Ask the Pediatrician

A healthy adult can go years between doctor visits. But even the heartiest child requires regular checkups and occasional tune-ups. So if you find yourself constantly dialing up the pediatrician’s office, don’t worry; it doesn’t make you a hypochondriac. More likely, you’re just a concerned parent. However, to help curtail your anxious moments, we asked five Marin-area pediatricians to address the most common concerns that arise at each stage of a child’s development. 

{ Ages 0 to 1 }
Common Issue: Sleep

How do I get my baby to sleep through the night? According to Dr. Rachel Bauer, pediatric director of Prima Kids, the pediatric arm of Marin’s Prima Medical Foundation, that’s the question on most sleep-deprived new parents’ minds. And the short answer: “I tell parents that most babies are developmentally and physically ready to sleep through the night beginning at around 4 to 6 months,” says Bauer. But getting a baby from ready to able isn’t always easy. And that’s because a baby doesn’t instinctually know how to put herself to sleep. It’s something she needs to be taught. According to Bauer, parents can begin teaching this skill at around week six or eight. The goal is to train your infant to soothe herself rather than rely on external cues such as rocking or feeding. “The best way to achieve this is to put your baby to bed slightly awake so she can learn to nod off without any assistance,” says Bauer. 

Of course, not every baby is a quick study in this early life lesson. Teaching her to fall asleep without assistance may mean allowing her to cry herself to sleep. Parents need to know that they are in no way harming their child by letting the child cry out in frustration. Quite the opposite. “It’s the first of many lifelong skills a parent needs to teach,” says Bauer. Keep in mind, too, that between four and seven months is the ideal time to impart this important lesson. “From the standpoint of a baby’s brain development,” Bauer says, “it just gets harder because then you have to teach them not only to self-soothe but also to undo their reliance on external sleep cues.”

{ Ages 1 to 3 }
Common Issue: Minimizing Sick Days

The term “snot-nosed kid” is definitely not a flattering way to describe a child. But when it comes to toddlers, the label, however unkind, often fits the bill both figuratively and literally. In fact, at this age it’s developmentally appropriate that your child both be cantankerous and have a seemingly endless runny nose. “Toddlers are out and about more and as a result they are going to be exposed to more illness,” says pediatrician Stacia Kenet Lansman, founder of Pediatric Alternatives in Mill Valley, a practice that combines alternative healing theories with Western medicine. “It’s not uncommon for a child to get a cold every month, and each of those colds can last for up to two weeks.” And, of course, each time the child gets a cold he runs the risk of contracting a secondary infection, which just adds to the overall number of sick days. When you consider that a sick toddler is typically surlier than one who is well, it’s clear why parents are desperate to keep their children healthy.

Fortunately, there are ways to boost a child’s immune system and curtail sick days. For starters, Lansman stresses the importance of eating a diet of organic, whole foods and minimizing the consumption of processed products. “Good nutrition is key to keeping your child healthy,” she says. To that end, Lansman recommends children take a daily supplement of omega-3 fatty acids because there’s simply not enough of it in the American diet. “They can get the omega-3 they need by giving them one teaspoon of flavored cod liver oil daily or by mixing one to two teaspoons of ground flax seed or chia seed into oatmeal, yogurt or smoothies.” She also sings the praises of probiotics. “Studies show that children who take probiotics twice a day get sick less often and heal quicker.” And last but certainly not least, she emphasizes the importance of quality sleep. “Skipping naps, or keeping a child up late will negatively affect your child’s immune system and lead to frequent illness.”

{ AGES 3 to 5 }
Common Issue: Picky Eaters

Among the preschool set, buttered noodles, grilled cheese and hot dogs are true delicacies. Fruits, vegetables and whole grains, not so much. This leads many parents to worry that their child isn’t eating a well-balanced diet. “It’s normal for children to get more selective in their foods choices at this age, but that doesn’t mean you shouldn’t try to expand their tastes.” says Dr. Julie Bokser, a pediatrician in private practice at Tamalpais Pediatrics with offices in both Greenbrae and Novato. “Eat meals as a family when possible; kids are much more likely to try a new food if they see others eating the same. I recommend placing three different foods on a plate, one that you know they like, plus another two that the rest of the family is eating.” As a parent, Bokser notes that your job is to offer healthy food choices, make mealtimes enjoyable and be
creative about the presentation. How much and when kids eat is mostly up to them. Also, she notes to keep in mind that you may have to offer a child a food a dozen times before he’s willing to give it a try.

“Have your child prepare the meal with you,” suggests Bokser. “The likelihood that they will try a new food increases greatly if they’re involved in cooking it.” The goal is five servings of fruits and vegetables a day, “but,” Bokser cautions, “you don’t want to turn it into a power struggle. Children this age may eat only fruits one day and vegetables the next. I would make it a goal to have a balanced week, and not look at each individual day.”

Bokser also suggests these additional tricks for enticing preschoolers who are picky eaters: Be creative and make it fun. Ideas include dipping fruits and vegetables in spreads, such as carrots in hummus and apple slices in yogurt. Make sandwiches into shapes using cookie cutters and create a colorful face out of fresh fruits and vegetables.

{ AGES 6 to 12 }
Common Issue: School Performance

Until a child is ready for elementary school, parents are mostly focused on honing their little one’s social skills. Learning to share, taking turns and negotiating conflict are life lessons taught at home as well as in a preschool setting. But beginning around age six, children are also expected to achieve academically. And that’s when parents may begin to notice a child is falling behind.

“Parents will come in and note that their child is struggling in school, and they’re at a loss for how to help them achieve,” says Dr. Cindy Chung, chief of pediatrics for Kaiser Permanente San Rafael. In these instances, Chung will ask questions to explore possible explanations. Sometimes children are distracted because of issues going on outside the classroom. If the child is being bullied, for example, or there’s instability within the family unit, it can certainly have an effect on a child’s scholastic success. Working toward improving external circumstances can help turn things around. But other times the problem is in the child’s hard wiring.

“This is the age when we begin to see kids struggling with learning disabilities and/or attention deficit disorder,” she says. If Chung suspects as much, she’ll recommend that a child be evaluated. Once a diagnosis is made, the parent can decide how to address the problem. “Medication is sometimes used to control ADD/ADHD,” says Chung. “But it’s also about educating the parent about the condition so they can help create an environment where the child is more likely to be successful.”

{ AGES 13 to 18 }
Common Issue: Mental Health

Caring for a newborn can be physically grueling. But parenting a teen, well, that can be emotionally grueling. And it’s not surprising that growing into an adult is no cakewalk for your pubescent offspring either. In fact, according to Dr. Mary Piel, a pediatrician in private practice at Golden Gate Pediatrics in Mill Valley, 21st-century adolescents are constantly struggling to stay afloat in a sea of stress. “It’s incredible what today’s teens are expected to accomplish,” says Piel. “These days if you want to get into a good college, a 4.0 isn’t good enough. They also want you to take advanced placement classes, play a sport and participate in multiple extracurricular activities, too.” And for some kids, expectations such as those are simply overwhelming. Add to that the steady stream of unattainable body images projected by the media and, well, now nearly every teen has some beef with his or her physical appearance.

“The grass is always greener,” says Piel. “The tall ones wish they were shorter. The short ones want to be taller.” Piel points out that to some extent these feelings of inadequacy are natural. “Parents need to keep in mind that feelings of angst are normal and part of the growing up process. You just have to hope that eventually they get to the place where they can say, ‘I like who I am.’ ”

Of course, for children who seem particularly unhappy, stressed out or anxious, Piel recommends counseling. “We regularly refer kids to see a psychologist or psychiatrist,” she says. “Of those referrals, I’d say around one-third also use medication to keep the symptoms under control.” But even kids who suffer from more garden-variety stress need to be carefully monitored. Piel suggests slowing things down to give the adolescent enough space to unwind. “One after-school activity is plenty,” says Piel. She also emphasizes the importance of family dinners. “It’s a great way for parents to stay in touch with their teens and listen to what they have to say,” she says. “Even if you don’t agree with everything they’re saying, they need to have their opinions validated.”

From newborn to teen, raising a child is difficult. But staying involved and active in your child’s life and handling these issues as they come up goes a long way toward creating not only a healthy child but also a healthy parent-child relationship.