From KFIT video star Dr. Pat: Tips to get kids to eat their fruits and vegetables

It’s a heat wave and in extreme temperatures, kids, like adults, find it tough to go outside for physical activity. We find it perfect timing for the release of Dr. Pat Cantrell’s new kid fitness video (demo below). The video, made in conjunction with kids fitness expert Anna Renderer, gives follow-along exercises along with health advice tailored to kids. We asked Dr. Pat to expand on one piece of advice she gives in the video: eat five servings of fruits and vegetables a day. For many parents, even one serving can be tough to get into a child. Many a parent has asked himself, “Does one bite of zucchini spit back onto the table count as a serving?” If this is you, then you’ll appreciate Dr. Pat Cantrell’s guest blog post.

– Dr. Lai and Dr. Kardos

Not eating enough fruits and vegetables is one of the biggest concerns that parents have regarding their children’s diet. The US department of agriculture recommends that children get at least five servings of fruits and/or vegetables in their diet every day. But most kids aren’t getting that amount. Below are 5 tips that can help children get their 5 a day.

Cut it! Kids love when food is cut into pieces that they can pick up. An apple or orange might sit on the counter in the fruit bowl. But, cut it up and all of a sudden it is much more appealing. Even the fast food restaurants have figured this out and instead of just handing a child an apple or orange with their kid’s meal, they get apple or mandarin slices.
Dip it! Some vegetables can be bitter to a child’s immature taste buds. Offering a yogurt or ranch dip can add the flavor they like and helps mellow out the taste of the vegetable.
Hide it! What they don’t know won’t hurt them! By disguising fruits and vegetables, kids will get the nutrients they need. Plus, without knowing it, kids will learn to develop the taste for the vegetables or fruits and their taste buds will be more accepting of the fruit or vegetable in the future. Smoothies are a perfect way to blend in a few servings of fruits and/or vegetables. You can also puree vegetables like carrots or spinach and add that to a pasta sauce! For more ideas, check out Jessica Seinfeld’s cookbook “Deceptively Delicious”.
Grow it! Gardens are a great way to get kids to eat more fruits and veggies! I took my sons (7 and 9) to their grandmother’s house and they ate just-picked sugar snap peas. I was shocked! First of all, they tried it without whining and second, they liked it and asked for more! Since the fruits and vegetables can be picked when they are ripe, they often taste better than the store bought version. Kids love to see the food grow and helping them be a part of the process encourages healthy eating.
Make it fun! Put cream cheese on celery and add raisins on top and you have Ants on a Log. Use cookie cutters to cut watermelon or cucumbers into fun shapes. The more appealing it looks, the more kids want to try it. For some fun ideas, check out http://familyfun.go.com/recipes/cooking-with-kids/.

Be creative and persistent and try to offer at least one or two servings of fruits and/or vegetables at each meal.

Pat Cantrell, MD, FAAP

Dr. Pat Cantrell, mother of two young boys (who can be picky eaters at times!), is a board certified pediatrician who has been practicing pediatrics at Southern California Permanente Medical Group for over 14 years. She has a special interest in pediatric obesity and is the President of KFIT Health, LLC (www.kidfitnessandhealth.com) which creates fitness and nutrition DVDs and products for children. A board member of the San Diego Childhood Obesity Initiative, Dr. Cantrell is also the Pediatric Obesity Champion for her medical group. Additionally she serves as Secretary of the San Diego Chapter of the American Academy of Pediatrics.

[youtube https://www.youtube.com/watch?v=BAx3wwtCbfQ?rel=0&w=560&h=315]

So big- we’re three years old today!

Two Peds in a Pod® turns three years old! In honor of our third birthday, we bring you our top ten parental experiences through the years list:

“Helping” your child manage his ice-cream cone (especially when he orders the soft chocolate kind with the chocolate sprinkles)
Coaching a sport you have not played in twenty years.
Playing hours of Mario Cart or Just Dance on the Wii (and losing every time)
Building snowmen
Coloring with brand new crayons (and the aroma of opening that new box of Crayolas!)
If you are a mom, discovering your teen daughter is the same shoe size and you can borrow her hip shoes
Experiencing your child’s first bike ride without training wheels
Getting to be the Tooth Fairy (shhh… don’t tell!)
Re-reading your favorite kid books (Dr. Seuss really was a genius)
Realizing your child honestly believes that you have a really good singing voice

We hope to celebrate many more birthdays with you. Please continue to send us your ideas at twopedsinapod@gmail.com, comment on our posts and tell your friends about us.

Happy,

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

Hold tight, but remember to let go

Let’s think about universal parental admonishments:

“Hold on tight.”

“Be careful.”

“Look out!”

“Don’t let go.”

Now let’s think about the universal goal of parenting: to create children who grow up to become independent.

That means that at some point, after your child learns to hold tight, be careful, and look out, your child will need to let go.

This inevitable march toward independence does not begin when your child turns eighteen, but rather years before. Kids learn independence in small steps starting when they are still babies in our eyes.

For instance, take feeding. First you breastfeed or bottle feed. Eventually you encourage your young child to drink out of her own cup as SHE holds it. When she’s able to pick up lint from the floor and stuff it into her mouth, you know she’ll be able to feed herself finger foods from the family dinner table. At 18 months, children are capable of wielding their OWN spoons and fork—so let her do so, no matter the mess. By constantly challenging her with self feeding, your toddler becomes the preschooler who eats lunch with her friends at “lunch bunch” and the college student who chooses to eat salad at the cafeteria.

How does a child learn to maneuver stairs? If you always carry her, she will never learn. Older siblings often teach the younger ones how to crawl backwards to the top of the steps and then go down safely buttocks first. I have fond memories of my son crawling backwards like a dump truck nearly the entire length of the hallway before reaching the steps. I would imagine a high pitched beeping sound as he inched backwards. As walking becomes steadier, your kid will learn to hold onto the banister as she goes up and down. Fast-forward and someday she will be the dexterous mom who carries her coffee in one hand, the laundry basket in the other and her phone between her ear and shoulder as she heads downstairs.

What does “be careful” mean? I find that kids often have no frame of reference for “careful” So be specific with your advice. When my kids were toddlers and carried cups of milk to the table, instead of only saying “be careful” I would remind them to “walk slowly.” If they (gasp) cut paper with scissors, I would say, “watch where your fingers are.”

For kids, personal safety is often not enough of a motivation to listen to advice. When my twins were almost two years old, I realized that I belted them in their double stroller so often in public, they did not have an opportunity to learn how to stay with me. So, one day I had them hold my hands as we crossed the parking lot at their older brother’s school. They immediately tried to escape and run in opposite directions. I instructed them to “hold tight to my hands” or “Mommy will have to carry you like a baby.” The thought of walking into their older brother’s school like “big boys,” kept them holding on.

Sometimes we need to allow children to fall, literally and figuratively. If missing the carpeted step that leads to the living room means your toddler falls, then let her learn from her mistake. An older child who insists on leaving his jacket at home will learn from natural consequences if he is too cold outside (remember you can’t catch a cold from the cold, you just feel cold). Remember all those skinned knees you sustained as a child? Yet now you can ride a two wheeler bike and you run faster because you practiced running, even if you fell a few times. If you make your child too afraid of falling, then he will be unable to take the risks involved in learning new skills.

Let your child complete his own homework from a young age. Offer to proofread but don’t nag. Teachers already have consequences in place for children who do not complete homework, or for those who do a sloppy job. Let your middle schooler choose which foreign language or musical instrument or sport he wants to learn without pointing out the practicalities of what you consider the “better” choice.

Of course we need to protect and guide our children. But we need to learn to relinquish control over our children’s actions at the appropriate ages.

As the viral internet sage Eva Witsel says, “I can spend my energy on limiting my child’s world so that he will be safe and happy or I can spend my energy on helping my child learn the skills to navigate our world himself so that he will be safe and happy. I think the latter has a better chance of success in the long term.”

In grade school I remember holding tight to the chains of the playground swing as I swung higher and higher. But I also remember that glorious feeling as I let go, sailed through the air, and landed on my feet.

Don’t deprive your child of that same glorious feeling of letting go.

Julie Kardos, MD with Naline Lai, MD
©2012 Two Peds in a Pod®

Molluscum contagiosum: the little rash with the big name

Kinda cute. At least that’s what the medical books lead you to believe. They are described as little pink or flesh-colored dome-shaped harmless bumps with belly buttons. The little rash with the big name, Molluscum Contagiosum, is cute only until you discover the bumps on your child’s skin. Like your neighbor’s cute toddler, the little belly-buttoned rash can overstay its welcome.

Pictured here is the rash of molluscum. The bumps are generally flesh colored, but can be slightly pink. Look carefully at the circled bump— this one has a tiny dimple in the center (the “belly button”). While the rash often appears on areas with irritated skin such as eczema, molluscum can show up on every part of the body. As with any new rash, visit your child’s doctor to confirm the diagnosis.

The best thing about molluscum is that it is not harmful. Children can attend school and camp with it. Yes it looks funny, but like warts, it is a virus that is only skin deep. Also, like warts, it can be very stubborn about going away. Probably because it is so benign, children’s immune systems don’t get excited about an out-cropping of molluscum and do not bother attacking the rash.

The rash is spread by direct skin to skin rubbing (think wrestlers or think kids rolling around in play or think sexual contact—teens can get molluscum in compromising areas) and by towel sharing and very close contact in water—siblings catch molluscum from each other when they bathe together. However, kids do not contract the virus in swimming pools. The rash itself is not particularly itchy. But, because it often appears on itchy patches of skin, kids will scratch areas with molluscum and with each scratch, spread the molluscum over a greater area. One of my patients first developed molluscum on the inner aspect of his arm. During the summer when he went shirtless, the rubbing of his arm against his body caused molluscum to appear on the side of his chest where his arm brushed against his body. Mysteriously, some kids don’t seem prone to picking up the rash. One of my twins had the rash all over his belly for close to a year. Yet my other twin only had one bump on his ankle for a few months.

Treating molluscum is frustrating. Pediatricians and dermatologists have some agents which irritate the molluscum in hopes that the body’s immune system will wake-up and get rid of it. Medications such as cantheridin (extract of blister beetle), Retin A, liquid nitrogen, and others all are used to treat molluscum with varying success rates. Hydrocortisone 1% three times a day for a few days will soothe itchy skin patches of molluscum. Although the medication will not cure the rash, it will help calm the itch and prevent further spread. Rarely, just like any area which is scratched, bacteria from the skin will infect the rash. If a bump is scratched open, put a dab of antibacterial ointment on along with the hydrocortisone. If redness increases and the area becomes progressively tender, seek medical attention. Take heart in the fact that molluscum DOES go away on its own, but can linger for months or even years before finally fading. My husband and I opted not to treat our twins, and waited for the molluscum to leave on its own, which it did. Often, just before spontaneously going away, the bumps become red and irritated for a day or so and then just… go.

When I diagnose a patient with this condition, the name of this rash always makes me feel like I am casting a Harry Potter spell:

Parent: “Doctor Kardos, what is this rash on my child?”

Dr. Kardos, brandishing a magic wand: “MOLLUSCUM CON-TA-GIOSUM!!!”

The medical literature and 15 years in pediatric practice tell me there are no vitamins or behavior therapies that play any role in banishing this rash. In short, there are no quick fixes.

If only the cure were as easy as waving a wand. We’ll let you know if we hear of any new spells.

Julie Kardos, MD with Naline Lai, MD
©2012 Two Peds in a Pod®

Dad to Dad: Parenting Like a Pro

Just in time for Father’s Day— the book Dad to Dad: Parenting Like a Pro. Written by our pediatrician colleague, Dr. David Hill, this North Carolina based Pediatrician brings a humorous, yet practical perspective on fatherhood. His book includes chapters on nontraditional parenting relationships, talking to kids about sexual development and helping your child sleep. Two Peds in a Pod is pleased to give you a sneak peek:

Dads are not good for kids just because we do the same stuff moms do. That’s not to say doing that stuff isn’t important; it’s critical! Mothers and fathers have a similar effect on their children’s moral development, social comptence, school performance, and mental health. There is a reason, after all, it takes 2 parents to make a baby, and not just because it’s more fun that way.

Probably the most accurate generalization about dads versus moms is that fathers play more. In the first 4 years of a child’s life we tend to focus on activities that involve touch and stimulation, like tickling, wrestling, and playing an airplane. It’s our job, in other words, to get kids all wound up so they won’t go to bed, to make them laugh until they pee on themselves. (Note: If this happens, be a good sport and help with the clothing change; after all, it is your fault.) During middle childhood, we’re more likely than mothers to get out and do stuff, like take walks, go fishing, or see a ball game. Are you surprised? No, you are not. You already knew that from watching sitcoms.

……

Some people might still call this a man’s world, but the corners of it devoted to child care can sometimes feel downright unfriendly to fathers. I recall times when, taking my young children to the playground, moms actually got up from a park bench where they had been talking and moved over to the next swing set. It’s possible they were just following the shade, but I couldn’t help looking around to see if my picture was stapled to a nearby utility pole.

As an involved father you might expect everyone you encounter to smile and praise you or tell you how impressed they are at what you’re doing. At times you will get this reaction. Some people seem amazed I can get my kids out of the house wearing 2 matched shoes. In fact, one of my pet peeves is when the children’s clothes clash and someone says, “Daddy must have dressed you today.” I want to look that person dead in the eye and say, “You don’t know me very well, do you? My daughter here left the house in a perfect little outfit, but she threw up on that one, and this is what was in the trunk of the car. Now stand back— she’s looking a little pale.”

David L. Hill, MD, FAAP

excerpted with permission, from Dad to Dad: Parenting like a Pro

Dr. David Hill is a pediatrician, writer and father of 3. He believes humor is essential to surviving parenthood. He has put this theory to the test at various times as a stay-at-home dad, a primary breadwinner, part of a 2-working-parent family, and a single father. He is vice president of Cape Fear Pediatrics. As a writer, Dr. Hill has composed and recorded humorous commentaries for National Public Radio’s All Things Considered and NPR affiliate WHQR. Dad to Dad: Parenting like a Pro is available at bookstores everywhere and through Independent Publishers Group and the American Academy of Pediatrics bookstore.

Summer time reading: crypto, poison ivy, swimmer’s ear, and preventing dehydration

mother cartoon Welcome to summer! Some seasonal topics to read up on: a germ that lurks in pool water, itchy rashes from poison ivy, painful ears from swimmer’s ear and how to prevent kids from dehydrating.

Julie Kardos, MD and Naline Lai, MD

A shred of advice: how to remove splinters

Yow!

Although I first cringed when I saw this splinter, it is actually one of my favorite kinds. It’s obvious and relatively easy to remove.

Now that summertime is upon us, many kids will want to run barefoot outside. Have your children wear shoes, especially on decks and docks, in the woods, and even in grass and sand in order to protect their feet. In short, if they are not actually swimming, kids (and adults) should wear shoes outside. Even for those who are careful, splinters have a way of magically embedding themselves in bare feet.

If the splinter is very tiny (too small to grab with tweezers,) seems near the skin surface, and does not cause much discomfort, simply soak the splinter in warm soapy water several times a day for a few days. Fifteen minutes, twice a day for four days, works for most splinters. Our bodies in general dislike foreign invaders and tend to evict them. Water will help draw out splinters by loosening up the skin holding the splinter. This method works well particularly for multiple hair-like splinters such as the ones obtained from sliding down an obstacle course rope. Oil-based salves such as butter will not help pull out splinters. However, an over-the-counter hydrocortisone cream will help calm irritation and a benzocaine-based cream such as Oragel will help with pain relief.

If the splinter is “grab-able”, gently wash the area with soap and water and pat dry. Don’t soak an area with a “grab-able” wooden splinter for too long because the wood will soften and break apart. Next, wash your own hands and clean a pair of tweezers with rubbing alcohol. Then, grab hold of the splinter and with the tweezers pull smoothly in the direction opposite of the way the splinter entered. Take care to avoid breaking the splinter before it comes out.

If the splinter breaks or if you cannot easily grab the end because it does not protrude from the skin, you can sterilize a sewing needle by first boiling it for one minute and then cleaning with rubbing alcohol. With the needle, pick away at the skin area directly above the splinter. Use a magnifying glass if you have to, make sure you have good lighting and for those middle-age parents like us, grab those reading glasses. Be careful not to go too deep, you will cause bleeding which makes visualization impossible. Continue to separate the skin until you can gently nudge the splinter out with the needle or grab it with your tweezers.

Since any break in the skin is a potential source of infection, after you remove the splinter, wash the wound well with soap and water. Flush the area with running water to remove any dirt that remains in the wound. See our post on wound care for further details on how to prevent infection. If the splinter is particularly dirty or deep, make sure your child’s tetanus shot is up to date. Also, watch for signs of infection over the next few days: redness, pain at the site, or thick discharge from the wound are all reasons to take your child to his doctor for evaluation.

Some splinters are just too difficult for parents to remove. If you are not comfortable removing it yourself of if your child can’t stay still for the extraction procedure, head over to your child’s doctor for removal.

Now you can add “surgeon” to your growing list of parental hats.

Julie Kardos, MD with Naline Lai, MD

Limiting BPA and other potential toxins in your child’s environment

Guest blogger pediatrician Heidi Román returns to us today to give practical advice on how to decrease potential toxins in your child’s environment.

In today’s world we are surrounded by “stuff”. We touch it, we eat from it, we drive in it, and we wear it. Before becoming a parent, I have to admit I didn’t think all that much about whether this “stuff” was safe. I had passing thoughts about toxic chemicals in “stuff”. Mainly, the environmental toxin I worried about as a pediatrician was my little patients’ exposure to lead.

Suddenly, as a new mom, I started to think about toxins a lot. I did little things like get BPA-free cups and bottles and avoid plastic toys. But, sometimes it feels like a losing battle. I did all kinds of research and bought a car seat with great safety ratings, only to later read a report that suggested it was “toxic”. And, in many cases the science is not definitive. A product may be found to have a substance that is considered toxic, but it is unclear whether or not the exposure is sufficient to actually impact the health of children. It all feels a bit overwhelming.

So, I’m here today to offer a few practical tips to parents who want to make their home environment safer for their kids; and, to let you know about some important legislation that is coming up that may help us all out.

1. Reduce exposure to BPA (bis-phenol A). We don’t yet have all the answers about the impact BPA may have on our kids. But, we do know this. BPA is all around us- particularly in food containers and linings. And, we have emerging evidence that it is an “endocrine disruptor“. The endocrine system is a set of organs that controls everything from body temperature to puberty via complex hormonal interactions. So called “endocrine disruptors” are thought to somehow alter these interactions. There is enough evidence out there about potential detrimental impact of pre-natal and post-natal exposure in kids (including suggestion of impact on behavior of young children) that I think it is time to dramatically reduce our exposure to BPA. Many companies who market products to babies have already made the switch- so look for BPA-free bottles and the like. You can also reduce your own exposure. Switch to glass food containers. Try to eat less canned food.

2. Improve the air quality in your indoor environment. Bring a few plants into your home. Varieties like the peace lily and rubber plants have been shown to significantly improve air quality. Switch to less toxic household cleaners or make your own from simple ingredients like vinegar, lemon juice, and baking soda. “Conventional cleaners often contain volatile organic compounds whose fumes can trigger asthma attacks and irritate the eyes, nose and respiratory passages”, says Maida Galvez, a pediatrician and environmental health specialist at New York’s Mount Sinai School of Medicine. Not only that, they are a significant poisoning risk to children if swallowed.

3. Decrease the number of products (cosmetics, etc) you use on your hair and skin. Learn more about the safety of those that you continue to use. Definitely use broad-spectrum sunscreen, but consider switching to a zinc oxide or titanium dioxide based formulation, especially for young children. Avoid aerosolized skin products, as there is risk of inhalation. Keep all personal care products out of reach of children.

4. Support TSCA reform. The Toxic Substances Control Act is the federal law that regulates which chemicals are deemed “safe” for use. The problem is that TSCA was passed in 1976 and has never been updated. TSCA grandfathered in 62,000 chemicals that were “presumed safe”. It does not require studies of health impact prior to chemicals reaching the market. Instead of requiring industries to prove the safety of chemicals, TSCA leaves the onus on the consumer and public and environmental health agencies to prove that they are unsafe after they’ve been available for use. It ties the hands of agencies like the EPA when they try to limit exposure, even to chemicals such as asbestos that are known to have adverse effects.

The great news is that for the past few years a growing coalition has organized to tackle TSCA reform. The EPA put forth a list of Essential Principles for Reform of Chemicals Management Legislation. Most importantly, the Safe Chemicals Act of 2011 (SB 847), put forward by Senator Frank Lautenberg, is making its way through the early legislative process. This bill seeks to improve chemical safety and protect our health using the best science available. It aims to reward innovative companies that attempt to put safer products on the market. The bill still needs our help to push it forward. Call your Senator and ask him or her to sign on as a co-sponsor.

One last thought. Many products are actually very safe. The trouble is, right now it is really hard to know which ones are okay for children and which ones aren’t. Parents have enough to worry about. Let’s give some of the responsibility regarding unsafe chemical exposures back where it belongs- to the industries producing chemicals and the regulatory agencies designed to keep our communities safe. And, for now, a few easy changes at home can keep toxic stuff away from your kids and help keep them safe and healthy.Heidi Román, MD

Heidi Román MD, FAAP is a mother and pediatrician who practices in San Jose, California. She has special interest and experience in public policy issues and working with under-served families from diverse racial and socio-economic backgrounds. Find her thoughtful blog posts at

mytwohats.wordpress.com.

Special thanks to toxicologists Alan Woolf and Melisa Lai Becker for reviewing this post.

Add 7/18/12: The FDA announced on July 16, 2012 that BPA is banned from use in baby bottles and sippy cups. BPA use in other containers is still permitted. Click here for the New York Times article.

Air on the side of caution: Is your child having difficulty breathing?

Early childhood educators wear many hats. Not only do they teach, but also they are often called on to give medical attention to their students. Last week we shared with early childhood teachers at the Delaware Valley Association for the Education of Young Children’s 2012 Early Childhood Conference the signs a child is in respiratory trouble. Although we focused on asthma, these signs of respiratory difficulty may be present in a variety of illnesses such as pneumonia.

Since parents also put on “medical hats,” we also wanted to share with you what we taught them to watch for. Signs of difficulty breathing:

Breathing faster than normal
Your child’s nostrils flare with each breath in an effort to extract more oxygen from the air
Your child’s chest or her belly move dramatically while breathing—lift up her shirt to appreciate this
Your child’s ribs stick out with every breath she takes because she is using extra muscles to help her breathe—again, lift up her shirt to appreciate this. We call these movements retractions
Grunting sound (a slight pause followed by a forced grunt/whimper) or a wheeze sound at the end of each exhalation
A baby may refuse to breast feed or bottle feed because the effort required to breathe inhibits her ability to eat
An older child might experience difficulty talking
Your child may appear anxious as she becomes “air hungry” or alternatively she might seem very tired, exhausted from the effort to breathe.
Your child is pale or blue at the lips

In this video, the child uses extra chest muscles in order to breath. He tries so hard to pull air into his lungs that his ribs stick out with each inhalation.

[youtube https://www.youtube.com/watch?v=MydbWObLzDU?rel=0]

For those with sensitive asthma lungs, review our earlier asthma posts. Understanding Asthma Part I explains asthma and lists common symptoms of asthma and Understanding Asthma Part II tells how to treat asthma, summarizes commonly used asthma medicine, and offers environmental changes to help control asthma symptoms.

Mother’s Day: thoughts to nosh on

mothers day My youngest child clambered off the bus Friday afternoon with a fixed grin across his face.

“What are you doing here?” he asked curiously. Usually, I am not home in time to greet the afternoon bus.

“I came to walk you home from the bus stop and then go for a run,” I said beaming, and kissed him on the forehead.

As my son stiffly kissed me back, the strange fixed grin remained on his face. Then I noticed his hands were behind his back. With a sly glance, I saw he clutched a crinkled brown paper bag. I smiled. Hidden crumpled paper bags close to Mother’s Day mean only one thing — a “surprise” gift.

“Don’t you want to go running now?” my son asked as we walked up our driveway, carefully rotating his body so that he continued to face me.

“Yes, good idea” I said, and resisted the temptation to look back.

As I jogged through the neighborhood, I mused over the upcoming holiday and what it meant to be a “happy” mother on mother’s day. Last week I had gained some insights after participating on a panel at Brown University’s Women’s Leadership Conference. The topic of the discussion was “Happy Kids/Happy Parents: What’s the Secret Sauce?” The talk was lively, and since it was a women’s conference, discussion focused on motherhood. Ultimately the conclusion made by moderator Clare Hare was “There is not one right way to parent,” but, perhaps, some good guidelines. Here are some ideas to think about:

On the dilemma of working outside the house vs. working full time as a mom at home: As a mom it is easy to give, give, and give so much of yourself to others that you can lose a little (or a lot) of your own self-identity. By maintaining a self-identity you become a more confident mother. Some women draw confidence from forging a career outside the home. Others draw from organizing local community-based activities. A mom ultimately needs to feel at the end of the day that she raised her own child, no matter how she does it. Stop comparing yourself to others and do what is right for your own family. In an economy where it is often not financially feasible for one partner to stay at home, working outside the home may be less of a choice and more of an obligation; however, the crucial point remains— if you are not the person you want your child to see, then become the person you want her to see.

On helicopter parenting: Worried that you are too much of a helicopter parent? Know where to draw the line. Use the “cry now or cry later” philosophy. If you know your child will be crying in 30 years when he is obese and diabetic because you didn’t insist on a healthy diet with limited “junk”, stand your ground and let him cry now and you refuse him a second helping of cake. If you know your child will NOT be crying in 30 years because you didn’t insist that he continue piano lessons, let it go.

On keeping you and your child sane during the college admission process: Yes, statistically it’s tougher than ever to get into colleges- this is a matter of demographics. There are more college-bound seniors because of population growth, and hence more applicants per spot. But the pressure for students to overextend themselves in multiple activities is imposed by parents and the kids themselves, not by the admission offices. In the years preceding applying to college, encourage your child to concentrate on excelling in specific areas—think quality not quantity. Do what comes from the heart. When your child seems overwhelmed, as Dr. Kardos and I always say, insure basic needs are met — eat, sleep, drink, pee and poop. And don’t forget to leave time for play and relaxation.

On ignoring hype: Be willing to change your opinion in light of data. Use evidence, not hype, to drive your actions. Despite data showing teens naturally awaken later in the morning than younger children, one audience member recounted how she still encountered many difficulties when she advocated for later high school start times in her school district.

All thoughts to nosh on.

You never realize the soaring magnitude of your own mother’s love until you meet your child. No matter your approach to raising children, we wish you “happy” as you remember how you felt when you were the child who brought home a brown crinkled paper bag to surprise your own mom. And again “happy” as you feel gratitude and awe for the privilege of now receiving the surprise.

Dr. Kardos and I wish you a Happy Mother’s Day.

Naline Lai, MD

Special thanks to my fellow panelists: Clare Hare, Principle of Clare Hare Design; Jill Hereford Caskey, Director, Alumni College Advising Program, Office of Alumni Relations, Brown University; Judith Owens , Director of Sleep Medicine, Children’s National Medical Center; Peg Tyre, Director of National Advocacy, Edwin Gould Foundation, author of The Trouble With Boys and The Good School.