Filed under: Parenting
I just saw a blitz of headlines about a new study indicating an ‘optimal’ amount of sleep for teenagers. The study (see here) indicates that less sleep, down to about 7 hours, is better than more sleep. At least, that’s the take away headline in the popular press articles but I see it as an example of data taken out of context.
If you read the article, the data is self reported and correlated with test scores to determine the most successful students. This reveals the most successful students only slept seven hours compared to longer sleep duration for less well performing teens.
The actual article fairly points out some limitations: the experimenters can not state a causal relationship between seven hours of sleep and good test scores. Young adults with more drive, perhaps, study more and sleep less leading to better scores. The authors further point out that ‘our estimates do not account for overall health and well-being,’ just test performance. What they are making clear is that high scoring students may sleep less but this isn’t necessarily healthy.
I don’t think this study in any way refutes the idea that our kids really aren’t sleeping enough, despite what the headlines today might indicate. Is lack of motivation or laziness bad for teens? Sure. Is sleep bad for them? No way.
Take the headline that lead me to this study as an example: “Study: teens perform best with less sleep.”
The inference is that sleeping less aids performance and that conclusion is not supported at all by this study. I wish journalists were held to a higher standard!
I also hope parents don’t get the wrong idea.
February 23, 2012
Is spanking ever justified?
Many current experts wonder why it isn’t illegal when study after study links spanking and corporal punishment in general with bad outcomes, notably aggressive tendencies later in life and even lower IQ. A recent article in the popular press relating to a Canadian study on spanking is illustrative of all of the negative impacts of spanking (news article). The AAP has long disapproved of spanking (AAP Policy Statement).
Despite all the negative data, there is still a great debate on the subject of spanking and I think that’s because it touches a certain American nerve. The idea being that no one has the right to come into your home and tell you how to raise your own children.
When I see a parent lash out at a child, either verbally or physically, what I see is a person who has lost composure and given in to anger and irritation. The spanking is no different from yelling or taunting, or bribing, or any other sign of an irritated adult who has lost control of the situation.
Some people argue that there is ‘good’ spanking and ‘bad’ spanking. Good spanking is done when a child is clearly told the negative outcome of a certain action and in a controlled, non-emotional way, a spanking is administered as punishment for the transgression. Bad spanking is done impulsively under the cloud of anger. I think there is a grain of truth in this idea but, overall, I think it is missing the point. It isn’t the spanking or the lack thereof that imprints itself on the child. It is the way the parent conducts him or herself.
To raise a child properly takes focus, patience and consistency. Toddlers aren’t supposed to understand the rules. They are supposed to be wild and attempt deceit. They are supposed to throw tantrums when, one tiny revelation at a time, they begin to realize that they are not the center of the universe. This is how we start out: little selfish animals.
All children require training and example to be transformed into polite and thoughtful children. As a pediatrician, every day I see the results of overindulged and poorly disciplined children who literally walk all over their parents. We expect toddlers to test the limits of their environment and we expect them to try hitting and biting and screaming. It is how we react to these things which determines whether or not children are still doing them as they leave toddlerhood behind.
A child can be taught to ape good graces out of fear. Corporal punishment and physical fear can create superficially well behaved children. A child learns not to grab or hit or throw a tantrum in order to avoid being hit afterwards. In the best of circumstances, parents who spank are not doing it out of anger, are careful to set a consistent example and are also teaching the child why what they did was wrong. The irony here is that all of those things alone would have been enough without the spanking. An alternate symbolic gesture of punishment and parental authority would work just as well. It is the emotional disapproval, the way the parent conveys that the action was wrong, that really counts.
As much as I don’t agree with it, I don’t think spanking should be illegal. A certain amount of physical restraint and sternness is warranted for some very rambunctious children. While children should not be raised in fear, they should have respect for parental authority. I don’t think parents should be afraid to be stern with or restrain an unruly child. By hyper-focusing on whether or not a controlled spank is ever warranted, I think we are really missing the point. I would wager all of these studies show bad outcomes from spanking because of an overall environment of bad parenting. If you simply made spanking illegal, it would not make people magically become better parents. It would not force them to show more self control or be more consistent with their children.
What creates a truly well behaved and thoughtful child is a thoughtful and well behaved adult. The consistent example of good behavior and control by a caregiver is the best discipline for a child and it is also the most challenging thing for a parent to do.
February 9, 2012
Is sleeping with an infant in bed with you healthy and nurturing or is it as dangerous as this ad campaign in Milwaukee makes it out to be? Am I as dangerous as a meat cleaver as I lie, snoring and grinding my teeth, next to a baby? Certainly the cleaver is a quieter companion.
A few days ago I offered some links and advice on the new Academy of Pediatrics Guidelines on SIDS. Within the guidelines is the suggestion to sleep with baby in the same room but not in the same bed. I honestly did not register anything wrong with this statement: clearly part of the safe sleeping environment is to keep the baby on a firm mattress free of objects that may cause suffocation, and one of those objects is me.
Yesterday, I noticed all the hubbub on the web over these adds being displayed in Milwaukee to teach parents not to co-sleep. It’s a firestorm…I’ve never seen so many parents so mad!
Many are pointing to Dr. Sears who describes his own personal use of co-sleeping and the evidence from around the world that co-sleeping is safe and healthy. Many parents feel, intuitively, that co-sleeping is the right and the natural way for a baby to sleep. La Leche League, the prominent breast feeding advocacy group supports co-sleeping as part of the breastfeeding algorithm (See their page on maximizing the safety of co-sleeping). Unfortunately, I have mixed feelings on the subject.
I see the convenience of it for a breastfeeding mother. I agree that it ‘feels’ natural and is used around the world in other cultures. If you examine the evidence against co-sleeping, you see that some studies only found statistical significance between death and bed sharing when mom was a smoker (some found it independent of smoking). I certainly agree with the idea that there may be some instances when co-sleeping can be done safely.
For the majority of families and in the vast majority of cases, I think the AAP has the right idea: discourage co-sleeping. It’s a little bit like the recommendation not to stick Q-tips in your ears: while some people might be careful, it’s a far better policy across the board to just tell everyone not to stick anything in their ears. Period. It prevents a lot of bad outcomes and I think that is the idea here.
Our daughter was breastfed and did not sleep in our bed. We considered the AAP’s position the right one but it wasn’t a hard decision for us. There were enough nights when my wife woke up pinned under the weight of one of my limbs, struggling for breath herself. We had no intention of bringing an infant into a dangerous situation like that.
November 16, 2011
The ‘back to sleep’ campaign is now just about 20 years old and there has been a significant reduction in sudden infant deaths.
The AAP has released a new policy statement this month outlining a broader approach to infant sleep. Similar to the push for ‘medical homes’ this information is somewhat common sense but tries to bring a little bit more together for a broader picture: it isn’t just about putting a baby to sleep on her back but is about the whole environment. Is anyone smoking around the baby? Are there any loose blankets or wedges close to the baby while sleeping? Is the baby fully immunized?
Here’s a link to what we already know are risk factors: SIDS on our website.
Here is a summary quote of what the AAP wants parents to think about: “The recommendations described in this policy statement include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs.”
In summary, the baby should sleep on her back on a firm surface, free of encumbrances like pillows, blankets, crib bumpers, etc. Parents should not be smoking or using drugs. Breastfeeding is best. Keep an infant fully immunized. Do not overheat or over-bundle a baby. Consider having the baby in the room with you but not in the bed and consider using a pacifier.
Here is a nice table the AAP included in their release: Table 1.
I personally do not think you need to add a pacifier if you have been raising baby without one. The evidence here is real and there is certainly nothing wrong with it. Another common question is that of the baby rolling over on her own. The recommendation is to put the baby back to sleep until one year but you and I both know most babies turn over to side or even tummy long before this. There is no recommendation to pin or wedge them down! If they turn, they turn. The important thing is to keep the sleeping surface firm and unencumbered so there is nothing loose for them to turn into and create a suffocation risk.
November 11, 2011
I suppose it was inevitable.
For the first time in ten years, the AAP has updated the diagnostic criteria for ADHD, expanding the window of diagnosis in children down to 4 years old and up to 18 years. This effectively covers everyone in the pediatric setting out of diapers. It also gives wiggle room for diagnosing those four and five year old children who are having behavioral problems and not sitting still in preschool and kindergarten.
The new guidelines stress that pediatricians should recognize ADHD as a ‘chronic condition.’ Management of these children should follow the ‘chronic care model’ as outlined in the new medical home terminology. The new guidelines recommend behavioral therapy for these younger children but leave the door open for medical treatment. It also stresses the importance of looking for co-morbid conditions like anxiety and depression.
Currently, over 7 billion dollars is spent annually in our country on medications for ADHD and that number increases by about a billion dollars per year. This upward trend will certainly continue with this expansion of diagnostic criteria.
How you react to the changes really depends on how you view ADHD. Some people recognize there is a subset of children with hyperactive behavior and/or trouble focusing and welcome any interventions that seem to help these symptoms. Other folks tend to wonder how we define ‘diseased’ vs. ‘normal’ behavior and react against the medication of a brain that is far from mature.
I see valid points in both camps but I tend to lean toward apprehension at the sheer amount of medication being prescribed. Recently it was noted that about 9% of children (mostly boys) have ADHD, up 22% from just a few years ago. In terms of boys 4-8 that I saw for school physicals this past summer, I think the concern was raised closer to 90% of the time, not 9%. That was truly shocking to me. I seriously doubt there is something organically wrong with the brains of 1/10th of all children but when it is a majority who have had a conversation with a teacher where this diagnosis was suggested, I know something is seriously out of whack. Either the training methods are off or the expectations are. The conclusion that so many little boys have a problem in their brains seems, to me, to be the least likely explanation.
October 27, 2011
A recent experiment seems to indicate that Sponge Bob and other fast paced, frenetic cartoons may not be the best thing for a young child’s development of concentration and patience.
The experiment was a simple and interesting one: four-year-old’s were split into three groups, one watched Sponge Bob, another group watched a slower paced PBS cartoon and a third group was allowed to color and draw. Afterwards, the children were asked to perform tasks that involved following rules and delaying gratification. Apparently, the children who were quietly coloring or watching Caillou did about the same but both groups significantly outperformed the ones hot off a Sponge Bob high.
Does this mean fast paced cartoons damage a child’s brain or exhaust it in some way? I don’t know that you could make that point definitively but this is a nice little experiment. It shows that just after watching one of these shows, the child does not perform as well at tasks requiring concentration and patience. Does this seem somewhat intuitive to you? It does to me.
Sometimes we are wrong when we have a gut reaction to something. Sometimes the evidence doesn’t bare our idea out but it has always seemed intuitive to me that the fast paced, multi-angle, color flashing, scene changing cartoons and video games that mesmerize toddlers and children do so for a reason (see my thoughts on TV): they engage the child’s primitive attention centers that focus on quick changes and quite literally enthrall them.
When the TV shuts off, when there loud blare is gone, things aren’t exploding, nothing is flashing and nothing is flying around, how dull and boring the real world must feel to these kids. Imagine ‘preparing’ for a thought-intensive task that requires precision and patience (like taking an important test or editing a complex report for work) by spending 30 minutes riding roller coasters at Six Flags. Would you feel relaxed, collected, and prepared to sit down and concentrate? How long after would you be able to calm down to work: five minutes, an hour? Who knows?
My gut tells me years of exposure to this stuff in developing minds must do harm but I don’t have concrete evidence of that. This experiment doesn’t prove anything but it does indicate, at least in the short run, fast paced media isn’t doing children any favors.
September 13, 2011
Do we read anymore?
A recent study from the UK shows that children self report text messages as the most popular form of reading material, followed by magazines, emails and then social networking websites and other websites. Fiction checks in at number six on the list. Non-fiction ranks lower. A child is apparently more likely to read song lyrics than a work of non-fiction and poetry is even further on down the list.
Following the trail back from the popular news article in the Telegraph (http://www.telegraph.co.uk/technology/facebook/8716114/Warning-as-children-shun-books-in-favour-of-Facebook.html) to the actual research paper put out by the Literacy Trust (http://www.literacytrust.org.uk/assets/0001/0336/Omnibus_reading_2010.pdf) I found the sample size was pretty good (over 18,000 children). The data was gathered by self report but I think it mirrors what I see in the office: There are readers and non-readers, the dichotomy is stark, and there are far more of the latter.
Here’s my anecdotal summary of what kids do while waiting for me to come into the exam room:
Teenage Girl: Texting.
Teenage Boy: Texting or staring at the wall.
Grade School Boy: Playing a handheld video game or thinking about the video game he wishes he was playing.
Grade School Girl: The wild card. This one might be doing any of the above but I just might find her working on her homework or reading a book.
As I said, there are the readers and the non-readers, and for some reason, as a society, we seem to be fine with this. Readers tend to be younger and tend to be female. They tend to like books about vampires. It’s considered a hobby, like playing soccer. By the time they are teenagers, many of these readers have abandoned this socially isolating ‘hobby’ for more interactive diversions. ‘Bookworm’ isn’t a label that adds to social prestige in the high school setting in America.
And I don’t think this is a recent trend. Back in the day, when I walked five hours through the snow without shoes to get to school, back in the 90′s, kids didn’t read then, either. I don’t remember much interest in the assigned books from classmates in high school or college. Now these folks are the parents of the children I see in the office. I don’t think reading was ever very important to many of these parents. So why should their children be interested?
Well, for one thing, the more a child reads the more well rounded, knowledgeable and eloquent they become. I can’t really think of anything more important for a child to be doing. Mastering a video game takes a few hours. Getting in shape takes a few weeks. Learning a subject in school takes a semester. The creation of an intellect takes a lifetime and it is sculpted one hammer blow at a time with each written idea a person consumes.
A few years back they unceremoniously did away with the analogy portion of the SAT. It wasn’t fair, apparently. A better assessment of verbal skill is a written sample of work from the child. Well, here is an analogy from an article out of the NY Times by Adam Cohen from a few years back on just this subject:
(A)Wealth: gold; (B) Hunger: food; (C) Car: Driver; (D) Cook: Stove.
Two words next to each other: what is the relationship and which of the choices comes closest to the same relationship? This is obviously an easy one. Poverty is the lack of money. Hunger is the lack of food. I remember some that tied my brain in knots. What’s wrong with children being forced into the mental gymnastics of understanding our language? We think in language so how can the mastery of that language not be important to the development of intellect? Communication is easy. Cave men communicated. I am talking about thought. Language, vocabulary and word logic are the stuff of thought and the only way to build these things is to read.
Luckily, even people who didn’t seem to care much for reading as kids, find subjects they like as adults and become readers. This is fantastic. Men who never picked up a book as students become history buffs or economic theory buffs or some other kind of buffs. The book industry is still doing a pretty brisk business, a little more than 10 billion dollars per year. Not bad. I hear kindle sales are up.
Compared with other countries around the globe, American children have about ‘average’ verbal skills. We tend to have a wider spectrum of proficiency than a country like South Korea but, overall, we fall well behind them. We have higher per capita consumption, more access to resources and free access to every book in print through our public libraries yet our children, as a whole, are average. I have a close friend who taught some introductory classes to incoming college freshman and was appalled at their complete lack of ability to answer simple history and geography questions. The same goes for language. Our young people can talk, they can communicate, they even believe they can multitask (which they really can’t) but can they understand language and logic if they can’t understand simple analogies or have no interest in devouring new books?
Whatever your take on the state of public schools in America, the written word is available to the vast majority of our children and I am not talking about emoticons on a cell phone. The more a child reads, the smarter they get, the more interesting they become, the more they excel. Ideas expand the mind. Unless there is a lively debate on Kantian ethics ‘binging’ back and forth on your teenage daughter’s jewel encrusted cell phone, chances are there isn’t much mind expansion going on. Reading is the genesis of thought. Texting is the genesis of… what? A place in the social hierarchy of middleschoolers? Honey bee colonies and dolphin pods have complex social hierarchies, too. They do not have Homer or Virgil or Shakespeare. They don’t have Jane Austen or Ralph Waldo Emerson. They don’t have Walt Whitman or Robert Frost. They don’t have Kurt Vonnegut or Isaac Asimov. They don’t even have Oprah’s Book Club.
Speaking of Oprah, I am not a big fan of many of the books I have read from her list but I am a big fan of what she has done. Book clubs are an excellent way to spark a child’s interest. A family can be a book club. Parents can reread classics or new works that are assigned in school and these can be discussed over dinner. We can even teach our children at home to read for enjoyment.
The books are right there in the library. The payoff is huge in terms of a child’s overall success in school and life. We just need to find the will to put away the distractions and become a society that takes advantage of the wealth of knowledge available to us. We live in a country built by men and women of absolutely epic inspiration. Have we become a society of hamsters on wheels, to busy or distracted to think, destined for decline, destined to be outpaced by hungrier and harder working people around the globe, or do we teach our children the inspiration of the written word and the limitless potential of the human mind?
August 30, 2011
A recent study released shows an alarming number of daycare centers do not adhere to the AAP policy on television exposure in children. Children under two years old should not watch ANY television. Toddlers, in my opinion should also avoid vegetating in front of the idiot box. As children grow a bit older, some TV time is OK but it should be a specific, parent approved show, not just clicking mindlessly through the channels. When the show is over, it is time to do something else!
This study is disturbing to me because I see how much effort my own infant takes and how much personal interaction she requires and I feel happy that my wife and I decided to be very thrifty instead of putting our baby in daycare. We value this mommy/baby time over eating out and vacationing and made a family decision based on these values. We live very simply but we are also very happy this way. Watching our infant develop, we can not imagine her without one on one care.
Sadly, for many single parents and even some two parent households, this isn’t financially feasible, even when cutting back to a bare minimum. Any daycare where infants and young children are being placed in front of a television to vegetate instead of interacting with a caregiver is causing them harm. Find another daycare ASAP.
Television article on PediatricianNextDoor.com here.
May 4, 2011
In a recent nationwide study, investigators found serum levels of cotinine (evidence of exposure to second hand smoke) in more than 2000 non-smokers age 8-15 years. The researchers found a positive correlation between exposure to second hand smoke and the development of major depressive disorder (MDD), generalized anxiety disorder (GAD), attention-deficit/hyperactivity disorder (ADHD), and conduct disorder.
Is there causality here or is an environment where children are being exposed to cigarette smoke also the type of environment that cultivates psychiatric disorders? I have no idea. I do know that nicotine has powerful effects on the brain and it seems quite obvious that children should not be exposed to cigarette smoke. Period. They should not be exposed to it inside the womb or out of it.
April 28, 2011
A recent analysis of various complementary colic therapies out of the UK is not promising for those hoping for a cure for colic: evidence doesn’t seem to support any specific dietary supplements or alternative therapy. The authors are not saying nothing works, just that nothing has been proven to work.
The article notes some positive data for fennel but none of the studies, the authors point out, were scientifically sound.
The article in Reuters
At this point, we still don’t have a clear cure for colic. This is unfortunate because a colicky baby can drive a parent to her wits end. There are many proposed etiological factors for colic. Just as treatment is a mystery, so too is cause. Emotional, nutritional and biological causes have all been put forward.
An important point for parents, though, is to remember how frequent colic is and how, as yet, no particular cause has been found. If you are taking good care of your baby and they still cry inconsolably, you are not doing anything wrong and there isn’t something more you should be doing!
Read more about colic here.
March 29, 2011