I'm thinking about ADHD....wait..what was I thinking about??

I  LOVE ADHD!!! Really..this is the best time of my practice. The first few weeks of school, I have so many patients come in for evaluation of "attention issues"..

A child doesn't ever develop ADHD in kindergarten. Now, preschool is available at 4 years of age. Children also don't develop ADHD in preschool.

Children are BORN with ADHD.

First time parents sometimes don't know any better. They have no comparison. Second time parents are aware that there are differences but can allow for other reasons...." He is acting out...he is stubborn...he is bad...".

The first time that parents observe that their child has trouble with following directions like...staying on task...sitting quietly at a table with peers...waiting their turn... is usually noticed in the day care, pre-k or kindergarten environment.

They come to me in the first weeks of school saying that the teacher thinks there is a problem. The teacher tells them that their child is disruptive...can't pay attention..talks out loud..is fidgety..can't keep his hands to himself..can't sit in circle time...annoys others kids...can't follow directions...talks incessantly...

WOW.

Where are the parents? Where are the grandparents? Where is the babysitter? Where is the daycare?

I'll tell you. All of the above have noticed. The problem is that no "program" will recognize ADHD until the child gets to school and is singled out for his/her behavior.

By then it is harder to help the child in question.

That is where I love the chance to help.

The earlier the better. This gives me more chance to evaluate the child and set him/her up for testing.

The first thing I ask of the parent(s) is if the child met developmental milestones appropriately.

I ask if they can see and hear. Most people know...even without testing. If there is a question, then I set them up for evaluation with audiology and ophthalmology.

I then interview the child. If the child isn't able to sit still or engage in a task or answer questions or play or interrupts or climbs everywhere...etc.........then I get started.

I am amazed at how many K- 3 kids, with ADHD, when asked if they like school, say " NO"! I'm even more amazed that when I ask them if they have any friends..they say "NO". 75% of kids cry when I ask them if they feel welcome and loved at school. This always blows away parents ....and they usually cry too. I think because the parents ache for their child and they feel guilty or responsible. Which parent doesn't want their child to feel as special as we know they are?

The child with ADHD can't help behaving in a manner that is irritating. There is no regard for personal space, their thoughts race, they can't help yelling out, they fidget, they can't follow directions, they are disruptive, they act as if driven by a motor, they miss the innuendo and social cues that other kids have naturally.....they are obnoxious to teachers and fellow students.

The child hears, " Sit down...keep your hands to yourself..stop running around..pay attention..stay in line....focus...stay in your seat...stop talking...take turns...don't shout out loud..."

Then, the child gets a "note" for mom as he watches the rest of the "well behaved" kids get rewards for good behavior.

He goes home and hears..." You're bad..another note? ...Sit down...EAT!! Do your homework...stop wiggling...be like your sister...Wait 'til your dad gets home...etc..etc...

Pretty soon the child just tunes out and resolves himself to being the "bad egg".

This is where I step in.

I only wish that I had an hour with every child.

First, if I'm thinking that the child really has ADHD, I ask that the school test the child.

As I've been doing Pediatrics for 14 years, I have a good idea who is really ADHD. Not that I'm so smart, but  I am really willing to listen to teachers and parents.

I start meds at once if I'm convinced that the child is ADHD. I still put in the EVAL for development but I'm unwilling to let a child suffer when he or she could benefit from therapy.

I also tell the child that it is not a magic pill. It won't make their parents nicer or the teacher more lenient.
I tell them that it will only help them concentrate a bit longer. The rest , I tell them is up to them.

I also tell the parents that this child will need to be parented differently than most. I stress a highly structured environment.


Those of you that know me ...know I'm about as structured as a glob of silly putty. My kids just don't need rigid structure. In fact, they NEED to be flexible.

ADHD kids need structure. The meds ONLY help them concentrate a bit longer. Long enough to not do impulsive things... long enough to listen to and follow directions...long enough to regard a friend...long enough to form a bond...long enough to understand and feel empathy...

If the meds offer this "bit more" of focus, then the parents and teachers need to know what to do with that moment more.

Kids don't WANT to have ADHD. They want to be successful in kindergarten and 1st grade and 6th grade and 8th grade and 11th grade and college. If you asked your child in kindergarten if she wanted to drop out of school......she would LAUGH at you. The world is their world. It only takes a few months to take the wind out of their sails.

Don't be that parent that says, " There is NOTHIN wrong with my kid".

Teachers know. Doctors know. Most parents know.

I love ADHD kids because I can help change their lives if the parents and the teachers are on board early.

So, what was I thinkin about?

The "Back to school Bitch"...

What is UP with school starting in the middle of August?

Regardless, kids everywhere are going school shopping with their parents to get ready for the year. Every child wants the best backpack, shoes, clothes, notebooks..etc..

Why?

They want to fit in. They want to be accepted. They want friends. They want to learn.

Some can't wait to get OUT of their home and get to a stable environment.

So what happens when a child goes to school and gets relentlessly bullied?

That kid has no reprieve. Used to be that if you could make it to your bus on Friday and get home then you wouldn't have to deal with bullying until Monday. Now, kids are harassed on Facebook, texts, twitter..24/7.

What can we do as parents to prevent this?

First, figure out if your child is the" bullied" or the" bullier" or the "passive watcher" or the "oblivious to everything" kid.

Ask if they have been picked on or have seen someone picked on. Ask what they did in the situation.

I had a patient in Chloe's class. He was overweight and had a speech problem and came from a rough home. He came in for a sore throat. After figuring out he was in Chloe's grade, I asked him if he knew her. He smiled and said , "Yeah, I know Chloe..she's nice to me".

I felt all kinds of things. I was glad Chloe was nice. I was sad that this kid divided up people in school that were either nice to him or were mean to him. When he was out of the room ,I asked his mom if he had a best friend. She said that she had no idea. She is a great mom and was worried sick about her little guy's throat, but had no idea if he had a friend.

Later, I asked Chloe if she knew this kid. I didn't tell her he was my patient but she probably assumed. She said that she knew him and felt sorry for him cus he was so nice to everyone but most people were mean back. She said she always says " Hi" to him.

I really used that situation to help Chloe realize how much that " Hi" meant to him everyday. She never forgets to say "Hello" to him now. She also called out a person that was picking on him.

We should all take a moment with our kids and remind them how their actions and words can make or break some one's day..week..year..

Also, ask your child if someone is being mean to THEM. If so, be aggressive. Don't let your kid think he or she is alone. Let them know that you have their back.

Call other parents. Call the school. Be your child's advocate!

Back to school safety by a psycho safety mom

Why? Why do I watch Criminal Minds and CSI and SVU and Discovery ID ? I'm obsessed. So, let me just get this outta the way.

I must preface this safety tip with this. When I was pregnant with Darby, we went to Cancun. I met a NYC cop and his family. I said, " OH MY GOD ( OMG) ...you must go crazy with all those kidnappings and Amber alerts...you must keep your kids under lock and key...HOW do you DEAL with these tragedies everyday??"

"Nalini , I've been a cop for 15 years...guess how many child abductions I've seen and investigated?" He said.

I replied..."At least 50..75...100...THOUSANDS!!!"

Silence.

More silence.

" None...zero...nada...zilch..", He said while staring at me like I had a screw loose.

That said.....I still go over " How to not get abducted and /or molested 101".

First, let your child know that THEY HAVE A VOICE and that they should use it . So many kids are intimidated by adults...especially in and around school. I tell 'em..if you're uncomfortable or unsure..just scream your head off and RUN!!

Let them know who they CAN get in the car with when not with you. That is easier to remember.

Have a code word if the child is old enough to understand that concept.

Tell them where their "private parts" are and who can see them ( mom, dad, safe caregiver..etc..)

I give my girls a word for people who could want to " take or hurt " them. Most kids don't know "pedophile".

We use "pee-pee touchers".

Now, this could lead to a nice neighbor offering your 7 year old a ride home from school to help you out and your child pointing and waving and running while screaming... "PEE PEE TOUCHER..PEE PEE TOUCHER!!"

Your neighbor may be ostracized for a while but at least ya know you got through! Bye Bye Bunko!!

Have a current pic of your child available. Know heights and weights.

My kids say, " Mom..a kidnapper van!!!" when they see a van with no windows.. A little over the edge I admit.



OK..Here are 2 other things to go over!! More will come!!

1. Food and bee allergies.
    Have an action plan with the school nurse and teacher.
    Have Epi-Pens accessible if your Doc has prescribed them. Always 2 pens!!

2. Bus etiquette. How to get on ( always cross in front and wait for the oncoming traffic to stop)....bullying...what to do if your baby gets on the wrong bus...what if your child drops stuff and it rolls under the bus..

Be creative. Think of potential questions and situations.

When good kids say BAD things

I was cooking the other night with Ruby and Darby. They were sitting on either side of me on the counter, helping throw veggies in the salad.

Ruby casually says" So mom, today I was at K's house ( BFF) with Darby and we were all dancing to that Justin Bieber song...you know..the one that goes..baby,babyoohh......Anyway mom, the Chipmunks were singing it instead of Justin Bieber and they sang 'STAR F_ _ _K' in the song."

I choked on a cucumber but calmly told her that it would be highly unlikely that either Justin Bieber or Alvin,Theodore and Simon would say F_ _ K.

"Really mommy, they say 'STAR F_ _ K'." Says Darbs in her casual 4 year old way.

Chloe came downstairs at the end of the conversation and trying desperately to stifle her laughter calmly told them that the word in question was STAR STRUCK.

The two little girls looked at each other and laughed. They told Chloe that STAR STRUCK didn't make any sense.

Ahhhh but STAR F_ _K does?????????????????????????????????????????????????????????

The minds of kids are fascinating. How could I get mad? They were just repeating what they THOUGHT they heard.

It was a learning/teaching point. I pointed out that the F -word was a "not nice" word that no decent Chipmunk or teeny bop singer would EVER use...especially in a little girl dance song. Then we listened to it. Then I told them what star struck meant in the context of the song.

They were satisfied and I was left wondering why they didn't think the Chipmunks were singing "STARBUCKS".

Bad word are a part of our society and we'd be naive to think that our kids won't hear them... in the home.. on TV..  on the school playground .. from older siblings... from cranky post call moms (oops) ..  from songs like those featured on the HIP HOP sat radio station ( TURN IT OFF CHLOE!!).

It depends on how your child USES them that will pick the parenting skill to end the use of FOUR LETTER WORDS. And..I don't mean whether or not he uses them in a grammatically correct way.

If a child is saying a bad word over and over for effect, then the best thing you can do is ignore it. Well, and disguise it in public.."Really that's his word for TRUCK".

Ignoring the behavior will cause it to extinguish. Simple to say...hard to do.

Kids that just say it because they've overheard it can just be told very openly that "BAD WORDS" are words that people should NOT use and that you don't want the child to use those words. Avoid if you can, going through the "George Carlin" list of bad words. I think this would do more damage than good.

Also, be honest. Tell them what the word is "slang" for and give them other options. " SH_T, means poo-poo and I'd rather you tell mommy you have to POO-POO than SH_T. This unsolicited advice is aged based obviously.

Liza asked me a few years ago if she could ask Santa for a "Disco Stick". You know the one in the lady GaGa song ( I wanna take a ride on your disco stick). I calmly explained that Lady G was indeed using the word "Disco Stick" to mean PENIS. I told her that I would NOT expect her to get on Santa's lap and ask for a "Disco Stick" for this reason. SHE WAS MORTIFIED. She thanked me for telling her and turned the station whenever the song came on.

Clearly, I reserve such blunt explanation when listening to Darby sing " I want to touch your Peacock..Cock..Cock.."   THANKS KATY PERRY   I just told her that Peacocks were mean birds and that we should sing PIZZA...I want to eat some PIZZA..ZA..ZA..ZA.

When Ruby sings " Sticks and stones may break my bones but whips and chains excite me"...I throw up in my mouth..SILENTLY curse Rhianna...and wish for the days that we happily and without fear listened to THE WIGGLES. I have nothing for that one.

Sad, but songs, siblings, potty mouthed moms, TV , U-tube, i-phones etc are influencing our kids language in many ways. Just BE AROUND to redirect the fall out and be selective if you can to what the children are exposed to in their world. That said...It's impossible to shelter the 4 and 5 year olds exposure from the 10 and 13 year olds world. I just do my best prevention and even more important ...my best damage control..

STAR F_CK??  REALLY??   THAT MAKES

unsolicited pediatric advice: Getting SOME for the computer DUMB

unsolicited pediatric advice: Getting SOME for the computer DUMB: "First Blog I think. It's 2:30 AM and the third quiet hour I've had in 5 days. I've wanted to do this 'blog' forever but I didn't know a thin..."

Getting SOME for the computer DUMB

First Blog I think. It's 2:30 AM and the third quiet hour I've had in 5 days. I've wanted to do this "blog" forever but I didn't know a thing about blogging. Not sure still.
I'm doing it to create a place where parents can feel comfortable asking a pediatrician advice about anything.
I'm blunt and I use foul language at times.
I've been in practice for over 13 years and have 4 daughters that I adore.
Questions about everything will be answered honestly and with humility and humor.
Your children are the most precious people in your life. Raising them well...with self esteem...will reward both your children and you.
I've seen too many parents raise their kids by the "status quo" because they think they are doing the right thing by listening to the media and ridiculous parenting guides that are based on parents ignoring their natural instincts in order to make THEIR life easier.
I'm here to empower parents to make decisions that draw upon the parent's natural instinct to nurture and enjoy their child.