Tuesday, June 29, 2010

A village is never wrong?

Checkup with a father present?  Automatically, a list of "things to talk to the pediatrician about" pops out.  Why? Because we Dads, if asked, "how are things going with Johnny?" will answer, "Oh, not much.  He's a good kid.  So, what...do you have to check him out or something?"

It's not our fault - the Y chromosome is an X with a leg chopped off.  In essence, we could very well be lacking genetic material, stuff that might code for, I don't know, focusing for long enough to remember something...anything?

Switch over to the playground.  One might see a child climbing along the outside of the playground structure, 5 feet up.  If Dad's watching (or...rather...not paying attention at all...), he might look at the child and pause for a second, but then looks around for his other child (you know, the one he hasn't seen for a few minutes?).  If Mom's watching, it's certainly possible that she runs over and grabs the child off the structure, telling him it's too high.

I realize I'm painting with a broad stroke, and certainly, there are exceptions, but there's often a relatively laissez-faire parents and a planner, and though it often falls along the gender lines I created, it can be reversed.  Furthermore, I realize I am omitting single parents and alternate family situations.  The point is, in typical situations, parents tend to complement each other, and the child benefits from that dialogue.  One might say too high, the other says try it.  One blows things off, the other gets the rash checked out.  One says, "why can't she act her age?" while the other says, "She is acing her age."  Dad says, "Oh let him do it, what's the big deal?" and Mom says, "Once he starts, he'll think he can always do it."

Beth and I have a rule (that, now that we've been married for almost 12 years, we seem never to need to invoke anymore).  In the Beth and Brian rulebook, it reads:

"Whensoever a conflict between Beth and Brian shall arise, be it in the realm of child-rearing (a term that always made me snicker a bit), interior decoration, vacation planning, or ice cream flavor choice, the choice shall be determined by rational discussion, but is shifted away from a possible choice if either person really hates that choice."

Worked like a charm.  Beth used to ask me about curtains, furniture color, whatever, and while I usually had an opinion, usually the opinion was, "I don't really care," a phrase that tattoos me XY.  However, every now and then I completely hated one choice.  Decision made.

A famous Islamic passage states that "My community will never agree on an error."  So...make sure that you're listening to your spouse, since it's somewhat possible that the cautious mother, the doofy father, the detail-oriented father, or the absent-minded mother just might have the opinion that helps the 2 of you guide your child in exactly the right way.  Along the way, mutual spousal respect might also evolve.

Monday, June 28, 2010


  1. Princesses lined up side by side on our screen door push-bar.
  2. Shed door with scrawled happy faces.
  3. 10,000 random pieces of paper with slides, monkey bars, playgrounds, and other themes-du-jour.
My kids decorate my life.  I cannot help but collide with this evidence of their presence, in addition to the accumulated clutter of toys, crayons, and books in any room in our house.  I sometimes think ahead to a time when they direct their creative energies elsewhere, on friends, clothes, and activities, and in advance, I miss this stage of my girls.

Fortunately, exam table paper wads, colored children's books, stickers on walls, and self-portraits trick out my patient rooms, so, on some level, I will always have pixies in my life who seek to color my world, even if that's not their intent.  However, there's something extra special about my own kids' masterpieces that I know I will miss.  I must remember to treasure the red pen on my screwdriver, or the blotted marker on my sheets (from a Sharpie Picasso with nothing behind it), because someday my things will be boring and plain, with no guerrilla artistes performing their flit-by fancifications.

It's the whimsicality of it all that gets me.  Junk mail might sport a smiley face.  Used post-it notes (sometimes with important stuff on them) might have Horse,Version 4.023, galloping across the bottom edge.  Claire once saw Charlotte draw a playground slide, so half over her drawings have stick kids (with curly hair) on swervy lines with swervy handles, sometimes with grass and a sun.  The colors don't have to be real-world - no, whatever pink highlighter or rainbow pencil that's available will do the trick.  And both of the kids went through an R-rated stage where the centrally located, twin circular representations of the shoulders of their drawing-world-girls' dresses looked a lot like Charlotte and Claire were attempting to depict anatomically correct females.

The cut-things-up-into-tiny-pieces phase that I know I should regard as mastery of fine motor skills instead stands out as the Vacuum Cleaner Period for me.  The experimental, load-as-much-water-colors-on-one-piece-of-paper stage?  AKA Stained Place Mat Period.  I especially love that period, since Claire also loved coloring her hands in the brown-purple waste water in which she had been dipping her paintbrush.

So we can't have nice things - and I am ok with that.  Plastic-covered expensive sofas and fancy dining room sets might look too sterile in our house.  Our table is a relic from Beth's great aunt, and it's great for its abilities to take a beating, to fold out into double its size (though Claire bemoans her uncanny ability to be found at a table leg), and to collect oatmeal in its folded-up state.  Once there, the oatmeal hardens into a compound that is not only breakable by nothing short of the Jaws of Life but also being utilized by NASA as a panacea for all things broken outside the space shuttle.  The chairs have interesting swirly patterns where tiny fingers have picked off the finish (and then flicked the pieces on the floor, where they join the party started by oatmeal, breadcrumbs, cereal, and whatever else got the invitation).

Now I'd like to go for a run, but not before I remove 3 princesses, a dog, a cheetah and 3 super balls from my sneakers.

Thursday, June 24, 2010


During my college days, my roommate was a huge Rush fan.  I get that liking Rush dates me in a certain way, but that's me.  Neil Peart is a machine, Geddy Lee has a tenor range through the stratosphere, and their songwriting is outstanding.  In any case, this morning I pulled out the "Roll the Bones" CD (no, I haven't converted all of my CDs to digital, I hate FM tuners, and won't spend the green to upgrade my car radio).

Bravado came up, one of my favorites; here are the lyrics:

If we burn our wings/Flying too close to the sun
If the moment of glory/Is over before it's begun
If the dream is won/Though everything is lost
We will pay the price/But we will not count the cost

When the dust has cleared/And victory denied
A summit too lofty/River a little too wide
If we keep our pride/Though paradise is lost
We will pay the price/But we will not count the cost

And if the music stops/ There's only the sound of the rain
All the hope and glory/ All the sacrifice in vain
And if love remains/ Though everything is lost
We will pay the price/ But we will not count the cost.

Why does this song ring relevant to me today?  What else is parenting, if not paying the price without counting the cost?  Of course, I doubt most of us look at the price, but let's examine.  You're a clueless 20-,30-,40-something with your bachelor-couple's lifestyle.  You go out when (and WHERE) you want, wake up when you want, vacation wherever, and deal with childish behavior only insofar as you or your friends and families manifest it.

AFTER children?  Reverse everything - it's Opposite Day.  Up at 6 AM, eating at Friendly's, trekking to see the Lowell Spinners and missing the whole game so your kids can hang out in the carnival section instead of moaning about how bored they are with the game (the reason YOU'RE there?)...avoiding 5 star restaurants, no more serene weekends at a bed-and-breakfast (without imposing on the grandparents)...no more 2 AM poker games or nights with the girls, or at least fewer without the pained look on your spouse's face on your return...

That's not to mention pregnancy - morning sickness, the disappearance of your pre-pregnancy body, the disappearance of modesty (amazing what a few pregnancy checks and a birth do to that personality trait), the pain of labor...miscarriages...clusterfeeding...no sleep...crying for ? reason...a new addiction to coffee?

Have any of you counted the cost?  Apart from maybe wistfully recalling lazy Saturdays?  I'd bet not.

The song's reference to Icarus recalls the hubris of the young Greek boy, but I say bring on the hubris, bring on the mammoth responsibilities of parenthood.  Does any parent say, "Man, I've got this great kid, but hooooooowwwwwwwweeeee it wasn't worth it.  My life really sucks now?"  Do we sigh and shake our heads sometimes as we watch our kids do something "their way," all while we watch, knowing that they are square-peg-round-hole-ing a task?  Sure, but we love the game!

We reach for the sun and dare our wax to melt, for "if love remains" at the end of the day, and it always does, "we will pay the price."  Anything requiring real labor, emotional or physical, is worth the number on the price tag, not just parenting.  I remember talking to my mother after my grandfather passed away about how she was there with him at every step, during every hospitalization, through rehab, through his sad decline away from the Rock we had known in the prime of his life.  I doubt I fully grasp the price she paid, but pay it she did.  She'd do it again, and what a selfless act it was.

Is the song about bravado, "a false show of courage?"  Some might look at the song and feel that Rush's point is that we are foolish to take on impossible tasks and Sisyphean trials, that we should pack away anything requiring vision and perseverance, and sit back with a cold one to watch the evening news?  How much easier to sit back, point at those sweating and bleeding, and say, "Wow, I guess you really blew that one?"

I don't think Rush intended a cynical tone.  As long as love remains, the "means justifies the end", exactly the way some philosophers define the good life.  Let's not take it too far, though.  I wouldn't try to climb the "summit too lofty" of my 3 kids at the Ritz's fanciest restaurant.  But "all the sacrifice in vain?"  Surely not.  Live it, run your fingers through it, EAT it.  It's only fun if you throw yourself into it wholeheartedly.

Monday, June 21, 2010

Will my eyes really freeze that way?

After a solid childhood of evil uncles and cousins, I learned the following:

  1. Your face will not freeze that way, no matter how hard you scrunch it.
  2. Santa Claus, the Tooth Fairy, the Easter Bunny, Mr. Hannukah, and leprechauns don't exist...in Massachusetts.  They have a secret hideout that cannot be known by any adult that every child knows but to which they cannot travel because, clearly, kids can't drive.  And thank God for that.
  3. You will not shoot your eye out.
  4. There's no such thing as zombies, ghosts, vampires, creatures, demons, monsters, fiends, goblins, or things.
However...how much fun is it to say something ludicrous to a child, with your best Steven Wright

and watch as they frown, bunch up their eyebrows, and say, "No, Daddy...really?"  No matter how ludicrous the line, there's some possibility that Daddy might be right...this time.  I like to think that this kind of teasing tests kids' logic a bit, maybe sniffs at their creativity.  Can the kids discern truth from BS, merely by comparing the truth offered to the reality they think they know?  Will their creative minds grasp at the kernel of truth within the line and run with it, following me to my Crazy Place?  True, repeating these lines too often might upset the kids, and make your wife say, "Jeez, will you cut it out already?" (not that I have any idea how that might sound).  Still seems worth it.

Daily conversation, though, sometimes unintentionally tests kids.  Grief experts have seen kids do some pretty strange things in order to cope with our euphemisms for death.  A good example is the boy who, after his mother died, exhibited really terrible behavior for a few months until one day, tearful, he came to his father, saying that he could no longer be "bad."  Further questioning revealed that a teacher had told him that his mother's death was awful, and that "only the good die young."

Other examples include:

  • promising something but not delivering.  (promise is a tough word to use).
  • telling them you'll let them do something "later" (that never comes).
  • "I'll break your leg" if you... - or- "Ah, jeez, Billy, I'm gonna kill you if you do that again."
The bottom line?  Because kids are concrete, we need to watch what we say, or be prepared to translate.  Pediatric textbooks say kids are not little adults;  even so, it's hard for us to remember.  We know how to throw a ball; we've been doing it for a long time.  It's just that it's hard to teach someone what is second nature to us already.

This post made me think about something that happened the other day.  My daughter Charlotte saw a clip from Jaws in which a swimmer grabbed her leg underwater, screaming in agony.  The clip was part of "The Today Show" that runs in the morning.  It took everyone by surprise, since Jaws doesn't usually run in the morning (though, true enough, some questionable content does run on the program, usually prompting us to turn off the TV during our search for weather in the morning).

Charlotte: What happened to that lady?
Me:  She had a really bad cramp in her leg. 
Charlotte (looking doubtful and hopeful at the same time) Really?
Me: Yeah, really.   Her leg hurt really badly.

Good thing my poker face works well when the situation swings the other way.  The truth, the whole truth, and nothing but the truth doesn't always apply to real life.

Wednesday, June 9, 2010

Celebrating firsts

"I do it mah-sef."

"I wanna do it!"

"Ma, let me just do it, ok?"

(nonverbal child screeches and yanks back toy so that she can pull the handle that makes the noise)

"These are our rules, Grammy.   Please help us enforce those rules so that Johnny will sleep/eat/behave like we've been trying to teach him."

Kids should do things for themselves.  Not dicing tomatoes - young kids and knives do not blend well.  And while some oversight is probably a good idea, as I said in Hovering, allowing kids to experience the bumps of "haven't quite got it right yet" serves as a perfect appetizer to "Mom, I did it!"  How else can they learn how to do something,or, just as important, how not to do something?

And just as it's important to let them crow about their successes, let them hear you celebrate.  It can be hard, though, as you swim through a sea of:

  • "Knock-knock." "Who's there?" "Chair." "Chair who?" "Chair tomato broccoli aaaaaaaaaaaaaaaaaaaaaa!" (serious giggles). "Knock-knock..."
  • "Mom. Mom.  Mom.  Mom.  Mom.  Mom.  Mom. Mom.  Mom.  Mom.  Mom.  Mom."  "What???" "I forgot."
  • "Mommy, today I went to...uh...the...uh..(inaudible)...and...uh...Michael...(inaudible)...and then he...uh...went like...(inaudible)...and I was like...(inaudible)...is that ok?"
  • "I am not going to the potty, and I don't care!" (1 minute 15 seconds later, puddle on floor)
  • "I HATE this stupid thing!" (throws thing across room, hits sister square in eye.  Commence escalated chaos).
  • "I can't (fill in the blank), I'm too scared!"
  • No, Mommy..wait...I have to tell you something. (repeat eleventy-seven times)
Add these classic hits (all for 2 installments of $9.99) to your dishes, the lawn, their homework, your to do list (which is looking more and more like Martin Luther's Theses), the oil slick, unemployment, and your recent sleepless night because of any number of issues, and you'll miss:

  • the first whatever on the potty...and the attendant 2.73 rolls of toilet paper used to do so.
  • writing her name for the first time...or merely trying to write her name for the first time.
  • getting to the end of the maze
  • telling that overbearing friend, "No, I want to do it my way for once."
  • first time brushing teeth by himself, complete with Blob-sized splat of toothpaste clogging the sink.
  • walking down the dark hallway where the goblins live by herself.
  • the "I love you" that was supposed to come out, but you'd already had it with the 78 other things you'd been dealing with, so you said "Not now, honey, ok?"
We miss too much; we're just not there enough to see it all.   To capture some of it, at least once a day, try the following.

  1. Stop what you're doing
  2. Kneel down with your child (being much taller and staying way up there can be intimidating)
  3. Listen.  Really listen.
  4. Give them a chance to say it themselves. 
  5. Clarify what they're trying to say without interrupting.
  6. "VERY nice name." "Horray for peepee on the potty!" "You rode your bike that far?  WOW!" (even if it's only 2 feet)  "Wow, your breath is NICE and minty."
  7. Big hug.

Sunday, June 6, 2010

Medical Home - the Final Frontier

Check this medical home handout sometime.  Yes...it's very long.  Yes, you have to take the survey first...but then...check it out (I know many of you won't, but if any of you do, it will have been worth including the link).  The authors have given me (and everyone) permission to "shamelessly share and borrow" it, and so I shall.  They deserve credit for such outstanding work.

Medical home.  It's a funny-sounding term.  For those not ready to embrace the idea of medical home...twitching, headaches, and nausea.  Why?

Because yes, Virginia...there is such a thing.

Medical home is a place where you/your child are known. Where they speak your language.  Where your every test is tracked, where every result is communicated to you.  Where every specialist note, ER visit, or hospital stay is tracked.  Where, if they don't know the answer, they find it for you.

In the not-too-distant past, I'd have thought someone blurting out the above might have been caught earlier that day holding hands with the Tooth Fairy , but our practice has developed many of the processes necessary to be a medical home (thanks in large part to the guidance from the Pediatric Physicians Organization at Children's).  We're hoping to uphold the ideals of medical home; we hope to care for people in a manner that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.

 Ask for it- you deserve it.  Who wouldn't want it?

Thursday, June 3, 2010


I was never a Bowie fan.  This...

was just too weird for me as a kid.  But his song, Changes, brings up a point that I struggled with in Landslide, and Haunted by Waters - how do we cope with change?  For the point of this blog, how do kids?

Bowie thinks this:

"And these children that you spit on
As they try to change their worlds
Are immune to your consultations
They're quite aware of what they're going through"

For anyone trying to guide a child through something, be it mashed up broccoli, tying shoes, hitting a baseball, riding a bike (link), dating, sex, drugs, graduation, college choice, wedding planning, job choice, raising kids, planning for a bar mitzvah, planning your child's wedding...this line rings with migraine-link intensity.

Another song from my childhood, Changes by Yes, contrasts with Bowie's self-deprecating take on change.  Darker-seeming (the song seems born of a riven relationship), it somehow stresses the self-control we have over our own destinies.  A simple statement at the start:

"I`m moving through some changes
I`ll never be the same"

climaxes in the bridge of the song, rising up, full of the emotion of the song's peak:

"For some reason you're questioning why
I always believe it gets better
One difference between you and I
Your heart is inside your head"

expressing the control we have over accepting the inevitability of change by agreeing to change, rather than allowing blind emotion to rule us.

The song also embraces the idea that we do it better the more we do it.  Practice makes perfect in relationships and change, just like in any other arena of life.  These thoughts jive with the intro to the song, where the time signature vacillates between 7/8 and (?) 10/8, affirming the existence of unpredictable variations within the very fabric of our lives.

What does this mean for kids?  Some kids cope with change and transition very nicely.  No warning, time to go?  No problem.  Other kids, especially young kids, need the "stop signal ahead" light that cues them of the stop signal ahead.  Most people figure this one out pretty quickly.

I warn most parents, as they're about to have a second child, that though they might have some questions about their growing baby at each of the many appointments in the first year...inevitably, they'll pull the "yeah, yeah, the baby's fine - can we talk for a second about his big brother/sister?" out of the bag.  Can't blame the parents - their angelic firstborn has begun to channel Dennis the Menace.  Can't blame the firstborn - his universe has been chopped into 2, as his parents pay attention to something else in addition to (and often before) him.

Another scenario, and a special topic for me, being a child of divorced parents, is dealing with kids in a divorce situation.  Most parents ache over the Dr. Jekyll/Mr. Hyde rotation through which their kids spin.  Some kids go bananas before they visit "the other" parent, some careen out of control once they return.  The kids often tilt between feeling guilty about leaving one parent to feeling guilty that they had fun with that parent.  Plus, each household often has its own set of rules; one allows cookies in bed but focuses on homework before fun, the other has no junk food whatsoever but there's a party all day long.   Throw in both parents trying to get back at each other for wrongs during the marriage, with each child now serving as a bioweapon against the other parent?  It's surprising when individual or family therapy isn't involved at all.

I don't think I have any miracle advice for any of these situations...only these ideas.

  1. Know that change can be hard to accept;
  2. Some kids who depend on structure have an especially hard time with change.
  3. When kids act out, try to remember that "why" is as important as dealing with the situation, despite the fact that Bill Cosby was right when he said that  "parents are not interested in justice, they're interested in peace.
  4.  Blend consistency with enforcing the rules with understanding and warmth, and know that sometimes 5 parts rules zero parts understanding (or vice versa) is the right answer.
  5. You know your kids best.