Breakfast of champions

I know that as a pediatrician I shouldn’t find it hard to keep up with parenting trends, but honestly, it’s exhausting! The new thing now is “grit,” right? I thought I had it down, but even here in the South, there are only so many ways to feed kids ground hominy before they complain, ironically demonstrating a complete lack of grit.

I like this grit concept, though. As parents, we get to do what we’ve always done: make our kids’ lives difficult for no reason. But now we can claim that we’re just preparing them for an economic landscape in which only the most determined workers will ever earn more than their parents. While those successful few feast on caviar and champagne, everyone else will have to eat...well, you know.

Hows and whys

Pediatricians are just so nice! It’s weird, right? I mean, we’re too nice. Apparently. the folks at the American Academy of Pediatrics and the ABIM Foundation agree, because they’ve teamed up to create the Choosing Wisely campaign, a coordinated multimedia strategy to help us learn how to say “no” to stuff. They knew, after all, that if they offered us this program we’d be too polite to turn it down.

iStock

Using evidence-based guidelines and surveys, the sponsors identified the Top 10 common pediatric interventions whose risks clearly outweighed their benefits, ranging from #10: Using home apnea monitors to prevent SIDS to #1: Treating viral upper respiratory infections with antibiotics. That one probably needs a #1a: Justifying doing #1 based on some lame excuse like green snot or a red throat. If you can convince yourself that green snot means a sinus infection, hopefully you can later convince yourself that a giant boil draining methicillin-resistant Staph aureus means a mosquito bite.

Not only does Choosing Wisely include a list of stuff not to do (antacids for “happy spittters,” anyone?), but it comes with video modules to teach pediatricians exactly how to tell parents that their kids do not need a CT scan for falling off the couch. Future modules will walk providers through explaining to their hospital administrators why their Press Ganey patient satisfaction scores have fallen.

Psych!

Do you find it scary how many patients you send for help with serious psychiatric conditions who never go? Is it possible that we would live in a perfectly sane world if only every child referred to a mental health provider actually went? Of course, in such a world we may never get another Miley Cyrus.

A group of researchers in Pittsburgh may have solved this problem: Every pediatrician’s office should have its own mental health provider. How good an answer is it? Among 321 kids sent for mental health referral, only 54% went when the provider was located somewhere else, compared with more than 99% when the provider was in the same office as the pediatrician.

Once they see these numbers, I expect psychiatrists to be lining up outside our doors begging to sublease our broom closets. Unless, of course, we already don’t have enough pediatric mental health providers to see the patients who do show up. Right. I may as well put those brooms back.

But why stop with co-located mental health services? My dream office would include a toy store, an ice cream shoppe, a day care, and a puppy adoption center. Of course with all that, we’d definitely need to add services for adult mental health.

Chemistry minor

This is the kind of quote I find scary: “It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

What could this man, speaking to the New York Times for a March 23rd article, be talking about? Sarin gas? Methamphetamine? Whatever they put in Vienna sausages? What if I told you this potent neurotoxin was also brightly colored, attractively scented, and sold with no regulations whatsoever in non-child-safe bottles? No, it’s not 5-Hour Energy. Try nicotine refills for e-cigarettes. Now are you scared?

Depending on the concentration, e-cigarette liquid refills contain enough nicotine to send a child to the hospital just from spilling it on the skin. Drinking a bottle could be deadly. By now, you’ve already grasped the possible consequences: We have one more hazard to discuss at our well child visits. Hopefully before long, regulators will address these substances, with some grit.

David L. Hill, M.D., FAAP is the author of Dad to Dad: Parenting Like a Pro (AAP Publishing, 2012). He is also vice president of Cape Fear Pediatrics in Wilmington, N.C., and  adjunct assistant professor of pediatrics at the University of North Carolina at Chapel Hill. He serves as Program Director for the AAP Council on Communications and Media and as an executive committee member of the North Carolina Pediatric Society. He has recorded commentaries for NPR's All Things Considered and provided content for various print, television, and Internet outlets.

I know that as a pediatrician I shouldn’t find it hard to keep up with parenting trends, but honestly, it’s exhausting! The new thing now is “grit,” right? I thought I had it down, but even here in the South, there are only so many ways to feed kids ground hominy before they complain, ironically demonstrating a complete lack of grit.

I like this grit concept, though. As parents, we get to do what we’ve always done: make our kids’ lives difficult for no reason. But now we can claim that we’re just preparing them for an economic landscape in which only the most determined workers will ever earn more than their parents. While those successful few feast on caviar and champagne, everyone else will have to eat...well, you know.

Hows and whys

Pediatricians are just so nice! It’s weird, right? I mean, we’re too nice. Apparently. the folks at the American Academy of Pediatrics and the ABIM Foundation agree, because they’ve teamed up to create the Choosing Wisely campaign, a coordinated multimedia strategy to help us learn how to say “no” to stuff. They knew, after all, that if they offered us this program we’d be too polite to turn it down.

iStock

Using evidence-based guidelines and surveys, the sponsors identified the Top 10 common pediatric interventions whose risks clearly outweighed their benefits, ranging from #10: Using home apnea monitors to prevent SIDS to #1: Treating viral upper respiratory infections with antibiotics. That one probably needs a #1a: Justifying doing #1 based on some lame excuse like green snot or a red throat. If you can convince yourself that green snot means a sinus infection, hopefully you can later convince yourself that a giant boil draining methicillin-resistant Staph aureus means a mosquito bite.

Not only does Choosing Wisely include a list of stuff not to do (antacids for “happy spittters,” anyone?), but it comes with video modules to teach pediatricians exactly how to tell parents that their kids do not need a CT scan for falling off the couch. Future modules will walk providers through explaining to their hospital administrators why their Press Ganey patient satisfaction scores have fallen.

Psych!

Do you find it scary how many patients you send for help with serious psychiatric conditions who never go? Is it possible that we would live in a perfectly sane world if only every child referred to a mental health provider actually went? Of course, in such a world we may never get another Miley Cyrus.

A group of researchers in Pittsburgh may have solved this problem: Every pediatrician’s office should have its own mental health provider. How good an answer is it? Among 321 kids sent for mental health referral, only 54% went when the provider was located somewhere else, compared with more than 99% when the provider was in the same office as the pediatrician.

Once they see these numbers, I expect psychiatrists to be lining up outside our doors begging to sublease our broom closets. Unless, of course, we already don’t have enough pediatric mental health providers to see the patients who do show up. Right. I may as well put those brooms back.

But why stop with co-located mental health services? My dream office would include a toy store, an ice cream shoppe, a day care, and a puppy adoption center. Of course with all that, we’d definitely need to add services for adult mental health.

Chemistry minor

This is the kind of quote I find scary: “It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

What could this man, speaking to the New York Times for a March 23rd article, be talking about? Sarin gas? Methamphetamine? Whatever they put in Vienna sausages? What if I told you this potent neurotoxin was also brightly colored, attractively scented, and sold with no regulations whatsoever in non-child-safe bottles? No, it’s not 5-Hour Energy. Try nicotine refills for e-cigarettes. Now are you scared?

Depending on the concentration, e-cigarette liquid refills contain enough nicotine to send a child to the hospital just from spilling it on the skin. Drinking a bottle could be deadly. By now, you’ve already grasped the possible consequences: We have one more hazard to discuss at our well child visits. Hopefully before long, regulators will address these substances, with some grit.

David L. Hill, M.D., FAAP is the author of Dad to Dad: Parenting Like a Pro (AAP Publishing, 2012). He is also vice president of Cape Fear Pediatrics in Wilmington, N.C., and  adjunct assistant professor of pediatrics at the University of North Carolina at Chapel Hill. He serves as Program Director for the AAP Council on Communications and Media and as an executive committee member of the North Carolina Pediatric Society. He has recorded commentaries for NPR's All Things Considered and provided content for various print, television, and Internet outlets.

I know that as a pediatrician I shouldn’t find it hard to keep up with parenting trends, but honestly, it’s exhausting! The new thing now is “grit,” right? I thought I had it down, but even here in the South, there are only so many ways to feed kids ground hominy before they complain, ironically demonstrating a complete lack of grit.

I like this grit concept, though. As parents, we get to do what we’ve always done: make our kids’ lives difficult for no reason. But now we can claim that we’re just preparing them for an economic landscape in which only the most determined workers will ever earn more than their parents. While those successful few feast on caviar and champagne, everyone else will have to eat...well, you know.

Hows and whys

Pediatricians are just so nice! It’s weird, right? I mean, we’re too nice. Apparently. the folks at the American Academy of Pediatrics and the ABIM Foundation agree, because they’ve teamed up to create the Choosing Wisely campaign, a coordinated multimedia strategy to help us learn how to say “no” to stuff. They knew, after all, that if they offered us this program we’d be too polite to turn it down.

iStock

Using evidence-based guidelines and surveys, the sponsors identified the Top 10 common pediatric interventions whose risks clearly outweighed their benefits, ranging from #10: Using home apnea monitors to prevent SIDS to #1: Treating viral upper respiratory infections with antibiotics. That one probably needs a #1a: Justifying doing #1 based on some lame excuse like green snot or a red throat. If you can convince yourself that green snot means a sinus infection, hopefully you can later convince yourself that a giant boil draining methicillin-resistant Staph aureus means a mosquito bite.

Not only does Choosing Wisely include a list of stuff not to do (antacids for “happy spittters,” anyone?), but it comes with video modules to teach pediatricians exactly how to tell parents that their kids do not need a CT scan for falling off the couch. Future modules will walk providers through explaining to their hospital administrators why their Press Ganey patient satisfaction scores have fallen.

Psych!

Do you find it scary how many patients you send for help with serious psychiatric conditions who never go? Is it possible that we would live in a perfectly sane world if only every child referred to a mental health provider actually went? Of course, in such a world we may never get another Miley Cyrus.

A group of researchers in Pittsburgh may have solved this problem: Every pediatrician’s office should have its own mental health provider. How good an answer is it? Among 321 kids sent for mental health referral, only 54% went when the provider was located somewhere else, compared with more than 99% when the provider was in the same office as the pediatrician.

Once they see these numbers, I expect psychiatrists to be lining up outside our doors begging to sublease our broom closets. Unless, of course, we already don’t have enough pediatric mental health providers to see the patients who do show up. Right. I may as well put those brooms back.

But why stop with co-located mental health services? My dream office would include a toy store, an ice cream shoppe, a day care, and a puppy adoption center. Of course with all that, we’d definitely need to add services for adult mental health.

Chemistry minor

This is the kind of quote I find scary: “It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

What could this man, speaking to the New York Times for a March 23rd article, be talking about? Sarin gas? Methamphetamine? Whatever they put in Vienna sausages? What if I told you this potent neurotoxin was also brightly colored, attractively scented, and sold with no regulations whatsoever in non-child-safe bottles? No, it’s not 5-Hour Energy. Try nicotine refills for e-cigarettes. Now are you scared?

Depending on the concentration, e-cigarette liquid refills contain enough nicotine to send a child to the hospital just from spilling it on the skin. Drinking a bottle could be deadly. By now, you’ve already grasped the possible consequences: We have one more hazard to discuss at our well child visits. Hopefully before long, regulators will address these substances, with some grit.

David L. Hill, M.D., FAAP is the author of Dad to Dad: Parenting Like a Pro (AAP Publishing, 2012). He is also vice president of Cape Fear Pediatrics in Wilmington, N.C., and  adjunct assistant professor of pediatrics at the University of North Carolina at Chapel Hill. He serves as Program Director for the AAP Council on Communications and Media and as an executive committee member of the North Carolina Pediatric Society. He has recorded commentaries for NPR's All Things Considered and provided content for various print, television, and Internet outlets.