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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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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It’s not the website

aca photoMuch of the noise about the Affordable Care Act (ACA) recently has been about the nonfunctional website.  That makes sense in that the ACA forces people to get insurance but the website makes doing so impossible.  However, I think the larger issue is what happens after the website is running.  Dr. Jane Orient of the American Association of Physicians and Surgeons (AAPS)  discusses the idea that the ACA is a system designed to fail.  When that happens, government can then take over insurance and medicine both.   When resources are limited, governments have to make priorities.  They generally give resources to the most productive while withholding them otherwise.  That means that the elderly, and (more germane to me), children, are likely to get last place in the line for medical resources.  Although, I am worried for the elderly (I hope to be included in their ranks one day), as a pediatrician, I feel the need to fight for what is best for children.  I do not think that includes supporting the ACA.

–A pediatrician

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Temper Tantrums

toddler girlWhen my daughter was a toddler, she would stand next to me and scream until I picked her up. This went on until it was pointed out to me (I’m not the sharpest knife in the drawer) that she would continue to cry to be picked up until I stopped picking her up when she cried.

That’s pretty obvious except it wasn’t to this young father. So, with this new found realization, I quit picking her up when she cried. And boy did she cry. When she did, I’d sit down beside her and explain that I couldn’t pick her up while she was crying. That didn’t help. She would cry for a long time until she finally got to the point where she would quietly sob and catch her breath. Then I’d say “Oh good! You’re not crying now so I can pick you up.” Although it seemed like forever, it only took two days for her to realize she was no longer going to be picked up when she cried. She started asking nicely to be picked up – “Dad I want to hold you” – and we were both happier about the whole thing.

Kids are experts at getting what they want. They are also receptive to re-direction. So if your child tries to get her way by crying or having a temper tantrum, consider resisting the temptation to give in and help her learn how to get her way “nicely.”

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How to modify a child’s behavior

behaviorIn a classic experiment, rats were placed in identical cages. Each cage had a bar that could be pressed down. In cage 1, pressing the bar resulted in food being dispensed, every time. In cage 2, pressing the bar resulted in nothing happening. In cage 3, pressing the bar resulted in food sometimes being dispensed and sometimes not being dispensed in a random fashion.

You have probably guessed which bar was pushed the most – the bar that randomly dispensed food. We humans are not rats and we humans respond to rewards differently than rats – or do we? If you want your child to continue a behavior, praise them randomly. If you want your child to stop doing something, try ignoring the behavior. If you praise them every time they may simply come to expect it.

 

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Media and Sexual Exploitation

sexy 6 y.o.Parents feel sad and horrified when they hear of the sexual abuse or exploitation of a child or young teen. We are concerned that we do everything possible to protect our children from such abuse – but what specific actions can we take?  How can we help our children and adolescents recognize individuals who might seek sexual favors or who might coerce them into unwanted sexual activities?

One of the greatest risk factors for adolescents is to date an older individual, and the risk for coercive sexual relationships is even greater when the adolescent is younger (12 – 14 years of age).  Young adolescents who watch more television are more likely to participate in early sexual activity. (Manlove J, Moore K, et al.  “Sex Between Young Teens and Older Individuals:  A Demographic Portrait”   Child Trends Research Brief. September 2005 at www.childtrends.org.)

A protective factor is a strong and stable family.  Children and teens that experience secure, loving relationship at home are less likely to be coerced or exploited by others.  Don’t be afraid of tough topics – be willing to talk and listen and admit when you don’t know the answers.  Convey your values and teach your child to respect herself and others for character traits rather than physical appearance.

Children and teen are often at risk during unsupervised time after school.  Please think of ways to assure your child’s safety during this time.

For additional information, see the book So Sexy So Soon:  the new sexualized childhood and what parents can do to protect their kids by Diane E. Levin, Ph.D. and Jean Kilbourne Ed.D.

Jane Anderson, MD
Excerpted from the Prescriptions for Parents Newsletter found at this link: Media and Sexual Exploitation
 

 

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Obamacare

Healthcare.gov

Do you  find it hard to understand Obamacare?  If so, you are not alone.  My son, a healthy medical student in his twenties, still has medical insurance through my job.  However, like many people in the country, I got a letter saying that the affordable care act makes his health insurance product illegal.  If no actions were taken, his insurance would automatically change to another product at over three times the cost.  What happened to “If you like your insurance, you can keep it.”?  Furthermore, if anyone tries to sign up for Obamacare, they face an impossible obstacle in trying to use the non-functional web site.  Confused, I did some research into the website woes.  The best explanation that I could find was  this two minute video:    http://unclejayexplains.com/2013/10/30/uncle-jay-explains-healthcare-gov/.
Enjoy.
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pixel people

Pixels or Patients?

Pixels or patients?  That is a choice that government mandated EMR (electronic medical records) has foisted upon me.  Not so long ago, I could actually look folks in the face as I listened to what was going on with their children.  Now, I spend much of the time, looking for the right boxes to click.  After all, parents and patients often don’t give the history in the same sequence that my EMR program wants it. (“How dare they!”).  I miss the face time.  I fear that my medical records have changed from a thoughtful history, physical, assessment and plan.  Now, I find that it reads like awkward boilerplate.  With the increased cost and decreased productivity,  it seems like I am forced to spend time documenting to justify the highest billing codes.  I know that there are some benefits to EMR (legible records, easy to transfer information), but  unfortunately, they were forced upon us before they were user friendly enough to be worthwhile.
–a physician
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