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Modern Issues for Your Pediatrician
"It is the pediatrician's role to help parents and children grow together as a family," says Larry Gruenwald, M.D.,a practicing pediatrician for the past 23 years and former Clinical Chairman of the Department of Pediatrics at Saint Barnabas Medical Center. "We are there to be a resource and a common sense guide. Parents should be comfortable bringing up any issue with their pediatrician." Some areas of parental concern that a pediatrician can address include the following: eating problems, sleep problems, discipline and questions pertaining to sex or drugs. Children and Food Many parents today are concerned about their child's eating habits. Common complaints are that a child is eating too much or too little, or that the child's diet does not include enough of a variety. As a young pediatrician, Dr. Gruenwald provided specific directives to his patients about what their children should eat. Then he had children of his own and found that little ones have their own ideas about food. "People spend a lot of time worrying about eating, yet in all my years of practice I have never seen a malnourished child," says Dr. Gruenwald. "As long as parents are providing three well-balanced meals a day for their child, I generally tell them to relax. Most children will expand their repertoire of food as they grow and end up all right." As long as children are falling within "reasonable growth curves, the pediatrician recommends that parents provide the meal, plus perhaps one other choice for the picky child. He encourages parents not to offer so many choices that the kitchen becomes a restaurant. In his practice, he has noticed an increase in overweight children and a decrease in the age when obesity begins. While parents may be concerned about their child's weight gain, he notes that until the child is motivated to make a change, that it will be difficult to alter the situation. To promote a positive body image, Dr. Gruenwald recommends physical activity, such as family walks, and a limit to junk food in the home. A Good Night's Sleep Parents often have questions about the sleep habits of their child. The most common questions pertain to children who have difficulty falling asleep, rise too early in the morning or wake frequently during the night. "First, I always ask the parent if the issue is a problem for them," says Dr. Gruenwald. "For example, one couple might not mind their fouryear-old child coming into their bedroom during the night. For another family, this may be a major issue." For those who are troubled by a young child who leaves his or her bedroom, Dr. Gruenwald suggests that the child be forbidden from coming into the parent's room unless something is wrong, such as an illness. If necessary, he says, close your door or briefly close the child's door so they understand that nighttime wandering is not acceptable. Children should have a set bedtime routine that helps them to fall asleep. Dr. Gruenwald recommends that it take place at a specific time and not extend beyond 10 or 15 minutes. He adds that for certain children there is a difference between bedtime and sleeptime. "Some children, like some adults, are just night people," he relates. "They may be in their room, not necessarily sleeping, but also not disturbing the family." In regard to children who are early risers, Dr. Gruenwald recommends that parents allow those over four or five months of age to entertain themselves in the morning within the confines of the bedroom. "Avoid going into the room, even if the child protests," he says. "Once a child learns that crying will not achieve the desired result, he will learn to amuse himself until it is time to get up." Dr. Gruenwald's preferred method of helping a child over four or five months of age to stop the cycle of nightwaking is the "cold turkey" version (i.e. letting the child cry it out.) He relates that unlike the popular Ferber method, which "gives false hope to the child that you will continually re-enter the room," refusing to enter the room offers no opportunity for confusion and works effectively. However, he urges parents to use whatevermethod makes them comfortable. "The child will still love her parents in the morning," he says, adding that parents can be assured that their child will not spend years in counseling because of a few difficult nights. Discipline Decisions Of all of the roles that parents acquire, disciplinarian is often the least favorite. Beginning with twoyear-olds who push the limits of their independence, parents encounter a child-rearing experience filled with lines drawn and boundaries established. "The word 'no' is not supposed to be a happy experience for children," says Dr. Gruenwald." It is the responsibility of parents to socialize the child and protect him or her from danger."
He also finds that the time-out is a helpful "cooling off period" for stressed parents. "It is okay to feel like you want to hit your child; it is not okay to do so," he adds. Dr. Gruenwald recommends that parents choose the issues that are most important to the family, ignoring smaller behaviors related to control issues. He adds that it is important for parents to work together as a supportive team. Sex and Drugs In polling his friends, Dr. Gruenwald found that most had not felt comfortable discussing sex or drugs with their children. He feels this is probably a common pattern with many parents in his practice. Parents may want to have a pediatrician speak with their teenager about these issues. At his office, Dr. Gruenwald establishs a confidential relationship with adolescents where they can discuss such concerns freely without the presence of a parent. At the same time, he encourages young people to allow him to share any concerns they have with the parents. In addition to advocating abstinence, he creates a "realistic atmosphere for discussing safe sex." Dr. Gruenwald assures parents that although a child may seem uncommunicative, this is a normal part of the transition to adulthood. He encourages parents to maintain a dialogue and to reassure their adolescents that they are loved. He adds that teenagers seeking greater freedom from parents must first demonstrate greater responsibility. In Conclusion "Being a parent is the most awesome responsibility and at times it may seem overwhelming," says Dr. Gruenwald. "We all tend to muddle through and most of us do a very good job. In general, most people are good parents!" For a referral to a Saint Barnabas Medical Center Pediatrician, please call 1-888-SBMC-DOC [ top ] |
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The mission of the American Academy of Pediatrics is to "attain optimal physical, mental and social health and well-being for all infants, children, adolescents and young adults." While most parents know that a pediatrician is the first line of defense for their child's physical ailments, they may not be aware that a pediatrician can also be a resource for issues pertaining to social and emotional health. 
Discipline begins when children are taught the meaning of the words "no," "don't" and "stop." When parents use these words, they must follow through on them or the admonitions become meaningless, he relates. Beginning at about 15 months of age, children can be placed in "time-outs" for aggressive, destructive or dangerous behavior. Dr. Gruenwald favors time-outs instead of physical punishment, which he says can relay the message that when someone displeases us it is acceptable to use physical means of correction.
