These are challenging times for everyone. Even though children are relatively safe from physical harm from a COVID-19 infection, they are still stuck at home, living in a world of uncertainty. Most children’s parents are very stressed right now, and children can sense these things. Stress, uncertainty, and a different schedule affects how we parent.
When I need help parenting, I first look for material published by “Triple P,” otherwise known as the Positive Parenting Program. Their resources are evidenced-based and thoroughly researched.
They have published a document called “COVID-19 – Parenting Tips for Parents and Caregivers in Uncertain Times” that I have found very helpful and discussed on my recent COVID-19 Facebook Live episode. I have summarized their document here:
Reassure your children that your family is your top priority
Maintain everyday family routines
Involve children in the creation of new routines
Prevent Boredom
Involve children in making a list of at least 20 activities to keep them busy
Take notice of behavior you like
Make sure your child knows you are ready to talk
Let them know it’s okay to be worried
Be truthful in answering children’s questions
Find out what they are worried about first
Have a family plan of action
Involve children in planning
Help children learn to tolerate more uncertainty
You, can say, for example: “I don’t know; lets learn what we can.”
Take care of yourself the best you can
Reach out and connect with loved ones
And below is a video where I discuss these parenting tips:
Had a great time having lunch with my son at his elementary school last Thursday. I did suffer temporary hearing loss (I forgot how loud elementary cafeterias can be!), but I can hear again.
But really, it was great to see the smile on his face when he saw me (and when he saw the Jersey Mike’s subs in my hand). I cannot believe that this was only my second time visiting him for lunch this school year! I have decided that I am going to commit to going once per month! (which really doesn’t seem like much, does it?)
Did you guys know that there is a debate as to whether it’s good for parents to have lunch with their children? Some schools discourage parents from having lunch with their kids, and they have good reasons. Some parents have brought food for their child and their child’s favorite students, making other children left-out. Some parents have shown-up and fed their children or made sure they ate all their food, which does not allow their child to learn food independence (though I’m sure there are some children with eating disorders that would benefit from their parent coming for lunch). But I think that most of the time, it is good for a child to see that his or her parents will go out of their way to come have lunch with them at school.
This reminds me of some interesting research. It is generally more meaningful to children when their parents engage with them more times per day for shorter durations (think 3 to 5 minutes), rather than just one or two longer engagements. I think lunch with your child is like this. It’s loud, it’s hard to hear what your child is saying, but it shows that you care, and you took time out of your busy day to spend time with them. They are only around for so long!
We struggle with limiting electronics and getting our kids to play outside. Recently, we spent a beach weekend with two other families and their kids, and we enforced a “no electronics rule.” We got some push back from the kids, and some kids still did sneak their video games, but it was great to see them running wild on the beach, making lots of noise, and playing games like we used to play, like tag, pretending, and building sand castles. They enjoyed old-fashioned, outdoor “unstructured” play.
I believe that getting our kids outside and experiencing “unstructured” play is worth the struggle. Studies have shown numerous physical and mental benefits to outdoor unstructured play. Since kids have to “find” something to do, it helps creativity. Since they have to work together to make a fun game, it helps cooperation and behavior. Since there is not a screen giving them constant feedback, outdoor play helps develop attention. And since there is not a constant barrage of stressful and intense gameplay, outdoor play has also been found to improve anxiety.
I am not saying that video games are all bad. Video games have their benefits too, like improved spatial awareness and planning, but if your kids are like mine, I do not have to struggle to make sure they get enough time in front of the screen.
So join me in the struggle! The struggle to get our kids outside having fun!
My 12 year-old son quit baseball before try-outs on Saturday. We have had a few experiences of signing-up our kids for a sport, followed by them complaining about going to practice. So the Thursday before try-outs, my wife, Trish, had a conversation with Wesley to see how serious he was about baseball. She explained to him that we are a very busy family (she is a new tenure-track FSU professor, and I am starting a new pediatric practice), so it will be hard on our family to get him to all the games and practices, but if he was committed to playing baseball, we would support him and make sure he can play.
Well, he decided he did not really want to play.
I am pretty bummed. I myself enjoyed playing baseball all through elementary, middle, and high school, and I enjoyed watching Wesley play and practicing with him. And baseball was my father’s favorite sports, so we had a lot of good father-son baseball moments. At Winthrop last year he played third base and hit okay. The year before he had been his team’s best pitcher. I think he has had a lot of fun playing baseball and experienced much growth over the last few seasons.
Initially the disappointment led me to feel upset at my wife, that she had talked him out of playing baseball. But after more thought, many questions surfaced, and after thinking about these questions, I am convinced Trish did the right thing. Some of these questions were:
Is it my fault that he doesn’t want to play more? Maybe I did not play catch with him enough? Is participating in sport so valuable and important that we should really push our kids to play? Wesley already plays soccer for RAA Middle School and wants to run track, so how much sport should he (or kids in general) play? And he loves fishing, he could fish all day every day. So is playing a sport more important than other less physical activities or less competitive activities, such as fishing, playing an instrument, chess, or pottery?
So here are some of my thoughts (and what I was reminded of after looking through some of the research): Yes, playing a sport is valuable, and can be very beneficial in many ways, but it’s not NECESSARY for a child’s success. I know a lot of people are thinking “duh,” but when you played sports all your life (and grew-up in Texas or Florida), this is very hard to grasp–even for a pediatrician!
Research shows that, yes, kids who play sports do usually get more exercise than kids who participate in other activities such as chess or fishing, but in almost every organized, goal-oriented activity, children will learn to face challenges, to work together, and to have fun. So if a child does not play a sport, but participates in non-aerobic activities, such as chess or fishing, then the child needs to find a way of developing a life-long consistent exercise habit–such as hiking or biking.
So in our case, our son does not really need another sport. He gets his exercise through playing outside, gym (which he has all year at RAA), soccer, and track. And he is serious about fishing, which is teaching him how to improve himself, learning about new techniques, work as a team, and hard work (he helps me clean the boat after fishing). Trish instinctively knew all these things. I just have a hard time getting over the primacy of sport.
Which reminds me, I haven’t done much for exercise myself this weekend, I should walk my dogs. Until next time!
I just finished my first educational video, and the positive feedback has made it worth the work! It’s about my S.O.S. positioning strategy for the breastfeeding parent. For those of you that haven’t seen the video yet, I’m going to hit the high points.
First, the whole point of my breastfeeding video is for the breastfeeding parent to have a lactation experience that is as comfortable, joyful, and successful as possible. There are many possible problems that can get in the way, such as low milk supply, mastitis, or tongue-tie, BUT the most common problem is NIPPLE OR LATCH PAIN.
Now, most people focus completely on the latch. But what I have found (and research shows) is that if you first make sure that the breastfeeding parent is well-positioned, then your chances of having a comfortable latch increased greatly. I cannot over express the importance proper positioning of the breastfeeding parent before trying to get a comfortable, functional latch. Good breastfeeding parent positioning is especially important for the first-time parent, newborns, or premature infants.
Thankfully, positioning is not that complicated, and to make it even easier, I have created a system for the cradle-hold that is easy to remember:
S.O.S.
“S” for Semi-reclined Positioning
“O” for Open Shoulders and Chest
“S” for Skin-to-Skin Contact
Semi-reclined Positioning
Semi-reclined positioning is achieved by laying back 30 to 45 degrees like you were sitting in your grandparent’s recliner. Not only is the semi-reclined position comfortable for repetitive nursing sessions, but it also enables the baby to rest her weight against the nursing parent’s chest and brings the nipples upward so that they are more accessible to the baby. The mother in the top picture is semi-reclined.
Open Shoulders and Chest
Focusing on maintaining open shoulders and chest brings the breasts even more out for the baby and keeps the nipples upward for the baby and keeps the arms out of the baby’s way. It’s also just more comfortable than being turned inward. Notice how the mother in the top picture has her shoulders and chest open and this helps keeps her upper arms away from the baby.
Skin-to-Skin Contact
And the last “S” is for skin to skin contact, which comforts the baby, activates the breasts to produce more milk, and activates the baby’s natural nursing reflexes. In the picture, you can see that she will maximize skin-to-skin contact by nursing without a bra or top. She will also have the baby covered only by a diaper. If a nursing parent is in a situation where clothing is necessary, it is very helpful to at least have the baby’s face, her nose, cheeks, and chin, make contact with the bare breast. Last, notice the wonderful skin-to-skin contact the mother in the top picture is getting.
Not every breastfeeding parent that has poor positioning will have breastfeeding trouble. But, breastfeeding problems are more likely if there is poor body positioning. Breastfeeding position is especially important for the first-time parent, newborns, or premature infants.
An Example of Poor Positioning
Now consider the body positioning of the woman in the above picture. She is not in a semi-reclined position, rather she is upright and is even leaning over somewhat. Second, her shoulders are turned inward and her chest is turn downwards. Last, she and the baby are both fully dressed, which minimizes skin to skin contact.
Again, this mother-infant pair may be having breastfeeding success in spite of poor positioning, but again, breastfeeding problems are more likely with poor positioning. Conversely, breastfeeding success is not a guarantee with good positioning either.
An infant feeding herself a piece of cooked carrot.
As a physician, we have the motto, “first do no harm,” so sometimes it is a little difficult accepting new ideas–because we are fearful of the harm that they may do. And it took me a while to accept and recommend infant-led feeding. I had some reservations.
No, I’m not nervous about babies choking, which most parents seem to worry about, that was not my top concern. Ever since the idea of baby-led feeding came out, I have been very nervous that it will cause babies to be low on iron when I check their blood at the one-year check-up. And this is no small matter, as we know (and I’ve seen) that iron is important for brain development, growth, and adequate red blood cell production, among other things. In fact, my first patient who really pushed the idea of baby-led feeding, did not grow well and was iron-deficient at one-year of age. I do not think that mother understood how serious I was about giving her infant iron-rich foods.
The general idea behind infant-led feeding was good, that babies can to listen to their appetite and eat “whole” foods if they aren’t just spoon-fed purées. Know how to listening to our appetite, our fullness and hunger cues, is very important in our current culture’s obesity epidemic.
So when Sarah Ward invited me to come visit her breastfeeding support group at Capital Regional Medical Center, I decided to see what new research had been published about infant-led feeding. And body did I find some meat! The research that has put my mind at ease is called BLISS, which stands for Baby Led Introduction to SolidS,” and it started in 2015 and finished in 2018. The BLISS researchers were fully aware of the risks of choking, developing iron-deficiency, and inadequate weight gain, so they gave families principles to follow. I have summarized these here:
Choking Precautions
Test foods before they are offered to ensure they are soft enough to mash with the tongue on the roof of the mouth (or are large and fibrous enough that small pieces do not break off when sucked and chewed, e.g., strips of meat).
Avoid offering foods that form a crumb in the mouth.
Make sure that the foods offered are at least as long as the child’s fist, on at least one side of the food.
Make sure the infant is always sitting upright when they are eating – never leaning backwards.
Always have an adult with the child when they are eating.
Never put whole foods into the infant’s mouth – the infant must do this at their own pace and under their own control.
Iron-rich and Energy Recommendations
Offer the child 3 different foods at each meal:
iron-rich food, such as meat, beans, or lentils
an energy rich food like cheese, eggs, or nuts
a food like a fruit or vegetable
Avoid hurrying your baby (she may not eat enough, of sense your urgency and eat too fast herself and choke!)
Always include your baby at meal times just as you would other family members (we know that families that eat together have better mental illness and eat healthier)
Avoid offering “fast” foods or foods that have added sugar or salt
The researchers followed these babies for 2 years, and they found that when families were properly educated, babies who were infant-led, did not choke any more and grew just as well as infant spoon-fed.They were also not more likely to be iron-deficient at one-year of age. They also found that some of the spoon-feed babies were sometimes allowed to self-feed and that some of the infant-led babies were occasionally spoon-fed.
Summary of Findings
Infant-led babies were not more likely to choke, be iron-deficient, or be underweight at one-year of age
Infant-led babies breastfed longer
Infant-led babies did consume a little more salt between 6-12 months of age. The researchers think this was due to their recommendation to try things on toast.
Infant-led babies ate more often with their families and had better appetite control
But, no everything was roses. They found that both infant-led and spoon-fed babies and toddlers had excessive amounts of sugar and salt intake! This is the culture that we live in, and it is very hard to change our habits, I know. My three kids would live off candy if I let them, and they sneak sugar and hoard it like it’s on national shortage. We struggle at my house too, but we keep fighting. We limit juice, soda, and candies and try to feed our kids whole foods.
So, in closing, now I fully recommend infant-led feeding as the best way to introduce solids to your baby. In reality, a mix of baby-led feeding and spoon feeding is probably the most realistic way to go.
