Posted tagged ‘anxiety’

The cost of fear

March 21, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

The image of a “mad scientist” can be hard to shake: a deranged man with crazy hair in front of a row of bubbling test tubes and antennae shimmering with a ghostly electric glow. BWAHAHA, my monster is alive!

Real science, of course, has nothing to do with any of that. But it still sparks fear, and that fear has consequences.

One of the best ways to fight Zika virus is to reduce the mosquito population. We’ve got tools – already tested, already shown to be effective and safe – to use releases of sterile mosquitos to stop breeding populations. But we’re afraid to use them.

Parents fearful of vaccines put their own children, and their communities, at risk. One example: diphtheria, eradicated in Spain for 30 years, returned and killed an unvaccinated child. At least 8 other children contracted the diphtheria bacteria, but none of those other children became ill. They had been vaccinated.

Zimbabwe, facing a horrific drought with millions of starving citizens, has announced that they’ll accept no food aid that includes genetically modified organisms. They’d rather starve than eat food that’s often more nutritious and easier to grow with fewer resources. Here’s a funny and illustrative example of how far fear goes: they’ve explicitly banned GMO chickens, despite there being no GMO chickens in Africa, or anywhere else. They don’t exist. That’s what happens when fear makes decisions. Imaginary chickens, eek!

Zika is spreading, causing brain damage and other birth defects. Vaccine-preventable diseases have come roaring back. Ways to help feed the world are rejected. What do all of these follies have in common? Fear, stupid fear, making our decisions.

“So, first of all, let me assert my firm belief that the only thing we have to fear is…fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.”

Franklin D Roosevelt, 1932

AAAAAA!!!

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Depression in the family

December 15, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

Beth posted, “As someone who has battled clinical depression since childhood, and whose husband has many of the same issues, I’m very curious about the risks my children face in this area. How much more likely are they to suffer from depression?”

Depression, as well as other mental illnesses, do run in families. The population risk of major depression—that is, the risk that someone will have depression at least once during their life—is probably about 5-10%. Add in the risk of an anxiety disorder, and you’ve probably got a lifetime risk in the 10-15% range. With one parent with problems with anxiety or depression, the risk for their children is about doubled, to 20-30%; with both parents, it’s somewhat higher than that (I couldn’t find an exact number.) So you’re right to be concerned about the risk in your kids.

We do know that there is more than genetics at work, though. Depression and anxiety are also influenced by environmental factors, including early childhood trauma, and exposure to parents and other loved ones with mental illness. If you and your husband are being successfully treated for depression,  it should reduce your own children’s risk—because they’re being raised by parents without symptoms (or with reduced symptoms) of mental illness.

The diagnosis of depression and anxiety disorders in children may be more difficult because kids do not necessarily have the same symptoms. While adults have anhedonia (lack of joy), children will more typically have irritability or chronic unexplained pain, trouble sleeping, or trouble with peers and in school.

If you’re worried about symptoms of mental illness in your kids, please bring them to your pediatrician. Be open about your own history of these problems. That can help the doctor come up with the best diagnosis. Though your kids are at elevated risk, that’s not to say that they’ll definitely—or even probably—have problems like these.

Secrets of the impossible exam

September 16, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

From Linda: “A question I’ve had for years….how can you hear the heart or lung sounds when the child is crying? Thanks!”

I’m pretty good, at least most of the time—but sometimes my Jedi Mind Tricks fail, and Junior gets worked up. I’ll keep trying for a little while, maybe pop in a pacifier if he’s younger, or make funny faces, or count toes. But once a kiddo is really squalling, you just have to plunge ahead and get what you can get.

So can a pediatrician really hear lung and heart sounds in a crying child?

No, not really. I can usually tell the that heart is actually beating (note: I already knew that, having observed that the child is moving and upright and quite clearly alive), and I can tell that air is moving in and out of the lungs (again, we all already knew that, even the nurses in the hallway and the family next door). Maybe I could discern that the breath sounds are more-or-less symmetric from side to side, and maybe I could even tell that the heart beat is regular. But really, once there’s a lot of yelling the stethoscope is more decorative than functional.

I’ll tell you something else: getting a good ear look is nearly impossible once Junior’s over the edge. You can hold ‘em down, but without general anesthesia squirming is inevitable. And those eardrums turn quite pink from the yelling, so it’s easy to “over-call” an infection that really isn’t there. Using a little bulb to blow air into the ear canal can help, but with the kicking and yelling (especially in a toddler) it’s hard to get a good stable look. Besides, the most-upset kids also tend to be the kids with the most earwax, and the hardest kids to scrape out cleanly and painlessly.

The best way to avoid this problem is to bring Junior to all of the ordinary scheduled well checks. That way he stays used to the routine, and hopefully recognizes me. It also gives me a chance to repeat the exam over and over, so hopefully at least sometimes I’ll get a decent look and listen.

Some kids have a more-anxious personality than others. That doesn’t mean that mom or dad has done anything wrong. But there are some things that parents can do that might make it more likely to get through a visit without tears:

  • Be calm and confident. Say “The doctor’s going to look in your ears now.”
  • Don’t apologize or fret. Don’t say “Oooo baby I’m so sorry.”
  • Don’t wave toys frantically in her face. That ratchets up the worry.
  • Do bring a few favorite lovies to hold (for your child to hold, I mean. Not you.)
  • Avoid using the worst word ever said at the doctor’s office: “Hurt.” Do NOT say “this isn’t going to hurt,” because all your child hears is “HURT HURT HURT HURT.” Trust me on this. Don’t say it.
  • Don’t remind the child that she doesn’t like the physical exam. I already know that. As soon as you say, “She doesn’t like it when people look at her ears,” she’ll get teary and upset.
  • If things are getting tense, ask the doc “How can I help?”

It’s not all up to the parents, of course. The doc needs to turn on the calming mojo:

  • Take things slow. Don’t rush.
  • Don’t jump to the “most invasive” parts of the exam first. Counting toes is rarely offensive to babies, and it does help confirm that there are in fact 5 or so toes on each foot.
  • Don’t immediately try to hold down the child—give her a chance to hold still herself.
  • Let Junior look in your ears first. Then in mom’s ears. Then in her stuffed bunny’s ears. Then let the stuffed bunny count her toes (in kids older than 3 or 4, there can be six or seven toes on each foot. Cracks ‘em up.) Then the bunny can look in her ears. Etc.

For long term issues—the toddler who always freaks at the doctor’s—a few other tricks can help. Get a doctor kit to practice with at home (if you’re really ambitious, get a chrome-plated kit that looks like my toys instead of the plastic ones.) Stop by the doctor’s waiting room every once in a while to say hello (bring beignets!). Read books like Elmo’s appendix and Spongebob goes to the endodontist, or watch the video hit “Why do they have The Wiggles? A trip to the neurologist”.

Not every exam is going to go well, and even with every trick some kids will not be calmed. You can increase the odds of success, but sometimes the pediatrician will just be unable to get a great exam. Keep calm, try again, and try again next time. We’ll get through it together.

Fear not: Health risks you don’t need to worry about

March 12, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

Melissa sent me a great topic suggestion: “Dr. Roy- would you consider doing a post on worry vs. living your life? What I mean is, we live in a world with SO much information and warnings etc. that it is hard to simply enjoy life. Ever since having my son 5 months ago, I’ve been hyper-aware of all of the ‘warnings’ that exist. Sometimes I become so bogged down in worrying about germs, water quality (the list goes on and on) that I waste time researching when I should really be down on the floor playing with him. Just thought it would be nice to get your perspective in creating a nice balance.”

I love this topic, and I think it would be a great subject for my next book. If I ever get around to writing it, Melissa gets a free copy!

Dispelling health worries has become a favorite topic of The Pediatric Insider blog. Health scares are a rich source of material– there’s always some new firestorm that needs a good bucket of ice water. It seems to me that the main goal of American media is to create and cultivate worry and fear. I don’t think it’s an exaggeration to say that the ill-effects of this fear itself—the worry, the heartache, the handwringing paralysis caused by the near-constant deluge of bad news—has been far more harmful than the cumulative effect of all of unsafe exposures.

We are living in the healthiest, safest era of human existence. Never have we had more food, or safer food; never have our lives been longer or healthier. Never have our children been safer or healthier. We have far more free time than ever before. So much free time, it seems, that one of our favorite hobbies has become imagining sources of worry for each other.

The only thing we have to fear is fear itself. – Franklin D. Roosevelt.

I blame our addiction to new anxieties on two fundamental forces. One is our own evolved brain. We developed during a time when fears were real, and anxiety saved lives. Food was always in short supply—for most of human history, people spent most of their time hunting, cultivating, storing, and protecting their food (ref: Little House on the Prairie, L. I. Wilder.) Most children did not live to adulthood. Food and water supplies were a common source of death and disease; ordinary mosquitoes killed millions by spreading malaria and other diseases; illness from malnutrition was normal. Ordinary injuries frequently resulted in death from untreatable infections. Polio paralyzed, pertussis and diphtheria made it impossible to breathe. What’s known as ordinary strep throat nowadays was once deadly scarlet fever. Fearfulness was normal, and useful, and helped keep your family safe. Our brains are wired to rely on distrust and anxiety to protect ourselves—but that wiring, in today’s developed world, is causing far more harm than good.

(Note: I’m talking here about life in The United States and the rest of the developed world. There are plenty of places where food scarcity, disease, and crushing poverty are rampant. Be thankful you don’t live there.)

There’s another odious, seemingly inescapable force that’s turning us into worry-warts. The 24-hours news cycle has to be fed, and demands a constant flow of new, eye-catching stories. Every freakish problem is blared into our ears and eyeballs, and every concern is exaggerated into a killer crisis. The worst of all is the local news, with their ridiculous, out of context teasers—“Death in the school lunchroom, what you need to know now!”, or “The Killer On the Playground!” There’s no time for context, and certainly no time for careful, reasoned journalism or follow-up. The media wants your clicks and your eyeballs and your TIVO. They seem to have no interest in genuine teaching or giving you useful information to stay healthy.

Back to Melissa’s opening question: how to you sift through a relentless barrage of scary health news from the media and internet without driving yourself insane with worry? First, keep in mind that the sky is not falling. It is not all bad news; in fact, our children are genuinely healthy and thriving in today’s world. Recognize that the most attention goes to the loudmouths, troublemakers, and malcontents rather than those of us who are calmly trying to raise our families and live our lives. Don’t put too much stock on any “new” science information until it’s been verified independently, by genuine scientists and doctors in the field rather than fly-by-night websites that are selling things and pushing an agenda. Realize that fearfulness itself carries a price, and that you and your child will be healthier (and happier) playing together instead of worrying together.

I’ll be revisiting this topic with more examples in the months to come. For now, relax and enjoy a list of topics I’ve already covered. Call it “The Pediatric Insider’s list of stuff not to worry about”:

Imaginary fears about vaccines

Cell phones

Fever

Caramel Coloring

Soy protein

Recalled fever medicines

Non Organic food

Plasticizers

Early puberty in girls

Minor bonks on the head

Reducing the pain and anxiety of immunizations

April 9, 2008

From DMM, on the Topics Suggestions page: “Any ideas for a kid scared of immunizations. I have a 5 year old who needs his kindergarten shots before August. He has anxiety issues.. He is now able to go to the Pediatrician and trusts her, but he knows that he will need to get some shots before school. Some of his friends have gotten them, and just the mention of them sends my son into meltdown/anxiety attack mode.
Any ideas on how to make this a doable situation for us all?”

I agree that the pre-kindergarten visit can be rough on the kids. The good news is that we can protect our children and their classmates from serious infections. The bad news is for the child himself: that’s 3 or 4 booster shots. Though many kids take this in stride, it can be a scary experience for many children.

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