Council on Communications and Media Blog

Screens and Teens: The Downside

2018-06-24T21:53:00.001-04:00

Azadeh Sami, DO, MSPH

A typical encounter for pediatricians: We walk into a room to begin a well check for a teenager, whose eyes are glued to a cell phone. We gently ask for the teen’s attention to begin the visit, as he/she reluctantly turns the phone over to the parents. When reviewing lifestyle habits, we discover that although a 9:30pm bedtime is reported, actual sleep onset occurs 2 hours later. When asked what they typically do before bed, the teens’ answers consist mainly of “on the phone”, “texting”, or “on my computer.” Homework is online, texting maintains social status among peers, study breaks consist of video games, and by the end of the day, the teen has spent at least 6 hours of the day on the screen. Parents note, by the way, that the patient has recently been feeling very fatigued.

Thankfully, journals and websites have raised awareness of this overwhelming problem, in ways that are now hitting home for many families. Recently, Forbes magazine published an article effectively illustrating the link between screen time and shifts in brain activity. The infographic in this article strikingly notes that brain imaging research shows screen technologies and cocaine affect our brain’s frontal cortex in the same way. This correlation is exactly what we as pediatricians need to help make our advice more concrete for the new generation.

The article presents a Cincinnati Children’s Hospital study examining brain activity in those who spend more time on screens versus reading books. Screen time was linked to poorer connectivity in areas that govern language and cognitive control. Reading, on the other hand, was linked to better connectivity in these regions. Furthermore, another study cited in the article demonstrated that GABA levels were increased in those who were addicted to the internet. More specifically, the rise in GABA levels is believed to be a functional loss of integration and regulation of processing in the cognitive and emotional neural network. But no need to worry, as these changes generally reversed when the teens went through cognitive behavior therapy (CBT) for their addiction.

I recently gave a community lecture regarding How to Increase Your Child’s Success in School, incorporating the AAP’s recommendations as well as studies done by psychologists regarding the true qualities needed for success in life. In preparing for this lecture, I learned about the role of excess screen time on the balance between the visual system and the vestibular system. When the two are not in sync, as when the visual system has been overly stimulated by the bright screen, without allowing the rest of the body to “catch up”, young children begin to feel restless. For that, I like to recommend to patients to put a timer near the screen. For every hour spent on the screen, when the timer goes off, they must stop and engage in some sort of physical activity for one hour. The invention of the Wii seemed initially to be the answer to our struggles, but to our disappointment, we have discovered that levels of physical activity did not significantly change with the coming of this exciting “exer-gaming” concept.

Not to mention the added effects of social media. Patients who are perpetually exposed to their peers’ posts about the car they drive, the parties they went to, or the vacations they took, acquire a feeling of inadequacy. Over time, the sense of inadequacy can become so uncontrollable, it ultimately develops into depression. The Forbes article cites a study showing that about 48% of those who spent five or more hours a day on their phones had thought about suicide or made plans for it, as compared to 28% of the teens who spent only one hour per day on their phones.

With regards to sleep onset and quality, we know that the type of light emitted by screens is primarily blue light. This blue light is what the sun emits, which in turn suppresses melatonin.

The bottom line is this: the effect of screen time is multi-fold. Poor vision. Depression. Inactivity, and thus, obesity. Delayed sleep onset. Poor sleep quality. Poor brain connectivity leading to poor school performance. Suicide. It’s overwhelming.

I hope the information presented in this blog is helpful for those pediatricians who feel they are truly struggling to convince their patients the dangers of excessive screen time. At least I’m sure you can all relate.

Is Your Child Being "Brain Hacked"? Part 2

2018-05-25T09:51:00.000-04:00

Paul Smolen MD FAAP

Semi Retired Pediatrician Charlotte, NC

Founder of the pediatric blog, docsmo.com, Portable Practical Pediatrics

Author of Can Doesn't Mean Should, Essential Knowledge for 21st Century Parents

Let's get started thinking through how parents can manage this technology with their children. As I see it, there are two big questions when it comes to children and digital technologies - “Do I grant access” and, if I do, “When and with what restrictions". To answer these questions, I always like to consider the extremes. By examining the extremes of a decision, I find it easier to make tough decisions.

So first the question, “Do I grant access"? Here the extremes are between total denial of access to digital technology and unrestricted access do as you wish use. Neither of these choices are very satisfying for most parents, so the answer will be somewhere in between. Defining that point will be difficult, and different for every parent, but at least that may offer a starting point.

Assuming you have decided to provide your children with digital technologies, questions arise; at what age, how much, and what other restrictions do you need to impose? If you want to see why parents are currently getting smartphones for their children, at what age they provide them, and what children are doing with them, check out this 2016 Nielsen survey.

According to the survey, the most common age children get a smartphone is between 10-12 years. For me that's way too young but is in keeping with what I see among my patients. Ultimately, every parent needs to decide for themselves about age and restrictions. The best advice I have to offer is what I would do if I were raising children today. So here goes.

Ownership of smart phones- Let's face it, ownership of a smartphone is both expensive and dangerous. I feel that having possession of a smartphone is not for most children. For me, the criteria for ownership is when they have proven to be responsible, tend not to lose things, and have good decision-making skills. You know, when they begin to demonstrate adult-like judgment and have earned your trust. Harsh but true. I feel that before then, having possession of a mobile smart device makes them too susceptible to cyber bullying, sexting, curiosity seeking in dangerous places on the Internet, and interaction with dangerous people. I know this very much goes against the trend I see with children in my community. Check this article entitled "Can You Raise a Teen Today without a Smart Phone", if you think this opinion is too extreme.

Simple cell phones w/out Internet access- Cell phones without online access and limited or no texting ability should be considered for the parent’s convenience and possibly a child's safety. Allowing a child to carry a cell phone does give parents and their children instant access to one another and that can be very helpful.

Online access via desktops, tablets and laptops at home- All screen activities for children should be supervised by parents, including and especially social media sites. We were all taught that keeping secrets was bad when we were young, right? Does that change with online activities? An emphatic no! I find services like Snapchat and Wickr particularly dangerous for children because they are invisible to parents. This type of communication should be forbidden because they preclude adult supervision.

Appropriate online parental controls need to be used with these devices, and most, if not all, computing should be done in a public part of your home. Some of the families I care for turn off Wi-Fi at bedtime, a good idea because many children will wander on the Internet in the middle of the night. Bottom line - when it comes to online activities, there should be no secrets. You as a parent have a right to know how these devices are being used and that your children are safe while using them.

Final thoughts

Thankfully, not all children are susceptible to internet addiction and brain hacking, but sadly, many are. Your best strategy for minimizing the dangers these technologies pose is to limit your children's access to them as much as possible, but probably not altogether. They will need the skills associated with digital technologies for the rest of their lives, as internet communication is part of our world. But they also need to recognize a dangerous technology when they see it. It is up to you, their parents, to help them understand the dangers and make their Internet experiences healthy ones. Discuss the dangers of online communication with your children frequently. Watch what they do carefully even if that leads to some uncomfortable confrontations. And don't forget, to set a good example, never forgetting that you are not immune to internet addiction and brain hacking either.

Is Your Child Being "Brain Hacked"?

2018-04-24T10:11:00.000-04:00

Paul Smolen MD FAAP

Semi Retired Pediatrician Charlotte, NC

Founder of the pediatric blog, docsmo.com, Portable Practical Pediatrics

Author of Can Doesn't Mean Should, Essential Knowledge for 21st Century Parents

Still not sure about if or when to get your children a smart phone or allow them access to social media? Tech expert Roger McNamee, an early investor in and advisor to Facebook, has an interesting perspective about the power these tech giants have over your children. He introduced me to the term “brain hacking technologies" that he says were designed to maximize and sustain the attention of both you and your children.

What is Brain Hacking?

Here's a link to Mr. McNamee’s full article in USA Today so you can read it for yourself, but these are three big themes from the article:

Point # 1: Facebook took its lead from the gambling industry, using their techniques to “addict” users to their content. Quoting from Mr. McNamee’s article, “Like gambling, nicotine, alcohol or heroin, Facebook and Google - most importantly through its YouTube subsidiary - produce short-term happiness with serious negative consequences in the long term.“

The companies running social media are in the business of grabbing your children’s attention and they have learned to do it very effectively. Many of today’s children are consumed by their smart phones, social media sites, and on-line chatting. You know this is true. Just go to any restaurant and watch older children. They are often more focused on texting and the chatter in cyberspace than engaged with the people sitting right in front of them. And it doesn't just happen when they are with their families - the same behavior occurs even when they are with friends. For this generation social interaction seems to be much safer and preferable digitally than face to face. Whether it be a video game, virtual athletics, a conversation with a friend, or flirting, social interaction seems to be happening for today’s children virtually - physically separated from the people they are interacting with. Children seem dependent on and addicted to their devices.

Point # 2: Big Internet companies like Google and Facebook know a lot about your children. Each word children choose to use on Facebook reveals information about their education, socioeconomic class, buying habits, favorite stores, wants, and desires. Knowing these things allows the tech companies to target children like a cruise missile closing in on its target. As your children’s wants and desires change, so does their data, changing the marketing campaigns social media giants direct at them. Your child’s online behavior allows the media giant to know what makes your children tick and to leverage that information to its own advantage.

Point #3: Once someone is addicted, an Internet company can manipulate that users moods with the newsfeed. Your child is having a day when they are angry at authority figures in their life? We have a newsfeed for them that will justify and intensify those feelings. Your child is feeling depressed or sad one day? Advertisers can take advantage of that by marketing products and services to them that will resonate with those feelings as well. The point is, once the addiction has occurred and the digital content supplier knows your children's motivations and interests, they become susceptible to manipulation, often by companies who wish to sell them something or influence them in some way. Not a good place for children to be.

Advice about managing your children's digital life

You can see that allowing your children unfettered access to digital devices (smart phones, computers, tablets etc.) is a serious decision you need to consider carefully. But also understand that you have a choice and ultimately, you are in control. In fact, I would say that you must be in control. What's the old expression, measure twice, cut once? Once you grant your children free access to the online world, it will be very difficult to take it away. My advice? Consider the decision to grant your children unchaperoned access to the Internet very carefully. I think you will find all these resources helpful: AAP screen guidelines for children, Common Sense Media and a Charlotte based organization called Families Managing Media.

to be continued

Plagiarism: A Hidden Problem in Academic Medicine

2018-03-25T12:55:00.002-04:00

Irène Mathieu. M.D.

Dr. Mathieu is a resident in pediatrics and poet who lives in Philadelphia. For more of her work please visit her website: irenemathieu.com.

The last time I heard anyone explicitly lecture about plagiarism was around the fourth grade. An aspiring writer, I remember thinking that it sounded like such a horrific breach of integrity that I couldn’t imagine anyone needing to reiterate such a thing. True to my instinct, no one ever did. Except for a brief discussion of my college’s honor code, I never again received any specific education around plagiarism and authorship – not as an undergraduate or medical student, and not in the nearly three years that I’ve been a pediatric resident. I never thought that it would happen to me.

However I am still in residency and have had more than one unfortunate experience around authorship. These experiences have been professionally distressing and disappointing, as the perpetrators are my peers – pediatricians close to my level of training who purport to be interested in social justice and equity. One specific instance was particularly egregious.

A mutual mentor introduced me to a colleague a few years ahead of me in training who had similar interests and perspectives. I was very excited to meet this person several years ago, and I began to think about possible collaboration almost immediately. When I approached her about writing a commentary on a topic of mutual interest she said yes without hesitation. She was just out of residency, and I was a fourth-year medical student with quite a bit of time flexibility, so I offered to do the background research and write the initial draft. We discussed authorship extensively over email during this phase of planning, and agreed that I would be the first author, she would be the second author, and that we would later invite a more senior pediatrician to provide further direction and to be the third author.

Over several months I completed background research for the commentary and wrote multiple drafts, to which my colleague provided feedback and direction. I created a framework, laying out the problem as we saw it and potential solutions. After several rounds of edits, I felt the piece was finally approaching readiness for publication in a major journal. Then things suddenly shifted.

My colleague told me that she didn’t like my writing style and that she wanted to make sure any piece with her name attached was consistent with her personal style. Therefore she proposed making herself first author after making more substantive edits, and sent me a modified version that was organized differently from what I had been working on for weeks. I was taken aback, as she had seen multiple drafts and had not brought up this concern previously, so we discussed it further over the phone. We came up with an alternative solution. We would write two papers – one in which she was the sole author and would lay out the scope of the problem, and one in which I was sole author, in which I would cite the papers I had researched and lay out the solutions that I had drafted. We would submit them as parallel papers, with the hope that they might be published in successive issues of a major journal. I agreed to the plan because I didn’t want to lose the work that I had already done, but the whole situation left me with a foreboding feeling.

At this point our communication dropped off. Months passed. One day I opened the latest issue of a major journal – the one in which we had been aiming to publish – and saw the article. There were the problem and the solutions, in a framework nearly identical to the one I had originally developed, complete with the data and citations that I had researched. My colleague was the first author, and two other people were second and third authors. My name did not appear anywhere in the piece, not even in the acknowledgments. Perhaps worst of all was how I discovered that the manuscript had made it to press.

I had no idea what to do, and I still don’t. No one taught me what steps you are supposed to take when you have been plagiarized. While I believe this piece was important and I’m glad that it found a home in a prominent place, my trust in my colleagues suffered from the betrayal. I flinch now when I come across her name, and even when I sat down to write this piece I had the same sick feeling in the pit of my stomach that rose up when I first saw the published paper.

I still want to be an academic pediatrician, and I trust that most of my present and future colleagues are people of integrity and good intentions. But I wish that at some point in the last ten years someone had crafted a lecture around authorship, how to reduce the chances of being plagiarized, and what to do if it happens. I know that many of us in academic medicine are bent on productivity and that we face intense pressure to publish. However this should not be at the expense of integrity and ethical teamwork. As a future mentor to medical students and residents, I will use my experiences as learning opportunities. Hopefully the day will come when plagiarism is omitted from medical education, not because it is uncomfortable to discuss, but because it no longer happens.

Top 10 Tips for Hosting a Twitter Chat

2018-02-27T09:43:00.002-05:00

Peggy Stager, M.D.

Director, Division of Adolescent Health

MetroHealth Medical Center

Cleveland, Ohio

By now, as a savvy #Tweetiatrician you have likely participated in a Twitter chat. It is usually hosted by one individual or organization, centers around one topic, and has a specific date and start/stop time (typically lasting 1 hour). The conversation is posted on a single specific hashtag, such as #HPVvaccine, to allow for a central location for all to “attend”. The chat platform creates an open forum for questions/answers, postings of resources, and sharing of ideas and solutions to particular challenges or issues. The role of the host is to post questions to generate discussion, engage the participants, and summarize resources or links related to the topic of discussion. It’s an excellent tool for meeting people who are champions or experts in the field, and for sharing ideas. Think of it as a power learning collaborative condensed into one hour.

If you are experienced with Twitter chats, are you ready to host one? Anyone can host a Twitter chat. Hosts can be an individual, organization, or campaign with a desire to generate discussion around a specific issue. I was approached by the AAP Media team and hosted my first Twitter chat in October on the hashtag #AskAPediatrician. The chat was sponsored by the AAP and focused on the topic of parental resistance to the HPV vaccine, as well as general information about the vaccine. I learned a lot from the experience and if you’d like to host a Twitter chat then consider my top ten tips:

1. Pick a specific healthcare issue. If the topic is too broad, the conversation may be too diffuse without addressing pertinent questions or discussion points.
2. Recruit organizational sponsors. Reach out to those organizations whose work centers around the topic. Many organizations have large numbers of people following them which will expand your potential audience. For example if your topic is related to sports concussions, contact sports medicine professional organizations, or concussion prevention awareness campaign organizations.
3. Consider the specifics of your topic. Ask yourself, “What specific questions need discussion?”, “What do I want to be sure to convey?” This will help in the preparation of your questions and slides.
4. Reach out to individuals on Twitter who are experts on the subject – even if you’ve never met them. In addition, there are many non-physician advocates/educators on Twitter who have powerful voices and platforms for their causes. Examples include: Moms Demand Action (gun control).
5. Set the date and time and announce it on Twitter frequently. Be sure to mention the sponsors, and experts who’ll be on the chat. Create a colorful powerpoint slide as promotion for the chat. You may want to include a logo or a jpeg picture to set the visual theme. Once you have your slide design selected, use it for every subsequent slide.
6. Create 4-5 questions that flow as a progression of the topic. Again, I recommend powerpoint slides with the same design as the announcement slide. Label each question 1-5 so as participants respond they can label their responses as “A1”, meaning answer to question 1, etc. Have the slides at easy access during the chat.
7. Send out countdown messages as the chat time approaches: one day prior, 4 hours prior, 1 hour prior and 5 minutes prior. Be sure to include your specific chat hashtag on every message. Countdown messages can be posted on other platforms like Facebook, organizational websites, or Instagram.
8. Create a distraction-free setting. The participants’ posts come fast and furiously and you’ll need to be typing and responding as quickly as you can. I advise working from your computer with your cell phone as a backup.
9. Welcome all of the participants and invited experts. Post your questions every 10-12 minutes, and watch how the conversation is flowing and evolving. Retweet and like those posts that you want to be sure to share and amplify.
10. Wrap up the chat with a summary statement. As the hour comes to an end, thank the participants. Offer to share additional resources and links post-chat.

If you’d like to see the reach of your chat, Twitter has analytics embedded in each account. But keep in mind the analytics won’t track the specific hashtag of the chat. For that information, you can try Symplur. It’s a software product that allows you to track a hashtag and get specific data on your chat such as number of participants, impressions, and top influencers. In closing, hosting a Twitter chat is a great opportunity to create an open forum for dialogue on a specific healthcare topic. You’ll likely meet new people, connect with fellow advocates, and learn from other healthcare professionals from all around the country- in one quick hour!

Centering the Power of Our Networks With Our Hearts

2018-02-17T11:42:00.001-05:00

Julie M. Linton, MD, FAAP

Executive Committee, AAP Council on Community Pediatrics

Co-Chair, AAP Immigrant Health Special Interest Group

A Culture of Health Leader (1)

This is my first solo blog. Typical of most of my social media interactions, I confess I have not been an early adopter. I didn’t join Facebook until 2010. I joined Twitter in 2014 — but didn’t really use it until 2016 and am still getting the hang of it. I still don’t really understand LinkedIn.

And yet, I am curious, willing to explore, and at times even hungry to understand why certain ideas that seem unjust or unfounded are often perpetuated through the power of networks. Where I struggle is the balance between the breadth of connections via these often artificial networks and the depth of genuine human connection.

When I see patients (in my case, when I see children), I often have only a short time to understand the essence what is ailing them. That understanding is based on an instinct for human connection. To do so, physicians have a responsibility to establish an environment of cultural safety, embody cultural humility, and embrace shared humanity.

In medicine, the network for care must not only include the child but the family. Taking that to a broader level, it includes the community. And when I consider the impact of policy on the children I see - the risk of family separation due to threatened deportation, educational inequity based on race or zip code - I recognize that clinical care falls within an even broader network. And that is where my daily human connections intersect with the power to combat inequity with networks.

Pediatricians inherently see advocacy as fundamental to our field. This concept is increasingly recognized across the field of medicine (see the recent Blog by Dr. Esther Choo, https://opmed.doximity.com/dr-esther-choo-discusses-why-advocacy-is-medicine-too-cdce79f784f1). We can take this even further, towards a world where most physicians are part of authentic partnerships between sectors that may not lie within traditional views of health, such as education, business, and law. And again, that is where the power of the network has its appeal.

One approach to communication, called the Heart, Head & Hand framework by Thaler Pekar (http://pndblog.typepad.com/pndblog/2010/09/heart-head-hand.html) prioritizes the critical role of appealing to the heart with stories, the head with data, and the hand with a call to action. And this, I believe, is the essence of my role as a physician, a social scientist, and an advocate.

I am still not sure what this intersection will look like. But as a pediatrician to the core, I am committed to explore respect for intimate human connection with recognition of the power of the network.

1. Culture of Health Leaders is a national leadership program supported by the Robert Wood Johnson Foundation to support leaders—from all sectors that have an influence on people’s health—to create collaborative solutions that address health inequities and move their communities and organizations toward a Culture of Health.

EMR; Harming My Patient Relationships

2018-01-25T11:38:00.000-05:00

Mary McAteer MD FAAP
General Pediatrician
President Indianapolis Medical Society
Indianapolis, IN

One of the biggest failures in health care is the use of the electronic medical record.  By proving to be inefficient and unreliable, EMR systems have undermined confidence in the patient/physician relationship.  The quality of the relationship is essential to improving our patients’ health outcomes and the health of our profession.  Building that relationship involves developing trust by personally committing to creating respectful communication and defining mutual expectations.

Workflows involving EMR distract doctors from practicing the complicated skills involved in treating patients.  Using EMR requires doctors to validate, navigate and input data in the system, rather than give personal attention to their patients.  This has resulted in dissatisfaction for all involved in the patient experience, a known factor leading to physician burnout. Patients are given the impression that the doctor is not communicating meaningfully with them, which disengages patients from being open, decreases compliance and worsens health outcomes.  Patients come with expectations that their health information is valid and complete, like their experiences conducting searches for themselves.  Physicians also expect the information to be valid. But with the inefficiencies of data entry and retrieval, that reliance on validity is up for grabs.

I believe our patients trust us to bring it all together for them, and I hope they realize how much we all would like that too.  To illustrate the cooperation needed, here is my story about Chris, who came to my office for his wellness visit prior to college.  We are in the exam room laughing about the last time he received shots and passed out in his dad’s arms.  He swallows hard when he asks about shots he may need this visit, believing that they are necessary and good.  I turn to the electronic version of our 18-year relationship, which had previously existed on paper.  I am searching his data, still searching, his laughter is getting a little more anxious. I am getting a bit more anxious too, trying to talk about the Colts' upcoming season or something….anything else.

Soon, Chris offers his help. He has rebuilt computers, has programming experience and feels confident with anything electronic.  Appreciatively, I show him his EMR and the vast array of possible spaces where his records of past immunizations may reside.  He studies the screen and we navigate through some of the options.  After a while, he stands up and shrugs saying, “This is a mess. I feel sorry for you, so go ahead and give me any of the shots you think I might need.”  My office staff interrupts us with a knock on the door, supplying the old paper records.  Upon consulting those, he receives the appropriate vaccinations.  The tragedy of this story is the waste of time, precious time, that we could have spent preparing him for this new phase of his life.

I have heard many defenses of the EMR as a necessary evolution in health care. Using an unreliable and inefficient tool will never evolve into better health care.  It is imperative to develop better technologic tools to result in more productive and reliable communication, reasonable expectations, and personal commitment to patient care.  We need improvements focusing on more efficient workflows and communication that uses valid clinical information.  The standard for adopting clinical tools should be primarily to improve the quality of the patient experience, leading to rewarding, trusting relationships with physicians.  With tools designed with the goal of serving the patient/physician relationship we will rejuvenate health care.

Doc Smo's Holiday Message 2017

2017-12-18T22:30:00.000-05:00

Paul Smolen MD FAAP

Semi Retired Pediatrician Charlotte, NC

Founder of the pediatric blog, docsmo.com, Portable Practical Pediatrics

Author of Can Doesn't Mean Should, Essential Knowledge for 21st Century Parents

The world seems to be getting into more and more of a mess; global warming, global political conspiracies, global terrorism, and global threats of nuclear war. Undoubtedly, your children are paying attention to all this chaos and wonder what is happening. They can’t avoid the negativity and hate on 24-hour cable news, on social media, on their ever-present mobile devices, and even at school with bullying, social cliques, and gangs. Not only are children worrying about horrific events they see in the media, but they are also wondering who will protect them, how can they escape from the chaos, and how can the world become a better place?

Your children may ask you “How did the world become so polarized and dangerous?” I think the answer lies deep in our own human nature. In contemporary America, like many places in the world, we are quick to construct barriers between us and people who are different. We choose our friends, schools, neighborhoods, and places of worship to surround ourselves with people like ourselves rather than seeking to meet people from different backgrounds.

There is safety in being with people like ourselves. It’s all so safe and predictable. It’s comfortable… but polarizing. Our ancient tribal instincts may tell us to live this way, but following these instincts leads to demonization of people we don’t know much about and living our lives in fear of strangers. Tribal existence was once the key to our ancestors’ survival, but today it could be the cause of our destruction.

How do we counter and mitigate these destructive forces on our children? Here are three ways to begin that process:

1. By teaching your children to accept and appreciate people who are different. That starts locally, with you and your children - in your homes, schools, neighborhoods, and communities.

2. By making sure that you set a good example for your children. Put aside cynicism and negativity and live a life that is positive and inclusive. Your children should learn that small acts of kindness, volunteering, and openness to people who come from different cultures and backgrounds can be fulfilling and downright refreshing. A parent’s powerful influence on their children depends not on your words but on your behavior.

3. And finally, by working collectively for positive change. Individually we have limited influence, but collectively we are powerful. As Henry Ford eloquently put it, “Coming together is a beginning. Keeping together is progress. Working together is success.” The same is true about our lives; by working together we can achieve wonderful things.

Parents who commit themselves to act collectively for causes greater than themselves can enrich their children’s lives immensely. The cause can be the Boy Scouts, the local PTA, an organization to feed the hungry, a religious charity, or anything that serves others. Don’t pass up the opportunity to instill in your children the desire and joy of serving others. And what better time to start than the holidays!

So this is my 2017 holiday wish for you and your family. Leave your comfort zone and meet and serve people your instincts tell you to avoid, whether your resistance is based on race, socioeconomic background, religion, country of origin, language spoken, sexual orientation. or whatever.

Here are some ideas about how you can help your children counteract the negativity they are witnessing and move toward more understanding and tolerance.

- Limit the negativity they experience by limiting screen time. Whenever possible, turn off the TV.

- When your children view disturbing info, help them understand it. Listen, and give them your perspective.

- Reassure your children that you will protect them with all your power.

- Try taking your children to a church, mosque, or synagogue you and they have never been before.

- If you can afford it, travel, so your family can experience other cultures.

- Talk with your children about their fears and hopes for the future.

Also:

- Volunteer your time to help those that need assistance.

- Socialize with someone unexpected whether that is a coworker or a more incidental acquaintance,

- Be charitable with your money and your time.

- Greet people on the street with respect, especially if they have been marginalized. It’s easy to turn away and look past people in trouble but try not to do that.

Why should you do these things? Because your children are watching and learning and will likely imitate your behavior when they are adults. If we could collectively change our worldview and concentrate on what we have in common with others rather than our differences, we might stop the current spiral of polarization.

At the end of the day, the human experience is all the same. We are all looking for acceptance, respect, love, and security. The world desperately needs us to stop segregating ourselves based on our differences and move toward a bigger sense of we. Your tent has plenty of room for members from other tribes. It’s hard to be fearful of people that you know.

A How-To Guide For New Tweeters

2017-09-26T09:04:00.000-04:00

Scott Krugman MD, MS, FAAP

Chairman, Department of Pediatrics

MedStar Franklin Square Medical Center

I joined Twitter almost 2 years ago. I wouldn’t say I’m a “pro,” but I’ve learned a few things about what to do, and what not to do. As many of our mentors told us as residents – it’s OK to make mistakes, just not twice. It’s easy to make mistakes on Twitter, but not so easy to correct them, since Twitter doesn’t have an edit function.

Most physicians join to learn, to advocate, and to engage in thoughtful conversation. But unfortunately, that’s not all you get. Occasionally there are trolls, bullies and inane memes. So what can a new Twitter doctor do (and not do) to be part of the productive discourse?

Re-read your tweet before sending it. Would you be comfortable with it on the front page of your local newspaper? If not, don’t send it.

Avoid any tweet that can be linked to a patient. HIPAA laws apply and most institutions do not want descriptions of the care that goes on their hospital broadcast to the whole world. If you must talk about that awesome case you just saw, make sure you have approval from the patient, your hospital, and it is completely de-identified.

Do you want to amplify a message or story? Don’t just re-tweet – add a comment and quote tweet it. This allows you to provide context or your opinion, and is a good use of quote tweeting. But don’t just read the headline, read the story! You don’t want to tweet out something you either haven’t read or actually don’t agree with.

Do you want to have a conversation with someone? Use the reply function. Two (or more) people can engage in effective banter by replying to each other. Quote tweeting and commenting on a post does not foster conversation.

Do you agree with a tweet? Easy, just like it and re-tweet it.

Do you disagree with an opinion? You have two options: ignore or engage. There are definitely times to ignore. The most obvious is when the person tweeting has fixed beliefs that may or may not be based in reality (just search “vaccines”). If you choose to respond, be prepared for an onslaught of vile personal attacks (especially if you tweet about political issues or guns). The same goes for bots or trolls. If you are brave, you can engage, but sometimes it’s better not to feed the trolls. If you do choose to engage, don’t forget the first rule, and be professional. State your opinion and stick with facts. Don’t just make vague contradictory statements. And remember, you can always leave the conversation.

When you get annoyed or frustrated with someone or a topic, you have options: block and mute. You can block anyone on Twitter. If you do, you cannot see their tweets, they cannot see your page, and they can’t tweet at you. If you feel someone is being abusive or hateful, you can report a tweet to @support and they will investigate and potentially take action on the user. The mute function can be used for users, or even words. If you are tired of a thread that keeps coming up in your conversation, you can mute a word, and no tweets with that word will appear.

Finally, don’t forget to take a break from Twitter. It can be a time suck, it can be addicting, and you can feel like you’re missing something when you aren’t on. Don’t feel obligated to see every tweet that comes your way. One tool that can help manage your time is lists. You can group users together in a personal list, like “doctors,” “politicians,” or “news”, and then see topical tweets quickly. Even easier, there are public lists, and lists you can subscribe to, like the American Academy of Pediatrics “tweetiatricians”, so you don’t have to create your own.

Good luck new user. Be careful out there in the Twitter universe, and make sure you clear with your organization what you may (and may not) tweet (Pro-tip: don’t call out a specific organization). Otherwise you might get that dreaded call from your hospital’s public relations department or your boss calling you to task.

TV Harming Kids' Health?

2017-08-28T11:54:00.000-04:00

Paul Smolen MD FAAP

Adjunct Associate Professor

UNC School of Medicine

DocSmo of Portable Practical Pediatrics

Charlotte, NC

A Real Life Story

Recently, I got a real-life lesson in the effects of media consumption on illness while helping my 93-year-old mother, a passionate Democrat, recover from a small stroke that occurred the day after the 2016 presidential election. Her stroke a coincidence, you say? I thought so too, but I have become convinced otherwise.

According to her doctors, the triggering event for my mother’s stroke was severe hypertension – 212/110 upon arrival at the ED.

Since her discharge and recovery, we have been monitoring her blood pressure carefully, and here is the strange thing I have noticed: her blood pressure while at home watching “cable news” is invariably high, but when we take her to a medical facility, away from the television, her blood pressure normalizes. I’ve coined a name for this phenomenon: “The Cable News Hypertension Syndrome” or CNHS. Simply watching cable news seems to cause my mother to develop a malignant spike in her blood pressure.

The Mind Body Connection

How can exposure to images, music, sound effects, and dialogue cause such a strong physical response adversely affecting someone’s health? We have all heard of the severe and devastating long-term health effects of real life adverse childhood experiences (or ACE factors).

Children exposed to ACE factors tend to have; higher cortisol levels, higher blood pressure, higher sympathetic tone, and less well developed self control than children who have not endured such exposure.

Could exposure to emotionally charged events such as images of terrorism and war on TV, have the same deleterious influence on a child? Could watching carefully crafted, emotionally charged television content have negative effects on children just like on my mother? Of course. Evidence already exists that, in children between the ages of three and eight years of age, watching television has the effect of raising blood pressure, independent of whether the children are obese or not.

Big Brother is Watching

To make matters worse, the invention of the internet, social media, and big data has magnified the effect of media on all of us. In today’s world, when children watch something on TV, a website, or YouTube, the producers of that content are measuring not only the size of their audience but often the emotional response of the audience to their content. They are tweaking content to maximize its emotional and physical impact on viewership, the better to attract and benefit advertisers.

Orwellian you say? You bet. Ever wonder why news outlets give their articles away on your Facebook feed? You used to have to buy the paper or magazine to read these articles. No more. They “give” them to you because the publishers are collecting data on what interests you and learning how to connect with you emotionally via your likes and shares.

The same is true for children. Even the words children use in social media posts are analyzed and sold to advertisers. Think Google and Facebook are just ways of connecting children with information and their friends? While they do achieve this goal, they are also some of the largest advertising companies in the world, targeting children with laser-like precision.

Parents Need to Take Control of the Messages

Instant access to information and entertainment is fundamentally changing childhood in the United States. Ever more adroit media companies, combined with ubiquitous access to screens, are gradually eroding the influence of family members on the emotional and physical development of children. Unless parents actively understand and deflect the new media reality, many will lose control of the most important positive influence a child can have: the time and attention of their parents.

Just as my mother’s example demonstrates, exposure to media with strong emotional messages can be harmful to one’s health. We have known about the potentially negative effects of media consumption on the health of children for some time. Childhood obesity, sleep difficulties, and greater childhood aggression have all been correlated with high media consumption during childhood. My advice to today’s parents is the same as the advice I gave my mother after her stroke, “Turn off the TV mom”.

Truth or Consequences

2017-07-27T11:36:00.002-04:00

Don Shifrin MD FAAP

COCM

Mercer Island WA

Here’s my question for all AAP ‘Mediatricians’ (apologies to the original Mediatrician, Michael Rich FAAP, of Harvard’s Center on Media and Child Health).

Which of these statements do you envision as the most important when you go on record advocating for children in media interviews?

1) You calmly and quickly establish your single overriding communication objective (SOCO). Then consistently reinforce that message.

2) No matter how uniformed, hostile, or far afield your interviewer seems, you can comfortably bridge back to your SOCO.

3) Despite being pushed, prompted, or provoked you remain undaunted and steadfast while always remaining truthful.

Full marks to those who selected number three. As Mediatricians we have had personal and painful media experiences when science succumbs to ‘alternative facts’ and belief systems. As clinicians we repartee with families, or in public such subjects as spanking, guns, screen-time, and vaccinations. How many times have we debated Dr. Google during clinical interactions?

However, in the last 18 months pre-and post the November 2016 presidential election Americans have noted a significant and seismic shift in what could be reasonably interpreted as the ‘truth’. We can find ample evidence for the Oxford Dictionary’s choice for their 2016 Word of the Year to be “post-truth,” an adjective defined as “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion or personal belief”.

A clarifying explanation comes from the Yale professor Jason Stanley, whose 2016 book, “How Propaganda Works”, analyzes modern propaganda. In his New York Times Op-Ed of November 4, he stated that Americans heard candidates that “engaged in rhetorical tactics unprecedented in recent electoral history” and repeatedly “endorsed false claims.” Professor Stanley’s book reinforced that calling someone a liar “misses the point of authoritarian propaganda altogether.” Stanley’s message is that the speaker attempts to convey power by defining a reality that will change listener’s value systems. Once that power is granted it can effectively supersede accuracy and honesty. and erode public trust.

We are familiar with Daniel Moynihan’s dictum that, “everyone is entitled to his own opinion, but not his own facts.” However, that statement seems unlikely to be validated in viewing today’s mass media communications. Everyone has access to their own version of ‘the truth.’

Pediatricians can verify that when patients come to us with a particular purpose in mind, that purpose often isn’t to uncover the truth, but to defend themselves or attack the current science topic.

Parents and the public will continue to rely on motivated reasoning to accept authoritarian propaganda that conforms to their opinions. Perhaps then if a vaccine is not 100% effective it could be 100% dangerous. Fear often leverages science. Fears that appeal to the vaccine-hesitant are no secret to our pediatric community. Paul Offit summarizes this when he states, “It is easier to scare people. It’s harder to unscare them.”

Of the seven Cs of communicating media content, - be current, clear, concise, consistent, compelling, caring, and correct - which would you rate highest?

ABC: always be correct!

If you do not know, do not bluff, bluster, or be boorish. Do not speculate. Admit what you do know (SOCO) and that certain questions do not currently have accurate answers backed by solid science. When that occurs, you can and will follow up with accuracy.

To be credible we must be believable. And to be believable we must not misconstrue the truth. Truth or Consequences is not just an arcane reference to a 1950’s TV show. All Mediatricians should remember one of your mother’s most oft-repeated mantras (other than wash your hands or wear clean underwear): no matter how much it may hurt, always tell the truth.

Three Steps to an Awesome Interview

2017-06-18T22:01:00.000-04:00

Elizabeth Murray DO MBA FAAP

Assistant Professor

Department of Pediatrics and Emergency Medicine

Strong Memorial Hospital, University of Rochester

I’m pretty chatty. Give me a topic to discuss and I’m on it. However, ask me to write 500 words and I freeze (maybe because I cannot type and “use my hands to talk” at the same time!). Regardless, a video blog seemed appropriate for this month’s topic of “Three quick steps to an awesome interview”.

I have experienced great mentorship over the past 15 years. Even so, I have encountered situations that I never would have predicted. I’ve found that if I follow these steps (wow, I sound like an infomercial) things work out pretty well. Remember the goal: provide concise, accurate information that will help children and families lead healthier lives. You are the expert, you’re a Pediatrician! Time to get out there and share what you know!

https://youtu.be/FAqbnu8JWnA

Part 2: Healthcare Communications and Social Media (#HCSM) - Why It's Important

2017-05-23T10:33:00.000-04:00

Jaime Friedman MD FAAP

San Diego CA

drjaimefriedman.com

@drjaimefriedman Facebook and Twitter

How to safely be online as a physician

It’s important for healthcare providers to be online, but as seen in the Cleveland Clinic case, (see previous post) it can be a scary place. One error can make a big difference for a physician or organization. But it can be a lot of fun too, so don’t be discouraged!

When physicians decide to have an online presence, the first thing they need to do is to make sure who they want to be, how they want to portray themselves, and who their intended audience will be. They need to understand the policies of their employer, place disclaimers in their bios, and be very careful about posting any protected health information. Probably the major reasons many physicians opt out; are the fear of saying too much, damaging their reputation, or causing someone harm. That and the time factor.

Many physicians stick to posting only medical information and don’t get very involved with conversations. That’s helpful from the standpoint of providing healthcare-related information, but is not very social. Over time, you might find that you connect enough with colleagues on Twitter that you actually become friends! This is when many start to let their guard down and show their personalities.

I think it’s perfectly OK to have fun, be yourself, and tweet about non-healthcare topics that interest you. As I’ve previously written, this is what makes us human and humans are social beings. However, if your primary goal on Twitter is to be an expert voice as a physician, and you are using MD, Dr, DO, or other identifying information in your name/handle, I believe it is important to be truthful about who you are and to stick to your message as much as possible.

Your intended audience may be other doctors, students or colleagues, but if you have a public account, anyone can see your feed. The public will expect you to know what you are talking about and will expect you to communicate accurately. Furthermore, your institution or employer will expect that you represent them well. Anonymous accounts not only make it hard for someone to own their words (a phrase I borrowed), but also makes it hard for the public to trust that you are who you say you are.

I understand the reasons some, especially medical students, want to stay anonymous. Future employers may not look kindly on you due to your social media activities. Although if you have an account you wouldn’t want your employer to see, it may be a good idea to rethink what you post. Also, physicians can have a personal account that is separate from their professional account. This is common on Facebook, with personal accounts frequently kept private.

Sometimes physicians and medical students, both anonymous and non-anonymous, share patient information, act in a way that is unbecoming of a physician, or say things that they later regret. Again, it is up to each individual to decide how you want to be perceived online, and it is perfectly acceptable to delete tweets if you feel your original post misrepresents you. It’s important to be accountable, learn from your experiences, and represent your profession (or future profession) well. Think before you tweet.

Trolls

One thing that turns doctors off from being online is being trolled by people who will attack them and their message. They will be called a “shill”, their whole profession will be demonized, and they will be accused of horrible things. Some physicians don’t mind arguing online, and that is certainly a personal choice. My technique to respond to trolls comes from Kevin Pho of KevinMD. Give a calm, evidence based response and if they keep attacking, end it. Don’t feed the trolls. Twitter has “mute” and “block” options if needed.

Long term goals

Ultimately, I think physicians need to be in the digital space in order to stand out among the many voices that parents/patients hear. For those of us building our practice and hoping to carry our message further, being online can help that happen. Being online can also provide a wonderful network to connect with and learn from. There may be a steep learning curve as you get started, but it can be very rewarding. For anyone interested in getting started, I definitely encourage you to do so. Feel free to contact me with any questions.

Healthcare Communications and Social Media (#HCSM) - Why It's Important

2017-05-01T13:00:00.000-04:00

Jaime Friedman MD FAAP

San Diego CA

drjaimefriedman.com

@drjaimefriedman Facebook and Twitter

The art of communication is something that isn’t always taught in medical school (at least it wasn’t back in the day when I was a student). Of course we are taught how to take a history, but what about communicating a diagnosis with a patient, or even with the public? It’s not as easy as it looks. Here’s a prime example of the variability in how doctors communicate - my post about the phrase, "just a virus". The way a physician discusses a diagnosis, treatment plan, risks versus benefits and potential outcomes will be different for each doctor and can really have an impact on patients. A patient’s trust and confidence in their physician can vary depending on how they are communicated with, or at least how they perceive that communication.

Now that we have the digital space where anyone and everyone gives and receives information, the importance of communicating effectively and accurately is more important than ever. Furthermore, a physician’s presence in the digital space can have a large impact on his/her reputation and practice, both positive and negative. As I am now almost 5 years into Twitter and over 2 years into my blog, I have a lot of reflections on healthcare communications and social media It has been an amazing learning experience, and very humbling. My hope is that this post will help physicians young and old get into the digital space in a way that enriches their lives and helps patients.

My start in the digital world

In 2012 I was given the amazing opportunity by my company to move into a brand new office as the lead physician for that office. The office is in a growing neighborhood much closer to my home and was a complete start-up. I knew I needed to do some marketing, something I was never trained to do. My company already had a Facebook page, so I wasn’t able to start a new page for my new office. (We now have location pages for all of our offices thanks to some hard work by my marketing director, and after much pleading on my part to get it done.)

My next stop was Twitter, since we don’t have a company account. That is where I found a home. It didn’t take me long to realize that Twitter was not necessarily the place to get new patients, but it certainly was a place to connect with many other physicians, scientists, nurses, nutritionists, parents and all-around awesome people from all over the world. I also connected with journalists, which led to exposure in both printed media and on television, and I connected with several people who run websites for parents and have asked for my contribution. This is not direct marketing, but it has definitely helped build my brand. Having my name out there has helped prospective parents find me through a simple online search.

As much as I love connecting on Twitter, it’s hard to relay good medical information in 140 characters. After attending sessions on social media at the Medical Group Management Association meetings in 2014, I was convinced that I needed to blog, and so my site was born. This is where I really get to provide education to my patients and the internet at large. This is my chance to seed the web with medically factual articles in a sea of…well all kinds of stuff.

The Impact and Power of Social Media

One thing I can say for doctors on Twitter, they are a powerful force. And that’s not even coming from every doctor in the country! Imagine if every pediatrician had blog posts and Twitter feeds giving evidence-based advice. How much would that drown out the anecdotes and fear mongering?

Take for example the Disneyland measles outbreak in early 2015. My tweet was the first tweet about the cases, and you can read more about that here, but there was also a very loud and powerful outcry from many pediatricians about the importance of vaccination. Over 650,000 tweets were sent between February 1 and March 9, 2015 mentioning vaccinations. Furthermore, two members of the American Academy of Pediatrics decided to have a “Twitter storm” on February 6, 2015 under the hashtag #MeaslesTruth to highlight how dangerous the infection is. Symplur noted that not only were there thousands of tweets during the Twitter storm, but the impressions were through the roof. That’s powerful!

Recently, a physician from the well-known and respected Cleveland Clinic wrote an opinion piece spouting unproven myths about vaccines. Because he used the Cleveland Clinic name and logo in his byline, the doctors on Twitter took the Clinic to task in full force. Several articles were written debunking the piece and calling for the Clinic to respond. Not only can this one article ruin a physician’s reputation, but it also harms the reputation of the Cleveland Clinic. With a tweet, “We fully support vaccines to protect patients & employees. Statements made by our physician do not reflect the position of Cleveland Clinic,” they tried to distance themselves from the physician’s statement. They have since promised discipline. A public relations nightmare for them but a win for all the (other) physician voices online!

cont.

Doctors and Oversharing

2017-03-28T17:05:00.000-04:00

Jaime Friedman MD FAAP

San Diego CA

drjaimefriedman.com

@drjaimefriedman Facebook and Twitter

In medical school budding doctors are typically taught not to share personal information with their patients. Doctors should be neutral professionals, so their patients feel comfortable without feeling judged. Furthermore, the visit is 100% about the patient, not the physician.

However, we aren’t robots. We want so much for doctors to be seen and treated as humans with human emotions and flaws. When we aren’t available one day, it’s OK that we need to stay home with a sick child, attend a continuing education course or just take a much needed vacation. If we are a bit irritated by the late patient at 5:00, it’s because we may be missing Back To School night or an important soccer game. It’s OK for us to be sad when we give bad news or to have happy tears when we give reassuring news. Doctors are people too. We have families and personal needs that are often overlooked, as the demands of medicine pull us in many directions. Our needs get sacrificed.

So where is the balance? How do we relate to our patients on a human level without ever sharing any information about ourselves that make us more human? In my opinion, it can’t be done. Now before everyone freaks out, remember I am a pediatrician. The majority of my discussions take place with parents, not patients. Furthermore, my own experiences as a parent have made me a better pediatrician, and I want to be able to share the wealth. Imagine how empowering it is for parents (who feel like they always need to be perfect) to know that their own pediatrician isn’t a perfect parent.

Imagine getting advice from a million different sources on a variety of topics; it might carry more weight hearing what actually worked for their child’s doctor. I think being able to share my own sleep, feeding, and behavior successes and failures not only makes me more human but also helps my patients and their parents. And sometimes it’s just plain fun to talk to my young patients about my favorite ice cream flavor, or a good movie they may like, or what my Halloween costume will be this year.

Many times parents ask me, “What would you do if it were your child?”. They want to know, when they are hesitant, if my child had their shots. They ask how old my kids are and when I let them stay home alone. They want advice on everything from book ideas for the kids who aren’t excited about reading, to ideas about potty training, to ideas for behavior modification.

As a human being, I learn and grow from my patients as well. We bond and build our relationship by sharing with each other. I get, as well as give, book ideas from my teens. I get vacation ideas from parents. I even learn about therapists or other health professionals that parents have liked or haven’t liked. One of my favorite parts of a visit is “schmoozing” with a family about their summer, or school, or a new pet, or an upcoming holiday…the list goes on.

I do think it’s important to know when it is appropriate to share and when it isn’t. There are way more times that I’ve held back from sharing personal information than I have actually chimed in. But when I think it’s helpful or might make a mom feel better that I have been in her shoes, I choose to share.

Clearing the Air

2017-02-26T21:16:00.000-05:00

Yolanda (Linda) Reid Chassiakos, MD, FAAP

Director and Medical Chief of Staff

Klotz Student Health Center

California State University Northridge

Clinical Assistant Professor, Pediatrics

David Geffen School of Medicine, UCLA.

The CDC reports, “If smoking continues at the current rate among youth in this country, 5.6 million of today’s Americans younger than 18 will die early from a smoking-related illness. That’s about 1 of every 13 Americans aged 17 years or younger alive today.^”

Most new smokers start smoking as teens. Per the CDC, “Nearly 9 out of 10 cigarette smokers first tried smoking by age 18, and 99% first tried smoking by age 26.^”

My university, California State University Northridge in northern Los Angeles, wanted to “clear the air” - for non-smokers, as well as potential smokers - and promote a smoke-free, tobacco-free environment on campus. Over 80% of our students, faculty, and staff supported a transition to a non-smoking policy. So, working in partnership with the non-profit California Youth Advocacy Network and our sister campuses in the 23 campus CSU system, we developed a smoke-free, tobacco-free policy and implementation plan for a one year transition to clean air. Our goals included reducing the effects of second-hand smoke, as well as limiting opportunities for youth to be “introduced” to cigarettes, tobacco, and e-cigarettes at school.

The phases of implementation were identified for our campus community and local neighbors as information, education, resources and support, and, finally, enforcement, as a last resort. As a mediatrician serving as co-chair of the CSUN Becoming a Smoke Free Task Force and Implementation Committees, I recognized the critical importance of working with our communications department to develop messages that would reach our target audience;

- social media posts on Facebook and Twitter,

- public service announcements on our rock radio station,

- text announcements to students,

- videos on the campus website

all to complement an informative webpage with in-depth facts about the upcoming policy adoption and available resources for smoking cessation.

Our core website and the video can be viewed at http://www.csun.edu/clear-the-air

This multifaceted digital media approach allowed us to reach a wide audience and direct those with questions and concerns, or who needed assistance with cessation or FDA approved nicotine replacement options, to the appropriated resources. Additional steps included catalog revisions, website revisions, signage changes, removal of ashtrays, and smoke-free peer advocate outreach.

But the media “push” helped us achieve our goals. Our first year and a half of being smoke-free has demonstrated a compliance rate of over 95%.

Mediatricians can serve as excellent guides to improve the public health not only for your practice, but for your local communities. By using your skills and expertise in developing and sharing healthy messages, you can have a broad impact on the health and wellness of children, youth, and families beyond your office doors.

Are Your Children Fit For Life?

2017-01-27T10:58:00.001-05:00

Paul Smolen MD FAAP

Carolinas Medical Center, Charlotte NC
Creator of the blog, Portable Practical PediatricsAuthor of Can Doesn't Mean Should-Essential Knowledge for 21st Century Parents

Adjunct Professor of Pediatrics, University of North Carolina School of Medicine

Post originally published in slightly different form at www.docsmo.com September 12, 2016

So here is something you and your children should think about. Unless they develop a major illness, each and every morning your children get up out of bed, they are a little stronger, a little faster, and a little smarter than they were the day before. During the previous day, their little bodies had a chance to grow new cells in all of their organs. Compared to the day before, their hearts got a little bigger as did their lungs, kidneys, and brains. And of course, you are not paying attention if you don't notice the tremendous increase in their cognitive abilities - they get smarter every day as well. There is this steady march of growth and increase in organ function all during childhood that halts sometime between 20 and 30 years of age. Today, we are going to explore these phenomena in a little more detail and talk about why this aging/organ function curve has tremendous relevance for your children.

Childhood is about growth and change:

Do you remember how thrilling it was, as a child, to acquire new skills? I remember how excited I was when I learned to swim and dive, ride a bike, hit a jump shot from 15 feet, or hit a twist serve on a tennis court. I could literally feel my body getting stronger, faster, and more agile by the day. My growth and development physically seemed to increase until my 20’s, and then the party was over. Yes, I continued to get more knowledgeable well into adulthood, but my physical growth and agility began to decline. Research supports these facts. Current evidence confirms that humans reach their peak physical capacities between 20 and 30 years of age. Peak cognitive ability comes a little later, about age 30 to 40.

What this means is that, until the physical peak, each day your child is a little stronger, a little faster, able to burn more oxygen, and do more physical work. After that peak day, no matter how much we wish it weren't so, there is a very slow but steady decline in our physical prowess. It doesn’t matter how many yoga classes we go to, how many weights we lift, or how many miles we run a week, the decline still occurs. The rate of decline is biologic and predetermined.

So here is the big take home point we all need to understand that is relevant for your children - Since physical decline is inevitable in adult life, it is vital that children maximize their peak physical abilities when they are young. The higher a child's physical capacity is during their childhood, the longer and healthier a life they can have.

Obviously, the children with the highest functional capacity as they enter adulthood are likely to be the ones who reach the disability threshold last.

By exercising, breathing hard, sweating, chasing other children, climbing trees, eating good food, getting enough quality sleep, and expanding and challenging their cognitive abilities, a child’s organs develop a higher peak capacity than if they sit playing video games, eat low quality processed food, or get low quality sleep while watching TV and texting late into the night.

Parents need to take action:

Here is the great news - kids, your kids, can improve their long-term health. Good health as an adult is, to some degree, a choice. Make sure your kids know that! You and your child need to understand the graph of physical capacity versus age, and think about it as you make decisions about your child's activities, diet, and sleep habits.

We have all heard the expression, "use it or lose it". Well, it is extremely true - a fundamental truth of childhood. Pack that little truism into little Johnny or Janie's head before they leave your care. Maybe they will see why you are so interested in getting them to turn off the TV and video games and get outside to play. Physical activity that your children experience will give them health they will carry their entire adult life.

Here is a Doc Smo pearl for you to remember: It's a terrible mistake for parents to underestimate their influence on their kids - or its corollary - Wisdom kept to oneself is wisdom wasted. Make sure you take a few minutes regularly to share your life wisdoms with your children. You will both benefit from the effort.

This is your host, Doc Smo, asking you to remind your children that they will never become fit, if all they do is sit. Until next time.

Smo Notes:

Rate of decline of physical functioning in Women

http://www.who.int/bulletin/volumes/91/9/13-123075/en/

Age of Peak Cognitive ability

http://news.mit.edu/2015/brain-peaks-at-different-ages-0306

Saying Grace and Then Demonstrating Grace at Thanksgiving

2016-11-21T09:11:00.001-05:00

Don Shifrin MD FAAP

Bellevue, WA

As parents, we encounter “teachable moments” every day. There is an old saying about children that they have small heads but big ears. It is unlikely and impossible to ignore that they have not seen or heard, media portrayals of both presidential candidates this year that were (OK, perhaps not unjustifiably) significantly negative. And certainly, vitriolic rhetoric from the candidates and media pundits as well. We have seen and heard hateful remarks on all media venues and our children have been watching. We have not seen many role models of civility.

America has concluded a contentious election, and now there is a significant winner/loser mentality among at least half the population, again not unjustifiable based on previous statements by both candidates, especially from our new president-elect.

Regardless of what we are experiencing we do have a president-elect. And as parents we need to model respect for the office. Yes, we can comment that politicians can be flawed, but accusations of racism, sexism, and classism are going to stay in children’s minds a long time.

So how should we to speak to children and families about the results, how to help families cope with disturbing rhetoric, and how to explain news reports of increasing numbers of protests?

It is vitally important that we calmly reassure all children so they feel safe and protected in their day-to-day lives.

Explain clearly that the way democracy works is that we vote to elect who will oversee our government. This is a good opportunity to invoke what Abraham Lincoln (our 16^th president) meant (in his Gettysburg address in Nov. 1863 - 153 years ago) when he said “government of the people ( coming from the people), by the people, and for the people.”

Do find out what your children and teens have heard and what they understand. Teens may be very passionate when expressing their opinions about the election.

Listen! Try not to quickly interrupt. Allow your child to express what he or she is feeling, including fear, anxiety, or anger. Do not minimize or dismiss their concerns. As you listen, note any misconceptions, misinformation, or anxieties.

Every child is different. Their age and individual anxiety level will determine how much and what information you may wish to share. Try to separate fact from fiction. Put provocative statements (i.e. building a wall - deporting all ‘illegals’ - putting Ms. Clinton in jail.) in the context of our democratic system.

Because we live in a media saturated world, pay attention to what your children watch on screens. Try, if possible, to watch with them and use those ‘teachable moments’ to help them digest what is being discussed. Be careful not to verbally provide aggressive, dismissive, discriminatory, or inflammatory color commentary about topics being discussed. Children are not politically savvy and are unfamiliar with the checks and balances of the US Government.

We are all American citizens. You now have a continuing opportunity to be a positive and reassuring role model for your family. When you share your feelings about new information, do so in a respectful manner. The teachable moment emphasizes that respect and kindness are important values for families, even if they have significant disagreements with someone. If we see or hear that some adults do not understand or demonstrate disrespect by using shouts or threats, we will still value these attributes and proclaim them. Avoid generalizations about gender, race, or culture. And note that a strong democracy is designed to protect all Americans.

How can we act if we disagree? We have legislators we can petition, op-eds we can write. And we can recognize and provide commentary on incendiary and offensive words and actions. Your child is always watching, and you are the door they walk through on their way into the world. Your calm reassurance (we will be OK) and ability to promote wellbeing is the most empowering part of parenting.

So this Thanksgiving please pay attention when political commentary (if you even agree to discuss politics) becomes inflammatory or overwhelming to children that are present. Focus on what is positive is your lives, that our Republic has survived almost 250 years and will indeed survive this administration. If adults will not cease angry or fiery words, you can gently point out to the children that is not the kind of talk that you endorse. “Our thanksgiving table is a place where we model love and value acceptance, tolerance…. and thanks.”

Finally - Always encourage your child to tell you or a teacher if he/she feels threatened or bullied, and to speak up when they see or hear something inappropriate.

J. M Barrie (Peter Pan) “Always be a little kinder than necessary.”

Warren Buffet, (a vocal Clinton advocate) stated, “I support any President of the United states. It’s very important that the American people coalesce behind the President. That does not mean we cannot criticize him or disagree with what he is doing. But we need a country unified. He (the president) deserves our respect.”

New Media Plan Toolkit Available for Parents on HealthyChildren.org

2016-10-30T21:21:00.000-04:00

Corinn Cross, MD FAAP
Pacific Palisades, CA

Council on Communications and Media Executive Committee

The AAP’s Council on Communications and Media has two new policy statements, “Media and Young Minds” and “Media Use in School-Aged Children and Adolescents” as well as a corresponding Technical Report, “Children and Adolescents and Digital Media,” out in the November issue of PEDIATRICS. These statements outline the changing relationship children and teens have with media. While the policy statements allow for us to discuss what we know and map out what still needs to be researched, the toolkit on HealthyChildren.org gives pediatricians and families the guidance and tools they need to parent, now.

Media has become ubiquitous in our daily lives. For children and adolescents, this includes school time, free time and homework time. Media is used for communication, education and recreation. The policy statements and technical report outline something that many parents have realized -- the 2 hour limit just isn’t enough advice. Screen use is so nuanced and weaved into our day that parents need more guidance.

As busy pediatricians, we don’t often have the time to delve into media use in our office visits but recommending parents visit the website and create a Family Media Use Plan is something we can find the time to do. Creating a Family Media Use Plan is an important step in helping parents realize that they can, and should, still “parent” their children’s online life and be aware of, and hopefully approve of, their online and media choices. The toolkit discusses screen free zones and times, device curfews and where devices should charge overnight. It talks about displacement and the need to maintain a healthy balance, which includes an appropriate number of hours of sleep for age as well as 1 hour of physical activity a day. Parents are encouraged to co-play, and co-view media with their children and to research apps and shows through sites like Common Sense Media so that they can be aware of content and age appropriateness. The toolkit introduces the ideas of diversifying media experiences and encourages parents to think about what their family’s values are and to ensure that their child or adolescent’s media experiences are inline with those values.

Many parents feel overwhelmed when it comes to parenting, device use and media choices. The online resource gives parents concrete tools to navigate this new area of parenting.

Stress and Teens: Does Media Play a Role?

2016-09-29T10:18:00.000-04:00

Hansa Bhargava MD FAAP

Staff Physician, Children's Healthcare of Atlanta

Medical Editor, WebMD

Pediatricians are seeing more and more teens suffering from stress. Whether they are complaining of it or having somatic symptoms such as headaches and stomach aches, it seems that stress and anxiety are on the rise. We know that over scheduling, homework, and the pressures of getting into college can contribute to this. But can media also affect it? Is screen time and media a stressor or a remedy for stress?

In a recent WebMD survey published in their Teens and Stress report, 54% of teens were stressed according to parents. Interestingly, 40% of parents turned to the screen for family stress relief while 58% of teens did. Social media and texting was used as stress relief by almost half the teens. This is on the heels of the Common Sense Media survey reporting that US teens were using media for 9 hours a day. Other recent reports have shown that 94% of teens with mobile devices are online daily with many online constantly.

So it seems that stress is on the rise and media use is on the rise. Although there may not be a direct relationship, some real issues impact stress and anxiety. Consider this: 23 % of teens report cyberbullying, especially girls. There have been reports of “Facebook depression” and loneliness, as kids who aren’t in social media conversations may feel left out. Other negative consequences can also have an impact: many teens are in front of a screen late at night or ‘sleep text’, both of which can contribute to lack of sleep, which in turn can decrease focus and potentially cause irritability and depression. And last but certainly not least, what about the time media consumes?

Time spent on media is time often not spent communicating with family. Lately, when I’ve gone into a restaurant, I’ve observed that as soon as a family sits down, everyone pulls out a mobile device. No one is really talking. So even the short amount of time not doing homework, playing soccer, or at school is being compromised. Psychologists, community leaders and experts have long reported that family time can contribute to less depression, less anxiety, better academic performance and generally happier kids. But what if that family time is on media??

As the AAP reviews our screen time recommendations, I feel that we, as pediatricians should continue to advise parents about basic principles.

Parents need to lay down some parameters about when and how media is used. Media is a centerpiece of teens’ lives and is not going away, but just as we don’t give our kids a set of keys to our car and say “just drive”, we need to enforce appropriate media use. And good modeling is also critical: parents need to put down their mobile devices and simply communicate with their kids. Old fashioned parenting and just talking to your kids can build the foundation to a less stressful childhood and hopefully a happier life.

What’s New and Next? Applying Past and Present Principles of Professionalism for Posting

2016-08-29T22:37:00.000-04:00

Terry Kind, MD, MPH

Associate Professor of Pediatrics

The George Washington University / Children’s National

@Kind4Kids

From the latest way to share information, to dire concerns about career-ending posts, to the next new thing, where have we been and where are we going? Guidelines are essentially meant as a starting point [Kind in AMA J Ethics 2015], to encourage thoughtful posting. The same principles to guide your professional behavior in real life remain applicable in the online arena as well, but with additional considerations. Your personal and professional might blend. The voice you project --and the images you share-- are augmented. And, depending on the context, your post may be ephemeral or everlasting. Social media has transformed our communication options, and has great potential to improve healthcare, communication, and information sharing. It allows us to innovatively reach out and engage. And to listen.

We’ve crafted tips for using social media in clinical care drawing upon ethical and professional principles [Chretien and Kind in Circulation 2013] and tips for use in medical education [Kind, Patel, Lie in Pediatrics 2013 and Kind, Patel, Lie, Chretien in Med Teacher 2014]. When considering new platforms of communication, think about who you are online and offline, who is or may be reading and engaging with what you post, and what are your goals? Essentially, be a good and thoughtful citizen and share well.

What does sharing well actually mean? Just like in pediatrics where we aim to “catch a toddler being good” my colleagues and I sought to explore how medical students are using Twitter in “good” ways, such as for their professional development. Do they, and if so how? In this digital ethnographic study, we found that they do use Twitter to supplement their traditional medical school experience. It provides them with access and voice. Access, to experts and various perspectives, and to communities of support. Voice, for advocacy, and to craft their own digital identity, and to level the playing field among the various medical hierarchies. [Chretien, Tuck, Simon, Singh, Kind in JGIM 2015].

What do you need in order to post well, in addition to Wifi and a charger? We propose that in the health professions, your posting rests on a platform of public trust [Chretien and Kind in Acad Med 2014].. Consider security, that is, what online behaviors could jeopardize patient privacy and/or impact your own career security. Resting on that secure base, then reflect on your own online identity and the relationships you navigate. This sets you up to discover ways to use social media to improve health, enhance career paths (self and others) and innovate. Throughout your journey, maintain an awareness of potential challenges and opportunities.

Ultimately, you should draw upon the same principles of professionalism that you’d employ offline, as online. I shall leave you with this tweet-sized tip I once shared a few years back.

T is it thoughtful

W is it wise?

E is it educational?

E is if evidence-based?

T is it tweet-worthy?

References/Resources:

Kind T. Professional guidelines for social media use: a starting point. AMA J Ethics. 2015;17(5):441-7. FREE http://journalofethics.ama-assn.org/2015/05/nlit1-1505.html
Chretien KC, Kind T. Social media and clinical care: ethical, professional, and social implications. Circulation. 2013;127(13):1413-21. FREE http://circ.ahajournals.org/content/127/13/1413
Kind T, Patel PD, Lie DA. Opting in to online professionalism: social media and pediatrics. Pediatrics. 2013;132(5):792-5. http://pediatrics.aappublications.org/content/132/5/792.long
Kind T. Social media milestones: entrusting trainees to conduct themselves responsibly and professionally. J Grad Med Educ. 2014;6(1):170-1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963781/
Kind T, Patel PD, Lie D, Chretien KC. Twelve tips for using social media as a medical educator. Med Teach. 2014;36(4):284-90. http://www.tandfonline.com/doi/full/10.3109/0142159X.2013.852167
Chretien KC, Tuck MG, Simon M, Singh LO, Kind T. A Digital Ethnography of Medical Students who Use Twitter for Professional Development. J Gen Intern Med. 2015;30(11):1673-80.http://download.springer.com/static/pdf/378/art%253A10.1007%252Fs11606-015-3345-z.pdf?originUrl=http%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%2Fs11606-015-3345-z&token2=exp=1472527098~acl=%2Fstatic%2Fpdf%2F378%2Fart%25253A10.1007%25252Fs11606-015-3345-z.pdf%3ForiginUrl%3Dhttp%253A%252F%252Flink.springer.com%252Farticle%252F10.1007%252Fs11606-015-3345-z*~hmac=8e8f797462654fa3d16be35ed3d5c2c79fe585c1682250e65913b0bfd020a7ff
Chretien KC, Kind T. Climbing social media in medicine's hierarchy of needs. Acad Med. 2014;89(10):1318-20. http://journals.lww.com/academicmedicine/Fulltext/2014/10000/Climbing_Social_Media_in_Medicine_s_Hierarchy_of.9.aspx FREE

Fast Food Marketing to Children: What Parents Can Do

2016-07-26T09:33:00.000-04:00

Kathleen Lovlie MD FAAP
Gulf Shores AL
Author of "Practical Parenting: An Un-Politically Correct Guide from the Trenches"

Lately, children and teens are exposed to fast-food advertising from every angle. Traditional print, TV, and radio ads are ever present. Marketers carefully place products at child height and colorfully design packaging to attract their attention. Mobile devices and social media accounts are plagued with ads.

Social media sites entice with advergames, contests, points to redeem and free downloads. If your child subscribes to or follows a YouTube channel or Twitter handle, he or she is volunteering to be sent endless “opportunities,” with ads attached. These ads encourage users (your children) to “share” and “invite” friends to participate on the websites – free word of mouth advertising! Facebook, for example, comes with 6 billion fast food ads – 19% of the total ads on the site.

Food stylists make their products look better than they ever do in reality. Advertisements suggest health benefits and a happier, more carefree life. They bait with prices that will feed your children more cheaply than a grocery store, until you switch to higher priced items at the counter. Restaurants default to a less healthy options like French fries and soda, rather than the more costly fruit and milk.

The purveyors of fast food are not on your side. Their success depends on your failure, and they have bigger wallets than you do.

Fast Food Ad Facts

Here are some facts about fast food advertising from the Rudd Center for Food Policy & Obesity

In 2012, 4.6 billion dollars was spent on fast food advertising—a hard number for me to get my brain around. 4.6 billion dollars will buy 920 million kid’s meals: 33,000 lifetimes worth of daily happy meals. Imagine the profit that must be generated to make spending that amount of money reasonable. These people are not your friends.

Less than 1% of kid’s meals (33 out of 5427) met USDA nutrition standards.

Only 3% of kid’s meals met the industry’s own standards.

Fast Food Ads Have Presence in Your Child’s Life

Fast food ads are unavoidable. Your children will see them and will want what they are selling.

There is no evidence that media literacy in any way defends against the effectiveness of advertisements. Knowing that fast food ads are trying to sell you something that is bad for you does not keep you from wanting it. We are grownups, and we fall for the ads. We cannot expect more of our children than we do of ourselves.

In the end, it comes down to committing to do the right thing, and then acting on that commitment:

Clean out your cupboards and throw out all the junk.

Make a healthy meal plan for the week before you shop.

Shop with a list made from that meal plan, and stick to the list.

Shop at farmer’s markets and around the outer rim of the grocery store. Avoid the aisles unless there is something on your list that is on that aisle.

Prepare meals ahead for busy nights, so that you don’t end up in the drive-through line at the fast food restaurant.

Keep healthy snack food available at hand: fruits and veggies, whole grain crackers, cheese, popcorn... Throw out the chips and snack cakes.

Take the time to eat that lovingly bought food at home together at the table and with the TV off. Relaxed time together is much more enjoyable than time in the fast food line with your kids bickering in the back seat. See The Benefits & Tricks to Having a Family Dinner.

Why "Never" is Easier for Kids to Understand than "Sometimes"

Remember that “never” is much easier for a child to understand and deal with than “sometimes.” If you never stop at the drive through and never buy junk food, after the first two weeks your kids will rarely ask, even though they saw that yummy advertisement a dozen times and really wanted to try those fruit snacks. Be consistent.

If you sometimes give in, they will ask until your ears bleed. Pestering is powerful when you’re tired and stressed.

Remember, you have the greatest influence on your children’s health. Fast food companies have 4.6 billion dollars on their side, but you have love for your children and the responsibility they handed you with that warm sweet bundle. You win.

Diversity in Children's Media

2016-06-28T08:13:00.002-04:00

Jacqueline Dougé, MD, MPH, FAAP
Medical Director, Bureau of Child Health
Howard County Health Department
Blog site: DrJacquelineDouge.com

I had an interesting conversation with my older son after watching an interview of Marvel Comic authors and illustrators. The interviewer asked about the diversity of modern day Avenger characters. The new Spiderman is African-American and Latino, Ms. Marvel will be Pakistani-American and the new Thor is a woman. My seventeen year old son was surprised that the characters he grew up watching were going to be of different genders, religions, races and ethnicities. I asked him what he thought about the increasing diversity of the characters. His response wasn’t what I expected, “I’m older now and don’t need the characters to be diverse to look up to them.” Would his response have been different if he had grown up watching diverse superheroes?

But he also made another interesting point; characters shouldn’t be created solely to meet a demand for diversity. My son’s response surprised me. I expected to hear that he agreed with me that there should be more diverse images and characters for kids.

My son and I have had many conversations about race, especially being African-American. We’ve had more discussions over the past few years in light of news stories that report on the murder and violence of young black men. In addition, he’s had to address negative biases based on his race in school. My suggestion of having more kids of color in media was a possible solution to combat negative stereotypes and normalize the idea that different people live, work and play together. My son is very aware of the lack of diversity in media, and as a recently graduated senior no longer needs to look up to superheroes. He realizes that diversity in media is important, but to just have characters of different races and ethnicities isn’t enough and shouldn’t be done solely to meet some demand or current trend.

In 2013 blog post on diversity in children’s media, Dr. Kevin Clark wrote, “Diversity is more than demographics. We need to think about diversity holistically. Yes, it’s about gender and race, but we need to add a component to go with those demographic components of diversity—being aware of what children hear, see, and do.” In his blog, he discusses his work to help young children create video games. He realized that even thought he was the same race of the children, African-American, he was working with, their experiences were different. Race isn’t the only factor that connects or resonates with kids. In creating diverse media for children, one must also consider whether the content and experiences are relatable and realistic.

Children’s media has the opportunity to create positive and enriching experiences for children. What children see, hear and read influences their self-identity. In the 2015 AAP News article on racial socialization, which refers to the process how kids learn to deal with racial issues, the authors discussed the role that pediatricians can play to help parents navigate the issue of race with their children. One strategy mentioned was to discuss with parents the role that positive cultural and diverse images can have on children. These images provide a counter narrative to images of negative stereotypes and violence.

Most pediatricians aren’t in the business of developing media, but there are opportunities to promote positive culturally diverse media such as the books recommended to our families and books and magazines displayed in waiting rooms. In addition, there are opportunities to create diverse media content, i.e. write a book, create videos.

The term diversity is broad and complex. It must not only have individuals or images that check a box, such as gender, race, religion or sexual orientation, but include the multifaceted layers of being a person. Our kids are surrounded by and use media, why not have it also reflect the diversity of its users?

Resources to learn more about diverse media for children:

    •    Help your kids find books with diverse characters

    •    Apps and Games with Diverse Characters

    •    DiversityinApps

References:
Anderson A, Ellison A. Helping families navigate race issues should be an ongoing conversation. AAP News 2015;36;2. Retrieved May 28, 2016, from http://www.aappublications.org/content/aapnews/36/8/11.full.pdf

Clark, K., Ph.D. (2013, July 09). Diversity in Children's Media Is More Than Just Race or Gender - Fred Rogers Center for Early Learning & Children's Media. Retrieved May 28, 2016, from http://www.fredrogerscenter.org/2013/07/09/diversity-in-childrens-media-is-more-than-just-race-or-gender/

Screenagers

2016-05-16T14:08:00.001-04:00

Nelson Branco, MD FAAP
Tamalpais Pediatrics
Larkspur, California
www.tamalpaispediatrics.com

I recently had the opportunity to watch the documentary Screenagers with some friends, colleagues and two of my children. This documentary about the pervasive nature of screens in our lives and environment is relevant, informative and well done. The movie centers on a physician parent’s decision to give her middle-school aged daughter a smartphone and explores the ways that screens play a role, both positive and negative, in our lives.

This movie resonated with me as a pediatrician and a parent. I have tried to be thoughtful and balanced about both the rules I set for my family and the anticipatory guidance I give about screen time. Time will tell if my children have learned to manage the different screens in their lives, and whether I have modeled responsible behavior. Nonetheless, there are principles that we can use to guide us when giving advice to families and kids around screen time.

The amount of information at our fingertips and the ability to connect and communicate with virtually anyone in our lives is truly incredible. It’s not surprising that it is so addictive – these devices are useful, entertaining and engaging. When we deny this we lose credibility with the kids in our lives.

Minecraft is cool. It really is – spend some time with a Minecraft-savvy tween and you’ll see. Social media at it’s best is fun and interesting. Texting can be a good way to communicate – more immediate than email but not as intrusive as a phone call. Video games can teach kids to try, fail and try again. Movies and TV help us relax, share stories and learn.

There are well-documented negatives, of course. Few of us may qualify for the DSM-V diagnosis of Internet addiction, but we all react to the jolt of dopamine that we get from a new email or text. Minecraft can take over time that could be spent playing outside, reading, doing homework or being creative with another medium besides animated blocks and elements. Teens can use social media and text messaging to bully, harass or hurt their friends and schoolmates. Violent video games can expose kids to sights and sounds that we would like them to avoid, and can be addictive as well. Movies and TV shows can model unhealthy behavior and unwelcome stereotypes.

As parents, we work hard to protect our children from harm. In my practice, most families are aware of the need for rules around media and limit their young children’s screen time. I see it become more difficult in the middle and high school years, once smartphones become ubiquitous. I also see parents who think nothing of pulling out their smartphone while waiting, or while I am talking to or examining their child.

  I’m sure most of us have done the same. We often use the excuse that we are doing “work” when we’re on our screens. We should remember that teens can use the same excuse. Their “work” is to connect with their friends and form an identity. Social media, texting, Skype and email are all ways to do that – more efficiently and more pervasively than the phone calls and hanging out that our generation did as teens.

If we are going to teach our kids to use screens and media wisely we need to monitor and track our own use. Are we reaching for the phone as soon as it dings, even if we’re in the middle of a conversation? Do we stand around checking email or social media while waiting in line or sitting with our kids in an office? Do we have screen-free times for the whole family?

We can’t expect our kids to learn to eat vegetables if we aren’t serving and eating them ourselves, and we can’t expect kids to use devices and media responsibly if we aren’t doing it as well.

Screenagers touches on these same points, and uses stories and examples to illustrate these topics. This movie won’t break any new ground for pediatricians – these are topics that we talk and think about every day.

What I liked about this movie is that it gathers interesting information and presents it in a balanced and engaging way. It opens the door for consideration and conversation. I wish more documentaries about parenting, families and kids did this as well.

The movie is being screened in many communities. I highly recommend you see it and engage your colleagues, kids and other parents in the discussion. For information about the movie, visit their website: www.screenagersmovie.com.

Young I.V. Parody Rap Videos

2016-04-25T12:40:00.004-04:00

Ivy Pointer, MD, MPH
Pediatric Intensivist
WakeMed Health and Hospitals
aka Young I.V.

I have never been afraid to act like a fool for a good laugh and if you’ve seen any of my Young I.V. videos, you will have seen plenty of footage of me acting like a fool (I hope you laughed). People often ask me “How did you get the idea to start doing this?”

Well, I wish I could say that I planned it out from the beginning but it sort of happened spontaneously. I had seen many of the Holderness family videos (ed. note - a Raleigh NC family that makes parody videos about various topics) and thought to myself, wow that looks like fun. So I decided to write a rap about my entire family having gastro for 3 weeks. I shared the lyrics with some colleagues at work who thought they were hysterical. Since I really will do anything for a good laugh, I turned the rap into a music video and even enlisted the participation of my entire family.

Fast forward about a year, and I have now produced 23 videos on various pediatric topics, with several more raps written and ready to produce. The topics range from helmets, vaccines, and car seats to food allergies, croup, and reflux.

At first I joked that the goal of Young I.V. was to rap with Jimmy Fallon. Of course, that is still totally a goal, but as the videos started to gain some popularity outside my inner circle, I realized that these videos could have a broader reach and purpose.

In our social media, digitally-driven, entertainment-addicted world, I am hoping these videos can compete with all the other messages parents are hearing about how to keep their kids healthy and safe.

The goal of Young I.V. is to bring awareness to children’s health issues and educate the public in a nonthreatening and entertaining way. I hope you’ll enjoy and share them but most of all, I hope you laugh!

Here is my most popular video:
https://youtu.be/48DOigw98TM

And my newest on Back to Sleep:
https://youtu.be/vghgMc84Zek

Find all of the videos at:
www.youngiv.org https://www.youtube.com/channel/UCFwd3xAmX7x0_pa2D34wbIw