Comfort, Always.

To cure sometimes, to relieve often, to comfort always.

Early in medical school, newly minted doctors learn this phrase. It’s reassuring to young physicians at a time in training when all we know how to do is comfort – before we learn all the fancy terms and diagnoses and treatments we’ll soon have at our disposal.

It is meant to be a guiding principle in the care we give to our patients. But judging from the recent attitudes in the time of COVID-19, I’d say that doctors need a reminder that even though much of what we can do is to relieve, or merely comfort,  it’s still a lot – and part of our job as physicians.

Because there is no cure for COVID-19, the current advice is to stay home if you are sick, and only present for medical care if you are in need of oxygen or hospitalization. When it comes to going to a hospital or emergency room – that’s true!

But those of us who went into primary care presumably did so to be on the front lines of people’s lives 27/7. We chose to get to know families personally over years of care. We chose to cure and to comfort, to rise to big challenges but also to cradle every minor concern and fear. We chose to treat anxiety and diaper rashes and insomnia and mild allergies with as much attention as a neurosurgeon gives to each major surgery.

Yesterday a parent called me because her husband had been very sick for two weeks and “nobody would see him.” His doctor told him to go to urgent care and urgent care told him to stay home. His coworker had a confirmed case of COVID-19 and although he was isolating, he was scared because he had never been sick for so long or felt so awful. No one would test him – would I test him???

I did next what I do so often in medicine. I backed the conversation up. I said that yes, if he really wanted a test I would test him, but that there were several important issues we needed to discuss first.

First – was he ok? His wife said he had been in bed for almost two weeks. Okay right there I told her that we needed to make sure he was breathing okay, didn’t have a treatable pneumonia or other illness and I would see him and make sure of that. Step one – back up, forget about COVID-19 for a minute and assess the person. There’s a lot going around besides COVID-19!

From his symptoms she described over the phone I felt that he might indeed have the Coronavirus. I’ve been masking and goggling and gloving with every patient, but I added a patient gown over my clothes, just in case.  I asked him to stay in his car and when he mistakenly came into my office, even though it was after hours and no one was there and he was wearing a mask, I reflexly said with alarm – GET OUT!

He went back to his car, and first thing, I checked his pulse-oxy……98 percent – awesome! I told him he was getting plenty of oxygen and even under his mask I saw his face soften and relax a bit.

Next I listened to his lungs – all clear. I did a flu test because he wanted to know – normal.

To me he looked pretty good. Yes, he was quite fatigued, yes this had gone on a long time but his fevers were down and his shortness of breath had not gotten worse. In fact, despite feeling afraid, he noted that he might be getting a little better.

Next came the topic of testing. He was frustrated that he couldn’t get a test. I told him that I was frustrated too, and that I would do it. However, only having 24 vials of transport medium and no word on when I’ll get more, my supplies were limited. So we discussed whether knowing would change anything for him personally, or for any of his contacts.

After ten minutes, he said he didn’t think he needed a test. The family was locked down, they had all had some degree of symptoms already, and he thought maybe he might be getting better. The exam had helped him to realize that.

I prescribed a Zpack because with two weeks of up and down fever and fatigue and chestiness, that’s what I’d normally do. I might get a chest X-ray first, but in this setting exposing too many people wouldn’t be worth it. Plus, the outpatient X-ray down the street decided to cut their hours in the shutdown (don’t get me started on that).

I was able to tell him anecdotally that Azithromycin even helps with Coronavirus. One thing I learned from a brilliant comforter in medical school, an oncologist, was always to give some shred of hope. Don’t lie, but it’s okay to highlight something small. So I chose to highlight this as a prudent step, which I felt it to be.

He asked me if he got worse, if I’d still be willing to test him and I said yes. He needed to know I’d be there for him if he didn’t improve. And only when I said yes, was he ready to drive home.

This isn’t the first parent I’ve seen because their own doctor wouldn’t, or didn’t have room for them. Pediatricians are like that. Our doors are often more open and I can only imagine it’s because we take care of kids, our most precious resource. But adults are precious too. Everyone needs good care.

I’m alarmed that in this pandemic, sick patients are told to stay home. I remember Jim Henson, the creator of the Muppets, and how he died from curable pneumonia because he didn’t go to the doctor. So for that reason, we should be seeing sick people, same as always.

But I’m also alarmed that we have forgotten how to comfort. Comfort isn’t offering empty reassurances over the phone. Comfort is the laying on of hands, the careful evaluation of a patient, the attention to detail and the honest feedback we can give.

In this case, when I said, “I think you are okay, and you are probably getting better,” I was able to comfort. He could believe me because I had taken the time to see him and to make sure.

I am not writing this to toot my own horn. I’m writing this to remind patients to insist on appropriate care. He could have had a raging pneumonia. And I am also writing this to remind doctors to do their job.

To cure sometimes, to relieve often, and to comfort always.





Posted in Pediatrics | Tagged , | 3 Comments

Stop Counting!

Most parenting books get it wrong. They get it wrong as soon as the book opens and you are told how to solve some problem your kid is having.

The biggest reason they get it wrong is because they suggest things you should do to a kid – some system – that they swear will solve the problem. And then a parent launches into 1-2-3 Magic or some other technique that might produce some short term altered behaviors but long term, nothing much changes.

Let’s start with the beloved 1-2-3 Magic, because it’s the worst invention ever. Basically if a child is misbehaving or you need them to do something you count in a regimented way, and if they still don’t comply, you slam them into a time out.

Well, here’s the problem. Most of teaching kids is setting expectations, helping them understand and accept the expectations, and then teaching them to self-soothe and find the motivation to comply with the expectation.  That’s it.

I have found that most parenting books find ways to actually interfere with this process.

First up is setting expectations. We spend too much time telling kids how to act, but not enough time clarifying and holding to the expectation. You don’t tell a kid to hang up their coat when what you really want to teach them is to put away their things. You end up struggling over the coat and miss the bigger lesson.

“We must put away our things.” must be followed by the second part of this. You can ask your child if they are older, “Do you know why we must put away our things?” They probably can answer with a lot of reasons: so that the house doesn’t get messy…okay go on…(that isn’t a very compelling reason for kids, really)…so that we can find our things when we need them later….(a bit stronger reason, no?)….so that our things are well-cared for and last….

If you start at a young enough age you won’t even remember having the conversation, not until the kid gets older and starts to rebel a bit. Well, then it’s time to regroup and have the conversation again. You can go over all the reasons why and see what the kid has to say about it and generally speaking agree at the end of the day that putting things away is important. But they might not do it.

Then what? Well this is where you must get creative and be persistent. Say your kid comes home from soccer and throws their clothes on the floor. What now? Personally I wouldn’t ask them to put their clothes away. I think that already sets you up for failure. At the most I would say, “How will you have clothes for the next soccer game with your clothes on the floor?” Then wait. And here is what’s hard. I wouldn’t do diddly even if your kid ends up without their clothes or with dirty clothes to wear at soccer next practice. If you need more discipline, it can be that you as a parent will not let them go to soccer without a clean uniform. Then let them figure it out. Need more? Well if your kid asks for soccer and you pay the fee and they can’t go because they don’t have a uniform then they must do work for you or somehow pay back the wasted soccer fee. There’s always a way to teach whatever lesson is at hand. But that doesn’t mean it’s always easy. It can be super tough!

What if your kid doesn’t want to do anything? There’s always the kid who will say, fine, I didn’t like soccer anyway and I like sweeping so who cares? Well…..crud…thinking fast….I think it’s ok to have family expectations along the lines of “everyone moves their body and plays an instrument”. In that case they can run laps instead of soccer. But you do set a few absolutes.

What if they refuse even that? Um, come back later. I don’t know. I had a kid like that and I just don’t know.  There are some truly tough cookies out there, but fortunately most kids aren’t that challenging.

Still thinking……I think when it got to that point we tried scuba diving. Because what person can resist that? I’m pretty sure that every kid wants to do something but you  do have to be open to letting them discover it. And once you have their buy in, you’ve got their hook.

You can configure this any way that you want, but the point I’d like to make is that unless you are involving your child in understanding expectations and learning self-discipline, you are cutting to the chase too quickly and stunting your child’s progress and learning.

When you are 1-2-3-ing all over the place you are being loud and intrusive. Your kid can’t think. They might comply, but nothing is internalized or learned. The “best” kid may do everything you ask before you get to three, but that kid will only have learned to comply and will have no idea how to do the right thing next time.

That’s why to me, it’s super important that we give consequences, or allow consequences to happen, that are a direct extension of the topic at hand.

But we don’t.  We say, if you don’t hang up your clothes you can’t have dessert. So let’s talk about dessert. Should you tell your kid that they can have dessert if they eat all their dinner? Not the way I think. Dessert is fluff and so if our diet is healthy we can afford a little dessert. The kid who gobbles down everything doesn’t necessarily need dessert! So if a kid wants a cookie then they only need to examine whether the rest of their diet is healthy enough to support that. So it’s subtle, but it should be reframed like this: did you get enough that is healthy to have a cookie now? If not, let’s work on eating those things today and saving room for dessert tomorrow.

That means that a kid who is eating crap most of the time can’t afford dessert. You can say to your kid that in order to have a hit of sugar, the rest of your diet must be healthy. A lousy eater who will “only eat” mac and cheese doesn’t have a healthy enough diet to eat dessert. Sorry.

On the other hand, a kid who has been eating well all day might be in a position to eat a little sweet thing. But only if he has room. So let’s see, what if you ate some of your meal then saved a little room for dessert? Wouldn’t that be better than overeating to get to dessert? Isn’t that what you REALLY want to teach your kid? Why not help them plan a healthy smaller dinner with room for a sweet at the end? If you say, eat your dinner first, you really haven’t taught them how to eat well, even though that is what you meant to do.

Not every example I might give is one that would fit every family, but what I have learned is that somehow as parents, we often lose the lesson in whatever we are trying to teach and we do this by barking orders, moving too quickly through an issue, and not giving our kids both the time to think it through and the gift of natural consequences so that they can adjust their behavior if it isn’t working well.

Everyone feels pressure and stress, everyone acts out and then there’s some blow up when this happens – rinse and repeat.

It’s really hard to watch your kid sit out something that they wanted to do because they didn’t prepare adequately.  But it is equally gratifying to have your kid remind YOU that it’s time to leave in ten minutes to get to school! If you nag and micromanage, you will never have a kid who wants to get to school on-time. You are better off setting the alarm and letting them do most of it, but don’t forget to dangle a very positive consequence. And don’t shield them from the pain of realizing that if they don’t get to school on time, they will have to stay in on Saturday and help you organize the basement because they’ve wasted your time nagging, and you have things to get done!

My favorite lesson is helping kids think through their choices. Parents used to “let” their kids run away from home. It was a cute standing joke among adults. They’d even help their kids pack a bag. (Now sadly “I’m going to kill myself” has replaced “I’m going to run away…but that’s a whole other post)

This was a valid exercise. A kid would get frustrated and angry with the rules, and tell his parents that he was just going to run away. The parent would say, “Well, I’m really going to miss you, but let’s get packing.” Most kids made it down the block and came back within an hour or two. They weighed it all and decided to come back home. And the parent said, “I’m so glad your back, is there anything you’d like to discuss?”

I’m not saying that we should let our kids hit the streets, or callously turn them away. Kids aren’t used to free-ranging it anymore and the world may not look out for them in quite the same way as when we had more intact neighborhoods. But some version of that, done lovingly, gives a kid their autonomy back and generally, that’s a good thing.

So, be clear about expectations, make sure your child understands and is on board, then hand it back to your childrules and let them figure out (perhaps with a little bit of coaching) how to achieve the goal. You can certainly step in with rules like having a weekly room check but don’t overdo it or you’ll have a kid who resists taking responsibility for themselves.

Here’s a really good article on the topic, and they are hard to come by:

Posted in parenting, Raising kids | 2 Comments

Oh No You Didn’t!


I’m going to write about one my favorite things, and it’s called giving kids credit even and especially when they are struggling. This is something that I didn’t know how to do, or even that I should do, when my kids were growing up, and I feel bad about it.

I used to point out my children’s transgressions or issues, rave a bit, then demand change. I was usually nice about it, or so I thought, though occasionally when they got older and lippy – I went AWOL – and AWOL was not OK.  It was entirely understandable and no one would exactly have blamed me, but not good.

But now that I know what I know, I think that I wasn’t just abusive the few times I lost my marbles,  I was more abusive sometimes when I thought I was being nice.

Parents come into my office and some of them whisper things they don’t want their kids to hear and others say things out loud but no matter how much I can relate,  when they tell me about some problem, issue or flaw having to do with their kids……I just cringe.

I cringe because if the child is sitting there, I can feel the embarrassment and the shame creeping into that kid’s heart. And I know that since kids are really good at protecting themselves, they often are going to decide somewhere down the road to just go for it, to hell with it,  and fully live up to whatever assessment has just been dealt them. That’s when you lose the kid. They’ve had enough of feeling bad, thank you. That’s when you’ve got an oppositional kid on your hands and it is no party.

To help parents understand this, I say to them, “Hey, if I just reminded you of some butthead thing you did, and then added in that you were maybe deficient in some skill or attribute, exactly how motivated would you feel to work on that thing?”

Pre-school teachers get it. They talk about things kids are “working on” or  “learning to do.” Janey hit Billy, in the hands of a real pro becomes, “Janey is really working hard at keeping her hands to herself, and she had a big challenge today and learned some important things she might want to tell you about later.” But too often parents get told in front of their kid that their kid bopped someone, then everyone gets all serious and disappointed and the kid – who needs a hug at this point – just crumbles inside. You can’t always tell because sometimes the kid is arguing or deflecting or still acting out a little – but the kid always feels bad in some way and we just make it worse.

It may sound like new-age mumbo, but it is super important that we become effective coaches for our kids and our language – how we frame things –  is critical.

I tell my families that we used to smack kids and that was a kind of reverse motivation – the motivation not to get smacked. Then we went through a phase of bitching about our kids behavior (that’s where I got stuck) which actually was even worse than the old paddle to the behind, if you ask me.

At this point some parents think I’m advocating a good whack. To that I’m going to say that only very rarely and under very specific circumstances would I ever do that, and before you go nuts hearing me say that, the actual point I am making is that parenting has evolved, and that parents don’t have to hit their kids to abuse them.  Occasionally some form of physical restraint, or “punishment” might be reasonable. But that just isn’t where we are as a culture.

Since you’re not going to let the corporal punishment thing go until I explain myself I will tell you about the time I pinched my kid so hard that he cried one of those cries where no sound came out.  To this day, I feel zero remorse. Even he laughs and says I did the right thing.

What happened is that my eighteen month old son had been pinching me and leaving bruises on my arm. My first advice about that is that if your kid hurts you, immediately put them down and walk away. That’s it. Every time.

But instead, I had been saying some version of “Hey, stop that!” over and over and of course he kept right on pinching me. So, one day I said, “Listen, my fingers pinch too, and I don’t want to hurt you but if you pinch me I’m going to pinch you back.”

You all are better than me so you probably know that if you present a kid with the “Don’t” challenge they damn well are gonna. It’s Psych 101 – that’s why we are supposed to say, after we turn our backs on our pinching kids, “I’ll talk to you when your hands are gentle.” But I didn’t know that a NO draws a kid like a moth to a flame. So I said it and he promptly pinched me. True to my word, I kinda pinched him (but it didn’t hurt.) Then he pinched me again. I pinched a little firmer. Back and forth and it ended with me pinching him hard enough to leave such an impression on him that he damn well never did it again. I did what I had to do, but I wouldn’t have had to do it if I had known how to shut down and extinguish the behavior.  I could have done better if I had known better. But I don’t feel particularly guilty because he was old enough to understand what was going on and he walked into it of his own free will. And I wasn’t mad. Hugs, and on we go.

I whacked at my kids a few times, but the real abuse I handed out was subtle and emotional. I wasn’t a good coach. I’m better now, though still not the best. But I used to really suck at it. Abuse may be too strong a word. What I did was, I demoralized my kids and missed opportunities to help them learn.

Fortunately, my kids were pretty good a lot of the time, especially before puberty, so I’d like to think it wasn’t too bad. But we are here to do better.

Just like a really sweet but firm pre-school teacher, we can reframe a kid’s misbehavior, and that can make all the difference in the world. We can demonstrate clearly that we expect our kids to keep working on their issues but that everyone is challenged, and we can do this by making damn sure that the kid feels the consequence of their behaviors, both good and bad. But it takes a little finessing. You can’t just blurt it out at the curb on the way to the car. In fact, I would suggest that you mention nothing icky or hard on the drive home from school with your child. I made that mistake a kazillion times too because, well – captive audience!

A little later, we can say, “Janey, you are so thoughtful and kind, something must have been tricky today.” Then maybe Janey will tell you that Billy called her a dinglehead right before she smacked him. “Wow, that sucks. He must have been in some kind of mood himself today!”

Then pause and show that you understand your kid by not launching into part two immediately.

Part two can come a little later, maybe after she’s had a snack, a hug, and a little more time to de-stress.  And if you’re dealing with a teenager, you are best to say,”I think we need to talk about this, but you also need time to unwind and regroup so come find me later tonight.” Otherwise, if you push,  all you’re gonna probably gonna get is sullen impatience.

Part two is: “Since hitting isn’t allowed, we’re gonna have to think of other ways to handle it when someone calls us a name.” I like to commiserate a little. “I remember when Sally Eagan said my lunch smelled like fart and I got super upset!” I also like to throw in a little humor. If you are lucky your kid will be feeling better and may even be engaging in the conversation at this point.

At the end of part two, if things are feeling good, you gotta close with inviting the child to make things better. This is for the other kid, but mostly it’s  also so that your own kid can accept responsibility and move on. This step needs to be timed just right. If your kid is still struggling with taking responsibility, it might make sense to say, “Sounds like you are going to need more time to reflect on this.” and then bailing for a little longer.

But if you get to a good place, you can even help your kid think of a nice way of apologizing or making amends. Maybe all Janey can say to Billy is “It was dumb of you to call me a dinglehead but I still shouldn’t have hit you – so I’m sorry for that” Good enough.

Sometimes your child is going to detach and you might not find a way in. In that case, keep it simple and don’t talk too much. If the teacher or someone else has handled the issue maybe you don’t even have to say much other than, wow, rough day. Tomorrow will be better.

I understand that kids can do more serious things but we have a lot of power. We can insist that our kids accept responsibility without judgement or negativity. We can say, “It sucks that you and Emory cut school yesterday and now I have to drop you off at 8:00 am myself on your late day rather than have you bike in later.” I like to deliver the noxious consequence without a get out of jail card or any instructions about how to get the privilege back if the kid is over twelve or thirteen. I like the kid to come up with the fix. If they say, “what do I have to do to get my late morning back?” my answer is , “You tell me.” and then act all loving and sweet, because you aren’t angry, you are just in control and acting from a place of strength. If you give them the fix, you will have robbed them of the opportunity to make amends all on their own. If you are angry or overly punishing, you will incite more opposition. Kids know what’s fair.

You can help deliver consequences but it’s better if the consequences relate to the infraction. Taking away your kid’s phone in my opinion is only appropriate if there has been an abuse of the phone. Of course it’s also appropriate to not give them a phone in the first place, your call. But taking a way a kid’s phone just kindles the fire. You could say, “Tonight we are taking a technology break for an hour, mandatory  – to regroup, take a bath and meditate on some of this shit because today was a doozy and I as your parent am going to impose a little calm.” but I wouldn’t take a phone away for more than an hour or two or at the most an evening. Unless you want to get into a pissing contest. I know all about this. The phone was my secret weapon and I don’t think taking away my kids phone did diddly..

So the take home message I’m trying to get across is to treat your kids with respect and give them credit for wanting to do the right thing, even when they screw up. You don’t need to go on about the problem, you can just state the expectation with “Listen, I know that if I told you you could drop out of school tomorrow and work at McDonald’s for the rest of your life as the fry cook you probably wouldn’t want that, so getting to school is a no brainer for you.” And if they say they want to drop out of school you can  smile if they are just being a smart ass. If they are serious, offer to sit down and help them work out a budget and a plan for moving out and supporting themselves. Because that’s the way life works. I don’t mean do it in an assholey way. I mean, say, “Wow, that would be hard. If you are serious then maybe we should look at what it might take.” You are also free to declare that a high school diploma is a non-negotiable but I prefer a healthy dose of the real world. It’s way more motivatey.

I have to say that recently I told one of my patients who was being a little twatty about accepting her parent’s guidance that she was 16 and could emancipate herself if she really wanted to. Her mother gently shot that, and me, down and I felt pretty bad for just blurting it out. I tried to explain that I think when a kid is really struggling against our guidance it is helpful to play along and take it to its full conclusion. Of COURSE this kid didn’t want to be emancipated. On the way home she and her mom were talking and doing great and I’d like to think it’s because for a second she got to experience what it would feel like not to have her mom right there beneath her wings. But that was a close one in that I almost alienated someone I care very deeply for.

When you tell a kid that they are responsible, even when they slip up, or kind, even when they lash out, or gentle, especially when they are harsh – they will believe you just a little and they will ascribe to those higher behaviors. Especially if you acknowledge the extenuating circumstances that drove their behavior in the first place. Especially if you don’t pronounce judgement on them as a person. That kind of judgement is humiliating.

I’ve had really nice, but pissed off parents come in fed up with their teenager and say to me that their kid just isn’t very mature, grateful, responsible – that kind of thing.

I turn to the kid and usually they actually are most of those things, at least a little bit and certainly when compared to all the other kids I see. So I tell that kid – “You have just scared your parent and caused them to doubt something, now it’s going to be up to you to make amends and demonstrate blah blah blah.” When I tell them that I believe they possess some positive trait, they are much more willing to work towards attaining  it.

Sometimes I can’t get the parent to stop with whatever the judgement is, and it’s usually because they are worried about their kid.  I have to point out that at a certain point your kid is your kid the they are the way they are right now and they’re going to go out in the world very soon and everyone gets to – and has to -make a ton of mistakes. That’s the process of letting go and we all should do it as much as we can in raising our kids. Our culture infantilizes kids and teens by making it all about parenting. It’s not. It’s mostly about your kid.

By the time your kid is 16 or 17, you should mostly only step in when true safety is at stake or if some very serious issue is at hand. Then, you gotta fight like a momma or a poppa bear. But mostly, a kid that age should be working their own life pretty hard and be getting ready to launch.

There’s a guy named Ross Greene and he is really good at working with oppositional kids. He’s got some books and a website. His message is, “Kids do well when they can.”

Our job is to enable all the doing well that we can, and we can best do this by remaining positive and encouraging, and by supporting our kids in solving their own problems.

My other favorite thing to tell a parent who is super angry and pissed off and just done with their kid (usually a teenager or a toddler) is – pretend you are their teacher, not their parent right now. The distance really helps us chill out and be more effective.

One of my kid’s favorite teachers in middle school was his band teacher, Mr. Athayde. Mr Athayde was hard on his students, but usually fair and respectful. If a kid misbehaved, he respectfully gave them lunch duty in the band room. Since they interrupted him and wasted his time, he let them do work to pay him back. Usually the detentions were fun and everyone had a good time. My kid would say, “I deserved it, and we had fun cleaning up the room anyway.”

What a gift he gave these kids by cheerfully expecting them to do the right thing, to make amends when they slipped up – no hard feelings – just carry your weight, work hard and do your best.

That’s all I’ve got for today….

***disclaimer…there are a few really challenged kids. This approach still applies, but some kids need more. Some benefit from medications that help them stay calm so they can learn to handle things better. Some benefit from occupational therapy or riding horses or mentoring or a different kind of classroom. There are kids who need more, but they still will still benefit from good positive coaching and natural consequences. Be very careful that you find someone good to help you if you have a kid like this. Schools are coming around, but they used to flip cards and set out contracts and some of these kids were unable to pull it together with just a contract or card-flipping as a (negative) motivator. These kids who have extra challenges require more help, more understanding, and they need a lot of happy motivation and self-esteem (translate – responsibility, and small successes) to master their own bad selves. It’s even more important that we help them stretch towards all the good inside of them with positive coaching. But sometimes more is needed.

*** **** *** **** ****

One of my kids is very headstrong and we really got into it recently and I just shut it down and went limp and backed away. With some space, he came around by sending me one of his songs. I listened to it several times. No words. No insisting on having it out. Just space to let us each reflect on our own behavior. Because all you can do is get up and try again.pexels-photo-783941

The End.



Posted in parenting, Pediatrics, Raising kids, Uncategorized | 11 Comments


Yesterday I was talking to a dear colleague of mine, who just so happens to be one of the best developmental pediatricians around. We were talking about time outs. His star time-out moment with his kid was traveling abroad when his three year old had a meltdown. He put her in a doorway and stood blocking the doorway with his back turned until she calmed down.

I raised him one. Years ago when my youngest had a meltdown in public I put him on top of a garbage can and wouldn’t let him down until he pulled it together. I believe I won that round. (Before you call CPS, he screamed for a minute, took a few deep breaths and then we went about our day. And he grew up to be a fine young man.)

Time outs are not punishment and they shouldn’t be doled out in minutes per year of life.

Timeouts are natural consequences to behaviors that are incompatible with joining in whatever is going on, and they need to be phrased that way.

Basically, a kid needs to stand or sit in a place and pull it together until they can begin to interact properly. It’s a variation on stopping time….NOTHING happens until you settle down.

Kids hate it, more than anything, when nothing happens. However, they often need a little space to change gears.

However you do a time out, the key is separation and making sure that the kid understands the purpose, which is to reset. The goal is to let the moment of fury and misbehavior pass – then we’re good to go.

I don’t personally like there to be ANY talk after a timeout. We’re done, now let’s move on. Any talking can be accomplished later but if you dive into a discussion too soon, you are likely to just stir up whatever angst caused the problem in the first place. I much prefer just saying  “good for you, you are ready to go to the park now.”

There are issues with timeouts that make it less than a one size fits all approach.

Some kids are too worked up to sit in a predesigned place. Sometimes they need you to sit with them but do not face them, interact or do anything. Just sit nearby. Detach. The important thing is to cut off any interaction until things calm down.

It’s very difficult when a kid will not be structured. There are some cases that may take extra maneuvers from a parent’s bag of tricks.

One thing you can do is educate your child in advance of any trouble about the purpose of a time out. It is what happens when you need to regroup, and it can be as brief or as lengthy as it needs to be.  Mommy and Daddy take timeouts all the time.

We need to teach our kids to self-soothe, calm down, and to try to put their best feet forward. It isn’t always smooth or streamlined and no approach works perfectly, or even at all, all the time. But at least, if the purpose of a time out is better defined, a child can learn to own it and work it, each and every time. It’s a skill.

So, don’t interact with a kid that is off their rocker – take a break. And don’t use a time-out as punishment. Natural consequences are punishments, if we even want to use that word punishment. Timeouts are the consequence of behaviors that make civil  interaction impossible.

We ended our conversation with the kind of babble that pediatricians engage in when no one is listening. He said yeah, all those parenting books, sometimes the best use of one of them is to throw it at your kid.

images-4 Just kidding. But the struggle is real.


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Okay, You Both Win.

Today one of my favorite dad-son duos was on the schedule for “eating disorder.” Given that the kid wasn’t even a tween yet,  I thought it was odd, but pretty soon it became clear that the little dude was not bulimic. Rather, he was spitting out food that he didn’t want to eat into the toilet.

Specifically, broccoli.

This is one of those posts where I am going to say that I really don’t know the right  answer, except that I decided in the moment that this kid should not have to eat any more food that made him need to go to the bathroom to purge.

This is one of the hardest places we find ourselves in as parents. Do we make our kid eat the broccoli or do we give it up? And what does it mean if we let a kid win?

I think we have to be very good at urging the right sorts of things, but at the same time there are moments when you gotta give in to your kid because it just isn’t working and insisting is causing more dysfunction.

At the same time, giving in implies that all a kid has to do is freak out loudly enough and he or she gets their way. And that’s no good. Especially not when the freak out isn’t even really very genuine.

So, I am going to say something all Kenny Rogers. You gotta know when to hold up and know when to fold up. And no book or therapist or relative giving advice is going to necessarily know when to do each of those with your own kids.

In this case I made it clear to the boy and his dad that good nutrition is a must (the non-negotiable) but that this guy was now too old to be made to eat a food that he really hated. I told the kid that he was too old to be spitting out food and I told the dad that I didn’t want him to make the kid eat anything too revolting. We did some troubleshooting with regards to how to eat well without encountering the intolerable food standoff. And I sent them out with instructions to come together with a plan that honored the father’s responsibility to raise a healthy child and the son’s need to be able to swallow his dinner. They left chattering away with ideas and this would not have happened if we had just continued to push, or rolled over completely.

But what about the kid that will only eat white bread-without-the-crust PB and J’s and pixie stix? THIS is why parenting is so hard. Because it all depends…

What it has come down to for me is that we have to know how much our kids can take. This dad was so worried that his kid had developed an eating disorder (and he kinda had), that the he realized that if all he had to do was abandon all hope of broccoli, he was ready to forget broccoli.

But again, there is a dark place where kids can go to manipulate us. It’s where they pull out all the stops to get their way. One time one of my kids reacted to something so severely that I backed down. Later he said that I was the mom and he wished that I had stood my ground.

So which is it?

Hell if I know sometimes. What it has boiled down for me is that little compromises are reasonable but that we must preserve the gist of what a parent must do to be a good parent. You flex on the details but not on the underlying value or goal. When something needs to be non-negotiable you hold the line.

But I will share with you something. Almost everything is negotiable in the right setting and knowing when you should and shouldn’t negotiate is one of the biggest challenges you’ll ever face.

I’m an over-negotiater, and at times I would have been better off holding firm, according to my own child. But too rigid and you can fuel dysfunction – because kids will go to any lengths sometimes to get what they need.

The best you can do is the best you can do.

Good luck and Godspeed.


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Kids: It All Comes Down To This.

I’m about to tell you the most powerful advice I have ever been given about raising children. It’s a shame that I can’t remember who said this, because I would make them president and give them an award.

Are you ready…?

**Don’t put more effort into doing for your kids than they are investing themselves.**

But, but, but…..I hear you say, so let me explain.

There are obvious implications for older kids and teenagers, but I am going to suggest that this even applies to babies. Maybe it doesn’t apply to newborns, but as soon as a baby can reach for a toy, here is what you do: you let them get it themselves. But, but…listen. You can move the toy closer, you can make it possible for them to get what they are going after, but let them experience the mastery and joy of doing it themselves.

They drop the toy? Do NOT pick it up. You can put them on the ground to pick up their own toy, or you can leave the toy on the ground so that they can experience the consequences of what they have just done. But the minute you pick up their toy it’s game over. You are then the retriever and believe me, it might be cute now but ten or fifteen years from now you’ll be ripping your hair out.

I was a master at doing things my kids were perfectly capable of doing for themselves. A mother’s love, I called it. I dressed my kids, grabbed their backpacks, cleaned their rooms, looked into fun things for them to do. I did those things, and I didn’t even realize the trouble that lied ahead. I took away my children’s agency every time I acted from a place of love. I didn’t mean to, but that is what I did.

Sometimes we take over because we are in a hurry. Sometimes we don’t realize just how much our kids are capable of. Sometimes we feel nurturing. But we are creating a situation where a child learns to sit back and wait for things to come to them, instead of trying themselves to get that glass of water.

It’s not our fault. Anyone raised with the image of a doting wife or mother or father or husband making dinner, doing chores, driving carpool – we internalized a lot that isn’t helpful.

“But my child is six years old and cannot drive,” you say! Right. But your child can carry their things to the car, help choose the music, learn to pump gas, learn to not make a mess in the car – there’s a lot your kid can do to make driving a heck of a lot easier. And you need to explain it to them: “Mommy is going to be driving so your job is to gather up your things and take them inside.” Every time.

I remember reading some time back about a very small child from a third world country where children were expected to contribute daily to running the home. This girl was four, and she had been taken in by a family that was bowled over by what this girl could do. She offered to sweep, cook, fold clothes…she could do things at four that we don’t expect out of a ten year old half the time.

How many of us do chores ourselves because it takes too long for our kids to do them, or because they “don’t really know how to clean.” Well, I’m here to tell you that it takes its toll. We become crabby and exhausted. But worse, our kids have no purchase or investment. We alienate them from the family when we don’t include them in the day-to-day running of a household.

Giving a kid a few chores may feel like what I am talking about, but what I am talking about is much more encompassing. It involves letting a child participate more in their own self care and in the care of home and family. Rather than assigning a chore, expect that your child will help plan one meal a week, expect them to choose a job, expect a higher level of participation.

And what happens if they don’t participate? Maybe they don’t eat. Maybe they can’t go to a friend’s house because they haven’t done their laundry and everything they own is dirty. You have to learn to sit with, “I really wish you could go right now, and it looks like you have nothing clean to wear. When you have finished your laundry, we can talk about a playdate.”

Then retreat. Nothing else happens until the laundry is done. No negotiation because that’s how the world works. And besides, you undoubtedly have given them a few reminders before. They know that if their laundry isn’t done and they run out of clothes, they aren’t going anywhere. They know because you’ve already been over it. And believe me, they can do their own laundry. Starting at 3-4yrs you do it together, and by ten they will be flying solo AND putting their clothes away.

I didn’t think these things mattered. I thought my kids should be kids. I only expected very basic things like bussing their dishes. But it mattered more to their sense of self-worth and agency than I ever imagined.

Later in life, one thing “kids these days” seem to be suffering from is lack of motivation. As parents, we often jump in and sign them up for sports or we vow to spend more time reading or playing or talking to our kids – all good. But we must stop and realize that by doing for kids what they can do for themselves we have killed their motivation. We have thrust them into a dark place where they wait for things to happen, where minimal effort is necessary, and where nothing is ever good enough.  Learned helplessness.

A friend of mine has a beautiful and vibrant daughter who wanted to play club soccer. She was almost good enough,  but audition after audition, she didn’t make the team. My friend secretly would have preferred that his daughter not audition anymore, but he said nothing and gave no advice, which is probably why she had the drive to continue on. It was what she wanted for herself. Her fifth or sixth audition, she made it. All on her own. Huge pride all around!

My kids are just now grown, and they still sometimes ask for help with things they can do for themselves. I have learned to largely go limp. I will keep them company or suggest a starting place, but I pretty much leave them to it.

It is something I wish I’d done a lot more of a lot sooner.

I regret not empowering my kids at younger ages to do all sorts of things. We think we should make our kids do certain things, like “get them to eat vegetables” or  “get them involved in sports”. Here’s the deal, you want a kid to eat vegetables? Feed them vegetables for dinner. Just vegetables you say? Maybe. Maybe if there isn’t much else around they will eat vegetables and maybe they won’t. It’s up to them if they want to eat those vegetables or go hungry. Children in countries where food is scarce eat all kinds of things. Really.

As for getting them involved in activities – you are the one to set the tone by doing your own thing. You play soccer. They’ll probably want to join you. One of my patients runs races with her parents and has been from the age of four. No one has to make her, either.

Of course it is reasonable as a parent to set standards. Some families expect each child to have an instrument or a sport or both each season. That’s fine. But try to let them manage those things. My youngest son chose to play the French horn when he was maybe ten. I had chosen violin lessons for my older two and they hated it. I wasn’t going to make that mistake again. So I pretty much let him get started on his own in school with no input from me. He decided how much he would play his horn, and he didn’t even have a private instructor for several years. He had a piano teacher when he was younger and my one ask of this teacher was please not to “make him practice” or force him into a recital. Hence, my kid loved his lesson and developed an ear for music organically. Sometimes he played and sometimes he didn’t and that was fine. Owen is now minoring in music performance in college and is serious about his horn, and music. And I think it is because it was his thing from the start, and only his.

When you allow your child to master the world around them little by little, they will grow into a person who is capable, a person who’s motivation comes from the inside, and a person who believes in themselves. Their track record will be pretty impressive, and that will not be lost on either of you. Your life will run more smoothly and your kids will feel a sense of pride and accomplishment.

There is a marvelous video of a little girl trying to get her seatbelt on. She is two or three. Her father keeps asking if she needs help as she struggles and she says over and over, “No, no thank you – you worry about yo-self.” Besides being adorable, this girl knows the importance of autonomy and doing all we can for ourselves.

black-and-white-blur-child-289923 Bravo, little one!


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The Doctor is In!

Wouldn’t it be great if we all knew how to parent our kids?


Every day, in between diaper rashes and runny noses, I am presented with questions about kids and parenting. Sometimes I have answers, sometimes not. But I can tell you one thing: I learned absolutely zero about raising kids in medical school, residency, and  before I had my own kids – even in life.

I have met handfuls of parents who seriously know what they are doing. These parents are often preschool teachers or they come from large families. Some are excellent because they have a set of standards and they stick to them. Some are talented in adapting to change. There are some rock stars out there and I have stolen from every one of them.

Most parents aren’t superstars but they are definitely good enough, and some, like me, are loving, kind people who just have gotten by winging it. Winging it is okay, but modern parenting requires alittle more. I wasn’t the best mom. I love my kids, but I just wasn’t the best mom.

Here, I’d like to share some of what I have learned along with some of the day-to-day stories collected in my twenty-some-odd years as a pediatrician. Children are not for the feint of heart, and raising them can feel like a landmine.


Posted in Pediatrics, Raising kids, Uncategorized | 3 Comments