Monday, 4 February 2019

What parents should know — and do — about young children and mobile devices

I’ve been a parent for six years, and I still feel like I’ve always just missed some two-week window that would easily set up my oldest for the rest of his life. First it was swimming, then play dates, then soccer. The latest was riding a bike. In August, Milo was past 5 and a half years old and ripping his Big Wheel through the neighborhood. He loved it, but I feared that I had blown the chance to teach him to ride a two-wheeler before kindergarten started.

So, me being me, I scrambled and tried to undo time. I bought him a used BMX bike and removed the pedals. He went up and down our sidewalk; the cracks and roots made that two weeks of uselessness. He kept at it, but I didn’t see balance clicking in. However, on a Thursday afternoon while we were walking on our just-repaved road, Milo picked up his feet and started rolling. By Saturday, when he was pedaling without pedals, I realized it was time to reattach the real things. Before I could finish, “Just remember that you have to…,” he said, “I got this.” And he did and he hasn’t stopped.

I’d love to take credit. The most I can claim is that I went outside with him. But I knew one thing quickly: the playground basketball court wasn’t going to contain him for long. I also know that kids can’t ever be 100% prepped — that’s the point of learning — but streets are different than soccer and even kindergarten. They come with cars, distracted drivers, and more cars.

Pata Suyemoto is an instructor at the Bicycle Riding School in Somerville, Massachusetts. She says there’s no one method for teaching how to bike in traffic, but there are fundamentals to instill: visibility, predictability, and paying attention, not always the top three priorities for a kid. And she has some suggestions for parents on how to get your child there:

    Get on a bike yourself. It’s the best way to model anything, from using crosswalks to making turns to wearing a helmet. By riding, you’ll also experience what your child is contending with. You’ll see the limited sightlines, feel the rocky paths, and, if you have someone who loves to skid to a stop, you’ll know the loose dirt before an intersection. And with that information …
    Predict routes. You have to constantly scan and make notes about challenging areas, so you can give a heads-up to your child and chart the safest course. Don’t worry so much about explaining the whys — understanding comes with maturity. Just lay out a clear plan for what you want, such as, “At this intersection, stop on this corner, press the button and look both ways.”
    Practice passing. Riding in a straight line isn’t hard; the challenge is when a car passes. The narrowed space throws people of all ages. On a quiet street, bike path, or empty parking lot, take turns passing each other in a controlled way, and occasionally ride close alongside your child. He’ll see that he’s safe and can still maintain a line.
    Be prepared to repeat yourself. A new pattern is rarely set with one reminder, let alone two, 10, or possibly 100. Kids are constantly being distracted on a bike by everything from dogs to friends to Halloween decorations. You need to stay on message, and since you’re also on a bike, whenever your child isn’t focused, stop the ride and point out what was missed and what needs to be done. When there’s success, praise it, and make following directions into a game. At every cross street, have your child yell out, “I’m looking.” It gives her some control and you can see what she’s processing. It also reins in your voice, so you’re not constantly talking and running the risk of getting tuned out.
It used to be common for doctors to turn down or stop the pain medication flowing in an epidural during labor if progress slowed down. This practice was particularly common if the pushing stage of labor was prolonged. Many doctors and nurses, myself included, believed that the pelvic muscles were not optimally working because of the numbing effect of the epidural anesthesia. We also thought that women could not focus on the right place to push without pain as a guide. We especially worried that epidural anesthesia in labor might increase the chance of a having a cesarean. So, many women tried to go without epidurals and endure the pain so they could lower this risk.

It seemed like common sense, and if it were true, then the tradeoff of pain in labor might be worth the gain of a shorter labor, and especially a lower cesarean risk.

Thanks to one of my colleagues who is a specialist in obstetrical anesthesia at Beth Israel Deaconess Medical Center, Dr. Phil Hess, we now have strong evidence just published in the journal Obstetrics and Gynecology that epidurals do not prolong labor or increase cesarean rates. Common sense is not evidence, and we owe it to our patients to practice the best evidence-based medicine we can.

Dr. Hess and colleagues enrolled women who volunteered to be randomized into two groups. One group was given the usual self-administered epidural pump in the second stage of labor and the other received a sham medication. Women in both groups could ask for more pain medications. The investigators found that there was no difference in labor length or in cesarean rates, and both groups had equally healthy outcomes.

What is an epidural? Think of it as numbing medicine for the spinal cord, similar to Novocain, the medicine that is commonly used to numb the nerves in your mouth when you have a dental procedure. The difference is that for labor, the medication is injected near the lower spinal cord in order to numb the pain of a baby passing through the pelvis. The medication used in an epidural is a mix of a Novocain-like drug along with a narcotic medication. Unlike a shot or a pill, nearly no narcotic enters the woman’s bloodstream, so the baby’s exposure to narcotics via the bloodstream is virtually nil, which is a great benefit. From the level near the spinal cord that the drug is injected on downward, the body gets numb and a woman feels very little pain, leaving instead a vague sensation of pressure. For labor a dilute mixture is used, so women can typically feel their legs and feel pressure in the pelvic area, so they know where to focus on pushing the baby out.

This study confirms what many of us suspected. Women don’t need the incentive or focus of pain to push a baby out. They need verbal support and guidance! There’s no other place in medicine where we would subject a woman to pain and not offer pain relief. And now we can do so without women feeling guilt or fault if they have a cesarean (not that they should ever feel that way — except they do).

No comments:

Leave a comment