The future of America rests in the hands of parents. Literally. When you think about it, no other group yields as much influence on the behavior of future generations. Right now, American parents are shaping the moral fiber of our future leaders. No question about it–we have an awesome responsibility. But how often do you and I consider this task? All too often the hectic events of our daily lives engulf us, and we give little thought to our job of shaping the next generation of Americans.

The children of parents who shirk this duty are everywhere. They fill our prisons. They are the teachers and preachers who abuse our trust. They are bribe-accepting congressmen and shady CEOs who play Russian Roulette with our retirement savings.

Imagine if the offending parents had taken their responsibility to instill a sense of morality into their children more seriously. The obvious result would be fewer victims of abuse in our schools and churches, less government corruption, and infrequent financial scandals. But think beyond our borders for a moment. The world looks at America as a self-indulgent bully bent on dictating policy on foreign shores. It doesn’t matter that our vision of freedom and justice for all is a right and noble cause. The world doesn’t care. To them, we’re a sham. Why? Because of our example.

Everyday the world bears witness to our internal problems. It reads stories of abusive teachers and priests, of corrupt lawmakers, of shady businessmen. It reads these stories and shakes its head. America’s idea of freedom and justice for all sounded so good in theory. But the example we set reports a different reality. The world sees our vision as a pipe dream, one we have failed to achieve even in our own home. Why should the world want to be like us? Our domestic behavior has soiled our foreign reputation. And since our domestic behavior is really the daily decisions we make, and since the daily decisions we make reflect our upbringing, parents are ultimately responsible for America’s lack of credibility.

So what’s the answer? Do we take our kids to religious services and teach them to obey the Ten Commandments? That alone won’t make a difference. You know it won’t. Changing behavior takes something more. A lot more. Smart men and women have written oodles of books outlining their views on the right and wrong ways to raise children. Look them up sometime at your local library or bookstore.

I will leave you with my own thought on the subject. Never underestimate the power of your daily example. Children watch your every move, even when you aren’t watching theirs. They hear your lies. They see your sloth. They understand your compromise. And just as the world has figured out America, one day your children will realize your lessons are nothing but a sham. Then they’ll begin to act like you rather than listen to you.

Every move we make has to reflect our belief in what is right and what is wrong. We have to be a better example to our children than America is to the world. If we take our job seriously and succeed in leaving America with the legacy of a moral generation, then America will be better equipped to step forward and shine as a true beacon of freedom and justice for all.

Mike is an American pediatrician. Read more at http://www.pediascribe.com

COPYRIGHT 2006 Mike Patrick Jr, MD

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Dear Granny,

We know you mean well. Really, we do. And we acknowledge that your well-meaning often translates into wonderful actions. You support America’s first-time moms with your experienced advice, you volunteer to watch grandkids when they’re too sick to attend daycare, and you have taken on the noble responsibility of raising grandchildren fulltime when their parents are sick or neglectful or imprisoned. What’s more, you take on this job at a time when you should be enjoying the freedom of retirement. For these actions, we salute you. Really, we do.

However, it has come to our attention that at other times your well-meaning has turned into persistent nagging. In an effort to protect your grandchildren from the idiocy of their parents, you have gone overboard. Now before you dismiss our complaint as the ramblings of a bunch of disrespectful youngins, please allow us to describe a few concrete examples of the problem.

Let’s start with diet. Could you please limit your complaints to once a month? We know full well that you believe Little Johnny is starving. But you know what? We don’t share your concern. It’s okay if you feel his ribs. In case you haven’t noticed, there’s a bit of a weight problem in America today. Surprised? You shouldn’t be. After all, how many years did you pile on the food and tell us to clean our plates? Our pediatrician tells us it’s healthy for toddlers to graze–as long as they get a healthy diet with all the food groups over the course of several days. Eating only when you’re hungry and stopping when you’re full is a good habit to foster. Feeling guilty about throwing out left-overs is not. Sure, there are starving kids in other parts of the world. You taught us that. What we didn’t get was the connection between our table scrap and those starving kids. Were you going to box up the left-overs and send them to Africa? No. So please forgive us for skipping that lesson.

Next, let’s talk feet. So what if they turn in or point out a little? We’ll show our doctor and we’ll let him do an examine. If he says they’re fine, we’re going with that, and we wish you would too. Look, we understand back in your day kids wore special shoes and braces to straighten out their feet. But lots of other kids didn’t get those special shoes and braces. And you know what? Most of their feet straightened out just fine. Those that didn’t straighten out completely had few long-term problems. Most could walk and run and jump and skip just fine. Our doctor will keep an eye on the feet, and if he’s concerned he’ll send us to an orthopedic specialist. You voiced your concern. We heard it. Now, please, drop it.

One more example: Ears. The infections aren’t our fault. We don’t smoke around Little Johnny, and he doesn’t go to daycare anymore (since you agreed to watch him). Our pediatrician says those two things are the biggest ones we can control. The ear infections aren’t from water or wind or change of weather. They’re from mouth bacteria that get into the middle ear through the Eustachian tube, a natural connection between the throat and ear. Little Johnny has a floppy Eustachian tube. Bacteria go up the tube and get trapped when the tube flops closed. Add a little mucus from smoke or allergies or viral infections, and the situation gets worse. You can’t get rid of the mouth bacteria–they’re supposed to be there. Get rid of them and you’ll invite thrush to grow, and we don’t want that either. We’ll keep doing the antibiotics as long as our doctor tells us to, and when he suggests surgery, we’ll go with that. The antibiotics don’t stain teeth or stunt growth. Sure, antibiotic resistance is a problem. We understand that. We appreciate your keeping up with the medical literature. Still, if our doc says it’s best to stick with them, that’s what we’ll do.

As we draw this letter to a close, please understand our aim is not to offend. After all, you were an excellent parent. You raised us. You have lots of experienced advice to share. But let’s face it, raising four kids is not the same as seeing 30-40 kids a day. Our pediatrician’s advice wins over yours. You may not agree with him. That’s fine. But please, let it go and stop nagging us.

Love always,

Your Children

Mike is an American pediatrician. Read more at http://www.pediascribe.com

COPYRIGHT 2006 Mike Patrick Jr, MD

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I don’t currently advocate road rage. Laying on the horn, swearing like a sailor, and swerving around the slow guy in the passing lane is not my style. Of course, tastes change over time, so I’d like to reserve the right to practice road rage in the future. But understand this: It won’t be the slow guy in the passing lane that sets me off. Instead, it will be stupid parents.

You know the ones I’m talking about. You see them on interstate highways and city streets and country roads. You point them out to your spouse, and explain their poor judgment to your children. At least I hope you do. These are the parents who drive with unrestrained kids in the car, ones who let Little Bobby climb over the headrest and crouch on the floorboard and roam from window to window, pausing only to stick his tongue out at cars in the cruising lane.

Why do some parents allow their children such freedom? I think it boils down to convenience. Dad doesn’t want to wear a seatbelt and he doesn’t want to hear Little Bobby screaming to get out of his. So Dad lets him roam.

In every state, they’re breaking the law. Not that it matters. Most states have secondary seatbelt laws, even for kids. This means police can only write a citation for an unrestrained occupant in the course of pulling a car over for another violation. But let’s face it, toughening seatbelt laws into primary violations would do little to reduce the thousands of unrestrained children killed and injured in the United States each year. Why? Because you can’t force common sense through legislation. Don’t forget, these parents are stupid.

If you are still reading, I suspect you are either not a stupid parent or you are motivated to rise above your stupidity. And since smart parents ask lots of good questions about the appropriate use of car seats, booster seats, and seatbelts, I will review the basics for you.

The rules are pretty simple really. Until your child is a year old AND twenty pounds, use a rear-facing infant carrier in the back seat of your car. The middle of the seat is safest. Once your child is twenty pounds AND one year of age, it’s safe to use a forward-facing car seat. Again, keep it in the back, and if possible, put it in the middle.

When do you graduate to a booster seat? For most kids, you can make the move when they weigh forty pounds. Start with the type that has its own restraining harness. When your child outgrows the harness (usually between 50 and 65 pounds), advance to a booster that incorporates the car’s safety belt. The important thing here is to make certain the belt fits properly. The lap belt should fit over the pelvic bones and not slip up to the belly. The shoulder belt should cross the chest, not the upper shoulder and not the neck. Many of these boosters feature an adjustable clip to keep the shoulder belt in a good position. Never forsake the shoulder belt. Serious injury is common among children in booster seats who only use a lap belt.

For all car seats and boosters, be sure to follow the manufacturers guidelines for proper positioning and securing. You’ll have to pay close attention here. Some seats are rear-facing only, some only face forward, others are reversible. Also pay attention to minimum and maximum length and weight for a given seat. If your child outgrows the length recommendation of a rear-facing infant seat, but is not yet a year old AND twenty pounds, you’ll need a bigger reversible seat. Keep it rear-facing until he is big enough and old enough to face forward.

When are kids ready for seat belts without a booster? When their feet reach the floor while their back is against the seat. The lap belt must fit snuggly across the pelvic bones (not the stomach), and the shoulder belt must fit snugly across the chest (not the upper shoulder or neck). The exact age varies from kid to kid. If your son or daughter is petite, he or she might be 10 or 11 years old before meeting this criteria. I realize this is much older than most people (especially children) want to believe. But I bring you the facts. Please, don’t shoot the messenger.

There’s much more to say about car safety. When can kids ride up front? What about air bags? How do you secure premature babies and disabled children? The American Academy of Pediatrics has an excellent resource answering these and other questions at http://www.aap.org/family/carseatguide.htm

So what do we do with the dad who won’t buckle Little Bobby? It’s a tough call. This is America. Parents have rights. Does Little Bobby have the right to life, liberty, and the pursuit of happiness? Is Dad interfering with that right? Maybe. Until we sort that out, you’ll do well to avoid Dad’s mistake. Be a good example to your children and always wear your seat belt. Insist on your children being properly secured from day one. Always use a car seat. Make no exceptions. Little Bobby figured out that if he screams loud enough and long enough, he gets to roam the car and stick his tongue out at passing cars. If you have a Little Bobby in your car, it’s not too late. Let him scream. It won’t last long. Will you be interfering with his life, liberty, and the pursuit of happiness? Maybe. But I know which choice I’d make. How about you?

Mike is an American pediatrician. Read more at http://www.pediascribe.com

COPYRIGHT 2006 Mike Patrick Jr, MD

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You’ve had your baby home a month or so, and he’s a cutie–no doubt about it. There’s one problem though, a problem you hadn’t considered before he arrived: He pukes all the time! And it’s not just a little urp. We’re talking over your shoulder and through his nose kind of stuff. You’re embarrassed to let others hold him. Aunt Betty, the one who always knows best, thinks your baby needs to see a specialist right away, and your neighbor tells you she knows someone who knows someone who had a spitty baby who choked and died in her sleep.

You start making middle-of-the-night nursery runs to check your baby’s breathing. The baby monitor is turned up so loud you can hear its electric hum, and you promise yourself once more that in the morning you really are going to call the doctor and ask to see a specialist. In the meantime, your baby is asleep. There’s no unusual sound on the monitor, and no vomit in the crib. Your baby is fine, but the situation is driving you crazy.

So is this spitting-up okay? Or is it a problem?

Most of the time, baby spit-up is a temporary form of gastroesophageal reflux disease (GERD). It’s a condition caused by a loose valve on top of the stomach. From a mechanical point of view, the stomach is pretty simple. Food goes in, mixes with acidic digestive juice, and gets churned. Then the stomach gives a great big squeeze, forcing food into the small intestine.

For many, this is the problem stage. When the stomach squeezes, the valve on the bottom is supposed to open, and the valve on top is supposed to stay closed. But in babies with GERD, the valve on top also pops open, so food goes both ways–up and down.

Unfortunately, GERD is not the only cause of infant vomiting. There are life threatening causes as well. Bowel obstruction. Infection. Metabolic disease (such as PKU). So how do you tell the difference? Well, you don’t do it alone. You find a doctor you trust and you let her decide. Here are some questions she’ll ask:

Is the spit-up projectile? Bowel obstructions create a great deal of pressure. These babies have very forceful vomiting, often across the room.

Is there blood or bile in the vomit? These are serious signs. Blood may indicate erosions or high blood pressure in the GI tract, and bile is common with obstruction.

Does your baby choke on the spit-ups? We’re talking more than a little red-in-the-face gag here. If your baby is having pauses in breathing or is dusky blue in the face, you should seek medical help immediately. While severe reflux can cause this problem, heart defects, blood infections and meningitis can too.

Is your baby gaining weight appropriately? Severe reflux can cause weight loss, but your doctor will want to eliminate other possibilities.

Your answers to these questions, along with physical exam findings, will determine the next step. If there is a reason to suspect a cause other than reflux, some testing is likely. The most common test is the “upper GI.” Your baby drinks a bottle of barium, and the radiologist takes x-rays. The barium lights up, showing the structure of the intestinal tract. If all goes well, your baby will have a little spit-up action during the exam. The radiologist will see the reflux as it occurs, and you’ll have your culprit. On the other hand, your baby might not cooperate. He might not show any reflux during the test even when reflux really is the cause of the problem. Don’t worry; it won’t be the last time he refuses to show off for you.

Other tests are possible, but only a handful of babies need them. For most, reflux can be diagnosed on the basis of the history and physical alone. It’s like my grandma used to say: If it looks like a duck and walks like a duck and quacks like a duck, it’s probably a duck.

So let’s say we establish that your baby has reflux. What’s next? How do you make it go away? After all, that’s the question that brought you in. Well, you might not like the answer. The answer is you do nothing, unless the reflux is causing a problem. Dirty laundry doesn’t count here. We’re talking constant fussiness or breathing difficulty or weight loss.

For fussiness, something to reduce stomach acid usually does the trick–antacids and Zantac are good examples. Your baby will still spit up, but at least he’ll smile at Aunt Betty as he soils her blouse. Babies with breathing problems or weight loss are a more difficult bunch. They need reduction of their vomiting.

You can start by decreasing feed volume. Refluxing infants tolerate 2 ounces every 2 hours better than 4 ounces every 4 hours. Also, try to keep your baby upright during and after feedings. This allows gravity to keep milk in the bottom portion of the stomach. Your doctor may have you add rice cereal to the milk. Not Rice Krispies. Rice baby cereal. Don’t laugh. I’ve seen it done. Thicker milk stays down better, but it comes with a price–weight gain.

Sometimes these simple measures aren’t enough. Your baby may need medicine and possibly surgery to stop the vomiting. This is reserved for the most severe cases of reflux. Medicine and surgery may have side effects and unexpected results, so it’s best to make sure their potential benefit outweighs the risk of consequences. Your doctor will help you decide.

For most babies, reflux treatment is not necessary. These are the babies without projectile vomiting. There is no blood or bile in their spit-ups. They aren’t choking. They have no breathing difficulty. No weight loss. No extreme fussiness. It’s okay to let their milk fly over the shoulder or out the nose. It’s even okay if it soils Aunt Betty’s blouse. What you have there is not a baby problem. It’s a laundry problem–and that’s something Aunt Betty knows all about.

Mike is an American pediatrician. Read more at http://www.pediascribe.com

COPYRIGHT 2006 Mike Patrick Jr, MD

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Pie mold. No, it’s not the fuzzy stuff you find a week after Aunt Loretta sends you home with left-overs. Campers know what I’m talking about. Pie molds were all the rage in the Seventies–and they’re still popular today. One of my favorite childhood memories is sitting around the campfire as a kid, feeling the warmth on my face, watching the flames dance, listening to the hiss and pop of burning wood, and smelling the acrid aroma that will linger in your clothes until their next washing. In this memory, I’m holding the wooden grips of a pie mold, keeping its cooking surface just above the hot coals on the fire’s edge.

The Pie Mold was our campfire cooker, and a slick one at that. On the business end, two metal plates came together, sandwiching a creation of bread and toppings. Stick it in the fire a minute or two, pull it out, open it up, and wah-lah: You had a golden-brown pie filled with pizza fixings or cherry sauce or bacon and eggs or whatever else got your stomach growling and your mouth watering. It may not have been the healthiest of meals, but remember this is camping we’re talking about. Save your salads and yogurt for home. When you’re out in the woods, you gotta live a little.

There was a time I had forgotten this memory. High School and College have a tendency to erase some of your past, and for me the pie mold became a victim of that fate. I met a girl. We graduated from College, married, started a family–you know the drill. At some point in this process, I discovered something amazing: My wife’s father makes pie molds. I’m not kidding. Talk about an uncanny way of reviving a childhood memory. Soon after I made this discovery, he told me the story.

Back in 1962, pie molds were around, but they were made of cast iron. The iron took forever to reach cooking temperature and it distributed heat unevenly. So instead of a golden-brown pie, you ended up with burnt crust and a lukewarm center. He had the idea that heavy-duty aluminum would work better. It would heat quickly, it would heat evenly, and it was light weight to boot. Not being a man to sit on the sidelines while another takes action, he called a foundry, invested in a pattern, and the Minute Pie Mold Company was born. As it turns out, he was right about the aluminum. The Minute Pie Mold outperformed the old cast-iron model in every way, and sales climbed as campers started using them.

Upon hearing his story, I called my parents, eager to see if the pie mold of my memory was a Minute Pie Mold. How cool would that be?

Well, I’m sorry to say my parents couldn’t remember. It seems their divorce had put a damper on camping memories, and since a drop-down-drag-out custody battle over gear wasn’t in the cards, that old pie mold was lost to the ages. But to this day, I firmly believe it was a Minute Pie Mold. Don’t try to convince me otherwise.

So what’s my point? Well, I’m not after free advertising for the Minute Pie Mold Company (although I’m sure you’d put a smile on an old man’s face if you surf over to minutepiemold.com and take a peek at what I’m talking about) and I’m not trying to convince you that providence led me from an old campfire cooker to its creator’s daughter.

What it does boil down to is this: Memories. If I hadn’t married the daughter of a pie mold maker, I might have forgetten those campfire memories altogether. But I did marry the daughter of a pie mold maker. I do remember the campfire memories, and I did something about them. We have a campfire ring in the backyard and a whole set of Minute Pie Molds thanks to a generous family discount. Most important of all, the kids whoop and holler when we light a fire and break out the molds. They love pie mold nights. They’re forming their own campfire memories, ones they will someday share with their children.

What childhood memories have you forgotten? Don’t answer now. You can’t. After all, they’re forgotten. But if you slow down and pay attention, something will come back to you. And when it does, don’t ignore it. Let it come back. Hold on to it. Remember it. Then take the time to share it with your children.

Mike is an American pediatrician. Read more at http://www.pediascribe.com

COPYRIGHT 2006 Mike Patrick Jr, MD

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