The Intuitive Parent – PediaCast 337
- Dr. Stephen Camarata from Vanderbilt joins Dr Mike for a discussion on parental instinct and child development. We also cover chewing speed and the role it plays in weight gain, killing bacteria… with a virus, turtles & salmonella, and strategies for treating and preventing recurrent ear infections. We hope you can join us!
- Chewing Speed & Weight Gain
- Killing Bacteria with a Virus
- Turtles & Salmonella
- Parental Instinct & Child Development
- Treating and Preventing Recurrent Ear Infections (Otitis Media)
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It’s a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children’s Hospital. We’re in Columbus, Ohio.
It’s Episode 337 for January 20th, 2016. We’re calling this one “The Intuitive Parent”. I want to welcome everyone to the program.
So, lots to cover this week. The title of today’s show comes from our interview segment with Dr. Stephen Camarata. He’s a professor at Vanderbilt with the new parenting book that’s out there called The Intuitive Parent. It also comes with the subtitle, Why The Best Thing For Your Child Is You.
That’s an interesting parenting book because it’s evidence-based, which I like, but he makes the case for evidence, actually pointing us in the direction that Mother Nature knows a thing or two and that voice you hear in the back of your head, not the one that comes from doing more research on the Internet, but the one that just knows, that voice as a parent is often correct. And, there’s evidence to support that statement. We have innate knowledge built into us when it comes to parenting, and it has much to offer as we think about child development and raising our kids.
So that’s The Intuitive Parent in a very small nutshell. Like I said, it’s great book and there is much more to it. We’ll explore some of the nitty-gritty with the author, Dr. Stephen Camarata, in a little while. And that interview will be coming second in our line-up today.
First, though, we’ll be covering some news parents can use. We’re going to talk about how fast you and your children eat. So are you slow, take-your-time kind of eaters, or do you gobble down the meal in fast fashion? And more importantly, what difference does it make?
Well, it turns out how fast you chew and how long you wait between bites makes a very real difference in the amount of weight that you either gain or lose. So we’ll take a close look of that relationship between eating and chewing speed and weight gain and offer some practical suggestion on ways to change how fast your family eats. Very interesting story I think. One that’s as just helpful to parents as it is to children especially if you’re in a quest to lose a little bit of weight. So that’s coming up.
We’re also going to talk about an interesting way to kill bacteria using viruses. So this is pretty cool stuff and I think the science-y folks out there will really like this particular news story. Could a day be coming when we ditch the antibiotics and send a virus in to target and destroy bad bacteria while leaving the good ones alone? So we’ll consider that.
Then, speaking of bad bacteria, that study that we’re going to take a look at of bacteria-killing viruses that focuses on the treatment of salmonella. You’ve probably heard of salmonella. It’s an intestinal infection that causes bloody diarrhea. Maybe it’s come to visit your family at some point in the past. Definitely possible, and sort of likely you’ll be exposed to it or come into contact with salmonella at some point in the future, if you haven’t in the past.
But did you know that it’s more likely to pay you a visit if you have a small turtle in your home? So we’ll have a new story on turtles and salmonella a bit later on in the program.
And then, at the end of today’s show, for our final segment, after The Intuitive Parent interview, we’re going to cover chronic recurring otitis media, also known as middle ear infection. We’ve cover them before, but you know it’s that time of year and a listener asked a question. So we’re going to review the who, what, when, where, why and how of ear infections before we close out this week’s show.
Speaking of listener questions, if you have one, it’s really easy to get in touch with me, just head over to PediaCast.org and click on the Contact link.
Also, I want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child’s health, it’s important you call your doctor and arrange a face-to-face interview and hands-on physical examination. No practicing of medicine over apps or the Internet, not a good thing.
All right, let’s take a quick break and I will be back with news parents can use followed by our Intuitive Parent interview with Dr. Stephen Camarata and our listener question on recurrent infections. That’s all coming up, right after this.
Dr. Mike Patrick: Waiting 30 seconds in between bites of food allows children to realize they’re no longer hungry before they overeat, which can prevent excessive weight gain — so say researchers at the University of California, San Diego in last month’s edition of the journal, Pediatric Obesity.
Co-author of the article, Dr. Marcos Intaglietta, professor with the Department of Bioengineering at UC San Diego, says, “To lose weight, you need to stop eating. But it’s not that simple for most people. So we decided to investigate how effective eating slowly would be.”
The bioengineers worked in collaboration with physicians from the National University of Mexico. Dr. Ruy Perez-Tamayo, one of the investigators from the Laboratory of Research in Experimental Medicine in the School of Medicine at the National University of Mexico, says “Our method focuses on preventing weight gain. It’s simple, inexpensive and easy to follow.” And, it doesn’t require taking any medications or even exercising.
The study’s goal was to minimize the amount of food that children ate before their stomachs finally told their brains that they’re no longer hungry — the so-called “satiety reflex.” That signal usually takes about 15 minutes to kick in. But in modern society, researcher says whole meals can be consumed in much less time.
The study is the first clinically controlled trial to test how effective eating slowly is for detecting that feeling of satiety and losing weight. Investigators monitored the eating habits of 54 children, ages 6 to 17 years of age in the city of Durango, Mexico for a year. The students were compared to a control group with similar demographics. The students in this study group were then divided into two subgroups: those who ate slowly as instructed by the researchers — they were called the compliant group — and those who didn’t, called the non-compliant group.
Finally, the two groups were compared to the control group, and the results were striking. The weight of the students in the compliant group — so those who listened and chewed slowly — decreased anywhere from 2 to 5.7% after six months and 3.4% to 4.8% after one year. By contrast, the weight of the students in the non-compliant group — so those who didn’t follow the instructions and continued eating at their baseline speed — their weight actually increased by 4.4% to 5.8% after six months and 8.3% to 12.6% after a year. The weight of the control group also increased by 6.5% to 8.2% after one year.
Another of the study’s co-author, Dr. Geert Schmid-Schonbein, who is also a professor of bioengineering at the UC San Diego, says “The slow eating approach has the advantage of being sustainable over the long term, unlike most diets, because it doesn’t require you to change what you eat on a daily basis. It doesn’t deprive you of your favorite foods and it can be applied in any cultural and ethnic context.” He adds, “You can adopt this slow-eating approach for yourself and keep it up for the rest of your life. You can also teach this approach to your children and they can teach it to their children in turn.”
To avoid overeating, students were instructed to chew each bite for 30 seconds before taking the next bite. This give them time to realize that they were no longer hungry and stop eating. To make sure they waited the right amount of time, they all received small hourglasses that emptied in 30 seconds. Researchers instructed them to take a bite, flip the hourglass and not take another bite until after the hourglass ran empty.
Researchers also instructed the students to drink a glass of water before each meal and avoid snacks in between meals. The approach was called “Good Manners for a Healthy Future.”
Dr. Pedro Cabrales, co-author and bioengineering professor at UC San Diego says, “The hourglass made it more like a game. We also noticed that children kept each other accountable. If some forgot the hourglasses, the others would remind them.”
The results were so promising that the Mexican states of Michoacan, Yucatan and Veracruz — all those states — have invited researchers to bring the study’s methods into their schools. Researchers would like to conduct further studies with a larger sample size both in Mexico and in Southern California, targeting the region’s large Hispanic population.
Finally, the researchers caution that their approach is untested in adults.
So the only group to lose weight in the study was the group that followed the instructions of waiting at least 30 seconds between bites of food. All the other groups gained weight, and in some cases, as much as 12% weight gain after a year. All we’re talking about doing is swallowing down our eating and taking 30 seconds between bites as measured by a 30-second hourglass.
Now, I know researchers want a larger sample size and they seem to be saying, “Adults, this may or may not work for you.” But come on, what’s the risk, really, if you and your children are having some trouble shedding pounds and that’s being advised to something you should do? Then, it sure make sense and certainly easy enough to give this a try.
And I suspect you won’t need the hourglass forever. Once you get accustomed to the new pace, it might just stick, although that’s a study for another day. But hey, if you see the pounds coming back, get the hourglass back up on the table and use it again.
So again, the bottom line here is slow down your eating, 30 seconds between bites, pay attention to your body. Stop eating when you feel full. Pretty easy, really. And they also had the kids drink a glass of water before they started eating. It’s something you can start doing tonight if losing weight is what the doctor ordered.
My wife and I, so we’re middle-aged and pre-diabetic, which was picked up by our health insurance. That was great. You go for the biometric screening, so you can get your discount on your insurance. And they look at the numbers and they say, “You know, you’re at risk for developing Type 2 diabetes, so why don’t you go to a pre-diabetes class?”
So we did, and that class really focused on tracking fat calories. So for my size, it was keep it to no more than 42 fat calories per day on average. My wife and I have both lost about 20 pounds in four months just paying attention to our fat intake. No, lens speed record there, but definitely a steady decline to bring our BMI into a healthy zone.
We try to be more active, which worked out better on some days, but not all of them, especially as it gets colder outside and daylight shortens and work seems to get busier during the winter months. You know, the usual excuses.
But this, I think, is another tool in the weight loss or weight management tool box. In addition to watching fat calories, I should also be watching how fast I’m eating. I think that’s going to be good advice. I’m eager to give this a try.
So watch what you eat, watch the fat, try to be active. Get your heart rate elevated 30 minutes per day. Slow down your eating with at least 30 seconds of chewing between bites and paying attention when you’re full. Stop eating when you get full.
I think I’ll give it a try even though the technique is untested in adults. As the researchers put it, I’ll just be my own little n = 1.
Viruses that seek and destroy the bacteria that causes food poisoning are being investigated by researchers at the University of Nottingham in the United Kingdom. The work which is funded by The Bill and Melinda Gates Foundation could offer the potential for treating and preventing intestinal illnesses in children in developing countries including those caused by Salmonella, Campylobacter and E. coli.
They hope the viruses, known as bacteriophages — the word meaning “bacteria-eaters” — and which only affect their target bacteria, could offer a viable alternative to antibiotics and a potential new approach for the developing world where the illnesses can often be fatal.
Dr. Paul Barrow, research lead and a professor in the University of Nottingham School of Veterinary Medicine and Science, says, “In developing countries, there is a huge amount of enteric or intestinal illness. There is some evidence to suggest that gut flora — the bacteria that live in the gut — in childhood can offer protection against pathogens in later life, and that it is tied up with the immunity of the host, their diet and other environmental factors.”
The research is also supported by the Grand Challenges Explorations initiative, which funds individuals worldwide to explore ideas that break the mold in how we solve persistent global health challenges.
So here’s what the researchers are doing. They’re studying the effect of bacteriophages — so viruses that destroy bacteria — in pigs, which as it turns out are an excellent model for intestinal infections in humans because of the similarity in their gut bacteria and the way in which their immune systems work.
They use the bacteriophages to target Salmonella and other disease-causing bacteria in the pig intestine without disrupting normal gut bacteria, thereby eliminating the infection, allowing normal gut bacteria to flourish in the absence of the harmful bacteria and then see if improvements in immunity and general health take shape.
It’s all a tall order to be sure but if they can prove the bacteriophages are effective in killing and preventing the growth of harmful microorganisms in the pig gut, then this could be translated into a new method for improving intestinal health in children and newborn infants in the developing world.
Given the potential protective effects of good gut bacteria and immunity, this could also improve health during the child’s adult life.
Professor Barrow and colleagues are working closely with collaborators from the Universities of Liverpool, Washington and Florence who have expertise in gut flora in the developing world and are currently carrying out field research in West Africa and Southeast Africa.
So interesting story with lots of application in the future. For instance, when we talk about super bugs, once which are resistant to many antibiotics, what if we counter the super bugs with super viruses, ones which could seek out and destroy the harmful drug resistant bacteria.
You’ve heard about antibiotics killing good bacteria along with the bad. What if we had viruses that could target the bad bacteria and leave the good ones alone? Of course, this raises the question, could the target bacteria adapt to resist the bacteriophages and what effect do those changes have on the way harmful bacteria interact with their host, which is you and me? That might be important to know.
All of this will probably involve a little genetic tinkering of the viruses and it will give some folks another reason to fear science. But just between you and me, I think this is really cool groundbreaking stuff and something that we’ll be hearing more about in the years to come.
We mentioned salmonella in our last news story. You’ve probably heard of salmonella. It’s a bacteria consumed in contaminated food. It causes bloody diarrhea, abdominal discomfort and sometimes fever, sepsis and even death. Researchers at the University of Nottingham are working on a bacteriophage that targets and kill salmonella. We just talked about that.
But did you know this? Salmonella is the reason that sales of small turtles were banned in the United States 40 years ago after researchers determined the popular pet’s cause an estimated 280, 000 salmonella infections each year, mostly in children. After the ban, salmonella rates declined and eventually the sale of small turtles resumed.
But could the ban be back on the table? A new Centers for Disease Control and Prevention analysis published in the January 2016 issue of The Journal of Pediatrics found that while the ban, which took place in the 1970s on turtles less than four inches in length, while that ban helped reduce pediatric turtle-associated salmonella illness, today the public is largely unaware that turtles often carry salmonella and outbreaks continue to occur.
The analysis entitled Outbreak of Salmonellosis from small turtles identifies eight multi-state outbreaks between 2011 and 2013, which resulted in 473 illnesses from 41 states in US territories, and pockets of outbreaks continue today. As was the case in the 1970, most illnesses occur among young children who are more likely to touch their mouths while playing with the turtles and increase exposure to the potentially deadly bacteria.
Now, there’s no loud call for another ban of small turtle sales at least for now, but parents are urged to closely supervise their children with playing with small turtles. Make sure your kids keep their hands away from their face and mouth after or while they’re playing with the turtle. And it’s important to sanitize those little hands with soap and water or an alcohol-based gel after the turtle returns to his or her habitat.
Parents should also be alert for signs of salmonella infection which may include malaise, abdominal discomfort, diarrhea, blood in the stool, sometimes vomiting and sometimes fever. If any of these symptoms occur, especially if your child has been playing with a small turtle, then he or she might be infected with salmonella and you want to let your child’s doctor know right away.
Now, here’s the good news. Most salmonella cases resolve on their own without the need for an antibiotic. In fact, in many cases, the symptoms are going away about the time the salmonella test comes back positive. In this cases, treating with an antibiotic may increase asymptomatic stool shedding of the bacteria. Meaning, the bacteria is still there in the stool and able to infect others but symptoms had become very mild or non-existent. So your seemingly well child returns to school, shares his micro-organisms and an outbreak is born. It happens and antibiotics may play a role.
On the other hand, if your child is very ill, has a fever or persistent bloody diarrhea that’s not going away, then an antibiotic and stool monitoring — so you know for sure when the infection has cleared — are a good idea. We aren’t able to treat with a bacteriophage yet, but someday who knows? Stay tune to PediaCast and we’ll try to be the first to let you know when that novel treatment is available.
In the meantime, if you’d like to know more about turtle associated salmonellosis, you can read the report for yourself. I’ll include a link to it in the Show Notes for Episode 337 over at PediaCast.org.
Dr. Mike Patrick: Dr. Stephen Camarata is a child development expert at Vanderbilt University. He serves as professor of psychiatry in Vanderbilt School of Medicine, also a professor of Hearing and Speech Sciences, and an associate professor of special education at Vanderbilt’s Peabody College. But higher education isn’t his only source of parenting knowledge.
Dr. Camarata also lives in the trenches, raising seven children at home. He calls upon his academic knowledge and his street-smarts in his new book for parents, which is called The Intuitive Parent: Why The Best Thing For Your Child Is You?
That’s what we’re talking about today, being an intuitive parent. So let’s give a warm PediaCast welcome to Dr. Stephen Camarate. Thanks for joining us from Nashville today.
Dr. Stephen Camarata: Thank you very much. I appreciate you having me.
Dr. Mike Patrick: Yeah, appreciate you stopping by. Let’s just start with what is meant by the term intuitive parent?
Dr. Stephen Camarata: What that means is that parents have a certain common sense and intuition and instinct on how to respond to their children. And this is actually very important to a child’s development. So, if a parent pays attention to their child, the child will elicit the property teaching responses from the parent. It’s a very natural, very positive process.
And so an intuitive parent is simply someone who pays attention to her child and trusts her common sense and her inner parenting voice to interact with their child. And that does lots of really good things in terms of helping their child develop.
Dr. Mike Patrick: Just like in other animals, we kind of have this innate knowledge of how we should best raise our kids, kind of Mother Nature instruction manual, if you will.
Dr. Stephen Camarata: It is. That’s exactly what it is. So, in other words, the child development specialist, I have a PhD. I have post-doc. I have all these knowledge about how children learn. Most parents don’t come to the table with all that kind of knowledge. So how does it work? How does Mother Nature guarantee that our children develop in very positive ways? So there is an intuitive instructional manual where parents just sit back and access that using their common sense.
Dr. Mike Patrick: Well, tell us a little bit about the book, what parents can expect from it and how is it different from other parenting books that are out there?
Dr. Stephen Camarata: Yeah, the book includes a lot of practical advice and a lot of stories from the trenches, as you said, from raising my wonderful seven children. But, it also includes arguments that are sourced. It’s not technical manual by any structure or scientific book from that standpoint. But it does have science in it because what I realized is that people are using or misusing science to kind of argue for parenting strategies that aren’t really good for the children. So I felt like I had to meet science with science. That’s probably something a little different from other parenting books.
The other thing that’s really different about this book is it does not in any way shape or form say that one size fits all. In other words, there’s free-range parenting. There’s helicopter parenting. There’s tiger mother. There’s all these one-size-fits-all kinds of things out there.
That’s not how it works at all. Any parent that has more than one child knows there is no one size fits all. And that’s why intuitive parenting is so important because it allows you to meet your child where they are, in terms of their temperament, in terms of their needs, in terms of how they respond and so on. And so, it’s an approach, but it’s not a one-size-fits-all way of parenting.
Dr. Mike Patrick: I like how the book covers so many different aspects of parenting in the child-parent relationship. It goes beyond just child development and developmental milestones but also talks about learning, confidence, resilience and persistence which we’ll talk more about in a few minutes. Just behavior and helping your kids sort of shape appropriate behavior and steer them away from inappropriate behavior and consequences that relate to that, education in the schools, ADHD, autism, learning disability. So it’s really a good broad coverage of parenting.
Dr. Stephen Camarata: Well, thank you. I think all of those things are on parents’ minds today. Again, I also want to make sure that the common sense approach which just seems so simplistic actually really has a lot of benefits, and I want to make sure that parents were aware of those.
Dr. Mike Patrick: And I suspect one of the reasons that you wrote Intuitive Parent is just a lot of the bad information that’s out there — pseudoscience claims and facts, the vaccine-autism scare, for instance, and Baby Einstein. Speak a little bit to those things.
Dr. Stephen Camarata: Yeah, it’s certainly true that there’s a lot of misinformation out there. Part of it is just kind of a misunderstanding of what modern brain science tells us. And, part of it really is marketing forces. If people who are trying to sell parents product can make parents anxious or make them worry about their own abilities, then there’s an opportunity for them to sell something to the parent that ends up maybe actually undermining the child’s development rather than enhancing it.
Dr. Mike Patrick: Because at the end of the day, parents have their kids’ best interest in mind, the reason that they look after these things and search the Internet and read it and pay attention to it is because they really love and care about their kids.
Dr. Stephen Camarata: Yeah, and everybody wants to be the very best parent they can be. If there’s some information there, they want to take advantage of it. That’s certainly true and that’s one of the reasons I wrote the book. I wanted to have this information in that same arena, so that they can say, “My intuition or my common sense tells me to do this. This other website says, No, that’s wrong. Oh, here’s this book that’s really science-based that says yeah, my common sense is right.”
Dr. Mike Patrick: That’s a great tool for them to have and gives them a lot of reassurance. You talked about there still being some science kind of the foundation of this book. What kind of brain science do you cover?
Dr. Stephen Camarata: Yeah, so basically I look at some of the forces that are undermining parenting, intuitive parenting, and really harming children. A lot of that was based on the misunderstanding of science. So one of the things I talk about for example is a critical period. Many parents I talk to believe that they have to have all these learning and wiring done, brain wiring done by the time a child is three. And that’s a complete misunderstanding of the notion of a critical period.
What the critical period literature says is that the child has to have some input in the senses in order for those areas of the brain to be activated, and that should happen on the first three years of life. True enough, but you don’t have to wire reading, or wire language or anything like that by then. It’s not that specific, it’s general exposure.
So there’s a finding there about if, for example, a deaf child — a child who doesn’t hear — the auditory centers of the brain then become dedicated to vision because we don’t want to waste our brain cells. They’re useful kinds of things. But that doesn’t mean that we have to play magic classical music tapes or magic speech processing tapes to activate neural plasticity and harness that critical period. That’s just a misunderstanding of it.
So there’s no rush. The critical period notion was misunderstood and it cause a lot of anxiety in parents thinking that they had to really wire their child’s brain by the time they were three. One popular article said that there’s a metaphor for like windows slamming shut if the parents don’t get the information in by a certain time, and that window closes and then their child will be doomed to a less than optimal brain, which is just a complete misrepresentation.
Dr. Mike Patrick: You talked a little bit about neural pathways and neurotransmitters and brain plasticity but still in terms parents can understand.
Dr. Stephen Camarata: Yeah, I hope to. In other words, I did try to make it accessible to parents. As I said, I do source it. I do use primary sources, but it’s not a technical manual by any stretch or a graduate course on neural plasticity. It’s really kind of the concept of what neural plasticity is. And that’s another aspect that’s kind of misunderstood.
Neural plasticity simply means that the brain is learning. And so, if a brain learns a new word because a mother is sitting with her child on a rocking chair and reading them a book, that’s just as much real plasticity if you plug them in front of Baby Einstein video or Your Baby Can Read video. In other words, neural plasticity isn’t limited to computer types of learning. It’s any kind of learning.
Dr. Mike Patrick: What about developmental milestones? Pediatricians and parents alike really focus on our kids meeting certain developmental milestones at certain ages and times. Do you still think those are important?
They are in terms of understanding whether a child is falling grossly below expected level. So one of the examples I talk about in the books is walking. There’s a quite a bit of variability when a child learns to walk, and normal range is anywhere from 9 to 18 months. And a child can go up to a little bit further than that. But if they don’t walk after that, then there might be a concern that there’s some motor challenges that the child might have. And we might have to intervene and help him or her how to walk.
Well, the thing is that the average, the mean age, the specific average is 12 months. And so, if parents are watching their child like a hawk and say “OK, if they don’t take their first step by the time they’re 12months old, I’m going to have to get special shoes or put him on a treadmill,” or whatever it is they’re going to do to intervene. Lots of misunderstanding of the developmental milestones.
So developmental milestones are growth indicators. They’re useful for medical innovation and medical intervention. Certainly pediatrician should use them and developmental specialist should use them, but they’re not an exact timeline. There’s also variability. Walking and talking will happen in around 12 months of age. But a child may walk early, talk later. It’s not necessarily that everything happens in lock and step, and there’s a lot of individual variability.
Dr. Mike Patrick: And the season pediatrician is going to know that and look at the big picture, and that’s why you really want to get someone’s opinion, who’s seeing your kids and knows your family and can examine your child, and not just getting the information off the Internet.
Dr. Stephen Camarata: That’s absolutely right. That’s absolutely crucial. In other words, a family wants to develop a relationship with their pediatrician and keep them informed on development, because the pediatrician is trained across all these domains and they can put it in perspective. Absolutely, yeah.
Dr. Mike Patrick: Are there things that parent can do to enhance their child’s intelligence? The very best thing that the parents can do is actually respond to their child in an intuitive way, and to actually let them problem solve and to let them try and fail and then learn from their failures.
So if we think about intelligence, there’s many different aspects of it. Some aspect of it are memorization, but the essence of intelligence is the ability to take known information and apply it to new situations. We call this good reasoning, the ability to problem-solve. That’s the essence of intelligence. That develops if the parents kind of step back and interact with their child and encourage them to try new things. And then, when the child ask for information, they give that information.
Currently, there’s a movement to try to treat to children like mini-flash drive or many hard drive by downloading information to their brain. And that will increase their memorization, but it actually comes with the cost of reducing their ability to problem-solve. So we don’t want to do that.
Dr. Mike Patrick: What is the concept of life-long learning and why is that important?
Dr. Stephen Camarata: The most wonderful thing about children is they come to the world with natural curiosity and an amazing capacity to learn. And what happens all too often is that because of memorization techniques and some of the teaching techniques that make it uninteresting and boring, they kind of lose that curiosity and interest. So life-long learning means that the individual continuous to have that wonder and that thirst for knowledge that’s insatiable.
Everybody has the potential to do that, because it is a part of the human condition, but it needs to be nurtured. Again, intuitive parenting really helps with that.
Dr. Mike Patrick: Kids are naturally curious and ask questions, and sometimes that can get annoying for parents. You have a tendency, you just want to shut them down. But really, it’s important to feed into that curiosity.
Dr. Stephen Camarata: It is. What’s rewarding to children is, of course, attention and information. So when they ask questions, it is important to give them the answers the best you can. However, you know, as a parent of seven children, who are asking me questions all the time, it’s perfectly fine to say “OK, I’m going to answer your questions in a few minutes.” If there’s something you’re doing, it’s OK to put off the answer. You do want to try to attend to them and respond to them as best as you can.
But also, one of the little things you want to do, you want your child to find the information for themselves. So, I’m not anti-technology by any stretch. Certainly, we want to limit exposure to technology when the children are really little and their brain architecture is being wired in a foundational way. But after that, learning how to access information, learning how to get information from different sources, this is a good thing.
I know when I was growing up, I love the encyclopedia. I would go and read it to find information. I just love it now that we can get that information so much easier. So that’s fantastic.
Dr. Mike Patrick: Yeah, absolutely.
I’ve seen some studies that show that concepts and things like resilience and persistence and confidence are actually more important than IQ in terms of later success in life. Talk about those things.
Dr. Stephen Camarata: Yeah, if you think about that, the essence of it is when there’s a setback, when things don’t go quite as you plan, what’s the response? Does the child sulk and quit? Or do they keep trying? So confidence is the by-product of overcoming challenges. That’s why I said earlier, it’s important for the child, even a young child try and fail, and encourage them to keep trying and praise their effort to keep trying. Because when a child overcomes an obstacle, this instills self-confidence and give them that notion that when they encounter something they haven’t seen before, not to panic but to persist and to keep trying and that they’re capable. They’re capable of overcoming these kinds of things.
One of the real challenges that I talked a little about in the book is that this notion that if children are praised constantly, it undermines their self-esteem. Actually, praising them constantly in a non-specific way actually does undermine their self-esteem because “Oh, you’re awesome,” what does that mean? How do I maintain my awesomeness? That kind of feedback really actually isn’t healthy for the child.
Dr. Mike Patrick: So you really want the whole range of experiences, successes and pat him on the back, but also the failures and the encouragement to bounce back are just as important.
Dr. Stephen Camarata: It is. And then, also giving him authentic input. Now, in the example in the book, one of my younger children told an older brother in the basketball game that he stunk. He was not a good basketball player. So maybe that’s a little too authentic. We don’t want that.
But if the child gets the wrong answer or the child does something that’s not successful, it’s fine to say, try again. Try another way. The brain knows whether it was right or not. If you’re telling him right, and when the brain knows it’s wrong, that’s really not a good situation.
Dr. Mike Patrick: I think from a parent standpoint, you want your kids to succeed and be the best that they can be. Sometimes, we stir them toward things they’re good at and away from things that they’re not so good at, but without paying attention, is the child having fun doing it?
Dr. Stephen Camarata: Yeah, fun is important. We also want to have kids that really experience different things. We also want children to take on things that they’re not necessarily good at. So, it’s not always they’re cherry-picking activities. So it’s kind of a balance.
We always are going to gravitate to things we’re good at, and that’s certainly true in the professional arena. People are going to be engineers if they have good visual, spatial, visual, math schools. They might be teachers if they’re good communicators, and that kind of thing. But ultimately, all of us want to be well-rounded in some sense.
So it’s important for parents to nurture and help their child excel in whatever they’re good at, but also don’t pressure them to try things that don’t come quite as easily.
Dr. Mike Patrick: What about behavior? When kids have problem behaviors, then they’re dealing with the consequences of those behaviors, how can intuitive parenting help moms and dads in that arena?
Dr. Stephen Camarata: Yes, I actually had quite a bit of information on that. It’s actually really important and that’s that parents need to watch their children and see what the impact is of their responses to the child’s unwanted behavior and the responses to the desired behavior.
So an example I used in the book is I had one son, when I put him in time out, he actually enjoyed time out. He would draw. He would sing. It actually increased the unwanted behavior. Now, a daughter, I point her in time out and she melted and it really got control of the behavior.
So the point is that, a parent might have a belief about what the consequence is doing but you have to actually pay attention to whether it’s actually having the impact that you think it does.
The two real important principles are a behavior has to be consistent and contingent. What I mean by that is that when the child does an unwanted behavior, every time a parent has to respond with the consequence that they had in mind, a contingent means that it has to happen right away. In other words, if a child hits her little brother, then you go at the end of the day and say, “Well, you shouldn’t hit your little brother.” You really need to actually respond to that right away. It needs to happen in real time after the event.
If you can’t be consistent, then don’t take on that behavior until you’re ready to be consistent. And if you can’t be contingent, the behavior will happen again in the future and then you can be a contingent at that point and do it right away. Otherwise it’s very confusing. The child isn’t necessarily going to understand or the behavior isn’t going to be tied to the consequence in a way that it has is power in terms of changing the child’s behavior. So it’s really important that parents step back and pay attention.
Again, there’s no one-size-fits-all consequence. Some children are really stubborn and hard-headed. He obviously take after my wife and not after me. I’m being humorous here, of course. I’m quite hard-headed. And other children, they’re relatively shy and actually very minimal discipline is needed with them and everything in between. So parents really have to tune in to their child individually.
Dr. Mike Patrick: I think when parents read things on the Internet about this is the way that you should discipline your kids or this is appropriate behavior, not appropriate, it really is sort of a one-size-fits-all thing. A parent may be sitting back and thinking, “Well, this doesn’t describe my kid or my situation.” And that’s the voice you really ought to be paying attention to.
Dr. Stephen Camarata: Absolutely, that’s exactly right. For some children, talking a little with them is effective. Other children, there need to be a time out or some tangible response. And it just varies. It’s like you said, there’s not a one-size-fits-all. Again, I have seven children. Some forms of discipline works with some and not with others and that’s an inherent part of parenting.
Dr. Mike Patrick: Talk a little bit about the educational system. I think that a lot of parents have some intuition about the way that things go at school. Whether there’s too much homework, and your kids are involved or not involved enough. How can parents use their intuition to affect the school system?
Dr. Stephen Camarata: Yeah, OK, so a couple of pieces to that. First and foremost is that on average, schools are really trying to accelerate development in a way that doesn’t make any sense and they’re setting the children up for failures and really to appear that they have ADHD or some other problem when really they don’t.
If I take a child who’s advance in some ways, and I make him do something that’s too easy, he’s going to be bored. He’s going to be wiggly. On the other hand, if I try to teach him Calculus when they’re in first grade unless they’re a very remarkable child, I might be able to teach him to memorize and recognize things like an integral sign or whatever it is, but they won’t understand what it is.
So, parents have to really try to pay attention to what their child is actually learning and if they’re successful with it. And then, with the homework, homework has gone beyond the reasonable limits in terms of how much is done. One of the studies I cite in the book found that 75% of the homework is being done by parents. The kids aren’t even doing the homework because they are assigning so much, and it’s so out of whack with the child’s skill level that it doesn’t make any sense.
What I do with mine, and I’m not sure everybody is capable of doing this, but I actually told the teacher, when the homework comes home, I’m going to sit with the child. What they can do, I’m going to have him do. Everything else, I’m going to do. I’m going to sign my name to it. I’m like what every parent does, 75% of the homework, but at least, I’m being honest with it. You can put it in your little book that it was turned in, but there’s not going to be a misrepresentation about who did it.
There really need to be a national conversation about what we’re doing with education. So their problem is, you know, with the common core, it’s fine to have competencies that you want to teach. That’s a good thing. There should be content that’s being taught. But then to get down and micromanage it in the way do. Also, the other thing too is let’s say a child doesn’t meet the criteria, say in first grade for the common core, they just go ahead and pass them along anyway.
I mean, the whole thing is just completely out of whack. So parents have to really pay attention and really drill down and say “OK, I want my child to be able to read with comprehension. I want them to understand what they read. I want them to be able to have decent math skills, and I want them to have a knowledge of the world around them, as is scientific principles.” And pay attention to that, and really have home activities and things like that nurture that kind of thing because the schools, the teachers are phenomenal. They do the very best they can, but right now, our nation is trying to figure out how to improve the teaching product because it’s not working well for many children.
Dr. Mike Patrick: You talked about this more in the book, and you kind of mentioned it peripherally. But sometimes, kids get labelled with ADHD or learning disabilities, when really the issue is the school and not the child.
Dr. Stephen Camarata: Yes, right. So, the challenge here, there is such a thing as ADHD to be sure, both kinds, inattention and… Well, three kinds, inattention and hyperactivity and then that wonderful mix when they’re both wiggly and can’t pay attention. But a lot of that can be created by a school system that’s trying to present the children with information that’s above or below the child’s skill level and/or in a modality they don’t do very well.
So some of my clinical work is with children for example who have trouble understanding what’s being said to them. So a lot of education is what I call Sit Still and Listen. So a child who learns by doing, a child who is more of an experimentalist kind of thing, sitting still and listening is not their strong suit. They can learn the information but they need to be more interactive and hands-on with it. And that kind of a child is really a high risk to then be sent to the pediatrician or to the child psychiatrist with the idea of finding ADHD. So, we want to step back and think about that.
Finland, which has higher achievement than we do, they only have one in 1,000 children on average that’s medicated for ADHD. Here in America, it’s pushing one in ten, or even more one in eight in some studies. So, it doesn’t make sense that we have that much more ADHD than Finland. And in fact, their achievement’s higher than ours. Also, in France, it’s much higher as well.
Those our two countries that I looked at. It’s true really all over. The amount of ADHDs that we have in this country just doesn’t make any sense whatsoever. It’s probably being created by the school.
Dr. Mike Patrick: Well, this book definitely covers lots of grounds. I think parents will really get a lot out of it, in terms of development and learning behavior, the schools, ADHD, all of these things. Where can parents find the book?
Dr. Stephen Camarata: It’s available from Amazon. Of course, and then it’s also on the shelves of Barnes and Noble. It’s kind of fun. I go to Barnes & Noble and I go look and there it is.
Dr. Stephen Camarata: I take pictures with my cell phone and text it to my children. You can get it here, children, if you need any help. So, some of my children have children of their own now. It’s wonderful being a grandparents. Actually, that was one of the things that prompted me to write the book, because they’d ask me questions about the software and educational programs. And they listen, too.
And I guess this might be kind of my last word, which is one of the things that really tears my heart out in a very profound way, is that I cannot think of anything better in my life than raising my children. It’s been the most rewarding, profoundly joyful experience.
And now, with all the pressures and all the undermining of natural, intuitive parenting, it’s really stressful, and parents are losing out on all these wonderful moments with their children. Instead of playing with their child, helping them build blocks, cuddling up with them in a rocking chair and reading a favorite story, they’re parking them in front of the screen. The child’s sitting there and that social connection and emotional connection is being undermined.
I really wanted to let parents know that you’re not getting an advantage by doing that. I really wanted to return this wonderful amazing experience that parenting is, that it’s kind of being lost, and I worry about that.
Dr. Mike Patrick: Absolutely. Well, the book is The Intuitive Parent: Why The Best Thing For Your Child Is You? Our guest is Dr. Stephen Camarata. We really do appreciate you stopping by. We’ll put a link to the book on Amazon in the Show Notes for PediaCast Episode 337 over at PediaCast.org.
Thanks for stopping by.
Dr. Stephen Camarata: Thank you so much. I really appreciate it. Thanks for spending your time with me today.
Dr. Mike Patrick: We have a listener question today. It comes from Shannon in McKinney, Texas. Shannon says, “Hi, Dr. Mike. My now five-year-old daughter has been having chronic ear infections for the last several months. She had two ear infections between the ages of eight months and four years, then since age four and a half, she’s had about seven of them. Especially for the last few months, they’ve been running every two to three months.
“They always clear up with amoxicillin and other than some mild discomfort and sleep disruption, they don’t cause any other problems. Her hearing was fine at age four. We haven’t tested it since because we’ve been waiting for her to go two months ear infection free and that has not happened. Her speech development is 100% fine.
“This had all been run-of-the mill middle ear infections, except for the most recent which our doctor described is a blister in the ear but still caused by the same bacteria or virus as her other ear infections. They’ve been mostly in the left ear but sometimes in both. She’s had her share of very mild colds but otherwise has been healthy.
“These ear infections did roughly coincide with our move from California to Texas, so I thought maybe it was just exposure to the new bugs but we’ve been here for ten months now and they still keep recurring. My main question is if it’s Ok for her to keep taking amoxicillin on a semi-regular basis, and if there are any other things we should be concerned about? Our doctor is fabulous and doesn’t seem concerned. I just look forward to hearing your thoughts. Thank you.”
Well, thanks for the question, Shannon. Boy, that does sound really frustrating. As background, let’s review the most common way ear infections get going because when you’re dealing with chronic recurrent ear infections, it’s sort of nice to know why it’s happening. So you can give some thought as to how to arrest the process at the cause if you can rather than chasing the infection after it started.
So let’s start with a little anatomy. If we travel through the ear from the outside in, you’re going to come across the ear canal, then the eardrum, also known as the tympanic membrane, and then the middle ear space, which is made up of three little bones that transfer sound energy to the inner ear, which will then take it to the brain. Then, also, in the middle ear space, there is Eustachian tube which is a little tube, a hollow tube that connects the middle ear space to the nasal pharynx where the back of the nose and the back of the throat meet up with one another. So you can go from the outside of the ear to the ear drum into the middle ear to the Eustachian tube and then into the back of the nose and throat.
Now, under normal circumstances, bacteria from the nasal pharynx can go up Eustachian tube. Now, cilia cells — so these are cells that line the Eustachian tube and they have little hair-like projections on them — their job is to push things back down to the mouth. Now, despite that, a few bacteria make it up into the middle ear space, and that’s fine as long as they can come and go from the mouth to the middle ear and back again.
Now, anything that alters that setup can result in bacteria getting trapped in the middle ear space. So just that mouth and nose bacteria that everybody has, can’t really get rid of those effectively. But they can go up the Eustachian tube and if they get stuck there in the middle ear space and can’t get back down, they reproduce there. They overwhelm that small space. The body recognizes this and sends in white blood cells to kill them and you get inflammation and pus as a result, along with fever and malaise and presto, you have an ear infection.
So what sort of things lead to mouth bacteria getting trapped in the middle ear space? Well, first you got to consider Eustachian tube anatomy. So if the Eustachian tube just naturally is long and narrow versus white and short, then it’s going to be easier for bacteria to get trapped up there if it’s a longer route.
Now, it’s also less likely that they’ll get up there in the first place if it’s long and narrow. But, if they do get up there, it’s even more difficult for them to get back. And this is one reason that babies get ear infections easily and outgrow them as they get older because when they’re babies, they tend to have long narrow Eustachian tubes. And, as you get older and grow, they become more wide and short.
So the anatomy changes which it’s more conducive to ear infections in little babies, and then as your face gets bigger and grows, the anatomy changes in such a way that it’s a little bit less likely to get ear infections.
Now, another thing that can affect all of this is the cilia functioning in that Eustachian tubes — so those little hair-like projections that typically brush bacteria back down to the mouth. Viruses infect those cells, so when you get a cold virus, the virus infects the cells and then the cilia doesn’t work as well. So now, it is easier for bacteria to get up the Eustachian tube and go to the middle ear. So that’s one of the reasons why kids get the cold first and then they get the ear infection.
We also have to consider mucous production. So mucous, that goes along with the cold virus as well and with allergies too, that can clog the Eustachian tube. And then, we have to consider, kind of go back to anatomy a little bit because those long narrow tubes versus the short white tube, you also can have a flappy versus a stiff Eustachian tube, again depending on anatomy and sort of the genetics that a kid is born with.
So if you have a flappy Eustachian tube, with mucous, it can flap close and that mucous can sort of seal everything together which really causes a significant blockage. And again, any bacteria that had gone up into the middle ear space is going to get trap there, reproduce and cause the ear infection.
So, when you have little babies whose Eustachian tube maybe more likely to result in an ear infection, and then they’re getting colds all the time, because their immune system is new. They haven’t been exposed to all of these viruses yet. Every cold virus that comes along, it seems like they get it. Just normal. That’s how the immune system works and makes memory against that particular strain of virus for in the future. But in the meantime, while they’re babies, they’re getting virus after virus after virus, and that can set them up to also get a series of ear infections.
Also, I should mention that it’s not only bacteria that can cause ear infections but viruses can also cause ear infections. Sometimes it is a little difficult to know if a particular ear infection is caused by the virus, which is also causing the cold, and you’re just seeing fluid from that infection or if it is truly a bacterial infection. And that’s where you want a seasoned physician to look in the ear and help guide you on making treatment decisions.
Now, we talked about immunity and building up immunity to different viruses and that’s why kids get colds all the time. And I think, Shannon, that you’re on to something when you talk about your move from California to Texas kind of being the start of all this. When you do move to a new region, strains of viruses do vary from one location to one another.
So you’re family might be sick a little bit more often when you first move until you build immunity to the local micro-organisms. Although, you don’t always see this because viruses travel too in cars and planes and buses and boat. Wherever people go, viruses hit your ride.
But you’re right there, there’s a little of that going on as we get sick from encountering viral strains that our bodies have not seen before. Ten months may just not be enough time for your child to have been exposed to all the local strains of viruses.
The other big mucous maker is allergies. The allergens in Texas are going to be different than the allergens in California. Some will be the same but many others will be different. So, Shannon, allergies as an underlying cause of recurrent ear infections is definitely something to consider. You can talk to your doctor if you haven’t already had this conversation about trying allergy medication or taking a trip to see an allergist.
Now, chronically enlarged adenoids can also result in Eustachian tubes dysfunction. So some kids, because of the adenoid push on the Eustachian tubes and can cause them to collapse and cause a blockage that way. So some kids do find relief from recurrent ear infections by having their adenoids removed, although for others it doesn’t really seem to make much of a difference.
So how about treating all of these ear infections with antibiotics? Well, it’s a gray zone really and you have to take each kid into account on their own accord. The body does tend to clear ear infections on its own eventually, but never quite as quickly as we like it to.
Sometimes, although this is rare, but sometimes ear infections can lead to a bone infection called mastoiditis and it can even lead to meningitis and encephalitis as the infection travels to the brain in the spinal fluid. But again, those are rare events. So, if your child has mild symptoms from an ear infection , watchful waiting without using an antibiotics in older kids is acceptable. Let the body do its thing and see where it goes.
On the other hand, you don’t want your child miserable. So if he or she has persistent pain you can’t control or a fever that’s not going away, then an antibiotic makes sense. Amoxicillin is a fine one, and as long as it’s working it’s reasonable to keep using it, especially if your child suffers with itchy infection and antibiotics helps him get better sooner and ends the suffering quicker, then letting the body clear the infection on its own especially if they keep getting over and over. Seems kind of mean to do to put them through that if something is going to help him get better a little quicker and get him back in school and get you back to work.
Each kid and family is a little different with regard to what suffering looks like. High fever for a few days, excruciating pain, vomiting, I think we can all agree that is suffering and the give the child an antibiotic. But there are other clinical scenarios that aren’t as cut and dry. So this is definitely a conversation in the journey that you want to have with your child’s doctor.
By the way, if amoxicillin stops working, it does not mean that it stops working forever. It just means it killed all the bacteria it could and bacteria that are resistant to the amoxicillin were left behind in the mouth. Those ones reproduced and filled up the space that was left, and so you have to try something else. But if you give it a few months and your child will probably be colonized again with different strains of bacteria and amoxicillin may very well work again at that point.
Now, to be fair, antibiotics do have a dark side. They contribute to bacterial resistance patterns, especially as we think about their widespread use in communities and larger populations. They don’t kill viruses at all. Again, sometimes, ear infections are caused by viruses rather than bacteria.
And, antibiotics can cause allergic reactions which can rarely be life threatening. So there are possible antibiotics associations too that we’re not quite clear on, such as the role antibiotics might play in the later development of allergies and asthma.
So lots to consider and we don’t always have clear guidelines which is why at this point, each kid is unique with regard to management strategy.
School attendance and performance, parents missing work, hearing and speech considerations, all of these things are on the table. The elephant in the room that we haven’t talked about is ear tubes. Those are short little plastic tubes that’s placed through the eardrum. So one tube in each eardrum. Basically this hollow piece of plastic, it’s a little tiny tube provide an exit route for drainage when your child has an ear infection. But more importantly, they provide an emergency exit route for bacteria that had otherwise become trapped by a blocked Eustachian tube.
But ear tubes aren’t without their risks — risks from surgery and anesthesia (although these are low risks), risks of scar formation at the tube insertion site, risk of chronic holes in the ear drum where the tube used to be.
My son has had to have one ear drum rebuilt three times due to complications that stem from his ear tube. But what issues would we have encountered if we hadn’t done the ear tubes at all? I don’t know because I don’t have a crystal ball. Certainly, at the time that we made the decision to do the ear tubes, I don’t think I would have made a different decision based on what we had to go through later because his ear infections were pretty severe and recurrent and the tubes did help him quite a bit.
So lots of options and ways to go. I’m not completely sure I’ve really helped you that much, Shannon. I agree, your doctor sounds fabulous. Keep communicating with her. The only thing I have to add really is the possibility of allergy treatment or testing if you have not gone that route for recurrent ear infections and a kid who just moved to a different area of the country.
Ear tubes may be on the table if the infections continue to recur but it’s less clear when you make the decision to go that route. That is why, as I always say, you need a doctor and not a computer to help you make health care decisions.
Thanks for the question, Shannon. It definitely provided the nugget I needed to review ear infections again. Given the time of year, that’s something many parents want to know more about.
Don’t forget if you have a question for me, it’s really easy to get in touch. We do need questions. We’re going to try to cover and answer more questions from you guys as we move on with shows in the future. So head over to PediaCast.org to find the Contact link and shoot me a question that way. I’ll be watching for it.
Dr. Mike Patrick: We are back with just enough time to thank all of you for taking time out of your day to make PediaCast a part of it. Really do appreciate that. Also, thanks to my guest today, Dr. Stephen Camarata, author of The Intuitive Parent and a professor of psychiatry at Vanderbilt.
That’s all the time we have today. PediaCast is a production of Nationwide Children’s Hospital.
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