Tuesday, November 17, 2009
As a junior doctor I was amazed to learn that constipation was a frequent pediatric disorder. When my daughter started having these problems, I learned that even if you give your kids a healthy diet, they still can develop constipation...
Constipation occurs commonly in children, affecting up to 10% at any given time! Still, not more than 3% of parents actually seek advice from a doctor for this condition. Constipation describes the infrequent passage of stools (bowel movements) or the passage of hard stools. Any definition of constipation depends upon comparison to how often the child normally passes stools and to the normal consistency of his or her stools.
One of the things that is frustrating for lots of parents is trying to understand why their child is constipated. Although many parents understand the role that too much cow's milk, a diet low in fiber and not drinking enough fluids have in contributing to constipation, they may have other children with the same diet who aren't constipated...
In addition to your kid's diet, the other important factor that contributes to constipation is having infrequent bowel movements. This often occurs after a child has had a large, hard and painful bowel movement, which can occasionally occur in anyone. After this, because (s)he may associate having a bowel movement with pain, (s)he will try to hold his/her stools. This creates a viscous cycle, where bowel movements are painful, so the child holds them in, causing the stools to be even larger and harder, which causes more pain when it finally does pass. Many parents mistake the behaviors that children develop to hold in stool as straining to have a bowel movement, but they are usually stiffening their muscles or fidgeting as an attempt to hold their stool in and avoid a painful bowel movement.
During the last thousands of years, when cholera and other gastro-intestinal infectious diseases where common and killed many people (especially children), natural selection favored people with slow bowels. I believe that is one of the reasons so many people have problems with their bowels.
Other factors that can contribute to constipation and infrequent stooling are: a bad experience with potty training or avoiding strange toilets (i.e. at school).
Non medical treatments for constipation include the 4 F's: more fluids, more fruit, more fat and more fibers. Of these 4, fluids (preferably water) and fibers (mainly found in vegetables like peas and beans) are most important.
Thursday, September 03, 2009
Most children who visit my office get this question somewhere during the consultation: "What do you want to be when you grow up?"
It is interesting to see that most kids aged 3 through 7 will have an answer to that question. However lots of teenagers disappoint me with some variant on "I have no idea". Teenagers live for today. Their brain is different. Somehow everything beyond today is hardly worth any attention. This "old" knowledge has recently been confirmed by f-MRI studies.
But don't parents play a role too? I think that the indecision we see in teenagers regarding their future doesn't improve from "modern parenting". No, don't get me wrong, I certainly don't want to go back to those times where parents determined the trade for their children. Parents should go beyond just saying "I leave it to my children to choose what they want to be when they grow up". I certainly believe parents should coach their kids from young age to think about what different choises there are, what each job implies. Learn them to weigh the up and the down sides of jobs. Teenagers who have an idea about what they want to be are more likely going to attend the correct school and will probably perform better.
Monday, May 18, 2009
Every fortnight, and sometimes every week I take my three kids to the
Rotterdam zoo (Blijdorp). I started this habit when Leanne, my eldest, became 2 years old (march 2007). Maarten, my eldest son was only 8 months old at that time. Believe me or not, but even an eight month old baby enjoys a zoo. Especially the aquariums with fish. You could see him looking at the fish and the water and marveling at it. My youngest son, Jesse, is eight months, and I see the same marvel in his eyes when he looks at the large sea-turtles or sharks swimming in Blijdorp's big "oceanium".
Leanne always walked the entire zoo. As soon as Maarten could walk, I encouraged him to leave the trolley and walk. He was only 15 months old, when I decided to leave the trolley at home because he walked most of the time. He would walk 3 or 4 consecutive hours without any problems.
Every time I visit the zoo, I see 3, 4 or even 5 year old kids sitting in trolleys pushed by their parents or grandparents. Why on earth do they do that? Don't they realize that walking is good for kids?
I find the zoo the ultimate place to educate my kids according to the principles of
philosophy for children. While walking the zoo with them I find many leads to stimulate their reasoning abilities, inquiry, critical and caring thinking (the creative thinking part is more up my wife's alley).
Sunday, May 17, 2009
One day during one of my consulting hours it occurred to me that I often get the same complaint from parents with completely different problems. In both cases the parents tell me their kids eat almost nothing! The first kid was growing on target but the general practitioner was concerned about her light weight. Her weight was indeed a bit more than 2 standard deviations below the expected weight-for-length. According to her mother she hardly ate at all. However, she did drink a lot, especially milk-derivates. I explained that such drinks have a lot of calories. Kids who drink rich drinks sometimes stop eating. If she wanted to get her child to eat better, she would have to give her water, or other drinks without sugars and protein. But as long as her kid was growing well, I wasn't to concerned.
The second child was sent to me because the GP wondered if the kid might suffer from "metabolic syndrome". She was very, very heavy. I don't think I ever saw a heavier child of that age (5 years old). According to her mum she ate almost nothing. She grew fat on the air she was breathing. This happens all the time. Most mothers of obese children tell me seriously that their kids never eat sweets, or snacks, or chocolates, actually they never eat, period. Apparently childhood obesity has something to do with parents who fail to see what is really going on. Often these kids drink to much rich drinks, another similarity with the skinny kids.
I always send such kids on a program to loose weight. Unfortunately I have yet to find a study that shows that such programs have a better outcome. On the long term that is. Lots of studies show short term weight-loss, but when you look at the same kids after 10 or 15 years, they are still obese.
Apparently childhood obesity is a more serious condition than leukemia. Nowadays almost all kids with leukemia are cured after 2 years of intense (evidence-based) chemotherapy. However, there is no evidence based therapy for childhood obesity. There is nothing more the doctor can do for you.
Saturday, May 16, 2009
Pediatricians in the Netherlands are seeing a dramatic increase in cases of alcohol-intoxication in teenagers. Past night I had to admit a 14 year old girl to the hospital who had drank half a bottle of Vodka (375 cc). She was quite fuddled and incoherent, but when I told her that I was going to take her to the children's ward she became angry and told me loudly and with a thick tongue that she was almost 15 and definitely NOT a child.
Well, I must admit she didn't look like a child, and I can imagine that the shopkeeper who sold her the Vodka might have thought she was adult. I took my time to talk with the parents, and the father confessed that he had allowed her to drink a cocktail on her 14th birthday.
Experts say that is where it often goes wrong. Children learn to drink alcoholic beverages at home, and then when there is no adult supervision, they drink to much.
The teenager brain is very vulnerable and gets damaged easily by alcohol intoxication. Since the brain continues to grow and develop until the early twenties, progenitor nerve-cells are at risk, which might explain why teenage alcohol abuse leads to serious problems in adult-hood as shown in recent studies.
Dutch hospitals have setup a network of outpatient clinics where teenage alcohol abuse is tackled. However I fear there is one similarity between alcohol abuse in teenagers and severe obesity, both are very serious problems, but health care professionals stand more or less powerless.
Friday, May 15, 2009
A few days a go my 2 year old son had a night terror. Around midnight we heard him crying loudly. Heidi and I were not sleeping yet, so we both run to his room to see what was wrong. We found Maarten was not awake, but crying loudly as if he was very scared and hurting.
Even though I knew that trying to sooth him was useless it was very hard not to do so. Heidi took him to our bed, trying to sooth him. It took several minutes before Maarten woke up, crying uncontrollably, all the time. Once awake he immediately stopped crying, pushed away my wife and run back to his own bed, and within minutes he was sleeping comfortably again. It was a very ungrateful experience for Heidi.
Night terrors are probably quite similar to the sleep walking you may see in elder children. In both cases one should not wake the child but just make sure that it doesn't hurt itself. Soothing, even calling their name may prolong the night terror, so following your instinct achieves the opposite of what you are trying to accomplish.
