There was an interesting article recently in the Wall Street Journal discussing this very question (thank you to my patient JW for pointing me towards it!).  In an excerpt from her upcoming book, this British mother living in France addresses some differences she has noted in the parenting of French children.  The thoughts are very interesting, as all of us can admit seeing children in restaurants or museums who are poorly behaved and have no regard for their parents authority.


Among the highlights of her thoughts:
- she feels French parents are much better at discipline, and that they do so not through physical means, but with stern words that say to their children that they mean business

- she thinks that French children eat only at mealtime, which creates better structure and more patience
- she notes that when parents buy treats for their children in France, they must wait until later to eat the treat, and this teaches them both patience and delayed gratification (she implies everything in America is immediate with children these days)
- she notes that French children are encouraged to learn to play by themselves from a young age, and so are better able to occupy themselves and less in need of constant attention or stimulation from parents or other children or adults

As many of us know, there has been a significant increase in asthma, allergies, and eczema over the past 30 years.  There have been many theories postulated to explain this rise, but none that have been definitively proven.  Now, another theory is making the rounds, and this one blames Tylenol; this theory has gotten alot of attention recently, including pieces in the New York Times, Fox News, and CNN to name a few.  In short, many years ago, we became aware of the dangers of Aspirin in children, as it can cause Reye's syndrome, which is a potentially lethal liver disease.  As a result, many families stopped using Aspirin and switched over to Acetaminophen (most commonly Tylenol).  It is around that time that the increased asthma and allergy rates began...

So what are the details?  What further data exsists?  What should we do now?  Needless to say, there are no definite answers at this time.  Some experts feel this theory may be correct, and are recommending that kids with a personal history of asthma or a family history of asthma should avoid all Acetaminophen products including Tylenol.  Other experts feel the data is not convincing, and are holding off on making recommendations until more information is available.  At the very least, its an interesting idea and worth thinking about if asthma runs in your family.

For more information, please see the following links:
- New York Times story
- Fox News story and video

Another topic that has received lots of attention recently is cyberbullying.  It is an issue that affects many children in this day and age, though it is something that parents are often not fully aware of.  Below are some nice videos detailing bullying-related issues:

• Think Time, How Does Cyberbullying Affect You? (2:20)
  
• Words Hurt (0:31)
  
• The Price of Silence (Anti-Bullying PSA) (1:59)
  
• Once Posted, You Lose It (1:39)
  

Recently, there has been lots of media attention given to concussions.  This is a good thing, because we are seeing more of them occur in kids every year, as kids play more organized sports and are more active than ever before.  Fortunately, with all this attention, we are gaining a better understanding of what concussions are and what should be done for a child or teenager who has a concussion.  For example, in the past, athletes with concussions who felt better in 15-20 minutes were allowed to return to the game that day; now, we know this is unsafe, and any athlete with a concussion MUST be held out of the game in which they are playing.

With all this attention has come new legislation.  There is a new Illinois law mandating that school boards and the IHSA work together to better education schools, teams, and coaches on concussions and how to manage them.  The following is actually part of the new legislation: “In cases when an athlete is not cleared to return to play the same day as he/she is removed from a contest following a possible head injury (i.e., concussion), the athlete shall not return to play or practice until the athlete is evaluated by and receives written clearance from a licensed health care provider to return to play.”

Any athlete with a concussion must be evaluated by a health care provider.  This will help determine any treatments that might be needed as well as establish a plan for return to athletic activity.  Here are some resources for more information, from Children's Memorial Hospital and from the CDC.

Although summer itself is not over, the summer relief for allergy sufferers seems to have ended.  This week, allergy levels have been on the rise, and this weekend, they are at a sky high level.  What does this mean??  Its time to go back on your allergy meds, and if you have asthma triggered by allergies, its likely time to start back on those meds as well.  Whatever it is that your family uses, whether its oral anti-histamines (Claritin, Zyrtec, Allegra, Benadryl), nasal steroids (Nasonex, Nasacort, Rhinocort, Flonase, Omnaris, Veramyst), nasal anti-histamines (Asteiln, Patanase), oral anti-leukotrienes (Singulair), steroid inhalers (Flovent, Pulmicort, Advair, QVar, Asmanex, Dulera), nebulizers, or others, its probably time to get back on those meds.

Pollen levels are useful to track in order to know when symptoms are coming and when they may be going.  It allows us to PREVENT symptoms in patiens we know will have them, rather than just TREAT them when they occur.  This is the key to starting meds early.  Pollen levels can be seen locally on several websites; one of the easiest is on pollen.com.

Everybody knows about the importance of sunscreen.  It protects the skin from sunburns, reduces the formation of freckles and sunspots, and significantly reduces the risk of skin cancer in the later years.  However, there are so many sunscreens out there these days, it may be hard to know which ones to use.  Here are some tips about sunscreen use for the summer:

1. Remember to re-apply frequently.  This is perhaps the most often overlooked sunscreen rule.  Many parents are great about remembering the first layer, but for an all-day sun adventure, please remember to apply a second and even third time if staying in the sun for long periods of time!  Most dermatologists recommend re-applying every 3-4 hours, and after playing in the water.
   
2. Contrary to popular belief, sunscreen IS ok for infants under 6 months of age.  The safest method of sun protection is wearing hats and keeping them in the shade, but sunscreens are the next best thing.  A physical-based blocker, such as Zinc Oxide or Titanium Dioxide, is recommended, and select one that is fragrance free and hypoallergenic for your infant.   Some good options include Neutrogena Sensitive Skin SPF 30, Neutrogena Pure and Free SPF 60, and Vanicream Sunscreen for Sensitive Skin SPF 30 or 60.
3. The higher the SPF, the better.  At least SPF 30 is always recommended.
4. Protection against both UVA and UVB light is best (ultraviolet A and ultraviolet B rays).
   
5. Avoid buying sticks and sprays for the best results.  Sprays certainly are convenient, and of course are better than nothing, but typically are less effective than creams or lotions.
6. Make sunblock part of the daily routine for sun-exposed areas and use it on the face year-round.  If you start young, it will become a habit and less of a struggle.  
7. Do not rub sunblock in, as this is really rubbing it off.  Put on a thicker layer, let the little one run around for 5 minutes, and then rub in whatever is left visible on the skin. 

Enjoy the summer and enjoy the sun, but be smart about it!  And if you have any questions at all, call

The AAP has recently changed their recommendations for infant and toddler car seat use.  Previously, the recommendation stated that infants should be in a rear-facing car seat until age 1 year old.  At that time, it was advised to turn them around so they are forward facing.
After reviewing both European and American data on deaths, head injuries, and limb injuries, car safety seat (CSS) recommendations have been updated. 

• Children are now recommended to remain rear-facing in their CSS until age 2 (or until they exceed the weight/ height limits for their particular CSS). 
  
• Children age 2 or older who have outgrown their rear-facing CSS (by exceeding the weight or height limit of that particular seat) should remain in a forward-facing CSS with a harness for as long as possible (until they outgrown the limits of that seat).
• Children whose weight or height exceed the forward-facing limit for the CSS should use a belt-positioned booster seat until the lap-and-shoulder seat belt fits properly, typically at a height of 4'9" tall (and over 8 years old).
• Children under age 13 years are recommended to ride in the rear of the vehicle, not in the front seat, regardless of size.

Some interesting facts to remember in support of these recommendations include the following:

• Children under age 2 are 75% safer facing backwards than forwards.
• Children between 12 and 24 months old are 5 times less likely to die or be seriously injured if they are rear facing during a collision.
• Only 1 in 1000 children who are rear facing will suffer a lower extremity injury during a crash, while that rate is exponentially higher for forward facing toddlers.

Some of this information was taken from aapnews.org, and more can be seen about this topic on that site.

Families these days are not drinking nearly as much milk as they used to.  More and more individuals are lactose sensitive, dairy allergic, or vegan.  And there are many more options of beverages these days than ever before.  As a results of all of this, many children nationally may not be getting enough calcium.  In general we recommend getting your child 3 solid servings per day of dairy, which is the most common calcium source in our diets.  The IOM has issued new guidelines, telling us exactly how much calcium is recommended for each age.  Here are their recommendations:
    Ages 1-3: 700 milligrams per day of calcium.
    Ages 4-8: 1,000 mg.
    Ages 9-18: 1,300 mg.
    Ages 19-70: 1,000 mg - but for women the amount rises to 1,200 mg at age 51.

For more information on this, please check here.

Over the past several years, more families have turned to Minute Clinics for medical care for their children.  Often, this is for things that appear simple to treat, such as sore throat or ear pain.  Unfortunately, especially in children, these medical problems and their treatment may not be as straight forward as they appear.  At Elm Street Pediatrics, we have had an alarmingly high number of children mis-treated by these so-called Minute Clinics in the past few years.  We hope you will not allow them to continue to make these mistakes. 

Making an accurate diagnosis in a child is often challenging.  For example, a sore throat could be strep, which is what we all worry about; however, it could also be infectious mononucleosis ("mono") or a peritonsillar abscess.  Ear pain, while it could be from fluid in the ear, could also be from a sinus infection or an otitis externa ("swimmer's ear").  Several of our patients have been misdiagnosed with examples such as these when seen at local Minute Clinics in the recent past, and there are many more such reports nationwide.

Determining the correct medication to use to treat children is difficult as well.  Kids come in all shapes and sizes, and with a fairly high incidence of medication intolerances or allergies.  Thus, selecting the correct and safe medication at an appropriate dose is not easy.  To make matters worse, each particular medication may have different doses depending on the illness being treated!!  For example, the dose of Amoxicillin needed for an ear infection is higher than for treating strep throat.  However, the dose of Azithromycin needed for an ear infection is lower than for strep throat.  These subtleties are often missed by minute clinics, all too often with kids being put on the wrong medication... or the right medication but with the wrong dose.

And so.... those of us practicing pediatrics, including all of us at Elm Street Pediatrics, feel very strongly that the medical care we provide is superior to the care given at Minute Clinics.  We know your family better, including medication allergies, vaccine histories, medical histories, and more, and we are also much more experienced diagnosing and treating children's medical issues.  We strongly believe that your child will get better care at our office, and we recommend avoiding those tempting Minute Clinics and letting us treat your family.  The concept of a Medical Home is vital to our work as pediatricians, and we do our best to provide that for you.