Scribit Veritas

Protecting the Child, Preserving the Family, and Honoring Life

Welcome to the Blog page of the American College of Pediatricians.  Each issue of the Blog is intended to assist parents, encourage children, and enrich the family.  Read our most recent issue below, and scroll to the bottom of this page to read earlier issues.

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Making Adjustments: When One Thing Doesn’t Work, Try Another

Our third child struggled with impulsivity and inattention even though we home-schooled and provided a far less restrictive academic environment than most students have.  This was interfering with his learning so we took him for an evaluation by one of my pediatric partners. A decision was made to try a medication to help his focus and decrease his impulsivity.

Our little boy was a wonderful ball of energy with a sweet disposition to match (and he is still a great kid!).  He was never down or discouraged for long and was always quick with a smile.  Shortly after starting medication, he was chided for a typical childhood infraction. Ten minutes later, his older brother found him sulking on the backyard swing. The observant teenager said, “I don’t know what medicine he’s on…but that’s child abuse.” And he was right. We stopped the medicine.

Fast forward about 5 years.  This same child is now being sent to school outside the home for the first time, without any medication.  He’s a bit nervous.  We’re a bit nervous.  After a few days of school, he walks into the house and without saying a word takes a sheet of paper out of his book bag, adds a piece of scotch tape from the kitchen drawer to it and attaches the paper to the knob of the door he just walked through.  It turns out that the sheet of paper was a form all the kids had to have signed by their parents and was due the next day.  He knew his limits and, without having to be told, he devised this strategy to avoid forgetting this important assignment.

As parents – we make the best decisions we can for our children, and we practitioners do the same for our patients and our own children.  We thought starting our son on medication was the right thing to do and we reversed course as soon as we recognized we were wrong. That may not be every parent’s  experience; but it was ours. Wise parents consider input from multiple sources and make adjustments as necessary.  Apparently…so do our kids.

Visit this link at the College website for tips on helping the inattentive child.

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It’s All Good

Long ago, in a kingdom far away, there lived a kindly king and his prime minister. Whenever news of any sort was presented to the prime minister he would always say, “It is for the best, it was meant to happen that way.” The king didn’t object to this characterization as the kingdom was doing well.

thumbOne day the king, on an accident, amputated his thumb. News of this was brought to the prime minister who responded as he always does and said, “It is for the best, it was meant to happen that way.” The king was outraged when he heard of the prime minister’s pronouncement and ordered the prime minister thrown into the dungeon. This was done promptly and the prime minister remained in the dungeon until…

Many months later, the king decided to take two of his closest advisors and go hunting. As they pursued a deer, the group inadvertently strayed into the neighboring kingdom in which lived cannibals. They were captured. The cannibals had a ritual when preparing to eat. The “food” was placed alive over a pile of wood. A medicine man would then perform a ceremony “blessing” the “food” and would then set the wood on fire. He did this for both of the king’s advisors. When he came to the king, he stopped abruptly and said, “We can’t eat this food. He is missing a thumb and it is our practice to eat only complete humans, not humans who are missing thumbs or any other body part.” The medicine man ordered the king freed and it was done.

When the king returned to his kingdom, he immediately released the prime minister. He praised him for his wisdom regarding his amputated thumb. “But tell me,” he asked, “what was so good about your time spent in the dungeon?” The prime minister responded, “It is for the best, it was meant to happen that way. If I wasn’t in the dungeon, I would have been on the hunting trip and I have both thumbs.”

It is hard to be always cheerful and is unrealistic to always think, “It is for the best, it was meant to happen that way.” On the other hand, seeing things in a positive light and making the best of bad circumstances has been shown to increase health and well-being. So be of good cheer!

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Letting Go

learning to ride bikeWhen I was a four year old lad, I became very angry with my mother. I do not remember why I was mad but I was SO mad that I announced that I was going to run away from home.  Hearing this plan of mine, my mom said in a calm and loving way, “let me help you pack.” Man oh man, I was floored. I didn’t expect that response!

My mother’s suggestion that she would help me pack helped me grasp that I had choices. I could leave if I wanted to.  She knew that I wouldn’t have gotten far, she would not have let me out of her eye sight and she would not let me know that she was watching me – a very loving response to my anger. I chose to cancel my travel plans and have never regretted that decision.

One thing we parents must do is let go of our children. Her willingness to let me go in this instance and many more helped me grow into an independent, productive adult. I fell off of my bike many times while learning to ride it (she taught me how to ride a bike) and she let me decide if I was ready to try again that day or wait to try again another day.

So, let go of your children – gently and lovingly. Be there to pick them up after they fall or fail – it is in the falling and failing that they are likely to learn valuable lessons. And cheer them on when they succeed!

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Retail [Medical] Clinics

nurseA couple of [physician] colleagues recently vented about the proliferation of retail [medical] clinics.  Not only do they fragment patient care and decrease the ability to follow growth and development, they also are more likely to decrease the number of folks willing to become physicians.  Often these retail clinics are staffed by unsupervised mid-levels (non-physician health care professionals).  These clinics “skim off” treatment of the easy stuff  leaving the much more complex, time consuming and less profitable problems to actual physicians.  The problem is that with the retail clinics getting paid for the higher volume of minor illnesses, and with decreasing financial reward for taking care of the complex problems, who will want to become a physician anymore?   I think we should all contact our respective State medical boards to address this issue.   If they do not, the future of continuity of care looks dim.

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Anxiety

stress meterA friend gave me a book Fearfully and Wonderfully Made which contained essays by a Dr. Brand.  Dr. Brand worked with lepers and made a good argument for the benefit of pain to help protect us.  Certainly, too much pain is not a good thing but too little pain can lead to problems and disfigurement as in his patients with leprosy.  As much as I hate it, I have to admit that much of what I am I owe to anxiety.  Anxiety over possible failing grades was essential to force me to sit and study.  Even from a very young age, anxiety has played a part in my life.  Anxiety isn’t always a bad thing.

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Marriage: an Endangered Species?

marriage proposalMarriage is getting to be an endangered species.  If Pew polls are accurate, the institution is at an all-time low; not just in numbers (only about half of U.S. adults are married) but in enthusiasm (only a third of adults feel a successful marriage is one of the most important things in life).  That’s the bad news.

Is there any good news? I get excited while making rounds in the labor & delivery suite when I see a young man in the room, presumably the father of the newborn baby.  The fact is, however, most of these men are not actually married to the mother of the baby – and married couples raising children is superior to other arrangements; even those where the parents are living together and not married. I’m glad to see men like LeBron James stepping up to the plate and fulfilling their parental responsibilities.  It’s certainly better than what most men in such situations are doing.

Children deserve better, however.  Marriage is a level of commitment far beyond attending soccer games or PTA meetings.  My own marriage, for instance, is more than the legal agreement between my wife and me that we will share assets and responsibility for our children (though it does say that).  It’s even more than the public acknowledgment of love and support for the woman I fell in love with some 25 years ago.  It’s a statement TO OUR CHILDREN, perhaps the first and most important such statement, that demonstrates how life is about personal sacrifice and commitment, not material success.  That’s why divorce, serial monogamy, cohabitation and even polygamy are often so harmful to children.  If we teach our children the importance of putting others (specifically our spouse) first, they will learn to do likewise.  And THAT is worth more than all the pick-up games and birthday parties in the world.

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A man on “Top of the World” still struggles with why his dad left him!

James LeBronLeBron James, four-time NBA MVP, has not forgotten the gift of his mother Gloria who chose life and gave birth to him as a single mom at the age of 16 and raised him to be the man he is today. LeBron also sharing his still-hurting soul in an Instagram post remembering the father he never had: The man who chose to walk away and leave his mom and him to wade life’s challenges on their own.

Kudos to LeBron James and his mother Gloria for rising above their challenges and not making excuses. LeBron today takes his parenting responsibilities to heart. He is a devoted father in spite of the man who chose to walk away and not teach his son lessons in love.

Fathers and potential fathers everywhere: take note! Your presence is important and necessary. Children need a mother and a father. The wounds left behind when one or another is absent lay raw even years into adulthood.

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Belgium

Belgium mapAh Belgium, the “home” of  Hercule Poirot, famous chocolate, the Walloons and the Flemish.  I remember as a student traveling to Brussels and enjoying the diversity of cultural experiences there (although, I avoided the famous red light district).  Now it saddens me to learn that the Belgium government has voted to include euthanasia in children with disabilities.  Euthanasia has been legal there for over a decade but limited to adults only until this recent vote.  I think this issue demonstrates that once you cheapen life, the slippery slope causes things to get worse over time.  When I visited as a student, I was already horrified to learn (second-hand) how the red-light district turns women into mere objects for salacious activities.  Then it was “okay “to kill adults.  Now it is “okay “to kill children with disabilities.  I cannot imagine where it can go from here.  In my experience, many of my disabled kids are very happy.  They may be limited but in their own little worlds, they are happy.  The problem is the other people that are uncomfortable seeing wheelchair bound and/or retarded kids.  It makes me wonder.  Do people support euthanasia because they think it is in the child’s benefit?  Or do they support euthanasia because of their own discomfort in seeing and dealing with these “non-perfect” kids?

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The Media and Sex

turn off the tvMost parents would say that they would do anything possible to protect their children from sexual exploitation.  In an article “Sex Between Young Teens and Older Individuals: A Demographic Portrait” (Child Trends Research Brief, September 2005 at www.childtrends.org by Manlove J, Moore K, et al.) the authors presented evidence that large doses of television watching was associated with early sexual activity among teens.  Yet many folks continue to let their children have almost unlimited screen time.  That reminds me of the old joke about the young man bragging to his girlfriend about how much he loved her.  He could swim oceans, climb mountains, etc., just to be by her side.  Of course the punch line was that he would visit this weekend “as long as it doesn’t rain.”  We know that excessive television watching is associated with obesity, aggression and now, early sexual activity.   How much effort does it take to turn off the tube?

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Maintenance of Certification

mocAs a pediatrician and having recently finished a cycle of re-certification, I did not expect to revisit this topic [Maintenance of Certification (MOC)] soon.  However, now I have had some time to reflect.  It seems to me that to require ongoing certification with recurrent exams, three questions need to be answered:
1) Does it lead to better medical outcomes?
2) Does it lead to fewer malpractice cases?
3) Does it help us practice medicine more efficiently (better care with less cost and less time)?

I’m not saying that MOC does not meet these goals but I have not been presented with any evidence that it does.  Are the data out there?  If so, why doesn’t the American Board of Pediatrics (ABP) present it?

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