Of all the adjectives used to describe constipation, “frustrating” is by far the most commonly used by parents in my practice. If you are reading this article, know that you are not alone. Constipation is a very common complaint of otherwise healthy children. Understanding the answers to the following commonly asked questions will give you a solid foundation in the subject, so let’s get moving.
Q: What is a normal bowel pattern?
A: This will vary based upon age. “Normal” stools are not rock hard, and not watery, but anywhere in between. Breastfed infants can stool anywhere from once a week to as much as with every diaper change. For formula fed and older infants, stooling between three times a day and three times a week can generally be considered normal.
Q: What is constipation?
A: There are technical definitions of constipation, however the answer really is “you know it when you see it.” In practical terms, constipation is difficulty passing stool. Even if your child stools daily, if the stool is hard, dry, and associated with straining and pain, that is constipation. If your child stools only three times a week but they are soft and painless, that is normal.
Q: What causes constipation?
A: In a nutshell, the muscles of the colon (large intestine) contract and move stool from the beginning (ascending colon) through to the rectum. This is mostly controlled by nervous system input to the colon, which is out of our control. Staying well hydrated and eating a balanced diet can help with colon movement. Some kids, however, have naturally slower colon movement than others, which may lead to constipation.
The most common cause of constipation is “stool withholding,” when instead of relaxing our bottom while attempting to stool, we contract our pelvic muscles and external anal sphincter to prevent stool from coming out. Repeating this over time will cause the rectum to distend, which only worsens the problem. Fear of defecation due to a history of painful bowel movements or due to inconvenient timing (not wanting to stop playing) are common causes of this behavior.
Q: What are “red flags” that constipation is from a serious underlying medical condition?
A: Well over 95 percent of constipation is called “functional” constipation, meaning there is no medical or surgical cause. However, red flags that should prompt medical attention would be lack of meconium bowel movement at birth, failure to thrive, abdominal distension and blood mixed in stool, among others.
Q: How can I help my constipated child?
A: Provide a healthy, balanced diet, a supportive and positive environment during toilet training, and look for the stool withholding behavior discussed above. If your child is still exhibiting signs of constipation despite the above, or if they develop fecal incontinence (accidents) after already being toilet trained, please bring this up with your child’s doctor.
Q: What are the most commonly prescribed medical treatments for constipation?
A: There are medications called “osmotic laxatives,” which hold water in the colon to soften stool and make it easier to pass (Lactulose for younger infants, Miralax for older infants and children). There are “stimulant laxatives” which help the colon to contract, usually used on an intermittent basis when osmotic laxatives are not working (Senna or Bisacodyl). There are suppositories and enemas given at certain times, but in general we try to avoid using these.
Q: Will my child become dependent upon laxatives?
A: The medicines themselves are not habit forming and have no chemical dependency. Your colon does not “forget how to work.”
Q: Will this ever get better?
A: The vast majority of children will improve and go on to have a normal bowel pattern. A small percentage of children do develop chronic or severe constipation, which is where a pediatric gastroenterologist can be of help.
Dr. Dranove is board certified in general pediatrics and pediatric gastroenterology, hepatology and nutrition. He is a fellow of the American Academy of Pediatrics and the director of neurogastroenterology and motility disorders in the division of pediatric gastroenterology at Atrium Health Levine Children’s Hospital.
Meg McElwain lost her son Mitchell to leukemia when he was only 2 years old. Since his death in 2014, Meg and her son Frank Turner IV, have been open about their grief journey.
Meg is a philanthropist at Mitchell’s Fund, the non-profit she founded to help families struggling to cover the living expenses during the crisis of a life threatening pediatric illness. The heart of Mitchell’s Fund is pediatric cancer, but the fund also supports pediatric behavioral health. She believes her purpose is to help others recover after loss. This is what she learned and would like to share from the experience of losing a child.
Things Happen Fast
When Mitchell first got sick, things happened really quickly. He was only 3 months old when we noticed bruising on his legs. That was a Sunday on the afternoon of his baptism. We went to the doctor the next morning who immediately recognized something was very wrong with Mitchell. He ordered a blood panel, and by noon Monday, we knew Mitchell had white blood cell cancer. By 5:30 p.m. that evening, Mitchell was diagnosed with a rare form of leukemia with a 40 percent chance of survival and chemotherapy to start the next day. There was no time to sit and think.
I am so thankful we were taken seriously and not told to “watch and wait.” Getting a blood panel immediately gave us the diagnosis we needed to start aggressively treating the cancer. That is likely why we had as much time with Mitchell as we did.
Listen to Your Nurses, not Dr. Google
Our doctors gave us material to read and told us NOT to Google anything about leukemia. We listened and I am glad we did. Dr. Google will tell you your foot’s going to fall off when you have a hang nail. We trusted our medical team and were open to the social services the children’s hospital offered. That gave us an incredible amount of hope.
Acquaintances Forget. Friends Don’t.
In the beginning, everyone was there to help whether it was cooking meals or helping with Frank, who was 3 at the time. But that stopped, especially after Mitchell died. People went back to their lives and were less attentive about our circumstances, which is human nature, but can also be hurtful.
In a way, I think people feel like they are supposed to get back to normal, but there is no normal after you lose a child. Everything changes. It has become impossible for me to hear a baby cry without thinking about the child I once rocked to sleep. It’s hard seeing other children achieve milestones that my child never will. Mitchell would be starting first grade this year.
Through this experience, I learned a lot about the people in my life. Some people are drawn to tragedy in a strange way or are grief vultures. The people whose friendship I value the most made it a point to circle the anniversary of Mitchell’s death on their calendar and reach out to say, “I know it’s coming up and I am sorry. I am praying for you and I love you.”
People say Stupid Things
After I lost Mitchell, people said the most ridiculous things, like, “you need to have another baby,” or “you need to adopt a child.” It was also unhelpful to hear, “he’s in a better place,” and “you’re so strong.” Once someone said, “if you stop talking about it, maybe it will get better.” I get it … it’s hard to know what to say, but I always value when someone just lets me talk about him and how much I miss him. Sometimes just saying, “I love you,” is enough.
It’s OK to say What you Need and What you Don’t
The experience of losing my son has made me less inclined to engage in drama and to be more direct. For example, some people are big huggers — I am not one of them. Eventually, I told people hugs were not what I needed. After Mitchell died, there were certain conversations I just had to remove myself from though people may have not understood why. I turned down offers of help that weren’t helpful as well-intended as they were. I think some people wanted to “fix” or “help” me. If you are grieving the loss of a child, it’s not about other people, it’s about you. I think this is why many marriages end in divorce after the death of a child. Each person grieves differently and the pain often causes such differences that relationships suffer. My marriage to Mitchell’s dad ended in divorce three years after Mitchie died.
There’s Always More Beyond the Surface
Whether it’s a marriage in trouble, impending financial ruin, addiction or mental health illness, there’s always more going than just the long-term critical illness. Mitchell’s illness went on for two years, and there were so many other things we were dealing with that others never knew about. Much of the stress families feel during this time is financial because one parent has to basically live at the hospital while the other works or cares for other children.
Childhood cancer treatment protocols are so much more intense and fast paced that adult cancer. There is more time in the hospital and at the clinic. This is one of the big reasons why I started Mitchell’s Fund, to try to alleviate the burden of everything else that happens at the cost of prioritizing your critically ill child.
Life Goes on
You are never not going to feel the pain, but it gets easier to carry. The first two years were the absolute worst. … I felt so emotionally heavy and physically burdened. But after I had been through the second Christmas, the second Easter, the second Mother’s Day, I knew I could get through it because I had done it once before. It was then that I felt I could really move forward. I miss him every single day.
You will Survive
I now know my purpose on this earth: to channel my hurt to help others heal. Whether fund raising for Mitchell’s Fund, speaking to groups about resilience or just being more present with my living son, I am more intentional with everything in my life and have learned that living slower is better. At the end of it all, I will hold by baby again and hear him say “Mama.” I can’t wait.
Meg McElwain is a professional speaker and blogger on resilience. Learn more about her at megmcelwain.com.
Two years ago, six children on our beach vacation developed symptoms of hand, foot and mouth disease. As physicians, we appreciated watching the various symptomatology and timeline of transmission in our small sample size (insert pushing our nerdy glasses up our noses here). As their parents, however, it added a facet of stress to the week that we could have done without. Much anticipated vacations can be derailed by illness or injury, making it memorable for other reasons. In anticipation of the upcoming summer season, we have compiled some practical advice based on common questions asked in our practices.
A little research prior to leaving is worth it. During the planning stages, consider where you will be traveling and what resources are available. Is there a hospital? Is it a children’s hospital? Are there any urgent care clinics close by? We are very fortunate in Charlotte to have urgent care clinics that only see children but this is not the case in many areas. Ask relatives you may be visiting if there are local pediatricians who could see your children, should an illness arise.
When packing, make sure to include not only daily medications, but also as-needed prescriptions, such as epinephrine pens and asthma rescue inhalers. It is a good idea to pack over-the-counter fever medications, hydrocortisone and Benadryl along with your sunscreen and bug spray. Additionally, write down a list of everyone’s known drug allergies, daily medication dosages and dates of last tetanus vaccines. A quick memo on your phone could save you a panicked call to your home pediatric office.
Try not to overload yourselves with equipment you may not need but do think ahead with regards to safety measures, including car seats. Airlines may have specific requirements regarding air travel with children and proper restraints. Two helpful resources include the American Academy of Pediatrics and the Centers for Disease Control and Prevention for travel tips with children.
Some of the most common problems encountered on vacation include gastroenteritis, food poisoning, fevers, sunburns and minor injuries. Initial treatments for signs of vomiting or diarrhea include home therapies like Pedialyte and rehydration. If your child is worsening, however, or not improving over 24-48 hours, it would be time to take other steps. For sunburns, prevention is key. Do not overlook good sun protection just because your trip does not involve the beach.
Minor injuries and cuts should be able to be managed at an urgent care, if available. Less commonly, broken bones or surgical issues arise. Consider how remote your location is when deciding when to seek medical care. For instance, if you are far from any medical facility and something happens, seek care earlier rather than later just to be safe. Emergent surgical issues that arise would be triaged by local physicians and transfers would be made based on the comfort level of that institution to take care of children.
If you are uncomfortable or have questions, consider calling your home pediatric office. Triage nurses at Charlotte Pediatric Clinic commonly answer questions for our traveling families and can assist in starting home therapies over the phone. The surgeons at Pediatric Surgical Associates often know the providers in their specialty in other parts of the country and can act as a resource if contacted.
Canceling a trip or going home due to illness should be considered when a problem arises that will need close follow up or the illness/injury substantially interferes with the activities you have planned. As in our case last year, our son’s broken arm sustained three days prior to a trip that involved water activities called for a readjustment. In general, if local resources are sparse, think carefully about participating in high risk activities like zip-lining, parasailing and scuba diving.
Last but not least, age appropriate flexibility is key. Try not to overschedule everyone before you get there. Concentrate on the time away from day-to-day activities and remember the “family” part of the vacation. Even in the event that a medical situation arises, it will be woven into the memories of your time together, which will help shape your child’s life. Our previous beach vacation may have involved more indoor games and less beach time but we still had fun, blisters and all.
Anna Schmelzer, MD, is a pediatrician at the SouthPark office of Charlotte Pediatric Clinic, and Thomas Schmelzer, MD, is a board-certified pediatric surgeon at Pediatric Surgical Associates. They are married and have two children.
Many of us have experienced the temporary panic of watching our child struggle after swallowing something that “didn’t go down the right way.” Whether the result of consuming a drink too quickly or breathing in while eating a snack, your child starts coughing and sputtering as their watery eyes look at you for help. Most of the time, it’s just an episode of a few seconds. …The drink goes down or the food comes up, and then he or she is fine.
But every once in while something gets stuck! That’s when Pediatric Surgical Associates gets a call.
The medical term for this common problem is “foreign body ingestion” or “foreign body aspiration.” Foreign body ingestion means something went down the esophagus (the tube that connects the mouth to the stomach), and aspiration means something went down the trachea (airway or breathing tube). In either case the “something” can get stuck and must be removed.
Let’s talk about ingestion
Seventy thousand pediatric foreign body ingestions occur each year. Most foreign body ingestions occur in toddlers and preschool-aged children, who inquisitively explore the world around them, often with their mouths. An intriguing object is discovered, mouthed and inadvertently swallowed. Children most commonly swallow coins (which comprise 80 percent of foreign bodies lodged in the esophagus), but other objects we regularly remove include magnets, batteries, small toys, buttons and jewelry.
Although caregivers sometimes see the child swallow the object, as many as half of these cases are not witnessed. These children might suddenly start drooling or throwing up continually, refuse to eat or complain of achy pain in the chest. Many will have respiratory symptoms like coughing or wheezing. They also might not; some children initially show no symptoms whatsoever!
What happens if your child swallows something and seems fine? It is likely that the foreign body has traversed the esophagus and made it to the stomach. Foreign bodies in the stomach and intestine can almost always be left alone, because the child will usually pass it without complication. There are exceptions to that rule. If your child swallows a button-style battery, it is possible he or she will develop an internal burn since the current of those batteries runs continuously. If your child were to swallow multiple magnets, it is possible the magnets could connect and pinch whatever tissue is in the way.
If you are concerned your child may have swallowed a foreign body but seems fine, don’t panic; just call the doctor to be safe. If your child has any of the symptoms described above after a witnessed foreign body ingestion, take them to one of the two pediatric emergency departments here in Charlotte for evaluation.
Now for aspiration
Most foreign body aspirations occur in children younger than 4. Though very often the item is a piece of food (think peanuts and popcorn), we see many interesting non-food items (air-soft pellets, jewelry, beads). Older kids and adults suffering from foreign body aspiration inhale thumbtacks, pen tops, guitar picks, screws and nails — things they were holding in their mouths while their hands were otherwise occupied.
When a child “aspirates” or inhales something, he or she will likely choke on it temporarily, then cough and wheeze. This almost always happens by accident while the child is talking, moving, coughing, singing or sighing. Sometimes the child will have immediate symptoms like noisy breathing. Foods such as nuts or rice may cause trouble several days later after the they absorb enough fluid and increase in size.
Pediatric surgeons remove foreign bodies of the esophagus and airway using a scope under sedation in the operating room. This is typically a brief (less than 10-minute) out-patient procedure (most children go home immediately afterward). In all cases of suspected foreign body ingestion or aspiration, the most important thing you can do is try not to panic and document or retrace what happened before, during and after your child swallowed or inhaled the object. Ask yourself these questions and write down as much as you know or can find out:
- Was your child alone or accompanied when it happened?
- What did your child consume? If you are not sure, look around for what might be missing or out of place.
- What happened immediately after? Did your child turn blue for a short time? How long did the cough persist? Did your child vomit? Did his or her voice change?
Foreign body ingestion and aspiration sound scary, and in some cases these conditions can be serious. But most of the time, we can identify foreign bodies on an x-ray and use minimally invasive methods to remove them quickly and easily. Always err on the side of caution and call the doctor if you have any concerns about an ingested or aspirated foreign body. And if you do need surgery, we’re here.
Dr. Graham Cosper’s research on foreign object ingestion and aspiration was published in “Current Treatment Options in Pediatrics” (Graham H. Cosper & Angela M. Kao, Springer, April 2017). Learn more about Dr. Cosper.
Cleft lip and palate remain one of the most common birth defects, affecting up to one in 700 live births. I meet with parents during pregnancy and newborns with cleft lip and palate all the time. One of the most important things to explain and show with pictures and individual stories is that the diagnosis of cleft lip and palate does not have to define the children or families. We have excellent treatments and a great team of specialists who work together on all aspects of care.
What is a cleft lip and palate?
A cleft lip occurs when the normal process of the joining of the lip does not occur. Sometimes this can be linked to a specific genetic change, but most of the time this occurs spontaneously for no known reason. Sometimes there is just a small “notch” in the lip, and sometimes the cleft carries through the full height of the lip into the nose. The lip is usually seen on ultrasound during pregnancy. If there is a cleft, it is often picked up by your obstetrician.
The palate forms the roof of the mouth and is “hard” in the front (formed by some of the bones of the mid-face) and “soft” in the back (formed by muscles that help with speech and swallowing). A cleft palate occurs when the two halves of the palate do not join properly during pregnancy. It may occur along with a cleft lip, as an isolated cleft palate, or with another difference in development.
What is the soft palate?
The soft palate is the back part of the palate that contains important muscles to help with speech and swallowing. Normally the soft palate moves toward the back of the nasal passage and helps form certain sounds. When there is a cleft of the soft palate, these muscles do not connect, and the normal movement of the palate is disrupted. Children have difficulty making certain sounds (e.g. b, d, k).
What is the hard palate?
The hard palate forms the front part of the palate containing bone that supports the upper teeth and the midface. This separates the mouth from the nose and also helps with feeding and the formation of certain sounds (e.g. d, s, t).
How is a cleft lip and palate diagnosed?
A cleft lip can usually be seen on ultrasound during pregnancy, and when there is a cleft palate it may sometimes be seen. When a palate occurs on its own, it is usually seen when your child is born. Often times one of our pediatric genetics doctors will also evaluate your child after birth.
How does a cleft lip and palate impact speech?
One of the most important functions of the palate lies in the development of speech as children grow. There are physical factors (the anatomy of the palate and nerve function of the muscles) as well as cognitive factors (the brain’s ability to learn language) that work together to help children learn how to talk. The speech and language therapist plays a critical role in helping children and families develop normal speech. The plastic surgeon helps to restore normal anatomy of both the soft and hard palate.
When is a cleft palate treated?
A cleft lip is usually closed by six months of age. A cleft palate is usually closed by 18 months of age before the child begins to develop the core sounds for speech.
What does this mean for my child?
Most children can and will achieve normal speech. Some children may require additional surgery on the jaws or palate as they grow. Your cleft surgeon will follow your child to ensure they are developing normally and will coordinate care as a team with other specialists as indicated.
David Fisher, MD, is a plastic surgery specialist in Charlotte, North Carolina and practices at Levine Children’s Hospital. Dr. Fisher delivers advanced, compassionate care for children with complex conditions affecting the head and neck and performs major reconstructive procedures to correct abnormalities and improve children’s health.
By Sarah Jernigan, MD, MPH, Carolina Neurosurgery & Spine Associates
When you hear the word “spasticity,” what do you think of? Many people think of the term “spastic” used for years to describe people with cerebral palsy (CP). This term was likely inspired by the sometimes jerking and seemingly uncontrolled muscle movements of those who manage CP. Sadly, it can be a colloquial term used to make fun of someone who is uncoordinated or incompetent, but for someone who lives with spasticity every day, the condition is no laughing matter.
Spasticity is a condition that can greatly impact a child’s ability to walk and perform other day-to-day activities, and it’s surprisingly common. Two out of every 1,000 children in the United States are born with CP, and 75 percent of those children have spasticity. It can also impact children who have multiple sclerosis or have experienced traumatic brain injury, stroke or spinal cord trauma.
People who live with spasticity describe spasticity as a range of feelings, from a mild sensation of tightness to severe, painful spasms. To understand what spasticity looks like, think of a child living with CP who is sitting with her legs crossed. Her leg might suddenly kick out or jerk forward. This child might be perfectly aware the kick is going to happen, but she may not have the muscle control to prevent it or control her leg.
It’s important to note that spasticity is caused by a dysfunctional signal that loops between the brain, spinal cord and nerves in the arms and legs. Spasticity is not a sign of decreased intelligence or cognitive function.
Spasticity can greatly limit mobility and generate significant discomfort. Although many children (almost 50 percent) with cerebral palsy can walk with the assistance of braces, canes or walkers, spasticity can eventually rob them of that ability.
Spasticity can also negatively impact other parts of the body, including the tendons and ligaments. These changes can cause muscle stiffness, atrophy (deterioration or wasting of the muscle) and fibrosis (changes in the properties of the muscle fibers). Muscles affected by spasticity have difficulty stretching the proper length needed to keep up with a child’s bone growth. The muscle then becomes shorter than it should be and prevents a joint from achieving normal, full range of movement. This condition is known a contracture, and can lead to significant pain and bone deformities.
So what can we do to help children living with spasticity to live their best life?
The initial evaluation for spasticity includes a comprehensive assessment of the presence, severity and impact of spasticity on the child. Physical and occupational therapists evaluate which muscles are affected and start by stretching these muscles. A physiatrist may also prescribe muscle relaxants to help block the abnormal nervous system signals. If these treatments are not effective, Botox injections into specific muscle groups may also help loosen these muscles and stop the cycle of spasticity.
Surgery may be an option in children with more severe spasticity or for patients who do not respond to these other treatments. Two surgical treatment options for spasticity include implantation of an intrathecal baclofen pump and selective dorsal rhizotomy.
Baclofen is a medication used with spasticity treatment. It is a central nervous system depressant and skeletal muscle relaxant. A pump can be implanted into the spinal fluid space and provide baclofen directly to areas of the spinal cord where it is most needed to loosen muscles and prevent spasms. This is appealing because the pump can be removed leaving no lasting or permanent effects.
Selective dorsal rhizotomy is a surgical procedure in which a neurosurgeon permanently cuts the nerves that are firing abnormally and contributing to spasticity. Those nerves are then partially or completely cut, to stop the dysfunctional signal loop, and decrease the spasticity. While the results of this surgery are permanent, these patients must continue with additional spasticity therapies throughout their lifetime.
Taking care of children with cerebral palsy and spasticity requires a team approach from families, therapists, physicians and you. Taking the time to understand spasticity is a great way to be a supportive friend, classmate or neighbor, and can help everyone reach their maximum potential.
Sarah Jernigan, MD, MPH, is a fellowship-trained pediatric neurosurgeon with Carolina Neurosurgery & Spine Associates, home to the largest team of pediatric neurosurgeons in the Southeast. Dr. Jernigan specializes in diagnosing and treating children with brain tumors, hydrocephalus, spasticity, craniosynostosis, spina bifida and vascular disorders such as Moyamoya disease.
By Frank Gaskill, PhD, SouthEast Psych
We live in very strange times. As adults, our brains are not wired to process the world in which we currently live. It’s easy to forget what life was like before the internet, the 24-hour news cycle and social media. But this summer I remembered. Social media and most news was gone from my life for seven weeks. The first days were rough because being on my phone was such a habit, but then I just forgot. I found I could concentrate better, had more ideas and communicated more with my family. I was also significantly less stressed.
Now imagine being a child in this world.
Their world is an incredibly stressful and unpredictable place filled with terrorism, scary weather patterns and political strife. At the same time, kids are now more depressed and anxious than at any other time in history. Sadly, suicide is also on the rise. Some longitudinal research suggests that kids today have levels of anxiety comparable to children hospitalized for anxiety in 1957. In another 2010 study from Clinical Psychology Review, the significant increase in depression is graphically documented.
In addition to all this stress and depression, social media tells kids they should be happy, popular, and semi-famous either through YouTube or Instagram. And the gap between social media’s message, “Be Happy!” and the message from the news, “Be Scared!” is widening.
And this is why parenting right now is so important. And by parenting, I mean talking about difficult topics. Talking with a trusted adult actually reduces stress, anxiety and depression.
So Where Do You Start?
What’s a difficult topic? I include sex, drugs, terrorism, suicide, kidnappings, divorce and death just to name a few. While this is a crazy variety of subjects, the underlying theme is these are the topics that usually make parents squirm. But wouldn’t you rather your kids discuss such things with you than someone else?
Here are five guidelines I often suggest for parents to consider:
- Difficult topics are ongoing conversations. It’s not just one talk. And before diving in, check your relationship first. While you may want to talk with them, they may not be willing to listen to you, especially teens. Entering into these conversations requires trust and openness.
- Before you talk, think through the emotional and developmental maturity of your child. Some 9-year-olds can handle topics for which some 12-year-olds are not prepared. All kids are different. And, kids are detectives. All their answers can be found online. Online information may be misleading, developmentally inappropriate, or just not compatible with your family’s values. It’s better for them to learn from you.
- With many topics, you as a parent will feel uncomfortable as well. Acknowledge your emotions to yourself and to your child. Recognize they likely are feeling similar and it is comforting for them to know you understand and are experiencing similar emotions.
- Before a conversation, practice by yourself or talk it through with a friend or partner. You never know what emotions may well up in you especially around loss, sickness, or family strife. It’s ok for you to show your emotions, but don’t overwhelm your child or put them in a position of trying to comfort you.
- Reassure them. Let them know they are loved and protected. Show them leadership, and be their safe space. These conversations don’t need to be long and preferably, should be brief. Some kids may take time to process the information. Be sure to ask them specifically if they have questions. Reassure them that they can come to you at any time for more information. It never hurts to check in with them later.
Making a habit of being able to talk about difficult topics makes you a better parent, relieves guilt and builds confidence in your child. Also, demonstrating your willingness to have these conversations also conveys love and demonstrates confidence in your child’s ability to engage with you. And finally, for the long-term, your child is seeing you model a level of parenting that they, too, will hopefully model with your grandchildren.
“Dr. G” specializes in Aspergers and the Autism Spectrum. Dr. G works with children and adolescents using a family based approach. He also serves as a member of the private schools admissions testing team (CAIS). Dr. Gaskill is the author of the graphic novel Max Gamer, a contributing author to The Walking Dead Psychology, and Star Wars Psychology: The Dark Side of the Mind. He is also the host of the Dr. G. Aspie show (“Asperger’s is Awesome!”).”
By Alison Schulman
In March 2017, Dr. Andrew Schulman wrote a popular blog post titled “A Day in the Life of a Pediatric Surgeon,” which described a busy, sometimes chaotic 24-hour period during which he balanced being a doctor, colleague, husband and father. We asked Dr. Schulman’s wife about the other side of this demanding schedule. Here’s what Alison Schulman had to say.
How did you and Andrew meet?
We were both at the University of Virginia doing our medical residencies in surgery. I met Andrew when I was at the end of the first year of my residency; he was finishing his fourth. When it became apparent we were going to be together long-term, I decided to stop my studies in medicine. There is not a day that I regret my decision. I love being available for my kids.
Andrew completed his subspecialty training for Pediatric Surgery at the Children’s Hospital and Regional Medical Center in Seattle. We jetted back to my hometown of Houston to get married and had a four-day honeymoon because Andrew had to get back to be on-call. Kate (now 11) was born 15 months later. When she was eight months old, we moved to Charlotte for Andrew’s position at Pediatric Surgical Associates. About two years later, Max (now 8) was born. We love it here in Charlotte. The people and practice continue to be a great fit.
What is the hardest thing about Andrew’s job?
I’d say the hardest part is thinking I know what his schedule is for the day – but never really knowing. At any second, he might get pulled away. This weekend, he wasn’t even on call, but he spent hours on the phone to ensure everyone at the hospital knew the necessary details about a complicated patient.
Having spent time inside surgery culture, I knew what I was getting into. But it definitely took me a couple of years to get used to it. Nowadays, I just don’t plan anything for weeknights, and we don’t go on vacations where Andrew will be unreachable. Especially with young children, I generally have to assume that Andrew is not going to be available. It’s a pain, but after a while you get used to it and when he’s here, it’s like a bonus!
It’s hardest on the kids, but they are old enough to understand how important his work is.
Is the work worth it?
There are two things about work that Andrew really enjoys. First is the actual operating, particularly when it’s something that will really change an outcome for a child who is extremely ill. He loves finding new ways to approach a problem and find a solution. Second is seeing the kids come back to the office in better health, particularly the ones who have had complex issues. For example, with some rectal surgeries, a surgeon will perform an operation on a newborn baby but not know if the surgery was successful until the child is toilet-trained. Andrew will come home and say how glad he is that a patient is able to poop on his own!
Despite the impact on our personal lives, our family knows Andrew is helping families in what can be their darkest hour. What help us with this understanding is knowing the other doctors in the practice have Andrew’s back, and that he has theirs. This is a rare situation in healthcare. At PSA, you never feel like someone is working more than someone else. It’s truly a group effort.
The surgeons at PSA are all family first, and the practice is part of the family. The other doctors’ wives and families all support each other. We make sure every doctor gets to important functions for his family, because we all get it. We make it work, and it works for us. PSA is a true team.
What is it like to have Andrew home?
Obviously, Andrew’s time off is incredibly valuable. When he’s home, he tries to do normal “Dad” things, like pick up the kids from school. I know many dads do the morning drop-off, but by that time, Andrew has usually been at work for two hours or more. But when he’s off duty, he really loves getting to do those little things with our kids – that, and barbecuing!
By Andrew Schulman, MD, and Megan Tillery, RN Supervisor
Whether your child is scheduled for a simple procedure, like getting ear tubes, or preparing for major surgery, many of the questions we receive from our young patients (and their parents) are very similar. As medical professionals, it’s important for us to be as open, honest and clear as possible. As pediatric surgeons and nurses, it’s important for us to help moms and dads communicate expectations accurately, with the right amount of reassurance.
Will it hurt?
This is the most common question that patients ask. First, we tell children that they will feel nothing at all during surgery. Afterwards, they maybe sore, but that soreness can be managed with over-the- counter medication or a prescription, if needed.
Will I be awake during the surgery?
If the child is very young, we explain to him/her that we will give them a special type of medicine to help them fall asleep. We reassure the child that he/she will not feel or remember anything from surgery. Occasionally doctors will perform minor procedures in the office where the child would be awake, but for the most part, he or she will be under anesthesia.
Can my parent(s) be with me in surgery?
We tell children that their parent(s) can be with them until they go back to the operating room before the surgery, well after they have fallen asleep. Though no parents are allowed in the operating suite, we like to inform them that many of the doctors and nurses present are moms and dads, and that we promise to treat them with as much care and concern as we would our own children. We assure them that their parent(s) will be there with them when they wake up.
Can I have my blanket/stuffed animal?
Comfort items like blankets and stuffed animals cannot be part of a sterile procedure. However, we reassure patients that they can fall sleep with their favorite item. Afterwards, the nurse staff will make sure that it is kept in a nice, safe place during the procedure and returned to the patient before they wake up.
What, exactly, is going to happen when I am asleep?
Children are smart, and some really want more detail about what is going to happen and why surgery is necessary. It’s important to give enough information to answer their questions, but not so much to cause panic. For major surgeries, we work with parents closely on this question, and we offer these guidelines based on the child’s age, or equivalent developmental ability to understand:
- Toddlers: We explain that we are going to do something that will fix their problem and make them feel better. We might describe the problem using analogies or rough sketches for children who are a little older and want to know more.
- Preteens: We offer a little more detail on the problem and the solution. We also try to reassure them by sharing how many other kids their age experience similar procedures.
- Teens: For teenagers, we typically give them as much detail as they want, and provide them with age-appropriate resources should they want to know more. At this age, it’s important for them to understand what is going to happen so that we can obtain their approval for surgery. Parents give consent to those under 18.
When can I go back to sports/swimming/physical activity?
This varies depending upon the procedure, but generally we instruct children to wait two weeks before returning to sports, swimming or strenuous physical activities. In “kid time,” two weeks sounds like an eternity, so we remind them that recovery is a good time to watch shows, play games and catch up on movies.
Is this a really big deal?
There are times when the task at hand is complex and far from routine. During these times, children and parents can be understandably frightened and fearful of the surgery and outcome. Our communication philosophy remains the same – we strive to be open, honest, clear and reassuring.
The Charlotte region is lucky to have two exceptional hospital systems, along with some of the country’s best medical professionals. We hope that your child will never need surgery, but if they do, know that some of the nicest and most caring people you could ever met are there to help your family through this stressful time.
By Christopher Tebbit, MD, Charlotte Eye Ear Nose & Throat
Your baby is fussy and seems to be in pain. It looks like they have an ear infection. Another one. Chronic ear infections can be a problem for many small children, but how do you know when it’s time for them to get ear tubes?
What causes ear infections?
The middle ear is an air-filled cavity separated from the outer ear canal by the paper-thin eardrum. The Eustachian tube is the passageway that connects the middle ear to the back of the nose. This passageway allows air pressure to equalize and prevent fluid from accumulating in the middle ear space. If the Eustachian tube is not working well, middle ear problems, including recurrent ear infections, can develop.
In children, the Eustachian tube is often dysfunctional due to its small size and swelling from respiratory infections. Without ventilation, a vacuum draws fluid into the middle ear space, creating a risk of infection or persistent fluid. Signs of ear infections can include ear pain, trouble hearing, fever, and ear drainage.
While middle ear infections cause pain and irritability, another concern is the impact they have on hearing. The fluid prevents the eardrum from moving appropriately, so sound does not get conducted to the inner ear. If a child has recurring ear infections, the constant blocking of sound can impact their speech development.
How are ear infections treated?
The best way to try and keep children from getting ear infections in the first place is to keep them away from sick children or other aggravating factors, like secondhand smoke. Yet despite the best hygiene efforts, many children will still suffer from ear infections. Additionally, if a child’s parents were prone to ear infections when they were young, their child has an increased chance of getting ear infections, too.
The standard treatment for ear infections is a course of oral antibiotics. However, if ear infections recur frequently, or if fluid persists in the middle ear, the doctor may suggest your child get ear tubes.
Ear tubes are soft, tiny cylinders placed through the eardrum that allow air into the middle ear. Short-term tubes are smaller and typically stay in place for six months to a year before falling out on their own. Long-term tubes are larger and secured in place for a longer period of time.
Ear tubes are a good solution for children with recurrent ear infections or persistent middle ear fluid that creates hearing loss. Tubes ventilate the middle ear space, bypassing the dysfunctional Eustachian tube.
Ear tubes benefit patients in several ways. First, they very often decrease or eliminate ear infections. If an infection does occur when tubes are in place, the infection can be treated with medicated ear drops, avoiding the need to use oral antibiotics. Restoring normal hearing by removing fluid from the middle ear space is another benefit of ear tube placement.
Ear tube surgery is very safe, with about 700,000 cases performed each year. The procedure takes about 10-15 minutes, with the child briefly asleep under light anesthesia.
Dr. Tebbit is an otolaryngologist who specializes in comprehensive adult and pediatric ENT care. He practices in CEENTA’s Belmont office. CEENTA doctors have been involved with ear tube surgery since the very beginning, as ear tubes were actually invented by CEENTA’s own Beverly Armstrong, MD, in 1952.