Plan B often works by preventing implantation of a human embryo in the uterus, thereby causing death of the new life.  It can also act by preventing or delaying ovulation.  The American College of Obstetrics and Gynecology (ACOG) has defined pregnancy as implantation of a fertilized egg into the uterus, not conception.  So, technically speaking, using ACOG’s definition of pregnancy, Plan B does not cause an abortion.  For this reason a lot of media outlets are saying that “Plan B is not an abortion pill,” or “Plan B does not cause an abortion.”

The mechanism of action (MOA) of Plan B is becoming an increasingly important issue. The American Academy of Pediatrics policy statement on emergency contraception also states that physicians should counsel patients on the mechanism of action of emergency contraception.  Yet many physicians are not discussing the full mechanism of action of Plan B.

Most medical professionals and ethicists have come to believe that Plan B given in the fertile window works by primarily by preventing or blocking ovulation. This is not true.  Plan B’s own website states that Plan B One-Step works primarily by, ‘Altering the endometrium, which may inhibit implantation’ – the implantation of a human embryo.

Research shows that ~80% of women who take Plan B in the fertile window still ovulate, yet the drug is still very effective in preventing pregnancy.  There is a great article that explains this science in detail, “The State of The Science, Why Catholic Hospitals Should Not Dispense Plan B.”  I’ve republished it with permission of the authors here:

http://www.catholicpediatrics.com/articles/state-science-why-catholic-hospitals-should-not-dispense-plan-b-patrick-yeung-jr-md-and

There is evidence that oral contraceptives (birth control pills) can work through a similar mechanism, also preventing implantation of an embryo.

Many health care professionals promote contraceptives and emergency contraceptives such as Plan B as a good way to reduce or prevent abortions.  In reality, though, we are just killing life at an earlier stage.  It’s forcing us, as Catholics and Christians, to really ponder the miracle of life.

Many, if not most, of my colleagues think I am rather crazy for even caring about this issue.  How can we continue to promote a culture of life in this atmosphere?

Copyright 2013 Kathleen Berchelmann, MD

This week my husband and I announced our big news: we’re expecting our 5^th child in September.  “Really?”  is the most common reply.  Here are some of the other zingers we have heard:

“Do you hate money?”

“Are you done now?”

“Are you crazy?”

“Was this planned?”

“Don’t you know there are things you can do to prevent this?”

“Do they all have the same father?”

“You must be Catholic or Mormon.”

“Is the quiver full of arrows?”

Critics of large families mention the burden that our children will be on society and the Earth.  We hear about the health care costs our children will generate and the size of our family carbon footprint.  Others simply express concern for my husband and me, that we will be too tired, have financial stress, or not have enough time for each other.

Here’s my question: why can’t we look at children as future contributors to society, not burdens on society?  My children are the best gift I have for society.  Children bring hope for the future and model unconditional love.  Have we forgotten?  It is the sign of a dying society when we see our children as burdens rather than beacons of hope, future innovators.

The National Center for Health Statistics says the over all birth rate in 2011 is the lowest in this country since 1920. As a college-educated Caucasian female, I am predicted to have 1.6 children per 2011 statistics.  America’s overall fertility rate is 1.96, below replacement rate of 2.1.  We do not have an overpopulation problem in the United States, we have a low-birth-rate problem.  Experts predict that global population is also slowing.  This trend is likely to continue as contraception becomes increasing availability in the developing world.  When birth rates fall below replacement rates societies suffer.  The average age of the population increases, creating a top-heavy society with heavy health-care and resource needs.   Children are the answer to this problem—our future workers, innovators, and supporters.  Children are our hope and future, not our burden.

But I’m not having kids to re-populate the Earth, I’m having kids because I love them.  Yes, I will have a few more years of diapers and crying babies at night, but the rewards are many.  Here are my favorites:

• Children keep me young and joyful.  I have to turn my anxiety off and play pretend with my 4-year-old, I rest every few hours and breastfeed my baby, and I share my six-year-old’s delight in drawing a dream-house with fifteen stories.  They get me to eat home-made snow cones and play in the rain.  I play outside almost every day.  Do you?
• Younger kids bring joy out of my older kids, no matter how grumpy they get.  My son can have a terrible attitude, but when his baby sister wants to play with him, he always smiles and obliges her.  And then I smile, too.
• Life is never boring!  Our kids each so unique, so different from the others.  And they keep growing and changing.  We never know what to expect.
• I don’t sweat the small stuff anymore.  I used to clean polish away every nick in my wooden furniture and keep my bathroom spotless.  These days I figure a few marks in my furniture adds to their antique value.  I find fingerprints on my bathroom mirror endearing.
• Parenthood makes me work hard.  Without kids, I’m sure I’d watch more TV, drink more wine, and become a more selfish individual.  With kids, I’m forced to think of others and avoid self-absorption.
• Kids make me realize how ridiculous I can be.   One of my kids complains about dinner almost every night.  It’s really annoying.  Then I realize there are things I complain about too much, too…
• There is nothing like parenthood to keep you humble.  Just when you think you have it all figured out, they throw you another curve ball.
• I want less stuff.  I keep thinking, if we had fewer kids and more disposable income, what would I do with it?  Drive a fancier car, live in a bigger house?  I don’t want a fancier car and I certainly don’t want to clean or care for a bigger house. 

Some people worry that we won’t be able to give each of our kids the one-on-one attention that they need.  Because we homeschool [link to this blog post], our kids get plenty of individual attention every day.

A new baby is perhaps the best gift you can give to your other children.  A 14 year-old from a family of five told me, “I can’t imagine not having siblings.  That would be my worst nightmare.  It would be lonely.”

My four year-old said it best, “Can we have as many kids as the Duggars?” Umm… maybe not that many.

Copyright 2013 Kathleen Berchelmann, MD

Rethinking Your Baby’s First Few Minutes of Life

Think back to when your babies were born—what happened in those first 5-10 minutes of life?  Did you hold your baby?  Were you encouraged to breastfeed your baby?  Or did someone take your baby away from you?

These days most babies go directly to a health care provider for evaluation, or, if the baby is breathing and appears well, the mother will get to look at or hold the baby for a minute or two before someone whisks the baby away for “necessary” medical care.

Things are changing.  We are rethinking how a baby should spend his or her first few minutes of life.

As a hospital-based pediatrician, I have been attending deliveries regularly for almost ten years, and I love it.  I never tire of witnessing the joy of new parents.  I feel privileged to take care of babies in their first few seconds of life.  St. Gianna, a pediatrician who also attended deliveries, expressed the same thoughts in her writings.  But those first few minutes of life are not meant to be spent with me.  Those precious few minutes are meant for bonding between baby and parents.

With the support of the Best Fed Beginnings program and Baby Friendly USA, my local hospital in St. Louis (BJH/Washington University) has started giving babies directly to mothers as soon as they are delivered, provided they are breathing and appear healthy.  Newborns go “skin-to-skin,” meaning that we place the baby, unwrapped, on mom’s bare chest, between her breasts.  We usually place a warmed blanket over the baby.

Babies can be evaluated by a pediatrician and/or nurse on mom’s chest, if needed.  If a baby is in distress and needs medical care, obviously we do whatever is necessary.  But most of the time babies are fine.  They do not need a pediatrician in the first few minutes of life.  We can even do skin-to-skin at cesarean sections.

And then something amazing often happens: babies start breastfeeding.  All by themselves.  They just find the breast and latch right on.  And usually when they are less than ten minutes old.

If you’ve ever struggled to breastfeed a newborn, you know how hard it can be to get them to latch on to your nipple.  Breastfeeding can become a stressful burden on a very tired mother.  But babies who breastfeed in the first hour of life—and preferably in the first 30 minutes—have a much easier time learning how to latch.  Why? Because when the baby is inside mom’s uterus, she is constantly and rhythmically sucking in amniotic fluid and swallowing it.  At birth she cries, breaths air, and starts to forget how to suck and swallow.  If you wait more than an hour to breastfeed, babies can have a hard time latching, sucking, and swallowing.  If you breastfeed right away, the baby still remembers how to suck and swallow.  If you put a baby skin-to-skin between mom’s bare breasts at delivery, she will be warm, soothed by mom’s voice, find the breast herself, latch right on and start nursing.

The moms giggle and cry.  They are so happy.  This is how the first few minutes of life are meant to be. In the sentiment of Blessed John Pau II’s Theology of the Body, these first few minutes are a total  self gift of mother’s body to the baby, from the uterus to the breast.  And with total self-gift comes incredible joy, even through pain.

What did the nurses and doctors used to do when they took babies away from moms at delivery?  Here’s what we used to do, and how we do it now:

• Check baby to be sure she is healthy: Pediatricians and/or nurses used to take babies away from moms to be sure baby is breathing well and healthy.  We still do this, just on mom’s chest.  Later, when mom is ready to rest, we do a complete physical exam on baby.  We also weigh the baby, measure length and head circumference, and get footprints.  But all this can be done when the baby is one or two hours old—it doesn’t need to be done in the first ten minutes of life.
• Draw blood tests: If necessary, we would draw blood for tests, usually to check babies for infection.  Now we do any needed tests a bit later, when we do the baby’s physical exam.  Occasionally it is still necessary to get tests right away, but usually only on very sick newborns.
• Give baby a shot of vitamin K: Vitamin K deficiency can cause serious bleeding and death in newborns under two weeks old.  This uncommon condition can be prevented by a shot of vitamin K in the first few hours of life.  The Vitamin K shot is recommended by the American Academy of Pediatrics and is standard newborn procedure in most hospitals.  We still give vitamin K shots to newborns, but after mom and baby have bonded and breastfed. 
• Put antibiotic ointment in baby’s eyes:  All babies get antibiotic ointment in their eyes shortly after delivery to prevent serious newborn eye infections.  The ointment does blur baby’s vision.  Now we wait an hour or so before giving the ointment, so that baby can breastfeed and bond with mom. 
• Give baby a bath: Babies are born covered in vernix, a white substance that coats them in the uterus.  Usually babies get a bath to remove vernix, at least within the first few hours of life.   There is no reason for a bath in the first few minutes of life.

So go skin-to-skin with your baby, talk to her, nurse her.  Everything else can wait.  If you are currently pregnant, don’t be afraid to express these wishes in your birth plan.  Be sure to discuss these methods of infant care with your OB/Gyn and the nurse who admits you to Labor and Delivery.

Copyright 2013 Kathleen Berchelmann, MD

Milk

Organic, raw, cow, almond, soy, rice, omega-3 fortified, breast or none?  What kind of milk to you give your kids?  For my mother, the answer was easy:  I was not excused from the table until I drank all my cow milk.  But new data is changing the age-old recommendation that kids need three glasses of cow milk per day.  The internet is full of moms with passionate milk advice, but I found they raised more questions than answers.  So here what I came up with when trying to decide what milk to buy for my family:

• Two 8-ounce glasses of cow milk per day is about right: New research out of Canada shows that kids who drink more than 2 glasses of cow milk per day are at risk for anemia, or low iron levels.  Anemia is associated with behavioral problems and poor school performance.  Kids who drink less than 2 glasses of milk per day are at risk for low calcium and vitamin D levels.
• Organic milk isn’t worth the extra price: I’ll admit it, for nearly ten years I bought organic, hormone-free milk.  I was scared by recombinant bovine growth hormone.  I was worried about pesticides on the grass the cows eat.  I didn’t like all the antibiotics given to milk cows.  But after studying years of research on organic milk, here’s what the American Academy of Pediatrics concluded: “There is no evidence of clinically relevant differences in organic and conventional milk.” If you, like me, have spent lots of money on organic milk, don’t feel too bad.  The report also says: “Several studies have demonstrated that organic milk has higher concentrations of antioxidants and polyunsaturated fatty acids.  However, it is important to recognize that the composition of milk is strongly related to what cows eat. This differs by time of year (outdoors in the summer, indoor forage in the winter) and whether the farms are high or low input.” [http://pediatrics.aappublications.org/content/early/2012/10/15/peds.2012-2579]
• Chocolate milk probably isn’t worth the bribe: If you look in the milk cooler at our local public elementary school, there’s plenty of chocolate, vanilla, and strawberry milk and a few lonely white milks hiding in the upper corner.  Adding sugar and artificial flavor to milk may seem like a worthy trade-off to get kids to actually drink it.  But the more we understand that milk is not a perfect food, the more I wonder if sugary, flavored milk is really worth the protein, calcium and vitamin D.  For my kids, the answer is no.  We pack a water bottle in their lunch boxes.
• Omega-3-fortified milk isn’t worth the price: Kids do need omega-3 fatty acids, which are naturally occurring in breast milk and usually added for formula.  Once they transition off breast milk or formula, I recommend supplementing unless you really do convince your kids to eat enough fish, walnuts and other foods that are naturally high in omega-3’s.  [Vitamin Wars].  But the high price of omega-3 fortified milk doesn’t make it worthwhile for me.  It’s cheaper to just give supplements.
• Only breast milk or formula for babies:  Infants under 12 months of age are at risk for microscopic bleeding in the intestines if they are started on cow milk too soon.  This bleeding can cause anemia.  More commonly, cow milk causes constipation and results in a very irritable little one.  What about almond, soy, and rice “milk”?  Have you ever noticed that these products carry a warning that states, “Not intended as an infant formula”?  Almond, rice and soy milk do not offer the nearly-complete nutrition offered by breast milk and formula.  I once cared for an infant who was admitted to the hospital with rickets after she was fed almond as a natural alternative to formula.  As always, remember that breast is best for babies.  Do you have the breastfeeding blues [link to article]?  Are you struggling with breastfeeding?  Consider supplementing by syringe feeding.
• Almond milk isn’t a great alternative:  Almond gets an A+ on taste and makes fabulous non-dairy ice “cream,” but it isn’t a great source of protein, calcium and vitamin D.  Although commercial almond milk is usually fortified with calcium and vitamin D to match the calcium and vitamin D content of dairy milk, the American Academy of Pediatrics warns that people absorb the nutrients in milk and milk products better than they do those in plant-based milks.
• The science is unclear on soy milk: Soy milk is a protein-rich white drink made from the soy bean, and it is usually fortified to have nutritional content similar to cow milk.  But the internet is full of theories that suggest that the phytoestrogens—plant estrogens–in soy milk increase cancer risk.  Still others claim that drinking soy milk during childhood reduces lifetime cancer risk.  I haven’t been able to find any sound published research that supports either side of this debate.  But soymilk is still a plant-based milk and hence has the same nutrient absorption problems as almond milk.
• Forget the rice milk: Rice milk has recently been shown to have such high levels of arsenic [link to arsenic article] that it is not recommended for children under five years of age.  It also has very little protein.  My third child is allergic to milk and soy, and so after he was weaned from breast milk we gave him rice milk about twice a day.  So I was horrified to read this research… being a good mom is not about being perfect, it’s about trying your best to do what’s right.
• Raw milk isn’t safe for babies and pregnant moms: Raw milk, or unpasteurized milk, makes tasty cheese and yogurts, but it can contain harmful bacteria.  The CDC reported that unpasteurized milk is 150 times more likely to cause food borne illness and results in 13 times more hospitalizations than illnesses involving pasteurized dairy products.  Anyone can become ill from the bacteria found in raw milk, such as Listeria.  But pregnant women and infants are especially prone to the serious ramifications of Listeria infection.
• You don’t HAVE to drink milk: Are you vegan?  Or perhaps you subscribe to the philosophy that cow milk is intended for baby cows.  Or maybe you are still worried about hormones, bacteria, or pesticides in cow milk.  In any case, you and your kids don’t have to drink milk.  There are many other great sources of protein, calcium, and vitamin D.  Sometimes it’s just hard to get kids to eat leafy green vegetables and fish.

If you do choose to reduce the amount of milk in your family’s diet, consider what they will drink instead.  Try to increase water, and limit high-sugar drinks such as soda, sports drinks and juice.

Copyright 2013 Kathleen Berchelmann, M.D.

Last month the American Academy of Pediatrics even wrote a policy statement suggesting that all pediatricians prescribe the morning-after pill to all adolescent females at each well-child check, just in case they need it.  Pediatricians prescribe birth control, refer for abortions, and treat STDs.  We’re taught in medical school that masturbation is alright and to encourage experimentation with same-sex relationships.  I’ve been a pediatrician now for almost ten years, and I love my profession, but my heart aches each times my profession refuses to recognize that such permissive views on sexuality will only hurt our children in the long-run.  As Catholics, we can’t just tell our kids to “Just say no” to sex.  We have to teach them why to say “no” to premarital sex.  How can we really do that?

Text4RealSex draws together resources from many Theology of the Body authors and speakers including but not limited to Christopher West, Sr. Helena Burns, and of course, Blessed John Paul II.  Weekly text messages go to your teen’s cell phone (or yours!) and often include links to YouTube videos and websites.  You can also follow Text4RealSex on Facebook (https://www.facebook.com/text4real) or Twitter (@Text4RealSex).

Please try this out and let me know what you think!

Copyright 2013 Kathleen Berchelmann, M.D.

Editor’s note: In response to the Newtown, CT tragedy, I asked Dr. Kathleen Berchelmann, our personal physician, to share her perspective on how she is addressing this incident in her home. I would love to hear from our readers in the comments about conversations you have shared with your children in the aftermath of the shootings. We continue to pray for the families impacted by this horrific incident. LMH

Culture of Violence: A Mom- Pediatrician Responds to the Newton Shooting

I just talked to my 3 and 6 year-old kids about the Newtown shooting.  We’ll talk to our 8 year-old later today.

We’ve become a country where school shootings and family homicides have become so common that I’m barely surprised by the news.  My husband and I continue to grieve over the growing culture of violence in our country, a culture than many people refer to as “the culture of death.”

I’m a doctor.  I try to help people heal.  Here is what I’m doing to help heal this culture of violence.  What are you doing?  What do you think I am doing right or wrong?  Please tell me in the comments below.

- I teach that all life is precious—through my choices as a parent and doctor and through my words as a writer.  My husband and I teach our children never to resort to violence except to protect their own life.  This means that we, as parents, cannot be violent, ruthless, or hard-hearted, either.  We’ve had to tame our own anger.  When we focus on the intrinsic value of life, we become better parents and better people.

- I encourage parents.  Parenting is perhaps the most powerful tool to help people learn the meaning of mercy.  Filling hearts with mercy prevents violence.

- I tell my honest stories about teaching non-violence in a violent world.  Teaching non-violence at home is hard.  Even legos are violent.  Parents—we need to support each other.  How do you teach your children the value of human life?  How do you teach that selfishness, anger, and lack of self-control lead to disrespect of life?  I’ve written about why I stopped spanking my kids.  I’ve written about the importance of creative play for socialization and the dangers of excessive digital playtime.  I want to write about saying “no” to violent toys.  I have a lot more to say, but I worry that I will burn bridges instead of building them.

- I realize that childhood is getting shorter and parenthood is getting longer.  We’ve found we have to talk to our kids about ugly topics like war and abortion much earlier than we want to.  What do you say when your kids ask about the pictures of aborted babies that are displayed outside a church that their school bus drives by twice a day?  Our kids were very opinionated from an early age that abortion is wrong.  Thankfully I have the freedom to agree with them.

- I remain pessimistic that stronger gun legislation will reduce violent crime.  I think crazy people would still have access to illegal guns, just like drug addicts still have access to illegal drugs.  Perhaps I am wrong on this.  I hope I am wrong.  Here are my thoughts on gun ownership: http://childrensmd.org/browse-by-topic/guns-and-kids-do-they-ever-belong-under-the-same-roof/

Copyright 2012 Kathleen Berchelmann, MD 

Once my kids started school they didn’t  have time to play together anymore.   On school nights we had four hours from the time they got home from school until bedtime.  In that four hours, they had to accomplish homework, chores, piano practice, dinner, bath and bedtime.  Add in scouts or soccer practice and something else had to give.  Free playtime was never a priority.  And I had stopped enjoying parenting—I had become a driver and an enforcer.  It seemed my job as a mom had been reduced to getting kids into the car and shuttling them to activities.  Something had to change.

We quit most of our extracurricular activities.  No more ballet.  No more soccer for my oldest.  We started teaching religious education at home, ourselves.  Now, our kids are home more.  Our house is more peaceful.  I spend less time getting angry at kids.  And my six and eight year old have started to play creatively together again.

Last week I wrote about choosing the right extracurricular activities for your kids.  But just because you cut down on activities doesn’t mean your kids will use their time well.  Here are my eight tricks to get your kids away from screens and organized activities and back into creative play.

1)     Limit TV and computer time.  Every single kid in my son’s second grade class said that they watched TV every day after school.  It’s not that TV and computer are so bad themselves—it’s about the time lost.  What aren’t your kids doing when they are watching TV or playing computer/video games?  Don’t be fooled by supposedly educational TV and computer programs—many provide a limited amount of educational content, but kids miss out on creative play with siblings.

2)     Assign chores:  Are you tired of “I bored!” and whining for TV and computer?  Tell them its time for chores.  Free play time isn’t fun if you don’t have to work for it.  After chores, free play time is as exciting as school recess.  While my kids do chores, they start talking about their plans for their creative play.  Once chores are done, they are eager to carry out their plans.  Many parents don’t expect kids to do nightly chores because they want their kids to focus on homework.  But even 15 minutes per night of kitchen cleaning or trash will teach lessons that will last a lifetime.  Even toddlers can do chores—find age appropriate tasks like changing hand-towels or stocking toilet paper.  Try to do kitchen chores and yard work together as a family. 

3)     It’s OK to ask older kids to care for younger kids.  Responsibilities towards younger kids naturally transition into creative play with younger siblings.  How else will you teach your kids to be a parent?  Do you want your kids to learn parenting from you or from a book?

4)     Cook together.  Cooking is creativity, art, and science all mixed together.  Start with really easy stuff like scrambled eggs or sandwich making, and don’t be afraid to serve this for family dinner.  Talk about your day while you cook.  “Chef” will soon become the favorite chore.  

5)     Keep toys that encourage creativity: dress up clothes, blocks, plastic animals, legos.  Keep them organized enough that they can actually be played with.

6)     Encourage outdoor play:  Pretend-play and active play are usually much easier outside.  A bush can become a house, elves can live under trees, and before you know it your neighborhood can become a magic kingdom without a trip to Disney World.   Outdoor play often becomes active play, which is great exercise.

7)     Appreciate what your children have created.  Be the “baby” in a game of house.  Learn to love their bad magic show or play that lacks a plot.  Help them improve their creativity when they are stuck.  If you get bored, you can always play Hide and Seek, no matter what age.

Last week my six and eight-year-old created an “underwear machine” that catapulted a storage basket full of toddler underwear into the air.  As the underwear basket fell, it turned on a light and launched a toy space-ship.  My three-year-old dressed up in a magician costume and the older kids taught him how to be master of ceremonies.  And my husband and I got to watch.  And the dishes and homework were already done.  This is better than soccer.

Copyright 2012 Kathleen Berchelmann , MD    

To Spank or Not to Spank

When my mother had her first child my grandmother visited her in the hospital and gave her a wooden spanking paddle.  “Some day you will need this,” she told my mother.  I heard my mother tell this story again and again throughout my childhood to justify her use of corporal punishment.  As a child, I was determined never to spank my children.  “Some day you will understand,” my mother told me.

When I became a pediatrician, I took care of toddlers that ultimately died from corporal punishment.  I watched their brains swell until the neurosurgeons had to drill holes in their skulls to release the pressure.  I took care of one teen who was beaten so badly by his mother that he was hospitalized with renal failure.

Then I became a parent.

I, like 94% of American parents, utilized corporal punishment.  Not often.  Not severely—just an occasional quick swat on the buttocks.  Spanking was an ultimatum used only for defiant children that refused to go to time-out, and I threatened it far more than I ever actually did it.  I finally understood what my mother, my grandmother, and generations of parents faced.  But I don’t spank anymore.

Few issues are as controversial as corporal punishment.  In September, 2012, Delaware made spanking illegal.  Yes, that’s right, parents who inflict any “pain” on their children can go to jail… in Delaware.  Yet 19 states still permit spanking in public schools.  California and other states are working hard to push through legislation that makes spanking a crime.  There are organizations that oppose all forms of child punishment, including extra chores, writing assignments, etc.   But you can go online and hire a professional spanker to come and spank your child or teen.  There are even those who advocate for “spanking therapy” and discuss “whipping theory” as a cure for depression, and addiction.   Is your rear end burning yet?

The experts are just as conflicted.  The American Academy of Pediatrics (AAP) strongly opposes corporal punishment.  But The American College of Pediatricians (ACP) feels that “Disciplinary spanking by parents, when properly used, can be an effective component in an overall disciplinary plan with children.”  From the AAP’s “Guidance for Effective Discipline,”:[http://pediatrics.aappublications.org/content/101/4/723.full]

• Spanking children <18 months of age increases the chance of physical injury, and the child is unlikely to understand the connection between the behavior and the punishment.
• Spanking models aggressive behavior as a solution to conflict and has been associated with increased aggression in preschool and school children.
• Spanking and threats of spanking lead to altered parent–child relationships, making discipline substantially more difficult when physical punishment is no longer an option, such as with adolescents.
• Spanking is no more effective as a long-term strategy than other approaches, and reliance on spanking as a discipline approach makes other discipline strategies less effective to use. Time-out and positive reinforcement of other behaviors are more difficult to implement and take longer to become effective when spanking has previously been a primary method of discipline.

But the ACP criticizes the research behind the AAP’s statements.  [ http://pediatrics.aappublications.org/content/early/2012/06/27/peds.2011-2947.abstract/reply#pediatrics_el_54057 ].  The ACP feels that “appropriate spanking” should be an option for parents.  “Appropriate spanking” includes:

• two open-handed swats to the buttocks in a child of about 2-7 years who defiantly refuses to cooperate with milder disciplinary measures, such as time out

The ACP quotes other research “That limited use of spanking, when directly compared to alternative disciplinary tactics, has actually been shown to lead to improved compliance and less aggression in children.”

As for me, my spanking days are over.  I have other parenting methods that are more effective.  Violence is a poor solution to the ills of our world, and the challenges of parenting are no exception.  I feel freed from some burden now that I don’t have to spank my kids.  But I certainly have not given up discipline.  Teaching discipline and self-control is a primary obligation of a parent.

So what do we do instead of spanking?   In our house we do a lot of service projects for people we have disrespected.  If you mouth off to me, you might need to help me with laundry, or gardening, or cleaning the bathroom.  If you are mean to your sibling, you might have to help them with homework or clean their room.  Exercise can also help calm strong emotions.  Sometimes I’ll send a child outside to walk a few loops of our cul-de-sac.  If a child is truly out of control, they usually have to sit in the bathroom and draw a picture or write an essay about the issue at hand.  Those too young to draw pictures just have time out in the bathroom, one minute for each year of life.  5-8 year-olds often have to copy essays I have already written.  My favorite starts like this: “Attitude is a choice.  When I have a bad attitude, I am hard to live with.”  If they refuse to write their essay, they get a longer essay.  Until the essay is written there are no privileges such as tasty meals, toys, extra-curricular activities, etc.  Different children have different needs and temperaments, and there is on one-size-fits all form of discipline.

Many people say they spank as a rare attention-getter when a child puts his or her life in danger.  My ear piercing screams have served this purpose the few times my toddlers have run towards busy streets or otherwise endangered their lives.

Most importantly, we try very hard to tame our own anger.  Yelling and using angry verbal reprimands is just as bad, if not worse, than spanking.  We say we discipline out of love.  Anger is not love.

Love and discipline go hand in hand.  For my grandmother, spanking was what it meant to love and discipline her children.  When I had my first child, I wondered if my mother would bring me a spanking paddle as a baby gift.  Fortunately, she loved me enough to find a better gift.

Please follow Dr. Kathleen on Twitter @CatholicDoc and “like” CatholicPediatrics on Facebook!

Copyright 2012 Kathleen Berchelmann, MD

Food Fights: A Pediatrician’s Attempt to Get her Kids to Eat Well

I used to gloat that my four-year-old would eat salad, but now I have a three-year-old that refuses anything green and is seriously challenging my best pediatric dietary practices.  My four kids, now one, three, six and eight years old, have each presented their own dietary challenges.  Here are my tried-and-true tricks of the trade to get your kids to eat well.

Kids eat what you eat. 

Healthy kid’s diets start with healthy parent’s diets.  Parenting challenges us to become better people, even when it comes to our food.  You already know that you can’t eat treats in front of your kids without them asking for some.  Your long term dietary habits will become those of your children.  What are your dietary guilty pleasures?  Do you want your kids to share them?   If not, this may be your motivation to change.

Moms actually have higher body mass indexes and are more likely to drink sweetened drinks compared to women without children.  Why?  Because parenting is hard and moms need our pick-me-ups.  If you just can’t give up a personal treat, save it for when you are alone.  I have my stash of dark chocolate hidden on a top shelf in the kitchen.

Young kids will regulate their own calories

Most toddlers have a built-in dietary trick: they actually auto-regulate their own calories.  Toddlers will eat the same amount of calories each day whether those calories come from vegetables or cookies.  So, if a toddler eats one 100 calorie cookie after lunch, they will eat about 100 calories less for dinner.  Toddlers quickly learn to hold-out for their favorite foods, be it dessert, chicken nuggets, or macaroni and cheese, and they happily skip the vegetables. This is why toddlers are notoriously picky eaters.  It’s also why obesity is less common in this age group.

Armed with this knowledge I offered by picky three-year-old only oatmeal with fruit for breakfast and a healthy lunch and dinner that included vegetables.  He started eating two or even three helpings of oatmeal for breakfast and simply skipping lunch.  He’d skip dinner too if he talked someone into giving him a mid-afternoon snack, or if he got a free cookie from the grocery store or his sister’s soccer game.  Now he’s only permitted one serving of breakfast and we try to leave him home from events that include free treats.  Occasionally we give in.  Yesterday we took him to a business picnic and he had his fill of junk food.  He did start eating vegetables again about twenty-four hours later…

Exposure, Exposure, Exposure

Kids will eat almost anything if they are repeatedly exposed to it in a positive context. Let kids look at salad and green stuff on their plate every day.  Talk about how good you think it tastes.  Never force them to eat it.  Usually, I eat my salad and then eat half of what I put on my kids plates.  Eventually they will eat it, especially if they are not filling up on other calories.      

Don’t let your kids drink their calories

Sugary drinks are the fastest way to consume calories.  In just a few seconds a child can consume as many calories as a candy bar or fast-food hamburger.  Most parents are good about limiting soda, but sports drinks, lemonade, iced tea and juice can be just as bad.

The recommended serving size of juice in a toddler diet is four ounces per day, according to the American Academy of Pediatrics.  That is less that almost all juice boxes.  “Mots for Tots” is a juice box brand targeted towards toddlers that provides watered down apple juice such that one-serving per day is still within the recommended range.  But even when I bought these I found my kids just begged for me.  I recommend just cutting juice out of your regular diet.  In our house, juice is a special treat reserved for birthday parties and other special events.  What about vitamins?  If your kids eat fruits and vegetables they will get plenty.  If you are still worried about vitamins, try a kids multivitamin.

My salad-eating toddler became a school-aged child with an elevated BMI.  How?  He drank too much lemonade.  A few years ago he talked me into buying lemonade drink-mix so our family could have a lemonade stand.  They sold a few cups of lemonade and we spent a month using up the rest of the lemonade mix.  It turned into habit and lemonade became a regular part of his diet.  We limited quantities but our son started putting eight scoops of sugar-laden drink mix into six ounces of water.  We didn’t recognize the problem until a doctor’s visit revealed a BMI more than two standard-deviations above the norm…

Tune in next month for the conclusion of this article.

Please follow Dr. Kathleen on Twitter @CatholicDoc and “like” CatholicPediatrics on Facebook!

Copyright 2012 Kathleen Berchelmann, MD

The Top 10 Scams and Rip-Offs for New Moms: What NOT to Buy for Your Baby

Editor’s note: Wow, I want to personally thank Dr. Kathleen for sharing this well-reasoned article on “What NOT to Buy for Your Baby” — this will save me a lot of grief and money when planning for future baby showers! I’d love to hear from our readers in the comments – how do you feel about the items on Dr. Kathleen’s list? What would you add to the list, and what can’t you do without? Let us know in the comments below! LMH

The average American baby costs her parent about $12,000 before her first birthday, according to a 2010 USDA survey.  Want to cut your baby-budget?  Here’s my top ten list of the biggest scams, gimmicks, and rip-offs targeted towards new parents.

1) Crib Bedding: See this picture?   What’s wrong?  This crib bedding is not safe for your baby.  Every year more than 2000 babies die of Sudden Infant Death Syndrome (SIDS) in the United States.  SIDS is largely preventable by putting babies to sleep on their backs in cribs without suffocation hazards.  Nothing should go in your baby’s crib except the baby and a tight fitting crib sheet.  No blanket, no bumper, no coordinated stuffed animals.  If you buy that expensive coordinated blanket and bumper, you can’t use them safely in your infant’s crib.  So don’t waste your money.  For more information on safe sleeping and SIDS prevention, see my blog about the ABCs of Safe Sleep.

2) Baby music, gym, and swim classes: By the time your kids are in kindergarten you will be inundated with extra-curricular activities.  Take a break while you can and enjoy time with your baby, not time driving them around to expensive activities that you can replicate in your own home.  Sure, music is great for infant brain development, but your baby wants you to sing to her, not a music teacher.  Play a Mozart CD in your kitchen, dust off your college guitar, and sing with your best vibrato.  Your baby will love it.  Climbing on play equipment is fun and helps develop motor control, but you don’t have to pay for specialized gym classes.  Build a fort under your kitchen table and crawl in together.  Swimming with your infant is great fun for both of you, but do you really need a teacher to help you play motor-boat with your six-month old?  Many new moms sign up for infant classes to connect with other parents of babies and get out of the house.  If you’re looking for a community of moms, try the free play groups through Parents as Teachers or your local hospital or religious community.

3) Pimp-My-Ride Strollers: Unless you’ve got triplets or more, you don’t need that $800+ stroller, no matter how much you may want it.  Even if you splurge for the Mercedes-Benz of strollers with your first child, you may soon find that you need a double stroller when a second child arrives.  Most airlines are no longer permitting “oversized” strollers to be gate-checked, so your fancy double jogger can’t help you get your growing family to the gate.  Consider buying an economical umbrella stroller that is light enough to carry with one hand and fits easily in the trunk of your car.  Try using a sling instead of a stroller [link to my blog about baby slings].  If you must have that dream stroller, consider buying a like-new one from a second-hand kids sale.

4) Infant/Child Life Insurance: Life insurance makes sense for parents, but why buy life insurance for your kids?  If your child dies, what do you need money for?  If you are worried about covering the cost of a funeral, why not start saving for a family emergency fund instead?  Or, spend the money on your own life insurance policy so that your children’s needs are met if you die prematurely.

5) Name-brand and specialty formula: When babies are fussy and spitting up, most people blame the formula.  Pediatricians know that most of the time switching an infant’s formula does little to improve their temperament or your sleep.  Specialty and name-brand formulas cost up to three times the price of generic formula.  So call your pediatrician before you switch formulas and give your wallet a break.  Or better yet, breastfeed your baby for their first year and save between $1600-2000 on formula.  I know, I know… breastfeeding is hard.  Are you frustrated with breastfeeding?  Read my blog “Breastfeeding Blues.”

6) Designer shoes: After four babies of my own, I have a gallon zip-lock bag full of adorable, useless infant shoes.  And they are all in perfect condition, because my kids never got any use out of them.  Babies need shoes that can get scuffed on the toes while they crawl and have treads on the bottom while they learn to walk.  It seems fun to dress them up with shiny shoes for family parties, but most infant shoes never even stay on their feet.  Those shoes always ended up in my husband’s pockets before we even got the baby out of the car seat.

7) Expensive thermometers and first aid kits: An infant medical kit is often listed as a baby registry “essential,” but the truth is that they contain lots of stuff you may never use.  You really do need a thermometer, but an inexpensive digital thermometer is more than adequate.  You don’t need a pacifier thermometer or an expensive temporal thermometer.  See my blog about choosing a thermometer to find the one that is best for your family.  You won’t need fancy medication dosing devices; pharmacies give oral dosing syringes out for free with infant medications.  Nail clippers are useful, but nail files generally don’t work on paper-thin infant fingernails.  You will need a nasal bulb syringe for your baby’s first cold, but most hospitals will give you one when you deliver.  Many hospitals will also give you a digital thermometer.

8) Video baby monitors: If you want to see and hear your baby while he sleeps, put him in a bedside bassinet.  Even medical-grade infant monitors that track respirations and heart rate have do not prevent SIDS.  Monitors do cause parents to wake up and worry more.  It is reasonable to use a sound monitor if your baby is sleeping far from you, but skip the video and movement monitors.  If your baby requires specialized medical monitoring, your pediatrician will let you know.    

9) Hats and bibs: Most newborns own ten times more hats and bibs than they will ever use.  Healthy newborns are able to maintain their own body temperatures in most indoor environments after the first few days of life, and don’t need to wear a hat unless they are going out into the cold.  Hospitals provide hats for newborns, sometimes even hand-made super-cute hats.  Just about every newborn layette includes a cute infant hat, yet somehow half of them are the wrong size.  Bibs are not terribly useful until infants start baby foods, around 4-6 months.  If you are formula feeding, just use a cloth diaper tucked under your baby’s chin instead of a bib.  They are softer and more absorbant.  When your baby does start foods, you will need a large, washable bib that you are not afraid to stain with regurgitated infant vegetables.  Someone once gave me a velvet bib.  What’s the point?

10) Stuff you can get in the hospital for free: New parents walk out of the hospital with one tiny baby and many bags of stuff.  Chances are, your hospital will give you enough diaper rash ointment to last you the first year, and infant wash and lotions to last at least a few weeks.  If you are breastfeeding, they often provide breast pumping supplies and bottles that retail $50-$60.  A handful of lanolin packets for mom’s sore nipples is all that most breastfeeding mothers will need.  Formula-fed babies usually get formula samples, and breastfed babies often go home with an insulated breast-milk carry bag with re-usable ice packs and breast milk storage bottles.  And don’t forget the digital thermometer, nasal bulb syringe and hat.  One time we were even sent home with a week’s worth of diapers.  They’ll also give you plenty reading material about infant care.  

Now that your bank-account is healthy, stop worrying about finances and go snuggle with your baby!

Please follow Dr. Kathleen on Twitter @CatholicDoc and “like” CatholicPediatrics on Facebook!

Copyright 2012 Kathleen Berchelmann, MD

Should Catholic Parents Own a Gun?

Should Catholic parents own a gun?  We dedicate our lives to teaching our children to love one another as God has loved us.  We teach the commandment, “Thou shalt not kill.”  We try to model non-violent conflict resolution.  So doesn’t it seem like a mixed message to our children if we own a gun?

A few times a year I see teens that are brought to the hospital by their parents after they were caught holding a gun to their head.  I used to counsel these families to remove the guns from their home.  Never once, however, did parents agree to do so.  They assure me that they will lock the guns, hide ammunition, or take other steps to limit their child’s access to the gun.   But get rid of the gun?  No…

During my pediatric training I felt strongly that guns and kids don’t belong in the same house together.  I would cite the position of the American Academy of Pediatrics, “The best way to keep your children safe from injury or death from guns is to NEVER have a gun in the home.”  I was even trained discuss this opinion with families during well-child check-ups.  It was the statistics that convinced me:

• A gun kept in the home is 43 times more likely to kill someone known to the family than to kill someone in self-defense.
• A gun kept in the home triples the risk of homicide.
• The risk of suicide is 5 times more likely if a gun is kept in the home.1

I also felt that civilian gun ownership was not consistent with my Catholic faith.  Although Roman Catholic Just War Theory does condone the use of force for self-defense, I felt a civilian should turn to law enforcement or the military for defense.

And then, I started working with families from rural Missouri.  They thought I was ridiculous.  And I realized I was a bit ridiculous.  “What if an intruder is coming into your home?” They asked.  My answer: “Call 911.”  Their answer: “But law enforcement is at least 20 min away…and meth is a big problem around here.”

In fact, having kids in the home actually increases many people’s desire to own a gun.  With parenthood comes a tremendous obligation to protect your children, and a gun can seem like an important part of that plan.  Even if a gun is never used, just having it in the home can serve as a deterrent to crime.  These above statistics don’t address crimes that were avoided because the criminal knew the potential victim was armed.

My patients and colleagues eagerly tell their tales of the times they have shown off their “piece.”  One young mother, conservatively dressed in a mid-calf-length skirt, was alone at a carwash at twilight.   A man approached her with inappropriate requests.  Without saying a word, she put her hand on her gun, and he left.  So how do the statistics capture this?  They don’t.

So should Catholic families with children have guns in the home?  I think this decision is dependent on your family’s personal situation, your access to law enforcement, and your willingness to take the time and effort to be a responsible gun owner.  As your kids get older, be aware that you may have to change your decision about gun ownership:

• Do not keep a gun in the home if any member of the household has a history of depression, drug abuse, anger, violence, or unstable mental health.
• If your teen shows signs of depression, consider finding a new home for your gun.  Even the best plans for gun security often fail.

A few times a year I see teens that are brought to the hospital by their parents after they were caught holding a gun to their head.  I never see the teens who pulled the trigger.  Don’t be that kid’s parent.

Copyright 2012 Kathleen Berchelmann, M.D. 

Dogs and Babies Don’t Mix: A Catholic Perspective

Truly, dogs are part of the glory of God’s creation. They are “man’s best friend” when everyone else is gone and Jesus seems far away.  But what is the best role of a dog in a family?  As a pediatrician, I am not sure there is a good role for a dog in a family once you have accepted God’s call to parenthood of babies and young children.  I am well aware this is a highly contraversial statement.  But please, read on, and you will understand my perspective.

I recently cared for a nine-month-old baby girl who came to our emergency room with a dog bite that had ripped her face and scalp into pieces.  As soon as I entered the room her father’s first words were, “It wasn’t the dog’s fault.”  He went on to explain how this crawling infant had provoked the dog.  I spent a long time talking to this nervous father and crying mother about dog bite prevention, and I reported the situation to animal control and the local police.  The parents assured me that this infant would never be around this dog again.  A few months later this same infant came back to our emergency room with another dog bite to the face, from the same dog.

I wish I could say that this was an unusual story, but it’s not.  While the plastic surgeon was sewing up this infant’s face, we exchanged dog bite ER stories.  Most notably, he sewed up one woman’s dog bite to the face only to read in the newspaper that she had been killed by her dog a few months later.   The ER nurses also had plenty of dog bite stories to share.

What makes these stories so amazing is the consistent denial from dog owners that “man’s best friend” can be an enormous risk, especially to young children.  While sitting in the ER with their bitten child, dog owners have told me, “He’s really a very friendly dog,” and “he’s never bitten anyone before.”  Usually, there is a sentiment that the dog was provoked by the child and therefore the dog is not at fault.

There are almost five million dog bites every year in the United States and nearly one million require medical attention, according to the Centers for Disease Control.  There were 31 fatal dog attacks in the United States in 2011, including a 15-day-old infant.  You can read their stories at www.dogsbite.org.  Children under ten years of age are at particular risk of dog bite.  Most dogs bites are from dogs known to the victim, owned either by the victim’s family or neighbor.

Here are a few key things you can do to prevent dog bites:

1. Never, ever put an infant or toddler on the floor with a dog.
2. Be sure that dogs cannot access children, especially infants, while they are sleeping.
3. Even if you do not own a dog, teach children age appropriate interactions with dogs.  When teaching children how to approach a dog, always be sure a dog is leashed and under an adult’s full control.
4. Teach children never to put their face at a dog’s level.
5. Do not approach an unfamiliar dog, even if it looks friendly.
6. Do not run from a dog or scream.
7. Remain motionless (e.g., “be still like a tree”) when approached by an unfamiliar dog.
8. If knocked over by a dog, roll into a ball and lie still (e.g., “be still like a log”).
9. Do not play with a dog unless supervised by an adult.
10. Immediately report stray dogs or dogs displaying unusual behavior to an adult.
11. Avoid direct eye contact with a dog.
12. Do not disturb a dog that is sleeping, eating, or caring for puppies.
13. Do not pet a dog without allowing it to see and sniff you first.

When a dog bites a crawling baby or excited toddler, whose fault is it?  Dog owners are quick to say it wasn’t the dog’s fault, as evidenced by my stories above.  And they are right, it wasn’t the dog’s fault. The dog was being a dog, and the toddler was being a toddler.  Was it the owner’s fault for not controlling their dog, or the parent’s fault for not supervising the child?

Our law says that it’s the owner’s responsibility to control their dog.  As a pediatrician, it’s my best professional opinion that dogs and young children just don’t mix, and I think parents have a responsibility to keep their young children away from dogs.  Even “good” dogs bite and can kill, and it is a parent’s job to keep dogs and young children separate.  I know this is a highly controversial subject, especially for dog lovers. But as parents, we go to extremes to protect our children.  We’ve stopped using baby walkers and drop-sided cribs.  Playground safety regulations get tighter every year.  So why would you expose your child to the risk of a dog bite?

Some parents do understand.  I recently took care of two sisters who had been attacked by a family dog.  I started to explain to the parents that I am required to make a report to animal control.  “Don’t worry,” they told me, “the dog’s already dead.”

Video Link

Copyright 2012 Kathleen Berchelmann, M.D. 

Menstrual Misery? New hormone-free therapy for teens with heavy, painful periods

Data out this week from Harvard University shows that 98% of adolescents with chronic pelvic pain have endometriosis. For the 176 million women worldwide that suffer for endometriosis, this data provides a strange form of relief and recognition. They aren’t complaining, whining, histrionic women and teenagers who can’t handle their menstrual period. On the contrary, they probably have a medical condition called endometriosis that needs treatment. And they don’tneed hormonal contraceptives or birth control pills.

For decades medical science has either ignored and not treated painful menstrual cramps and heavy menstrual periods, or offered only hormonal contraceptives as therapy. But now we know that these symptoms of chronic pelvic pain represent endometriosis 98% of the time, and hence cannot be ignored or treated only with ibuprofen. We also know that hormonal contraceptives mask the symptoms of endometriosis, but don’t effectively treat the disease or decrease the infertility associated with endometriosis. Catholic moms were right after all. Birth control pills really aren’t good for your teen daughter, no matter how bad her periods are.

The best news is that now we have effective therapy for endometriosis that treats symptoms and improves fertility, and it doesn’t involve taking hormonal contraceptives.

Between 25 to 65 percent of women with endometriosis have fertility problems. Approximately 5 million U.S. teenagers are affected by the condition. In other words, pretty much all of us moms know some teen or young adult out there that has endometriosis and needs it treated to prevent infertility. Don’t ignore those painful heavy periods. Find them a good Catholic doctor.

Dr. Patrick Yeung, Jr., MD, is a minimally Invasive Gynecologic Surgeon and director of the Center for Endometriosis at St. Louis University. He’s also a faithful Catholic father of two beautiful daughters. He’s a real Catholic dad, the kind that goes out to the church lobby with his noisy thirteen-month-old but still sits under the speaker so that he doesn’t miss the mass and kneels on the marble lobby floor during the consecration while keeping one eye on his toddler. He’s the kind of guy you feel comfortable bringing your daughter to.

He’s also advancing a better therapy for endometriosis—laser excision. Laser excision, compared to ablation therapy, has a much lower risk of recurrence of endometriosis. He’s published the research that shows hormonal contraceptives are usually unnecessary after surgery for endometriosis.

You can read more about Dr. Yeung, his research, and The Center for Endometriosis at http://www.endometriosis-excision.com. There’s also a detailed article about Dr. Yeung’s work by Jennifer Brinker of the St. Louis Review: http://stlouisreview.com/article/2012-05-03/catholic-doctor-who.

To find a Catholic physician near you, visit www.CatholicPediatrics.com, www.OneMoreSoul.com, or http://www.cathmed.org/physician_directory/search/

Copyright 2012 Kathleen Mary Berchelmann, MD, CPHIMS

When I Had My First Child: Why Choosing a Catholic Health Care Provider Matters

I never considered the faith of my pediatrician to be important when I started my family.  I figured I would leave medicine to the doctors and faith to the Church.  I wanted to find a pediatrician who was smart, clinically experienced, and would know how to take care of my child in an emergency.  But I didn’t really understand that my pediatrician would become a personal mentor for me, as a parent, as I pursued the beautiful yet difficult call of raising children.   I didn’t really consider that my pediatrician would become a private confidant of my children, discussing sensitive issues behind closed doors.

As a pediatrician, a wife, and a mother of four, here are my top reasons why you need a Catholic health care provider for your children, and why I have started a not-for-profit directory of Catholic pediatric health care providers at www.CatholicPediatrics.com.  Do you know of a faithful Catholic health care provider that sees children?  Please visit www.CatholicPediatrics.com and refer them to us so that we can list them!  Our listing is free to both patients and providers.

1)   Families need Catholic pediatric health care providers who will mentor and support them as they seek to build the domestic church and raise healthy children.  Unfortunately it can be challenging to find Catholic health care providers who practice in accordance with traditional Catholic teachings.  For this reason we have started this not-for-profit physician directory, CatholicPediatrics.com.  All health care providers listed sincerely support a Catholic faith-centered approach toward pediatric care in accordance with the Ethical and Religious Directives for Catholic Health Care Services.

2)   Most pediatric medical problems, from constipation to leukemia, require both sound medical care and a strong spirit to overcome.  Your health care will be incomplete if your physician prescribes treatment but cannot help you approach medical challenges with a faith-filled spirit.

3)   Catholic Hospital Systems don’t always provide Catholic health care.  Just because a health care provider works for a Catholic hospital or institution does not mean that they are Catholic or that they practice in accordance with the Ethical and Religious Directives for Catholic Health Care Services.  One study found that 48% of Catholic hospitals have performed and billed for direct sterilizations (see www.catholichospitals.org).  I suspect the number is actually much higher.  Many Catholic hospitals have started off-site affiliated facilities that are not under the jurisdiction of the Catholic church, such as off-site surgical centers for sterilization, and off-site primary care practices that provide “family planning” or “adolescent medicine.”  Additionally, Catholic hospitals have no way to regulate what a physician says to a patient behind a closed door.  Any provider can counsel your child with values other than your own, and you have no recourse or control.

4)   Jesus was a healer.  Don’t you want a healer who follows Jesus?  Never under-estimate the power of God to heal, even though modern medicine.  I believe health care providers need to be praying for the strength and guidance of God that the care they provide will be healing and bring glory to God.  You need a physician who is praying for God’s guidance as he or she cares for your child.

5)   The United States government is quickly stripping rights away from parents and shortening childhood.  In some states, parents cannot have access to your child’s medical records after age 12.  In most states, health care providers can prescribe medications including contraceptives to children 14 and older and providers can withhold that information from parents.  You will send your pre-teen and teen into exam rooms with closed doors and allow your child to talk to providers about controversial issues.  You will not have any ability to discover what is said and prescribed behind those closed doors.  You need a pediatric health care provider who shares your faith and values.  

6)   There is nothing like parenthood to improve humility.  From breastfeeding and newborn care to adolescent drug abuse and sexuality, every step of parenthood is fraught with challenges and failures.  Parenthood can be humiliating.  In the words of Mother Teresa, “Humiliation is good for humility.”  You need a health care provider who will help you learn and grow in your faith through the challenges of parenthood.

7)   It is futile to heal the body and not the soul.  Through the sacrifices of parenthood and the suffering of physical illness, our souls can be healed.  When we accept parenting and health challenges with faith, we can more fully appreciate the sacrifices that God, our father and parent, makes for us every day.

Please follow Dr. Kathleen on Twitter @CatholicDoc and “like” CatholicPediatrics on Facebook!

Copyright 2012 Kathleen Berchelmann, MD

In the next few weeks my husband and I will be launching an online directory of Catholic pediatricians at www.CatholicPediatrics.com.  At present this website is my personal blog, but soon my blogging will be moving to a back page.  The new goal of CatholicPediatrics.com is to bring families to Catholic pediatricians who understand a faith-filled approach to raising healthy children.  Right now I need help from you, my CatholicMom.com community.

CatholicPediatrics.com started as my personal blog and an effort to reach out to parents as they approached common pediatric illnesses and parenting challenges. To my surprise, CatholicPediatrics.com is now the top Google listing for the search string “Catholic Pediatrician” and other similar terms.  I tried to find an online source of referrals to Catholic pediatricians, but as far as we can tell, no such directory exists.  There are plenty of Catholic hospital chains that are happy to refer you to one of their staff pediatricians, but many doctors working in Catholic hospitals are not practicing Catholics.  In response to public requests, my husband Greg and I are in the process of building an online directory of Catholic Pediatricians and Family Practice physicians that see children.

CatholicPediatrics.com is a not-for-profit effort to bring families to faith-centered health care, because we believe it is futile to heal the body and not the soul.  We do not charge any fees to physicians listed at CatholicPediatrics.com.  All pediatricians listed will have to sign a pledge that they do not prescribe or refer for contraception, do not perform or refer for abortion or euthanasia, and practice in accordance with the Ethical and Religious Directives for Catholic Health Care Services.

We do not make any money off this effort.  In fact, we incur significant costs for web hosting and insurance which we pay out-of-pocket.  My husband Greg does all the IT development.  We hope to defray some of these costs by selling a few books and resources.

A similar organization, One More Soul, (www.onemoresoul.com), is oriented towards women’s health and reproduction and provides an online directory of pro-life, NFP-only physicians.  CatholicPediatrics.com hopes to fill the unmet demands of parents seeking Catholic pediatricians who share their views on healing, parenting, and family life.

Families need Catholic pediatricians that will mentor and support them as they seek to build the domestic church and raise healthy children.  Catholicism in pediatrics is about so much more than the hot-button issues of abortion, contraception, homosexuality, euthanasia, etc.

As Greg and I launch our online directory of Catholic pediatricians, we’d love to hear from you, our CatholicMom.com community. Do you have a favorite Catholic pediatrician or family practice physician that you would like to have listed?  Why do you think it is important to have a Catholic pediatrician?  Do you have ideas for blog posts or questions that you would like to have answered by a Catholic pediatrician?  Do you have comments about what you love or really don’t like about your own pediatrician?

Please follow me on Twitter @CatholicDoc and “like” CatholicPediatrics on Facebook!

Thanks for your help!

Copyright 2012 Kathleen Berchelmann, MD

The first rule of ADD and ADHD parenting is to love your children passionately.  Remember that God made them for YOU, and that He will give you the strength and resources to parent them.  The second rule is never to let your child’s diagnosis justify bad behavior.  Kids with ADD and ADHD need to be held to the same family behavior standards as other children.  They need to do age-appropriate homework and chores like everyone else.  They should be expected to sit in their chair through family dinner.  With a lot of patience (and perhaps medication), you can even teach them to get through the family rosary.

The job of a parent of an ADHD or ADD child is to be a secretary, to constantly remind and try to implement routines and systems of order and organization.  Try to be a secretary first, then (and only then) a disciplinarian.  This role can turn mom and dad into the nag they never wanted to be.   Thankfully, we now have a digital secretary available for kids with ADHD and ADD—the smart phone.  Do you have an old smart phone collecting dust in a drawer?  Great!  Read on to put it to good use.

How to set up a smart phone to help your child with ADHD/ADD:

1)     Disable the telephone and internet features of the phone.  Children under age 12 should not have unregulated access to a cell phone or the internet, especially kids with ADHD and ADD!    But you can disable the internet and telephone features and still use a smart phone as digital assistant, providing reminders and academic support.

2)     Set alarms with cool ringtones for different daily activities.  For example, have an alarm for getting up in the morning, for getting dressed, for packing their school work in their backpack etc.  Whatever those things are that you have to remind your child to do daily, set an alarm for it.  Now the phone becomes the nag, not you!

3)     If the phone has a “reminders” feature (as do many iPhones), you can consider using this feature in place of the alarms, especially for activities that are not recurring.

4)     Put a ToDo list on your child’s smart phone.  Include all their chores.  Add a reminder or alarm when it is chore time.

5)     If you want to get even more sophisticated, set up an Outlook or Google calendar for your child, and sync your smart phone to the calendar by manually connecting the phone to your computer.  Put your child’s daily schedule on the calendar, including homework time, dinner time, soccer practice, etc.  Set reminders to chime 5 minutes before each activity.

6)     Make it fun!  Let your child use the camera and/or music features of the smart phone.  You can still sync to iTunes yourself provided that you don’t give your child your iTunes password.  Make sure the phone is so much fun that they have it attached to them every time one of those reminders is about to go off.

7)     Give digital rewards—let your child pick a new song from iTunes or a new educational app if they complete all their chores on the todo list or make it through the day without reminders from you.

8)     Inspire creativity—as a reward, allow your child to download the photographs they have taken with their phone onto a family computer.  Let them use photo editing software to make collages and fun gifts.

9)     Have your child turn the phone off while in school, or leave it at home.

10)  Once your child is in love with their phone, install a free rosary app and remind them to love God, not their phone.  Then ask them to lead the family rosary.

If you try this smart phone approach, please do submit a comment—I’d love to hear your tips on what worked and what didn’t work for your family.

Copyright 2012 Kathleen Berchelmann, MD

Many parents are strongly averse to giving their child a stimulant medication, such as thosen often used to treat ADHD and ADD.   Most parents wouldn’t give a child with attention deficit hyperactivity disorder (ADHD) a caffeinated drink, for fear that their hyperactivity would only worsen.  So why do doctors give stimulants to kids with ADHD?  It seems so counter-intuitive.

A quick internet search will give you the medical explanation that ADHD stimulant medications increase dopamine and norepinepherine neurotransmitters in the brain and also increase blood flow to the brain.  While this is true, this explanation still leaves many parents confused as to why stimulants work.  As a pediatrician and a parent, I would like to offer another way of thinking about this paradox.

Kids with ADHD are constantly self-stimulating.  They wiggle, they talk out of turn, and their mind doesn’t seem to turn off.  Their thought processes are non-linear.  They talk while brushing their teeth and wiggling their foot at the same time.  They seem to do everything except follow directions.  Whey you give a stimulant to such a child, they no longer have such an urgent need to self-stimulate.  Non-medication stimulants also work, although for limited amounts of time.  If you give an ADHD child a lollypop, which provides oral stimulation, they are more likely to listen and follow directions.  ADHD kids usually have no problem paying attention to video games, which provide constant visual, auditory, and tactile stimulation.  Reading books and following directions, however, are not stimulating activities.  ADHD kids will try to get through these experiences by self-stimulating through wiggling, talking, etc.  If you give them a stimulant medication, they no longer have the need to self-stimulate.

According to a recent survey by the Center for Disease Control, nearly 1 in 10 U.S. children have been diagnosed with ADHD by a health care professional, about 5.4 million kids.  About two thirds of these children take a medication.

Many parents are hesitant to give their children a stimulant medication.  In part because of this parental resistance to stimulant medications, drug companies are now marketing new non-stimulant drugs for ADHD, including Straterra and Intuniv.  These drugs are heavily marketed with a stress on the fact that they are non-stimulants.  There are situations where such drugs are necessary, such as the 10-30% of patients who do not respond or do not tolerate stimulant medications.  They are also appropriate for patients with certain types of heart disease that cannot take stimulant medications.  Yet, there is a reason why they vast majority of ADHD medications are stimulants—they work.

As a pediatrician, I do not feel that non-stimulant medications for ADHD have been in use long enough to really show their long-term efficacy.  Many of these drugs are mild sedatives.  It is my best medial opinion that sedating medications may meet the needs of teachers and parents more than the needs of the child.   These medications may keep kids from having hyperactivity in the home and classroom, but do they really help kids learn?  We do not yet have sufficient scientific data to suggest that sedating ADHD medications improve childhood learning and cognitive performance, especially in the long term.

Stimulants, however, are a tried and true treatment for ADHD.  Ritalin has been used to treat ADHD since the 1960’s and is still in use.  Many of the brand-name ADHD medications such as Concerta are just long-acting/slow release formulations of Ritalin.  There is an enormous amount of quality medical research on stimulants, especially Ritalin, that was not funded by drug companies.  Stimulants increase both fine and gross motor control as well as cognitive performance and executive function.  In other words, stimulants can improve handwriting and sports performance as well as behavior and attention.

ADHD diagnoses continue to increase in the United States.  Many attribute this increase in diagnoses to improved screening and greater awareness of the diagnosis.  As diagnoses increase, drug companies are going to continue to advertise designer drugs that curb the fears of parents.  I encourage parents to thoroughly research treatment options before declining stimulant medications.

Although research shows that medication is better than behavioral interventions alone, all ADHD treatment plans should include behavioral interventions.  What interventions?  Stay tuned for my column next month…

Copyright 2011 Kathleen Berchelmann, MD 

So, realistically, this means that your sixteen-year-old, no matter how innocent, is supposed to have an HIV test at age 16 and will be offered this testing by her pediatrician. Many emergency rooms will also start offering an HIV test to all teens 16 and older that come to the ER for any reason.  My own hospital, St. Louis Children’s Hospital, is already offering universal teen HIV testing.  You do have the right to decline testing.  As Catholic parents, what do we say to our sixteen-year-olds that swear virginity? What do you say when you take your son to the ER with a broken ankle and he’s offered and HIV test? Who’s going to pay for this test?

These new recommendations for universal screening at age 16 stem from the unfortunate reality that the rate of new HIV infections among teens continues to be high. Young adults and teens between 13 and 29 represent 34% of new HIV infections, the largest share of any age group.1  And, 48% of youths who are infected don’t know they have HIV. Teens who don’t know they are positive for HIV are more likely to spread the virus than those who are aware of their infection. Under the old recommendations, the rate of new infections in teens was not declining.

The new test is a cheek swab, not a blood draw, and is essentially painless. It takes only seconds, and costs $14.

But really, would you spend $14 of your own money, your insurance company’s money, or even the government’s money for a test that your teen swears is not necessary? At first thought, I’m not sure I would. But, as a pediatrician and a mother, I still support the recommendation for universal testing at age 16. Here’s why—just the offer of testing promotes those essential and uncomfortable conversations about adult relationships that we need to have with our teens.

I ask those embarrassing questions all the time—“When was your last menstrual period? Any chance you might be pregnant? Have you ever used any recreational drugs? Do you smoke?” Depending on the situation, I often ask the parents for privacy. Most parents are anxious to give their child the opportunity to have a private conversation with their physician and readily hop up and leave the exam room. The parents always seem anxious when I invite them back into the room. They want to know what their teen told me, but they are afraid to ask. Occasionally, teens request that their parents stay with them, and these kids warm my heart. I’ve never had a parent decline to leave the room, but if they did, that would be fine. When a teen reveals risky behavior to me, I try to facilitate a conversation between them and their parents. Legally, however, I cannot discuss anything with their parents unless they give me permission or they have a potentially life-threatening condition.

My heart always sinks when a teen feels they cannot talk to their parents about their risky behaviors. We all know they are only seeking love, intimacy, joy and acceptance.  Even well-meaning health care professionals will offer our teens medical advice that is inconsistent with our Catholic values.  And they will do it behind closed doors.  Now, with universal HIV testing, teens are offered an HIV test during the initial part of the ER visit and then put in a room to wait.  That long ER wait after an HIV test is a prime opportunity for parents to talk to teens about healthy adult relationships.  As parents, we love our children in a way that no one else can. We need to talk to our children about sexuality and healthy adult relationships before someone else does.

1. Sources: Kaiser Family Foundation Fact Sheet: The HIV/AIDS Epidemic in the United States, September 2009.

Copyright 2011 Kathleen Berchelmann, MD

Editor’s Note: The Catholic Medical Association (CMA) – the nation’s largest professional organization of Catholic doctors – has released a position paper on implementation of the new vaccine for HPV, Gardasil®. The CMA encourages the use of this safe, effective, and ethically acceptable vaccine but at the same time rejects efforts at the federal level, and in some states, to mandate that girls be vaccinated against HPV. For more information, visit the CMA website. LMH

“To have innocent little 12-year-old girls be forced to have a government injection through an executive order is just flat out wrong. That should never be done. That’s a violation of a liberty interest.” – Rep. Michele Bachmann, during the September 7^th republican presidential primary debate.

The American Academy of Pediatrics has recommended universal vaccination against HPV for 12-year-olds.  Our government is debating the need to mandate this vaccine against an STD.  What more evidence do we need of the absurdly sad state of morality within the United States?  I would like to say congratulations, and thank you, to all the Catholic moms out there that are fighting the pervasive sexual sins of our society, the same sins that have lead our country to recommend an STD vaccine for 12-year-old girls.  Sexuality is Satan’s primary foothold in our society.  We need to keep up the good fight.  But do our beautiful 12-year-olds, many still so sweet and innocent, need the HPV vaccine?  As a catholic pediatrician and mother, I would like to offer my perspective on this debate.

Unfortunately, most 12-year-old girls and boys do indeed need the HPV vaccine, Gardasil®.  First off, I do oppose mandating vaccination, in general.  But, by using the words “little” and “innocent,” Rep. Bachmann seems to imply that many 12-year-olds may not need the vaccine.  The statistics speak otherwise.

HPV, or the Human Papiloma Virus, is epidemic in the United States.  A recent study published in the Journal of the American Medical Association found that 24.5% of females in the United States aged 14 to 19 years are HPV positive.  Among women 20-24 years old, an astounding 44.8% were positve.[1]  HPV is everywhere.  And HPV is a nasty virus.  The consequences of HPV go far beyond cervical cancer.  It also causes anal, penile, and oral cancers.  It causes genital warts.  The therapy for HPV can cause “incompetent cervix,” or a weakened cervix that causes woment to deliver babies prematurely.  Therapy for HPV is time-consuming, expensive, and truly unpleasant.

Children and teens are contracting HPV at alarmingly young ages, many during their first sexual encounter.  Why?

• We do not know how many men carry HPV.  It is difficult to test men for HPV, and most men with HPV are asymptomatic.  Men usually contract the disease and pass it on unknowingly.  Many young people think they are safe if their partner says they have never had any STDs and/or that they have had negative STD testing.  Not true for HPV.  Hence, males need the HPV vaccine, too.  Gardasil has been approved for use in males since 2009.
• Condoms aren’t great at preventing HPV transmission.  HPV can be carried in the pubic area at the base of the penis in men and around the vulva in women.  Just covering the shaft of the penis with a condom does not prevent transmission.
• HPV can be trasmitted by hand-genital or oral-genital contact.  You do not need to have full-fledged intercourse to get HPV.
• HPV can be transmitted through sexual abuse and rape.

But what about the risks?  They are minimal and rare.  HPV is not rare, and the consequences of HPV are not minimal.

So, let’s just say that your innocent little 12-year-old girl waits until marriage for her first sexual encounter.  She still has a very significant chance of contracting HPV from her spouse, even if he has had only one prior sexual partner, and even if he only had hand-genital contact with that partner.  And, statistically, her spouse probably will have had another partner.  According to a 2006 study, 75% of Americans have had pre-marital sex by age 20, and that number climbs to 95% by age 44.[2]

So, let’s just say your innocent little 12-year-old girl is a statistical anomoly and manages to find herself a spouse who has never had any form of sexual contact with another partner.  She is still at risk of contracting HPV by rape.

Yes, your innocent little 12-year-old girl, or boy, needs the HPV vaccine.  That’s the sad truth.

Our American society has exceptionally varied approaches towards talking to young children about pregnancy, childbirth, and breastfeeding.  As a pediatrician who frequently attends infant deliveries, I have seen toddlers, tweens, and teens present at vaginal deliveries.  I have also met parents who request that I not discuss the body changes of puberty with a girl who has started her menstrual cycle.

Even I dreaded that classic big brother/big sister question, “But Mommy, how does the baby come out?”  When my six year-old asked at the dinner table in front of our four and two year old, I was relieved by the spontaneous answer of my husband, “Through mommy’s vagina.”  “How does the baby fit,” he asked?  My husband had an even better answer for this one—“It’s just like a pulling a turtle neck over your head.  The vagina stretches.”  My three children were surprisingly fine with this answer.  Satisfied, they switched to a different topic of conversation.

I thought back to all the children I have seen present during vaginal deliveries.  They never seem upset or traumatized.  As a breastfeeding mother, I have become accustomed to the stares of young children when I nurse a newborn in public.  They are intreigued, and some have even gone so far as peak under my nursing cover.  They never seem upset by what they find.

What about that other kid question, “How did the baby get into Mommy?”  Parents, don’t fret.  I find that most kids are very satisfied with the honnest answer that God put the baby there.

So if young children do so well with the concepts of pregnancy, childbirth and breastfeeding, why are we, as a society, often so averse to the topic?  I suspect it is in part due to the close proximity of these topics to sexuality.

Some early childhood experts have started to suggest discussion of intercourse and adult sexuality with toddlers.  There are even toddler picture books in publication that describe intercourse, homosexuality, and other such topics.  I feel it is almost never necessary to try to discuss adult sexuality with toddlers.  But young children happily desire to learn about pregnancy, childbirth, and breastfeeding.  This information is infrequently upsetting.  Perhaps it may even be easier to joyfully understand these topics when learned as a young child compared to an older child.

What do you think?  When is it appropriate to discuss pregnancy, childbirth, and breastfeeding with a young child?  How have you introduced these topics?

Copyright 2011 Kathleen Mary Berchelmann, M.D.