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The Colicky Baby (addendum) or the Purple Baby

by Doctor Laurence H. Miller on 10/29/18

I've previously reviewed the trial parents encounter if they have a "P.U.R.P.L.E." baby at home.

I've described how the young infant has to LEARN not to squeeze the anal sphincter muscle as they have a bowel movement.

But there are other reasons they become so distressed as they're about to have a bowel movement after they reach one month old:

Fetuses don't have any bowel movements while growing inside their moms. So that when they are born and begin to have BM's, the strength of the intestinal waves that push the waste along toward the rectum is naturally weak, sluggish.  These are muscles that have never been used before.  But as the weeks go by, the intensity of the intestines' squeezing increases.  The muscles being used every day get stronger and stronger.  The baby is bound to FEEL the stronger PUSH of the waste through the bowel, and since it is a NEW feeling of cramping, it is likely to be UNCOMFORTABLE and SCAREY.

At the same time, the baby's BRAIN is "putting two and two together", and the baby becomes more alert, and MORE AWARE of the feelings on and inside its body.  So, while the two week old baby might have a vague sense of discomfort when his gut squeezes swallowed food along, the six week old FEELS the cramp MUCH MORE INTENSELY.  But the baby has NO IDEA what is happening, or why.  It has NO MEMORY of what happened an hour ago, let alone yesterday. So when the baby feels strong pressure in the rectum before a BM, it feels like IT'S GOING TO DIE. EXPLODE. WORSE than appendicitis!  Gradually, over a month or two (or three), she begins to remember the daily pattern of slight belly ache followed by a pushing out of the stool; one always following the other, and she realizes it's not a big deal after all. And the hysterical panic crying begins to ease a bit at a time.   Little by little, the "P.U.R.P.L.E." baby, starts to shade into pink.

G-BOMBS

by Doctor Laurence H. Miller on 10/29/18

The title of this entry sounds scary.  But it isn't at all. 

My wife and I were watching a "health" special on Public TV (Channel 21) and the topic was "Living longer and WELL".  Naturally, one of THE worst health problems of our time is obesity.  So the docs were telling how they help their patients get into better shape:  There are two prongs to the attack:

1) Daily exercise (even 1/2 hour of moving is enough);  In March of 2013, a lady named Jill Vento of Des Moines, Iowa weighed 370 and was diagnosed with diabetes.  She began to walk, a lot.  (ten or fifteen minutes, three times daily) and has lost over 200 pounds! Her diabetes and sleep apnea resolved.   And everyone at the airport knew her as "the smiling lady" because she was beaming with joy as she made her daily rounds, 5 days a week! Check out her story online (NOT FAKE NEWS!)

2) Better nutrition.   That's the tough one; to a large degree because we always focus on what you CAN NOT eat.  But if you eat a lot of good stuff, you won't be as hungry for the bad.

G-Bombs is the memory jogger for some REALLY good stuff, with each letter standing for a good group/type of delicious food:

Greens

Beans

Onions

Mushrooms

Berries and

Seeds!          Every day, try to pile these onto your plate. You should cook them,

         add them to other dishes, or snack on them. 

And drink at least 2 quarts of water every day.

Yogurt and the brain

by Doctor Laurence H. Miller on 12/19/17

Today, most people know that eating yogurt is good for their stomach because of the beneficial live bacteria that's a major ingredient.  Now scientists have shown  that the bacteria in yogurt also affect Emotions and Behavior in a powerfully positive way.

An experiment was performed in which mice were placed in a bucket of water. Although mice can swim, they hate water and try desperately to get out of it.  The scientists split the mice into two groups: Half of the animals were treated with the various bacteria that are found in yogurt by being fed the germs and the other half were not.  When the untreated mice were dropped in the water, they swam around continuously for approximately four minutes, trying unsuccessfully to escape from the bucket and the water.  Then they "gave up", floating without moving (although they didn't drown).

The mice that had eaten the yogurt germs kept swimming beyond 4 minutes, and 5 minutes, and 6 minutes!  They would NOT give up. 

 How do we explain the difference in the two groups' BEHAVIOR?  There is no reason to think the mice in the untreated group just "got tired".  To put it in human terms, it seems like they became hopeless and were despairing after four minutes.  So they stopped trying.  But the bacteria group were like "Energizer bunnies" who kept Going and Going and Going!  They didn't seem stressed; they were resilient and "hopeful" and persisted in trying to swim out of the bucket.  It didn't matter that the task was impossible. 

The scientists even proved HOW the bacteria made the mice more determined: If the experimenters cut the vagus nerve (which runs from the stomach up to the brain) before the swim test, it didn't matter if the animals got the bacteria.  They still gave up after only four minutes of trying.  So the vagus is required to bring the helpful signal to the brain in order for the Reslience Persistence Effect to be seen. 

Hearing this story has affected MY behavior:   nowadays, I eat yogurt EVERY DAY!  We live in an unpredictable world where "speed bumps" and "roadblocks" could always be waiting around the next curve.  I want to be at my best every day, ready to face whatever surprising challenges could be coming.  And I want to be hopeful, and not even think about giving up when difficult problems arise. 

 So, unless someone has SEVERE MILK ALLERGY, I advise eating yogurt every day.  And, for those allergic people, there's a new food product on the market called "Co Co Yo", which is made from coconut fermented with the same bacteria germs that are in yogurt.  But it has no milk in its ingredients.

 

 

The Child Who Stutters

by Doctor Laurence H. Miller on 10/02/17

Our first daughter spoke at a very early age and we were so proud of her that we frequently prodded her to repeat what she'd said earlier that day when she was with our relatives or friends. After a week or two of our showing her off, we noticed that she was having some trouble when she'd begin speaking.  There was a hesitation, and soon it appeared that something was BLOCKING her from speaking.  She was struggling to get the first sound out when she wanted to speak. I quickly realized that she was having the beginning of stuttering and I knew it was important to help her immediately so the problem didn't get worse, or permanent.

I found a guide for helping children with mild stuttering and followed its recommendations:

Try to model slow and relaxed speech when talking with your child, and encourage other family members to do the same.  Don't speak so slowly that it sounds abnormal, but keep it unhurried, with many pauses.  Children usually can't help from acting the way they see people close to them behaving.  So they will tend to imitate the slower, relaxed pace.

Slow and relaxed speech can be the most effective when combined with some time each day for the child to have one parent's undivided attention.  Set aside a few minutes at a regular time when all you plan is to listen to your child talk about whatever is on her mind.

When your child talks to you or asks you a question, try to pause a second or so before you answer.  This will help make talking to your child less hurried, more relaxed. (And the child will see that she, too, can take her time speaking when YOU are done.)

Try not to be upset or annoyed when stuttering increases.  Your child is doing his best as he copes with learning many new skills all at the same time. Your patient, accepting attitude will help him immensely.

DO NOT tell the child to "slow down" or "take your time". This will likely make him MORE upset by his trouble.  You can SHOW the child that they can slow down by patiently waiting  and listening to them and looking at their face with love.

Don't put the child on display where they must perform to show off under pressure.  Don't question them in a way that they must answer under pressure.

Make certain that when your child speaks to you, your focus is ONLY ON HIM.  The child should NOT have to compete with computers, phones, TV's, or newspapers for YOUR ATTENTION.  SHOW the child how important he and his ideas are to you.

Acne and Food

by Doctor Laurence H. Miller on 10/02/17

The first surprise I had in my Dermatology Course at Johns Hopkins was learning that the experts believed NO FOOD caused a worsening of acne in teens.

I had been raised to believe that eating greasy foods, chocolate, and pizza were damaging to the skin.  That turned out to be untrue when controlled experiments were done with volunteers. 

Now some good research has shown that SKIM MILK will aggravate acne.  Patients drinking skim milk tended to have worse complexions than those who drink whole milk, or low fat milk (and the subjects drinking whole milk were actually a bit better off than the low fat group).   Some people using skim milk still had good skin, but it's something to consider if a young person is having acne problems.

I also have a suspicion that eating A LOT of orange vegetables and broccoli can be helpful.  The Vitamin A in carrots, sweet potatoes, and butternut squash is chemically similar to the active ingredient in THE MOST POWERFUL acne medicine around, Accutane.   So eating a bunch of those foods every day seems like a good idea for healthy skin.  Even if it doesn't improve your skin, you will be healthier because you are eating them!

 

Hug/Kiss/Carry Your Baby

by Doctor Laurence H. Miller on 06/11/17

In his incredibly informative book Why Zebras Don't Get Ulcers, Dr. Robert Sapolsky, the famed Stanford neuroscientist and primatologist, explains that as animals age, they tend to have higher levels of cortisol, the stress hormone, in their blood.

This causes an increased rate of decline in their health for many reasons.
He describes how the rise occurs:  the part of the brain called the hippocampus works to limit and control how much cortisol is secreted by our adrenal glands.
As we age, the hippocampus gradually gets less effective at keeping the cortisol down; AND the higher cortisol levels even INCREASE the failing of the hippocampus at this job.  So, a "vicious circle" of increasing damage to the brain and body occur as the cortisol levels go higher and higher.
Now, the good news:   If newborn rats in a laboratory were held and caressed for 15 minutes every day while they were pups, something amazing happened.
When their blood level of cortisol was checked when they were old (two years later), all the rats that were held and caressed had much lower cortisol levels than rats that were left in their cages, fed, but not picked up.  And the rats who were held appeared younger and were healthier.
There is every reason to believe that this anti-aging treatment will work for human babies too.  The more our children are held, hugged, and kissed during their infancy, the better the chance they will be healthier in their OLD AGE.
So tell your friends and relatives to IGNORE those sour pusses who tell you that you will "spoil the baby" if you hold her too much.

Baby Safety Continued

by Doctor Laurence H. Miller on 12/13/16

A while back I discussed some baby safety issues in bathrooms and kitchens.

But let's not forget bedrooms and living rooms.  A young infant can't be left alone on a bed.  Not even a 3 month old on a king sized bed.  The child can choose that moment to try her first "roll over", and roll right off the bed!  (It happened to my daughter over 30 years ago; we were lucky as the floor had a thick carpet and she only got a small bump on the scalp.)

Coffee tables have no place in a home with a toddler.  They are an accident waiting to happen!  Whether glass or wood, the hard, unforgiving edge is an invitation to severe cuts, bruises, or knocked out teeth.

Getting outside is an adventure with babies but safety must come first.  With kids riding in an automobile, you HAVE TO worry about the closing of the car door.  We played a compulsive game with our daughters to always have their hands on their head when we were about to close their door.  That is a good ritual to develop.  And always, always, always, in their car seat.

We don't want to frighten children unless there is a powerful justification.  But walking with a toddler outside in the suburbs can be really dangerous.  We made it a rule with our little ones that they would hold the hand of a grown up.  And we taught them from an early age that stepping off the curb was SCARY.  We WANTED them to have fear of the roadway, because a toddler running into the roadway can end in tragedy.  Once they get older, the kids can learn to cross the street with care and without fear. 

Next we'll discuss playgrounds.....

Early introduction of Egg to infants four to six months old

by Doctor Laurence H. Miller on 05/06/16

I previously presented the new recommendation to offer peanut butter to young infants as published last year in the New England Journal of Medicine.  Babies who eat peanut early and on a regular basis are much less likely to become allergic than if they wait until after their birthday.

In the May 5, 2016 issue of the New England Journal of Medicine, new research was reported showing that 1.4% of babies "at high risk" for egg allergy DID become allergic to egg when it was introduced at 4 months of age. But this was 75%reduction compared to the 5.5% of high risk babies who became allergic to egg if they didn't eat it until their birthday.  A baby was in the HIGH RISK category if they had bad eczema, or if their parent or sibling was allergic to egg.
We are advising that young high risk infants be tested by an allergist before beginning egg or peanut, as a precaution.  Babies who aren't high risk can routinely start these foods by six months of age.  
Parents should discuss early introduction of egg and peanut with their Pediatrician before giving their baby these commonly allergic foods.

Time out? Spare the rod and spoil the child?

by Doctor Laurence H. Miller on 03/20/16

What does the above quote from the bible mean? It is almost always referred to as justification for striking a child to teach them moral behavior.  But the reference is to a shepherd gently GUIDING his/her flock with a staff, to point out the best way for the sheep to go. Hitting isn't necessary at all.  "Limit setting" is an important part of parenting.  But it can and should be done without violence.  In fact, kids who live in homes where limits are clear and understood are usually happier, and feel more secure and safe.  Kids understand that parents know what's best for them and the family.

 The American Academy of Pediatrics published a position statement in 2012 clearly discouraging corporal punishment. There is no good reason to cause physical pain to a child in order to improve his/her behavior.  There are GOOD reasons not to use corporal punishment:

1. There are more successful ways to help teach your child right from wrong.
Most important is by setting a good example.  Kids have eyes and minds like recording machines, and they watch how their parents, the grown ups, behave and are for sure going to imitate what they see.  So if parents act in a kind, moral way, their children are bound to do the same eventually as they mature.
When a parent feels a child has done the wrong thing, and needs to learn not to do it again, a short "time out" is effective in teaching consequences of "bad behavior".
A toddler can be placed in a playpen, or in their room, or asked to sit in a corner. The recommended amount of time is ONE MINUTE for each year of a child's age.
The time out should NEVER be in a child's crib because we don't want them to feel they're being punished when they are going to sleep!  That bad choice by the parent might cause a sleep disorder.
But even the "time out" method can cause harm to a child when used excessively:
Every time a child feels punished, they are injured in an emotional way.  They feel bad about themselves; they feel they are bad; they are unworthy. And they feel anger at whomever is doing the punishing.  We want our children and parents to feel warm love for each other.  But an excess of anger and hurt is destructive to the positive feelings. So Psychologists advise giving a child 25 hugs and kisses for every time a "time out" is used to stop a child's misbehavior.  And the parent is not simply hugging RANDOMLY.  They have to see actual good behavior in the child that they are hugging them for!
There are two lessons here:  
Avoid time out when you can.  A parent should think ahead to protect their kid from frustrating or dangerous situations.  Keep the kids out of a room with expensive and delicate items.  That SAVES the child from having to refrain from touching or running there.
CATCH THEM BEING GOOD:   I wrote about this some years ago (see the item) to describe how most parents don't even see their kids when they are behaving well, playing quietly or politely.  If  parents make a big deal and praise their little one during these good times, the child is likely to WANT to act that way MOST OF THE TIME.  And isn't that what we are hoping for!

2. Corporal punishment is emotionally very damaging to kids. Bruno Bettelheim tells us why in the book I previously recommended, "A Good Enough Parent".  For a young child, a parent is a loving protector, all wise.  So when a parent hits their child, it is painful AND terribly confusing.  Little kids don't KNOW right from wrong yet, so they are shocked and feel badly BETRAYED when their PROTECTOR is harming them.  They can't understand it.  And it damages the relationship between parent and child because TRUST is lost.  
The pain and confusion the child feels from these feelings of betrayal, often causes the child to "bury" the hurt and feeling of betrayal.  So they "bury" their feeling that they were treated unjustly, and tell themselves that their being hit by the parent WAS deserved. And that it "didn't do them any harm".  And then the cycle of violence against a child is CONTINUED when that child grows up and treats THEIR child the same way.  Violence by a parent against their child is NEVER justified because it is MORALLY WRONG and because IT DOES NOT WORK to help the child learn good behavior.

What about Chickenpox?

by Doctor Laurence H. Miller on 10/25/15

In the mid 1990's, the Varivax vaccine was introduced to put an end to chickenpox.  But was this necessary?  If a vaccine were offered to put an end to "dandruff", would it make sense?  Dandruff is an annoyance, but would we want another expensive, uncomfortable shot to give our kids?

Even Pediatricians were uncertain.  We knew that chickenpox was common and occasionally serious, but almost always in older people, hardly ever in young patients.  So we dutifully began to vaccinate kids above the age of 8, as we explained to parents it was important to protect the older kids "for now".  (This would become a problem for us going forward, which I will soon demonstrate.)
It was about a year after the vaccine had been "rolled out", that the infection specialists belatedly began to orient us, the doctors, to its POWERFUL selling points:
During the twentieth century, there were an average 100 deaths of children annually from chickenpox, most of them previously healthy individuals.
Approximately 1 in 5000 children would have severe complications during the illness.  (This translates to 200 kids out of every million who would have frightening, often life threatening disease.)  The complications included:
Necrotizing fasciitis (known as "flesh-eating strep") as bacterial superinfection of blisters rapidly invaded the child's skin and muscles. This could lead to disfiguring surgery and amputation.
Encephalitis with brain inflammation and brain damage.
Pneumonia.
Reye syndrome with usually fatal liver and brain injury when kids with Chickenpox were treated with common Aspirin.
Hemorrhage (uncontrollable bleeding).
All of these were more common and more severe in immunocompromised kids who already had disease like leukemia or ongoing treatment with prednisone (used to help children with severe asthma, arthritis and bowel inflammation). 
Newborn infection was frequently deadly.  If a woman got chickenpox just before or after having a baby, the child could become severely ill and die.
Congenital malformation or death would happen to around 2% of infants of women who got chickenpox in the first trimester of pregnancy.  They could have permanent brain damage, blindness, and deformed arms and/or legs.

A sad case of which I am aware:  About 15 years ago, a family carried their 7 year old severely ill child with Chickenpox into the LIJ Emergency Room.  They had refused the Vaccine as they wanted their child to get the disease the natural way.
The boy was paralyzed from the waist down, in the way Polio used to damage the spinal cord nerves.  This is a known, tho uncommon chickenpox complication.


So we began to vaccinate all kids over one year old.  But parents were confused and anxious.  Why the change in our policy? Hadn't we stated that ONLY the older kids needed the shot?  That young kids were not in danger if they got chickenpox?   We had inadvertently undermined the best strategy to protect all of America's children.  We proceeded to do our best to correct the first, incorrect impression.  Many parents still refused the vaccine, stating concerns that the Vaccine might need a booster dose in the future.  That is a misguided reason to refuse a vaccine:  Most of the vaccines we use require booster doses, and they are well worth it.
In fact, ten years after the vaccine release, the infection experts recommended a second, booster dose to be given at some point to all children.
This was advised because Varivax (as the vaccine is named) is not 100% protective.  While it gives 95% protection against getting SEVERE chickenpox, about 20% of recipients still did get a mild case some time in the future.
And that means they could still spread it to innocent infants under one and pregnant women.  
The two dose schedule has nearly completely eliminated Chickenpox and its ravages.

Any misguided individual who speaks against routine use of vaccines such as Varivax, should be introduced to the families who have suffered tragic loss in the past from this now preventable unpredictable disease.


Breastfeeding Addendum

by Doctor Laurence H. Miller on 10/05/15

I recently heard a lecture on breastfeeding that gave me an "AHA!" moment.

The consistency of breast milk CHANGES during a feeding.  It is thinner and sweet at the beginning of a feeding, and becomes thicker and creamy "at the end of the meal".  
What is the importance of this?  It means that babies "know" when a feeding is "winding down" and coming to an end.  Even in the first weeks of life, they become aware of the change, anticipate it and accept it.  The creamy milk at the end is MORE FILLING.  So the baby is more likely physically and emotionally satisfied by the end.  (Everyone enjoys dessert when dining!)
And this is experienced by the baby at EVERY FEEDING.  A baby who experiences this all through infancy will have a different "approach" to feeding than a baby who has a homogenized liquid (like formula) at every meal, where there's no difference from first suck to last.
Remember that this has been the feeding technique of ALL BABIES for ALL of HUMAN HISTORY, until the LAST HUNDRED YEARS.
So you can be sure that this pattern HAS MOLDED US AS A SPECIES, IN OUR RELATION TO FOOD AND EATING.  This is all likely part of the cause for the EPIDEMIC OF OBESITY IN YOUNG PEOPLE we have seen in the last 50 years.  Every suck a baby takes from a bottle gives him/her a mouthful of milk. But it wasn't meant to work that way:   SOMETIMES, A BABY'S DESIRE TO SUCK IS NOT FOR FOOD BUT FOR COMFORT. (It is a pleasurable activity IN ITSELF.) So it is very common that "bottle babies" overfeed.   The sucking instinct is like the breathing instinct in a way: it is never satisfied for long, or we would die.  
Unfortunately, when breast milk is pumped and served in a bottle, this benefit of consistency change over the course of a meal IS LOST, as the baby gets THE SAME MILK FROM FIRST SUCK TO LAST.  But pumped breast milk is still preferred to formula since the nutritional and immune benefit is superior.


Measles

by Doctor Laurence H. Miller on 07/20/15

Unfortunately, a dark sad story to report:

It was reported on July 2, that, for the first time in A DECADE, a person has died in the USA from Measles.  Clellam County in Washington State, reported a woman died of Measles, complicated by pneumonia.  The tragedy is that it was TOTALLY preventable, if all of the children eligible for vaccination had received it.  The death is almost certainly connected to the outbreak that occurred in Disneyland in California this year, with over 100 cases traced directly.

We know that, some years ago,  an unethical physician named Wakefield took money to fraudulently "prove" that the MMR vaccine caused autism.  The Journal Lancet has retracted the article and apologized for the lie, and the doctor punished.    But the damage from the lie continues, as it is almost impossible to put out the smoke and stop the falsehood from continuing to spread!  Parents hearing rumors of a child being harmed by a vaccine, become fearful of vaccines,  that their child might develop abnormally as a result of being vaccinated.   Being anxious about the health of a loved one is natural.  But we should use the energy we get from anxiety to EFFECTIVELY protect our baby.
We KNOW that MEASLES is a horrible, dangerous and thankfully PREVENTABLE infection.  In the early 1960's, before the vaccine, there were HUNDREDS of THOUSANDS of cases of Measles yearly.  ONE OUT OF A THOUSAND PATIENTS DIED!  And one out of a thousand had severe encephalitis (brain inflammation) and were permanently damaged.  Terrible.
But we almost never see that in the USA today. 
But Measles still spreads in other parts of the world; so we must protect our citizens.  If we travel abroad, we should make sure that we and our kids are protected.  IN FACT, it's advised that young kids traveling internationally, who haven't completed the TWO DOSE series,  get the next dose before their trip, even if it's before the usual age for getting it.
Check with your doctor. 

Addendum on Food Allergy: Early introduction of Peanuts

by Doctor Laurence H. Miller on 04/07/15

Exciting news on the science of FOOD ALLERGY was just published in the prestigious NEW ENGLAND JOURNAL OF MEDICINE last month.

It's been the conventional wisdom to avoid giving peanuts to babies until after they turn a year old. Now it's been proven that the risk of peanut allergy is reduced by WELL over 50% by introducing it to the diet at around six months of age.

Interestingly, one of the mothers in our Practice shared with me that that has been the tradition in Israel for YEARS.  And very few people there have peanut allergy.

Begin with less than a teaspoon thinly spread on soft bread.  Always start a new food before noon, at least three days after starting any other new food.  And always have Benadryl liquid in the home, just in case you see a reaction to the new food.  It's easy to remember how much to give if a child has hives:

a 22 pound baby gets 1 teaspoon 4 times a day;

a 33 pound baby gets 1 1/2 teaspoons 4 times a day;

a 44 pound baby gets 2 teaspoons 4 times a day;

a 66 pound child gets 3 teaspoons 4 times a day.

The science shows that early introduction reduces the risk of developing peanut allergy  ESPECIALLY IN CHILDREN AT HIGH RISK OF FOOD ALLERGY.  That would be kids who have close relatives with allergies, or if the child already shows signs of sensitive skin (eczema, atopic dermatitis), or asthma.

The study that was conducted only looked at peanuts, but we'll keep a look out for reports on early introduction of other "at risk" foods, such as eggs and tree nuts (almonds, walnuts, pistachios).

 

Books for Parenting

by Doctor Laurence H. Miller on 12/10/14

Children don't come with a "Manual" on how to get the most out of them, how to enjoy them the most, or how to "fix them when they're broken".

Hopefully our kids don't get  "broken", but ALL NORMAL kids run into "rough patches".  And, if we know a little bit about "how they work", we're more likely to be able to help them, these beautiful persons that we love so much, during these times.
There are three books I recommend all parents read.  They are informing AND entertaining.
Infants and Mothers: Differences in Development by T Berry Brazelton
This is a month by month review of the developmental progress of the first year of life.  Written by a pediatrician, the book follows three children (an active baby, a quiet baby, and an "average" baby) as they grow and change before their parents' eyes.  Most parents will be helped by knowing if their child is meeting  expected milestones as well as having an idea "what will come next" for their baby.
The Magic Years by Selma H. Fraiberg
A literate, entertaining review of how the minds of young children work.
It explores how they develop mind skills, the emotional challenges all children face, and how healthy children overcome the challenges.
Two of the biggest emotional difficulties all humans face, young and old, are
FEAR AND ANGER. 
Fraiberg brilliantly describes how children use PLAY to deal with problems they are dealing with and how parents can help them function well.
A Good Enough Parent by Bruno Bettleheim
This is a challenging Parenting book, but SO WORTH the effort!
It also reviews how parents can help a child with fears and misbehavior.  But it's non-traditional because it asks the parent to think for him/herself about why the child is HAVING the problem.  That can be hard work, but very satisfying, and likely to help because even if you don't get the exact answer, the effort, love and faith you show in your child helps them.  He does give specific tips about how to get into your child's head, and he warns not to blindly follow "expert's" advice, because NO ONE can know your child as well as YOU do.

A Really Healthy Diet for Humans

by Doctor Laurence H. Miller on 09/12/14

Not many years ago, people were advised to eat foods with a lot of starch, as many as 12 servings daily.  The problem with this strategy is that our ancient ancestors did not eat this way.  There was VERY LITTLE STARCH in their diet because until about 10,000 years ago, there was NO AGRICULTURE.  That means no wheat, rice or potatoes. If you believe in evolution and natural selection, that means our ancestors had to grow and thrive for HUNDREDS OF THOUSANDS of years on a diet LOW in STARCH.  Since the genetic make-up of animals changes very slowly, that means WE are genetically engineered to eat a diet low in starch.  On the contrary, most Americans LIVE on STARCHY foods:  bread, pasta, potato, rice, corn, and sugary sweets make up a huge part of what we eat.

The Paleolithic (or Old Stone Age) Diet is becoming popular today, as people attempt to use our ancient ancestors as role models for making healthy nutritional choices.  This Diet avoids the starches, and also DAIRY products.  Because humans only domesticated animals and began drinking cow milk and eating cheese or yogurt about 10,000 years ago.

What DID the "cavemen" eat?  They were "hunters and gatherers".  They picked fruit and nuts off the trees. (And those fruits WERE NOT NEARLY as sweet as ours are today!)   Ate lots of meat as animals were plentiful.  Took eggs from bird nests.  Caught fish.  May have dug up some WILD root vegetables.  Eating these foods kept our species alive for hundreds of thousands of years.  Without fruit juices or soda.

And everybody had THE SAME JOB:  Looking for food.  From rising at dawn, until lying down at dusk, we were usually hungry and searching for food to survive.  (Just like the birds and squirrels do today.)  AND we moved around. A lot.  It's believed that when early humans searched for food, they didn't walk or stroll.  They jogged or ran as much as five miles a day.  Covering more ground in a day gave them a better chance to be successful in their hunt.

What did humans NOT HAVE before ten thousand years ago? NO ONE suffered from Celiac disease (also known as gluten sensitivity enteropathy).   Because there was NO GLUTEN TO EAT.  No bread. No pasta. Today there are communities with up to ONE PER CENT of the population with this dangerous disease. 

Cow milk protein allergy affects up to 3% of my newborn patients. If the baby isn't changed to a "hypoallergenic" formula, they become seriously ill  with violent vomiting and diarrhea, often becoming bloody.  Simply changing the formula cures them almost without fail.  It's wonderful that 97% of babies can tolerate cow milk.  But it's not surprising that 3% become ill when exposed to a foreign protein, "intended" to be only consumed by calves.          

So if you believe the old saying: "If it ain't broke, don't fix it!" has merit, consider changing your daily menu closer to the one that successfully kept us around for a very long time in the wilderness.          

The Baby Tantrum and the Breath-holding Baby

by Doctor Laurence H. Miller on 06/24/14

There are as many personalities in children as there are children.  Some are very "mellow", easy-going and calm.  A few children are VERY sensitive and become wildly emotional when they are frustrated or experience a sudden unpleasant shock/surprise.

It isn't anyone's fault that they behave this way; neither the parents' nor the child's. It's just the way they're "programmed" to respond.
If you are lucky enough to be the parent of such a child, you may be challenged by their behavior in a particular way.  If they are thwarted in getting something they desire, or are suddenly injured, such as a painful bump from a fall, they get so upset as they BEGIN to cry, that they take a very, very deep breath, AND THEN HOLD THAT BREATH!  They will not exhale.  They are frozen, mouth open, body stiff, usually lying or thrashing on the floor.  The face is bright red and then becomes dark red, and then usually a purplish color.  Until they faint.  Some kids doing this might have a brief seizure/convulsion.  This is seen in as many as 5% of babies between the ages of one and four years old, with the most common age 12 to 18 months.
Needless to say, this is distressing for the parent to watch.  But within a moment or two of fainting, the baby wakes up and starts moving around, AND IS FINE.
So what is a parent to do when this is THEIR child?  The advice is quite clear and VERY SUCCESSFUL IF Mom and Dad can FOLLOW the advice.
First off, a parent knows his baby, what sets him/her off into a tantrum.  A loving parent will THINK AHEAD and PROTECT the baby from UNNECESSARY frustration and injury.  Don't leave a valuable antique vase within reach of the baby and then demand that she not touch it!  If there is something you MUST do, like put Baby in the car seat before you drive off, it doesn't matter how he protests/complains. But it IS a good parenting HABIT to always keep your child "in the loop".  Give them a running "play by play" of what's going on and, more important, what is ABOUT to happen.  If you've been at Grandma's house for four hours, and you know you'll be leaving at 5 PM, MAKE SURE you clue the children in by 4:30 that they should get ready to say their goodbyes soon.  It helps them EMOTIONALLY get ready for CHANGE.  Otherwise, they may feel that they're being whipped around in a life that's like a tornado.
The key to helping your child get control over THEIR OWN behavior and also their FEELINGS is to respond in a helpful way when they "fall into" a tantrum or hold their breath.  A rule of psychology is that behavior that is rewarded is likely to be REPEATED.  Since people, and especially children, are REWARDED by ATTENTION, if a parent shows excitement and pays special attention when a child acts in a wild way, the child will tend to do that behavior again and again.  
For that reason, it's important to briefly LOOK AWAY or WALK AWAY from a child's tantrum or breath-holding attack. The parent MUST NOT show alarm or distress.  If the baby sees shock or upset distress in the parent while the tantrum is happening, it will make things worse:  The baby will be alarmed  by the parent's frightened face AND the baby will feel POWER, in a bad way.  The baby knows she is "little" and "weak", but if they can cause such STRONG EMOTION in Mommy/Daddy, it is giving the baby CONTROL over the parent!  So getting that POWER/CONTROL is a reward and the baby will keep doing whatever gave her that power.  It's irresistible.  So breath-holding attacks will be MORE likely in the future. 
Instead of showing upset while the baby is screaming, parent should WAIT till the moment the baby acts calm, and THEN quickly come soothe the child. This is recommended EVEN for the baby that turns blue and then faints.  After a number of episodes like this, the baby will learn that he DOES NOT get attention when WILD, but rather when he is calm and quiet.  If WILDNESS doesn't "pay off", the tendency to act that way will really come less often.  
It IS a challenge for a parent to follow this plan, but if followed consistently, it works.

BABY SAFETY

by Doctor Laurence H. Miller on 01/28/14

It's very exciting to see your infant getting around by herself; but it should also be a bit anxiety-provoking.  With the new mobility comes a degree of danger.

It's essential that you "baby-proof" your home to reduce the risk of injury to your baby.  But you must remember that there is still no substitute for adult supervision.  Almost every accident that happens (whether minimal or tragic in consequences) occurs DESPITE precautions in place.  All swimming pools are fenced in; medicines have "child-proof" caps; electric sockets are plugged.  But every year we hear horrible new reports of baby injuries.

Kitchens are the most dangerous place in the home.  One should always use the back burner on a gas/electric range so baby can't pull a hot pot down.  But more importantly, there should be a compulsive rule that baby is NOT ANYWHERE NEAR the range when food is cooking.  When my baby was three years old, my wife was boiling spaghetti and dropped the pot on her arm, getting a severe burn.  Thankfully, we had the baby sitting safely at the kitchen table where she belonged.  Drawers with silverware and knives, as well as glass casserole dishes in cupboards need "kinder-locks".  We had ONE cabinet in our kitchen without a lock.  The pots and pans were stored there and our toddler spent hours at a time banging and playing with them.  For her, there was only one cupboard in the room; for her, the locked doors didn't even exist!

All sockets need safety plugs so that baby can't stick a pin into live electricity.  Electric wires must be kept away from babies.  They explore by mouthing objects.  If they bite into a live wire, the mouth burn injury can cause a permanent disfiguring scar.

Bathrooms are not safe for an unescorted baby.  A fall on the hard tile is likely to cause a fracture or laceration.  Family members' medicines could be poison to an overdosed baby who thinks that they are candy.  A baby could fall into a toilet and drown.  Drownings occur in bathtubs as well.  The door should ALWAYS BE LOCKED.

to be continued.......

Food Allergy

by Doctor Laurence H. Miller on 09/16/13

Allergy is a condition in which a generally harmless (or healthful) substance injures a person because of the way they react to being in contact with it.

More people suffer from allergy today than ever before.  The exposure to the offending substance can be contact with the nasal lining, the eyes, the lungs (from inhaling it), the skin, or the mouth (when eating it).

The symptoms of food allergy can vary in people, and in the same person over time.

Many foods can be the cause of allergy.  The eight most common culprits are

Eggs

Wheat

Cow milk

Soy

Peanuts (which are not "nuts" at all, but legumes like peas that grow in the ground)

Tree nuts

Fish

Shellfish

Other foods commonly responsible include chocolate, berries, tomatoes, apples,


With a mild food allergy, the lips and gums may feel swollen and itch.  This is called "oral food allergy syndrome" and should be taken seriously as it can progress to full blown severe symptoms.  Frequently the feeling will leave on its own or with swallowing an anti-histamine allergy medicine such as Benadryl.  It is wise and logical to AVOID any food that you can connect to such a reaction.

A severe food allergy reaction can be life threatening.  The victim may later describe having the sense of "doom" upon them.  The throat and upper airway may swell so that breathing is impossible.  Blood pressure and circulation can fail sending the patient into "shock".  Without immediate treatment, they can die.  To buy time so the patient can get to a medical center for help, people who are known to have a severe food allergy are given an "epi-pen" to carry with them.  If they have a severe reaction they inject themselves and the adrenalin it contains can give them relief for fifteen or twenty minutes.  It is urgent that they head for a hospital after they've had the epi-pen injection.  The attack can resume even more severely as the adrenalin wears off.

Again, AVOIDANCE is the main strategy to prevent the illness.  Friends, relatives and restaurants must be notified of the patient's problem.

 

I'll review inhalant allergens in my next post.

Let's Ride a Bike

by Doctor Laurence H. Miller on 03/31/13

When I was 18 years old, I taught a friend how to ride a bicycle.  He was 19 and had not learned earlier because his mother was afraid he'd be injured riding.  So she kept the family in their apartment across from a schoolyard his entire childhood.  That way, he'd always have a place to play nearby and have no need to learn. But then our gang started playing tennis - at courts that were two miles from our homes. Mark had a choice of a forty minute walk or a bus ride to join us at tennis.  It was a pain for him.  So he decided to finally learn to ride a bike - and I got to teach him.  I wasn't sure how it would go.  I wasn't sure that I'd be able to teach him, or how long it would take.  To my pleasure, it was easy and didn't take more than a half hour.

I taught my first daughter to ride at age nine.  She wanted to learn because lots of kids on our block were riding every day and she wanted to be one of them.  I can't remember actually teaching her because it was easy, uneventful.

 My younger daughter was eight years younger.  Although she enjoyed having a bike, she insisted on keeping her training wheels on until she was ten years old.  There were no kids on our block now (so she had no motivation to keep up with her friends), and we lived on a hill.  It's hard to learn on a hill:  tough to go up, scary to go down!    We decided that we'd seriously try to learn on the Fourth of July weekend.  We went to a parking lot with plenty of empty spaces and began.  I was in my late 40's.  This is a problem because the teaching involves running alongside the child on the bike, one hand on the steering handlebar and one hand behind the child on the rear of the seat, to keep the bike steady and upright.

As we began "the learning"  that day, I promised her that she would be successful.  I guaranteed that she'd be riding a bike on her own before she went back to school in September.  I had no idea how long it would take her to learn.  I didn't want her to feel like a failure if she still hadn't learned to balance a week or more after we'd begun practicing. So I set the deadline target date way, way in the future.

So we started going around the parking lot:  she was peddling and I was running alongside.  I quickly sensed that she was tilting away from me.  That didn't feel good.  I felt as if she would tip over if I didn't pull hard to tilt the bike back toward me.  But despite my strong pulling on the bike seat, the bike continued to angle away from me.  It was a puzzle.  Why was the bike leaning over away from me?

Suddenly, a light went on over my head:  Juliette was leaning over to the right, away from me, because she felt the bike being pulled over (by me!) and she was compensating adjusting for that force.   What should I do?  We couldn't go on the way we were.  I was really out of breath!  Then I realized what I had to do:  I had to stop pulling on her seat; I had to let go of the seat!  A small weak part of me was terrified:  "But if I let go, the bike will tip right over!"  But my gut knew that wasn't true.  If she stopped feeling my pulling her toward me, she could ride centered and straight up. 

So I secretively removed my hand from the bike seat, continued to run alongside with my hand on the handlebar, and watched the bike straighten right up and balance evenly!!   Juliette was riding a bike.  She was successful.  I was successful.  WE were successful.  Then she noticed from our shadow on the parking lot tarmac that my hand was not on the seat.  "Daddy, you promised not to let go!!"  I shouted back that I was sorry but had to let go or suffer a heart attack.  She yelled with joy as she revelled in her flight, as she pedalled away from me.  Then she screamed in panic that she didn't know how to stop! (But she did fine with a soft landing.)

 What is the point of my little tale?  It is this:  For this father and daughter to agree to begin the project of "learning to ride", there had to be in place four testaments of faith.  Juliette had to trust that her father was competent to teach her and that he would not let her get hurt.  I had to trust that Juliette would be capable of learning to ride.  Juliette had to trust herself; that she would be able to ride the bike alone.  I had to trust in myself, that I was up to the task of helping her succeed in this "rite of passage".   And life is filled with similar challenges that must be met head on:  Learning to tie your shoes, to recite the alphabet; learning to swim; learning to skate and to cook and to go on a first date.  A good portion of the joy of parenting is in the ushering of one's child along the road of achievement and growth.

What about "MONO"?

by Doctor Laurence H. Miller on 01/29/13

The dreaded nightmare of the teen years: draining fatigue with a terrible sore throat, huge "kissing" tonsils coated in pus, so bad that the youngster can't swallow his/her own saliva(!), severe nausea/abdominal pain, with insomnia mixed in for good measure...

This may be the harbinger of Infectious Mononucleosis.  The infection is caused by the Epstein-Barr virus, a member of the Herpes Family.  It belongs in the Herpes group because, like Chickenpox (Varicella to doctors) and Herpes Simplex viruses, you only get severely ill from them when you are first infected by the germ.  As a rule the patient completely recovers, but never clears the virus from his body.  It becomes dormant, hiding out in body tissue (usually nerve cells).  It can make a reappearance even years later (as shingles can after chickenpox), but almost always in a limited form.  I mention this early in my essay to clear away the MYTH of chronic mono.  Because of the theoretical possibility that the "E-B" virus could reactivate, some people who suffer with relentless fatigue of unknown cause are labeled sufferers of chronic Epstein Barr viral infection.  I've discussed this condition with many Infectious Disease specialists, and not a single one believes the theory is valid.  Close to 100% of these patients are proven to NOT have active E-B viral infection.
But what of acute mono?  The syndrome I described in the first paragraph usually strikes only a teenaged patient.  If a young child is infected by the virus, she may only suffer symptoms of a standard cold/sore throat.  In communities in the world where crowded living conditions are the rule, kids are frequently infected when they are young, even four years old.  But, unlike the bacteria that causes strep throat,  E-B virus requires very close, intimate contact to spread.  Hence, its nickname, "The Kissing Disease".  But it can also be spread during intense athletic sports where young people share each others' water bottles, or share food from the same plate.
The illness begins with signs of a cold and sore throat, but it becomes MORE severe with terrible tonsil pain as a week passes.  Marked swelling of the lymph nodes in the back of the neck occur along with fever.  Rarely, it can present with terrible fatigue alone.  Often, infection with Group A streptococcus is considered as the possible culprit causing the illness.  It is important to know that both infections can occur simultaneously.  In fact, an estimated 30%of patients with "mono" have Group A strep infection at the same time!
But this illness is not just a "tired sore throat":
Hepatitis occurs in the majority of patients.  The liver is injured by the infection so that some patients can become jaundiced with yellow/orange eyes and skin.  Blood tests will prove this damage with changes in blood chemicals.  Fortunately, the injury is almost always mild and brief.  The liver heals quickly when the body/immune system overcomes the infection.
Classic "Mono" also involves the spleen.  It becomes painful to pressure and large enough for a doctor to feel in one quarter of cases when the abdomen is examined.  The engorged spleen is in danger of hemorrhage if injured.  Contact sports, including bicycle riding, aren't permitted during the illness.
Riding in an automobile is discouraged since a seat belt could injure the spleen in an accident.  And, rarely, a spleen could begin bleeding even without a noted injury.  Patients are warned to beware of severe abdomen pain and to notify their doctor should it develop.
There is no medicine to treat "Mono".  In fact, taking the antibiotics amoxicillin, ampicillin and Augmentin are almost GUARANTEED to cause a severe body rash, confusing patients to believe they are allergic to the treatment.
Occasionally, however, a patient's throat and tonsils are so swollen that he can't swallow at all.  In that case, offering the child prednisone or decadron steroid medication for a few days can avoid the need for hospitalization.  The swelling shrinks in a remarkably short time, and the patient feels much better. (Because of the possible side effects, this treatment shouldn't be used routinely.)
Rarely, an alarming neurologic syndrome occurs with the patient "not feeling like themself".  They may also be confused with the size of objects, with things appearing much smaller or larger than reality, as in "Alice in Wonderland".
These complaints are thankfully only temporary, as a rule.
The blood tests that help us make the diagnosis include
The CBC.  This reveals "atypical lymphocytes" found almost exclusively in "Mono".  The platelet count is typically mildly lower than normal.
The "liver enzyme" test is ALMOST ALWAYS abnormal with elevated levels (usually only mildly so) even to the point that jaundice (yellowed eyes and skin) can occur.
The rapid "Mono spot" test gives a result in under ten minutes.  But the test is unreliable if the patient is a young child, or if the illness has been ongoing for less than a week.  More definitive is the viral capsid antibody (VCA) test for IgG and IgM.  If the IgM value is elevated, the patient almost CERTAINLY has EBV infection.  If only the IgG level is high, it means the patient is ALREADY immune to Mono and NOT currently ill with that infection.
It is important for the patient to eat lightly, drink plenty of fluids, and try to keep out of bed during the day.  MOST patients recover in two to three weeks.
Return to school and activities is best done gradually, so the patient regains endurance and doesn't become exhausted after weeks of inactivity.

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