according to The American College of Foot and Ankle Surgeons. Most often, the condition will improve with medication, physical therapy, ice, and a reduction in exercise.

Many kids can continue in sports if they pamper their heels and tendons a bit with stretching, shoe inserts, ice massage, and a reduction in the intensity of their training when the pain returns or becomes more intense. Some never experience that pain again.

Our son was not a typical case. He is tall and his bones grew faster than his muscles, tendons, and ligaments, the doctor said. With such a short Achilles tendon, there wasn’t much he could do to prevent that constant yanking. No amount of casting, booting, medication, or icing was going to make the pain go away. He needed to accept that activities involving repetitive walking or running would be off the table or a while.

His new doctor tossed the orthotics and prescribed simple, comfortable heel lifts to shorten the tendon while he walked, relieving the stress on his growth plates. He recommended physical therapy and daily exercises to stretch the Achilles tendon. Even the slightest gain in length would relieve his pain during daily activities such as walking to classes, he assured our son. He had to keep them up at home long after therapy ended, stretching the tendon three to six times a day.

It was that simple.

The lifts, therapy, and stretches created a new bounce in our son’s step. He knew what to expect and he finally understood that he was playing a waiting game. He knew that a full recovery was around the corner and that he just needed to bide his time until then. So he began lifting weights and working on his abdominal muscles, preparing for the day he could return to gym and sports.

In tenth grade, he joined the cross-country team again. This time, he finished the season pain-free.

Determination and the Will to Live

This is a submission in our monthly contest. October’s theme is Determination. Enter your own here!
In the mirror I could see the impossibly tiny blue foot sticking out of my abdomen, no bigger than an almond. I only glimpsed it for a moment as the doctor hurried to slide his large hand around the leg and reach for the body. But the tininess, and the blueness of course, alarmed me. Within moments the doctor was holding the smallest infant I had ever seen in front of me, briefly, before he was whisked from the room to be resuscitated. In my head a voice screamed, “Put him back! He’s too small! He’ll never make it!”
When I awoke I was taken to see my son whom we’d decided to name James. He had been put on a ventilator and it was tougher than anticipated to see him on it. Every breath looked intensely painful. When he breathed in it looked as if his ribs were touching his spine. His whole chest would compress incredibly hard. It appeared that every muscle in that tiny two-pound body would tense and it gave the impression that James was experiencing acute pain.
But James was born with two things that mattered: flaming red hair and the determination to match it. He was here to survive. He had Hyaline Membrane Disease which affects the lungs and makes it very difficult to breathe. Yet he fought every day determined to breathe on his own one day. He also required a blood transfusion but at two pounds they couldn’t find any veins large enough to use. Eventually they had to go through a vein right in the top of his head near the forehead. He didn’t like it but he tolerated it with his determination and will to live.
Each week he experienced two steps forward and one step back. That sweet little baby struggled for over 60 days in the hospital before they finally released him to come home. Yet even with all the pain he experienced in the first days and weeks of his life James was the most sweet spirited child that anyone who knew him had ever encountered. He was a joy to his family. He was especially adored by his Daddy. He and his Daddy developed a close bond. They loved to read together, take walks, have “guy talks” and wrestle. For nearly five years they shared a great father/son relationship.
That is why James almost fell apart when his Daddy died suddenly two days before James turned five years old. He had experienced a sudden stroke. No apparent reason. He was totally healthy and there was no family history of it. After the stroke they had done surgery to open the closed artery. We had thought all was well. He had hemorrhaged and within hours was declared brain dead. Then I had to tell James. I have never seen a child that upset. I’ve seen children cry. I’ve even seen children throw fits. I have never seen a child experience that true depth of sorrow. He cried so hard for so long we had to take his clothes off because he was overheating.
Still, we wondered if he was fully comprehending the permanent nature of death. It wasn’t until after the viewing that I would understand what he was thinking. At the viewing I took James and his sister in with me to see their Daddy’s body before the guests arrived. After a moment James asked to be alone with his Daddy. I was hesitant at first and then agreed. After leaving him alone for about five minutes, he came walking out of the room with a tear stained face and looking exhausted. He let me pick him up and hold him and he rested his head on my shoulder.
The next day when I asked him about it he told me, “I didn’t know if Daddy was really dead so I wanted to be alone with him. When you left I said to him, ‘Daddy, wake up!’ But he didn’t wake up. So them I took his hand to shake it. But his hand was very cold. So then I knew he was really dead. And then I cried and cried.” He waited until he was done crying to come out of the room to me.
It seems to me that when James learned his Daddy had died for real that was a moment of determination for him. He had to once again choose to go on and live, to dry his tears, and put on a brave face for mom. That brave, sweet little boy by five years old had already twice in his life, both when he was a tiny two-pound preemie and as a five year old facing the death of his Daddy, shown amazing determination and a will to live!

If These Scars Could Talk

I’m grateful for my scars. Each blemish has a story. Without my stories – and my scars – who would I be?

This is a submission in our monthly contest. November’s theme is Gratitude. Enter your own here!

I remember a story I saw on television as a child. It was the 1970s, before lasers were available to remove tattoos. The story was about a woman who wanted a heart-shaped tattoo removed from her derrière. Apparently, the doctor incised the heart tattoo and stitched up the wound. The scar that the excision left was in the shape of a capital letter Y. I remember thinking to myself, “She better marry someone whose name starts with a Y. Otherwise her husband might get jealous!” Something about that heart-turned-into-a-Y-shaped-scar always intrigued me. That woman had a story to tell.

At age nine, I earned my own first noticeable scars when I broke my femur. My parents bought a small motorcycle, and they’d take us kids out for rides on a piece of country property that our family owned. I was too young to ride the motorcycle alone, so I climbed on the back and hung on behind one of my father’s friends. It was an accident. Emile certainly didn’t want me to get hurt, but a piece of barbed wire was dangling in our path and it snared the wheel, yanking the bike onto my leg. I still remember the pain and the long drive to the hospital. The orthopedic doctor surgically inserted a metal pin through my leg to set me up for traction. After six weeks in the hospital, six weeks at home in a body cast, and several weeks on crutches, my femur finally healed. Over 40 years later, I still think about that accident whenever I see the small scars on either side of my right leg where the pin was.

Most of us don’t like scars. If you Google the word “scar,” numerous plastic surgery and dermatology websites for scar removal pop up. There’s a lot of money to be made in getting rid of our scars. Everyone wants beautiful, flawless skin that’s free of freckles, moles, and wrinkles. But if you think about it, scars equate to experiences. I’m grateful for my scars. Each blemish has a story. Without my stories – and my scars – who would I be?

I acquired other scars over the years, too. There’s a small one on my knee from a cut I received in a high school car accident. I think of my friend Linda when I see that scar, because she was in the car with me. Our vehicle was totaled, but Linda and I were okay. In adulthood, two cesarean section deliveries left a thin zipper across my lower abdomen. My sons are the result of those childbirth experiences, and the scars remind me of bringing Mason and Will into the world. There’s also the one on my back where I had a benign skin cancer removed. The basal cell carcinoma was likely the result of childhood sunburns, and that scar brings back memories of a particularly hot family beach trip to Corpus Christie, Texas one summer. I’m grateful to those doctors. The scars are my reminders.

My most serious scarring accident happened last year. It was spring break, and I was on a skiing vacation with my family. I was skiing to the right while a young man turned too fast to the left. Our skis crossed and I flew out of control into some trees. It was a frightening experience. I immediately felt intense heat throughout my ankle. I thought it was another broken bone, but I was wrong. It turned out to be a full rupture of my Achilles tendon, requiring immediate surgery.

Despite tearing my Achilles tendon, I somehow managed to attend the book launch events for my first children’s book. I couldn’t drive for a few months, but a wheelchair, a knee scooter, and Uber provided the mobility that I needed. I’m grateful to my husband, children, parents, siblings, and friends for taking care of me. I disliked being dependent on them, but I learned that the Beatles were right when they sang, “I get by with a little help from my friends.” I’m grateful to the ski patrol team that took quick action. I’m grateful I didn’t die when I hit the trees in that skiing accident.

When the orthopedic surgeon unwrapped the bandage to reveal my new Achilles tendon scar for the first time, I almost hoped it would be in the shape of a capital letter Y. That would’ve been perfect. But no, it’s just a two-inch horizontal mark.

My scars don’t bother me. They’re a literal skin road map of life that allows me to retrace my varied experiences. They reveal a sense of adventure. The scars point out that I might be a bit clumsy, and they always remind me to be grateful.

This post was originally published on the author’s blog.

How I Missed My Kindergartner's Color Deficiency

Roman’s perspective of the world was colored, literally, different, yet his outlook was unfazed.

This is a submission in our monthly contest. October’s theme is Determination. Enter your own here!
It was only two weeks into kindergarten when my son, Roman, brought home a coloring assignment, a cut-out owl, with a big letter F marked in red on the top of it. The owl was colored not brown, but green, adorned smartly in a graduation cap and gown, holding a diploma and donning wiry spectacles. Under the bitter mark was a lengthy and unsympathetic explanation of the grade: Owls are NOT green! With respect for the rules of writing, I use one exclamation point here, but Roman’s owl had not, one, but three of these dramatic punctuation marks, marks that typically need to be well earned when chosen over a simple period for ending a sentence.
I’m not undermining the importance of following directions and learning the motor skills and conventions of coloring in a kindergarten classroom, and if this had been a high school final exam, perhaps a math or a science or an English language test, my own instinct would have been to ask Roman why he didn’t try harder, why he didn’t get a better grade, explain that an F is not acceptable, as my overachieving parents would have done. However, my son seemed to be faced with a burned out teacher radiating indomitable meanness at this early stage in his education, a time when fostering success and enthusiasm about school is paramount. Even worse, I suspected something more significant.
I suspected that something was medically wrong with Roman.
As I held the crumpled owl in my palm that I had balled up in anger, a wooden knot rose up in my throat. I swallowed, slowly spread the owl out on my desk, and examined Roman’s beautiful work, that I had initially been critical of myself, his best effort. I put Roman’s folders back into his book bag, recalling the many times we’d played toddler games. I’d quizzed him like the proud mama I was. I’d held up flash cards and pictures for him to name. Animals. Shapes. Even letters.
And colors.
In toddlerease, he proudly named chinchillas, ostriches, and bearded dragons, from his book entitled, “My First Animal Book.” He could tell the difference between a puffin and a penguin which, at his age, I’m sure I could not – all the more reason he seemed too smart not to know his colors correctly.
But I figured he’d catch on eventually, didn’t sweat it.
Then I thought even further back, to images from my own childhood.
I recalled my own mother throwing up her arms at my father’s mismatched outfits. My grandmother noting how he had to read the position of the traffic lights, instead of the colors, green, yellow, red. My dad was colorblind, and I was certain, now, that Roman was, too.
Then I thought of how I’d failed as a mother the time I’d yelled at Roman for not picking up his toys from the lawn, remembered the time clearly. There was a brown baseball in plain sight and I was pointing right at it where he left it, along with numerous other whiffle bats and balls, lying on the grass.
“I don’t see it.” He shrugged.
“It’s right there in front of you,” I yelled in frustration.
And then I thought of how my own frustration might hinder Roman’s determination to succeed in school, throughout the year, if I didn’t hold back my urge now, to march into the principal’s office and have the teacher reprimanded for her intolerance to his unconventional coloring that was, to me, at least, so obviously indicative of a visual disability.
Instead of reacting, I poured myself a glass of wine. I gave Roman a hug and told him I liked his green owl, flattened out the paper and blacked out the F, the unkind words, too, with black sharpie marker. I put a sticker on it and pinned it on my office corkboard next to his baby pictures and snapshots of our family vacations.
How could I have missed this?
What kind of mother was I?
What kind of doctor?
I gave myself a little slack on my professional vocation, since I’m an anesthesiologist by training, not a pediatrician, not an ophthalmologist. But as a mother, I truly felt I’d failed.
I was determined not to create a bigger problem for my son, yet I wanted to help him. I’m aware that there is no cure for color deficiency, so my determination focused on ways to help him succeed, despite a possible disability.
I held back, instead of reacting negatively like Roman’s teacher had done, undulating waves of her criticism in our direction that crashed on the deaf ears of a developing child who still, after receiving the grade, could not understand what he had done wrong. There was no way he could visualize the clear distinction between the green and brown. I held back and I learned everything I could about the condition of color deficiency, which I had been calling colorblindness, incorrectly. I learned that up to eight percent of boys are color deficient, not possessing the correct number of cones in the inner eye needed to see shades of red and green colors as well as the rest of us can. I quickly researched the diagnosis, reading up on possible treatments which sadly, are lacking. In Roman’s case, color chart testing performed by his pediatrician confirmed that he was a deuteranope, or red green color deficient.
When I left the office I wrapped my arms around my little boy, handled my glassed eyes with tissues, trying to wipe away the uncertainty. He seemed more vulnerable, imperfect, yet I loved him more for his flaw, and I felt the intensifying urge to nurture and protect him. I realized that he’d face certain tasks that made his life much more challenging. I still felt guilty for my flood of emotions when I thought of how much worse it could be, how it wasn’t the most physically limiting disability he could face, and yet I smiled.
I smiled because mostly, it didn’t seem to bother him at all.
Roman’s perspective of the world was colored, literally, different, yet his outlook was unfazed. And as I took a moment to process the implications of his disability, I was determined to affect change in a positive way, a kinder and gentler way, when I explained his condition to his teacher. I thought of the thirsty bird in the famous Aesop’s Fable, who slowly raised the water level in the vase with each tiny stone it dropped into the vase with its beak. By solving the problem effectively and not knocking over the whole vase in the process, the bird quenched its thirst. Explaining Roman’s condition calmly to his teacher seemed to be a better way to try to prevent this from happening again in the future, than ratting her out to the principal would. And I knew that Roman would need to solve problems on his own one day, by labeling colors or asking for help.
She didn’t apologize.
This was disappointing, to say the least, yet I hadn’t created any additional tension that could affect Roman’s grades for the remainder of the school year. What was more important was the way I wanted my son to see me, not in tan or pale hues, not in shades of blonde or brunette or redhead hair, and not for the point of noticing the colors of my clothes, but to see the person I am. I wanted him to know that I would do everything in my power as a mother and as a doctor to help him. Even before doing so, I wanted him to see me as someone who would fulfill the Hippocratic Oath I took in medical school, one that applies as much to mothering as it does to medicine. I remained determined for him to see that my promise to him above all, is to do no harm.

I Don’t Regret My Birth Plan: Notes From the Forever C-Section Mom

We all have the ideal plans for how we’re going to raise our kids and how they will turn out. Then life happens.

The pregnant woman sitting next to me at the park talks jubilantly about her upcoming birth and the way she hopes her labor plays out. I smile and nod, feeling excited on her behalf. I have four children, and the birthing days are solidly behind me.
“Did you write a birth plan?” she asks me.
“Yep. Every time.”
“What happened?”
I hesitate, always hating the answer. “I had three C-sections.”
I am the ultimate cliché, the woman who detailed her plans for birth, going slightly over the recommended limit of one page for a birth plan. My husband and I took a birthing class and watched “The Business of Being Born”, taking notes for later reference. I dreamt of unmedicated birth, immediate skin-to-skin contact, and going home quickly after labor.
Then, for three separate reasons – breech baby, three-weeks-overdue baby with no signs of labor, identical twins with TAPS – I was taken to a sterile OR to be sliced open, my children removed from my body that was numb from the waist down. I baked under the heat of the OR lamp while still shivering and wondered what I had done wrong. I was handed my babies before I promptly puked. Still, I attempted to cradle them in shaking arms, my body wrecked from all the medication.
It wasn’t until I needed a procedure to obtain a sample of my endometrial lining that l learned I have a defective cervix, one that simply will not dilate. It was a painful discovery, both in a physical and emotional way, but I chuckled maniacally thinking of my still-saved birth plan stored on my computer.
How the hell was this little discovery supposed to make me feel?
A friend said I should be grateful. In countries where access to C-sections isn’t promised, I would have likely been dead, an obstructed labor taking my first daughter as well. I tried on gratefulness and truly did feel thankful that all of my births ended well. However, I still felt like a fool, a woman who felt humiliated by my own body and its betrayal of me.
I’ve had a year to absorb the defective cervix news, and in that time, my feelings have changed. Today, my decision to write birth plans makes me proud. I’m glad I did it, that I trotted into my doctor’s office each time with my wishes spelled out in ink. I’m glad I was educated about childbirth, that I went from knowing nothing about having a baby to researching and planning for months for the birth I felt was right for me.
It was my first step towards mindful parenting, the process of weighing all my options and settling on what I believed was the ideal outcome for our family. Of course, the ideal didn’t pan out, but having a plan in the first place gave me a jump-off point to work from. What could we salvage from the plan? How could we adjust? What was best for everyone when the circumstances shifted?
This lesson, it turns out, is one that every parent will have to learn at some point. We all have the ideal plans for how we’re going to raise our kids and how they will turn out. Then life happens. We regroup. We save what we can. We find ways to be thankful along the way and fully grasp that none of this was ever truly in our control. We keep trying.
I also gained experience in standing up for what I believe is best for my kids. When I planned to VBAC with my son, I received a variety of responses. People laughed at me. They expressed shock that I wasn’t signing up for another C-section without a fight. Many questioned if VBACs were even a thing and if I was endangering my son by trying.
I held my ground.
I now do this regularly when people question my decisions to homeschool, to not dress our twins in the same outfits, or to try gentle discipline instead of spanking. I didn’t successfully VBAC, but I knew it was the chance I wanted my son to have, so I tried to give it to him. I wouldn’t take that back.
Writing a birth plan prepared me for looking ahead and making conscious choices. It taught me that I don’t have to follow the crowd or someone else’s way of doing things. I can chart my own course and do everything possible to navigate the experience and land where I want.
I can also live through it when life inevitably has other plans.

How to Test Your Kids’ Vision Before They Can Read

You might be wondering how your three-year-old could possibly sit still for an eye exam, let alone read one. Here’s how.

The US Preventive Services Task Force recently recommended vision screening for all children between the ages of three and five.
If you’ve logged a good amount of time trying to distinguish “C” from “O,” you might be wondering how your three-year-old could possibly sit still for an eye exam, let alone read one.
Childhood vision screening generally takes place in a pediatrician’s office. Here’s what your child’s pediatrician is looking for and what you can expect during the visit.

What your child’s pediatrician is looking for

Unlike your eye exams, which may include testing for glasses, your child’s vision screenings are generally looking for warning signs of future vision problems.
Your child’s pediatrician is specifically screening for evidence of amblyopia, which occurs when one eye is unable to communicate properly with the brain. The risk of amblyopia is low: according to the USPSTF, between one and six percent of kids under age six will have either amblyopia of a risk factor for amblyopia.
In its review, the USPSTF found there to be small but permanent improvements to vision in three- to five-year-olds when amblyopia is identified and treated. Because the tests for amblyopia and its risk factors are non-invasive, the USPSTF has determined that the benefits of vision screening outweigh any harms.

What to expect during the visit

A pediatrician may use many different tools to examine your child’s eye structure, coordination, and acuity. The following three tests are among the most common.

Tool 1: Red Reflex

What it measures: Your child has likely had a red reflex test before, as many kids have them before two months of age. The test helps identify any physical abnormalities in the back of the eye, ranging from cataracts to retinoblastoma.
The red reflex test is named after the color healthy eyes give off when viewed through an ophthalmoscope from about one foot away. That red color is easier to see in the dark, which is why your pediatrician may turn the lights off for this test.
The phenomenon is the same as the “red eye” you try to edit out of photographs. In fact, photographs featuring a single red eye have been used to identify serious eye conditions.

Tool 2: Cover/Uncover Test

What it measures: You’ve probably seen your child’s pediatrician do a fix and follow test, in which your child is instructed to look at the pediatrician’s finger and follow it around the room. That test examined how well your child’s eyes function together.
The cover/uncover test works a similar way. Your child will be asked to focus on an object in the distance, then the pediatrician will cover one of your child’s eyes. While your child is still looking at the object, the tester will uncover the eye and watch for movement.
The test is observing for strabismus (incorrectly aligned eyes), which is one risk factor for amblyopia.

Tool 3: Lea Symbols Chart

What it measures: You may have not spent a lot of time thinking about how the letters at your optometrist office get made. They are optotypes, specially designed tools for testing vision. The letters in an optotype are designed to all blur equally under the same conditions, which give examiners a better understanding of a patient’s visual acuity.
Pre-readers get their own special optotypes. Instead of letters, they’ll likely have four symbols: a square, a circle, a house, and an apple. Those symbols, called the Lea Symbols, have been shown to get more cooperation from kids than other eye tests.
The Lea Symbols test works much like the eye charts you see (or don’t see!) at your optometrist. The test measures kids’ visual acuity, and can determine whether or not your child may need glasses.

When Food Is Medicine

This is a submission in our monthly contest. November’s theme is Gratitude. Enter your own here!
One night, after the results of my son’s routine blood work showed scary-high levels of phosphorous, an effect of his kidney disease, anxiety fluttered inside my chest like I had swallowed a hummingbird. Anxiety about his health, the new medication I’d have to force down him, the disease’s progression, his eventual transplant, school, life, friends … I clicked on the TV to take it away, to lose myself in some gorgeous, rainy, heavily-accented series on the BBC. I landed, somehow, on the “Great British Baking Show.”
I ate through the first season like it was cake, watching home bakers whip together sometimes beautiful, sometimes disastrous creations in their bowls and mixers and ovens. What struck me was how real – how average – these people were, baking for the simple pleasure of creating something, of feeding their families. I thought: I could do that.
My first loaf of bread came out lumpy and awkward but delicious. My three children ate it smothered in butter as I spoke to my son’s doctor and nutritionist on the phone. We needed to start him on a grainy, awful-tasting powder – a phosphorous binder – which would be his ninth daily medication. But something in me refused. They said I could sprinkle it on his food, or mix it with water – but I knew, and they knew, it wouldn’t be as easy as that. He was three-and-a-half, very particular, with a history of eating issues. There must be something else we can do.
They relented: We can try to make changes to his diet first, they told me. No cheese, no milk. Limit whole grains, meats, nuts, the list went on and I scribbled notes as the hummingbird fluttered inside me. Really? For this boy who spent the first two years of his life nearly unable to eat solid food? Who would spit out (or vomit up) a single Cheerio? Whose crackers I’d break into grains of sand and set with something like a prayer on his high chair? This child whom I’ve been spoon-feeding for far longer than is good for either of us? For years the message was always FEED HIM, in alarming capital letters. FEED HIM or we will we will write failure-to-thrive on his chart. FEED HIM or we will thread a feeding tube down his nose and into his belly and do it for you.
Now you want me to take the food away?
But my son, like my two healthy children, ate my bread and butter and something clicked. I went to the supermarket; I read ingredients. What I thought of as “good bread” with the label from a fancy Los Angeles bakery wasn’t just flour and water and yeast; it was a science project of chemicals and preservatives, even a phosphorous additive. I put it back.
I started keeping bread dough in the fridge, ready to bake when we were running low. Then on to other things: carrot cake, corn muffins, zucchini bread, forgoing the nuts and doubling the vegetables; French toast with pasture-fed eggs; from-scratch pancakes, waffles, everything with almond milk instead of cow’s. I baked at night, when my family was asleep and everything was quiet and dark, which was better anyway because summer days in LA were just too hot. I kept batches of waffles and French toast in the freezer to warm-up in the mornings. I joined a CSA and looked forward to Wednesdays, when a giant box of organic fruits and vegetables, sometimes with the farm dirt still kissing the heads of lettuce, would land on my doorstep.
Baking turned to cooking. Roasted delicata squash in coconut curry. Pasta with burst cherry tomatoes and garlic and kale. My littlest one now eating spoonfuls of (almost) dairy-free spinach pesto for breakfast, and why not.
Meat quickly took a backseat to fruits and veggies, but chicken from the farmer’s market, lightly pounded and pulled through sesame seeds could save the world. Soups, stews, sauces, and after too many years of spoon-feeding, my son started to use utensils on his own. Rosemary shortbread cookies. He’s feeding himself. Cucumbers and avocado with balsamic vinaigrette. Not just feeding himself, but feeding himself a salad.
I’m lucky to live where the produce is so bountiful. I’m lucky that my children (and husband) are good sleepers, so that I have my nights alone in the kitchen. I’m lucky that I enjoy the quiet miracle of turning ingredients into food. Some things take time, so I save them for when I have time. Good produce, meat, and eggs – it’s expensive, but hey: I serve expensive food on cheap plates.
Sometimes my cooking is beautiful and sometimes it’s a disaster, just like the bakers on TV, but watching my son’s phosphorous levels stabilize without medication, and watching my healthy son and daughter eat their veggies (and their cookies) with pleasure, makes the effort, and the expense, entirely satisfying.
 

Your Kid Wants a Tattoo or Piercing? Don’t Freak Out, Talk.

Tattoos and piercings are not new by any means, but studies show that more kids are getting them even at younger ages than in the past.

For the first time ever, the American Academy of Pediatrics decided to review the incidence of youth tattoos and piercings in depth.
Led by Dr. David Levine, a general pediatrician and professor at Morehouse School of Medicine in Atlanta, and Dr. Cora Breuner, an adolescent medicine specialist at Seattle Children’s Hospital, the new AAP report highlights the potential health risks and social/emotional consequences of tattooing and piercing in adolescents and young adults.
Tattoos and piercings are not new by any means, but studies show that more kids are getting them even at younger ages than in the past. According to the Harris Poll in 2015, about 30 percent of Americans have at least one tattoo, up from 20 percent just four years before.
Tattoos are especially popular among younger generations, with nearly half of all Millennials sporting one. According to the Pew Research Center, about a quarter of 18 to 29-year-olds have piercings in locations other than their earlobe.
This may not be a big deal for some parents, especially those who have their own tattoos and creative piercings. But for some parents, it becomes an issue to add to the long list of parenting dilemmas. Permanent body art may not even be on their radar if nobody else in the family enjoys that form of expression or if their cultural or religious beliefs consider the practice taboo.
We have two choices: forbid our kids to get tattooed or pierced and risk that they do it anyway behind our back (and possibly get hurt or regret it), or initiate an open dialogue and work with our kids to guide them to the best decision possible.

Identifying why your child wants it

The first step is to explore your kids’ goals and motives for wanting a tattoo or piercing. This conversation can lead to a simple answer, like they just want to show off their artistic flare. Alternatively, the conversation could open the door to issues you were not aware of.
According to the Harris Poll, people typically get tattoos because it makes them feel: sexy (33 percent), attractive (32 percent), rebellious (27 percent), spiritual (20 percent), intelligent (13 percent), employable (10 percent), and healthy (9 percent).
If your daughter wants a tattoo at age 15 to feel sexier, then a red flag may go up. You could broaden your conversation to her reasons for wanting to attract more attention, her current sexual activity, and the feelings she has about her own body.
If your son wants a tattoo to feel tougher or more rebellious, you may want to explore his level of anger and aggression. Is he having trouble making friends in school? Has he displayed signs of bullying?
If your child wants to ingrain the name of a significant other on their skin, you may need to talk to them about the level of commitment involved and the possibility of future heartbreak.
Finally, if they are doing it for spiritual reasons, what is the message they want to communicate, and why now? Should you be concerned about the influence a religious leader or spiritual mentor has on your child?
We need to take the time to listen to our children’s reasons so that we can help guide them. The answer may be very simple and positive, like they want the word “peace” on their body because they wish for world peace. It’s hard to argue with that.

Addressing your concerns

Talk to your children about exactly what getting a tattoo or piercing involves. They may be so set on it that they haven’t thought through some of the possible risks or downfalls.
For starters, the AAP report addresses the possible job market repercussions down the road. Some employers may frown upon visible tattoos in the workplace, which can limit your child’s job prospects and success. In a 2014 survey of nearly 2,700 people, 76 percent thought that tattoos and/or piercings had hurt their chances of getting a job, and 39 percent thought employees with tattoos and/or piercings reflect poorly on their employers.
While your child may be many years away from getting their first job, it’s important to talk to her about how a tattoo or piercing can impact her life in the future. Ask her to consider the risk involved, taking into account that life dreams should take precedence over a potentially rash, trendy decision in her teenage years.
Consider a compromise. Suggest that your child get a tattoo in a place that would not be visible on the job. Piercings are a bit more challenging. Clearly, a tongue ring could hinder one’s speech, and other piercings on the face in particular may motivate an employer to choose another candidate.
Tattoos, moreso than piercings, are pretty permanent. When you talk to your kids about getting a tattoo, be sure to bring up the fact that this commitment is not easily erased. Laser removal can also be costly – up to $300 per square inch of treatment area – and may only be partially effective.
Plenty of people have admitted regrets that you should bring to your child’s attention. According to a survey, nearly a quarter of people with tattoos say they regret getting them because they were too young, their personality changed, it no longer fits into their lifestyle, they chose someone’s name with whom they no longer associate, it was poorly done, or it’s simply not meaningful to them anymore.
Perhaps most important, weigh the health risks associated with tattoos with your child before he goes ahead with it. The most serious complication from any form of body modification is infection.
Other health concerns related to tattoos include inflammation, abnormal tissue growth like keloid scars, and vasculitis, a rare inflammation of the blood vessels. Body piercings have also been associated with pain, bleeding, cysts, allergic reaction, and scarring. Tongue rings, meanwhile, can cause tooth chipping.
Once you’ve openly discussed the pros and cons, give your kids some time to ponder their decision. Ask them whether they feel it’s really worth it, all things considered. How will the tattoo or piercing enhance their life? How will it hinder them? Are there alternative forms of expression they would be happy with, such as creative fashion choices or changing their hair color and style?
No matter their decision in the end, at least you sparked a mature conversation that will bolster their respect for you and remind them of your genuine, loving interest in their life. When something more serious comes about, they will know they can turn to you, which is, of course, more important and lasting than any tattoo or piercing.

The Highs and Lows

We learned the management of diabetes is an art form. Her little fingers became paint brushes of red expressing her glucose levels.

This is a submission in our monthly contest. October’s theme is Determination. Enter your own here!
 

The storms of life move us in unexpected directions. Sometimes they hit us simultaneously. One spring our family survived a nor’easter where hundred-foot oak trees swayed like reeds of grass on a beach, rain hammered our windows, and power lines whipped to the ground causing  power loss for a week. Incredibly, the winds of this nor’easter paled in comparison to the gales blowing in my life.

My concern for my five-year-old daughter, Sophie, grew as she became more tired, cranky, and was drinking more water than ever before. I thought I was overreacting due to my emotional and physical exhaustion from attending graduate classes, working at an internship, parenting three girls, and struggling financially during the Great Recession. In order to appease my fears, I called the pediatrician and dreaded driving to the office in Friday rush hour traffic.

Sophie’s blood glucose level was 535 and very high. My motherly instinct was right.

How could this be? I don’t know how many times I have gone to the pediatrician’s office with a sick child and have been told they are fine. I looked at the doctor with an expression of uncertainty.      

The nurse brought Sophie into another room to get stickers and the doctor touched my shoulder. “Do you know what this means?”

I felt like the world was closing in on me. “I’m not sure.  What do we need to do?” My voice was eerily calm but I was barely breathing.

“Type 1 diabetes is a result of not enough insulin being made in the pancreas. It is an autoimmune disease and the insulin-producing cells in the pancreas are destroyed. Normal blood glucose levels in children range from 70 to 120.1. You need to go to the hospital and stay for a couple of days to learn about the disease and how to manage it.” His kind eyes spoke volumes.

“This can’t be happening. Can we go home first?” The churning feeling in my stomach was building.

“Yes, but you have to go to the Emergency Room tonight.”

On our way home, my husband called to find out about the doctor’s appointment. I could no longer hold back my tears and struggled to share the diagnosis. Verbalizing the reality of our daughter’s chronic disease weakened every part of me.

“Mommy, what’s wrong?” Tears started welling up in Sophie’s eyes.

I took a deep breath and looked at her. “Nothing is wrong, Soph. Don’t worry. Everything is going to be okay.”

There is no parent handbook to tell you how to handle every situation. I wanted to take care of Sophie but I didn’t know anything about Type 1 diabetes. I focused on giving her my love and calm reassurance. When we were in the ER, Sophie allowed the nurses to put an IV in her hand and check her blood glucose levels every 30 minutes.

“Do you really need to prick her finger again? She doesn’t like it,” I asked.

The sympathetic nurse replied, “Let’s just check her glucose level one more time.” Later, I realized this compassionate nurse didn’t have the heart to tell me Sophie would have to prick her fingers six to eight times every day for the rest of her life.

I didn’t sleep the first night in the hospital room. Feeling overwhelmed and afraid Sophie’s blood glucose levels were too low or too high, I asked the nurse numerous times to check her. Eventually, I cried myself to sleep.

The next day we were questioned multiple times about why we were in the hospital. I was exhausted and frustrated. In between these interrogations, a nurse gave me a 45-page guide titled, “What You Need to Know When Newly Diagnosed with Diabetes.” She showed me how to inject insulin using a syringe and an orange since I’d have to give Sophie three injections every day. My thoughts of attending classes, writing papers, working, and paying bills were non-existent. How was I going to take care of Sophie?

In the hospital Sophie and I were on our own personal journey. We learned the management of diabetes is an art form. Her little fingers became paint brushes of red expressing her glucose levels. Her small voice cried several times, “Is this the last time I have to prick my fingers?” My heart broke. I knew there was no other choice. Love and hope would be our guiding light.

Sophie’s resilience during this challenging time gave me courage to be strong. She was still an active and vibrant five-year-old who liked to swing and swoosh down a slide. I knew we would have many more highs and lows and nothing would crush our spirits.

Why I Don't Worry About the Small Stuff Anymore

When your child is born with a heart that’s broken beyond full repair, you learn what you can and cannot control.

This is a submission in our monthly contest. October’s theme is Determination. Enter your own here!
I used to have a recurring, panic-inducing dream about an underground parking garage. The garage lies beneath the children’s hospital where my son receives ongoing treatment of his heart defects and other serious medical conditions.
Picture incredibly narrow parking spots with load-bearing columns scattered about everywhere, creating an obstacle course that even the most compact of vehicles must navigate carefully. Scuff marks with glimmers of auto body paint litter the sides of every single one of those load-bearing columns: a reminder that many who have gone before me have failed to make it out unscathed.
I’m a horrible parker, hence the nightmares.
Thanks to my poor depth perception, visuospatial tasks have never been my forte. I’ve hit more than a few stationary objects in my nearly 15-year-long driving career.
Throw in the previously unfathomable level of sleep deprivation that accompanies the job of parenting a medically complex child (which exacerbates my depth perception problems), and I stand no chance against this parking garage.
For the first several visits, I have my husband park the car, or I give up and drop it off out front with the valets. But this arrangement eventually becomes unfeasible. Sometimes my husband and I need to arrive separately, and the valet booth has limited hours.
I realize I’m going to have to learn how to park the car in that hellish garage so that I can always be there with my son while he’s in the hospital. There’s just no way around it anymore.
I take the scholarly approach, as I tend to do. I make diagrams of the precise angles necessary to maneuver my way into one of the spots without scraping a column or a neighboring car. I visualize the garage and imagine myself parking. I even ask my husband for pointers, but he’s not much help since he’s been graced with a natural gift for this sort of thing: “I dunno, I just turn the steering wheel and park the car?”
After all that preparation, I get a chance to put it into practice at the next scheduled appointment I must take our son to by myself. I meditate on (that’s my code for “obsess over”) the task at hand the whole drive to the hospital, and I briefly contemplate saying, “Screw it, I’ll just do valet parking” before turning into the garage.
I choose my target. I take a hard pass on the spot between two huge SUVs that are barely within the lines and decide on one with well-behaved neighbors instead.
Much of the elegance of my diagram was missing in this real-life attempt, but I managed to get my car in the spot. Never mind that I’ve wedged myself into a position that will require a nine-point turn to exit. That’s a problem for “Future Me,” and it’s beside the point.
When your child is born with a heart that’s broken beyond full repair, you learn what you can and cannot control. I can’t control whether the cardiac surgeon I’ve handed my son over to will return him in a better condition than he was in before – or if I’ll even get him back at all.
I can’t control the fact that I’ll probably outlive my child.
But I can learn how to park the damn car. I can conquer that fear and make that nightmare go away. I can let go of all the anxieties that used to plague me, the worries about issues that seem so trivial in retrospect.
Now I know that if the worst-case scenario in a situation is a scraped fender or having to file an insurance claim, that’s not something worth worrying about. Those are problems we can solve if the worst should happen.
It’s the unsolvable, uncontrollable, life-threatening types of problems that are the real stuff of nightmares, anyway.