Kids Corner with Dr. S 

 

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Welcome to my blog! I am Dr. Lauretta Stombaugh (Dr. S) and I have been part of the Hendersonville Pediatrics family for over 8 years. I have decided to share this blog because I feel that it is vital for parents and caregivers to be well-informed as well as have access to solid, accurate medical information. Your children are our children and we take pride in the excellent care we provide here at Hendersonville Pediatrics. Please join me monthly (or every two weeks if my four kids allow me time to write!) and I will in turn provide interesting, helpful and maybe even comical blogs. Please share a link to my blog! Ready, set, go!!

 

      The fluctuating emotions of parenting can be trying and wondrously ever changing. It may seem like your child tiptoed into this new phase as it sneaks up on some parents. It can be a tumultuous time for all. It’s a beautiful thing to watch our babies become toddlers then kids then tweens then teens then dare I say it? Adults! Navigating through the developmental shifts and their newfound independence is an experience we are blessed to have. That being said, it’s not always easy.  

So, how do we stay connected or “ get connected” to our teenagers?

1. Validate their feelings. This is new and scary territory for them and they need to feel supported. They will not come out and ask for your validation, but they need it now more than ever just as we all do. Even if they want to hibernate because of a pimple, sleep until 5 minutes before they leave for school or change a class because it’s boring, we should respect their feelings. This does not always entail giving in to irresponsible demands.

2. Encourage them. Just as we advise to encourage children (specifically and thoughtfully), we need to be mindful to continue this with our teens. Good self-esteem is critical and delicate at this age as they experience peer pressure, new relationships and a biological need for independence.

3.Communicate. Don’t “helicopter” but be involved and keep talking. The more you model honesty and communication, the more comfortable they will be developing those attributes. Know where they are, what they are googling, how they are performing academically and who they are choosing to socialize with, but don’t get too involved either. Here’s that “ balancing act” again as you give them space to fail and problem solve while still being aware of their struggles and strides. You can’t get there without communicating with them ( not with their friends, siblings, friend’s mothers, doctors). Converse about peer relationships, friendships and their feelings about their life’s happenings. Speak openly, directly and with open- ended questions ( rather than ask “ how was your day?”, ask “ what was a positive thing that happened today?” Or “ how was your math test?”. This invites them to share and allows you to gain some perspective. Ask the hard questions once in awhile. The ones you are hesitant about because you may not like their answers.

4. Keep things fun. Try not to get caught up in the serious, parental, disciplining role 24 hours/day. Allow yourself some space to relax, laugh and be spontaneous. Ice cream for dinner once in a long while will not kill anyone. Let down your “mom or dad voice” and converse on their level. This is not being best friends with your child, it is creating a two-way, mutually respectable, fun loving relationship.

5. Teach them. Don’t change the tire for them, teach them how to change it. Warn them about safety, awareness and good decisions, being careful not to create anxiety. After all, making good decisions requires clear thinking. When was the last time you were overly anxious about something and could make a solid, informed, well thought out decision? Teach them to schedule their own doctor appointments, show up for them and speak to the doctors during the exam. As a physician, I expect teenagers to converse with me and answer my questions. They are the only ones who know how they feel physically and emotionally. I personally speak to every teen alone at each well check up for this reason. They need to have an open forum to ask personal questions. We need to teach them in a language they understand on their level.

So many more…to be continued.

Dr. S

       

                                                                               It's All About Balance

     A cherished friend, recently shared an interesting article with me which focuses on positive attachment and its’ effect on children later in life. It discusses ways to form a positive attachment or loving bond with your children. Be mindful of their need to have close physical contact early on. Some older generations may view this as spoiling the child, lacking boundaries or the “attachment parenting” style. In some ways it parallels attachment parenting, however, in more ways it is vital for a healthy child. We know this when we look at studies on orphans who lack the physical contact, bonding experiences and attachment early on. It affects their physical growth, mental capacity and ability to learn and thrive.

     I believe that wherever you are from, whatever decisions you make in your life, whomever you choose to partner with, that there is an art to how you live. The first step is recognizing that it’s there. The next step is finding out exactly where it is in the space of your days and how it feels. How can you be in touch with it most of the time? Specifically, the art of parenthood is present the second you hold your child for the first time, whether you give birth, adopt, foster or choose to be a guardian.

      After a visit to my daughter’s friend’s house for a party, she says, “Mommy. ____’s mom told her not to tell me something, but she did tell me.” A few thousand scenarios quickly sweeped across my mind and I casually said, “Oh really? Well, you know that you can tell me anything.” And then, she calmly said, “She has lice.” Ah! The dreaded,anxiety-producing, blood -loving parasite! I reassured her that she would likely escape getting lice, this time, because I was sure that her friend was already treated. (scratch, scratch) Of course, I had to then convince myself. Here are some debunked myths about lice.

     A few weeks ago, I attended the national conference for the American Academy of Pediatrics. It was a positive experience with many “friendly pediatricians” (as we are often called) wandering the conference center drinking insane amounts of Starbucks with their cell phones encased in colorful cases. Throughout the day, I glanced out the south end of the building and watched as 20-30 people picketed against circumcision. I tried to avoid that group because I was not interested in their negative energy. Circumcision is always a source of controversy just like the vaccine debate. As pediatricians we aim to be mindful of both perspectives. It is a personal decision impacted by ethical, religious, scientific and emotional beliefs. Here is some unbiased information for you to ponder.

     The Amercian Academy of Pediatrics (AAP) policy statement published in 2012, states that “the health benefits of newborn male circumcision outweigh the risks.” then, “the procedure’s benefits justify access to this procedure for families who choose it,” and later “health benefits are not great enough to recommend routine circumcision.” Well that doesn’t make it easy to make this decision if you have a boy now does it? So, it basically says the good outweighs the bad, but there’s not enough good for the AAP to recommend circumcision. Where does that leave parents of males in the US with regard to this decision? …caught somewhere in between the social norms, religious beliefs, scientific studies and the desire to make the “right” decision for their child.

The Negatives (b/c I’d like to end this blog on a positive note)

     Male circumcision is a surgical procedure. Albiet a minor one, the risks are still real. There can be bleeding, disfigurement of the penis, infection and pain. Studies show that newborns who are circumcised have high heart rates, elevated blood pressures and high cortisol levels (stress hormones) during and following the procedure. Therefore, it is standard practice to use a local anesthetic as well as another method of pain control (lollipop for comfort? pacifier?). Excessive bleeding can occur, particularly if there is an unknown bleeding disorder, but also in normal, healthy newborns. It is usually minor and easily controlled with simple measures. Infection is always possible, but the procedure is done following strict, sterile precautions. Then there is the ethical point that the newborn cannot verbalize consent. Consider though that performing a circumcision after 1-2 months old or years later is more risky and more painful. It usually requires general anesthesia, incurs a higher cost and has a higher risk of complications. Circumcision is not usually covered by insurance unless medically indicated (rarely the case). Circumcisions can be costly (over $200). Paying cash upfront is normally required. Lastly, it is not guaranteed that a circumcision will end with the desired cosmetic effect. Some physicians remove less foreskin than others which can result in excess foreskin.

The Positives:

According to the CDC website, these are some conditions which may occur in uncircumcised males at higher rates:

• Urinary tract infection
• Penile inflammation (swelling)
• Candidiasis (yeast infection)
• Phimosis and paraphimosis (where the retracted foreskin gets stuck)
• Inferior hygiene (can result in a collection of smegma or dead skin cells)
• Sexually transmitted infections including high-risk human papillomavirus (HPV), genital herpes simplex virus (HSV), trichomoniasis, mycoplasma, syphilis, chancroid, and HIV
• Physical injuries to the foreskin, including coital injuries
• Cancers of the penis, prostate, and cervix

While some of these are rare, others can be recurrent issues for some boys/ men. A circumcision can make the above less likely. Some believe that it is easier to keep a circumcised penis clean, however, good hygiene is possible in an uncircumcised male. Regardless, care should be taken to gently pull back the foreskin when bathing. Eventually it will be easily retracted although this can take years.

So, as pediatricians, we strive to “do no harm” when caring for our patients. Unfortunately, there are some situations where we can only educate parents on the facts, debunk the myths and share our experiences. We can tell you with honesty what we would choose for our own children as far as vaccination, circumcision, medication choices, etc. We realize that these are ultimately your decisions. Just remember that trust is a vital part of any relationship. We trust our parents because they know their children better than we do. We aim for our parents to trust us and the information we provide as pediatricians.

Dr. S

- please share your topics for future blogs on our Facebook page or my twitter account (LaurettaStombaugh @hpedsdoc). This blog is for our families! I’m happy to write on any, appropriate, pediatric topics!