It was an ordinary summer day. People were milling on the main thoroughfare, bikes zig-zagging through traffic, cafés and pubs spilling onto the sidewalk, patrons sipping their way through a lazy Friday afternoon.
We were ordinary that day too. Just another family, managing the hectic jumble of kids’ lessons, bills, our careers, endless streams of birthday parties, too little sleep and the occasional date night out.
But it was all shattered with …
“Is it weird that I cut myself on purpose?”
A 14-year-old girl from a local middle school asked me this question at work last week. In my years as a Teen Xpress counselor, I have been asked about self-injurious behaviors many times.
They ask:
“What is it about?”
“Isn’t it just a way to get attention?”
“Why would someone do that?”
“Are they trying to kill themselves?”
It’s not only teens that ask about self-injury. I’ve …
Recognizing and treating self-injurious behaviors in teens
Before you jump all over me, I have already outlined why I think we (doctors and medical offices) are the biggest part of the wait time problem. But, patients can help. Here are 3 ways you can help avoid long wait times at the doctor’s office.
1. Don’t request peak times during the day. Every office has busier times and not as busy times throughout the day. If you don’t know …
3 ways patients can help reduce wait times
I wrote recently about getting started with an evaluation for a child who’s not doing well in school. Don’t rush to just do ADHD testing: There are many reasons for attention problems, and it’s best to not just zero in on ADHD at the start.
Still, there’s a time when confirmation and testing for an ADHD diagnosis is appropriate. What kinds of tests are available?
A clinical history is, well, talking …
Toilet training can sometimes be a stressful process. This is particularly the case for children who achieve daytime dryness but continue to wet themselves, and the bed, overnight. It may leave you wondering what’s normal and what you can do to help your child.
Nighttime wetting is one of the most common urologic conditions in childhood. The vast majority of cases are not related to a physical cause. Most commonly, nighttime …
What to know about children’s enuresis and nighttime wetting
I met Madelyn for the first time last month in clinic. Six months prior, she was an otherwise healthy 14-year-old girl. One afternoon, Madelyn’s phys ed teacher led a gym class aimed at completing fitness and health assessments on all of the children in the grade. One at a time, each child was asked to step up and onto a scale …
When school boards fancy themselves health care providers
There is a new emerging health threat to our children: nicotine poisoning.
The number of nicotine exposures in children reported to the National Poison Data System has more than tripled in the last year.
Here’s the fact every parent should know: 1 tablespoon of nicotine oil can be lethal to a 60-pound child!
When doctors were campaigning against tobacco companies through public health legislation, we did not foresee a resultant new market for …
E-cigarettes are an emerging threat to children
As a parent, my words to and about my child will probably be one of the single most influential aspects of their development. Children learn to see themselves through their parents’ eyes, and what we tell them they are, they are likely to become. The labels we place on them often tend to be a self-fulfilling prophecy.
I’ve seen this play out in my own life and in the lives of …
Labels leave an indelible mark on children
Painful wait times at the doctor’s office. It’s an old story with few exceptions.
As a dad, I have to deal with many of the same issues of parenting that you deal with: sleepless nights , fevers and holding my kids down for shots (my wife did it once, I think, then she promptly retired from this job). However, waiting at the pediatrician is not something I have to do. So, I can’t truly empathize …
Reasons why your wait time at the doctor’s office is so long
This quarter of medical school has by far been my favorite, because almost everything we do has an explicit clinical correlation. Each week we work in small groups of 10 or so students to go over patient cases, practice respiratory and cardiovascular (our two organ blocks this quarter) physical exam skills, and interface with real patients in the hospital. These experiences have been both exciting and humbling, and two in …
A passion for family-centered care
When my sister and I were little, we had an almost daily ritual with my father: drawing stories.
He would sit us on his lap and get out his clipboard, a piece of paper and his black click pen. He’d divide the paper into four parts, and draw as he told a story. Sometimes he drew old favorites and we knew what …
I so wish I could say: Daddy, thank you so much for the stories.
Measles is on its way to an all time high.
In 2000, measles was eliminated (meaning some travelers from areas with low vaccine penetration might arrive in the U.S. with the disease, but no case came from U.S.), but has been slowly creeping back. Since 2008, this has been more than a trickle.
Let’s put the important goal of measles elimination in perspective. Before …
Dr. Bob Sears deserves blame for declining vaccination rates
A pediatric oncologist seems to suggest we shouldn’t be getting too upset about childhood cancer because kids and teens dying or going blind “are things that we don’t typically encounter.”
“I think the important thing to realize is that cancer in children is highly treatable and ultimately curable,” Dr. Charles Hemenway of Loyola University said in HemOnc Today, in response to the movie …
Criticizing The Fault in Our Stars does childhood cancer a disservice
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What if a big TV station came out with a blockbuster story claiming that infant car seats were implicated in cerebral palsy (CP)? After all, something like 99.7% of babies diagnosed with cerebral palsy had been brought home from the hospital in a car seat. In fact, every single time they went anywhere in a car, they were strapped into them. That’s …
Applying the anti-vaccine mentality to car seats
When we moved to Irving, TX and I decided to join a practice in nearby Lewisville, I realized I wanted to know more about the schools in the area and get a feel for the culture of the teachers that would be teaching my patients and kids. I searched online and found great and encouraging information about Carrollton-Farmers Branch, Irving and Lewisville school districts. I also looked up several teachers …
What would a flipped checkup look like?
Antibiotic use is the direct cause of the rise of untreatable superbugs that are killing people.
Antibiotic use is also the cause of most cases of C. diff colitis in kids, a potentially life-threatening, difficult-to-treat gut disorder. Antibiotics have also been linked with recurrent wheezing in infants and inflammatory bowel disease. They can also trigger allergic reactions that can be …
Find yourself a physician who is stingy with prescriptions
In pediatrics, almost all of our patients are healthy. We’ve got some doozies of special-needs kids, but by-and-large your ordinary pediatric patient is doing well, and does not need extensive testing or elaborate procedures to ensure good health.
Still, we do run across some occasional problems. Some children have poor vision, or hearing problems, or kidney disease, or hypothyroidism. Or autism, or Tay-Sachs Disease, or a penny up their nose. A …
Pediatric screening tests: You can’t have it both ways
A perspective that comes from continuity of care over many years. An awareness of local resources. A sense of who a family is. An appreciation of the things that give life meaning and value to a child and family. Isn’t this care a lot to offer families of seriously ill children? What happens to all of this knowledge when a child becomes more ill and spends increasing amounts of time …
Training community-based pediatricians in palliative care
I wouldn’t say I’ve had a lot of revelations in my professional life, but there is one that still affects me emotionally to this day, and it’s about nurses.
I had been a PICU doctor for a number of years, and I was rounding on all the patients in the PICU with the rest of the team. The background sounds consisted of the usual beeps, alarms, and humming from the patient’s …
Nurses are the reason doctors look good
Once a year, I give a high-stakes presentation in front of a single audience member: my son’s teacher. I have 20 minutes to teach her how to save his life.
I need to explain the science of food allergy, list all of his many allergens, accurately describe the symptoms of anaphylactic shock, instill an appropriate sense of urgency and responsibility with one …
How to save my son’s life: 20 high-stakes minutes
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