An apology in advance: this post is mostly non-medical. And, it is a little self-congratulatory. Yep, that’s right. Congratulations to me (and to my amazing, exquisitely tolerant better-half) for making it through one year. Our twins celebrated their first birthday this past weekend with a little shindig consisting of family, friends, and lots of birthday cake.
There are often clear-cut criteria in medicine for deciding what tests to order for a particular patient. This is even more true in pediatrics, where I am learning that less is often more. Thinking about doing a lumbar puncture in a 3 month old? We have the Rochester criteria to help us decide whether there is significant risk of an occult bacterial infection. Think someone has a blood clot in their leg? Let the PERC (PE rule-out guide) be your, well, guide. No sense in getting the test if the chance of it being true positive are minutely low, or the chance of false negative supremely high. Medical decision making rules abound and honestly, make 2 am decision making in the ED a whole lot easier.
Which is why I propose there should a similar decision rule for ear-piercing in 6 year olds. Sure, it may seem like a good idea at the time to surprise your daughter with some shiny studs in reward for her hours of piano practicing. Yes, she may have begged you multiple times for earrings. She may have pulled at your heartstrings, a la “my cousin has earrings, and she is 1 year younger than me! And now I’m in 1st grade. Pleeease!”. How could you predict that she would allow one earring to be placed, and become a shrieking, wailing terror scaring other customers out of Claire’s? How would you know that you would spend a golden weekend (2 days off in residency-speak) going back and forth to the same Claire’s, and that with each attempt she would summon the strength of 3 men and the resolve of Katniss Everdeen?
Here is my handy and free rule, which is not yet available on Epocrates:
4 Point Decision Rule to Rule-Out Ear Piercing. Do not attempt if any of the following criteria are met:
1. Daughter is age 4-10, or above 20 pounds
2. Claire’s has only one employee to hold down daughter, and only one earring can be placed at a time
3. Daughter has asked and received a band aid for every scratch she has had since she’s been able to talk
4. Daughter’s father has been consulted on earring placement, and says “I’m staying out of it”.
I’d name this rule after my daughter, but then again, I wouldn’t want to scar her (more).
A new message pops up on my phone. I signal to the attending and step out of the OR. I’m on anesthesia rotation at Santa Clara Valley Medical Center, as a Pediatrics resident at Lucile Packard Children’s Hospital at Stanford. But because I’m also a mom to a first grader in Cupertino, both my pager and my cell phone are frequently “on call”.
“I want to take this opportunity to update you about the police activity at Monta Vista High School this morning.”
My heart skips a beat.
It’s the superintendent, to tell us a bomb threat closes Monta Vista and a nearby elementary school. My daughter’s school, just a few miles away, will stay open. I rationalize that this is Cupertino, the heart of Silicon Valley and home of Apple. Surely nothing bad will happen here, of all places. I call my husband to make sure he keeps an eye on the news, and head back to the OR.
This was December 13, the day before Newtown.
A neat little study/survey looking at children aged 6-10 years old was published recently in the Journal of Pediatric Health Care that gives some interesting numbers on how caffeinated beverages and TV, computers, or phones in the bedroom affects your child’s sleep.
The authors did a secondary analysis on the children from the National Sleep Foundation’s Sleep in America Poll and looked at the relationship between caffeine and technology use while adjusting for things like age, race, gender and overall health.
The results? Here’s what was the most surprising:
- Children slept an average of 9.5 hours each night (recommended is 10-11 hours).
- 22% of kids complained of daytime tiredness.
- 47% of kids had a TV in their room.
- A whopping 30% of kids had a caffeinated beverage daily.
- Kids who drank caffeinated drinks got 15 minutes less of sleep each night AND had a higher BMI.
For those of us on the baby train, there’s an inescapable truth that smacks us in the face about every other day: no matter how great of a job you think you’re doing at the moment, someone else is doing it better. One of these moments occurred for us a few weeks ago when a buddy of my husband’s came to visit. This friend was also a new father – in fact, his beautiful daughter was born just a few weeks before our twins. While catching up over dinner, he casually mentioned that his family had not only done a few day trips up and down the East Coast with their baby, but also, you know, flown to Paris. As in Paris, France. (Hey, there’s one in Texas too! It was a valid question).
If you went to college with my husband you probably know this friend and his wife. Yes, they are both tall, beautiful, and impossibly talented with a baby to match. We love them dearly. That’s why we were inspired, rather than envious, when he also mentioned casually that they had enrolled their baby in weekly swimming lessons. Oh, and that their entire family was taking part in the upcoming Boston Marathon. That’s right. This guy was running the marathon, his wife was doing the half, and their baby was doing the “diaper dash.” Consider us smacked. Down.
A couple months ago, a friend who was anticipating the imminent start of solids in our then 5-month old babies commented, “You’ll have so much fun!” Inwardly I groaned. In my mind, I could only imagine sweet potatoes and peas splattering everywhere like a Jackson Pollock painting. Or having to resort to sneaky distraction tactics to get our twins to eat. Surprisingly, starting solid foods was the one thing that has been very, very fun!
We did extensive research before we started: I polled all (okay, like two) of my parent friends: “How old were your kids when you started?” (4-6 months). “What did you start with?” (rice cereal, veggies, fruits) My husband, being more analytical, vetted everything with Dr. Google before letting me unleash my inner Julia Child on the kids. Good thing, too, because I had the brilliant idea one morning of giving them some of our Greek yogurt – it turns out it contains dairy (duh), which isn’t easily digested in babies under 12 months.
Over at The Mommy Files, the San Francisco Chronicle’s online parenting blog, there was a recent post about how the parents of twin 14 week-old boys had preemptively prepared bribery goodie bags for all the passengers on the babies’ first airplane trip. The bags included treats like Jolly Ranchers, earplugs, and an endearing note apologizing in advance for any crying their fellow adult passengers might encounter during the flight. I had two immediate reactions to this story:
First: really?! Do you know any parents of an infant – let alone two infants – that have time to prep 100+ goody bags for strangers? In our household, we’re lucky if we manage to prep the babies’ bottles the night before. And second: who are these parents that are so capable and smooth that they managed to travel cross-country with their twins? Up until last week our twins had only left the house for required doctors’ appointments. Heck, we even considered asking our family physician to make house calls so we could avoid the hassle of traveling to and from the clinic.
A few weeks ago I mentioned two stories I enjoyed reading to my 5 year old. They weren’t ones you’d traditionally think of as children’s stories, but they were entertaining and more importantly, they preserved my sanity. I’ve expanded on that idea, and offer a short list of books that have been put through the test – but this time they’re color coded for appropriateness!