Patients are sometimes confused when doctors differentiate the terms pain and tenderness. The reason we use these words differently is because they mean different things when it comes to making a diagnosis. If something is painful, that means it hurts. If something is tender, that means it hurts when it is touched or moved. A good example of how we use these terms relates to abdominal pain. I could have a horrible stomachache, but if it doesn’t hurt more when someone pushes on my abdomen, I am not tender. Appendicitis always causes a tender abdomen. Similarly, migraine headaches cause severe pain in addition to nausea and photophobia (it hurts to look at lights), but patients with migraine usually don’t have scalp tenderness. If someone has a bad headache associated with scalp tenderness, it’s often due to muscle tension that’s brought on by psychological or physical stress such as carrying a heavy backpack or keyboarding for long periods of time.
Although the human body isn’t perfect, there are lots of awesome ways that it functions. One of these is called the gastrocolic reflex. In this context, “gastro” refers to the stomach and “colic” refers to the colon or large intestine.
When we eat, the stomach stretches and begins digesting our meal. The stomach does this by releasing chemicals and contracting to break down the food we have eaten. At the same time, the “machinery” of the intestinal tract is turned on. The rhythmic contraction of the muscles in the stomach and intestine is called peristalsis. If a child is constipated, the onset of peristalsis within the large intestine (especially the rectum) can cause pain as the intestinal muscles contract against large or hard fecal material. If the pain was because of stool in the rectum, having a bowel movement will usually relieve the pain. If the pain was because of stool higher up in the large intestine, stooling won’t necessarily relieve the pain. Sometimes the pain is so severe that parents may worry their child has an appendicitis.
Constipation isn’t the only condition that can trigger pain after someone eats. Lactose intolerance, overeating and celiac disease can cause similar symptoms. However, 90% of the time pain after eating is due to constipation.
Many childrearing books tell you not to use soap on a baby’s face. One of the reasons for this is because soap may irritate a newborn’s sensitive facial skin. Another is that a newborn’s skin is slightly acidic, which helps prevent infection. Soap can reduce the natural acidity of a newborn’s skin.
The problem with not using soap on a baby’s face is that some of them will be more prone to newborn acne and other rashes because of dead skin, saliva and regurgitated milk that accumulates on their face. The answer to this problem is to wash the baby’s face with a ph-neutral soap substitute like Cetaphil Gentle Skin Cleanser. Using Cetaphil with a washcloth helps remove dead skin, etc. without harming the baby’s skin.
Body temperature varies throughout the day whether you’re sick or healthy. If you take your daughter’s temperature three times a day for a number of days, you will see that the highest readings come in the evening. Similarly, if she is sick, you are more likely to find high temperature at 9pm rather than 9am. This diurnal variation in body temperature causes two problems for parents. First, it’s harder to manage high fevers at night when everyone is trying to get some sleep. Second, if your feverish child wakes up cool, you may think all is well until the fever returns in the afternoon or evening. Although it’s not always clear when a child isn’t contagious, most schools have adopted a 24-hour fever free policy because they know temperatures can come back as the day progresses. That’s why you shouldn’t take your kids to school the morning after a feverish night.
It’s common for people to use baby powder after showering to keep dry, especially during the warmer months. Similarly, parents often use baby powder on their baby’s bottoms after diaper changes. I disagree with the latter use for two reasons. First, I’m not convinced it does any good. Although baby powder may absorb perspiration on an adult, it’s hard for powder to contend with the volume of urine a baby produces in between diaper changes. More importantly, baby powder can be dangerous. A number of reports have been published in medical journals where an older infant had grabbed a container of baby powder while he was lying on his back during a diaper change. Because baby powder containers look like bottles, these infants held the bottles up to their mouths and inadvertently aspirated the powder into their tracheas.
Parents frequently hear that they should never compare children to each other. As a pediatrician, I can unequivocally state that this is one of the dumbest things I’ve ever heard. Not only do we compare our children to each other, but we also compare them to other people’s children. Why? Because it’s instinctive for humans to compare things. We compare which apples to pick at the grocery store. We compare which shampoo to buy. We compare which clothes to wear to work.
So where does this “wisdom” come from? I think it’s derived from the difference between comparing and judging. Things can be different without one being superior to the other. When it comes to children, there is never one thing you are comparing. People are more complicated than apples or shampoo so most parents find they appreciate each child for different things. The flip side of this is also true. Namely, each child can make us crazy in different ways.
When this topic comes up in my office, I start by telling parents what I just said. I then expand on the topic by reminding them that what you never want to do is to compare your kids unconsciously and not be aware of it. It’s also a bit perilous to censure one child by invoking the more desired attributes of his sibling.
I have two teenagers who are very different. I horse around with and go to movies with my son, but have intellectual conversations with my daughter. I am proud of both of them, but in different ways. Sometimes I wish my daughter and I could do things like I do with my son and visa versa. That is comparing them, but neither one is a better child than the other. The flip side is that they each annoy me in different ways as well.
Comparing your kids to your friend’s kids is a bit trickier because you don’t have all the facts regarding someone else’s children. You may still find that you like certain aspects of your friend’s children more than your own. Just remember that most kids behave better with people other than their parents.
It’s also very important to remember that children have big ears. They love to eavesdrop on their parents because it’s exciting to hear what grownups have to say when they are alone. If my son heard me saying something comparing him to his sister, I am setting myself up for trouble. I can think it, and I can discuss it with my wife. But this should only be done when all children are accounted for.
While every parent hopes his or her teenager will be able to “just say no” when asked to use drugs or alcohol, it’s clear that many adolescents will have difficulty resisting peer pressure. One way to handle this situation is to give teenagers an excuse so it won’t look like they’re not “being cool” when asked to use an illegal substance. Here are some comebacks that may help kids get out of tricky situations:
- “I can’t drink/smoke because I’m taking a medication for my allergies (or some other condition) that interacts badly with alcohol/marijuana.” If someone asks the teen what he’s taking, he can say he doesn’t know because his mom just gives it to him in the morning.
- “I’ve had a stomach ache all day, and the last thing I need is to drink tonight.”
- “I’ve got asthma so I can’t smoke weed.”
- “My parents are planning to buy me a car for graduation, but if they ever catch me doing drugs or alcohol, they told me I can kiss the car goodbye.”
- “My brother/sister/cousin got into a lot of trouble doing alcohol/drugs so I’m not into this stuff.”
- “I’ve got plans tomorrow morning so I need to be clear headed.”
- “I’m the designated driver tonight.”
- “My brother/sister/pet is sick, so I know my parents will be awake when I get home tonight.”
- “I’ve got relatives in town so I need to be straight when I get home tonight.”
- “My dad goes to sleep late every night, so I can never get away with this stuff.”
Have your own tips? Let me know by posting a comment or sending me a note on the contact me page.