Archive for the ‘Guilt Free Parenting’ category

Just because a chemical is present doesn’t mean you have to worry about it

July 31, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Advocacy groups have been busy lately with their fancy-pants chemicalz detection science instruments, and their press releases have made it into the news. But is there news here, and are these chemicals something parents really need to worry about?

First it was a big lead from the New York Times called “The Chemicals in your Mac and Cheese.” The article started:

Potentially harmful chemicals that were banned from children’s teething rings and rubber duck toys a decade ago may still be present in high concentrations in your child’s favorite meal: macaroni and cheese mixes made with powdered cheese.

Oh noes, not high levels! The chemicals they’re talking about are from a family called “phthalates,” which sounds scary and difficult-to-pronounce. (Words shouldn’t start with four consonants. On this we should all agree.) Phthalates have been in wide use for over 80 years in plastics and other compounds. Though they’re not added to cheese, they’re on the coatings of tubes and platforms and whatever else is used in the machinery to make Magic Orange Cheese Powder. Foods with a high surface area (like a powder) are going to come in more contact with it, and a teeny bit of a trace of a few molecules are going to transfer over.

Important point: these chemicals have been in our food for many, many years. What’s changed is that we’ve now got fancy equipment to measure it. The Times story is quoting a kind of press release – not a medical study, or even anything published in the medical journal. It’s a “study” done by a consortium of food advocacy groups. It’s being promoted by an organization called “KleanUpKraft.Org” (Cutesy misspellings are at least as bad as starting words with four consonants, K?) And their “high levels” are in tiny parts per billion, at levels that are very low compared to amounts that cause adverse effects in animal studies.

Just because you can detect a chemical as present doesn’t mean there’s enough of it to hurt you. Mercury and arsenic are part of the natural world around us, and any food tested with equipment that’s sensitive enough will find at least traces of these and many other chemicals. It is not possible to get the values of phthalates or arsenic or many other chemicals down to zero in our foods.

Speaking of chemicals, this week another food advocacy organization announced that they’d found traces of an herbicide (glyphosate, found in Round-Up) in Ben & Jerry’s Ice Cream. And in every flavor tested, too, except Cherry Garcia, which is kind of nasty-tasting anyway (I’m sticking with Chunky Monkey, which wasn’t even tested.) But: their press release didn’t even reveal the levels that they found, only that they found it. Maybe it was one part in a zillion. Who knows? But: Do you think if the value were genuinely high they’d hide it like this? No way. It’s there in some kind of teeny amount, and they’re trying to scare you.

Don’t fall for all of this “The Sky is Falling, There’s Chemicals in My Food” hype. Just because something is hard to pronounce doesn’t make it dangerous, and just because something is present doesn’t mean it’s going to kill you. We’ve all got enough to worry about without being scared of Mac and Cheese and Ice Cream. In fact, a little comfort food in these troubled times would probably be good for all of us. Maybe even the grumps at KleanUpKraft.org.

By the way, I don’t disagree with one thing – homemade Mac n Cheese is at least as good as that boxed orange stuff. Though sometimes, I won’t deny it, the orange stuff sure does hit the spot…

Vaxxed versus unvaxxed children: What a real study shows

July 26, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

You may have seen it on Facebook: A published study claiming to be “The First Ever” comparing vaccinated and unvaccinated children supposedly showed that vaccinated children are more likely to have a number of health problems. Let me promise you: there’s nothing to worry about here. The study is one of those garbage-in-garbage-out whackjobs that’s almost indescribably bad and unreliable. And: a much better study of the same thing – children who are vaccinated, versus children who are not vaccinated – shows that there are not any worrisome risks. The long-term health of vaccinated children is just fine, and even better than unvaccinated kids (because they don’t have to suffer through vaccine-preventable diseases.)

Let’s cover the good study, first. It was published in 2011, and tracked over 13,000 randomly selected children in Germany, tracking their health status and correlating that with their documented vaccine histories. The authors could find no examples of any increased risks of infectious or allergic diseases in the vaccinated children.

And now, this more-recent, execrable study. They didn’t use randomly selected children. What it actually compared were the 666 children of homeschoolers who chose to complete the survey (which was promoted on antivaccine websites), using their self-reports of vaccine histories and health status. Of these, 40% hadn’t been vaccinated, at least according to the surveys. No attempt was made to track who received the survey, what percentage of respondents completed it, and what kind of respondents completed it. Do you think it’s possible that a high proportion of vaccine-distrusting parents would complete a survey like this? Hint: if you did a survey of musical tastes at a Justin Bieber concert, you’re not going to find many Cab Calloway fans.

The “study” was really just a survey, and a biased one at that – a survey among people who were guaranteed to say exactly what the study authors wanted them to say. It had already been retracted, once previously (and, laughably, by a bottom-feeding journal that looks like it requires authors to pay to publish their studies. This isn’t the way legit journals work.)

Vaccines are safe, and they save lives. Make sure your kids are fully vaccinated. Don’t believe the Facebook rumors, or idiocy dressed up like science – what the real science shows is what parents should feel confident about. There’s no need to worry about vaccines.

A more detailed evaluation of this fakakta survey is here, and here’s more information about reliable vaxxed versus unvaxxed studies. Yes, they’ve been done before. Yes, they consistently show that vaccines are safe and that vaccinated children are healthy.

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What can be learn from vending machines and casinos to stop childhood whining?

December 19, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Megan, like all parents, hates the whining and nagging:

It’s driving me crazy. My children whine and complain until they get what they want. I try not to give in, but sometimes it’s just impossible. What can I do?

(That’s an excerpt from a much longer message. You get the idea.)

Let’s look at whining from a classic behavioral approach. Stay with me, here – behavioral theory is a big part of why we do the things we do, children and adults alike. It’s worth understanding.

What we’re talking about here is called “operant conditioning.” Basically, whether people continue to do something depends on the consequences. If complimenting your spouse gets you a friendly smile or peck on the cheek, you’ll keep doing it (assuming you like smiles and kisses.) If your child’s whining means she gets what she wants, she’ll keep doing that, too. A related term is “positive reinforcement” – that’s a reward or benefit that comes after a behavior. Positive reinforcements (giving a child exactly what she wants) make it more likely that the behavior (whining) will happen again.

So: step one of dealing with whining (or many other undesirable behaviors) is to remove the positive reinforcement. But there’s a twist, here – it turns out that the schedule of the positive reinforcers can change how well it works. This might not be intuitive, but it turns out that regular, always-given, predictable positive reinforcements are not as lasting or powerful as irregular, unpredictable, changing positive reinforcers.

Think about vending machines and casinos. With a vending machine, you always get exactly what you ordered (assuming the stupid thing isn’t broken – there’s an interesting behavioral lesson about that situation, too, but we’ll save that for another time.) People who get things from vending machines are positively reinforced, but they don’t typically crave vending machines. And: when the positive reinforcement ends (say, for 1 or 2 times you don’t get your bag of Funyuns), you’ll quickly stop using the vending machine.

But at a casino, you don’t know what your reward will be, or even if you’ll get one. In fact, most of the time, you get nothing at all. But that kind of reinforcement, the “sometimes-surprise” schedule, reinforces the behavior even more effectively. Think about people pumping money into slot machines, only to get occasional, unpredictable rewards.

Let’s come back to whining. If you reinforce the whining sometimes, or in an unpredictable way (“Here! Just have the whole bag of lollopops!”), you’ll unintentionally be encouraging the behavior even more than if you always said “yes.” If Megan is serious about stopping the whining, she has to stop reinforcing it, and shouldn’t give in. Ever.

What about punishment to stop whining? A punishment is an action you take after the behavior, a consequence that’s designed to stop the behavior. It turns out that behavioral studies in animals, children, and adults show that punishment is typically only temporarily effective. Yelling at your child for whining, or restricting privileges, or some other punishment – none of these will work well. That’s like the vending machine giving you a bag of stale chips. You’ll be mad, and might avoid the vending machine for a few days, but you’ll be back. Or, imagine, if a casino sometimes just took your money away from you. That’s a valid punishment, but it doesn’t really change a behavior as well as completely stopping the positive reinforcements (in a casino, the occasional big payouts.) If the punishment of losing money at casinos actually worked, they’d all be out of business.

Sometimes, there’s more to whining than just behavior and consequences. I’d consider the child’s development and communication skills, and overall parenting style, expectations, mental health, resource scarcity — lots of things beyond behavioral theory. But a straight-up behavioral approach is sometimes the simplest, best way to get children to stop with the whining. And if it works, Megan owes me a trip to Vegas. Or at least a bag of Funyuns.

Red wine pouring into wine glass, close-up

Red wine pouring into wine glass, close-up

Homeopathic teething pills: Still poisonous

October 4, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

In 2010, I wrote about the FDA’s recall of Hyland’s Teething Tablets. It turned out that the tiny little pills, sold to allegedly help babies with teething symptoms, had measurable and potentially toxic amounts of a poisonous plant extract, belladonna. See, they were supposed to not actually have any of that, because homeopathic products aren’t supposed to have any of anything.

One principle of homeopathy works like this: by ultra-super diluting a poison, you get a cure for the poison, or at least relief of the symptoms that the poison would have caused if you ingested it. Which, of course, you shouldn’t do (ingesting the actual poison is discouraged, until it’s ultra-super diluted and isn’t there anymore. That’s what you’re paying for.) Those Hyland’s Tablets turned out to contain the poison that wasn’t supposed to be in there. Oops.

By the way, it’s called “belladonna” from the Italian roots for “beautiful woman”. Belladonna comes from the nightshade plant, and this “natural” chemical will make your pupils dilate (that’s the beautiful part.) It can also cause excessive sleepiness, muscle weakness, difficulty breathing, agitation, and seizures. Those parts are less beautiful.

Last week, on September 30, the FDA updated their 2010 release, warning consumers against using any homeopathic teething tablets or gels. This includes not just Hyland’s products, but those sold at CVS and other retail and online stores.

The bottom line: if they’re manufactured correctly, homeopathic products don’t contain any active ingredients at all. There is nothing in there that could possibly help with teething or any other condition. Oh, sure, there may be other things added to homeopathic products to make you drunk, but that’s not the point. Homeopathic products should be as safe as drinking a little water or swallowing a tiny little sugar pill—because that’s exactly what they’re supposed to be, a little vial of water or a tiny little placebo pill.

That’s if they’re made the way they’re supposed to be made. But homeopathic products, like all of the other alt-med goodies sold next to the real medications, aren’t regulated. There’s no guarantee of purity, and no guarantee that what’s on the label is on the bottle. You’re paying for what you hope is a bottle of literally nothing, but you might accidentally get something that can hurt you.

Funny world, isn’t it? Can you imagine someone complaining to the manufacturer that their placebo was contaminated with a biologically active substance that might actually have an effect on their body? Hey, I paid good money for absolutely nothing, and that’s exactly what I wanted!

Anyway: if your baby seems to be having teething symptoms, try hugs and love or a dose or two of acetaminophen. If that doesn’t help, go see your doctor (it may not be teething at all—those little babies can’t talk yet, and it’s hard to know exactly what’s on their minds. Maybe they got a glimpse of that presidential debate, and they’re understandably worried about the future.) “Homeopathic Teething Tablets” certainly aren’t going to help, and might just make your baby sick.

belladonna

Children aren’t professional athletes

September 19, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Daniel K. wrote in a one-line topic suggestion: “The professionalization of Youth Sports and stress level in children”. It’s a big problem – younger and younger children are being expected to behave like professional athletes. They specialize in one sport, train almost as much as a full-time job, and are often expected to “tough it out”, or play through pain. Not only is this bad for kids’ bodies and minds, but it’s bad for their athletic futures. If you want your child to be a star athlete, early specialization and professionalization are not good ideas.

Gone are the days of pick-up games and Ultimate Frisbee on the street. Children and adolescents now play organized sports coached by parents, or sometimes professionals, who may or may not know what they’re doing, and may or may not have the same goals as their players. Kids, overall, want to have fun and compete and play. Coaches want to see their players shine and win. There’s increased pressure to play “for real” in a single-sport, sometimes year-round, and sometimes on multiple teams. That increases the risk of injuries (both serious and minor), and burnout. A kid who gets sick of playing is going to quit – as do 70% of children playing organized sports, by the time they’re 13.

The cold statistics: only 3-10% of high school athletes play at a college level; only 1% receive an athletic scholarship. About .03-.5% of high school athletes make it to the pros. The vast majority of youth sports are played by people who are in it to have fun, stay in shape, and work off stress.

Let’s say your child really does want to take it to the next level. What’s the best way to increase that slim chance of becoming a big-name athlete? It turns out that early specialization is exactly the wrong thing to do. Athletes competing in a wide variety of sports have fewer injuries and continue to play longer than those that specialize early, especially before puberty.

What about that “rule” you may have heard, that athletes need 10,000 hours in their sport to really get good at it? That’s a myth. The number was extrapolated from studies of chess players, and has no empiric evidence in any sport. Many excellent professional athletes start their main sport late, even in college; and most young people who play far more than 10,000 hours of a single sport don’t end up playing for college or the pros. By playing in a variety of sports, young athletes learn the basics of body movement, tracking, reflexes, and teamwork – all skills that can easily transfer to any specific sport, later.

Certain sports do seem to require early specialization for elite competition, probably because the nature of the competition favors bodies that aren’t mature. Figure skating, gymnastics, and diving have long favored young competitors. Still, that’s not necessarily a good thing – female competitors, especially, in these sports are at high risk of overuse injuries and the “female athlete triad” of bone loss, unhealthy energy metabolism, and delayed or absent menstruation. I’ve also been seeing an increasing number of young men with, essentially, eating disorders and related health problems related to similar sports situations.

Youth, as they say, is wasted on the young – but that doesn’t mean we ought to take it away from them. Let your kids be kids, and let them run and play and make up their own games. If they’d like to try organized sports, sign them up for a different sport each season, with a few months of breaks here and there. Later, if they want to, they can specialize and take it up a notch. Children shouldn’t be treated like professional athletes.

Tara Lipinski

USA’s Tara Lipinski performs her routine during the ladies free skating long program at the White Ring Arena on Friday, Feb. 20, 1998, in Nagano, Japan. (AP Photo/Doug Mills)

Is burping really necessary? Grandma versus science!

August 22, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Ann wrote in: “My baby doesn’t burp easily – sometimes she doesn’t burp at all. Trying to make her burp makes her upset. Do babies really need to be burped after nursing?”

A fair question. Generations of parents have been burping their babies, and it seems like something we probably ought to do. I mean, it’s uncomfortable to have un-burped gas in your belly, right? And gas there probably causes fussiness, and maybe makes babies spit up, right? Not only does it make sense, but that’s what Grandma has been saying. Could Grandma possibly be wrong?

Let’s see what science says. There was a study of this exact question, published in 2014 in the journal Child: Care, Health and Development. A group including nursing and pediatric specialists from Chandigarh, India took on the Grandmas in their publication, “A randomized controlled trial of burping for the prevention of colic and regurgitation in healthy infants.” Their conclusion: “burping did not significantly lower colic events and there was significant increase in regurgitation episodes.” Yikes!

It was a simple study design, the kind I like best. 71 babies were randomly placed into two groups: an “intervention” group, where moms were taught burping techniques and told to burp their babies after meals; and a “control” group, where mom were taught other things about parenting, but were not taught about burping. The babies were all otherwise healthy, ordinary term infants, enrolled shortly after birth. They were followed for three months, with the families recording crying times and the number of spit-ups (regurgitation.)

The results: the amount of crying in each group was about the same. Burping did not prevent “colic”, or excessive crying. When comparing the episodes of spit-up, the “burping” group had approximately twice as many spit up episodes as the non-burped babies. So: burping had no effect on crying, and actually made spitting worse.

There are some important limitations. The study was done in India, and the conclusions might not be the same in babies from other parts of the world. Also, the intervention wasn’t “blinded” – for practical reasons, the parents knew if their babies were in the burping group. Still, the conclusions were statistically strong, and I think they’re probably correct.

Will this convince anyone to stop burping babies? Probably not. But I would say, for Ann, if burping makes your baby upset, there’s no reason to keep doing it. For the rest of you: you’ll have to settle this with Grandma, yourselves. I’m not getting in the middle of it!

Ogre belches are the worst

Thumb sucking in perspective: Not a thing to worry about

May 16, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Alana wrote in:

You’ve become my go-to guy for no-nonsense, ‘you seriously don’t need to worry about this’ advice, so I was hoping to get your take on thumb sucking. My 3 year old daughter still sucks her thumb often, and we were stopped the other day by a man who works as a pharmacist suggesting that I try a bitter nail polish to keep her from sucking her thumb. I do notice that her teeth are starting to be slightly affected by the thumb sucking, but she clearly uses it as a self-soothing measure (when she is sad or tired), so I’d never thought to discourage it (don’t kids grow out of that stuff eventually?).

What’s your perspective on this? Should I be intervening on her thumb sucking and telling her to stop? She’ll start kindergarten in the fall, so I’m not sure if that should also be a consideration?

I don’t think you can or should do much about the thumb sucking at this age. Let me give you reasons, both philosophical and practical, why it’s better to just leave her alone.

First: some philosophy. As Alana said, thumb sucking is a self-soothing measure. It helps young children like her daughter relax, and it’s often part of their go-to-sleep ritual. Does it sound right to take away a child’s way of settling down?  Many adults smoke and drink and do all kinds of worse or dangerous things “to relax”. At least thumb sucking doesn’t make the air stink, and no one is being hurt by second hand thumb, and thumb suckers don’t kill people in automobile accidents. Those electric Barbie jeeps just don’t go that fast.

Sometimes I wonder what would happen if more adults just sucked their thumbs, or used pacifiers. Maybe the world would be a better place.

Besides the goofy philosophical perspective, I’ve got another reason to leave Alana’s daughter alone. There’s very little mom can do that will actually help extinguish Alana’s habit. Sure, you can tell her not to, or even pull her hand out of her mouth—but as soon as you leave her in her room or turn your back, it will pop back in. And anxiety about mom being angry over the habit will almost certainly cause more worry and thumb sucking.

What about the thumb sucking hurting her bite, or changing the way her teeth grow in? How much the habit affects her teeth and mouth depends on many factors, like how much and how hard she sucks, and whether she’s really pushing her teeth or just letting her thumb sit there. Either way, her dentist will be able to warn mom well before anything close to permanent damage is done. And almost everyone is going end up in braces, anyway. It’s all fixable, and it’s just not something to think of as a huge deal.

When Alana is older (typically age 4 to 6), she might be able to start thinking about thumb sucking a different way – as something that might put germs in her mouth, and make her teeth grow funny, and something other children don’t do anymore. By then, she herself might decide she wants to stop– and many children just do stop, all on their own. If needed, things like reminders, or icky-nail-polish, or positive rewards for stopping might be able to help her quit. There are also clever sort-of gloves that can serve as reminders, or even a rake-looking thing that can be wired into the mouth. But until a child really decides for herself, it’s unlikely that there’s anything mom can do to force the issue. And that’s OK.

Linus