Wednesday, March 4th, 2015
When I think about what makes my life “hard,” it’s stuff like this: a frustrating commute. Young children who bicker a lot. Forever feeling rushed. Those extra pounds I’m always trying to ditch. Not getting enough sleep. In other words, nothing that hard.
If I find myself getting too caught up in all that, I remind myself of people whose lives are far more challenging than mine. One such person is a mom named Verena, whom I met last year when I was reporting a story about what it’s like to be a young mom with a chronic illness. Verena has multiple sclerosis (MS), which drives the immune system to damage parts of the brain and spinal cord and interfere with nerve signals between the brain and different parts of the body. She also has two children, ages 5 and 6. (They’re all pictured at right.) Verena has all of the same struggles as me, minus the commute. But on top of those, she has–to name a few symptoms–chronic pain, muscle spasms that make her feel like she’s permanently cramping, anxiety due to a recent divorce, severe exhaustion, and a lot of trouble moving quickly. In fact, at times it’s hard for her to walk at all. Can you imagine having active little kids and not being able to chase after them? Verena told me of the time her son, Stephen, climbed out their basement window as a toddler. She physically couldn’t have caught him–but her au pair did, which is a large part of why she needs live-in childcare.
Verena resists the outward signs of her disease, such as using a cane or wheelchair. But she often can’t function without them. I thought of this when I learned of a new national survey called “Women and MS: The Working Mother Report,” a joint venture with the National MS Society and Working Mother Research Institute. The survey outlines the challenges of women living with MS. One of the most interesting stats: 60 percent of women have tried to hide their MS symptoms at work. And 80 percent of women are currently experiencing symptoms; the most common are fatigue, numbness, problems with vision and walking, and pain. Another jarring finding: 64 percent of moms said their symptoms prevent them from participating in activities with their children. I saw firsthand how Verena’s physical comfort comes second to her children’s happiness–she tries to put on a cheerful face even when she’s in tremendous pain–but even so, she says her children will ask things like, “Mommy, when is your leg going to get better?”
This is National MS Awareness Week, and part of the mission is to recognize the tremendous progress that’s been made in treating this disease. The folks at the National MS Society say that studies in the works will determine whether certain drugs can help repair myelin, the casing of the nerves that is damaged by MS. And within a few years, researchers should better understand which exercises and activities can best help rebuild nerve connections and improve cognitive function.
In the meantime, I’m going to continue trying to keep things in perspective and make sure I always respect what parents with MS go through all day long, every single day.
Photo by Amy Postle.
Kara Corridan is the Health Director at Parents magazine, and the mom of two daughters, ages 9 and 6.
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Friday, February 6th, 2015
This is a topic that’s top-of-mind for me right now, as my 9-year-old daughter becomes increasingly persistent about wanting to have more and more of an online presence. She’s on Pinterest, which feels pretty harmless to me–when she even remembers to go on it, she pins pictures of desserts and puppies and bunnies. Over Christmas break I caved and let her join Instagram, on several conditions (such as no pics of herself, and no accepting followers without checking with me first). So far it’s working out okay, though there have been a few bumps. For one thing, she was startled and downright confused when a stranger commented on her comment, “Are you retarted?” (I pointed out the irony of the misspelling.) This gave us the chance to discuss what I’d warned her could happen by being on social media, which is that she could get her feelings hurt. Last week she came to me, terrified, after looking up a story about a dead girl who came back to life as a ghost that she’d seen posts about on Instagram. I was able to show her the stories she missed, the ones explaining that it’s a total urban legend, and used the opportunity to talk about how real and convincing things can seem online. (“But there’s a picture of her and everything!”)
Because I feel only barely prepared for everything that’s ahead of us, I was so glad to attend a symposium last night called “How Social Media Influences Our Children’s Development,” organized by The Meeting House, an impressive NYC nonprofit that provides innovative programs for children with social and developmental challenges. (Full disclosure: My sister, a pediatric occupational therapist, works for The Meeting House.) What I found interesting, and somewhat refreshing, about the event is that while the panelists covered the downsides to having children on social media, they spent as much–if not more–time on the benefits and values. I left with these key takeaways:
1. Children need a social-media mentor, someone in the know who can help them navigate the right way to behave online. Ideally, that would be a teacher or a librarian. But as keynote speaker Mega M. Subramaniam, Ph.D., explained, teachers and librarians rarely have the opportunity to guide our kids in that way, because school and public computers automatically filter out all social media sites. Of course, there’s a good reason for that. But I hadn’t thought of the downside until Dr. Subramaniam pointed it out. She’s the associate director of Information Policy and Access Center at the University of Maryland, and runs several social media literacy programs for tweens, and she suggests that in place of a trusted adult, find an older teen your child looks up to–a cousin, a babysitter, a camp counselor–who’s demonstrated responsibility online, and have that person help show him the ropes.
2. There’s a value to texting, even among younger kids. Julia is dying to text with her friends. I’m not allowing it. I feel it’s pointless–what on earth is there to text about when you’re in fourth grade?–and I fear it’ll erode her writing and spelling skills. But more than that, I worry that texting merely provides her with another avenue to see (or do) something inappropriate or rude. The panelists agreed that 9 is a little young, but they gave me ideas on how to allow it in a controlled way when I eventually do let her text. Stay away from group texts, suggested Orit Goldhamer, Psy.D., a middle-school psychologist at The Churchill School in NYC. Otherwise Julia will get sucked into a thread of neverending emojis and “Hey”s. And let her start out by texting only to plan get-togethers (I almost called them playdates!), as opposed to aimless chitchat that could more easily go awry.
3. Have your child ask herself one simple question before posting anything. And the question is this: “Would you show this to your grandmother?” Oooh. Good one. Or maybe this would work better for you: “Would you be proud to have your teacher see this?” I’ll be suggesting that Julia consider both of these.
4. Sign a digital media contract with your child. This will cover everything from time restrictions, to passwords, to where devices need to be kept at bedtime, to the importance of kind behavior, and more. The best one I’ve seen is from Common Sense Media, but a quick search will give you lots of options. And more importantly than signing the contract is revisiting it, points out Scott Gaynor, Ed.D., head of school at The Stephen Gaynor School in NYC. It’s tempting to go over the rules once and shove the paper in a drawer, but just like any important topic we want our children to understand, we need to talk about it often.
5. Fun fact: There’s an unspoken rule among kids that you post to Instagram no more than once a day. It’s clear that my daughter, who only gets to use her phone on weekends and goes to town on Instagram for those two days and nights, has no idea about this one.
Image: Surprised children on mobile phone via Shutterstock.
Kara Corridan is the health director at Parents. Her two daughters, ages 6 and 9, will tell you they have cell phones “with NO SERVICE.”
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Friday, January 23rd, 2015
Nearly 9 million children end up in the emergency room each year.
Roughly 8,000 children die each year from unintentional injuries.
In fact, preventable injuries are the leading cause of death for children in the U.S.
And among children up to 12 years old, their injuries often happen at home.
This is what prompted Nationwide Insurance to embark on an ambitious campaign called Make Safe Happen. The goal is simple: to reduce the number of preventable injuries in and around the home. Through the web site and free app—both called Make Safe Happen—parents and caregivers can learn exactly how their child is at risk. Both methods are impressively user-friendly; you can sort the info based on your child’s age, the various parts of your home and yard, and injury types.
One of the most helpful features of the app is the product recommendations. Say you’re looking at a checklist of steps to take to make your toddler’s bedroom safer: Among them will be to install window locks and guards. In addition to the tip, you’ll be prompted to immediately shop for the items and can be directed straight to Amazon to buy them.
Also key: Automatic reminders imported into your calendar, which are perfect for precautions like testing your smoke alarms every month and replacing their batteries.
All of the information has been created and vetted by experts from Nationwide Children’s Hospital in Columbus, Ohio, and Safe Kids Worldwide in Washington, D.C. Among the main contributors was Lara B. McKenzie, Ph.D., principal investigator for the Center for Injury Research and Policy at Nationwide Children’s—and mother of 3-year-old triplets! (I’m exhausted simply typing that phrase.) Though she’d already been working in the injury-research field by the time she became a mom, motherhood is what really brought this issue to life, she says: “In my professional world, we’re always asking how we can get parents to adopt countermeasures to prevent home-related injuries. When my kids were born, I thought, ‘Why do we have to make it so hard?’ And this is the idea behind the app: I’m standing in my kitchen, and I know I need to lock the cabinets. But what kind of locks do I need? I need to secure my TV to the wall—but what kind of straps should I buy? We’re answering those questions for parents. We’re telling them about the hazards, as well as the products that can reduce the consequences.”
I blogged just the other day about parents who go to incredible lengths—true extremes—to keep their children safe. It would seem I’m being hypocritical, following that up with a post about how dangerous our homes can be. But the reality is this: If you’ve taken the proper precautions around your home, with help from resources like the Make Safe Happen site and app, and if you’re aware (not hyperaware!) of what your child is up to, then you’ve done right by your child.
Kara Corridan is the health director at Parents. She has two young daughters and needs the Make Safe Happen app more than she cares to admit.
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Wednesday, January 21st, 2015
I got a sneak peek at a show debuting tomorrow night on Discovery Life Channel called “World’s Worst Mom.” It’s ironically named after Lenore Skenazy, the creator of the Free Range Kids movement; she got the nickname “America’s Worst Mom” after letting her then-9-year-old son ride a New York City subway by himself.
This is how Skenazy describes the reality show, which airs at 9 p.m. Thursdays starting tomorrow (January 22): “Think ‘Supernanny,’ except instead of taming bratty kids, I tame super-anxious parents.” In the premiere, 10-year-old Sammy has a mom so afraid that her son will hurt himself that she tries to remove all aspects of life that could lead to danger. She won’t let him ride a bike, or stay at anyone else’s house, or even cut his food with a knife (she does it for him—and, in one scene, feeds him, too). Her husband is ready for things to change (to put it mildly), so along comes Skenazy, who arranges for Sammy to take steps toward independence and act his age. His mom is truly tormented through it all, until… Well, I won’t spoil the surprise. It’s worth seeing for yourself.
Skenazy told me about a scene in an upcoming episode that I can’t wait to watch: She helps a 16-year-old, 6-foot, 2-inch boy take a commuter train for the first time. As he’s leaving the house, his frantic mom runs after him, bringing him an Elmo juice box.
But these parents aren’t caricatures, Skenazy insists: “They’re more nervous than the average helicopter family, but they’re part of a society that has chosen to focus on worst-case scenarios. We’re living in a hysterical society, and it doesn’t strike me as odd that people feel rational being very, very afraid.”
By the end of the 13-episode series, 12 of the 13 families Skenazy worked with underwent a dramatic transformation. And yet it’s not anything she said, or even really did, that led to the change. “It’s the kids who convince the parents. When a child rides a bike for the first time, and is so happy and proud and grateful, the image his parents had in their brain and heart—of a vulnerable, sweet baby they have to protect—just pops,” she explains. “And into that space comes a competent, grown-up young lady or young man. And there’s no place left for their fear.”
You might be thinking, Yeah, but this is reality TV. How do you know if the parents changed for good, or just for the cameras? Turns out that the crew—minus Lenore—returns to the home a month later for a checkin. And Skenazy has heard from the families in many cases; everyone is continuing to make progress. Which doesn’t surprise her: “If you start to walk, do you go back to crawling? If you see your child be 16 years old, do you make them go back to being a 2-year-old?”
At a time when parents are increasingly getting in trouble for acts like letting their children walk to a park alone, “World’s Worst Mom” raises a lot of questions about the level of protection we should provide for our children, and for how long.
Kara Corridan is the health director at Parents. She has two daughters, ages 9 and 6, and wrote an essay for Parents called “Worry Doesn’t Equal Love” that touches on the themes of protection and overprotection.
Image courtesy of Discovery Life Channel
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Wednesday, January 7th, 2015
This guest post comes from Steve J. Hodges, M.D., associate professor of pediatric urology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, and the co-author of It’s No Accident: Breakthrough Solutions To Your Child’s Wetting, Constipation, UTIs, And Other Potty Problems and the brand-new picture book Bedwetting and Accidents Aren’t Your Fault: How Potty Accidents Happen and How to Make Them Stop. He addresses the question raised this week about the safety of the laxative Miralax–which many children take every day–and gives excellent advice on how to prevent and address constipation in kids.
By Steve Hodges, M.D.
My phone has been ringing nonstop since the New York Times published an article raising questions about the safety of Miralax in children.
Many, many of my patients take Miralax (PEG 3350) daily and, following my advice, have been doing so for months, even years.
So when the Times mentions “ingredients in antifreeze” and “psychiatric illness” in reference to the laxative their children are taking, naturally parents want to know: Is the medicine you prescribed poisoning my child?
The short answer: Probably not, based on the available evidence. More than 100 studies have found PEG 3350 is safe to use in children, and I have found no published studies linking Miralax to severe or harmful side effects. (I discuss this research in It’s No Accident.)
Nonetheless, I welcome all inquiries into the safety of this ubiquitous laxative, and I look forward to the results of the government-funded study that will examine whether PEG 3350 may trigger psychiatric problems in children.
Still, the Times article misses the forest for the trees. While it is of course important to know whether Miralax contains trace amounts of toxins, no one is asking a more salient question: Why are so many American children constipated in the first place?
Constipation is an extremely common — I would say epidemic — problem among children in Western countries.
In a small minority of cases, constipation has a medical explanation — a child may have Hirschsprung’s disease or other rare, congenital conditions. But in 95 percent of cases, children withhold stool simply to avoid the pain of pooping. Stool piles up in the rectum, making bowel movements even larger, harder, and more painful. And the cycle continues.
This is no way a benign process. Failing to eliminate on time often leads children to develop painful, distressing, and embarrassing medical complications that needlessly cost the health-care system millions.
What’s the most common cause of abdominal pain among children seen in the emergency department? Constipation.
The most common cause of bladder and kidney infections in children? Constipation.
The most common cause of enuresis, both daytime accidents and bedwetting, in children? Constipation.
Virtually the only cause of encopresis (poop accidents) in children? Constipation.
Children are often subjected to expensive, uncomfortable tests and even surgeries that could have been prevented had the child defecated on time and completely. This is a travesty.
As I explain in It’s No Accident, the reasons children withhold stool are multiple but not complex:
•Our kids eat way too much processed food.
•Parents toilet train children too early (and without adequate follow-up), largely due to preschool deadlines.
•Dismal public school bathroom conditions and misguided restroom policies prompt children to steer clear of the toilet.
Compounding these problems, we as a society, we ignore the early signs of constipation. No one bats an eye if a child has enormous or hard bowel movements (the top two signs of a clogged colon) or doesn’t poop at least every other day. We’re happy as long as a child goes at some point and doesn’t seem to complain.
But children need to poop every day — soft, mushy poops. When constipation goes unrecognized, stool piles up rapidly, at which point simple, drug-free therapies such as fiber and dietary changes are too little, too late.
The Benefits — And Limits — of Miralax
We can argue about how to fix these cultural problems until the cows come home, but a child who already is constipated needs help now, which is why Miralax is so often prescribed.
Families with Miralax on the counter are often judged harshly — “Water bottles were the tool of choice for constipation when I was a kid. Prunes also help,” wrote one Times commenter. But the reality is, no amount of water, fiber, or prune juice will dislodge a large, hard rectal clog. (Another reality: Many kids who are excellent eaters end up constipated.)
So doctors typically turn to PEG 3350, which is not habit-forming and is easy to give to kids because it has no taste or odor. You can mix it in their beverages, and they typically won’t complain.
Miralax also is generally effective — more so, according to a 2014 meta-analysis, than magnesium hydroxide (Milk of Magnesia), lactulose, mineral oil, psyllium fiber, and fructose. The authors of that study concluded that is also safe, with minor side effects such as diarrhea, nausea, bloating, and vomiting.
For these reasons, I prescribe Miralax daily, but I don’t love this stuff.
While it’s effective at softening stool, PEG 3350 often does not fully clean out a child’s rectum. The rectum remains stretched and floppy, like a worn-out sock, and therefore doesn’t have the tone needed to fully evacuate or the sensation to signal to the child that it’s time to poop.
Only a completely cleaned-out rectum can bounce back sufficiently, which is why I typically prescribe enemas for my severely constipated patients. Enemas have been proven in rigorous studies to resolve enuresis and encopresis, and yes, enemas are safe for children. On the whole, my patients who receive enemas get far better results than those who use Miralax.
The problem: Most parents simply won’t give their constipated children enemas, insisting the child will refuse. (My experience demonstrates otherwise; it’s parents who project their fears on their kids.) Even many pediatricians won’t go near enemas. One doctor told a patient of mine that enemas are “cruel and unusual punishment.” That’s a travesty, too.
So, I end up prescribing Miralax all the time. And while it’s not as effective as enemas, it does an OK job.
“But Miralax Isn’t Natural”
Many folks object to Miralax on the grounds that it’s “not natural.” That’s absolutely true, and I wish I never had to prescribe it. However, carrying around a rectum full of poop throughout an entire childhood, a common scenario these days, is not natural either and can have serious, long-term consequences.
Also not natural: walking around with a tube inserted through your abdomen into your colon so you can flush out poop with liquid laxatives. Yet that scenario, known as a cecostomy, is becoming more common in children whose severe constipation has gone untreated for years.
Getting a constipated child cleaned out is critical, and laxatives can be an effective approach. As one of my colleagues, a pediatric gastroenterologist, told me, “Parents are terrified of the consequences of giving their kids laxatives, but what about the consequences of taking out part of a 6-year-old’s colon? Many people don’t realize how severe the cost of undermanagement can be.”
This doctor has performed more than 100 cecostomies in children whose stretched-out colons are permanently damaged from constipation and has sent more than a handful handful of his worst-case patients to surgeons for colostomies.
I do not think that parents should stop giving their children Miralax just because small amounts of toxins were discovered in eight samples in 2008. At the same time, I urge parents and pediatricians to give enemas a second look.
Ultimately, it doesn’t matter what method is used to empty a child’s clogged rectum (as long as that method doesn’t harm the child, of course). What does matter is that the child’s bowels empty completely on daily basis, so the kid don’t show up at the ER with painful urinary tract infections or opt out of sleep-away camp because she wets the bed.
I hope the harsh light shined on Miralax will help illuminate our nation’s epidemic of pediatric constipation, leading to preventive strategies, more rapid diagnoses, and more effective treatment for these kids.
Perhaps then we’ll all need less Miralax.
Photo credit: LunaseeStudios / Shutterstock.com
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