Empowering and Supporting Parents

I started working with children in 1986.  I always knew I would spend my life working with children, and have done so in a variety of fields.  I was a daycare and camp counsellor, a tutor, an umpire for little leagues, and a clinical researcher studying topics such as infant cognitive development and ADHD.   Those years were filled with significant learning experiences, and enabled me to really get to know children and their diversity, as well as their joys, passions, and boundless energy!   I am honored to be a pediatrician for over 23 years now, caring for children medically and holistically, sharing stories, empathizing  and supporting parents.  

In the old days, there just wasn’t as much pressure to do this parenting thing perfectly, but nowadays there are so many philosophies and models, that there is a tendency to feel like you are not doing a good job, or may not be doing things “right”.   

The most important thing you can do is give your child unconditional love.  They need undying support and smiles.  They need nutrition, warmth and hugs.  You are providing a base, a backbone, as well as a platform to jump from and explore the world and flourish.   So please never feel like you are not a good parent if you haven’t cracked the code of a newborn, or if there isn’t a set schedule of naps yet.  In the moment, these things feel like the most important thing in the world, and no one should minimize the stress of a crying baby who despite all your efforts won’t sleep.  But we need to keep it in perspective and rejoice if our kids are healthy, and gear up for the real stresses when they get older and venture into the world without us!  Some say, “Little kids, little problems, and big kids, big problems!”   Well, that doesn’t help at 2am when your little one is fussy and screaming – because in that moment it does feel like it’s the most stressful thing in the world.  And as someone who has worked with children of all ages for so long, and as a fellow parent, I would like to help you through all moments of stress.  I would like to help find “the answer” to the stress and solve the problem.  But of course, it isn’t always that easy.

I can tell you one thing about children for sure – they are each unique individuals.  And so are we!  Each parent has their own set of morals, values and ways they aim to parent.   Each one of us views subjects such as daily routines, nap schedules, discipline and nutrition differently.  So the dynamic between two different parents, each raised differently, and each with their own opinions, feelings, goals and aspirations can be quite complex.  Oh yes, and then we throw in their baby who is developing their own personality,  and playing their own card, and things can get quite intense and complex! 

I look at my role as a general pediatrician as encompassing a lot of areas.  As opposed to a neurosurgeon, who we would look to for one thing – just fix the problem – the pediatrician is indeed there for more than just the treatment of fever or illnesses.  But that is absolutely our main job, or priority – guarding, preserving and nurturing the medical and physical health of your child.  When it comes to things like fevers,  asthma, rashes, screening for developmental delays, monitoring growth charts, strep throats, accident prevention, and figuring out which set of clinical symptoms to worry about, versus  which will get better with time, I think the pediatrician may actually in a sense take the lead.   I always “shift gears” when I am worried about a child’s medical condition, and whether it’s doing a thorough physical exam, or medical testing such as blood tests, images, or arranging for consultations with specialists, I can assure you that you’ll see me truly “go to bat” for your child, and you won’t see me rest until things get better.  

When it comes to giving general parenting advice, on hot topics such as scheduling a baby’s routine, choosing when to travel, teething, starting solids, and the all-important questions of sleep, I have spent over 20 hours organizing my thoughts and writing everything I know and feel about these hot topics.  I create, fine-tune, manage and pay for that “bulletin board” – my website – as a method of communication.  It is me sharing all of my thoughts, instead of trying to give a quick summary or overview.  I aim to share everything I have researched, the true evidence-based scientific results of studies,  as well as sharing my experiences over these 32 years of working with children.  I detail my thoughts and go over options and approaches in more detail than may be plausible or practical during a typical pediatric well-child time slot.   I never want it to feel like we don’t have time to discuss these hot topics, but I have found that often these topics may take more than an hour to dissect all the medical research, what a parent has heard or read, and conflicting opinions or models.  Indeed, there are entire books over 100 pages written on nutrition and sleep in children!  I try to share my advice and perhaps nudge you in a certain direction, but I feel very strongly that each family needs to make their own decisions when it comes to many of these parenting topics. 

There are many reasons I try to empower and support parents to make these decisions.  First of all, despite what you hear from one or two friends, there is no right or wrong in many cases.  There is no one way to get your child to sleep, or one fail proof method to avoid a picky eater.  Each child is different, and each parent is different, and I really think no medical professional should tell a parent what to do a 2am in their own home.  I think we can all have inclinations of what we would like to do…but in that moment in the middle of the night, you have to do what you think is best, and not feel like a doctor told you that you were wrong if you decided to go to your baby and hold or feed them.   I think crossing those roads as a couple is a learning experience, and one that can take weeks or months to work through and find the best approach. Only you and your family can decide on these and many other important topics, such as what time is the second nap, or the third meal, and when to go to a daycare, or should we hire a specific nanny.  I wish there was a simple answer or one that was clearly best, but there are so many factors to consider.   

There are indeed times where there is a developmental, or even medical basis to my advice, but the truth is, many of these hot topics have a lot of flexibility to them, and I don’t want to overstep my boundaries and actually tell one family “how to do it”.   You see, every single 4 month old is so different.  Different in their stages of development, different in the amount of ounces or calories they may consume, in the hours of sleep they may get, and different in the parents that they have.  Websites and blogs will tell you when your child is going on a growth spurt, or how many ounces they need in a day – but this just isn’t necessarily true for any one child.   

My feelings are that parents and not pediatricians, should dictate their child’s ideal bed time, nap schedule  and exactly what to do at midnight, when a beautiful healthy baby is crying, and the question is should you go to your baby, or let them work it out, or even cry it out.   I offer guidance and my thoughts on nutrition, but there is no exact right or wrong in terms of when exactly to give the first solid food and whether it is avocado or cereal, and if cereal, which kind type of grain is the healthiest.  I give a lot of advice about how I view nutrition, but I feel strongly that as a medical doctor I should not take the power away from a parent to make those important decisions, as long as they are all safe options.

The moment that a scientific study makes something proven to help the health of a child, I promise I’ll “play my card” stronger.  But when it comes to these important, intense, even stressful parenting decisions, I’ll go the extra step and give you guidelines, on how I view teething, starting solids and sleep.  I’ll share my experience, my research, and my guidance.  But they are only my general thoughts, and they are not “the rules”.  They are based on evidence-based medicine, coupled with my plethora of face-to-face interactions.  It isn’t my two daughters I am basing my advice on – it is having over 100,000 child-doctor interactions or “visits” over these 23 years – and hearing from parents the trials and tribulations of different models, and what worked and what didn’t work.  

So please never feel as if I don’t want to hear more about the difficulties about establishing a good nap schedule, or about how a 4 month old fights their sleep or seems to regress.  I know about it, and I write a good amount of “parenting” advice on my website.  I share all my feelings, thoughts and some guidance. But I have to respect, empower, or shift the decision back to the parents I work with as I respect your decisions so much.  I have heard of practices that tell you exactly “how to do it” and enforce certain “rules” of sleep training or potty training.  And since that really doesn’t feel right to me as a person, I just won’t be that kind of a doctor.   I’ll always be there for my families, and you will see me switch gears and lead the charge 100% when there is something medical going on.  But I hope it’s ok that I’ll listen, and certainly empathize, but not always tell you how I would do something, or pretend to have the one correct approach or quick fix, when there is no true right or wrong answer.  


Please remember you are doing a great job, and giving your child an absolutely wonderful childhood.  

I respect your right to decide what is best for your child, and I respect the individuality of each child, and in turn each family.  

And I am honored to be part of that team!       

“Don’t listen to my Uncle Hugh! If I cry tonight, my parents better come! Look how cute I am!!!”

“Don’t listen to my Uncle Hugh! If I cry tonight, my parents better come! Look how cute I am!!!”

Potty Training

Potty Training 101

    I really think we should keep tabs on how many diapers we change!  When these guys are teenagers with attitude, we should just keep reminding them of just how much we did for them!  It is indeed a major celebration for every parent when we can convince these strong-minded toddlers that the coolest thing in the world is indeed to sit on that throne and say bye-bye to diapers.  

    I really believe that each child is so unique, and the truth is that in this particular endeavor, the parents feelings and attitude matter a lot as well.  There are so many new and groovy books that are written nowadays, and I don’t discourage you from reading them as some have really fun and novel ways of approaching this sometimes stressful process.  But after working with children for over 31 years, I hope to offer you some general pointers that just may help.

    I think parenting is a lot about choosing your battles.  And although I want you to scream when something is dangerous, and really make them brush their teeth, I just don’t think you can force them to poop on the potty.   So I would begin by saying that this process is almost 100% child-led.  This idea of a naked boot camp weekend, and by Monday Johnny is full potty trained just doesn’t work in most cases.  When Johnny was just about all ready, a stronger nudge might done the trick, but if children really don’t want to use the potty, they will often play their card, rebel, hold it in, and get constipated.  Constipation is actually a very common and sometimes chronic problem.  It becomes intensely behavioral, but it starts with a physical feeling that is annoying and painful, and then your little guy says, “I am just not going to go!”  And then things get worse.  

    So please always avoid or at least help with constipation, especially around these potty training months.  Keep it soft and flowing, and that at least will prevent an obstacle and give you the best chance to have your little one keep an open mind about the process.

    As it is really child-led, some people wait, and literally don’t even discuss the idea of the potty.  And that is ok!  I mean no pediatrician should tell a parent when to potty train.   I think each interaction is a delicate and unique balance, and I want both child and parent to go at their own pace.  But in most cases, the child around 15-18 months is actually becoming more aware of their bodily functions.  They may make certain faces after they go, or point to their diaper as if to tell you they just went.  Well, this may be called the first step!  I think potty training is like driving a stick shift car.  Your child is controlling the speed at which they will be willing to drive, and you are unfortunately often stuck in first gear for a long time!

    But if your child is showing signs they are willing to go into the next gears, then you should be ready to help them shift gears and allow the car to drive a bit faster!  When your child is first showing interest, or at least a willingness, you should get that first potty, and just make it oh so cool!

    You can decorate the potty with stickers, and perhaps save special activities that you do, whether it’s reading a book, playing a quick game, or telling a fun made-up story while they sit on the potty.  No actual result is needed, but you are celebrating their willingness to sit and befriend the potty.  Of course, the moment they resist or show a fear, just take a break.  Change something up, and try again.  I like the ideas of sticker charts, and reading books about potty training, or watching videos, but don’t use all of your tricks before they seem more ready.  Indeed it can take a full year before they are willing to feel the urge, hold it in, run to the potty and do their business!

    Many like to take the portable potties on the go, just to keep things consistent.  Try to keep it as light-hearted and without pressure.  You just don’t want them to rebel and develop an aversion to it.   You’ll see them go in spurts, where things seem like they are really getting closer, and then it will lag or slow down for a few weeks.  In many cases, it takes them seeing a buddy or cousin who can do it.  And all of a sudden they just decide they want to go for it!

It honestly runs the full gamut, where some kids are full trained at 2, but many are still not fully trained by 3.  

    In some cultures they find a way to read the child’s cues and faces so well, that the child can be trained closer to 9-12 months old!  But this is really the parent training themselves to read the baby, and doesn’t fully mean the child will go on their own when fully mobile.

There are of course the stubborn ones, and often these kids are the incredibly intelligent and super strong minded ones, who refuse to use the potty until 4, but this is not common.  

For most, number one is easier, and number two comes later.  Many will still wear a pull up at night for a full year more, or until around 4.  I aim for daytime control first, and really don’t push the night time - let that come naturally.  

    Sticker charts and even M&M’s are all fair game when it comes to convincing these guys.  I say don’t push, but a little nudge is fine.  You plant the seeds, water and nurture it gently, and it will grow I promise.  They won’t go to college in diapers! 

    So explore your feelings on it, as you count too!  And be sincere.  Don’t just follow one specific book or model - follow your heart.  This is just one of many stages where your child wants to feel your true support and encouragement, and not see your stress or feel like a failure.  So keep it light and fun and keep the faith!  It will happen…when they are ready.

Hey Gav...you doing poop on the potty yet?

Hey Gav...you doing poop on the potty yet?

Flu Vaccine

FLU VACCINE

All of the pediatricians here agree that the flu shot is very important and worth getting.  Influenza can be a severe infection, especially in young children, those with asthma or other medical conditions.   It is not just a cold – it is much worse, and can lead to hospitalization and severe complications.  Each year, children in the United States and abroad die from influenza infections, so even if the shot is not always effective, it is worth attempting to decrease the risk of this potentially dangerous disease.

The flu shot is safe and can’t cause the flu. It is completely inactive, and can’t make someone sick.  It can cause fever or localized muscle pain that night, but it has nothing to do with colds or getting sick weeks or months later.  It is specifically trying to prevent the influenza strains, but can’t lead to more or less “colds” from other cold viruses.   It is not 100% effective, but helps to prevent or lessen the effect of the flu in most cases.  

The nasal flu spray is not an option this year, unfortunately, as studies showed it was not be effective for the current circulating strains.  We won’t have any at all this year.  

Flu shot is safe and effective starting at 6 months old.

We recommend that all adults caring for a baby (family, nannies etc) get their flu vaccines.

 We give flu shots from September until May, but the earlier in the season, the better.  

If your check-up/physical exam is up to date, you can just call to schedule a shot-only visit with us.    

The first time you get a flu shot, you need a booster a month later, but then every future season, you only need one.  You need a new flu shot each winter!

Getting any shot or giving any medicine is not an easy decision.  But after seeing the effects of influenza on young children for over 21 years, I have learned to respect and fear the flu!  My daughters get it each year, and I think yours should as well!

 

flu pic.jpg

Summer Safety

I just love it when it gets warm here!  Flowers blooming, birds chirping and getting darker later! Unfortunately there are also some scary things that can happen to our little ones during spring and summer – so let’s go over a few pointers and guiding principles to keep your little ones safe and smiling. 

Sun

Maybe we have swung too far in sun avoidance.  Some experts actually want us to get a bit more natural sun, and Vitamin D levels can get pretty low even in kids.  Nonetheless, especially with the little ones, I think it’s best to aim to avoid most sun, and allow for the incidental sun.  Any time we know we are going to be outside, we should put sunscreen on all over a good 15 minutes before leaving the house.  Use a good kid’s brand, and not one with parabens.   An excellent source for looking at all the potential toxins in creams and sunscreens can be found at the environmental working group (ewg.org).  I really trust them, and they will list and rank all the brands out there.  You can’t go wrong with California Baby, Blue Lizard, Badger, and Babyganics, but there are a ton of excellent brands for kids.  Remember to reapply every 2-3 hours and sooner if they get wet. 

If you do get a sunburn, usually it will be mild, and you can use over the counter moisturizers such as vanicream, cerave for baby, or aquaphor, but if there is blistering and skin breakdown it is time to see the doctor. 

Bug bites

Summer in Brooklyn can be absolutely treacherous when it comes to mosquitos.  We try organic natural bug sprays, and these critters laugh at us.  It feels horrible when our little ones get bitten up, but almost always they will get better on their own, so in most cases there is no medical concern.  Any time you get a bite, it can swell, and some kids have a huge reaction to bites.  You can use Benadryl (check drgilgoff.com for proper doses according to their weight), liquid after-bite preparations, hydrocortisone 1% or calamine lotion for their comfort. 

Some bites cause actual infections – spreading redness and even pus – so see your doctor if any bite is getting worse and spreading.  Taking pictures can help show the progression, but it can be tricky!  Some bites are not infected, but are actually large, red, and tender – and those are actually the same signs of a cellulitis or abscess – types of skin infections.  So if you are worried, it’s best to come in for a same day visit to catch a potential infection early.

Zika virus is a work in progress in terms of our knowledge and recommendations, but as of 2017, we really don’t see much to worry about in terms of serious effects on a healthy child.  If you are pregnant it can be a different story, and there are updates every week or two in terms of prevention and testing, so check out the www.cdc.gov website for the latest info.  West Nile Virus is so scary, but is quite rare, and if your child has that illness they become very sick and weak, so see your doctor if you have concerns about that.  We do worry about our little ones so much – so I can’t tell you NOT to worry about these rare diseases with each mosquito bite.  In other countries they have malaria and other diseases to think about each day.  But luckily those are very very rare over here, and there is nothing you can do with each individual bite to prevent the mosquito from having West Nile or Zika or not, so it’s safe to just watch and wait and assume it isn’t anything serious. 

The organic child bug spray is the safest to use, but as kids get older ,and stop putting everything in their mouth, it is safe to try a low strength of DEET, especially if it is only on the clothes and not the skin.  Certain times or locations are also just asking for trouble – like at dusk on a humid day, or being near a body of water.  But it seems in Brooklyn you just can’t avoid getting attacked no matter where you go!

Not all that bites are mosquito bites – so remember to see your doctor if the bites are literally all over or spreading or don’t look like mosquito bites.  We continue to see patients with bed bugs, fleas and scabies, so come and see us for any rash that looks like it is spreading and getting worse.

Water Safety

This is an area where every parent is aware and cognizant of the risks, but I fear we don’t all take it serious enough.  The risk of drowning is so enormous with our little ones.  Even a bath could be a huge risk, but certainly a pool or large body of water is a set up for a disaster.  There are few summer scenes more enjoyable than hundreds of kids at the pool or beach, but please always take the proper precautions to ensure your child is 100% supervised, and this is even after they have aced all their swim lessons and have the independence of a teenager in their soul.  Children should never be unattended near any body of water.

Having your little newborn in your arms in a pool or ocean can be fun for a minute, but don’t let them ingest the water.  There have been some very scary stories about secondary drowning, but that is luckily extremely rare, and children get water in their mouth all the time.  If there was a significant ingestion of water, along with choking or the need for resuscitation, of course come see us immediately.   We usually say 6 months is a safe age for swimming classes. 

For some, the chemicals used can irritate the skin, or get those eyes red, but in general, there is nothing more fun for our kids than 8 hours in a pool!  So get out there, be safe and enjoy the summer!