Would You Order From the Original Kids' Menu?

The kids menu dates back to Prohibition. And while it may have changed a bit over the years, there’s a bleakness that seems to endure.

The children’s menu is nearly one century old. Michele Humes at Slate traces it to Prohibition. The dry laws implemented in 1920 meant that restaurants, which were used to upcharging on alcohol, had to drastically rethink their strategy. In an effort to accommodate more female diners, restaurants began writing menus for their children.
The kids’ menus then were as uniform as they are today, although the fare was much different. Most kid’s menus, including the Waldorf Astoria’s, offered a broiled lamb chop, which Humes calls “the chicken nugget of the Jazz Age.” The chop, along with a complement of other bland offerings, was the healthiest food to feed children, according to the pediatric wisdom of the time.
You can see bleak kid’s menu offerings in menus throughout Prohibition, including some of those cataloged in the New York Public Library’s expansive menu collection. The Cortile’s Luncheon menu for March 27, 1933 included Chilled Apple Juice, Cream of Spinach Soup, a Parsley Potato, and, of course, a Broiled Lamp Chop.

Courtesy of the New York Public Library

Menus like The Cortile’s represented the pediatric wisdom of the time that “wholesome” food made wholesome people. A tour through the dietary wisdom of the time demonstrates that although our menu offerings have changed, our approach to kid dining needs seasoning.

Boiled, mashed, bland

To understand this received wisdom, we need to travel back a few years to the 1907 edition of L. Emmett Holt’s “The Care and Feeding of Children.” The free, full-text version is well-worth the read, both for the striking similarities to modern parenting and the fascinating divergences.
In some ways, Holt sounds much like a modern pediatrician. He is pro-nursing, firmly anti-bedsharing, and staunchly pro-vaccination. He writes to parents who note that smallpox is on the decline and wonder if vaccination is necessary: “It should by all means be done. It is only by the practice of general vaccination that small-pox is kept down.”
Other parts of Holt’s text show their 110 years, including his entry for masturbation, “the most injurious of all the bad habits.” Holt advises parents to be ever alert, and to help children overcome their baser impulses by rewarding their good behavior.
That same mix of timeless and dated advice permeates the section on “The Diet of Older Children.” Holt’s dietary guidance for four- to 10-year-olds begins with the nutritional value of milk, eggs, and meat, making it not all that different from modern food guides.
A closer look at Holt’s advice reveals an interesting pattern. Although “no food that we possess has so high a nutritive value as milk,” kids should never be given “the rich milk of a Jersey herd.” Eggs are “a most valuable food,” but “fried eggs should never be given and all omelets are objectionable.” Many meats are forbidden, including “ham, bacon, sausage, pork, liver, kidney, game, and all dried and salted meats.” Fried meat was out of the question.
According to Holt, a child’s first vegetable should be white potatoes (baked or boiled, never fried). Most green vegetables are okay from early age, as are carrots and beets, but other vegetables, like sweet potato and cauliflower, are best saved until a child is six or seven. Corn and eggplant are for even older kids, and under absolutely no circumstances should a child under 10 years of age be served a salad.
Holt asserts that vegetables can cause digestive trouble, but that is not the fault of the ingredient but its preparer: “It is, in fact, almost impossible to cook them too much; they should also be very finely mashed.”
Given his attitudes about the dangers of raw vegetables, it’s not difficult to imagine where Holt came down on sweets: “A stale lady-finger or piece of sponge cake is about as far in the matter of cakes as it is wise to go with children up to seven or eight years old.”
Holt’s low-fat, low-taste diet goes generally unsourced. Humes hypothesizes that “although he stopped short of saying what it was that was so inherently great about the plain ones,” Holt saw “moral danger in sensual pleasure, and damnation in indulgence.”

You are what you eat

Holt wasn’t the only believer. His advice has roots in medical practitioners concerned with people’s moral failings, one of whom was much more explicit about the role of food in curbing people’s basest impulses.
In “Plain Facts for the Old and Young: Embracing the Natural History and Hygiene of Organic Life,” which was first printed in 1877, J. H. Kellogg chronicles the moral failings of the time. He devotes an enormous portion of the work to the “solitary vice” of masturbation (which he contrasts with partnered, “social” vice). Kellogg lists among its causes all of the usual suspects: “sexual precocity, idleness, pernicious literature.”
Kellogg also includes “exciting and irritating food,” which was thought to cause erections, “amorous and exotic thoughts” (which also caused erections), and sleep disturbances (which created idle time that led to amorous and exotic thoughts which caused erections). Children with adventurous palettes were imagined to have equally voracious sexual appetites: “A boy or girl who is constantly eating cloves or cinnamon, or who will eat salt in quantities without other food, gives good occasion for suspicion.” For Kellogg, spicy food made spicy people. Bland food made moral citizens.
Kellogg’s solution to the problem of solitary vice was to feed children a diet of “wholesome and unstimulating food.” Kellogg developed these ideas while working as the superintendent at the Western Health Reform Institute. When the institute burned down, it was rebuilt as the Battle Creek Sanitarium. There Kellogg set to work making the kinds of wholesome and unstimulating foods he argued for in his book, including granola and – as you’ve probably guessed given his name – Corn Flakes.

Spicing up the menu

The medicalization of kids’ menus makes it a bit easier to understand the dishes on offer then, but also now. In some ways, the menu hasn’t changed much. Kids’ meals are still often separate from the adult offerings. Although there isn’t much “wholesome” about burgers, hot dogs, chicken nuggets, macaroni and cheese, and pizza, the main offerings are, like their originators, still beige, and still largely non-vegetable.
In the 20s and 30s kids were served bland food because adults wanted to keep them pure. Although the menu items we offer them now are much different, they’re still clearly delineated as “kids” food. None of the food poses a challenge. Kids aren’t encouraged to try anything new. They aren’t even encouraged to try flatware: four of the five most popular options can be eaten without it. By giving kids all this bland food, we are producing bland people.
Now that we’re not concerned about a slippery slope from raw vegetables or cinnamon to sexual depravity, perhaps it’s time to make kid food stimulating again. Jeffrey M. Barker of The Takeout notes how insulted adult diners would be to receive a menu titled “for troglodytes with unrefined palates.” Such a menu would defy one main reason for dining out. “Going out to eat is supposed to be fun.” Barker writes. “It should be a treat, an adventure.”
One way to regain that sense of adventure stems from another byproduct of Prohibition: the speakeasy. Let’s just tell the kids that they cannot, under any circumstances, order off the grown-up menu. Not even if they’re really hungry. Not even if the food sounds delicious. Not even if we leave the table to go to the bathroom. Might they wave the server over and in conspiratorial tones ask for the chicken makhani? The pad thai? The pesto flatbread?

Worried Those Early Extracurriculars Are a Waste of Money? Maybe Not.

New research does proclaim that extracurriculars are promising for kids and their development in numerous ways, even during early childhood.

Today, some parents seem to put their young kids in everything: soccer, violin lessons, ballet, and golf. Kindergartners are schooled for eight hours, thrown a snack in their car booster seat, and then taken to some kind of enrichment activity. These children are likely overwhelmed and exhausted. The parents now serve as an Uber driver, only they are forking out the money instead of getting paid.
I admit I have secretly questioned these parents, asking myself, “Why don’t they give their child a break?” Although I do believe that Socrates was right when he said “everything in moderation, nothing in excess,” new research does proclaim that extracurriculars are promising for kids and their development in numerous ways, even during early childhood.
In a study found in the Journal of Applied Developmental Psychology, the researchers found that small children from kindergarten through the fourth grade endured positive outcomes due to the extracurricular activities they were involved in. The study included 548 children and the activities varied from a sport, club, or the fine arts. Some were involved in these outside school activities while others were not. The children were observed from kindergarten through the fourth grade, and finally evaluated by their fourth-grade teachers.
The researchers, Flourence Aumetre and Francois Poulin, said that their behavior was monitored and found that the “participation in organized activities may hold promise when it comes to preventing internalizing problems during childhood.” In other words, if a child is more at-risk for behavioral problems, the extracurriculars will help them learn to cope. And, the study showed that it helped all children who were involved in the added activities.
Growing up is hard. Learning how to make and keep friends can feel like navigating to a new destination before GPS devices were invented. Parents are the maps who can help, but we often just confuse the kids more. Further, children can feel overwhelmed at school because even at an early age, the stakes are suddenly high. Taking part in a club, sport, or the arts can help foster coping mechanisms in all of the possible directions that growing up can entail.
The study discovered that the students who were partook in extracurriculars achieved higher social competence, academic success, and exercised lower behavioral problems. Aumetre and Poulin said, “They could learn new ways to behave and new emotional responses by observing the actions of others, the consequences of their actions and the affective reaction following these consequences.” Seeing different kids in a different arena helps take them in other areas of their life. For example, if a child is reprimanded for bad sportsmanship on the soccer field, the same lesson can apply while playing an academic game in the classroom.
Further, when children partake in a new activity, they learn how to adjust and be adventurous. Within these activities, new skills emerge and they learn to carry them through several other domains like school and home. Therefore, when the child remains in extracurricular activities for a long period of time, the overall affects trickle into the classroom and their overall adjustment. Their “global self-esteem” increases as well as their “sense of competence.” The researchers claim that their behavior is likely better because they learn to cope with different situations due to their activities they are involved in.
Although I do not think young children should be taxied all over town to various enrichment activities all week long, the research does prove that starting them young has its benefits. If these extracurriculars can help make growing up a little less daunting, then yes, we should slowly engage our kids in them. Today, our kids need all of the GPS devices and maps to help guide them. And if partaking in a fun activity can do that, I don’t see why not. But I will always remember Socrates, and never do anything – including extracurriculars – in excess.

The Effects of Pre-K May Last Longer Than You Think

A new study indicates there are several measurable benefits of pre-K once the students reach middle school.

Is pre-K worth it? This is a hot button question that has been debated for many years since states began funding pre-K programs. According to the National Institute for Early Education Research, nationwide state-funded preschool program enrollment reached an all-time high in 2016, with nearly 1.5 million children, or 32 percent of four-year-olds enrolled. Policymakers, educators, and parents want to know if pre-K provides an academic advantage to children. Now a new study out of Georgetown University published in the Journal of Policy Analysis and Management indicates that there are several measurable benefits of pre-K once the students reach middle school.
The Georgetown research team began tracking about 4,000 children in Tulsa, Oklahoma in 2006 when they started pre-K through the time they were in eighth grade. The pre-K program in Tulsa was of special interest because it has been around for quite a few years, reaches a relatively large portion of four-year-olds, and is considered high quality. It has also been featured in the national debate about the merits of universal pre-K because the program has been studied in depth over more than a decade, Oklahoma was the second state in the nation to adopt a universal pre-K program, and President Obama highlighted it in his 2013 State of the Union as he endorsed universal pre-K as a national policy.
In order to evaluate the program, researchers reviewed performance measures throughout middle school in areas including standardized tests, GPAs, enrollment in either a gifted program or honors courses, grade retention, special education placement, absenteeism, and suspensions.
They discovered the following facts about eighth graders who attended pre-K:

  • They were less likely to be held back than their classmates who did not attend preschool.
  • Their scores on the state’s math achievement test were higher.
  • They were more likely to take algebra in eighth grade, which is a consistent predictor of college readiness.
  • They were more likely to be enrolled in honors courses.
  • They were more likely to be engaged in class, less timid, and more confident overall.

Then the researchers extrapolated the Tulsa data to project the impact of the program into adulthood. They predict that those students who attended pre-K will have a higher income and less of a chance for incarceration. This is a big deal for parents evaluating whether to send their children to preschool or not. It’s clear from this study that pre-K can help lead to success later in life.
The study also looked at the quality of the education provided. Tulsa preschool teachers devoted more time to academics and were more apt to talk with, not talk at, their students, than teachers in 11 other states who they were compared to. Additionally, the student-teacher ratios in the classroom were impressive, and every teacher has at least a bachelor’s degree and is certified in early childhood education.
William Gormley, a professor of public policy at Georgetown and one of the lead researchers for this study, thinks that a main reason for the success of the children in Tulsa who attended pre-K is that the elementary and middle school teachers have made the curriculum more challenging because the students are much better prepared than those who did not attend pre-K. In a nut shell, pre-K gives kids a jumpstart in their education and the positive social, emotional, and academic benefits surface later in their educational journey and after graduation.

For Parents of Babies Who Think They'll Always be Angels

Here is a list of Toddler Truths that you should come to grips with.

I know, I know, when they sleep they look so peaceful and innocent that you can’t imagine what people are talking about when they mention the “terrible two’s.” At nine months, spaghetti-kisses and applesauce-hugs are actually incredibly sweet. 

By the time your toddler is two or three years old, you’ve paid enough dry-cleaning bills to know that prime seating at the dinner table is no where near your beloved toddler. Here is a list of Toddler Truths that you should come to grips with:

1 | Children lie  

Yes, I said it! They indulge in self-preservation at an early age. They refuse to go down for crayons on the wall, shampoo on Elmo, or even lipstick on the toilet seat. They will look you dead in the eye and deny any involvement in the incident. They may blame the dog or even you, yourself. You are not alone if, at some sleep-deprived moment, you question if you were responsible for the offense. Stay strong. You are the parent. You can do this.

2 | Toddler poop in underwear is disgusting 

Remember when you first took your baby home from the hospital and their runny, yellow poops didn’t smell? Well, you’re not in Kansas anymore, Dorothy. 

A mushy brown lump in Super Hero undies is best just thrown away. Don’t try to clean that shit, just get rid of it. I give you permission. No one wants that running through the washing machine in the cycle before you clean your washcloths.

Parents, if your child goes to daycare and has an accident there, don’t get mad at your childcare provider if they throw the underwear away. Unless you employ Mary Poppins, no one wants to roll that up in a plastic bag and have it hanging around in a backpack all day. Just consider the $4.99 pack of six underwear part of the cost of the potty-training “business.”

3 | Sticky telephone screens are not always a result of candy

Honestly, most of us use our phones to entertain our children while we are at the grocery store, post office, in the car, at the doctor’s office, even in church. When we get those phones back, 100 percent of the time the screen is smudgy and sticky. Why is this? As the wonderful parents we are, we rarely give our toddlers candy during those times, and yet the screens are still filthy. 

The truth is that kids pick their noses. They dig in there with the same finger that they use to search your apps and play their games. The little lumps on your screen are sticky little boogers straight from your child’s nose. If you are not for sharing germs to build up natural immunity, my advice is to carry around sanitizing wipe packets. I hear they kill 99.99 percent of germs.

4 | Toddlers will embarrass you

Of course, we’ve all heard stories about toddlers innocently pointing at the large man driving the automated cart at the grocery store and loudly informing you (along with the rest of aisle nine) that he is fat. Yes, this is embarrassing, but at least you have the option of leaving the store. 

The humiliation I’m talking about is mortification that you can’t escape. I’m talking about when your toddler repeats overheard complaints you made to your husband about his overbearing, selfish, nagging, in-your-business mother who always “compliments” your cooking. You know, the one you’d like to backhand if given the chance? 

Yeah, well, when your three-year-old repeats that at Easter dinner, trust me, you will blush with shame. Unfortunately, the vocabulary your child will use will negate any of your attempts to convince those at the table that your child has “an over-active imagination.” It’s best to simply serve yourself a piece of humble pie and accept the fact that you will never live it down.

5 | Despite the discomfort of living with a toddler, they are extraordinary self-esteem boosters

No one else on the planet will unapologetically flatter you the way a toddler will. When you’re feeling emotional, bloated, and exhausted, there’s nothing like a two-year-old telling you how beautiful you are. Or when you ask them what their favorite color is and they tell you, “Green, Mommy, just like your eyes.”  Or when you’re driving around looking at Christmas light displays and everyone in the car is oohing and ahhing at their beauty when a small voice in the backseat says, “But not as beautiful as you, Mommy!” 

I think toddlers see us for who we really are. They’re not beholden to the cultural rules of our day. They can actually see your genuine love despite your glasses, bags under your eyes, extra rolls, unbrushed teeth, need for a shower, sweatpants again, and utter fatigue. Having someone recognize your light from within is worth putting up with the occasional lying, pooping, nose-picking, embarrassing child who has stolen your heart.

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.

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.

“Don’t Lick the Cat!” and Other Things I Never Thought I’d Have to Say

That was just the beginning of the downward spiral of strange pieces of advice I would be giving my son over the next two years.

There are a myriad of things that parents expect to say to their children. “Have you brushed your teeth?” “Your room needs to be cleaned,” “Bring me your dirty laundry,” and “Eat your veggies” were all things that I was completely prepared for. I had a mental notepad of all the “mom” things I knew I would need to say as my son grew up and as I said each one I would mentally tick it off my list with a smile. Little did I know there would be an even larger list of things I never thought I would have to say to another human being, ever.
One morning as I was getting ready for the day, when my son was about three, I heard a distinct cat hiss followed by a human hacking sound. I turned from the bathroom mirror to see my son vigorously attempting to get a clump of cat hair off of his tongue while he hopped around my room. I heard “Momma, kitty tastes bad!” while he scrunched his little face up as I attempted to stop my child from hacking up a fur ball later.
“I bet. And this is why we don’t lick the cat.”
That was just the beginning of the downward spiral of strange pieces of advice I would be giving my son over the next two years. He’s only six now but we have covered a vast array of subjects, each one more troubling than the last. Shortly after the cat licking incident I had to inform him that it was in bad taste to chew your toenails at a family restaurant. This was closely followed by me having to inform him that going to the store in only a diaper and rain boots was underdressing for the occasion.
As he has gotten older, the peculiarities of parenting have come out in full bloom. At least once a week I have to tell him that growling when being asked a question isn’t exactly the polite answer I was looking for. Our latest was me explaining that, because puppies don’t have thumbs, his new dog would most likely not be interested in playing with his kinetic sand so he should be fine on his worries about it.
There have also been a few new variations on tried and true “mom” things. “Eat your veggies” has now turned into “Please don’t shove the foods you hate up your nose.” “Have you brushed your teeth” is now “Please don’t lick me, a simple yes would have sufficed.” And “Bring me your dirty clothes” has turned into “Why are all of your things in the freezer and why didn’t I notice you doing this?”
Bath time has turned into me chuckling as he screams out that he peed in the bath, again, which is then followed by me telling him that he probably shouldn’t scream that at the pool, again. While I am trying to stop my son from running at the wall after watching “Harry Potter,” I am simultaneously trying to stop him from stabbing his father with a lightsaber while yelling “I’m Kylo Ren!”
“Get that out of your pants” is now a personal favorite of mine along with “Fancy goldfish can’t eat hotdogs so don’t even try it.” “Don’t lick the shopping cart” has now replaced various animals and telling him that his pet snail won’t climb out of his cage in the middle of the night and crawl up his nose is a new one – I’m not entirely sure of its origin. “Pinecones don’t make sounds so stop shoving it in your ear” took a while to get rid of and “The drapes are not vines, watch something other than Tarzan” lasted about a week.
Many of my interactions have morphed into me telling him to ask his father and then hearing an exasperated sigh from whatever room they are residing in followed by yet another reiteration of how something isn’t a good idea. The list of interesting conversations with my son could fill a book but unfortunately I need to go stop him from giving ants a swimming lesson in his kiddy pool … for the fourth time today.
This article originally appeared on lyvingdedgurl.com.

How to Arm Yourself to Go out to Dinner With Kids Without a Screen

From better family connection to simply teaching your children important social skills, there are many compelling benefits to a device free dinner.

It’s a special occasion, you have visitors in town, or you just can’t face cooking tonight. You want to take your family out to eat, but as a family with small children, the thought of a meal at a restaurant might induce panic. I still shudder at the memory of a dinner with out-of-town relatives that stretched on for hours when my oldest was a toddler.
The temptation to rely on screens to entertain children in restaurants is understandable. You’ve no doubt seen a child glued to a phone or tablet while the adults at the table enjoyed appetizers and civilized conversation. Maybe you thought, “I’d never do that.” Or maybe it was more like, “That looks amazing,” as you wistfully mopped up a drink spill.
There are so many compelling benefits to a “device free dinner,” though, from opportunities for family connection and better conversation to simply teaching your children important social skills.
From start to finish, here are some tips for an enjoyable, screen-free restaurant experience:

Do some restaurant reconnaissance

Call to confirm the restaurant has high chairs if you’ll need one (and by default, determine whether the place you’ve chosen welcomes little guests). Scout out menu options and pack baby food or toddler snacks if needed. To avoid waiting with starving kids, feed them a snack before you go, or plan to order an appetizer right away.
baby with People toy mirror ball at restaurant
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Parent Co. partnered with People Toy Co. because they know the right toys can make otherwise tedious moments fun and easy.

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Pack kid-friendly supplies

Babies

Spill-proof drink cups and appropriate utensils go a long way towards baby and toddler restaurant success. For kids likely to overturn plates, a placemat that sticks to the table can be a game changer. This one is easy to wipe down at the end of a meal and rolls up to fit in your bag.
Pack a few teething or tactile toys that can be attached to a baby’s wrist, clothing, or carrier handle to save yourself from crawling around on a food-strewn floor to retrieve dropped items. For a child who uses a high chair, an engaging toy that suctions to the table is a great option, like the Brain Builders: Magic Reflection Ball from People Toy Company.
toys and products to distract babies at restaurant
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Preschoolers

A small set of interlocking or magnetic building toys is the perfect choice for preschoolers at the table. Packing something for little hands to do discourages alternatives, like silverware symphonies or salt-and-pepper snow.
People Toy Co. magnetic blocks to distract preschoolers at restaurant
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Older kids

Mess-free art supplies, like Scratch Art, Magna Doodle, or a small container of beads with pipe cleaners for stringing them are fun additions to the standard provided crayons.
art supplies for older kids at restaurants
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Teach restaurant behavior

Dining out is an opportunity to teach children how to be polite and speak for themselves. Even a toddler can say, “Pizza, please!”
To teach children to engage appropriately with others at the table, it helps to have a few conversation starters at the ready. Go around the table to ask each person, “What was your favorite part of today?”
The Family Dinner Project has a long list of other ideas. Plus, if you’re dining with your perpetually single college roommate or stoic great aunt, this gives other adults a little help interacting with your kids.

Make waiting fun

It’s helpful to establish a few standby waiting games, because the chances are slim that new ideas will dawn on you while sitting in a crowded restaurant with fidgety kids. Games that can grow with your family – or the amount of time it takes for your meal to arrive – are especially useful:

What’s Missing?

Set up five small items from your bag or from the table – yes, condiments and blunt utensils are now up for grabs – and take turns secretly removing one so others have to guess the missing object. Gradually include more items.

I Spy

Once your kids know the general principles of looking for something of a certain color, you can mix it up. Try, “I spy something striped,” “I spy something that rhymes with moon,” or “I spy something that starts with the same sound as Mommy.” You could also hunt for letters, words, or items on the menu or signs.

The Question Game

Whether you limit it to 20 or not, asking yes-or-no deductive questions is another easily expandable activity. Start a small category and suggest helpful questions for your child. “I’m thinking of a pet. You could ask if it has fur.” Expand to other topics, like sports, foods, or favorite characters.
 

Tell a Story

Once again, the salt and pepper, or any of their counterparts, can be the stars of the dinner show. Establish “characters” using items on the table, imagine a setting, and work together to tell (or gently act out) an original tale.
For all of these games, you’ll want to model how to participate first so your kids understand how to join in effectively. If you play often, you’ll likely notice an improvement in their vocabulary and reasoning skills, which is a nice bonus to passing the time until the chicken fingers arrive.

Quit while you’re ahead

As pleasant as it can be to linger at the table after a delicious meal, this is an unrealistic expectation for many small children. If you want to continue the fun after everyone eats, plan to take a walk or move on to another venue. Or, just head home with the promise of another meal out soon.
Going out to eat with children screen-free can be done (your parents likely survived such outings with you, after all), and everyone involved can emerge satiated and unscathed. The occasional infamous evening of spills, botched orders, and angry sighs from other patrons who don’t seem to remember life with small children will happen regardless.
But rest assured that, with some advance preparation and tricks up your sleeve, you’ll be the one basking in the glow of other diners’ compliments, which may feel just as good as savoring that uninterrupted tapas platter.
 
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Parent Co. partnered with People Toy Co. because they know the right toys can make otherwise tedious moments fun and easy.

 

Mantra for the New Mom of Two

Staying present took more work this time around, but I still tried to relish the moments of joy between those long, lonely nights.

A coworker once told me it takes six months to get the hang of a new job. I don’t know whether she based that time frame on any scientific studies, but it sounded about right to me. As I prepared for the birth of my second child, I anticipated some transition time as I took on my new role as a mother of two.
My first day began as I happily went into labor a few days before my scheduled c-section. Compared to my water-breaking-five-weeks-early emergency birth of my first child, the birth of Baby Number Two was blissfully normal. She came into the world screaming and healthy. I kept waiting for the emotional wave of postpartum to wash over me like it had with my first, but when week one passed without incident, I was optimistic.
Then came week two of my new gig. Screaming turned out to be the norm. As I settled into sleep deprivation, I sent a bleary-eyed text to a friend who’d had a baby two months prior. I asked her to remind me how long it would be before things got easier. When she texted back “Yeah that first month is tough,” I thought “Month?! How am I going to survive the week?”
Crashing came the wave of postpartum emotions. How had I forgotten nearly everything about newborns? Surely some evolutionary mind games were at play as I pondered how people had more than one kid. Forging through those first sleepless nights felt like the hazing of a first time mom again.
But I wasn’t a first time mom. Through the eyes and experience of a second-time mom, I tried to remind myself that the struggle was only temporary. A line from an old Elton John song kept playing through my head.
“Don’t wish it away
Don’t look at it like it’s forever”
It was from “I Guess That’s Why They Call it the Blues,” a song my girlfriends and I had belted out many late nights in college. Now it had new meaning for me.
“Don’t wish it away”
Being present with my first baby was effortless. I remember staring at her flawless face, bawling my eyes out because I wanted her to stay that tiny and perfect forever. Now with Number Two, I was fantasizing about fast-forwarding to a time when she could hold up her head, sit without tipping, and maybe, just maybe, calm herself down.
“Don’t look at it like it’s forever”
Month one passed and, of course, I survived. The verse kept repeating in my head.
“Don’t wish it away”
She was likely my last baby, so I didn’t want to forget the sweet smell of her head or the weight of her body on my chest. I knew she too would be growing and changing quickly before my eyes. Seemingly overnight, my first “baby” had become an active and amiable three-year-old who adored her new sister. Staying present took more work this time around, but I still tried to relish the moments of joy between those long, lonely nights.
“Don’t look at it like it’s forever”
I’d comply every time my older daughter asked to hold her little sister and I’d melt as she’d softly pat her head and gingerly stroke her cheek because she thought the baby’s skin “was just so soft.” Postpartum moods subsided. Things started to get easier.
By month three, I was working again and time began passing a little too quickly. Sometime between months four and six, I found myself breastfeeding in the Costco parking lot, changing a diaper on the middle car console, and thinking I’ve totally got this!
Now I’m fully through the baby stage and my job has evolved to include school schedules and play date planning. There are still meltdowns and melodrama and I don’t always sleep through the night. But when I catch my girls sharing an overly-aggressive hug or laughing over a joke I don’t get, I know I’ve hit one of those sweet spots of parenthood. And somehow Elton captured that too, in next line of the song:
“Between you and me I could honestly say
That things can only get better”