Peanut butter: evil actor or yummy snack? February 4, 2009

It seems that every few years we get new and conflicting information about what to feed our kids and all of this advice is backed by data available at the time.  In the area of food allergies, there has been a whirlwind of information and none consistent.  Some data support the idea that mothers eating peanut butter when pregnant and breastfeeding increase their child’s risk of allergy and now new data suggests that children fed a diet with peanut butter in it from a young age, are LESS likely to be allergic.  This most recent study was done comparing children in England who uniformly did not have any peanut exposure until well after a year of age to demographically similar children in Israel 69% of whom were given peanut butter regularly before a year of age.  As the children grew older, there was a 10-fold difference in peanut allergy rates, with the children who had frequent and early consumption of peanut butter being 10 times less likely to be allergic than those whose parents restricted peanut butter.  Interesting.

These findings make sense to me.  Generally, children born into households with pets are not allergic to them.  Kids raised on farms where they are constantly bombarded with pollens and dirt and animals almost never have any allergies or asthma.  It makes sense that a frequent ‘dose’ of something will build tolerance….after all, that is how allergy shots work. 

I am not sure I am going to encourage everyone to go hog wild and start feeding their kids peanut butter at six months of age, but I have always told parents peanut butter is fine to give starting around a year of age but to be sure to give it often so the protein never seems ‘foreign’ to the body.

Eat lots of different foods, get dirty, and have benadryl around just in case and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Declan is 10! February 2, 2009

This morning started off with Declan awakening at 6:25, really excited to be turning 10.  He wanted to open one of his gifts before school and so at 7:15 he opened up a couple of Webkinz from my parents who are wintering in Florida (lucky dogs).  He was delighted! 

Lucky for me, today, although busy, went very smoothly and I exceeded expectations arriving home before 6 and could enjoy the gourmet dinner of mac and cheese and strawberry cake with chocolate frosting (surprisingly good).  And then came the presents….between the High School Musical 2 DVD, ‘Diary of a Wimpy Kid’ book, a bunch of bakugan, a Lion’s jersey (he’s the last remaining fan), and a Navy pilot jumpsuit (he loves his costumes) Declan had a great birthday!

It still amazes me to think that this 5 feet tall fourth grader was the little baby I eventually grew to understand.  He was colicky it seems from the day he was born and cried for hours and hours at a time.  I couldn’t seem to figure out how to make him feel better no matter what I tried…swaddling, nursing, pacifiers, diet changes, reflux meds, and nothing seemed to work.  It was depressing (or perhaps I was depressed and that’s why he was colicky) but anyway I looked at it, I felt like I could do nothing right.  As time passed, his colic improved and so did my mental state but that disconnect when he was a tiny baby always haunted me.  I wasn’t confident that I could read him, understand him, and meet his needs for years.  Eventually, I learned his delicious quirks, his wonderful heart-on-his-sleeve emotionality, and how to make him laugh and help him when he cries.  Now, at age 10, we are hitting our stride…..let’s just hope puberty isn’t right around the corner!

Eat lots of cake, learn everything you can about bakugan, and see the smile on your child’s face and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

What a weekend! February 1, 2009

When last we met, I had just discovered Spanx and found a terrific (incredibly expensive) outfit for the shindig on Saturday night.  Sooo much has happened since then.  Friday came and went with some emotional ups and downs and honest and necessary discussions…unfortunately, Saturday morning arrived with puffy eyelids and a full day of stuff to do before the partay. 

The kids and I spent the morning rounding at Troy Beaumont and then went to horseback riding for the afternoon.  When we got back at 4 o’clock, I decided to take a little nap before getting ready for the party….one of the smartest things I have done in years!  I slept for a little over an hour and awoke refreshed.  Off to the shower I trudged to shampoo and shave and moisturize.  Here are a few things I learned as I got ready for the evening out:

Skittles likes to lick my newly shaved and moisturized legs…GROSS!

Spanx really are amazingly comfortable considering you are actually in a suit better suited for a superhero. 

I never knew that a muffin top could be so high up (Spanx can only do so much).

I am REALLY white in the winter.

My boys are fascinated by women’s undergarments…..they had a good laugh and actually thought I was going out just in my black bra and Spanx!  They were as relieved as the rest of the world when they learned this was my underwear!

Little velcro rollers rock and roll.

Mary Kay cosmetics are fantastic.  I can go from looking like myself with no make up on to looking like myself only better with it on!

My Peruvian black alpaca cape is incredibly versatile…and warm!

Off we went to the Birmingham Education Foundation Unabashed Bash and what a nice evening we had.  The Townsend is a wonderful lace to have an event like this and after just a glass or two of wine, every item in the silent auction looked really really good.  I usually get really nervous about these sorts of events but this time I just had fun.  I saw friends and patient’s parents and new folks too who were interesting and great to be with. 

After the delicious dinner, the live auction began and when the four bedroom cottage on Lake Michigan just outside of Harbor Springs came up for bid, I went to town and GOT IT!  My family usually spends a week on the lake each summer and now our cottage is set….for less than we paid last year for a similarly sized place and the money went to a great cause!

The biggest highlight of the weekend though happened today when I met my very best friend from grade and middle school, Kathleen Steele Grieve (she’ll always just be Kathy to me).  We met this morning at Toast and even though we literally haven’t seen each other in 30 years it was as if no time had passed.  Kathy lives in Sonoma and we reconnected via Facebook a couple of weeks ago.  Kathy was coming in town this weekend for a cousin’s wedding and we had a chance to meet. 

What a joy!  Kathy is exactly the same.  Still incredibly tall, beautiful, funny and REAL.  We still have a ton in common and even with the years apart we found ourselves sharing very personal stories from our lives.  The happy things and the challenges.  Kathy lives with her husband and 2 sons, 6 sheep and 12 chickens in a wine growing region.  She runs, cooks, and knits and is wonderful.  After breakfast, Kathy came to the house and met the kids and Kevin snapped a few photos for us all to remember the day. 

As I sit here watching the Superbowl tonight, I am feeling so lucky to have found my long lost friend and even luckier that we still are the same people we were in 1979 when we were singing the Bee Gees and just starting to grow up. 

Dress up once in a while, find your very best old new friend, and make cakes for your birthday boy tomorrow and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

shopping sucks! even with spanx! January 28, 2009

I have a big hoo ha event to go to this weekend on Saturday night and since I haven’t actually worn a cocktail dress or gown in years, I trudged out my old stuff and tried it on.  Let’s just say that my body is no longer 25 (or 35 for that matter).  Three kids have taken a toll on my chest and back and belly.  I still have decent legs (thanks to running) but have the Kavanagh curse of excess trunk fat.  Sooooo when I went out to find an outfit appropriate for the black tie shindig this weekend I was duly depressed. 

I am jeans girl and on a fancy day, a sweater dress.  I like loose and flowing tops and chunky sweaters.  I wear fleece-lined slip on shoes or running shoes most of the time and never ever wear high heels.  The problem of course is that being a levi’s, anthropologie, hippy girl doesn’t work at a black tie event.  Soooo I made my way to Nordstrom today and tried on about 4 million dresses.  Some were flouncy, some were slinky, some were long sleeved, some were strapless, some were satin, some were beaded, some were colorful, and some were black.  I had the most patient woman assisting me and she gently suggested I try Spanx to smooth out my silhouette.  I wriggled into them and pulled them up just below my boobs and was very skeptical….until I put on the black satin skirt and emerald green shawl collared blouse and WOW.  Of course I still don’t look like I did before kids, but at least I don’t look like a bowl full of jello either!  I didn’t even bother to look at the pricetag until I got to the cashier and when it rang up at $72, I didn’t even blink.

I am glad to have something to wear and even though it was incredibly shocking at times to gaze in that mirror in slinky or strapless (do I really look like that?), I realize that as a woman of a certain age, I have to accept the reality of gravity and genetics and focus on being healthy and less on perky boobs.

Accept yourself as you are, be healthy, and wear Spanx and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

HIB infections on the rise January 27, 2009

Hemophilus influenzae type b is a wicked bacterium.  It causes pneumonia, blood infections, meningitis, and a type of throat infection called epiglottitis all of which are life threatening. 

In the very early 1990s a vaccine became available to combat this bacterium, the HIB vaccine and it has been incredibly effective.  When I was a med student in the late 80s and a resident in 1990, I saw four children die of epiglottitis due to HIB and many more kids with pneumonia and meningitis.  Within just a year or two of the introduction of the vaccine the rates of illnesses caused by HIB plummeted. 

HIB is spread by actively sick children but also by children who carry the bacteria in their noses with no symptoms at all.  The beauty of the HIB vaccine is that it not only prevents a child from getting sick who gets exposed to the germ but eliminates the bacteria from the noses of the kids who are just carrying it.  That is how herd immunity works. 

It seems now that since fewer and fewer children are getting vaccinated our herd immunity is waning.  It used to be that even unvaccinated kids were relatively safe since most  kids were getting the vaccine and as a result there were virtually no ’silent carriers’.  That is changing.  In 2008 Minnesota reported 5 cases of HIB disease and one death.  Three of the children had not received any vaccines at the parents request, one was so young he had only had two of the shots, and the one who died had all of the vaccines but had an immune compromising condition that prevented him from responding properly to the vaccine. 

I am not discussing this here to hit you over the head with a mallet if you are choosing not to vaccinate but rather to make sure that everyone has the data they need to make informed decisions.  It feels safer to opt not to vaccinate or delay vaccinations when the diseases the vaccines prevent are largely absent.  Now that safety net of herd immunity is fraying. 

More and more data support the safety of vaccines and over 20 studies have been published in the last couple of years refuting the association between vaccines and autism.  I also know that many parents remain skeptical and concerned about the risks of vaccinating their child on the AAP’s recommended schedule and my job is to make sure you have all the information you could need to decide about whether or not to vaccinate.  My job is not to bully you into doing it or chastize you for not, but rather to give you the information and allow you to make the decision for your child.  The tide though seems to be shifting.  The diseases vaccines prevent are resurfacing and as a result the decision whether or not vaccinate is more challenging and complex.  The risk of disease needs to be balanced against the risk of adverse outcomes from vaccinating.  We have good data about the risk of disease, and good data about the safety of vaccines and yet there is a common belief among many parents that they are taking a risk vaccinating.  But you are also taking an increasing risk by not vaccinating.  Food for thought.

Study the data, ask questions, and weigh the pros and cons and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

feeling under the weather January 26, 2009

Being a pediatrician has its pros and cons.  Starting yesterday I began to feel very tired and achey.  I did what I tell everyone else to do and drank a lot of fluids and slept an extra long time last night.  I even did what Jane Brody in the NY Times said was a good thing: to continue to exercise.  I ran on the treadmill today….a shorter distance and time than I normally would on a Monday and I must say, I DIDN’T HELP!  So much for THAT theory.

It was another busy day at the office and lucky for me, the day went very smoothly (thanks Tom and Maria!).  I am really growing quickly now with several new families every day and loving my work life…..I know its gotta be good when even on a day when I am achey and fatigued I left with a big, fat smile on my face.

As I have gotten busier, I have begun to think about the pros and cons of adding another provider.  I am just beginning to talk to pediatricians and pediatric nurse practitioners to see if I can find a good fit.  I am so committed to the different way the practice works (not just the physical environment but my accessibility and ability to really know every patient) that I would need to find just the right person.  I am only interested in someone part time but am hoping to find someone by the summer.   We shall see. 

If anyone has suggestions about whether a nurse practitioner or doctor would be more desirable to you or even what key features are important to you in a second provider, please comment here or email me at drmolly@birminghampediatrics.com.  I want to make sure that if I have someone join the family, that he or she will be embraced by all of you. 

Get lots of sleep, drink your fluids, and let me know what you think and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Superbowl Sunday and TV watching with kids (News blog too later this week) January 25, 2009

How much TV is too much?

This Sunday marks the biggest TV watching day of the year: Superbowl Sunday. More people will watch the pre-game show, the game itself, and the post-game show (not to mention the ads) than the inauguration! Lots of parents of young children ask me about TV watching and how much is too much. Lots of advice is out there and much of it good and full of common sense.

The American Academy of Pediatrics advises that children under two watch no television and children over the age of two watch no more than 30-60 minutes a day. This may seem extreme, but the children who watch a lot of television are much more likely to be obese, have difficulty concentrating in school, have poor imaginations, and act violently than children who watch much less.

Television watching is one of many things parents can do with their children and some TV is legitimately educational and enjoyable. But like the rest of life, you can have too much of even a good thing and frankly, a lot of what’s on TV isn’t even good! I advise parents to think about what they would be doing with their child if the television wasn’t on to help decide if they are watching appropriately. If you would have been building with Legos, reading together, dancing to music, cooking in the kitchen, playing catch or would otherwise have been actively engaged, and you have chosen to watch a DVD or TV show instead, then your child has lost out. Time one on one with you, engaged in a mutual activity will beat television (educational or not) hands down. But if you have already spent the last hour reading and coloring and playing kitchen with your child and you both need some down time, watching a DVD or television show together that you both enjoy could be a great way to spend a half hour.

Many parents aren’t asking about this sort of television watching but instead wonder about having the TV on in the background over the weekend or in the early evening, and ask if this is detrimental to the child. Most likely the answer is yes. Having the television on all afternoon on the weekend will distract and engage the parent, and even if the child is not interested or watching, he will miss out on time that could have been spent engaged with his parent who is less ‘available’ even when in the same room. In addition, children playing in the same room with the television on in the background had more difficulty sustaining attention to their activity and this may explain the association between TV watching and difficulties concentrating later on. So whether you have ‘Good Morning America’ and ‘The View’ and ‘Martha Stewart’ going all morning or the Michigan-Michigan State game on all afternoon, your child will have missed out.

Of course issues of exposure to the commercials that accompany sports (mostly for beer, cars, and PG-13 or R rated movie trailers) or the sexual content of many talk shows and soap operas also weigh in on the decision to have the TV on in the background. The morning and evening news programs are riddled with disasters and crime and would be distressing to many children.

Does this mean that you should just keep your TV off all the time? Not necessarily, but it does mean that using your DVR, Tivo or VCR to record the shows you want to watch is a better choice. Does this mean you should never watch a sports game with your children? Not necessarily, but it probably shouldn’t be an all afternoon or evening affair. So if you are going to watch the Superbowl, skip the pregame show and turn it off during half time. Talk about the game with your child and mute the commercials. Enjoy it, but do it with your children in mind.

Watch TV with your kids in moderation, play outside even when its cold, and run all winter long and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Potato chips, chocolate and family fitness night January 22, 2009

Yesterday was a great day.  I was just busy enough in the office to keep me out of trouble, I got to have my weekly meeting with my business partner, Cinzia, ran 3 miles and indulged myself with a small bag of potato chips and some Frango-like mints Pat brought back from Disney World.

As the afternoon was chugging along, I was happy as a clam.  The president of Quarton Elementary’s PTA brings her sons to me and when I saw Sharon in the office, we commented that we would be seeing each other that evening at the first annual Family Fun and Fitness Night.  We were both looking forward to it but were a bit uncertain about how it would go.  I joked with Sharon that I had loaded up on potato chips and chocolate to celebrate the evening event but had no idea I would need all those calories (and more) to make through the fun and active evening.

When I arrived at Quarton last night (I was a volunteer too), I sat with Sharon and Pam at the entrance filling out name tags and assigning kids to ‘teams’.  Six teams made up of at least 10 kids each (and just as many parents) converged for the first part of the evening where the kids could sample healthy foods like blueberries and organic sugar-free applesauce to healthy foods prepared by the school’s cafeteria vendor.  The food was donated by Trader Joes, Whole Foods, Plum Market and St. Joe’s hospital in Pontiac had folks there to talk about healthy living.  Posters filled with pictures of healthy foods on one side and less healthy ones on the other informed kids that they can still eat fun foods that are treats and be healthy at the same time. 

After that first half hour session was done, we then gathered as teams (color coded on our name tags) and traveled to six different classrooms over the next hour and fifteen minutes to try out a variety of different activities designed to keep your body healthy and active and have fun at the same time.  First we went to the yoga room and stretched, did downward facing dog, warrior 1 position, and a few other poses led by a parent from Quarton and a local yoga instructor before moving on to room number two.  In our second room we participated in a fitness game.  This was ingenious.  Mrs. Turner, the fit and inspiring phys ed teacher, had a picture of the food pyramid with colored sections that went from the peak of the pyramid to the base of varying sizes representing the major food groups (veggies, fruits, dairy, meats/proteins, grains, and fats) and had the kids review the categories.  She then showed us the four posters on the floor that matched the pyramid but were empty other than velcro.  A box in the middle of the room held a variety of laminated pictures of all sorts of foods that would be put on the food pyramid.  Kids (and parents in my case) would kneel or sit on a flat scooter and scoot ourselves to the box, choose an item, scoot to our food pyramid and place it in the proper place.  Four teams of three worked against the clock to see who could fill up their food pyramid with the most appropriate distribution of foods for a day in 7 minutes.  My team didn’t win but we had fun, were active, and learned something too!

The next activity we did was core strengthening.  Now THAT was a workout.  A Quarton parent led us through plank exercises (really hard to hold the position even for a minute or so), superman, some variations on the plank, some obliques strengthening and then finally some variations on a crunch that I am still feeling today!  That was 15 minutes of really hard work!  Next we moved to Punk Fitness which was a high energy, music booming aerobic workout using our bodies, hula hoops, and stretchy bands which was Conall’s favorite and really worked up a sweat.  This one was run by a woman who has been teaching these classes for a few decades and let’s just say she looks GREAT!

Our last stop of the evening (and by then my legs were singing from the action) was aerobics.  An energenic woman from Pleasant Ridge was running the class and worked out butts for the 15 minutes she had us.  It was invigoraging and fun and by the end of the hour plus of exercising (plus a 3 mile treadmill run at lunchtime) I was ready for bed!

This model of a family fitness night though was terrific.  One of the things I liked most about it was that it encouraged lots of activities that anyone could do regardless of coordination skills or abilities.  It didn’t require anyone to be on a true team where your performance was essential to winning or the cause for losing and as a result, all kids and adults of all abilities enjoyed it.  The only disheartening part of the night was that very few parents actually participated in the activities.  They would shepherd their kids around from place to place but wouldn’t do the yoga or punk fitness or aerobics with their kids.  I think one of the great potential messages of the evening is that keeping physically active is important for a lifetime and adults as well as kids should partake!  Kevin and I did and the kids loved seeing our large and uncoordinated bodies going through the same motions as theirs.  It was a great way to spend a family evening together!

Thanks to Betty Gusho and Mary Adams (along with their committee) for putting on this terrific evening.

Dance, aerobicize, and stretch with your kids and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Firsts January 20, 2009

As parents we get to experience the joy of many firsts…our child’s first smile, first laugh, first steps, first temper tantrum, first day of school, first time putting her head under water in the pool, first friendship, first date, first breakup, first day of college, and on and on.  Today we could share an historic first with our kids: the inauguration of the first black president.  

Whether you are a Democrat, Republican, Independent, or political agnostic, today will be a landmark in our lifetime.  Obama’s presidency will be a lot like the firsts we share with our children.  Today’s excitement will be tempered by the reality that can’t help but follow and will undoubtedly disappoint us at times.  As parents, we relish the firsts and love and support through the missteps and this presidency will be no different.  President Obama will err to be sure but how he manages and recovers from his mistakes will determine the success of his presidency.  

When each child is born, he or she is the vessel for all of our parental hopes and dreams but within a few minutes, or hours, or days, the child asserts her personality and our hopes and dreams adjust.  We have influence over our children but cannot make decisions for them.  When they make good choices, we can praise and congratulate them and when they make bad ones, we can show them the error of their ways and hold them close.  

President Obama will have the burden and blessing of great expectations.  Let’s hope that he makes more good choices than bad.  Let’s hope that the mistakes he makes are fixable.  

Since I was 7 years old I have watched each inauguration.  I have always been a patriotic sap and whether the incoming president represented my world view or not, the truly awesome experience of watching such a peaceful transfer of power amazes me to this day.  I remember well when Ronald Reagan took office and gave his first inaugural speech, I was crying because I was a Carter supporter and my parents helped me see that what makes our nation great is this democratic process, even when we disagree with the outcome.  A wonderful lesson learned.

Share the inauguration, the historic day, and your hopes or challenges for the new President with your children and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Influenza update January 19, 2009

This week I saw my first cases of influenza in the office.  Poor kids, they were really feeling lousy.  Of the four kids I saw this week with test proven influenza, one had had the flu vaccine.  Just to recap, influenza is a virus that gives high fever, runny nose, cough and severe illness….influenza does not cause the stomach flu (which is also running rampant these days).

Since one of the kids had the vaccine, I went to the CDC site to look at the data across the country and also to the Michigan Department of Community Health site to get more info.  I have good news and bad news.  The good news is that the strains through November that the CDC had available to test were vaccine preventable strains for the most part.  The bad news is that we have no data more recent than that to guide us and I did have a child who was vaccinated sick as a dog!  I will keep monitoring and let you know.

In the meantime, wash your hands like crazy!  Bring in your feverish kids if they are still having temps for three or more days or if they are acting very sick or coughing to the point of vomiting. 

High fever, really bad cough, and acting really sick means influenza and each day won’t be your best until you are over it!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com