Janelle Sorensen, Healthy Child Healthy World:
How many times has your child been sick or had a strange rash or some other malady that doesn't seem severe enough to rush to the doctor, but worries you nonetheless? I think I'm well into the thousands with my daughters, and while the internet is an amazingly helpful tool, I also have my go-to parenting library. Many of those tattered, worn books bear the trusted Sears name - not only because of the pediatric expertise found inside, but - more importantly - because of the friendly tone, balanced recommendations, and care giving philosophies that reflect my own.
Welcome the newest addition to that library, The Portable Pediatrician: Everything You Need to Know About Your Child's Health. Encyclopedic in scope, The Portable Pediatrician features timely and practical information on every childhood illness and emergency, including when to call the doctor, what reassuring signs can help you know your child is okay, how to treat your child at home, and much more-all in a convenient A-to-Z format.
After paging through it, I had the opportunity to ask one of the authors, Dr. Bob Sears, some questions. And, I asked our community to submit some, too. Here are his responses.
Q: I LOVED the "Pills-Skills" approach to medical care outlined on page 13. Can you briefly explain it for our readers? Is this a widely understood practice or something the Sears family is pioneering?
A: We have become a nation of pill-takers. For every problem there's a pill. Yet most parents don't feel comfortable giving their child a medication unless it's necessary. That's where our pills/skills model comes into play. We try to teach a parent and child the skills they need to overcome an illness or a medical problem so they don't have to rely too much on pills. Some doctors practice this way, but it takes time and effort. In today's busy pediatric offices, many doctors don't have such time, and writing a prescription only takes 30 seconds. This isn't really the doctor's fault, it's just the way our health care system is right now.
But we think that most parents want MORE. Sometimes pills are needed; we write prescriptions every day. But as pill use increases, the need to learn and practice health skills decreases. The more skills we teach, the less pills a child may need.
Here are two examples of how we'll teach skills instead of pills:
Allergies: it's easy to just prescribe a medication, but that doesn't fix the problem. Instead, we test for the causes of the allergies so we can eliminate them from the child's life. We teach several allergy-proofing steps for the home and ways to keep the sinuses clear and healthy. As a child learns these skills, he learns to take responsibility for his health and how to make the effort to address other health issues using the pills/skills model as he gets older.
ADHD: pills are easy, and they usually really help with attention and focus. But then a child doesn't need to learn coping skills to overcome the ADHD. We teach diet techniques (brainy breakfasts and snacks) and other school skills so a child can decrease his reliance on meds.
Q: This book, like the entire Sears Parenting Library, embodies an ethos of a more natural and holistic approach to parenting and medicine. What do you recommend for a parent trying to live this way who has a more conventional pediatrician? We often hear from parents that their pediatricians don't respect their concerns about things like vaccines, over-use of antibiotics, eating organic, etc. And, often, they can't find a more suitable practitioner. Do you have advice for navigating this relationship?
A: If you can't find a doctor that suits you well, then you have to rely on other resources, such as The Portable Pediatrician. We've written how we would evaluate and treat every pediatric illness and how we guide parents through each checkup. Of course, we aren't really being your doctor, and nothing can replace the hands-on healing a doctor can provide. But in terms of information, this book can help fill in the gaps that a parent won't get from their own doctor.
Q: Why don't pediatricians don't offer to test both parents for Hep B. If they are both negative the vaccine is unnecessary.
A: Good point. That makes perfect sense on an individual basis for parents who want to do this. But as a national health care policy it would cost more and take more time and effort. Policymakers have to consider those issues as they make policy. I don't agree with this particular policy, but this is the reason the chose to simply universally vaccinate for Hep B instead of screening and testing.
Q: I just blogged about why you don't necessarily need antibiotics for strep. (Even waiting two days before starting can help boost your own immune system) Why don't more MDs take a wait-and-see approach?
A: You are right that waiting two days for treatment helps the immune system create better immunity and decrease the long term complications of strep. But as for skipping the antibiotics altogether, I don't necessarily agree. Children and adults get over strep without antibiotics, but there's a risk of later complications - rheumatic heart disease or kidney disease. That's why we treat it - to avoid later complications. To skip the antibiotics altogether raises the risk of these complications. That's the mainstream medical opinion on this. To be honest, I haven't looked back at the research from decades ago that lead to this practice. It's one of the medical truths I learned in medical school. Now, I have questioned such "truths" and done my own research in certain areas, but this isn't one of them.
Q: In regards to children with bad seasonal allergies, suffering daily, affecting daily living etc.. - which antihistamines do you like best and why? Also do you have different recommendations for different age groups and why?
A: At this point you need allergy testing - any pediatrician can do this. I like Allegra - it's what I take when I'm having a bad allergy day. It's been prescription for a while, but is now over-the-counter. I also like Zyrtec. I don't have any particular preference with these. I've found that efficacy is fairly individual - one might work well on one child but not on another. They are approved down to 6 months of age.
Q: How do you feel about chronic use of antihistamines in young children? (Like a 2 yo)
A: I like them short term, but if you are needing them on a chronic basis it means there are likely some allergic triggers that you need to discover on testing.
Q: In a situation where a young child, 3 yo has such severe eczema he has been battling it with all possible remedies, but the only thing that helps it topical steroids, but he has been using them since he has been about 10 months old. Very hard to have clear skin. Never sleeps through night etc...only thing that helps is steroids. With that said, there is a controversial group of meds including protopic and elidel. what do you think is better in this situation?
A: I'm not a fan of the protopic and elidel meds. I understand your situation and I know it's tough. Have you tried Atopiclair? It's a new non-steroid anti-inflammatory prescription.
Also, and this is a long shot, I've seen some kids with eczema get better with a water filter used in the shower or bath. This filters a lot of impurities out of the water and may help a small percentage of kids with eczema.
Q: Does you think vitamin d supplements are important? Can a baby get enough of this hormone via sunlight? Can mom take extra vitamin d instead?
A: Vit D deficiency is a big problem - I've tested over 100 kids this year and have found only 10 that are normal. You can either test or just assume there's at least some deficiency. What I've started recommending is that every breastfeeding mom take about 4000 IU daily of Vit D3 as long as she is nursing. This will guarantee enough gets into the breastmilk. If a mom's going to keep taking this much for more than a year, she should get a blood test to make sure she's not overdoing it. As an alternative, the baby can be given 400 IU of Vit D daily. These come as drops. Formula has enough Vit D.
As soon as kids are weaned or stop formula, continue with the 400 IU dosing daily. It's actually not easy to get enough sunlight, but avoiding overdoing the sunscreen can help. Only use sunscreen when a child will be on a long outing (a few hours at the park or beach or swimming). But normal daily activities or an hour of playtime outside doesn't usually need sunscreen.
Q: I would like to know if there is any additional information on the likelihood of the separation of the MMR vaccine?
A: Nope - no plans to start making it again.
Dr. Bob Sears is a pediatrician and co-author of the Sears Parenting Library's latest book, The Portable Pediatrician: Everything You Need to Know About Your Child's Health. Visit www.AskDrSears.com for more information.
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