October 3, 2007 6:05pm

Day over. I had dinner. Now I am ready to calmly recap my afternoon learning.

I don't have kids of my own, so I always feel just a little bit guilty giving parents advice about their kids. Some things I am confident about like when immunizations are recommended, medication dosing, at what age to start baby food, when to switch to 2% milk, etc. Things that are fairly set guidelines that I just need to parrot back.

Then there's the grey areas on child behavior, discipline, going back to work, and other very personal decisions.

For example, a first time mom brought her 2 year old into the office this afternoon. Chief complaint of decreased appetite and decreased bowel movements, also tantrums. So I go in the room and find a very distressed mom who tells me that the little one has been very picky with his eating, and he is throwing 3-4 fits each day.

I was a little frustrated because she had been squeezed in on a very busy day and she was all upset over what is, essentially, the terrible two's and two year molars coming in. I checked him over thoroughly and assured her he wasn't ill, but the molars are probably bothering him so he doesn't much feel like eating. Not to worry, he won't starve. Less eating means less pooping. The fits are, well, normal, though annoying.

Then she asked me how to stop the fits. This is where I started to feel like I didn't have a right to tell her what to do because I don't have kids myself.

My advice, essentially, consisted of "Isolate and Ignore". He throws the fit to get attention. If you give in every time then he will know he can manipulate you. If you just let him have his fit and ignore it by leaving the room or just not feeding into it, then you can welcome him back when he's ready to calm down. She also needs to be consistent. Whatever is not okay to do today also can't be okay to do tomorrow. She can't just let him do something over and over and then one day not let him do it anymore. The rules have to be the same if he's at home or at grandma's house (luckily, grandma was also in the room so we could all be in agreement). Most of all, if she says she's going to punish him by taking x toy away...then follow through and really do if. If he learns that all of her threats are empty threats, he won't take her very seriously. He can start learning that there are certain "rules". Wherever he goes for the rest of his life, there will always be rules he needs to follow.

The doc agreed with my assessment that it was a healthy kid with a 2 year old 'tude. Mom even shook my hand as she was leaving, so maybe she appreciated what I said to her. We gave her the phone number of a local parenting class.

So, on the one hand I was glad to help. On the other, I felt guilty....like I had no right to tell her how to raise her kid. Then again, she asked for my advice. I didn't run up to her in the grocery store out of nowhere and start telling her what to do.

Now, the other thing that I wanted to write about....
I still don't have any children of my own (in case you thought I popped a few out in the past few paragraphs). Therefore, I can't actually relate to what it's like to look forward to bringing this perfect person into the world, only to one day find out that they have a problem of some sort. I'm sure it is devastating and requires some adjustment time.

However....

I am getting really frustrated over the past few weeks( and also in family practice, and also in my mom's pedi neurology office) with seeing parents who are unwilling to accept that their child has a problem and then get them the proper help.

Two examples:

An otherwise healthy 7 year old boy starts 1st grade and becomes a total emotional basket case. He worries about everything. Going to school every day is a battle. He cries and cries all morning. Then he goes into school and is okay for the day there, but as soon as he gets home he just sits in his room and doesn't want to play or talk or do anything. Some days he doesn't even go to school because he is such an emotional wreck that mom keeps him home. Mom brings him to the doc's office. Doc recommends looking into some counseling at the school and prescribes an antidepressant that also helps with anxiety in kids really well. Three weeks later, they come in for a follow-up visit. The first week was rough, but the last two weeks have been better. He gradually cried less and less. He is now just a little upset in the morning, but has made it to school every day for the past two weeks. He comes home in the afternoon and plays (ironically) school with his stuffed animals, and talks with mom and dad about his day when they have dinner. These are all good things, right?

So mom says she wants to immediately take him off the medication. Can't find out from him if he feels better now with the medication, because mom told him it was for his allergies (which he doesn't have). Mom keeps saying she's uncomfortable with him being on a medication. Okay, I get that. Other than the occasional antibiotic, it's tough to put your kid on something to take every day. But if he had asthma, or diabetes, wouldn't you want him to have the medication he needs to make his life better? We tried this to see if it helps, and he is obviously thriving on the medication. Taking him off of it might mean that he will go back to where he was 3 weeks ago, and then if she wants him back on it he will have to take it for a few weeks before it works well again. Mom seems to have a hang-up about even thinking that her kid could have a problem with depression, so she wants him off the medicine ASAP. Well, isn't that just hurting the kid? Aren't you making him suffer because you can't accept that he needs some help right now? He's okay with it. In fact, he's doing better than ever. Isn't this really about him and not you?

Of course, we can't say that to mom. So we agree to take him off it for a trial and see how he does. The counseling went nowhere. She had one visit with the school counselor and then declined any more visits and didn't want the counselor to contact him during the school day (she thought he would be embarrassed. In my opinion, kids are thrilled to get out of class to go somewhere "special". It's the mom who is embarrassed.)

Example 2. A 4 year old boy who weighs 80 lbs. Yes, 80 lbs. He has a vocabulary of less than 4 words. He expresses himself by grunting. He eats until he vomits, and then continues eating. He throws huge, violent tantrums whenever there is even a slight change in his routine. At the age of 3, when he wasn't speaking, doc referred the family to something called Birth to Three. It's supposed to help kids with developmental delays. Well, dad never let the people evaluate the kid. They hired a speech therapist and got his vocabulary up from 0 words to 10 words and some grunts. It was a nightmare trying to examine this kid because he thrashed around, punched, kicked, and screamed. Dad swore his behavior is "fine". Dad says "oh, he talks a lot at home." right. According to Dad, there is "nothing wrong with my son. He's just going at his own pace."

Coincidentally, I saw the mom later in the day with one of their older children. Just before she left she said, "Now, please don't tell me I'm crazy. Everyone says I am. But, I think there's something wrong with my son." Halleluah! Yes! We do too! It didn't take much convincing to get her to agree to an appointment with a neurologist (which isn't until December, unfortunately). She has done some of her own research on the internet and suspects something in the autism spectrum or Prader-Willy Syndrome. All are things we in the office had discussed as possible causes for his language delay and inability to deviate from routine. My fear is that mom will go home and dad will immediately control the situation again. Even if they go to the neurologist, who knows if dad will ever accept that his son has a problem that needs to be dealt with? Mom is already on that road, I think. I just hope she's strong enough to know when she needs to do what's best for her son and ignore the pig-headed dad.

Argh!!!!

Okay, all of that is off my chest now. I feel better. Whew!